The Use of Navigators to Increase Patient Portal Enrollment among Patients in a Federally Qualified Health Care System.

Purpose: To describe the training, preliminary results, and lessons learned from using patient navigators to increase the enrollment of low-income patients in a health system-supported and electronic health record-linked patient portal. Methods: Patient navigators (n=4) were trained to assist patients in a federally qualified health center to enroll in and use patient portals. Patient navigators were stationed at 3 clinic locations. Data from the electronic health record system (Epic) were used to compare MyChart patient portal activation rates and use among patients for the 8 months before and after patient navigation services were offered. Results: Navigators offered 83% of eligible patients with activation assistance. Sixty-four percent of the patients (n=1062) offered MyChart enrollment assistance accepted help. Seventy-four percent of assisted patients with no prior MyChart enrollment activated their accounts during that clinic visit. The primary reason for declining MyChart assistance was a lack of access to or comfort with technology. Patient portal activation increased during the 8 months when navigators were at the clinics (51%) compared to the previous 8 months (44%). Most new users viewed lab results and read a message [χ2(1)=49.3, p<.001], with significant increases evident for African Americans [44% before, 49% during; χ2(1)=40.4, p<.001] and Latinx patients [52% before, 60% during; χ2(1)=6.15, p=.013]. Conclusion: Study results suggest that using patient navigators is feasible and beneficial for increasing patient enrollment in the Federally Qualified Health Centers context. However, patient-, clinic-, and system-level factors were identified as barriers and should be addressed in future research studies.

Virus linfotrópico humano de células T tipo 1 (HTLV-1) en el embarazo / Human lymphotropic virus in T-cell type 1 (HTLV-1) during pregnancy

El HTLV-1 es un retrovirus que afecta principalmente a los linfocitos T-CD4, causando enfermedades como paraparesia espástica o mielopatía, uveítis, dermatitis infecciosas, leucemia/linfoma de las células T del adulto, además de otras enfermedades. Causa una infección crónica de por vida en humanos y su transmisión ocurre a través de la lactancia materna, el contacto sexual y las transfusiones de sangre. En Chile actualmente ocupa el cuarto lugar en notificaciones entre el año 2014-2021, estimándose a nivel mundial más de 20 millones de portadores. El mayor riesgo de transmisión ocurre por lactancia mayor a seis meses y alta carga proviral y altos títulos de anticuerpos en la madre portadora. El objetivo consistió en analizar la situación de la portación del virus HTLV-1 durante el embarazo, determinando su prevalencia, vías de transmisión y complicaciones. Se realizó una revisión bibliográfica sistemática de artículos publicados en bases de datos científicas referidos al virus HTLV-1. Este virus está globalmente diseminado y se presenta en forma endémica en algunas regiones del mundo con prevalencias entre muy elevadas y bajas. En Chile la seroprevalencia en promedio es de 0,124% para HTLV-1. Esta infección no cuenta con tratamiento, solo se tratan los síntomas por lo que mientras esto no cambie, solo es factible reducir la transmisión, incidencia y la morbilidad del HTLV-1 incorporando medidas de control del virus en las intervenciones de control de enfermedades y estrategias de salud pública. La forma más eficiente de transmisión del virus madre-hijo es a través de la leche materna, es necesario implementar la detección prenatal de HTLV-1, en especial en las zonas endémicas, así como también asesorar a las madres HTVL-1 positivas sobre la lactancia materna.

HTLV-1 is a retrovirus that mainly affects CD4-T lymphocytes, causing diseases such as spastic paraparesis or myelopathy, uveitis, infectious dermatitis, adult T-cell leukemia/lymphoma, and other diseases. It causes a lifelong chronic infection in humans and its transmission occurs through breastfeeding, sexual contact and blood transfusions. In Chile, it currently ranks fourth in notifications between the years 2014-2021, with more than 20 million carriers being estimated worldwide. The greatest risk of transmission occurs by breastfeeding for more than six months and high proviral load and high antibody titers in the carrier mother. The objective consisted of analyzing the situation of the carriage of the HTLV-1 virus during pregnancy, determining its prevalence, transmission routes and complications. A systematic bibliographic review of articles published in scientific databases referring to the HTLV-1 virus was carried out. This virus is globally disseminated and occurs endemic in some regions of the world with prevalence between very high and low. In Chile, the average seroprevalence is 0.124% for HTLV-1. There is no treatment for this infection, only the symptoms are treated, so as long as this does not change, it is only feasible to reduce the transmission, incidence, and morbidity of HTLV-1 by incorporating virus control measures into disease control interventions and strategies. of public health. The most efficient form of mother-child transmission of the virus is through breast milk, it is necessary to implement prenatal screening for HTLV-1, especially in endemic areas, as well as counsel HTLV-1 positive mothers on breastfeeding

