Development and Pilot-Testing of an Optimized Conversational Agent or "Chatbot" for Peruvian Adolescents Living With HIV to Facilitate Mental Health Screening, Education, Self-Help, and Linkage to Care: Protocol for a Mixed Methods, Community-Engaged Study.

BACKGROUND: Adolescents living with HIV are disproportionally affected by depression, which worsens antiretroviral therapy adherence, increases viral load, and doubles the risk of mortality. Because most adolescents living with HIV live in low- and middle-income countries, few receive depression treatment due to a lack of mental health services and specialists in low-resource settings. Chatbot technology, used increasingly in health service delivery, is a promising approach for delivering low-intensity depression care to adolescents living with HIV in resource-constrained settings. OBJECTIVE: The goal of this study is to develop and pilot-test for the feasibility and acceptability of a prototype, optimized conversational agent (chatbot) to provide mental health education, self-help skills, and care linkage for adolescents living with HIV. METHODS: Chatbot development comprises 3 phases conducted over 2 years. In the first phase (year 1), formative research will be conducted to understand the views, opinions, and preferences of up to 48 youths aged 10-19 years (6 focus groups of up to 8 adolescents living with HIV per group), their caregivers (5 in-depth interviews), and HIV program personnel (5 in-depth interviews) regarding depression among adolescents living with HIV. We will also investigate the perceived acceptability of a mental health chatbot, including barriers and facilitators to accessing and using a chatbot for depression care by adolescents living with HIV. In the second phase (year 1), we will iteratively program a chatbot using the SmartBot360 software with successive versions (0.1, 0.2, and 0.3), meeting regularly with a Youth Advisory Board comprised of adolescents living with HIV who will guide and inform the chatbot development and content to arrive at a prototype version (version 1.0) for pilot-testing. In the third phase (year 2), we will pilot-test the prototype chatbot among 50 adolescents living with HIV naïve to its development. Participants will interact with the chatbot for up to 2 weeks, and data will be collected on the acceptability of the chatbot-delivered depression education and self-help strategies, depression knowledge changes, and intention to seek care linkage. RESULTS: The study was awarded in April 2022, received institutional review board approval in November 2022, received funding in December 2022, and commenced recruitment in March 2023. By the completion of study phases 1 and 2, we expect our chatbot to incorporate key needs and preferences gathered from focus groups and interviews to develop the chatbot. By the completion of study phase 3, we will have assessed the feasibility and acceptability of the prototype chatbot. Study phase 3 began in April 2024. Final results are expected by January 2025 and published thereafter. CONCLUSIONS: The study will produce a prototype mental health chatbot developed with and for adolescents living with HIV that will be ready for efficacy testing in a subsequent, larger study. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55559.

Acidosis láctica en un paciente usuario de metformina / Metformin-associated lactic acidosis

Metformin is a hypoglycemic agent used as the first line for the treatment of non-insulin dependent Diabetes Mellitus. While it is a generally safe drug, it has an infrequent adverse reaction called lactic acidosis. We report a 49 year-old patient with non-insulin-requiring type 2diabetes who developed an acute kidney failure injury along with severe metabolic acidosis secondary to pneumonia during treatment.

La metformina es un agente hipoglucemiante que se ocupa de primera línea para el tratamiento de la Diabetes Mellitus no insulino dependiente. Si bien es un medicamento bien tolerado, tiene una reacción adversa bastante infrecuente que es la acidosis láctica. Reportamos el caso de una paciente de 49 años insulino no dependiente que desarrolló una injuria renal aguda junto con acidosis metabólica severa secundaria a una neumonía en tratamiento.

Immunohistochemical subtype and its relationship with 5-year overall survival in breast cancer patients.

Background: Breast cancer (BC) is the malignant tumour that has been most frequently diagnosed, being the second most common cancer worldwide and the most frequent in women. Objective: To analyse the probability of 5-year overall survival according to age, stage of disease, immunohistochemical subtype, histological grade and histological type in patients with BC. Methodology: Operational research that used a cohort design of patients diagnosed with BC at the SOLCA Núcleo de Loja-Ecuador Hospital from 2009 to 2015 and with follow-up until December 2019. Survival was estimated with the actuarial method and Kaplan-Meier method, and, for multivariate analysis, the proportional hazards model or Cox regression was used to estimate the adjusted Hazard Ratios (HRs). Results: Two hundred and sixty-eight patients were studied. Mean overall survival was 4.35 years (95% confidence interval (95% CI): 40.20-4.51) and 66% survived to 5 years. The main predictors of survival were advanced stage of disease (III-IV) (HR = 7.03; 95% CI: 3.81-12.9); patients human epidermal growth factor receptor 2-neu (HER2-neu) overexpressed (HR = 2.26; 95% CI = 1.31-4.75) and triple negative (HR = 2.57; 95% CI = 1.39-4.75). The other variables were not significant. Conclusions: The results show a higher mortality associated with higher clinical stage, more aggressive histological grades and immunohistochemical subtype HER2-neu overexpressed and triple negative tumours.

