Brief Telephonic Motivational Interviewing for People Living with HIV with Follow-up Problems.

Motivational interviewing (MI)-based interventions can be effective for people living with HIV (PLWHIV) with medical follow-up problems. This study aimed to assess the stage of motivation to attend medical appointments of PLWHIV with medical follow-up problems and to evaluate a single telephone session MI intervention directed to engage them in care. The change in stage was evaluated before and after the intervention, and attending medical appointments was monitored for six months. Thirty-nine PLWHIV participated; 51.3% were in precontemplation/contemplation and 49.7% in preparation/action stage. Most (excluding those in the action stage from the beginning) (n = 22, 71.0%) advanced to another stage after the intervention (z = - 4.235, p < .001), and most did not miss the following appointments. Brief and remote MI interventions could be useful in low-resource settings, especially for those in the early stages of change, to explore motivations related with missing medical appointments.

Human cytomegalovirus multiple-strain infections and viral population diversity in haematopoietic stem cell transplant recipients analysed by high-throughput sequencing.

Human cytomegalovirus (HCMV) is an important opportunistic pathogen in allogeneic haematopoietic stem cell transplant (HSCT) recipients. High-throughput sequencing of target-enriched libraries was performed to characterise the diversity of HCMV strains present in this high-risk group. Forty-four HCMV-DNA-positive plasma specimens (median viral input load 321 IU per library) collected at defined time points from 23 HSCT recipients within 80 days of transplantation were sequenced. The genotype distribution for 12 hypervariable HCMV genes and the number of HCMV strains present (i.e. single- vs. multiple-strain infection) were determined for 29 samples from 16 recipients. Multiple-strain infection was observed in seven of these 16 recipients, and five of these seven recipients had the donor (D)/recipient (R) HCMV-serostatus combination D + R + . A very broad range of genotypes was detected, with an intrahost composition that was generally stable over time. Multiple-strain infection was not associated with particular virological or clinical features, such as altered levels or duration of antigenaemia, development of acute graft-versus-host disease or increased mortality. In conclusion, despite relatively low viral plasma loads, a high frequency of multiple-strain HCMV infection and a high strain complexity were demonstrated in systematically collected clinical samples from this cohort early after HSCT. However, robust evaluation of the pathogenic role of intrahost viral diversity and multiple-strain infection will require studies enrolling larger numbers of recipients.

Neurologic Features Associated With SARS-CoV-2 Infection in Children: A Case Series Report.

INTRODUCTION: Although multiple neurologic manifestations associated with SARS-CoV-2 infection have been described in adults, there is little information about those presented in children. Here, we described neurologic manifestations associated with COVID-19 in the pediatric population. METHODS: Retrospective case series report. We included patients younger than 18 years, admitted with confirmed SARS-CoV-2 infection and neurologic manifestations at our hospital in Santiago, Chile. Demographics, clinical presentations, laboratory results, radiologic and neurophysiological studies, treatment, and outcome features were described. Cases were described based on whether they presented with predominantly central or peripheral neurologic involvement. RESULTS: Thirteen of 90 (14.4%) patients admitted with confirmed infection presented with new-onset neurologic symptoms and 4 patients showed epilepsy exacerbation. Neurologic manifestations ranged from mild (headache, muscle weakness, anosmia, ageusia), to severe (status epilepticus, Guillain-Barré syndrome, encephalopathy, demyelinating events). CONCLUSIONS: We found a wide range of neurologic manifestations in children with confirmed SARS-CoV-2 infection. In general, neurologic symptoms were resolved as the systemic presentation subsided. It is essential to recognize and report the main neurologic manifestations related to this new infectious disease in the pediatric population. More evidence is needed to establish the specific causality of nervous system involvement.

