Exploring Organizational Leadership for English Learner Equity.

In this study, we explore leadership practices in a dual-language elementary school led by three leaders of color committed to the ideals of cultural responsiveness. We employ an organizational leadership lens informed by aspects of culturally responsive school leadership (CRSL) and teaching (CRT) to interpret interview and observational data collected during the implementation of an equity-oriented engineering program for English learner (EL) students. In the midst of attempting to implement this school-research partnership, pre-existing tensions between the school's leadership and instructional culture rose to the forefront, offering the opportunity to analyze the data with this particular intersectional lens (organizational leadership and CRSL). Thus, subsequent data analysis focused not on program implementation but rather the existing challenges present in the school. Insights from our data suggest that both school leaders and teachers faced considerable challenges that appeared to stem from disparate understandings of how to achieve equity for their EL students. Ultimately, these challenges prevented leaders' successful enactment of CRSL within the existing organizational infrastructure. We suggest that the lack of explicit processes of critical consciousness defined the school culture and that accountability practices limited leaders' ability to implement CRSL.

Empresas con propósito social y ambiental / Companies with social purpose and environmental

El documento contiene un diagnóstico, opciones de política, recomendaciones para la implementación de la política propuesta y una hoja de ruta para el próximo gobierno con horizontes a 100 días, un año y cinco años de gestión. Todo ello se pone a disposición de los partidos políticos, los candidatos a la Presidencia y al Congreso de la República, los medios de comunicación, la sociedad civil y la ciudadanía en general. Finalmente, este esfuerzo no hubiera sido posible sin el apoyo de nuestros cuatro aliados estratégicos y 11 auspiciadores, a quienes agradecemos por su compromiso con la gobernabilidad democrática y el desarrollo sostenible del Perú.

Ensayos clínicos sobre Plasma convaleciente en COVID-19 realizados en países de la región / Clinical trials on Convalescent Plasma in COVID- 19 performed in regional countries

La terapia con plasma convaleciente ha sido utilizada para el tratamiento de pacientes con infecciones virales como la influenza AH1N1 o en Ébola. Actualmente, el plasma convaleciente se ha propuesto como una alternativa terapéutica y profiláctica para pacientes con COVID-19

Convalescent plasma therapy has been used for the treatment of patients with infections viruses such as influenza AH1N1 or Ebola. Currently, convalescent plasma has been proposed as a therapeutic and prophylactic alternative for patients with COVID-19

Prognostic Factors for Inguinal Lymph Node Involvement and Tumor Recurrence in Squamous Cell Carcinoma of the Penis / Factores pronósticos de compromiso ganglionar inguinal y recaída tumoral en carcinoma escamocelular de pene

Zoom Image Abstract Introduction Penile carcinoma is an aggressive disease with catastrophic consequences that frequently lead to death. Therefore, further knowledge on the prognostic factors that can help identify patients in need of more aggressive treatments becomes essential. Objective To identify the prognostic factors for lymph node (LN) involvement and tumor recurrence in patients diagnosed with squamous cell carcinoma of the penis (SCCP). Methods A retrospective cohort study was conducted. Patients diagnosed and treated for SCCP at Instituto Nacional de Cancerología between 2008 and 2015 were included in the sample. Cases in which no information on recurrence was available for the follow-up were excluded, as well as patients with no initial pathology and those getting penile reconstructions after cancer. Relevant data was retrieved from the medical records of each patient, and a descriptive analysis was performed. Subsequently, this data was used to apply a logistic regression model to determine the potential clinical and histopathological prognostic factors. Results A total of 104 patients were included in the present study. The average age of the sample was 59 years, while the follow-up averaged 24 months per patient. Inguinal lymphadenectomy was performed on 61 patients (59%) during the follow-up. The logistic regression model showed that lymphovascular invasion (odds ratio [OR]: 6.7; 95% confidence interval [95%CI]: 1.2­35) and poor tumor differentiation (OR: 17; 95%CI: 3.2­92) were associated with tumor recurrence. Likewise, the lymphadenectomy procedures showed that lymphovascular invasion was associated with LN involvement (OR: 3.3; 95%CI: 1.1­10). Conclusion Lymphovascular invasion was the strongest prognostic factor observed in our sample, aiding in the prediction of inguinal LN involvement and tumor recurrence in SCCP patients

