Oral Health-Related Quality of Life in an Institutionalized Population with HIV+/AIDS in the Northern Region of Mexico.

Approximately 39 million people worldwide live with human immunodeficiency virus (HIV), and antiretroviral therapy (ART) has improved life expectancy for these individuals, with quality of life (QoL) being a crucial aspect. However, there is limited information on oral health-related quality of life (OHRQoL) for institutionalized patients with HIV. This study used a cross-sectional design and included 43 residents of a non-governmental institution who had a confirmed HIV diagnosis and a history of intravenous drug use. The Spanish version of the Oral Health Index Profile-14 (OHIPsp) was used to assess the OHRQoL, with the 50th percentile serving as the cutoff for good or poor quality of life. All 43 patients had one or more oral lesions, with 44.1% having AIDS-related oral lesions (AROLs). Over half of the participants (48.8%) reported a poor OHRQoL, and females experienced worse quality of life in all dimensions compared to males. Subjects with AROLs were three times more likely to have poor OHRQoL than those without AROLs (p = 0.03; OR = 3.1 IC 1.04-9.6). These results highlight the need for a comprehensive treatment plan for patients with HIV that includes oral health, particularly for women living in precarious conditions or who are institutionalized. Improving oral health can significantly enhance quality of life.

Lung Underdevelopment: Case Reports and a Literature Review.

Lung underdevelopment is a rare congenital anomaly with variable clinical significance and presenting symptoms. It usually manifests during childhood. We present two cases of developmental lung anomaly subtypes and discuss clinical presentation and outcomes in such patient populations. LEARNING POINTS: Pulmonary underdevelopment is a challenging diagnosis and should be considered in patients with unilateral opacification on chest radiograph.Childhood developmental history is critical for diagnosis as delayed, or misdiagnoses are common. Definitive diagnosis can be made by computed tomography scan.Management is watchful waiting with close monitoring, with long term prognosis remaining unclear.

Epicatechin and quercetin exhibit in vitro antioxidant effect, improve biochemical parameters related to metabolic syndrome, and decrease cellular genotoxicity in humans.

Metabolic syndrome is a condition whose incidence has been increasing around the world. It promotes a metabolic state of chronic systemic inflammation, correlated to cellular stress and genetic mutations, and subsequently with deadly chronic diseases, such as type 2 diabetes mellitus, cardiovascular diseases, and cancer. A randomized placebo-controlled study (n = 156) was conducted to determine the effects of consuming an enriched bread with 0.05% of a 1:1 mixture of (-)-epicatechin and quercetin on anthropometric and biochemical parameters of the participants. As a result, total cholesterol, LDL-cholesterol, total triglycerides, and fasting plasma glucose significantly decreased after three months of daily enriched bread consumption. Nuclear abnormalities in buccal epithelium cells also decreased (15.8 ± 3.2 down to 8.3 ± 1.0), showing a genoprotective effect. The antioxidant properties of these compounds were observed by monitoring changes in the cytoplasmic redox tone of intact Caco-2 cells expressing HyPer, a fluorescent redox biosensor. The combination of (-)-epicatechin and quercetin changes the cytoplasmic redox ambient in living cells and significantly improves biochemical parameters related to metabolic syndrome, and decreases the number of cell abnormalities in buccal epithelium cells of patients.

Urgent Creation of a Palliative Care Team in a Small Hospital During the COVID Crisis.

The COVID-19 pandemic created a global health emergency that has changed the practice of medicine and has shown the need for palliative care as an essential element of hospital care. In our small South Florida hospital, a palliative care service was created to support the frontline caregivers. Thanks to the hospital support, our team was formed rapidly. It consisted of 3 advanced care practitioners, a pulmonary physician with palliative care experience and the cooperation of community resources such as hospice and religious support. We were able to support patients and their families facilitating communication as visitation was not allowed. We also addressed goals of care, providing comfort care transition when appropriate, and facilitating allocation of scarce resources to patients who were most likely to benefit from them. With this article we describe a simplified framework to replicate the creation of a Palliative Care Team for other hospitals that are experiencing this need.

Hemorrhagic stroke in setting of severe COVID-19 infection requiring Extracorporeal Membrane Oxygenation (ECMO).

