Identification of virulence factors and antibiotic resistance in Salmonella enterica subsp. enterica serovar Javiana (FARPER-220) isolated from broiler chickens.

Genome sequencing of highly virulent Salmonella enterica subsp. enterica serovar Javiana strain FARPER-220 (ST-1674) isolated from broiler chickens in Peru revealed multiple virulence factors, antibiotic resistance genes, and invasion-related subcategories. The results provide insights into the potential importance of this strain in causing infections in various animals.

Memory rehabilitation during the COVID-19 pandemic.

BACKGROUND: Loss of cognitive and executive functions is a problem that affects people of all ages. That is why it is important to perform exercises for memory training and prevent early cognitive deterioration. The aim of this work was to compare the cognitive performance of the participants after an intervention by using two mnemonic techniques to exercise memory functions (paired-associate learning and method of loci). METHODS: A longitudinal study was conducted with 21 healthy participants aged 18 to 55 years over a 2-month period. To assess the impact of this proposal, the NEUROPSI brief battery cognitive assessment test was applied before and after the intervention. In each session, a previous cognitive training was carried out using the paired-associate learning technique, to later perform a task based on the loci method, all from a smart device-based application. The accuracy response and reaction times were automatically collected in the app. RESULTS: After the intervention, a statistically significant improvement was obtained in the neuropsychological assessment (NEUROPSI neuropsychological battery) reflected by the Wilcoxon paired signed-rank test (P < .05). CONCLUSION: The task based on the method of loci also reflected the well-known age-related effects common to memory assessment tasks. Episodic memory training using the method of loci can be successfully implemented using a smart device app. A stage-based methodological design allows to acquire mnemic skills gradually, obtaining a significant cognitive improvement in a short period of time.

Detection and Genomic Characterization of an Avian Influenza Virus Subtype H5N1 (Clade 2.3.4.4b) Strain Isolated from a Pelican in Peru.

Surveillance helps us identify and monitor strains with zoonotic potential. A tracheal swab from a pelican on a Peruvian beach was H5N1 positive (clade 2.3.4.4b) using Oxford Nanopore's MinION platform. The near-complete genome sequence of strain VFAR-140 will aid us in understanding avian influenza epidemiology and spread.

Draft Genome Sequence of an Isolate of Genotype VII Newcastle Disease Virus Isolated from an Outbreak in Fighting Cock in Peru.

This study presents a draft genome sequence of a Newcastle disease virus (NDV) strain (VFAR-136) isolated from a fighting cock (Gallus gallus) in the south of Peru. Strain VFAR-136 is a new report of NDV genotype VII circulating in Peru.

Strategies and behaviors used by mothers in interactions with their young children during a mealtime in peri-urban areas of Huánuco, Peru.

This study aimed to gain an in-depth understanding about different strategies used by mothers to feed their 6-23-month-old children, as well as to learn about mothers' behaviors in response to situations of food refusal by her child, in order to generate evidence that contributes to the information gap on responsive feeding in Peru. The study was conducted in the city of Huánuco, a peri-urban area of Peru, with mothers of children in the complementary feeding stage participating. An in-depth 5-hour home observation was conducted in eight mother-child dyads. Both the mothers' and children's mealtime and food-related behaviors were coded and an inductive thematic analysis was applied. The primary objective of many of the strategies used by the mothers was to get their child to eat a little more. Six strategies were identified: pressure, encouragement, facilitating intake, acceptance, negotiation and reasoning. Certain differences were found in the strategies employed by the mother according to the age of her child, with mothers of younger children using more encouragement and mothers of older children using more pressure for their child to eat. The mothers' behavior in response to the child's refusal of food was both responsive and non-responsive (controlling), depending on the reason for the refusal. The findings are of great value for understanding about the feeding interactions of mother-child dyads in Peru and they start to address the information gap and can support the development of nutritional intervention strategies for use with children.

Squalene in oil-based adjuvant improves the immunogenicity of SARS-CoV-2 RBD and confirms safety in animal models.