Síncope en la edad pediátrica / Syncope in the pediatric age

Introducción. El síncope es la pérdida brusca y transitoria del nivel de conciencia y del tono postural a consecuencia de una hipoperfusión cerebral transitoria. Desarrollo. Se trata de un síntoma muy frecuente en la edad pediátrica, sobre todo en la adolescencia y que, en ocasiones, genera gran angustia entre las familias e inseguridad entre los profesionales, abusándose de exploraciones y tratamientos innecesarios. En esta revisión daremos las claves para hacer un correcto diagnóstico diferencial, analizaremos los datos de alarma que nos deben hacer sospechar que no nos encontramos ante un cuadro benigno, veremos qué recomendaciones debemos dar a las familias y a los pacientes y cuándo remitir al especialista. Nuestros objetivos con esta revisión: saber enfocar correctamente el síncope en la edad pediátrica; tranquilizar cuando se trate de un proceso benigno e identificar los casos de potencial gravedad. Conclusiones. En la edad pediátrica los síncopes son en su mayoría benignos. El síncope reflejo, concretamente el vasovagal, es el más frecuente. La historia clínica es la clave para el diagnóstico. Debemos estar especialmente atentos a los datos de alarma en la historia y en el electrocardiograma que nos puedan indicar la presencia de una cardiopatía subyacente. Los niños con una historia compatible con síncope vasovagal, sin antecedentes familiares de riesgo y con electrocardiograma normal no precisan valoración cardiológica adicional. Entre los aspectos más importantes del tratamiento del síncope reflejo están formar y tranquilizar al niño y a la familia (AU)

Introduction. Syncope is the sudden and transient loss of the level of consciousness and postural tone due to a transient cerebral hypoperfusion. Development. This is a very frequent symptom in the pediatric age, above all in adolescent age and which, at times, generates great anxiety among the family and insecurity among the professionals, unnecessary examinations and treatments being abuse of. In this review, we present the keys to making a correct differential diagnosis. We analyze the alert data that should lead us to suspect that we are not facing a benign picture. We will see what recommendations we should give the family and patients and when to send them to the specialist. Our objectives with this review are: to know how to correctly approach the syncope in the pediatric age; to reassure when it is a benign process and to identify the cases having potential severity. Conclusions. Syncopes are mostly benign in the pediatric age. The reflex syncope, specifically the vasovagal one, is the most frequent. The clinical history is key for the diagnosis. We should be especially alert to the alarm data in the history and in the electrocardiogram that can indicate the presence of an underlying heart disease. Children with a history consistent with vasovagal syncope, with no family background of risk and with a normal electrocardiogram do not require additional cardiological evaluation. Among the most important aspects of treatment of the reflex syncope are those of informing and assuring the child and the family (AU)

Metagenomics-based approach for studying and selecting bioprotective strains from the bacterial community of artisanal cheeses.

A metagenome-based approach was used to assess the taxonomic affiliation and functional potential for bacteriocin production of the bacterial community in cow's milk artisanal cheeses from Northwestern Argentina. Three different samples were analyzed by high-throughput sequencing of the V4 region of the 16S rRNA gene and shotgun metagenomics. Taxonomic analysis showed that cheese A and C were quite similar whereas cheese B displayed a rather different bacterial composition. Overall, two families, Streptococceae and Enterococceae, dominated the artisanal cheese microbiota, being the former family prevalent in cheese B and the later family the most important in samples A and C. Besides the usual species associated to cheeses, a number of bacterial taxa that have not been previously found in Argentinean artisanal cheeses were reported in the present work such as Macrococcus caseolyticus and Streptococcus macedonicus Functional metagenomics analysis using the bacteriocin mining software BAGEL3, identified 2 ORFs encoding antimicrobial peptides in cheese B and 42 different peptides in sample C. The bacteriocin genes found showed good correlation with taxonomy. Based on the microbial diversity and functional features found through shotgun metagenomic sequencing, a culture-dependent approach was applied aiming to isolate bacteriocin-producing bacteria able to inhibit the growth of the foodborne pathogen Listeria monocytogenes. From 151 bacterial colonies derived from the cheese samples, 10 were associated to high anti-Listeria activity. Based on partial 16S rRNA gene sequencing and RAPD-PCR analysis, all bacteriocinogenic isolates were identified as Enterococcus faecium. Finally, we carried out a pilot experiment with L. monocytogenes-contaminated cheese using one of the enterococcal isolates as a bioprotective adjunct culture. The use of E. faecium CRL1879 during artisanal cheese manufacturing did not alter the main organoleptic properties of the cheese and ensured an efficient control of the foodborne pathogen up to 30 days. This finding supports the use of E. faecium CRL1879 as an adjunct culture in the cheese-making process with a combination of both safety and minimal processing.

Quality and effectiveness of osteoporosis treatment decision aids: a systematic review and environmental scan.

