'She showed me a new path, a way forward': exploring how navigation influences mental health among Guatemalan gay and bisexual men living with HIV.

Mental health problems, including anxiety and depression, are a common comorbidity among gay, bisexual and other men who have sex with men (GBMSM) living with HIV. Informed by social support theory, health navigation is a strengths-based intervention that has been demonstrated to improve HIV care outcomes. The purpose of this study was to explore how health navigation influences the mental health of GBMSM living with HIV. We analyzed longitudinal qualitative in-depth interviews conducted with GBMSM (n = 29) in a 12-month multi-component intervention to improve HIV care outcomes, including health navigation. We used narrative and thematic analytic approaches to identify salient themes, including if and how themes changed over time. Participants described that navigator support helped them maintain good mental health, prevent crises and respond to crises. Navigator support included providing motivational messaging, facilitating participants' control over their health and improving access to care, which aided with supporting mental health. Navigators also responded to acute crises by providing guidance for those newly diagnosed with HIV and support for those experiencing critical life events. Participants emphasized the importance of feeling heard and valued by their navigators and gaining hope for the future as key to their wellbeing. In conclusion, health navigation may be an effective intervention for promoting mental health among GBMSM living with HIV. Additional research is needed to examine mediating pathways between navigation and mental health, including informational support, or if navigator support moderates the relationship between stressors and mental health outcomes for GBMSM.

A Novel Methodology for Classifying EMG Movements Based on SVM and Genetic Algorithms.

Electromyography (EMG) processing is a fundamental part of medical research. It offers the possibility of developing new devices and techniques for the diagnosis, treatment, care, and rehabilitation of patients, in most cases non-invasively. However, EMG signals are random, non-stationary, and non-linear, making their classification difficult. Due to this, it is of vital importance to define which factors are helpful for the classification process. In order to improve this process, it is possible to apply algorithms capable of identifying which features are most important in the categorization process. Algorithms based on metaheuristic methods have demonstrated an ability to search for suitable subsets of features for optimization problems. Therefore, this work proposes a methodology based on genetic algorithms for feature selection to find the parameter space that offers the slightest classification error in 250 ms signal segments. For classification, a support vector machine is used. For this work, two databases were used, the first corresponding to the right upper extremity and the second formed by movements of the right lower extremity. For both databases, a feature space reduction of over 65% was obtained, with a higher average classification efficiency of 91% for the best subset of parameters. In addition, particle swarm optimization (PSO) was applied based on right upper extremity data, obtaining an 88% average error and a 46% reduction for the best subset of parameters. Finally, a sensitivity analysis was applied to the characteristics selected by PSO and genetic algorithms for the database of the right upper extremity, obtaining that the parameters determined by the genetic algorithms show greater sensitivity for the classification process.

Intimate Partner Violence Victimization and Mental Health Among Men Who Have Sex With Men Living With HIV in Guatemala.

Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by poor mental health compared to their heterosexual counterparts. One factor that may increase mental health problems among MSM is intimate partner violence (IPV) victimization. The objectives of this study are to (a) describe the prevalence of different forms of IPV victimization experienced by MSM living with HIV in Guatemala City and (b) examine the relationship between IPV victimization and mental health. We analyzed cross-sectional survey data from a cohort of MSM living with HIV in Guatemala City (n = 374) to describe the burden of IPV, including physical, sexual, and emotional IPV. We then examined relationships between lifetime IPV and each form of recent IPV (past 12 months) with self-reported anxiety and depression using multivariable logistic regression. Over a quarter (27.3%) of the participants screened positive for anxiety and nearly one fifth (17.9%) screened positive for depression. Over a quarter of the participants (28.6%) reported ever having experienced any IPV victimization and 8.8% reported having experienced any form of recent IPV. In multivariable analyses, participants who experienced any form of lifetime IPV had roughly twice the odds of experiencing anxiety (OR: 1.86; 95% CI = [1.03, 3.38]) and depression (OR: 2.02; 95% CI = [1.02, 3.99]) compared to those who had not. Participants who experienced recent emotional IPV had over seven times the odds of experiencing anxiety (OR: 7.23; 95% CI = [1.46, 38.85]) compared to those who had not. MSM living with HIV in Guatemala experience a high burden of anxiety, depression, and IPV victimization. Those participants who had experienced lifetime IPV and recent emotional IPV were significantly more likely to screen for anxiety and depression. To improve their mental health, HIV clinics and other health services should provide support for MSM who have experienced IPV victimization.