COVID-19 pandemic has accelerated the development of vaccines against its etiologic agent, SARS-CoV-2. However, the emergence of new variants of the virus lead to the generation of new alternatives to improve the current sub-unit vaccines in development. In the present report, the immunogenicity of the Spike RBD of SARS-CoV-2 formulated with an oil-in-water emulsion and a water-in-oil emulsion with squalene was evaluated in mice and hamsters. The RBD protein was expressed in insect cells and purified by chromatography until >95% purity. The protein was shown to have the appropriate folding as determined by ELISA and flow cytometry binding assays to its receptor, as well as by its detection by hamster immune anti-S1 sera under non-reducing conditions. In immunization assays, although the cellular immune response elicited by both adjuvants were similar, the formulation based in water-in-oil emulsion and squalene generated an earlier humoral response as determined by ELISA. Similarly, this formulation was able to stimulate neutralizing antibodies in hamsters. The vaccine candidate was shown to be safe, as demonstrated by the histopathological analysis in lungs, liver and kidney. These results have shown the potential of this formulation vaccine to be evaluated in a challenge against SARS-CoV-2 and determine its ability to confer protection.

Intranasal vaccination of hamsters with a Newcastle disease virus vector expressing the S1 subunit protects animals against SARS-CoV-2 disease.

The coronavirus disease-19 (COVID-19) pandemic has already claimed millions of lives and remains one of the major catastrophes in the recorded history. While mitigation and control strategies provide short term solutions, vaccines play critical roles in long term control of the disease. Recent emergence of potentially vaccine-resistant and novel variants necessitated testing and deployment of novel technologies that are safe, effective, stable, easy to administer, and inexpensive to produce. Here we developed three recombinant Newcastle disease virus (rNDV) vectored vaccines and assessed their immunogenicity, safety, and protective efficacy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in mice and hamsters. Intranasal administration of rNDV-based vaccine candidates elicited high levels of neutralizing antibodies. Importantly, the nasally administrated vaccine prevented lung damage, and significantly reduced viral load in the respiratory tract of vaccinated animal which was compounded by profound humoral immune responses. Taken together, the presented NDV-based vaccine candidates fully protected animals against SARS-CoV-2 challenge and warrants evaluation in a Phase I human clinical trial as a promising tool in the fight against COVID-19.

Perceptions and experiences of healthcare professionals on the guideline of management and treatment of anemia among children under 3 years of age during the COVID-19 pandemic. / Percepciones y experiencias de los profesionales de la salud sobre la aplicación de la norma de manejo y tratamiento de la anemia en menores de tres años durante la pandemia de la COVID-19.

OBJECTIVE.: To understand the perceptions and experiences of healthcare professionals on the application of the guideline for the management and treatment of anemia in children under 3 years old, during the COVID-19 pandemic, in metropolitan Lima, 2020. MATERIALS AND METHODS.: Phenomenological design. Individual semi-structured interviews were conducted with healthcare professionals: physicians, nurses and nutritionists working at the first level of care in the Ministry of Health in Lima, Peru. The interviews were conducted virtually with the participants, all of whom worked face-to-face in services providing care to children under 3 years old. Data analysis was thematic and NVivo software was used for coding. RESULTS.: A total of 33 interviews with healthcare professionals were conducted between November 2020 and January 2021. Four themes emerged about the guideline: its feasibility, perceived imperfections, challenges in implementing it, and prospects for improvement. The health professionals interviewed perceived the guideline to be feasible to implement, but there were gaps in the indications that should have been more explicit. Nevertheless, they expressed their challenges and expectations for improvement. CONCLUSIONS.: Healthcare professionals perceived that it was feasible to use the guideline and emphasized their experiences overcoming perceived difficulties and weaknesses in the guidelines for anemia management and treatment.