Decision aids (DAs) are evidence-based tools that support shared decision-making (SDM) implementation in practice; this study aimed to identify existing osteoporosis DAs and assess their quality and efficacy; and to gain feedback from a patient advisory group on findings and implications for further research. We searched multiple bibliographic databases to identify research studies from 2000 to 2019 and undertook an environmental scan (search conducted February 2019, repeated in March 2020). A pair of reviewers, working independently selected studies for inclusion, extracted data, evaluated each trial's risk of bias, and conducted DA quality assessment using the International Patient Decision Aid Standards (IPDAS). Public contributors (patients and caregivers with experience of osteoporosis and fragility fractures) participated in discussion groups to review a sample of DAs, express preferences for a new DA, and discuss plans for development of a new DA. We identified 6 studies, with high or unclear risk of bias. Across included studies, use of an osteoporosis DA was reported to result in reduced decisional conflict compared with baseline, increased SDM, and increased accuracy of patients' perceived fracture risk compared with controls. Eleven DAs were identified, of which none met the full set of IPDAS criteria for certification for minimization of bias. Public contributors expressed preferences for encounter DAs that are individualized to patients' own needs and risk. Using a systematic review and environmental scan, we identified 11 decision aids to inform patient decisions about osteoporosis treatment and 6 studies evaluating their effectiveness. Use of decision aids increased accuracy of risk perception and shared decision-making but the decision aids themselves fail to comprehensively meet international quality standards and patient needs, underpinning the need for new DA development.

Concordance in the reporting of intimate partner violence among male-male couples.

Intimate partner violence (IPV) among male couples is increasingly recognized as a public health concern. Research on IPV in opposite sex couples indicates frequent underreporting of IPV and high levels of discordance in reporting among dyads. Concordance studies inform refinement methods to measure the experience of IPV among dyads; however the lack of dyadic studies of male couples impedes our understanding of the extent to which IPV is differentially reported in male-male dyads. This study utilized baseline data from a randomized controlled trial of a behavioral intervention to optimize antiretroviral therapy (ART) adherence among 160 sero-discordant male couples in three US cities and provides the first analysis of concordance in reporting IPV among male couples. Low degrees of concordance in the reporting of IPV were identified among male dyads, with a greater proportion of men reporting violence perpetration than experiencing violence. The greater reporting of IPV perpetration may be linked to adherence to concepts of masculinity. The results underscore the unique experiences of IPV among male couples and the need to reexamine current IPV measurement and intervention strategies.

Indicadores de evaluación de impacto de promoción de salud para adultos mayores en atención primaria / Indicators for the impact evaluation in promotional interventions of the elders' primary health care

Introducción: la evaluación de impacto se asocia con potenciales de efectos positivos o negativos en una investigación. El uso de indicadores permite la obtención de evidencias cualitativas y cuantitativas sobre determinantes de salud para evitar posibles resultados adversos, sobre todo si las intervenciones están dirigidas a modificar factores de riesgos en adultos mayores, a partir de la aplicación de programas o proyectos. Objetivo: determinar los indicadores para evaluación de impacto en intervenciones de promoción de salud con adultos mayores en la atención primaria. Métodos: se realizó un estudio de enfoque bimodal. Se utilizó el método de análisis documental y técnica de triangulación de la información. Fueron revisados los fundamentos de promoción de salud de referencia nacional e internacional y se sistematizaron ideas expresadas en documentos legales y políticas públicas cubanas. Se tuvo en cuenta el criterio de 15 expertos a partir de una selección entre 20 candidatos. El método Delphi conllevó a secuencia de acciones en tres rondas, entre abril y noviembre de 2017, en San José de las Lajas, Mayabeque. Resultados: se seleccionaron 15 expertos con alto coeficiente de competencia. Los profesionales llegaron al consenso de 15 indicadores científicos, 19 sociales y 10 económicos. Se estableció el porciento que debían alcanzar los indicadores para evaluar el impacto como positivo. Conclusiones: los indicadores establecidos contribuyen al desarrollo de instrumentos para evaluación de impacto en intervenciones de promoción de salud con adultos mayores en la atención primaria, asegurando solidez metodológica y calidad de resultados en este tipo de investigaciones gerontológicas(AU)