Examining How Health Navigation Affects Mental Health Among Gay, Bisexual, and Other Men Who Have Sex with Men Living with Human Immunodeficiency Virus in Guatemala.

Gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately affected by mental health problems and human immunodeficiency virus (HIV). Health navigation has the potential to improve both HIV and mental health outcomes; however, few studies have measured the impact of navigation on mental health among people living with HIV. We analyzed longitudinal data from a sociobehavioral survey and navigation monitoring system with GBMSM living with HIV in Guatemala (n = 346) that participated in a 12-month differentiated care intervention. We examined relationships between navigation characteristics (frequency, duration, mode of interactions, and level of emotional, instrumental, and informational navigation support) and anxiety and depression using fixed-effects regression. We also examined if these relationships were moderated by baseline social support. We found that as navigation interactions increased, anxiety significantly improved [B = -0.03, standard error (SE) = 0.01 p = 0.05]. Participants who received high levels of informational navigator support also experienced a significant improvement in anxiety compared with those receiving low levels of informational support (B = -0.81, SE = 0.40, p = 0.04). Unexpectedly, we found that as the proportion of in-person navigation interactions increased, anxiety worsened (B = 1.12, SE = 0.54, p = 0.04). No aspects of navigation were significantly associated with depression and baseline social support did not moderate the relationship between navigation and anxiety and depression. To improve the mental health of key populations affected by HIV, health navigation programs should prioritize frequent interaction and informational navigation support for clients with anxiety while considering other strategies that specifically target reducing depressive symptoms, including other cost-effective modalities, such as mobile apps.

Estado actual de Melongena melongena (Mollusca: Gastropoda) en la bahía de Cispatá, Caribe Colombiano / Current status of Melongena melongena(Mollusca: Gastropoda) in Cispatá Bay, Colombian Caribbean

RESUMEN Objetivo. Evaluar el estado actual de Melongena melongena en la bahía de Cispatá, Caribe Colombiano a través de los aspectos poblacionales de la especie. Materiales y métodos. Se establecieron tres sectores de muestreo, conforme con la zonificación de los manglares en la bahía. Para la recolección del material biológico se ubicó un transecto lineal de 4 x 20 m perpendicular al área del manglar con dos replicas a una distancia de 50 m. Para la determinación del sexo, se tomó una submuestra de 10 individuos con tallas superiores a la estimada para la madurez sexual de la especie. A las conchas se les midió la longitud total, con el fin de diferenciar las tallas de hembras y machos. En cada sector, la temperatura del agua y salinidad fueron registradas in situ, empleando un medidor multiparámetro Extech EC170, mientras la trasparencia del agua se calculó mediante el disco Secchi. Resultados. Se registraron un total de 1.149 individuos de M. melongena, obteniendo la mayor abundancia el sector Caño Salado (522), seguido de Las Cagás (458) y finalmente Amaya (169). El 63% de los individuos se encontraron en un intervalo de talla entre 41-61 mm. La proporción sexual fue 1:1.2 (H:M). Las tallas registradas en hembras fueron de 55 a 92 mm y en machos de 54 a 77 mm. Conclusiones. M. melongena en la bahía de Cispatá está presentando signos evidentes de recuperación en la última década, debido a que la mayoría de los individuos registrados han alcanzado la talla media de madurez sexual.

ABSTRACT Objective. Evaluate the current status of Melongena melongena in Cispata Bay, Colombian Caribbean through the population aspects of the species. Materials and methods. Three sampling sectors were established, according to the zoning of the mangrove in the bay. For the collection of the biological material a linear transect of 4 x 20 m was located perpendicular to the area of the mangrove with two replicas at a distance of 50 m. For the determination of sex, a subsample of 10 individuals with sizes greater than that estimated for the sexual maturity of the species was taken. The shells were measured in total length, in order to differentiate the sizes of females and males. In each sector, the water temperature and salinity were measured in situ using an Extech EC170 multiparameter while water transparency is calculated using the Secchi disk. Results. A total of 1,149 individuals of M. melongena were recorded, obtaining the highest abundance in the Caño Salado sector (522), followed by Las Cagás (458) and finally Amaya (169). 63% of the individuals were in a size range between 41-61 mm. The sex ratio was 1:1.2 (H:M). The sizes recorded in females were from 55 to 92 mm and in males from 54 to 77 mm. Conclusions. M. melongena in Cispatá Bay is showing evident signs of recovery in the last decade, because most of the registered individuals have reached the average size of sexual maturity.