OBJETIVOS.: Comprender las percepciones y experiencias de los profesionales de la salud sobre la aplicación de la directiva para el manejo y tratamiento de anemia en niños menores de tres años, durante la pandemia de la COVID-19 en Lima Metropolitana, año 2020. MATERIALES Y MÉTODOS.: Estudio de diseño fenomenológico. Se realizaron entrevistas semiestructuradas individuales a profesionales de salud: médicos, enfermeras y nutricionistas que trabajaban en el primer nivel de atención en el Ministerio de Salud de Lima, Perú. Las entrevistas se llevaron a cabo en forma virtual. Todos laboraban en forma presencial en servicios de atención a niños menores de tres años. El análisis de datos fue temático, para las codificaciones se utilizó el software NVivo. RESULTADOS.: Se realizaron 33 entrevistas a profesionales de la salud, entre noviembre de 2020 a enero de 2021. Surgieron cuatro temas emergentes sobre la norma: su factibilidad, imperfecciones percibidas, los desafíos para implementarla y las perspectivas de mejora. Los profesionales entrevistados percibieron que la norma era factible de ejecutarla, pero presentaba vacíos en las indicaciones que deberían estar más explícitos los aspectos del manejo y tratamiento de la anemia. A pesar de ello dieron a conocer sus desafíos y expectativas de mejora. CONCLUSIONES.: Los encuestados percibieron que fue factible utilizar la norma y destacaron sus experiencias para lograr superar las dificultades pese a encontrar vacíos en la normativa para el manejo y tratamiento de la anemia.

Percepciones y experiencias de los profesionales de la salud sobre la aplicación de la norma de manejo y tratamiento de la anemia en menores de tres años durante la pandemia de la COVID-19 / Perceptions and experiences of healthcare professionals on the guideline of management and treatment of anemia among children under 3 years of age during the COVID-19 pandemic

RESUMEN Objetivos. Comprender las percepciones y experiencias de los profesionales de la salud sobre la aplicación de la directiva para el manejo y tratamiento de anemia en niños menores de tres años, durante la pandemia de la COVID-19 en Lima Metropolitana, año 2020. Materiales y métodos. Estudio de diseño fenomenológico. Se realizaron entrevistas semiestructuradas individuales a profesionales de salud: médicos, enfermeras y nutricionistas que trabajaban en el primer nivel de atención en el Ministerio de Salud de Lima, Perú. Las entrevistas se llevaron a cabo en forma virtual. Todos laboraban en forma presencial en servicios de atención a niños menores de tres años. El análisis de datos fue temático, para las codificaciones se utilizó el software NVivo. Resultados. Se realizaron 33 entrevistas a profesionales de la salud, entre noviembre de 2020 a enero de 2021. Surgieron cuatro temas emergentes sobre la norma: su factibilidad, imperfecciones percibidas, los desafíos para implementarla y las perspectivas de mejora. Los profesionales entrevistados percibieron que la norma era factible de ejecutarla, pero presentaba vacíos en las indicaciones que deberían estar más explícitos los aspectos del manejo y tratamiento de la anemia. A pesar de ello dieron a conocer sus desafíos y expectativas de mejora. Conclusiones. Los encuestados percibieron que fue factible utilizar la norma y destacaron sus experiencias para lograr superar las dificultades pese a encontrar vacíos en la normativa para el manejo y tratamiento de la anemia.

ABSTRACT Objective. To understand the perceptions and experiences of healthcare professionals on the application of the guideline for the management and treatment of anemia in children under 3 years old, during the COVID-19 pandemic, in metropolitan Lima, 2020. Materials and methods. Phenomenological design. Individual semi-structured interviews were conducted with healthcare professionals: physicians, nurses and nutritionists working at the first level of care in the Ministry of Health in Lima, Peru. The interviews were conducted virtually with the participants, all of whom worked face-to-face in services providing care to children under 3 years old. Data analysis was thematic and NVivo software was used for coding. Results. A total of 33 interviews with healthcare professionals were conducted between November 2020 and January 2021. Four themes emerged about the guideline: its feasibility, perceived imperfections, challenges in implementing it, and prospects for improvement. The health professionals interviewed perceived the guideline to be feasible to implement, but there were gaps in the indications that should have been more explicit. Nevertheless, they expressed their challenges and expectations for improvement. Conclusions. Healthcare professionals perceived that it was feasible to use the guideline and emphasized their experiences overcoming perceived difficulties and weaknesses in the guidelines for anemia management and treatment.