Malnutrition Rates in Chile from the Nitrate Era to the 1990s.

Following Salvatore and the WHO, in this article, we provide the first long-term estimates of malnutrition rates for Chile per birth cohort, measured through stunting rates of adult males born from the 1870s to the 1990s. We used a large sample of military records, representative of the whole Chilean population, totalling over 38 thousand individuals. Our data suggest that stunting rates were very high for those born between the last three decades of the nineteenth century and the first two decades of the twentieth century. In addition, stunting rates increased from the 1870s to the 1900s. Thereafter, there was a clear downward trend in stunting rates (despite some fluctuations), reaching low levels of malnutrition, in particular, from the 1960s (although these are high if compared to developed countries). The continuous decrease in stunting rates from the 1910s was mainly due to a combination of factors, the importance of which varied over time, namely: Improved health (i.e., sharp decline in infant mortality rates during the whole period); increased energy consumption (from the 1930s onwards, but most importantly during the 1990s); a decline in poverty rates (in particular, between the 1930s and the 1970s); and a reduction in child labour (although we are less able to quantify this).

Factores de riesgo para enfermedad cerebrovascular en el adulto mayor / Risk Factors for Cerebrovascular Disease in the Older Adult

Introducción: La vejez está subvalorada, poco se piensa en el bienestar físico y psicosocial del anciano. La enfermedad cerebrovascular tiene como factores de riesgo comorbilidades como la hipertensión arterial, la diabetes mellitus, la dislipidemia, cardiopatías o malos estilos de vida como el consumo de cigarrillo, la obesidad y la poca actividad física, todos estos comunes en esta etapa de la vida. Objetivo: Identificar los factores de riesgo que presentan los adultos mayores para sufrir enfermedad cerebrovascular de un centro gerontológico de la ciudad de Medellín. Métodos: Fue una investigación descriptiva, de tipo transversal; se indagaron 37 adultos mayores con historias clínicas y exámenes de laboratorio. Se midieron los niveles de hemoglobina glicosilada, colesterol total, colesterol de baja densidad, colesterol de alta densidad y triglicéridos. Resultados: Se evidenció que la población era en su mayoría de sexo masculino con 51,4 por ciento y el sexo femenino con 48,6 por ciento; con rango de edad entre 60 y 70 años el 51,4 por ciento. Los factores de riesgo más relevantes fueron el índice de masa corporal mayor o igual a 25 con (75,7 por ciento), hipertensión arterial y no realizar actividad física. Conclusiones: Se logró determinar los principales factores de riesgo que tienen estos adultos mayores para sufrir enfermedad cerebrovascular; con resultados algunos similares y otros diferentes a estudios a nivel mundial. Con actividades de promoción y prevención se pueden intervenir estilos de vida de la población(AU)

Introduction: Old age is undervalued; little is thought about the physical and psychosocial well-being of the elderly. Among the risk factors of cerebrovascular disease, there are comorbidities, such as high blood pressure, diabetes mellitus, dyslipidemia and cardiopathies, or poor lifestyles like cigarette smoking, obesity and little physical activity, all of which are common at this stage of life. Objective: To identify, in a gerontological center in Medellín City, the risk factors that older adults present for being affected by cerebrovascular disease. Methods: This was a descriptive and cross-sectional research carried out with 37 older adults with medical antecedents and laboratory tests. The levels of glycated hemoglobin, total cholesterol, low-density and high-density cholesterol, as well as triglycerides were measured. Results: It was evidenced that the population was mostly male (51.4 por ciento), while females accounted for 48.6 por ciento. Their age range was mostly between 60 and 70 years (51.4 por ciento). The most relevant risk factors were body mass index greater than or equal to 25 (75.7 por ciento), arterial hypertension and not doing any physical activity. Conclusions: It was possible to determine the main risk factors for these older adults being affected by cerebrovascular disease; in this respect, some results were similar to and others were different from studies worldwide. With promotion and prevention activities, lifestyles of the population can be intervened(AU)

Veno-Occlusive Priapism in COVID-19 Disease.

Infection by COVID-19, being a respiratory disease caused by SARS-CoV-2, can predispose to arterial and venous thrombotic disease, in response to excessive inflammation, platelet activation, endothelial dysfunction, and venous stasis. During the COVID-19 pandemic period, the technological and resource availability for the care of these patients with thrombotic disease is critical, marking a factor of morbidity and poor prognosis in these cases. We describe a case of priapism in a patient with COVID-19, during the course of systemic inflammatory response syndrome and respiratory distress syndrome with a procoagulant state, seeking to relate the pathophysiological factors of ischemic priapism in patients with infection with SARS-Cov-2.

