Early-life external exposome in children 2-5 years old in Colombia.

Exposome studies are advancing in high-income countries to understand how multiple environmental exposures impact health. However, there is a significant research gap in low- and middle-income and tropical countries. We aimed to describe the spatiotemporal variation of the external exposome, its correlation structure between and within exposure groups, and its dimensionality. A one-year follow-up cohort study of 506 children under 5 in two cities in Colombia was conducted to evaluate asthma, acute respiratory infections, and DNA damage. We examined 48 environmental exposures during pregnancy and 168 during childhood in eight exposure groups, including atmospheric pollutants, natural spaces, meteorology, built environment, traffic, indoor exposure, and socioeconomic capital. The exposome was estimated using geographic information systems, remote sensing, spatiotemporal modeling, and questionnaires. The median age of children at study entry was 3.7 years (interquartile range: 2.9-4.3). Air pollution and natural spaces exposure decreased from pregnancy to childhood, while socioeconomic capital increased. The highest median correlations within exposure groups were observed in meteorology (r = 0.85), traffic (r = 0.83), and atmospheric pollutants (r = 0.64). Important correlations between variables from different exposure groups were found, such as atmospheric pollutants and meteorology (r = 0.76), natural spaces (r = -0.34), and the built environment (r = 0.53). Twenty principal components explained 70%, and 57 explained 95% of the total variance in the childhood exposome. Our findings show that there is an important spatiotemporal variation in the exposome of children under 5. This is the first characterization of the external exposome in urban areas of Latin America and highlights its complexity, but also the need to better characterize and understand the exposome in order to optimize its analysis and applications in local interventions aimed at improving the health conditions and well-being of the child population and contributing to environmental health decision-making.

Prognostic Factors of Long-Term Outcomes after Primary Chemo-Radiotherapy in Non-Metastatic Anal Squamous Cell Carcinoma: An International Bicentric Cohort.

Anal squamous cell carcinoma (ASCC) is a rare malignancy with a rising incidence associated with human papillomavirus (HPV) infection. The locally advanced disease is associated with a 30% rate of treatment failure after standard chemoradiotherapy (CRT). We aimed to elucidate the prognostic factors for ASCC after curative CRT. A retrospective multicenter study of 176 consecutive patients with ASCC having completed CRT treated between 2010 and 2017 at two centers was performed. Complete response (CR), disease-free survival (DFS), and overall survival (OS) were analyzed by Kaplan-Meier estimates with log-rank tests. The hierarchical clustering on principal components (HCPC) method was employed in an unsupervised and multivariate approach. The CR rate was 70% and was predictive of DFS (p < 0.0001) and OS (p < 0.0001), where non-CR cases were associated with shorter DFS (HR = 16.5, 95% CI 8.19-33.21) and OS (HR = 8.42, 95% CI 3.77-18.81) in a univariate analysis. The median follow-up was 38 months, with a 3-year DFS of 71%. The prognostic factors for DFS were cT1-T2 (p = 0.0002), N0 (p = 0.035), HIV-positive (p = 0.047), HIV-HPV coinfection (p = 0.018), and well-differentiated tumors (p = 0.037). The three-year OS was 81.6%. Female sex (p = 0.05), cT1-T2 (p = 0.02) and well-differentiated tumors (p = 0.003) were associated with better OS. The unsupervised analysis demonstrated a clear segregation of patients in three clusters, identifying that poor prognosis clusters associated with shorter DFS (HR = 1.74 95% CI = 1.25-2.42, p = 0.0008) were enriched with the locally advanced disease, anal canal location, HIV-HPV coinfection, and non-CR. In conclusion, our results reinforce the prognostic value of T stage, N stage, sex, differentiation status, tumor location, and HIV-HPV coinfection in ASCC after CRT.

Characterization of the external exposome and its contribution to the clinical respiratory and early biological effects in children: The PROMESA cohort study protocol.