Determinación de los factores de mal pronóstico de la hemorragia intracerebral espontánea / Determination of poor prognosis factors of spontaneous intracerebral hemorrhage

Introducción: Las enfermedades cerebrovasculares son un problema de salud mundial. Estas constituyen la tercera causa de muerte, la primera de discapacidad en el adulto y la segunda de demencia en el planeta. Dentro ella, la hemorragia intracerebral espontánea es la segunda causa más común de enfermedad cerebrovascular, y llega a ser la tercera causa de muerte en Cuba. Objetivos: Determinar los principales factores de mal pronóstico que influyen en la evolución de los pacientes con la hemorragia intraparenquimatosa espontánea. Métodos: Se realizó un estudio observacional, transversal de una muestra conformada por pacientes atendidos en el Servicio de Neurología provincial de Camagüey, con diagnóstico de hemorragia cerebral espontánea primaria, confirmada por tomografía axial. Resultados: En esta investigación se detectó el predominio de hombres mayores de 80 años, con afectación de leve a moderada del estado de conciencia, predominaron las lesiones supratentoriales, y pocos casos con evacuación ventricular y sí un elevado porcentaje de hemorragias superiores a los 30 mL, con predominio de hipertensión arterial. Conclusiones: La mortalidad al alta hospitalaria no fue elevada, muy relacionada con la escala ICH(AU)

Introduction: Cerebrovascular diseases are a global health problem. These constitute the third cause of death, the first of disability in adults and the second of dementia on the planet. Within it, spontaneous intracerebral hemorrhage is the second most common cause of cerebrovascular disease, and it becomes the third cause of death in Cuba. Objectives: To determine the main factors of poor prognosis that influence the evolution of patients with spontaneous intraparenchymal hemorrhage. Methods: An observational, cross-sectional study was carried out of a sample made up of patients treated at Camagüey provincial Neurology service, with a diagnosis of primary spontaneous cerebral hemorrhage, confirmed by axial tomography. Results: In this research, a predominance of men over 80 years of age was detected, with mild to moderate impairment of the state of consciousness, supratentorial lesions predominated, and few cases with ventricular evacuation and high percentage of hemorrhages greater than 30 cc , with predominance of arterial hypertension. Conclusions: Mortality at hospital discharge was not high, closely related to the ICH score(AU)

Factores asociados al estado y al riesgo nutricional en adultos mayores de establecimientos de atención primaria

Introducción. La población peruana está envejeciendo y ello viene asociado al deterioro de la salud. Dicho proceso puede ser retardado o acelerado dependiendo del estado nutricional. Objetivos. Determinar los factores asociados al estado y al riesgo nutricional en un grupo de personas adultas mayores. Métodos. Se encuestaron 265 adultos mayores, libres de deterioro cognitivo y capaces de comunicarse, atendidos en centros de atención primaria. Se aplicó el Mini Nutritional Assessment (MNA) y se midieron peso, talla, circunferencia de brazo y de pantorrilla. Las categorías del MNA según puntaje fueron: 'malnutrido' 23,5 'normal'. También se evaluó el estado nutricional según índice de masa corporal (IMC) con dos diferentes puntos de corte. Resultados. El 79% de los encuestados fueron mujeres; el 46% tuvo entre 70 y 79 años. Según el MNA sólo una persona tuvo 'malnutrición', el 32,4% tuvieron 'riesgo de malnutrición'. En cambio, según el IMC, el 50% tuvo exceso de peso según punto de corte de la OPS y más del 80% tuvo exceso de peso según el punto de corte de la OMS. Se encontró un mayor puntaje del MNA en los hombres, y el 'riesgo de malnutrición' estuvo asociado a un mayor consumo de medicamentos. Conclusiones. El estado nutricional de la mitad de adultos mayores fue de exceso de peso según IMC con los puntos de corte de la OPS y un tercio de ellos tuvieron riesgo de malnutrición según el instrumento MNA.