Introduccion El cáncer de pene es una enfermedad agresiva con consecuencias catastróficas que frecuentemente llevan a la muerte. Por lo tanto, es esencial un mayor conocimiento sobre los factores pronósticos que pueden ayudar a identificar a los pacientes que necesitan tratamientos más agresivos. Objetivo Identificar los factores pronósticos patológicos de compromiso ganglionar inguinal y recaída tumoral en pacientes con carcinoma escamocelular de pene. Métodos Se realizó un estudio de cohorte retrospectivo. Se incluyeron en la muestra pacientes diagnosticados y tratados por carcinoma escamocelular de pene (SCCP) en el Instituto Nacional de Cancerología entre 2008 y 2015. Los casos en los que no había información sobre la recurrencia en el seguimiento fueron excluidos, así como los pacientes sin patología inicial y aquellos que reciben reconstrucciones del pene después del cáncer. Se recuperaron los datos relevantes de los registros médicos de cada paciente, y una descripción fue realizada. Posteriormente, estos datos se utilizaron para aplicar un modelo de regresión logística para determinar los posibles factores pronósticos clínicos e histopatológicos. Resultados Un total de 104 pacientes fueron incluidos en el estudio. La edad promedio de la muestra fue de 59 años, mientras que el seguimiento promedió fue de 24 meses por paciente. La linfadenectomía inguinal se realizó en 61 pacientes (59%) durante el seguimiento. El modelo de regresión logística mostró que la invasión linfovascular (odds ratio [OR]: 6,7; intervalo de confianza del 95% [IC 95%]: 1,2­35) y la pobre diferenciación tumoral (OR: 17; IC 95%: 3,2­92) se asociaron con recurrencia tumoral. Así mismo, los procedimientos de linfadenectomía mostraron que la invasión linfovascular se asoció con afectación de LN. (OR: 3,3; IC 95%: 1,1-10). Conclusión La invasión linfovascular es el factor pronóstico independiente más importante que se asocia de manera independiente con compromiso ganglionar inguinal positivo y recaída tumoral.

Metastasectomy of Abdominal Wall Lesions due to Prostate Cancer Detected Through PET/CT Gallium 68-PMSA: First Case Report.

Introducing the topic of abdominal wall metastasis secondary to prostate cancer with a reminder of the disease's rarity, being the first published case. This article is about a 66 year old patient diagnosed with prostate cancer [cT2aNxMx iPSA: 5,6 ng/ml Gleason 3+3, (Grade 1 Group)], treated with radical prostatectomy as well as accompanied with amplified pelvic lymphadenectomy, who subsequently presented metastatic lesions to the abdominal wall diagnosed with PET/CT Gallium 68-PMSA technique and treated with abdominal metastasectomy with adequate short term results.

Ruptura espontánea de la vejiga: Reporte de un caso / Spontaneous rupture of bladder: Case report

La ruptura espontánea de la vejiga se considera una urgencia urológica que requiere un alto índice de sospecha para realizar el diagnóstico y su tratamiento puede llegar a tener gran complejidad. Se reporta un caso de una paciente de 54 años, con antecedente de cáncer de cuello uterino tratado con radioterapia en 1993 y un sarcoma pleomorfo en la región lumbar-sacra manejada con cirugía, quimioterapia y radioterapia en el 2007. Consultó al servicio de urgencias por un cuadro de dolor progresivo en el hipogastrio, emesis e incontinencia de orina mixta. En la tomografía abdominal y pélvica hubo evidencia de extravasación del medio de contraste en la pared posterior de vejiga. Se practicó una laparotomía exploratoria y sutura vesical. La paciente presentó una adecuada evolución y en el seguimiento la tomografía pélvica fue normal.