Endoscopic stenting for gastroduodenal outlet obstruction of a malignant origin, real life experience in a single center.

AIM: to evaluate the safety and effectiveness of self-expandable metal stent placement for malignant gastric outlet obstruction (GOO). METHODS: a retrospective, analytic cohort study at a single, tertiary-care center. RESULTS: thirty-six patients that underwent stent placement for GOO of malignant origin were identified during the study period. Technical success was achieved in 36 (100 %) patients and clinical success was achieved in 31 patients (86.1 %). Before the procedure, 17 (54.8 %) patients had a gastric outlet obstruction score (GOOSS) of 0, which is a complete inability of oral intake. Twenty-three patients were alive 30 days after the procedure, two (8.6 %) patients had a GOOSS of 1, ten (43.3 %) had a GOOSS of 2 and eleven (47.9 %) had a GOOSS of 3. Abdominal pain was present in all 31 patients before the procedure and only seven (22.6 %) patients continued with abdominal pain 24 hours after the procedure. During follow-up, ten (30.3 %) patients developed complications related to the stents and none of them was fatal. Additional therapy due to partial occlusion of the stent was necessary in three patients. The stents functional duration had a median of 72 days (IQR 25-75 15-105 days) and was closely related to overall survival. CONCLUSION: palliative stenting for gastroduodenal obstruction is a safe, feasible and effective therapy to treat patients with malignant gastric outlet obstruction.

Coronary Artery Dilation in Children with Febrile Exanthematous Illness without Criteria for Kawasaki Disease / Dilatação das Artérias Coronárias em Crianças com Doença Exantemática Febril sem Critérios para a Doença de Kawasaki

Abstract Background: Coronary dilatation is the most important complication of Kawasaki disease (KD) and, in addition to some clinical characteristics, is common to KD and febrile exanthematous illnesses (FEIs). Objective: To assess whether children with FEI, who do not meet the criteria for KD, have changes in coronary arteries dimensions. Methods: Echocardiography was performed within the first two weeks of the disease in patients < 10 years with fever and exanthema without other KD criteria. To make a comparison with KD patients, we reviewed the echocardiograms and medical records of patients with a diagnosis of KD of the last five years. Coronary ectasia was assessed using Z scores of coronary arteries. The means of the dimensions of the coronary arteries were compared with a z test and a level of significance of 0.05 was adopted. Results: A total of 34 patients were included, 22 (64.7%) with FEI, and 12(35.2%) with a diagnosis of KD. Using the Z scores of coronary artery, a dilation of any of the coronary artery branches was observed in six (27.2%) patients with FEI. Conclusions: An important percentage of patients with FEI has coronary artery dilation.

Resumo Fundamento: A dilatação das artérias coronárias é a principal complicação da Doença de Kawasaki (DK) e, além de algumas características clínicas, é comum à DK e a doenças exantemáticas febris (DEFs). Objetivo: Avaliar se crianças com DEF e que não têm critério para DK apresentam alterações nas dimensões das artérias coronárias. Métodos: Foi realizada ecocardiografia nas primeiras duas semanas da doença em crianças com idade inferior a 10 anos, que apresentaram febre e exantema e nenhum outro critério de DK. Para comparar com pacientes com DK, fizemos a revisão de ecocardiogramas e prontuários médicos de pacientes com diagnóstico de DK dos últimos cinco anos. Ectasia coronária foi avaliada usando escore Z das artérias coronárias. As médias das dimensões das artérias coronárias foram comparadas pelo teste z, e um nível de significância de 0,05 foi adotado. Resultados: Foram incluídos no estudo 34 pacientes, 22 (64,7%) com diagnóstico de DEF e 12 (35,2%) com diagnóstico de DK. Usando o escore Z das artérias coronárias, observou-se dilatação em algum dos ramos da artéria coronária em seis (27,2%) pacientes com DEF. Conclusão: Uma porcentagem importante dos pacientes com DEFs apresenta dilatação das artérias coronárias.

Coronary Artery Dilation in Children with Febrile Exanthematous Illness without Criteria for Kawasaki Disease.