Introduction. The Peruvian population is aging and this is associated with the deterioration of health. This process can be slowed or accelerated depending on the nutritional status. Objectives. To determine the factors associated with nutritional status and nutritional risk in a group of older adults. Methods. 265 older adults, free of cognitive impairment and able to communicate, were surveyed, cared for in primary care centers. The Mini Nutritional Assessment (MNA) test was applied and weight, height, arm, and calf circumference were measured. According to the score, the categories of the MNA were: 'malnourished' 23.5 'normal'. The nutritional status was also evaluated according to body mass index (BMI) with different cut-off points. Results. 79% of the respondents were women; 46% were between 70 and 79 years old. According to the MNA, only one person had 'malnutrition', 32.4% had 'risk of malnutrition'. In contrast, according to the BMI, 50% were overweight according to the PAHO cut-off point and more than 80% were overweight according to the WHO cut-off point. A higher MNA score was found in men, and the 'Risk of malnutrition' was associated with higher consumption of medications. Conclusions. The nutritional status of half of the elderly was overweight according to BMI with the PAHO cut-off points, and a third of them had a risk of malnutrition according to the MNA instrument.

Prevalencia de desnutrición en pacientes con enfermedad renal crónica terminal en un hospital nacional de Lima, Perú

Introducción. La enfermedad renal crónica (ERC) es un problema de salud pública a nivel mundial que se caracteriza por un deterioro persistente y progresivo de la función renal. En etapa avanzada es necesaria la terapia de reemplazo renal que desencadena una serie de trastornos metabólicos y nutricionales. Objetivo. Determinar la prevalencia de desnutrición en pacientes con enfermedad renal crónica terminal atendidos en un hospital nacional en Lima, Perú. Método. Se realizó un estudio descriptivo en pacientes con ERC, mediante entrevistas y mediciones antropométricas. Se utilizó el score de malnutrición e inflamación (MIS) para la evaluación del estado nutricional. Resultados. Se evaluaron 155 pacientes con ERC terminal, 106 (68,4%) fueron varones. La prevalencia de desnutrición fue de 36%; y para el síndrome de desgaste proteico energético fue de 74%. Conclusiones. Se encontró un porcentaje considerable de pacientes desnutridos, que podría ser consecuencia de diversos factores que convergen en esta patología; las más vulnerables al desarrollo de este síndrome complejo fueron las mujeres.

Introduction. Chronic kidney disease (CKD) is a global public health problem characterized by a persistent and progressive deterioration of kidney function. In advanced stage, renal replacement therapy is necessary, which triggers a series of metabolic and nutritional disorders. Objective. To determine the prevalence of malnutrition in patients with terminal chronic kidney disease treated at a national hospital in Lima, Peru. Method. A descriptive study was carried out in patients with CKD, through interviews and anthropometric measurements. The malnutrition and inflammation score (MIS) was used to assess nutritional status. Results. 155 patients with terminal CKD were evaluated, 106 (68.4%) were men. The prevalence of malnutrition was 36%; and for the protein-energy wasting syndrome it was 74%. Conclusions. A considerable percentage of malnourished patients was found, which could be the consequence of various factors that converge in this pathology; the most vulnerable to the development of this complex syndrome were women.

Evaluating Research Centers in Minority Institutions: Framework, Metrics, Best Practices, and Challenges.