Spontaneous rupture of the bladder is considered a urological emergency requiring a high index of suspicion for its diagnosis, and treatment can have a high degree of complexity. A case is presented of a 54 year-old patient with a history of cervical cancer treated with radiotherapy in 1993, and pleomorphic sarcoma in the lumbar and sacral region that received management with surgery, chemotherapy and radiotherapy in 2007. She consulted in the emergency room with symptoms of progressive lower abdomen pain, emesis, and mixed urinary incontinence. The abdominal and pelvic tomography showed no evidence of extravasation of the contrast medium in the posterior wall of the bladder. An exploratory laparotomy and bladder suture was performed. The patient showed adequate progress and the follow-up pelvic scan was normal.

Antiviral activity and tolerability of amdoxovir with zidovudine in a randomized double-blind placebo-controlled study in HIV-1-infected individuals.

BACKGROUND: Amdoxovir acts synergistically with zidovudine in vitro and the combination prevents or delays the selection of thymidine analogue and K65R mutations. In silico studies have shown that a reduced dose of zidovudine (200 mg) results in decreased zidovudine-monophosphate levels, associated with toxicity, while maintaining zidovudine-triphosphate levels, which are associated with antiviral effects. Here, we aimed to assess the short-term tolerability and antiviral activity of amdoxovir in combination with reduced and standard doses of zidovudine. METHODS: The study was a double-blind, placebo-controlled study in HIV-1-infected patients not receiving antiretroviral therapy and with plasma HIV-1 RNA > or =5,000 copies/ml. Patients were randomized to 10 days of twice-daily treatment with 200 mg zidovudine, 300 mg zidovudine, 500 mg amdoxovir, 500 mg amdoxovir plus 200 mg zidovudine or 500 mg amdoxovir plus 300 mg zidovudine. The mean change in viral load (VL) log(10) and area under the virus depletion curve (AUC(VL)) from baseline to day 10 were determined. Laboratory and clinical safety monitoring were performed. RESULTS: Twenty-four patients were enrolled. The mean VL log(10) change was 0.10 with placebo, -0.69 with zidovudine 200 mg, -0.55 with zidovudine 300 mg, -1.09 with amdoxovir, -2.00 with amdoxovir plus zidovudine (200 mg) and -1.69 with amdoxovir plus zidovudine (300 mg). Amdoxovir plus zidovudine (200 mg) was significantly more potent than amdoxovir monotherapy in AUC(VL) and mean VL decline (P=0.019 and P=0.021, respectively), suggesting synergy. There was markedly decreased VL variability with the combination compared with amdoxovir alone. All adverse events were mild to moderate. CONCLUSION: The combination of amdoxovir plus zidovudine appeared synergistic with reduced VL variability. This combined therapy, including the use of a lower zidovudine dosage, warrants further development for the therapy of HIV infection.

Cytomegalovirus UL97 mutations associated with ganciclovir resistance in immunocompromised patients from Argentina.

BACKGROUND: Prolonged therapy with ganciclovir (GCV) can result in the development of GCV-resistant strains due to mutations in the viral phosphotransferase (UL97 gene) and/or in the viral DNA polymerase (UL54 gene). OBJECTIVES: The purpose of this study was to detect by molecular methods the most prevalent UL97 mutants which confer ganciclovir-resistance in immunocompromised populations. STUDY DESIGN: Patients from two populations were selected: (a) renal transplant patients with active cytomegalovirus (CMV) infection and more than one cycle of GCV; (b) HIV-infected patients with retinitis due to CMV, who were under GCV induction, maintenance therapy or withdrawal. Patients were followed up by pp65 antigenemia and by viral isolation from blood or/and urine samples. Two fragments (133 and 255pb) of the UL97 gene were amplified by polymerase chain reaction (PCR) from CMV isolates. RESULTS: Nine from 12 isolates obtained were sequenced, three from two renal transplant patients and six from five HIV-infected patients. A UL97 mutation, known to confer GCV resistance, was found in two isolates from a renal transplant patient. A methionine to valine mutation at codon 460 (M460V) was detected. These isolates exhibited another mutation at codon 605, whose amino acid changed from aspartic acid (D) to glutamic acid (E). These findings were observed after treatment with IV-GCV/ O-GCV/ IV-GCV for 151 days. The 605 mutation was also detected in leukocytes from the same patient previous to the beginning of the treatment with GCV. CONCLUSIONS: Although a known resistant mutation appeared in a renal transplant patient, it was not associated with CMV disease. We suggest that the D605E mutation could "partially or totally compensate" for the effect of GCV resistance conferred by the 460 mutation. Further studies should be performed to confirm this hypothesis.