Burnout syndrome, anxiety, depression and occupational well-being among Peru hospital staff during the COVID-19 pandemic / Síndrome de Burnout, ansiedad, depresión y bienestar laboral en personal hospitalario de Perú durante la pandemia de COVID-19

Introduction: The COVID-19 pandemic has had serious consequences for the mental health of individuals, especially health care providers, who have experienced symptoms of stress, anxiety and depression that affect their personal, family and social lives. This situation has led health entities to evaluate the negative effects and to design interventions. Objective: To establish the relationship between burnout syndrome, anxiety, depression and work well-being, considering sociodemographic and work variables, including differences according to the type of work. Methods: The present study is non-causal, comparative, cross-sectional and prospective. The sampling was intentional non-probabilistic, with a total of 366 participants from three hospitals in Ancash (Peru) under COVID-19 conditions during the second wave. For the measurement of the variables, the Maslach Burnout Inventory, the Goldberg anxiety/depression subscales and the Sánchez-Cánovas work well-being subscales were used. Results: The results indicated multiple relationships among burnout syndrome, anxiety, depression and work well-being (p <0.05). Likewise, these relationships were also presented considering some sociodemographic and labor variables (p <0.05). Conclusions: The variables studied have a significant relationship in the health care personnel examined. Based on these findings, it is possible to have a baseline of the mental health of health personnel to plan interventions that emphasize those variables and groups at risk that require special attention(AU)

Introducción: La pandemia de COVID-19 ha tenido graves consecuencias para la salud mental de las personas, especialmente de los profesionales de la salud, quienes han experimentado síntomas de estrés, ansiedad y depresión que afectan su vida personal, familiar y social. Esta situación ha llevado a las entidades de salud a evaluar los efectos negativos y diseñar intervenciones. Objetivo: Establecer la relación entre el síndrome de Burnout, la ansiedad, la depresión y el bienestar laboral, considerando variables sociodemográficas y laborales, incluyendo diferencias según el tipo de trabajo. Métodos: El presente estudio es no causal, comparativo, transversal y prospectivo. El muestreo fue no probabilístico intencional, con un total de 366 participantes de tres hospitales de Ancash (Perú) en condiciones de COVID-19 durante la segunda ola. Para la medición de las variables se utilizaron el Inventario de Burnout de Maslach, las subescalas de ansiedad/depresión de Goldberg y las subescalas de bienestar laboral de Sánchez-Cánovas. Resultados: Los resultados indicaron múltiples relaciones entre síndrome de burnout, ansiedad, depresión y bienestar laboral (p<0,05). Asimismo, estas relaciones también se presentaron considerando algunas variables sociodemográficas y laborales (p<0,05). Conclusiones: Las variables estudiadas tienen una relación significativa en el personal sanitario examinado. Con base en estos hallazgos, es posible tener una línea de base de la salud mental del personal de salud para planificar intervenciones que enfaticen aquellas variables y grupos en riesgo que requieren atención especial(AU)

Síndrome de kartagener: bases genéticas y hallazgos clínicos. Reporte de un caso / Kartagener syndrome: genetic bases and clinical findings. A case report

Se presenta el caso de una paciente de 26 años, con cuadros respiratorios altos y bajos a repetición, que cedían con tratamiento sintomático o con el uso de antibióticos por vía oral desde la infancia. A los 25 años de edad, comenzó con episodios de expulsión de sangre roja, areada y rutilante por la boca de diferente cuantía, los que se hicieron cada vez más frecuentes. Por tal motivo, fue ingresada en el Servicio de Neumología del Hospital Neumológico Benéfico Jurídico. En esta ocasión, se le realizó una radiografía simple de tórax postero-anterior, en la que se visualizó una dextrocardia acompañada de una acentuación de la trama broncovascular bibasal. Una historia de infertilidad referida por la paciente, los episodios de pansinusitis recurrentes, los cuadros respiratorios bajos y los hallazgos imagenológicos despertaron la sospecha clínica de una discinesia ciliar primaria y, en especial, de un Síndrome de Kartagener. Nuestro propósito, al presentar este caso, es reflexionar en que, a pesar de ser una enfermedad poco frecuente, en nuestro país y a nivel internacional, es un diagnóstico posible cuando se asocian cuadros de hemoptisis e historia de infertilidad.