Segregation and Life Satisfaction.

Our aim is to cast light on socioeconomic residential segregation effects on life satisfaction (LS). In order to test our hypothesis, we use survey data from Chile (Casen) for the years 2011 and 2013. We use the Duncan Index to measure segregation based on income at the municipality level for 324 municipalities. LS is obtained from the CASEN survey, which considers a question about self-reported well-being. Segregation's impact upon LS is not clear at first glance. On one hand, there is evidence telling that segregation's consequences are negative due to the spatial concentration of poverty and all the woes related to it. On the other hand, segregation would have positive effects because people may feel stress, unhappiness, and alienation when comparing themselves to better-off households. Additionally, there is previous evidence regarding the fact that people prefer to neighbor people of a similar socioeconomic background. Hence, an empirical test is needed. In order to implement it, we should deal with two problems, first, the survey limited statistical significance at the municipal level, hence we use the small area estimation (SAE) methodology to improve the estimations' statistic properties, and second, the double causality between segregation and LS; to deal with the latter, we include lagged LS as a regressor. Our findings indicate that socioeconomic segregation has a positive effect on LS. This result is robust to different econometric specifications.

Effectiveness of the FIGO protocol for medical management of first-trimester abortion / Eficacia del esquema FIGO para el manejo médico del aborto en el primer trimestre

Objective: To determine the effectiveness of misoprostol using the International Federation of Gynecology and Obstetrics (FIGO) 2017 protocol for medical management of first trimester abortion. Methods: A cross-sectional study was performed between March and September 2018. Seventy-six patients diagnosed with first trimester spontaneous abortion were managed following the FIGO 2017 protocol for medical management of first trimester abortion. Results: Main indications for inclusion of the 76 patients were missed abortion 57.9%, incomplete abortion 25%, and anembryonic pregnancy 17.1%. Medical induction with misoprostol followed the FIGO 2017 protocol for medical management of first trimester abortion. The most frequent side effect reported was abnormal uterine bleeding associated with pelvic pain (72.3% of patients). Complete uterine evacuation was accomplished in 98.6% of the patients. Conclusion: Misoprostol use in patients with first trimester abortion following the FIGO 2017 protocol was a safe and cost-effective therapeutic option.

Objetivo. Evaluar la eficacia del manejo con misoprostol al emplear el esquema de la Federación Internacional de Ginecología y Obstetricia (FIGO) 2017 para el abordaje de abortos de primer trimestre. Métodos. Estudio transversal realizado entre marzo y septiembre 2018, que incluyó 76 pacientes con diagnóstico de aborto espontáneo en el primer trimestre de gestación y que tuvieron manejo de acuerdo al esquema recomendado por FIGO 2017. Resultados. Las principales indicaciones para la inclusión de las 76 pacientes fueron aborto diferido 57,9%, aborto incompleto 25% y embarazo anembrionado 17,1%. La inducción con misoprostol siguió las indicaciones de FIGO 2017 para el manejo del aborto del primer trimestre. El efecto adverso más frecuente fue el sangrado vaginal asociado a dolor pélvico en 72,3% de las pacientes. Se logró la evacuación uterina completa en 98,6% de los casos. Conclusión. El manejo médico del aborto del primer trimestre de gestación con el uso del misoprostol de acuerdo al esquema FIGO 2017 ofreció una opción terapéutica altamente segura y costo-efectiva.

Successful adaptation of a research methods course in South America.

BACKGROUND: South America has low research productivity. The lack of a structured research curriculum is one of the barriers to conducting research. OBJECTIVE: To report our experience adapting an active learning-based research methods curriculum to improve research productivity at a university in Ecuador. DESIGN: We used a mixed-method approach to test the adaptation of the research curriculum at Universidad Catolica Santiago de Guayaquil. The curriculum uses a flipped classroom and active learning approach to teach research methods. When adapted, it was longitudinal and had 16-hour programme of in-person teaching and a six-month follow-up online component. Learners were organized in theme groups according to interest, and each group had a faculty leader. Our primary outcome was research productivity, which was measured by the succesful presentation of the research project at a national meeting, or publication in a peer-review journal. Our secondary outcomes were knowledge and perceived competence before and after course completion. We conducted qualitative interviews of faculty members and students to evaluate themes related to participation in research. RESULTS: Fifty university students and 10 faculty members attended the course. We had a total of 15 groups. Both knowledge and perceived competence increased by 17 and 18 percentage points, respectively. The presentation or publication rate for the entire group was 50%. The qualitative analysis showed that a lack of research culture and curriculum were common barriers to research. CONCLUSIONS: A US-based curriculum can be successfully adapted in low-middle income countries. A research curriculum aids in achieving pre-determined milestones. ABBREVIATIONS: UCSG: Universidad Catolica Santiago de Guayaquil; UM: University of Miami.