The NIH-funded Research Centers in Minority Institutions (RCMI) program is currently funding 18 academic institutions to strengthen the research environment and contribution to health disparities research. The purpose of this multiphase mixed-methods study was to establish a uniform evaluation framework for demonstrating the collective success of this research consortium. Methods included discussions of aims and logic models at the RCMI Evaluators' Workshop, a literature review to inform an evaluation conceptual framework, and a case study survey to obtain evaluation-related information and metrics. Ten RCMIs participated in the workshop and 14 submitted responses to the survey. The resultant RCMI Evaluation Conceptual Model presents a practical ongoing approach to document RCMIs' impacts on health disparities. Survey results identified 37 common metrics under four primary categories. Evaluation challenges were issues related to limited human resources, data collection, decision-making, defining metrics, cost-sharing, and revenue-generation. There is a need for further collaborative efforts across RCMI sites to engage program leadership and community stakeholders in addressing the identified evaluation challenges and measurement. Program leadership should be engaged to apply the Evaluation Conceptual Framework and common metrics to allow for valid inter-institutional comparisons and consortium-wide evaluations. Stakeholders could ensure evaluation metrics are used to facilitate community impacts.

Riesgo cardiovascular en una población escolar con exceso de peso / Cardiovascular risk in a school population with excess weight

RESUMEN Objetivo. Determinar factores de riesgo cardiovascular en escolares con exceso de peso y medir su asociación con variables sociodemográficas. Métodos. Estudio transversal, analítico. Se encuestó a 2001 escolares mujeres de 6 a 17 años de un Centro Educativo de Lima Metropolitana. Se utilizó el índice de masa corporal para el diagnóstico de exceso de peso (sobrepeso entre 85 y 95p y obesidad ≥ 95p) y la circunferencia de cintura para obesidad abdominal (≥ 90p). HOMA-I para la resistencia a la insulina (RI) (≥ 3,16) y para las alteraciones lipídicas: colesterol total (≥ 200 mg/dL), C-HDL bajo (≤ 40 mg/dL), C-LDL alto (≥ 130 mg/dL), C no HDL (≥ 145 mg/dL) y triglicéridos (≥ 100 y 130 mg/dL) para niñas menores de 9 y de 10 a 19 años, respectivamente. Resultados. El exceso de peso se presentó mayormente en las escolares de 10 a 17 años, en las que nacieron con más de 2500 gr, con más de un antecedente familiar, con lactancia materna exclusiva y en aquellas cuyas madres no tuvieron instrucción. Las alteraciones lipídicas más frecuentes fueron hipertrigliceridemia y C-HDL bajo. El 82% presentó dislipidemia y el 55,4% de obesos RI. La obesidad abdominal estuvo asociada con los antecedentes familiares y la instrucción de la madre. Conclusión. Cuatro de cada cinco niñas con exceso de peso presentó por lo menos una alteración de los lípidos. Una de cada dos obesas tuvo RI.

ABSTRACT Objective. To determine the cardiovascular risk factors in overweight schoolchildren and to measure their association with sociodemographic variables. Methods. Cross-sectional, analytical study. 2001 female schoolchildren from 6 to 17 years of age from an Educational Center in Metropolitan Lima were surveyed. The Body Mass Index was used for the diagnosis of excess weight (overweight between 85 and 95p and obesity ≥ 95p) and the Waist Circumference for abdominal obesity (≥ 90p). HOMA-I for insulin resistance (≥ 3,16) and for lipid abnormalities: total cholesterol (≥ 200 mg / dL), low HDL-C (≤ 40 mg/dL), high LDL-C (≥ 130 mg / dL), non-HDL C (≥ 145 mg / dL) and triglycerides (≥ 100 and 130 mg / dL) for girls younger than 9 and 10 to 19 years old, respectively. Results. Excess weight occurred mainly in schoolgirls aged 10 to 17 years, in those who were born with more than 2500 gr, with more than one family history, with exclusive breastfeeding and in those whose mothers had no instruction. The most frequent lipid alterations were hypertriglyceridemia and low HDL-C. 82% had dyslipidemia and 55,4% of obese patients had insulin resistance (IR). Abdominal obesity was associated with family history and mother's instruction. Conclusion. Four out of five girls with excess weight presented at least one alteration of the lipids. One in two obese women had IR.

Whole-Genome Sequencing of a Salmonella enterica subsp. enterica Serovar Infantis Strain Isolated from Broiler Chicken in Peru.