BACKGROUND: Air pollution contains a mixture of different pollutants from multiple sources. However, the interaction of these pollutants with other environmental exposures, as well as their harmful effects on children under five in tropical countries, is not well known. OBJECTIVE: This study aims to characterize the external exposome (ambient and indoor exposures) and its contribution to clinical respiratory and early biological effects in children. MATERIALS AND METHODS: A cohort study will be conducted on children under five (n = 500) with a one-year follow-up. Enrolled children will be followed monthly (phone call) and at months 6 and 12 (in person) post-enrolment with upper and lower Acute Respiratory Infections (ARI) examinations, asthma development, asthma control, and genotoxic damage. The asthma diagnosis will be pediatric pulmonologist-based and a standardized protocol will be used. Exposure, effect, and susceptibility biomarkers will be measured on buccal cells samples. For environmental exposures PM2.5 will be sampled, and questionnaires, geographic information, dispersion models and Land Use Regression models for PM2.5 and NO2 will be used. Different statistical methods that include Bayesian and machine learning techniques will be used for the ambient and indoor exposures-and outcomes. This study was approved by the ethics committee at Universidad Pontificia Bolivariana. EXPECTED STUDY OUTCOMES/FINDINGS: To estimate i) The toxic effect of particulate matter transcending the approach based on pollutant concentration levels; ii) The risk of developing an upper and lower ARI, based on different exposure windows; iii) A baseline of early biological damage in children under five, and describe its progression after a one-year follow-up; and iv) How physical and chemical PM2.5 characteristics influence toxicity and children's health.

Consumo de enegía y nutrientes en estudiantes de la universidad de Carabobo, Venezuela / Energy and nutrient intake in students of Carabobo University, Venezuela

Fundamentos: Los estudiantes universitarios tienen importantes modificaciones en su estilo de vida, que influyen en su hábito alimentario, trayendo consecuencias que pudieran afectar su salud. La investigación tiene como objetivo evaluar el consumo de energía y nutrientes y su relación con el tipo de carrera en estudiantes de la Universidad de Carabobo, Venezuela. Método: Se trata de un estudio de tipo correlacional, no experimental, de campo y de corte transversal. La población está conformada por estudiantes de las carreras de Medicina, Ingeniería y Educación. Muestra de tipo no probabilística, de participación voluntaria, conformada por 370 alumnos, 112 en Medicina, 140 en Ingeniería y 118 en Educación. Se les aplicó un cuestionario de frecuencia de consumo y un registro de alimentación de 24 horas. esultados: El consumo de energía en calorías fue de 1.872 Kcal (1.697 Kcal en mujeres y 2.111 Kcal en hombres). La adecuación calórica fue mejor en la carrera de Ingeniería (90,7%) y Educación (84,5%), mientras que en Medicina de 78,23%; hubo alta adecuación para proteínas, vitamina C, hierro y zinc; baja adecuación de Calcio y Ácido Fólico, para todas las carreras. La fórmula calórica fue 16% para proteínas, 54% para carbohidratos y 30% para grasas. Conclusiones: Se concluye que hubo un déficit importante en la ingesta y la adecuación calórica, con una buena adecuación de proteínas y de hierro, además de una baja adecuación de calcio y ácido fólico en todas las carreras. La fórmula calórica se adecúa a las recomendaciones nutricionales para la población venezolana (AU)

Background: University students have significant changes in their lifestyle, influencing their food habits, bringing consequences that could affect their health. The research aims to assess the consumption of energy and nutrients and their relationship with the type of career in students from the University of Carabobo, Venezuela. Methods: It is a study of correlation, non-experimental type, field and cross-sectional. The population is formed by students of medicine, engineering and education. Sample type not probabilistic, voluntary participation, comprised of 370 students, 112 in medicine, 140 in engineering and 118 in education. A Food Frequency Questionnaire was applied and a food record of 24-hour. Results: The consumption of energy in calories was 1,872 Kcal (1,697 Kcal in women and in men 2,111 Kcal). The caloric adequacy was better in the career of engineering (90.7%) and education (84.5%), while in 78.23% medicine; there were high fitness for protein, vitamin C, iron and zinc; low fitness of calcium and folic acid, for all races. The calorie formula was 16% for proteins, 54% carbohydrates and 30% fat. Conclusion: It is concluded that there was a major shortfall in intake and caloric adequacy, with a good adaptation of proteins and iron, as well as a low adequacy of calcium and folic acid in all races. The calorie formula fits the nutritional recommendations for the Venezuelan population (AU)