BACKGROUND: Coronary dilatation is the most important complication of Kawasaki disease (KD) and, in addition to some clinical characteristics, is common to KD and febrile exanthematous illnesses (FEIs). OBJECTIVE: To assess whether children with FEI, who do not meet the criteria for KD, have changes in coronary arteries dimensions. METHODS: Echocardiography was performed within the first two weeks of the disease in patients < 10 years with fever and exanthema without other KD criteria. To make a comparison with KD patients, we reviewed the echocardiograms and medical records of patients with a diagnosis of KD of the last five years. Coronary ectasia was assessed using Z scores of coronary arteries. The means of the dimensions of the coronary arteries were compared with a z test and a level of significance of 0.05 was adopted. RESULTS: A total of 34 patients were included, 22 (64.7%) with FEI, and 12(35.2%) with a diagnosis of KD. Using the Z scores of coronary artery, a dilation of any of the coronary artery branches was observed in six (27.2%) patients with FEI. CONCLUSIONS: An important percentage of patients with FEI has coronary artery dilation.

Treatment of gastrointestinal bleeding with hemostatic powder (TC-325): a multicenter study.

INTRODUCTION: Hemostatic powder (TC-325) is a new tool for treatment of gastrointestinal bleeding that allows the treatment of large surfaces with active bleeding. The aim was to describe the initial success of TC-325 for the control of GI bleeding. MATERIALS AND METHODS: We did a multicenter cohort study with patients admitted to the endoscopy service for GI bleeding. A format was generated to standardize the information obtained in each center. It was determined whether this treatment had been used as a single therapy or as a combination therapy. Descriptive statistics with medians and ranges, or averages with SD according to distribution. RESULTS: Eighty-one patients with 104 endoscopic procedures were included. The median number of endoscopic procedures was 1 (1-3). In the first procedure, the initial success rate was 98.8% (n = 80), failure rate was 1.2% (n = 1), and rebleeding rate was 20% (n = 16). The majority of rebleeding cases occurred within the first 3 days (12/16, 75%). There was no association between rebleeding and etiology (malignant or benign; P = 0.6). In first procedure, 44 (54%) cases had monotherapy with TC-325 and 37 (46%) cases had a combined endoscopic therapy. There were no differences in initial success or rebleeding rates when TC-325 was used as monotherapy versus combined therapy (P = 0.7). The mortality rate was 4% (3/81). CONCLUSION: TC-325 is effective for achieving initial control of bleeding in patients with different GI etiologies. The rate of bleeding recurrence is considerable in both patients with benign and malignant etiology.

Limnological Characteristics and Rotifer Community Composition of Northern Mexico Chihuahuan Desert Springs.

Desert springs are critical for wildlife and human subsistence, but poorly studied. The springs in the northern Chihuahuan Desert region of Mexico are no exception. While groundwater overexploitation and other anthropogenic activities have endangered these waters, little is known about their water quality or biodiversity. We monitored five springs on a monthly basis for one year, and two others sporadically, to determine their physicochemical characteristics and to study rotifer community composition as an assessment of biodiversity. Seasonal variation in temperature, dissolved oxygen (DO), and conductivity was observed in the five springs. DO was occasionally below the criterion for aquatic life (<4mg/L) in some springs. Ca2+ (468-775.2 mg/L) was the dominant ion in all springs except Ojo de Santa María where Na+ (180-290 mg/L) dominated. Of 57 rotifer species identified, Lepadella patella (Müller, 1786), Lepadella triptera (Ehrenberg, 1830), and Philodina megalotrocha, Ehrenberg, 1832 were present in most springs. The rotifer community exhibited nestedness among the sites (supported by four null modes, p<0.05) and was correlated with fall season, DO, and nitrate concentration. This work provides information that will aid in management practices and provide important baseline data on water quality and regional diversity of a major component of the zooplankton.

CRISPR/Cas and recombinase-based human-to-pig orthotopic gene exchange for xenotransplantation.

BACKGROUND: Tools for genome editing in pigs are improving rapidly so that making precise cuts in DNA for the purposes of deleting genes is straightforward. Development of means to replace pig genes with human genes with precision is very desirable for the future development of donor pigs for xenotransplantation. MATERIALS AND METHODS: We used Cas9 to cut pig thrombomodulin (pTHBD) and replace it with a plasmid containing a promoterless antibiotic selection marker and the exon for human thrombomodulin. PhiC31 recombinase was used to remove the antibiotic selection marker to create porcine aortic endothelial cells expressing human instead of pTHBD, driven by the endogenous pig promoter. RESULTS: The promoterless selection cassette permitted efficient enrichment of cells containing correctly inserted transgene. Recombinase treatment of selected cells excised the resistance marker permitting expression of the human transgene by the endogenous pTHBD promoter. Gene regulation was maintained after gene replacement because pig endogenous promoter was kept intact in the correct position. CONCLUSIONS: Cas9 and recombinase technology make orthotopic human for pig gene exchange feasible and pave the way for creation of pigs with human genes that can be expressed in the appropriate tissues preserving gene regulation.