This report shows the whole-genome sequence of the multidrug-resistant Salmonella enterica subsp. enterica serovar Infantis strain FARPER-219. Antibiotic resistance genes are found mainly in the plasmid. Our findings show important genetic information that provides an understanding of the recent spread of this serotype in poultry.

Distinguishing patients with laboratory-confirmed chikungunya from dengue and other acute febrile illnesses, Puerto Rico, 2012-2015.

Chikungunya, a mosquito-borne viral, acute febrile illness (AFI) is associated with polyarthralgia and polyarthritis. Differentiation from other AFI is difficult due to the non-specific presentation and limited availability of diagnostics. This 3-year study identified independent clinical predictors by day post-illness onset (DPO) at presentation and age-group that distinguish chikungunya cases from two groups: other AFI and dengue. Specimens collected from participants with fever ≤7 days were tested for chikungunya, dengue viruses 1-4, and 20 other pathogens. Of 8,996 participants, 18.2% had chikungunya, and 10.8% had dengue. Chikungunya cases were more likely than other groups to be older, report a chronic condition, and present <3 DPO. Regardless of timing of presentation, significant positive predictors for chikungunya versus other AFI were: joint pain, muscle, bone or back pain, skin rash, and red conjunctiva; with dengue as the comparator, red swollen joints (arthritis), joint pain, skin rash, any bleeding, and irritability were predictors. Chikungunya cases were less likely than AFI and dengue to present with thrombocytopenia, signs of poor circulation, diarrhea, headache, and cough. Among participants presenting <3 DPO, predictors for chikungunya versus other AFI included: joint pain, skin rash, and muscle, bone or back pain, and absence of thrombocytopenia, poor circulation and respiratory or gastrointestinal symptoms; when the comparator was dengue, joint pain and arthritis, and absence of thrombocytopenia, leukopenia, and nausea were early predictors. Among all groups presenting 3-5 DPO, pruritic skin became a predictor for chikungunya, joint, muscle, bone or back pain were no longer predictive, while arthritis became predictive in all age-groups. Absence of thrombocytopenia was a significant predictor regardless of DPO or comparison group. This study identified robust clinical indicators such as joint pain, skin rash and absence of thrombocytopenia that can allow early identification of and accurate differentiation between patients with chikungunya and other common causes of AFI.

Clinical and epidemiologic characteristics of dengue and other etiologic agents among patients with acute febrile illness, Puerto Rico, 2012-2015.

Identifying etiologies of acute febrile illnesses (AFI) is challenging due to non-specific presentation and limited availability of diagnostics. Prospective AFI studies provide a methodology to describe the syndrome by age and etiology, findings that can be used to develop case definitions and multiplexed diagnostics to optimize management. We conducted a 3-year prospective AFI study in Puerto Rico. Patients with fever ≤7 days were offered enrollment, and clinical data and specimens were collected at enrollment and upon discharge or follow-up. Blood and oro-nasopharyngeal specimens were tested by RT-PCR and immunodiagnostic methods for infection with dengue viruses (DENV) 1-4, chikungunya virus (CHIKV), influenza A and B viruses (FLU A/B), 12 other respiratory viruses (ORV), enterovirus, Leptospira spp., and Burkholderia pseudomallei. Clinical presentation and laboratory findings of participants infected with DENV were compared to those infected with CHIKV, FLU A/B, and ORV. Clinical predictors of laboratory-positive dengue compared to all other AFI etiologies were determined by age and day post-illness onset (DPO) at presentation. Of 8,996 participants enrolled from May 7, 2012 through May 6, 2015, more than half (54.8%, 4,930) had a pathogen detected. Pathogens most frequently detected were CHIKV (1,635, 18.2%), FLU A/B (1,074, 11.9%), DENV 1-4 (970, 10.8%), and ORV (904, 10.3%). Participants with DENV infection presented later and a higher proportion were hospitalized than those with other diagnoses (46.7% versus 27.3% with ORV, 18.8% with FLU A/B, and 11.2% with CHIKV). Predictors of dengue in participants presenting <3 DPO included leukopenia, thrombocytopenia, headache, eye pain, nausea, and dizziness, while negative predictors were irritability and rhinorrhea. Predictors of dengue in participants presenting 3-5 DPO were leukopenia, thrombocytopenia, facial/neck erythema, nausea, eye pain, signs of poor circulation, and diarrhea; presence of rhinorrhea, cough, and red conjunctiva predicted non-dengue AFI. By enrolling febrile patients at clinical presentation, we identified unbiased predictors of laboratory-positive dengue as compared to other common causes of AFI. These findings can be used to assist in early identification of dengue patients, as well as direct anticipatory guidance and timely initiation of correct clinical management.

