Potential geographic "hotspots" for drug-injection related transmission of HIV and HCV and for initiation into injecting drug use in New York City, 2011-2015, with implications for the current opioid epidemic in the US.

OBJECTIVE: We identified potential geographic "hotspots" for drug-injecting transmission of HIV and hepatitis C virus (HCV) among persons who inject drugs (PWID) in New York City. The HIV epidemic among PWID is currently in an "end of the epidemic" stage, while HCV is in a continuing, high prevalence (> 50%) stage. METHODS: We recruited 910 PWID entering Mount Sinai Beth Israel substance use treatment programs from 2011-2015. Structured interviews and HIV/ HCV testing were conducted. Residential ZIP codes were used as geographic units of analysis. Potential "hotspots" for HIV and HCV transmission were defined as 1) having relatively large numbers of PWID 2) having 2 or more HIV (or HCV) seropositive PWID reporting transmission risk-passing on used syringes to others, and 3) having 2 or more HIV (or HCV) seronegative PWID reporting acquisition risk-injecting with previously used needles/syringes. Hotspots for injecting drug use initiation were defined as ZIP codes with 5 or more persons who began injecting within the previous 6 years. RESULTS: Among PWID, 96% injected heroin, 81% male, 34% White, 15% African-American, 47% Latinx, mean age 40 (SD = 10), 7% HIV seropositive, 62% HCV seropositive. Participants resided in 234 ZIP codes. No ZIP codes were identified as potential hotspots due to small numbers of HIV seropositive PWID reporting transmission risk. Four ZIP codes were identified as potential hotspots for HCV transmission. 12 ZIP codes identified as hotspots for injecting drug use initiation. DISCUSSION: For HIV, the lack of potential hotspots is further validation of widespread effectiveness of efforts to reduce injecting-related HIV transmission. Injecting-related HIV transmission is likely to be a rare, random event. HCV prevention efforts should include focus on potential hotspots for transmission and on hotspots for initiation into injecting drug use. We consider application of methods for the current opioid epidemic in the US.

Development of a heat vulnerability index for New York State.

OBJECTIVES: The frequency and intensity of extreme heat events are increasing in New York State (NYS) and have been linked with increased heat-related morbidity and mortality. But these effects are not uniform across the state and can vary across large regions due to regional sociodemographic and environmental factors which impact an individual's response or adaptive capacity to heat and in turn contribute to vulnerability among certain populations. We developed a heat vulnerability index (HVI) to identify heat-vulnerable populations and regions in NYS. STUDY DESIGN: Census tract level environmental and sociodemographic heat-vulnerability variables were used to develop the HVI to identify heat-vulnerable populations and areas. METHODS: Variables were identified from a comprehensive literature review and climate-health research in NYS. We obtained data from 2010 US Census Bureau and 2011 National Land Cover Database. We used principal component analysis to reduce correlated variables to fewer uncorrelated components, and then calculated the cumulative HVI for each census tract by summing up the scores across the components. The HVI was then mapped across NYS (excluding New York City) to display spatial vulnerability. The prevalence rates of heat stress were compared across HVI score categories. RESULTS: Thirteen variables were reduced to four meaningful components representing 1) social/language vulnerability; 2) socioeconomic vulnerability; 3) environmental/urban vulnerability; and 4) elderly/ social isolation. Vulnerability to heat varied spatially in NYS with the HVI showing that metropolitan areas were most vulnerable, with language barriers and socioeconomic disadvantage contributing to the most vulnerability. Reliability of the HVI was supported by preliminary results where higher rates of heat stress were collocated in the regions with the highest HVI. CONCLUSIONS: The NYS HVI showed spatial variability in heat vulnerability across the state. Mapping the HVI allows quick identification of regions in NYS that could benefit from targeted interventions. The HVI will be used as a planning tool to help allocate appropriate adaptation measures like cooling centers and issue heat alerts to mitigate effects of heat in vulnerable areas.

Antimicrobial properties of garlic oil against human enteric bacteria: evaluation of methodologies and comparisons with garlic oil sulfides and garlic powder.