Introduction: the evaluation of impact is associated to different potentials with positive or negative properties in one investigation. By means of the use of indicators, the investigators can obtain the qualitative and quantitative evidences to avoid possible adverse reactions, after all if the interventions are guided to modify risk factors in elderly adults since the application of programs and projects. Objective: to determine the indicators for the impact evaluation in promotional interventions of the elders' primary health care. Methods: a study of bimodal approach was performed. Documental analysis and triangulation technique of information were used. The promotional basics of health about national and international reference came under review and ideas came under a system expressed in legal documents and Cubans' political publics. Opinions by 15 experts, starting from a selection among 20 candidates were taken into account. The Delphi method was applied in three sequences from April to November, 2017, in San José de las Lajas, Mayabeque. Results: they selected 15 experts with high competitive coefficient. The professionals agreed with 15 scientific indicators, 19 social and 10 economic ones.The percentage that the indicators should have reached to evaluate the impact as positivewas established. Conclusions: the establishments of indicators for the impact evaluation in promotional interventions of the elders' primary health care contribute with the development of instruments assuring methodological solidity and quality of results in this gerontological investigation(AU)

The Endoscopic Reference Score shows modest accuracy to predict either clinical or histological activity in adult patients with eosinophilic oesophagitis.

BACKGROUND: Conflicting results have been recently reported for the accuracy of the Endoscopic Reference Score (EREFS), an standardised endoscopic classification, to predict the histological activity of eosinophilic oesophagitis (EoE). AIM: To evaluate the accuracy of the EREFS to predict either histological or clinical activity of EoE. METHODS: Prospective multicentre study conducted in eight Spanish centres evaluating adult EoE patients, either naïve or after treatment. Symptoms were evaluated before upper endoscopy through the Dysphagia Symptom Score, whereas researchers scored the EREFS immediately after the endoscopic procedure, unaware of the histological outcome. RESULTS: One hundred and forty-five EoE patients undergoing 240 consecutive endoscopic procedures were included. Exudates (P = 0.03), furrows (P = 0.03) and a composite score of inflammatory signs (exudates, furrows and oedema) (P < 0.001) accurately predicted histological activity. Exudates were the only endoscopic sign showing a good correlation with histological outcome after therapy. Furrows and oedema persisted in 50% and 70% of patients despite histological remission. No endoscopic feature exceeded 70% accuracy to predict histological activity. Likewise, no endoscopic finding could adequately predict dysphagia severity. Crepe paper mucosa, diffuse exudates and severe rings correlated with higher symptom scores. CONCLUSIONS: Endoscopic findings assessed by the Endoscopic Reference Score did not correlate with histological or clinical disease activity in adult EoE patients. Only exudates correlated with peak eosinophil count and histological outcome, whereas furrows and oedema persisted in over half of patients despite histological remission.

Varón de 70 años con parada respiratoria secundaria a angioedema / A 70-year-old male with respiratory arrest secondary to angioedema

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Orientaciones de meta, satisfacción, creencias de éxito y clima motivacional en nadadores / Goal orientations, satisfaction, beliefs in sport success and motivational climate in swimmers

En el presente estudio se plantearon varios objetivos; comprobar las relaciones existentes entre las orientaciones de meta, la satisfacción, las creencias sobre las causas del éxito en el deporte y el clima motivacional percibido en nadadores; examinar el efecto que tiene la orientación de meta en las diferentes dimensiones analizadas; y, por último, predecir la orientación de meta. La muestra estuvo compuesta por 163 nadadores. Los instrumentos utilizados fueron las versiones validadas al castellano del TEOSQ, SSI, BACSSQ y PMCSQ-2. Se realizaron tres tipos de análisis estadísticos: análisis de correlaciones bivariadas, análisis multivariante (MANOVA 2x2) y análisis de regresión lineal múltiple multivariado por pasos. Los resultados mostraron que la capacidad y el aburrimiento son variables predictoras de la orientación de meta hacia el ego, mientras que el esfuerzo y la diversión lo son de las orientaciones de meta hacia la tarea (AU)

The present study had several objectives; to check the relationships between goal orientations, satisfaction, beliefs about the causes of success in sport and motivational climate perceived in swimmers; to examine the effect of goal orientation in different dimensions analyzed, and finally to predict goal orientation. The sample consisted of 163 swimmers. The instruments used were validated to Castilian versions of TEOSQ, SSI, BACSSQ and PMCSQ-2. There were three types of statistical analyzes: bivariate correlation analysis, multivariate analysis (MANOVA 2x2) and multiple linear regression analysis stepwise multivariate. The results showed that capacity and boredom are predictors of goal orientation towards the ego, while effort and fun are the goal orientations to the task (AU)

Complex Population Patterns of Eunica tatila Herrich-Schäffer (Lepidoptera: Nymphalidae), with Special Emphasis on Sexual Dimorphism.