OBJECTIVE: To highlight the increased risk of hemorrhagic stroke secondary to postulated COVID-19 mediated vasculopathy with concomitant ECMO related bleeding complications. BACKGROUND: COVID-19 has shown to be a systemic illness, not localized to the respiratory tract and lung parenchyma. Stroke is a common neurological complication. In particular, critically ill patients on ECMO are likely at higher risk of developing hemorrhagic stroke. CASE PRESENTATION: 38-year-old man presented with fever, cough, and shortness of breath. Due to severe respiratory failure, he required ECMO support. Subsequently, he was found to have left temporal intraparenchymal hemorrhage. Overall, his clinical course improved, and he was discharged with minimal neurological deficits. CONCLUSION: Although intracranial hemorrhage is a known complication of ECMO, patients with COVID-19 infection may be at a higher risk of cerebrovascular complications due to vasculopathy.

[Factors related to oral candidiasis in HIV children and adolescents, species characterization and antifungal susceptibility]. / Factores relacionados a candidiasis oral en niños y adolescentes con VIH, caracterización de especies y susceptibilidad antifúngica.

BACKGROUND: Factors associated with candidiasis and colonization in HIV-positive children and adolescents in developing countries are not well understood. AIM: To identify the factors associated with oral Candida colonization and candidiasis in institutionalized HIV-positive children and adolescents in Tijuana, México, as well as the response of the isolates to antifungals. MATERIALS AND METHODS: Sample of the oral mucosa of 30 HIV positive children and adolescents were obtained to isolate and identify Candida species by culture and metabolic profile. Antifungal drugs susceptibility was determined according to CLSI. Indicators of immunological and virologic failure were classified in accordance to WHO criteria. RESULTS: Six Candida species were identified from oral mucosa, 53% colonizers and 47% in candidiasis. Factors associated with candidiasis and oral colonization were viral load (p = 0,001), CD4+ counts (p = 0,002) and HAART regimen (p ≤ 0,014). The most prevalent species was C. glabrata (33%), but C. albicans (27%) was more resistant to fluconazole (p = 0,001). Itraconazol resistant species were identified in regimens that include an NNRTI (p = 0,041). CONCLUSION: HIV-positive children and adolescents living in an orphanage showed high prevalence of colonizing Candida spp. and resistance to antifungals, related to NNRTI.

Factores relacionados a candidiasis oral en niños y adolescentes con VIH, caracterización de especies y susceptibilidad antifúngica / Factors related to oral candidiasis in HIV children and adolescents, species characterization and antifungal susceptibility

Resumen Introducción: Se desconocen los factores asociados a la candidiasis oral en población pediátrica con infección por VIH de los países en desarrollo. Objetivo: Identificar los factores asociados a la colonización por Candida, candidiasis oral y la susceptibilidad in vitro a antifúngicos, en niños y adolescentes con infección por VIH institucionalizados en la ciudad de Tijuana, México. Materiales y Métodos: Se examinó la cavidad oral de 30 niños y adolescentes con infección por VIH, se obtuvo una muestra de la mucosa oral para identificar las especies de Candida mediante cultivo y auxonograma. La susceptibilidad a los antifúngicos se determinó de acuerdo al CLSI. Los indicadores del estado inmunológico y falla virológica se clasificaron conforme a la OMS. Resultados: Se identificaron seis especies de Candida, 53% colonizantes y 47% causantes de candidiasis. Los factores asociados a candidiasis fueron alta carga viral (p = 0,001), menor recuento de LTCD4+ (p = 0,002) y esquema TARAA (p ≤ 0,014). La especie prevalente fue C. glabrata (33%); sin embargo, C. albicans (27%) fue más resistente a fluconazol (p = 0,001). Las especies resistentes a itraconazol se identificaron en esquemas que incluyen un INNTR (p = 0,041). Conclusiones: Los niños y adolescentes con infección por VIH institucionalizados mostraron una prevalencia elevada de Candida spp. colonizante y resistencia a los antifúngicos relacionada con los INNTR .

Background: Factors associated with candidiasis and colonization in HIV-positive children and adolescents in developing countries are not well understood. Aim: To identify the factors associated with oral Candida colonization and candidiasis in institutionalized HIV-positive children and adolescents in Tijuana, México, as well as the response of the isolates to antifungals. Materials and Methods: Sample of the oral mucosa of 30 HIV positive children and adolescents were obtained to isolate and identify Candida species by culture and metabolic profile. Antifungal drugs susceptibility was determined according to CLSI. Indicators of immunological and virologic failure were classified in accordance to WHO criteria. Results: Six Candida species were identified from oral mucosa, 53% colonizers and 47% in candidiasis. Factors associated with candidiasis and oral colonization were viral load (p = 0,001), CD4+ counts (p = 0,002) and HAART regimen (p ≤ 0,014). The most prevalent species was C. glabrata (33%), but C. albicans (27%) was more resistant to fluconazole (p = 0,001). Itraconazol resistant species were identified in regimens that include an NNRTI (p = 0,041). Conclusion: HIV-positive children and adolescents living in an orphanage showed high prevalence of colonizing Candida spp. and resistance to antifungals, related to NNRTI.