The antimicrobial effects of aqueous garlic extracts are well established but those of garlic oil (GO) are little known. Methodologies for estimating the antimicrobial activity of GO were assessed and GO, GO sulfide constituents, and garlic powder (GP) were compared in tests against human enteric bacteria. Test methodologies were identified as capable of producing underestimates of GO activity. Antimicrobial activity was greater in media lacking tryptone or cysteine, suggesting that, as for allicin, GO effects may involve sulfhydryl reactivity. All bacteria tested, which included both gram-negative and -positive bacteria and pathogenic forms, were susceptible to garlic materials. On a weight-of-product basis, 24 h MICs for GO (0.02 to 5.5 mg/ml, 62 enteric isolates) and dimethyl trisulfide (0.02 to 0.31 mg/ml, 6 enteric isolates) were lower than those for a mixture of diallyl sulfides (0.63 to 25 mg/ml, 6 enteric isolates) and for GP, which also exhibited a smaller MIC range (6.25 to 12.5 mg/ml, 29 enteric isolates). Viability time studies of GO and GP against Enterobacter aerogenes showed time- and dose-dependent effects. Based upon its thiosulfinate content, GP was more active than GO against most bacteria, although some properties of GO are identified as offering greater therapeutic potential. Further exploration of the potential of GP and GO in enteric disease control appears warranted.

Cuadro clínico de la intoxicación masiva con veneno paralizante de mariscos / Clinical presentation of masive intoxication with paralytic shellfish poisoning

Desde Enero 1991 a Enero 1992 han fallecido 11 personas en la XII Región a consecuencia de la intoxicación por veneno paralizante de mariscos en la marea roja. Otras 5 personas han fallecido entre los años 1972 y 1981. Se analizan 123 casos clínicos que consultaron en el Hospital FF.AA. "Cirujano Guzmán" de Punta Arenas por el cuadro de intoxicación masiva por saxitoxina. Se incluyen los 56 casos de personal de la Escuadra que consultaron a fines de 1991. 37 pacientes se hospitalizaron y 86 fueron tratados ambulatoriamente. De los 2 casos fatales, uno falleció a bordo antes de llegar al Hospital y el otro falleció a las 72 horas de su ingreso. Se presentan separadamente la sintomatología y la signología de los 37 pacientes hospitalizados y de los 86 pacientes ambulatorios. Las manifestaciones clínicas dependen de varios factores y hay que considerar la cantidad de bivalvos ingeridos, la concentración de la toxina y las respuestas individuales. Se presentan también los tiempos de remisión de los síntomas y las complicaciones observadas en los pacientes hospitalizados

Exclusión pilórica: una alternativa útil en el traumatismo duodenal / Pyloric exclusion: an alternative in duodenal trauma

Las lesiones duodenales, especialmente aquellas secundarias a traumatismos, representan un desafío para el cirujano que las enfrenta. Diversos precedimientos quirúrgicos se han empleado para su solución, todos tienden a evitar la temida fístula duodenal. Las lesiones pequeñas podrán ser reparadas exitosamente con simple sutura, la mayoría de las veces. Las lesiones mayores, que habitualmente comprometen el páncreas, requerirán de cirugía más completa, siendo necesario, en ocasiones, llegar a la duodenopancreatectomía de urgencia, cuya mortalidad alcanza al 30%. Para las lesiones intermedias, cuya simple suturaes riesgosa y la resección es excesiva, se han propuesto varias alternativas: sutura y protección con parche seroso; la triple ostomía de Stone y Fabian; la diverticulización de Berne y Donovan y la exclusión pilórica, de Jordan y cols. Esta última tiene la ventaja de ocluir temporalmente el píloro sin resecar estómago normal. No hay evidencia de complicaciones serias derivadas de este procedimiento, que es además técnicamente simple. Se comentan dos casos clínicos, en los cuales se utilizó exitosamente esta técnica y se revisa someramente la literatura al respecto

Cáncer renal bilateral y del riñón solitario / Bilateral renal cancer and solitary kidney cancer

Se presenta una serie de 4 pacientes con tumores renales bilaterales y un paciente con tumor en riñón único. Sólo un caso presentó hematuria. Tanto TAC como arteriografía renal fueron útiles cuando se practicaron, al permitir planificar estrategia. La cirugía empleada fue tumorectomía de la lesión menor con nefrectomía ampliada de la mayor. Con un seguimiento de 11 a 53 meses, un sólo enfermo ha tenido recidiva de la enfermedad tumoral