Invisibilización del riesgo de accidente biológico en paramédicos de hospital de alta complejidad en Colombia / Invisibilization of biological risk accident in a high complexity paramedic hospital of Colombia

Objetivo: Comprender los significados y las prácticas del personal paramédico con relación al accidente biológico en un hospital de alta complejidad de la ciudad de Medellín-Colombia. Metodología: Desde un enfoque histórico hermenéutico utilizando herramientas de la teoría fundamentada, se realizaron 21 entrevistas a quienes sufrieron un accidente biológico, con un guión semiestructurado que se modificó en el proceso. La selección de los participantes fue intencional inicialmente y luego por muestreo teórico. Posterior a la obtención del consentimiento y grabación de las entrevistas, se realizó la trascripción de las respuestas. El análisis se efectuó por medio de codificación abierta, axial y selectiva, además de la matriz paradigmática propuesta por Strauss y Corbin, hasta lograr saturar algunas categorías. Resultados: Emergió como categoría central el «riesgo lejano de accidentarse» a partir de la «construcción de ilusión de invulnerabilidad y optimismo ilusorio». Ante lo cual se da la «naturalización de los Elementos de Protección Personal», generando como consecuencia «convertirse en paciente». Conclusión: El riesgo del accidente biológico pasa a ser invisible en la cotidianidad de la acción asistencial, lo que implica desarrollar estrategias que influyan en los hábitos de las personas, que inviten a formas nuevas de pensar y de comportarse de manera individual y colectiva (AU)

Objective: to understand the meanings and practices of paramedical personnel in relation to the biological accident, in a high complexity hospital of Medellín-Colombia. Methodology: From a hermeneutic historical approach, using elements of grounded theory, 21 people who suffered a biological accident were interviewed in a semi-structured script modified during the process. Initially the participants were intentionally selected and then theoretical sampling became the new criteria of participants. The transcription started after obtaining the consent and recording the interviews. The analysis was performed using open, axial and selective coding as well as the coding paradigm proposed by Strauss and Corbin, until some of the categories were saturated. Results: «the far risk of getting into an accident» emerged as the main category from the «construction of an invulnerability illusion and illusory optimism». The «naturalization to the Personal Protective Equipment» process generates consequently «becoming a patient». Conclusion: The risk of biological accident becomes invisible in the everyday life of health and welfare. It consequently implies the necessity to develop strategies to influence people’s habits and encourage them to think and behave both individually and as a group (AU)

Modified Profile of Matrix Metalloproteinase 2 and 9 Production by Human Fallopian Tube Epithelial Cells After Infection In Vitro With Neisseria gonorrhoeae.

Epithelial shedding and scarring of fallopian tube mucosa are the main consequences of sexually transmitted Neisseria gonorrhoeae infection and probably involve an imbalance of host extracellular matrix components and their regulators such as matrix metalloproteinases (MMPs). In the current study, primary human fallopian tube epithelial cells were infected with N. gonorrhoeae, and MMP patterns were examined. Gonococcal infection induced a significant increase in secreted MMP-9 and an accumulation of cytoplasmic MMP-2 over time, but no significant MMP-3 or MMP-8 production was observed. Thus, MMP-9 in particular could play a role in tubal scarring in response to gonococcal infection.