Extended source model for diffusive coupling.

Motivated by the prevailing approach to diffusion coupling phenomena which considers point-like diffusing sources, we derived an analogous expression for the concentration rate of change of diffusively coupled extended containers. The proposed equation, together with expressions based on solutions to the diffusion equation, is intended to be applied to the numerical solution of systems exclusively composed of ordinary differential equations, however is able to account for effects due the finite size of the coupled sources.

Evaluación del status funcional actual en pacientes amputados por pie diabético complicado en el Hospital Dr. Gustavo Fricke durante el año 2007; cuantificación, descripción e impacto en la calidad de vida de los pacientes / Evaluation of the functional status present in amputees patients by diabetic foot complicated at the hospital Dr. Gustavo Fricke during the year 2007: quantification description and impact in the quality of life of the patients

Contexto y Objetivos: el pie diabético (PD) constituye una complicación tardía de la Diabetes Mellitus que afecta alrededor del 15 por ciento de los diabéticos, cuyo tratamiento quirúrgico tiene una elevada prevalencia, con gran impacto en la calidad de vida de los enfermos, comprometiendo su estado físico y psicosocial. El presente trabajo busca caracterizar las hospitalizaciones por PD durante el año 2007, y compararlas con la de años anteriores, para luego valorar el grado de discapacidad funcional en pacientes con amputaciones mayores y menores por PD complicado. Diseño: estudio descriptivo y analítico transversal. Método: Este estudio consistió en dos etapas. En la primera se realizó un estudio descriptivo de 109 hospitalizaciones correspondientes a 91 pacientes con diagnóstico de egreso "pie diabético complicado" tratados en el Servicio de Cirugía del HGF en el año 2007, para caracterizar a la población, y luego comparar los resultados con los años anteriores, 2004 y 2005. La segunda etapa consistió en la aplicación de una encuesta telefónica a una muestra de 28 pacientes para evaluar su grado de discapacidad funcional tras recibir tratamiento quirúrgico (amputaciones), aplicando el índice de Barthel modificado a la muestra para evaluar su grado de discapacidad. Resultados: en el año 2007 el número de hospitalizaciones fue de 138, correspondientes a 108 pacientes, significativamente mayor que en los años 2004-2005. La edad promedio aumentó en 4 años, con un aumento en la estadía de 3 días, y una mayor cantidad de complicaciones infecciosas. El grado de discapacidad funcional en los pacientes con amputaciones menores resultó ser en un 84 por ciento ligera, y en menor porcentaje moderada y grave; en las amputaciones mayores, en cambio, el porcentaje de discapacidad ligera descendió a 44 por ciento, asociado a un ascenso en la discapacidad grave a 33 por ciento

Context and objectives: The diabetic foot constitutes a late complication of Diabetes Mellitus that affects about 15 percent of diabetics, whose surgical treatment has a high prevalence, with great impact on the quality of life of the patients, compromising their physical and psychosocial status. This paper seek to characterize hospitalizations for diabetic foot during 2007, compare it with previous years, and then assess the degree of functional disability in patients with major and minor amputation for complicated diabetic foot. Design: descriptive and transversal analytic study. Method: this study consisted of two phases. The first was a descriptive study of 109 hospitalizations for 91 patients with discharge diagnosis of "complicated diabetic foot" treated in the Surgery Department of HGF in 2007, to characterize the population, and then compare the results with previous years, 2004 an 2005. The second step was the implementation of a telephone survey of a sample of 28 patients, to assess their degree of functional disability after receiving surgical treatment (amputation), using the modified Barthel to assess their degree of disability. Results: in 2007 the number of hospitalizations was 138, corresponding to 108 patients, significantly higher than 2004-2005. The average age increased by 4 years, with an increase in hospital stay of 3 days, and a greater number of infectious complications. The degree of functional disability in patients with minor amputation was mild in 84 percent, with a smaller percentage being moderate and severe; in major amputations, in contrast, the percentage of mild disability decreased to 44 percent, with an increase in the severe disability to 33 percent