The species Eunica tatila (Herrich-Schäffer) is present in the Neotropical region and comprises three subspecies. In Mexico, only one subspecies is reported: E. t. tatila (Herrich-Schäffer). The Yucatan Peninsula, in southeastern Mexico, is located in a transitional geographical position, between southern Florida, the West Indies and Central America. It is part of a transitional region, important for the dispersion of insects from southern Florida via Cuba and the Yucatan Peninsula. Considering the possibility of the overlapping and delimitation of described subspecies, we sampled different populations in the Yucatan Peninsula to possibly assign a subspecies name and evaluate the magnitude of sexual dimorphism. We collected 591 individuals (♀284, ♂307) in conserved areas. The study of male genitalia led to the identification of Eunica tatila tatilista (Kaye) as a subspecies; however, hypandrium structure and wing pattern analysis suggest a mix of E. t. tatila and E. t. tatilista characteristics. The analysis of sexual dimorphism provided evidence of more complex wing morphs for females, with 12 patterns instead of four as previously described. Our results demonstrate the complexity of characterizing E. tatila and suggest that the Yucatan Peninsula is a transitional zone for subspecies of some butterflies.

Inicio, diagnóstico y seguimiento de un caso con deficiencia de acil-CoA deshidrogenasa de cadena muy larga / Debut, diagnosis and outcome of a case with very long chain acyl-CoA dehydrogenase deficiency

Los ácidos grasos representan el 80% de las necesidades energéticas en periodos de estrés metabólico. La betaoxidación de los ácidos grasos es catalizada por varias enzimas, como la acil-CoA deshidrogenasa-coenzima FAD, que posee 4 formas específicas según la longitud de la cadena de acil-CoA. La acil-CoA-deshidrogenasa de cadena muy larga es una de ellas. Su déficit cursa con la acumulación intramitocondrial de ésteres de acil-CoA de cadena larga, y afecta al corazón, el músculo esquelético y el hígado. Presentamos un caso iniciado a los 22 meses de edad con un síndrome Reye-like. Confirmamos un déficit de la betaoxidación de los ácidos grasos de cadena muy larga, con las mutaciones p.A232T (c.694G>A) y p.Y201C (c.602A>G) en los alelos del gen VLCAD. Describimos su evolución durante 17 años recibiendo una dieta pobre en ácidos grasos de cadena larga y suplementos con aceite MCT (AU)

Fatty acids represent 80% of energy needs during periods of stress. Beta-oxidation of fatty acids is catalyzed by some enzymes including acyl-CoA-dehydrogenase-coenzyme FAD, wich has four different ways according to the chain length of acyl-CoA. The very-long-chain-acyl-CoA-dehydrogenase is one of them. A deficiency of this enzyme produces an accumulation of long-chain-acyl-CoA-esters in mitochondrias, affecting heart, skeletal muscle and liver. We report the case of a 22-month aged child whose first symptom was a Reye-like syndrome. We confirmed that he was affected by a deficiency in the beta-oxidation of fatty acids of very long chain. He showed some mutations in the VLCAD gene alleles: p.A232T (c.694G>A) and p.Y201C (c.602A>G). We explain the evolution in the next 17 years, following a diet with very little long chain fatty acids and MCT oil supplements (AU)

Ecological divergence combined with ancient allopatry in lizard populations from a small volcanic island.