Impact of the 2016 Ecuador Earthquake on Zika Virus Cases.

OBJECTIVES: To evaluate the impact of the April 2016 7.8-magnitude earthquake in Ecuador on the incidence of Zika virus (ZIKV) cases. METHODS: We used the national public health surveillance system for reportable transmissible conditions and included suspected and laboratory-confirmed ZIKV cases. We compared the number of cases before and after the earthquake in areas closer to and farther from the epicenter. RESULTS: From January to July 2016, 2234 patients suspected of having ZIKV infection were reported in both affected and control areas. A total of 1110 patients had a reverse transcription-polymerase chain reaction assay, and 159 were positive for ZIKV. The cumulative incidence of ZIKV in the affected area was 11.1 per 100 000 after the earthquake. The odds ratio of having ZIKV infection in those living in the affected area was 8.0 (95% CI = 4.4, 14.6; P < .01) compared with the control area and adjusted for age, gender, province population, and number of government health care facilities. CONCLUSIONS: A spike in ZIKV cases occurred after the earthquake. Patients in the area closest to the epicenter had a delay in seeking care.

A new species of Andean semiaquatic lizard of the genus Potamites (Sauria, Gymnophtalmidae) from southern Peru.

We describe a new lizard species of the genus Potamites from the montane forests of the Cordillera de Vilcabamba (Cusco region) and Apurimac River valley (Ayacucho region), between 1500 and 2000 meters of elevation, in southern Peru. The new species is distinguishable from all other species of the genus mainly by having highly keeled scattered scales on dorsum and females lacking femoral pores.

Relación entre anemia hipocrómica y peso placentario / The association between hypochomic anemia and placental

Con el propósito de conocer la relación que existe entre la anemia materna con el peso de la placenta, se realizó un estudio explicativo, transversal. La muestra estuvo constituida por 100 pacientes escogidas al azar con embarazo entre 37 y 41 semanas, que ingresaron en la sala de partos de servicio de Ginecología y Obstetricia del Hospital Universitario "Antonio María Pineda" las cuales fueron divididas en un grupo "A" con Hb<10 gr/dl y Hcto <30 mpor ciento y "B" un Hb>10 gr/dl y Hcto>30 por ciento, valores obtenidos en su último control prenatal en un lapso no mayor de 2 meses, además se les realizaron a su ingreso frotis de sangre periférica, luego del alumbramiento espontáneo de la placenta, se cortaron las menbranas ovulares y el cordón en su base y se peso. Los resultados fueron edad materna promedio de 23,9; paridad 1,2; instrucción 6,8 para el A y 7,8 el B, sexo del RN 60 por ciento masculino y peso de RN 2.880 el A, 3011 el B; hemoglobina materna 9,8 y 11,6 Hcto 29,2 y 35,2 y peso placentarios 628 gr para el A y 418 para el B siendo este último bastante significativo, por lo que puede afirmarse que un 44 por ciento de las variaciones del peso placentario se relacionaron con la hemoglobina materna. En conclusión podemos decir que en nuestro trabajo se verificó que la anemia materna produce aumento del peso placentario

Cardiopatías congénitas cianosantes / Cyanotic congenital heart diseases

El objetivo de este estudio es reconocer las características clínicas más comunes de las cardiopatías congénitas cianosantes, algunos de los factores de riesgo asociados y la frecuencia de cada una de ellas. Se utilizaron las historias clínicas de 263 pacientes con cardiopatía congénita cianosante tratados quirúrgicamente en la Fundación Cardio Infantil de Santafé de Bogotá, Colombia, entre el 1 de Octubre de 1988 y el 31 de Diciembre de 1992. La evaluación se hizo por medio de un cuestionario con preguntas de interés, el cual fué aplicado a cada una de las historias clínicas y analizadas con la ayuda de los programas EXCEL Y QUATTRO-PRO. Se concluyó que la cardiopatía más frecuente fué la Tetralogía de Fallot y la menos frecuente la Anomalía de Ebstein; la edad de mayor consulta fué entre el primero y el cuarto año de vida, el principal motivo de consulta fue la cianosis; la enfermedad infectocontagiosa del primer trimestre del embarazo con mayor relación fué la rubeola; la mayoría de niños fueron a término, con peso mayor de 2.500 gr. talla entre 45 y 50 cm y APGAR mayor de 8, pero en una tercera parte se presentó retardo pondo-estatural posterior. El electrocardiograma y el cateterismo son definitivos para el diagnóstico de estas cardiopatías