This article is a case report of a 26 years old woman with history of high and low respiratory problems to repetition, which yielded with symptomatic treatment or the antibiotic use by oral route from the childhood. When she was 25 years old, she began with episodes of expulsion of red blood, brillant and bubble by the mouth of different quantity; these were made frequent more and more. By such reason she was hospitalized in the service of pneumology of the Benefico Juridico Hospital. In this occasion a simple x-ray of thorax was made to her, in which visualized dextrocardia accompanied of an accentuation of the bibasal broncho-vascular pattern. A history of infertility referred by the patient, the episodes of recurrent pansinusitis, respiratory pictures and the radiologic findings made diagnose of a primary ciliary dyskinesia, specifically Kartagener's syndrome. Our intention with this case is to reflect in that it is a possible diagnosis when pictures of hemoptisis and history of infertility are associated, although in our country and in the rest of the world the frequent of this disease is low.

Síndrome de kartagener: bases genéticas y hallazgos clínicos: reporte de un caso / Kartagener syndrome: genetic bases and clinical findings: a case report

Se presenta el caso de una paciente de 26 años, con cuadros respiratorios altos y bajos a repetición, que cedían con tratamiento sintomático o con el uso de antibióticos por vía oral desde la infancia. A los 25 años de edad, comenzó con episodios de expulsión de sangre roja, areada y rutilante por la boca de diferente cuantía, los que se hicieron cada vez más frecuentes. Por tal motivo, fue ingresada en el Servicio de Neumología del Hospital Neumológico Benéfico Jurídico. En esta ocasión, se le realizó una radiografía simple de tórax postero-anterior, en la que se visualizó una dextrocardia acompañada de una acentuación de la trama broncovascular bibasal. Una historia de infertilidad referida por la paciente, los episodios de pansinusitis recurrentes, los cuadros respiratorios bajos y los hallazgos imagenológicos despertaron la sospecha clínica de una discinesia ciliar primaria y, en especial, de un Síndrome de Kartagener. Nuestro propósito, al presentar este caso, es reflexionar en que, a pesar de ser una enfermedad poco frecuente, en nuestro país y a nivel internacional, es un diagnóstico posible cuando se asocian cuadros de hemoptisis e historia de infertilidad(AU)

This article is a case report of a 26 years old woman with history of high and low respiratory problems to repetition, which yielded with symptomatic treatment or the antibiotic use by oral route from the childhood. When she was 25 years old, she began with episodes of expulsion of red blood, brillant and bubble by the mouth of different quantity; these were made frequent more and more. By such reason she was hospitalized in the service of pneumology of the Benefico Juridico Hospital. In this occasion a simple x-ray of thorax was made to her, in which visualized dextrocardia accompanied of an accentuation of the bibasal broncho-vascular pattern. A history of infertility referred by the patient, the episodes of recurrent pansinusitis, respiratory pictures and the radiologic findings made diagnose of a primary ciliary dyskinesia, specifically Kartagener's syndrome. Our intention with this case is to reflect in that it is a possible diagnosis when pictures of hemoptisis and history of infertility are associated, although in our country and in the rest of the world the frequent of this disease is low(AU)

Genetic background controls tumor development in PTEN-deficient mice.

PTEN is one of the most frequently mutated tumor suppressor genes in human cancers. Germ line mutations of PTEN have been detected in three rare autosomal-dominant disorders. However, identical mutations in the PTEN gene may lead to different symptoms that have traditionally been described as different disorders, such as Cowden disease, Lhermitte-Duclos disease, and Bannayan-Zonana syndromes. This lack of genotype-phenotype correlation prompted us to directly test the possible effects of genetic background or modifier genes on PTEN-controlled tumorigenesis using genetically engineered mouse models. In this study, we generated two animal models in which either exon 5 (Pten(Delta5)) or promoter to exon 3 (Pten(-)) of the murine Pten gene were deleted and compared phenotypes associated with individual mutations on two genetic backgrounds. We found that the onset and spectrum of tumor formation depend significantly on the genetic background but less on the type of mutation generated. Our results suggest that PTEN plays a critical role in cancer development, and genetic background may influence the onset, the spectrum, and the progression of tumorigenesis caused by Pten mutation.

Giant cell glioblastoma and pleomorphic xanthoastrocytoma show different immunohistochemical profiles for neuronal antigens and p53 but share reactivity for class III beta-tubulin.