Actualización. Modelo de Gestión de Calidad de la atención a la ciudadanía desde la dirección técnica del profesional de Enfermería / Updating. Quality Management Model for citizens support from technical direction of the Nursing professional

Resumen:

El modelo tiene por objetivo reflejar la necesidad de estimular prácticas gerenciales innovadoras basadas en la calidad de la atención a la salud de la ciudadanía, realzando el perfil gestor del profesional de Enfermería. Diferentes factores influyen en ese proceso: la complejidad de la vida del ser humano, el nivel de exigencia de los ciudadanos, la administración pública, la competitividad y la revolución de las tecnologías de la información. Con el propósito de satisfacer y acompañar al ciudadano, se vuelve necesaria la utilización de herramientas capaces de hacer la diferencia en los servicios ofrecidos: prácticas gerenciales basadas en la gestión de la calidad de los servicios de salud, acompañadas de la implementación de programas de atención humanizada.

Detección y caracterización molecular de cepas variantes del virus de la enfermedad infecciosa de la bolsa en el Estado Zulia, Venezuela / Molecular detection and characterization of infectious bursal disease virus variant strains from Zulia State, Venezuela

Las cepas clásicas del virus de la enfermedad infecciosa de la bolsa (por sus siglas en inglés IBDV) están presentes en la industria avícola venezolana desde el último tercio del siglo pasado, a pesar de la implementación de programas intensivos de vacunación. Recientemente, se ha reportado la presencia de cepas variantes del IBDV en varios países de Latinoamérica. El presente trabajo reporta la identificación, mediante técnicas moleculares, de cepas variantes en granjas avícolas venezolanas. En parvadas de pollos de engorde de cuatro semanas de edad se tomaron bolsas de Fabricio e improntas en la tarjeta Whatman Indicadora Clásica FTA® para evaluación histopatológica y detección molecular, respectivamente. Para la caracterización molecular se utilizó la prueba de reacción en cadena por la polimerasa-transcriptasa reversa (por sus siglas en inglés RT-PCR) acoplada a secuenciación directa de nucleótidos. El peso vivo del ave, el índice peso bolsa/peso corporal, así como el peso y diámetro de la bolsa se consideraron como indicadores de inmunocompetencia a la cuarta semana. Todas las aves muestreadas (n=113) resultaron positivas a IBDV. Los virus provenientes de 10 de las 13 granjas mostraron alta similitud con cepas variantes (A y E). En concordancia con los resultados de RT-PCR, los hallazgos histopatológicos mostraron lesiones relacionadas con IBDV. Los indicadores morfológicos de inmunocompetencia se afectaron significativamente en las granjas donde se detectaron cepas variantes. En Venezuela no se utiliza vacuna viva contra cepas variantes, lo que incrementa el riesgo de inmunosupresión, fallas en los programas de vacunación y la susceptibilidad a enfermedades endémicas.