Population divergence and speciation are often explained by geographical isolation, but may also be possible under high gene flow due to strong ecology-related differences in selection pressures. This study combines coalescent analyses of genetic data (11 microsatellite loci and 1 Kbp of mtDNA) and ecological modelling to examine the relative contributions of isolation and ecology to incipient speciation in the scincid lizard Chalcides sexlineatus within the volcanic island of Gran Canaria. Bayesian multispecies coalescent dating of within-island genetic divergence of northern and southern populations showed correspondence with the timing of volcanic activity in the north of the island 1.5-3.0 Ma ago. Coalescent estimates of demographic changes reveal historical size increases in northern populations, consistent with expansions from a volcanic refuge. Nevertheless, ecological divergence is also supported. First, the two morphs showed non-equivalence of ecological niches and species distribution modelling associated the northern morph with mesic habitat types and the southern morph with xeric habitat types. It seems likely that the colour morphs are associated with different antipredator strategies in the different habitats. Second, coalescent estimation of gene copy migration (based on microsatellites and mtDNA) suggest high rates from northern to southern morphs demonstrating the strength of ecology-mediated selection pressures that maintain the divergent southern morph. Together, these findings underline the complexity of the speciation process by providing evidence for the combined effects of ecological divergence and ancient divergence in allopatry.

Smoking does influence disease behaviour and impacts the need for therapy in Crohn's disease in the biologic era.

BACKGROUND: Recently, the notion that smoking may adversely affect Crohn's disease (CD) outcomes has been challenged by the suggestion that the widespread use of immunosuppressants and anti-TNF drugs might offset the adverse effects of tobacco. AIM: To reassess the influence of tobacco smoking on disease phenotype and complications on a time-dependent analysis, taking into account the different therapeutic interventions. METHODS: We designed a retrospective cohort study of 3224 patients with Crohn's disease. The data were collected from the Spanish national inflammatory bowel disease registry (ENEIDA), including information regarding demographics, clinical characteristics, disease complications, therapeutic interventions and smoking status. Patients were classified as nonsmokers, smokers and former smokers, according to their present and past smoking habits. RESULTS: In the univariate analysis, smokers had more strictures (22.6% vs. 19.3%, P < 0.05) and less colonic involvement (7.2% vs. 10.9%, P < 0.05), and were more frequently under treatment with steroids (91.6% vs. 85.8%, P < 0.05), immunosuppressants (73.5% vs. 63.6% P < 0.05) or anti-TNF drugs (31.4% vs. 25.1%, P < 0.05) than nonsmokers. In the time-dependent multivariate analysis, smokers were found to have a significantly decreased survival free of stricturing disease (HR: 1.5, CI 95% 1.18-1.90) or perianal complications (HR: 1.50, CI 95% 1.01-1.46), and had a higher risk for requiring thiopurine therapy (HR: 1.20, CI 95% 1.05-1.30). CONCLUSION: These results suggest that, despite the widespread use of immunosuppressants and anti-TNF drugs, smokers with Crohn's disease still have a more severe disease course, with increased therapeutic requirements when compared with nonsmokers.

Genetic characterization, at the mitochondrial and nuclear DNA levels, of five Canary Island dog breeds.

Many studies presenting genetic analysis of dog breeds have been conducted without the inclusion of island dog breeds, although isolation can be one of the main factors in their origin. Here we report the genetic analysis at the nuclear and mitochondrial DNA levels of five Canary Island dog breeds (Canarian Warren Hound, Canary Island Mastiff, Garafiano Shepherd, La Palma Rat-Hunter and El Hierro Wolfhound) to fill this gap and, at the same time, genetically characterize these breeds. We identified 168 alleles in autosomal microsatellites and 16 mitochondrial haplotypes. Observed and expected heterozygosities ranged from 0.556 to 0.783 and from 0.737 to 0.943 respectively. Furthermore, three haplotypes were newly described and exclusive to a particular breed (A17+ in the Canary Island Mastiff; A33+ in the Canarian Warren Hound; Bi in the La Palma Rat-Hunter). The outcome of our analyses also revealed different breed histories consistent with historical documents and hypothetical origin designations. Although mtDNA haplotypes showed poor breed discriminating power, autosomal markers allowed a clear clustering of each single population. We expect that our results, together with further analyses, will help to make the population histories of island dog breeds clearer.

A novel system for endoscopic closure of iatrogenic colon perforations using the Ovesco® clip and omental patch.

The growing endoscopic activity, both diagnostic and therapeutic, are also globally makes frequent endoscopic complications, perforation being one of the most serious. However, we also have more possibilities for endoscopic resolution of iatrogenic caused. We report the case of a sigmoid perforation during a colonoscopy that was resolved satisfactorily, avoiding surgery, by endoscopic closure with a nitinol clip Ovesco®.