Breastfeeding Education: disagreement of meanings / La educación para la lactancia materna: desencuentro de significados / A educação para a lactância materna: desencontro de significados

Objective.This work sought to analyze how educational processes have been developed for breastfeeding in a health institution, starting from the meanings mothers, families, and health staff construct thereon. Methods. This was qualitative research of ethnographic approach, which included observations during the group educational activities of the programs, focal groups, and interviews of mothers, their families, and the health staff of a hospital unit in the city of Medellín, Colombia. The analysis was guided by the constant comparison method. Results. The categories emerging from the data were: 1) breast milk is an ideal food. 2) The mothers' experiences influence upon the breastfeeding practice. 3) Family beliefs sometimes operate as cultural barriers. 4) Disagreements are revealed in the educational process. Conclusion. The way educational processes have taken place for breastfeeding reveals a break expressed by the scarce interaction between the meanings professionals have constructed on the topic and those the mothers and their families give to the experience of breastfeeding.

Objetivo.Analizar la forma cómo se han desarrollado los procesos educativos para la lactancia materna (LM) en una institución de salud, partiendo de los significados que las madres, sus familias y personal de salud construyen al respecto. Métodos. Investigación cualitativa de enfoque etnográfico, que incluyó observaciones durante las actividades educativas grupales de los programas, grupos focales y entrevistas a madres, sus familias y al personal de salud de una Unidad Hospitalaria de la ciudad de Medellín, Colombia. El análisis fue guiado por el método de las comparaciones constantes. Resultados. Las categorías emergentes a partir de los datos fueron: 1) La leche materna es un alimento ideal. 2) Las experiencias de las madres inciden en la práctica de la LM. 3) Las creencias familiares operan en ocasiones como barreras culturales. 4) Se revelan desencuentros en el proceso educativo. Conclusión. La forma cómo se han cumplido los procesos educativos para la LM revela un quiebre que se expresa en la escasa interacción entre los significados que los profesionales han construido sobre el tema y los que las madres y sus familias dan a esta experiencia.

Objetivo.Analisar a forma como se desenvolveu os processos educativos para a lactância materna (LM) numa instituição de saúde, partindo dos significados que mães, famílias e pessoal de saúde constroem ao respeito. Métodos. Investigação qualitativa de enfoque etnográfico, que incluiu observações durante as atividades educativas grupais dos programas, grupos focais e entrevistas a mães, suas famílias e ao pessoal de saúde de uma Unidade Hospitalar da cidade de Medellín, Colômbia. A análise foi guiado pelo método das comparações constantes. Resultados. As categorias emergentes a partir dos dados foram: 1) O leite materno é um alimento ideal. 2) As experiências das mães incidem na prática da LM. 3) As crenças familiares operam em ocasiões como barreiras culturais. 4) Se revelam desencontros no processo educativo. Conclusão. A forma como se cumpriu os processos educativos para a LM revela um quebre que se expressa na escassa interação entre os significados que os profissionais construíram sobre o assunto e os que as mães e suas famílias dão à experiência na LM.

Breastfeeding Education: disagreement of meanings.

OBJECTIVE: This work sought to analyze how educational processes have been developed for breastfeeding in a health institution, starting from the meanings mothers, families, and health staff construct thereon. METHODS: This was qualitative research of ethnographic approach, which included observations during the group educational activities of the programs, focal groups, and interviews of mothers, their families, and the health staff of a hospital unit in the city of Medellín, Colombia. The analysis was guided by the constant comparison method. RESULTS: The categories emerging from the data were: 1) breast milk is an ideal food. 2) The mothers' experiences influence upon the breastfeeding practice. 3) Family beliefs sometimes operate as cultural barriers. 4) Disagreements are revealed in the educational process. CONCLUSION: The way educational processes have taken place for breastfeeding reveals a break expressed by the scarce interaction between the meanings professionals have constructed on the topic and those the mothers and their families give to the experience of breastfeeding.