Alternation of antiretroviral drug regimens for HIV infection. Efficacy, safety and tolerability at week 96 of the Swatch Study.

INTRODUCTION: Alternation of antiretroviral drug regimens has been proposed as a novel treatment strategy for HIV infection. However, some concerns persist regarding antiviral efficacy, adherence, toxicity and resistance evolution in the long term. METHODS: A total of 161 antiretroviral-naive HIV-1-infected patients were randomized to receive stavudine/didanosine/efavirenz (group A) or zidovudine/lamivudine/ nelfinavir (group B) or to alternate between the two regimens every 3 months starting with regimen A (group C). Antiviral efficacy, adherence, safety and tolerability were analysed every 12 weeks. RESULTS: After 96 weeks, time to virological failure was significantly delayed in the alternating regimen compared with the standards of care regimens. Virological suppression was seen in 46%, 48% and 58% of patients in groups A, B and C, respectively, in the intention-to-treat analysis and in 75%, 76% and 97% in the on-treatment analysis (A vs C: P=0.014; B vs C: P=0.016; A vs B: P=0.849). At the end of the study, 94% of patients in group A and 92% in groups B and C reported an adherence greater than 95%. Alternating therapy was associated with a similar impact on CD4+ counts in comparison with the standards of care regimens, as well as a lower mitochondrial DNA/nuclear DNA (mtDNA/nDNA) ratio decrease in the mitochondrial substudy performed on 37 patients. The frequency and intensity of adverse events in the alternating group decreased during subsequent cycles. DISCUSSION: Our results favour the hypothesis that proactive therapy switching may delay the accumulation of resistance mutations. Moreover, the alternating regimen was well tolerated and adherence remained comparably high in all treatment groups. The lower mtDNA/nDNA ratio decrease observed in this group may imply a lower impact on mitochondrial toxicity than in standard regimens.

Tuberculosis and HIV: a partnership against the most vulnerable.

Tuberculosis (TB) is a major cause of morbidity and mortality worldwide. Each year, there are eight million new Mycobacterium tuberculosis complex (MTB) infections and three million TB-related deaths. The catastrophic effects of TB are borne disproportionately among the most vulnerable. The HIV pandemic has further increased the burden so that the risk of TB reactivation from latency is 5 to 15 percent in HIV/TB coinfection. Tuberculosis reactivation fuels further primary infections, creating a vicious cycle of increasing infection, disease, and deaths. In addition, drug-resistant TB exacerbates this increasingly common problem. The clinical presentations of TB in relation to HIV and HIV-associated immune deficiency are discussed from the perspective of clinical diagnosis and treatment in patient care. Tuberculosis prophylaxis, concurrent drug treatment of TB and HIV, drug interactions, and overlapping toxicities are detailed for the practitioner. Immune reconstitution inflammatory reactions are now a common phenomenon in HIV treatment, where similar reactions have been less commonly described in TB treatment in the past. Global distributive injustices in wealth, the burden of disease, and the provision of healthcare are obvious in TB, and clearly show us that the needs of the most vulnerable populations must be met in order to address the problems.

Origin of human immunodeficiency virus type 1 quasispecies emerging after antiretroviral treatment interruption in patients with therapeutic failure.