CONTEXT: Giant cell glioblastoma multiforme (GCGBM) and pleomorphic xanthoastrocytoma (PXA) are clinically, radiographically, and histologically distinct tumors of the central nervous system. However, they share features of gross circumscription, reticulin deposition, lymphocytic infiltrates, and prominent populations of tumor giant cells. Neuronal antigens have been detected in the neoplastic cells of PXAs, but to our knowledge have not been studied previously in GCGBMs. While TP53 is mutated in most GCGBMs, a feature usually paralleled by strong immunostaining of the protein, the expression pattern of PXAs has not been extensively studied. OBJECTIVES: To compare the immunoprofiles of GCGBM and PXA with regard to neuronal antigens and p53 and to evaluate the potential diagnostic utility of such a panel. DESIGN: Archival paraffin sections of 9 GCGBMs and 9 PXAs were immunostained for class III beta-tubulin, neuronal nuclear antigen, neurofilament protein, synaptophysin, glial fibrillary acidic protein, and p53. RESULTS: Giant cell glioblastomas were strongly immunoreactive for class III beta-tubulin and glial fibrillary acidic protein, but showed only rare staining for the other neuronal polypeptides. In contrast, PXAs usually showed at least focal staining of individual tumor cells for most of the neuronal antigens tested. Tubulin was strongly positive in tumor giant cells and in smaller neoplastic cells of both tumor types. Double-immunolabeling revealed distinct populations of tumor cells that expressed either glial fibrillary acidic protein or tubulin and dual-labeling of individual cells in GCGBM and PXA. Strong p53 staining was observed in many tumor cells in 5 of 8 GCGBMs tested, while staining for this antigen was negative or focally positive in 6 of 8 PXAs examined. CONCLUSIONS: Giant cell glioblastoma multiforme and PXA show distinct patterns of immunoreactivity for neuronal antigens and p53 that may be useful diagnostically in difficult cases or in limited samples. These results provide further evidence of neuronal antigen expression by PXA.

PTEN tumor suppressor regulates p53 protein levels and activity through phosphatase-dependent and -independent mechanisms.

We show in this study that PTEN regulates p53 protein levels and transcriptional activity through both phosphatase-dependent and -independent mechanisms. The onset of tumor development in p53(+/-);Pten(+/-) mice is similar to p53(-/-) animals, and p53 protein levels are dramatically reduced in Pten(-/-) cells and tissues. Reintroducing wild-type or phosphatase-dead PTEN mutants leads to a significant increase in p53 stability. PTEN also physically associates with endogenous p53. Finally, PTEN regulates the transcriptional activity of p53 by modulating its DNA binding activity. This study provides a novel mechanism by which the loss of PTEN can functionally control "two" hits in the course of tumor development by concurrently modulating p53 activity.

Conditional loss of PTEN leads to precocious development and neoplasia in the mammary gland.

PTEN tumor suppressor is frequently mutated in human cancers, including breast cancers. Female patients with inherited PTEN mutations suffer from virginal hypertrophy of the breast with high risk of malignant transformation. However, the exact mechanisms of PTEN in controlling mammary gland development and tumorigenesis are unclear. In this study, we generated mice with a mammary-specific deletion of the Pten gene. Mutant mammary tissue displayed precocious lobulo-alveolar development, excessive ductal branching, delayed involution and severely reduced apoptosis. Pten null mammary epithelial cells were disregulated and hyperproliferative. Mutant females developed mammary tumors early in life. Similar phenotypes were observed in Pten-null mammary epithelia that had been transplanted into wild-type stroma, suggesting that PTEN plays an essential and cell-autonomous role in controlling the proliferation, differentiation and apoptosis of mammary epithelial cells.

Ketotifeno como droga profiláctica en el tratamiento del asma en niños / Ketotifen as a profilactic drug in the treatment of asthma in children

Con el objeto de demostrar la acción preventiva del ketotifeno en relación al asma, se realizó un ensayo controlado y doble-ciego en el cual se incluyeron 51 niños con el diagnóstico de asma extrínseca tipo l de intensidad leve y moderada. Un grupo de niños recibió ketotifeno + teofilinato de colina y otro grupo recibio placebo + teofilinato de colina (5 mgs./kg. peso/cada 6 horas). En el grupo que recibió ketotifeno se observó una mejoria progresiva de los síntomas a partir de la 3ra. semana de tratamiento, siendo esta mejoría estadísticamente significativa (P<0,001) en comparación con el grupo control. Además, se observó una reducción importante de los efectos secundarios de la teofilina

Comparación del cromoglicato sódico con el Ketotifeno en asma desencadenada por el ejercicio / Comparison of sodium cromoglycate and Ketotifen on exercise induced asthma

Se compara en estudio doble ciego el efecto protector del Cromoglicato Disódico con el Ketotifeno para prevenir el broncoespasmo inducido por el ejercicio en 23 pacientes asmáticos con edades comprendidas entre 7 y 26 años. No se observaron diferencias significativas ente las dos drogas utilizadas, logrando una protección global del 40%. La eficacia fue mayor en el sexo masculino y en los grupos de menor edad