Classical infectious bursa disease virus (IBDV) has been present in the Venezuelan poultry industry since the last quarter of the past century despite intensive vaccination programs applied to control the disease. Lately, the presence of variant strains has been reported in several Latin-American countries. This work reports the molecular identification of variant IBDV strains in poultry farms from Venezuela. Bursal imprints in Whatman classic indicator FTA® cards and bursa tissues for histopathological analysis were collected from 4-week old broiler flocks. Reverse transcriptase polymerase chain reaction (RT-PCR) and direct nucleotide sequence were used for the virus molecular characterization. The bird´s body weight, the bursal index, the bursa weight and diameter were used to assess the immune status at four weeks of age. All the birds sampled (n =113) were IBDV positive. Viruses from 10 out of 13 farms showed high similarity with the IBDV variant strains (variants A and E). Histopathological findings where consistent with the RT-PCR, results showing IBDV related bursa damage in the infected birds. The immune status indicators were significantly affected in the farms where variant strains were detected. No variant strain live vaccination is currently used in Venezuela, increasing the risk of immunossupression, vaccine failure and susceptibility to endemic diseases.

Detección de títulos de anticuerpos contra anemia infecciosa aviar y su relación con otros virus inmunosupresores en pollos de engorde: estado Zulia Venezuela / Detection of chicken infectious Anemia antibodies and their relationship with other immunosuppressor virus in broilers chicken: Zulia state Venezuela

En Venezuela, la incidencia de enfermedades respiratorias virales e inmunosupresoras son dos de los mayores problemas en la industria avícola nacional, y hasta el momento no se cuenta con suficiente información epidemiológica al respecto que ayude a establecer medidas de control, por lo que el objetivo de esta investigación fue determinar serológicamente la presencia de anemia infecciosa aviar, reovirus y gumboro, y su relación entre ellas, así como determinar el nivel de anemia en las aves evaluadas. Se tomaron muestras de aproximadamente 14 a 15 aves, de forma semanal a diferentes edades (1, 7, 14, 21, 28, 35 y 42 días), en tres granjas comerciales, tomándose un total de 295 aves. Los títulos de anticuerpos se midieron a través de la prueba ELISA, y el nivel de anemia, por la técnica de microhematocrito. Se detectaron porcentajes de anticuerpos séricos: 90,8 por ciento (268/295) para anemia infecciosa aviar; 82,4 por ciento (244/295) para reovirus y 97 por ciento (286/295) para la enfermedad infecciosa de la bursa. En cuanto a los valores de hematocrito se encontró en forma general que, el 19,6 por ciento (58/295) de las aves evaluadas presentaron anemia, mostrando valores de hematocrito entre 20 y 27 por ciento. Se observó una correlación positiva altamente significativa entre la anemia infecciosa aviar y los otros virus inmunosupresores estudiados, con gumboro (r=0,437; P<0,0001) y reovirus (r=0,312; P<0,0001). Los resultados obtenidos en este trabajo permiten demostrar la presencia del virus de la anemia infecciosa aviar en pollos de engorde en la región, de manera aislada o asociada con reovirus y gumboro, que pudiesen estar afectando en forma subclínica o clínica las granjas avícolas zulianas.

The incidence of viral respiratory and immunosuppressant diseases are two of the biggest problems in the Venezuelan poultry industry, however in the country, there is not enough epidemiological information that helps to establish control measures. The aim of this research was to determine the presence of serological chicken anemia virus, reovirus and gumboro, and it´s correlation between them as well as to determine the level of anemia in the evaluated birds. In this research, approximately fourteen or fifteen (14 or 15) birds were tested weekly and at different ages (1; 7; 14; 21; 28; 35 y 42 days), in three commercial farms. The samples were taken from a total of 295 birds. The viral antibodies were determined by ELISA test and the anemia levels by micro-hematocrit. The presence of seropositivity was 90.8% (268/295) for the chicken anemia virus, 82.4% (244/295) for reovirus and 97% (286/295) for gumboro. Of the total, 9.6% (58/295) of the evaluated birds presented anemia, showing values of hematocrits between 20% and 27%. A positive correlation was found between chicken anemia virus and the other immunosuppressor viruses studied, gumboro (r=0.437; P<0.0001) and reovirus (r=0.312; P<0.0001). The obtained results in this research demonstrated the presence of viral anemia, in broilers, in the Zulia Region, with or without the presence of reovirus and/or gumboro. That could have an effect, in either sub-clinical or clinical forms.