The emergence of antiretroviral (ARV) drug-resistant human immunodeficiency virus type 1 (HIV-1) quasispecies is a major cause of treatment failure. These variants are usually replaced by drug-sensitive ones when the selective pressure of the drugs is removed, as the former have reduced fitness in a drug-free environment. This was the rationale for the design of structured ARV treatment interruption (STI) studies for the management of HIV-1 patients with treatment failure. We have studied the origin of drug-sensitive HIV-1 quasispecies emerging after STI in patients with treatment failure due to ARV drug resistance. Plasma and peripheral blood mononuclear cell samples were obtained the day of treatment interruption (day 0) and 30 and 60 days afterwards. HIV-1 pol and env were partially amplified, cloned, and sequenced. At day 60 drug-resistant variants were replaced by completely or partially sensitive quasispecies. Phylogenetic analyses of pol revealed that drug-sensitive variants emerging after STI were not related to their immediate temporal ancestors but formed a separate cluster, demonstrating that STI leads to the recrudescence and reemergence of a sequestrated viral population rather than leading to the back mutation of drug-resistant forms. No evidence for concomitant changes in viral tropism was seen, as deduced from env sequences. This study demonstrates the important role that the reemergence of quasispecies plays in HIV-1 population dynamics and points out the difficulties that may be found when recycling ARV therapies with patients with treatment failure.

Higher rate of toxicity with no increased efficacy when hydroxyurea is added to a regimen of stavudine plus didanosine and nevirapine in primary HIV infection.

Twenty-four subjects presenting at a single treatment center with primary HIV infection were enrolled in a pilot study aimed to establish the possible role of hydroxyurea in this setting. Study participants were randomly assigned to receive or not to receive hydroxyurea in addition to stavudine (d4T) plus didanosine (ddI) and nevirapine (NVP). Seventy-five percent of patients without hydroxyurea had plasma HIV RNA below 50 copies/mL at 48 weeks by both intention-to-treat (ITT) and on-treatment (OT) analysis in comparison with 50% (ITT) and 67% (OT) of patients with hydroxyurea (p >.1). A median increase of >200 cells/mm3 was observed from baseline to week 48 whether or not hydroxyurea was included in the regimen. Overall, in 12 patients treated with hydroxyurea, 33 adverse events were reported versus 19 reported for 12 patients who did not receive hydroxyurea (p <.05). Our results suggest that that adding hydroxyurea to a regimen of d4T plus ddI and NVP increases toxicity without improving the antiviral effect.

Estudio de la presencia de variantes del HIV-1 resistentes a drogas antirretrovirales en Argentina: período 1997-2001 / Study of the presence of variants of the HIV-1 resistant to antiretroviral drugs in Argentina: period 1997-2001

La instauración de tratamientos antirretrovirales de alta eficacia (HAARTs) ha llevado a la disminución de la morbimortalidad asociada a HIV-1/SIDA en países industrializados. Sin embargo, uno de los principales factores asociados a la falla terapéutica es la selección de variantes de HIV-1 resistentes a las drogas antirretrovirales (ARVs). Dichas variantes virales se caracterizan por presentar mutaciones en las enzimas virales que son los blancos de la acción de los fármacos: la proteasa viral (PR) y la transcriptasa reversa (RT). Las variantes del HIV-1 resitente a ARVs seleccionadas en pacientes tratados no sólo se asocian al fracaso terapéutico en dichos individuos, sino que también pueden ser transmitidas a la población no infectada. De esta forma, individuos infectados con HIV-1 que nunca han sido expuestos a drogas ARVs (naïve) pueden albergar virus resistentes, lo que llevaría a la falla terapéutica al iniciarse el tratamiento. El objetivo del presente trabajo fue el de caracterizar los perfiles de resistencia en pacientes HIV-1 seropositivos con falla terapéutica. Asimismo, con el fin de estimar la tasa de transmisión de variantes resistentes a ARVs, se estudiaron los perfiles de resistencia en individuos infectados con HIV-1 que no habían recibido tratamiento. Se estudiaron 399 pacientes HIV-1 seropositivos con falla terapéutica y 94 individuos naive infectados con HIV-1. Las muestras de plasma fueron recolectadas entre 1997 y 2001 de individuos de la Cdad. de Buenos Aires y sus alrededores. Se amplificaron las regiones de la PR y RT del HIV-1 mediante la reacción en cadena de la polimerasa (PCR) y se procedió a la secuenciación nucleotídica, luego de lo cual se analizó la presencia de mutaciones asociadas a resistencia a ARVS previamente reportadas. En la población tratada con ARVs, se encontraron mutaciones asociadas a resistencia en el 90,3 por ciento de las muestras. La prevalencia de mutaciones asociadas a resistencia a AZT, 3TC, los inhibidores no nucleosídicos de la RT (NNRTIs), indinavir, ritonavir y nelfinavir superó el 40 por ciento, siendo las sustituciones más prevalentes: M46I/L, V82A/F/S/T y L90M en la PR; y M41L, D67N, K70R, K103N, Y181C/I, M184I/V, G190A/S y T215F/Y en la RT. La presencia de variantes resistentes a miembros de múltiples familiars de drogas fue superior al 20 por ciento... (TRUNCADO) (AU)

Estudio de la presencia de variantes del HIV-1 resistentes a drogas antirretrovirales en Argentina: período 1997-2001 / Study of the presence of variants of the HIV-1 resistant to antiretroviral drugs in Argentina: period 1997-2001

La instauración de tratamientos antirretrovirales de alta eficacia (HAARTs) ha llevado a la disminución de la morbimortalidad asociada a HIV-1/SIDA en países industrializados. Sin embargo, uno de los principales factores asociados a la falla terapéutica es la selección de variantes de HIV-1 resistentes a las drogas antirretrovirales (ARVs). Dichas variantes virales se caracterizan por presentar mutaciones en las enzimas virales que son los blancos de la acción de los fármacos: la proteasa viral (PR) y la transcriptasa reversa (RT). Las variantes del HIV-1 resitente a ARVs seleccionadas en pacientes tratados no sólo se asocian al fracaso terapéutico en dichos individuos, sino que también pueden ser transmitidas a la población no infectada. De esta forma, individuos infectados con HIV-1 que nunca han sido expuestos a drogas ARVs (naïve) pueden albergar virus resistentes, lo que llevaría a la falla terapéutica al iniciarse el tratamiento. El objetivo del presente trabajo fue el de caracterizar los perfiles de resistencia en pacientes HIV-1 seropositivos con falla terapéutica. Asimismo, con el fin de estimar la tasa de transmisión de variantes resistentes a ARVs, se estudiaron los perfiles de resistencia en individuos infectados con HIV-1 que no habían recibido tratamiento. Se estudiaron 399 pacientes HIV-1 seropositivos con falla terapéutica y 94 individuos naive infectados con HIV-1. Las muestras de plasma fueron recolectadas entre 1997 y 2001 de individuos de la Cdad. de Buenos Aires y sus alrededores. Se amplificaron las regiones de la PR y RT del HIV-1 mediante la reacción en cadena de la polimerasa (PCR) y se procedió a la secuenciación nucleotídica, luego de lo cual se analizó la presencia de mutaciones asociadas a resistencia a ARVS previamente reportadas. En la población tratada con ARVs, se encontraron mutaciones asociadas a resistencia en el 90,3 por ciento de las muestras. La prevalencia de mutaciones asociadas a resistencia a AZT, 3TC, los inhibidores no nucleosídicos de la RT (NNRTIs), indinavir, ritonavir y nelfinavir superó el 40 por ciento, siendo las sustituciones más prevalentes: M46I/L, V82A/F/S/T y L90M en la PR; y M41L, D67N, K70R, K103N, Y181C/I, M184I/V, G190A/S y T215F/Y en la RT. La presencia de variantes resistentes a miembros de múltiples familiars de drogas fue superior al 20 por ciento... (TRUNCADO)