Initial Experience with Sildenafil, Bosentan, and Nitric Oxide for Pediatric Cardiomyopathy Patients with Elevated Pulmonary Vascular Resistance before and after Orthotopic Heart Transplantation

Background. Although pulmonary hypertension complicating dilated cardiomyopathy has been shown to be a significant risk factor for graft failure after heart transplantation, the upper limits of pulmonary vascular resistance (PVR) that would contraindicate pediatric heart transplantation are not known. Methods. A retrospective review of all pediatric orthotopic heart transplant (OHT) performed at our institution from 2002 to 2007 was performed. Seven patients with PVR > 6 Wood's units (WU) prior to transplant were compared pre- and postoperatively with 20 matched controls with PVR < 6 WU. All pulmonary vasodilator therapies used are described as well as outcomes during the first year posttransplant. Results. The mean PVR prior to transplantation in the 7 study cases was 11.0 ± 4.6 (range 6–22) WU, compared to mean PVR of 3.07 ± 0.9 WU (0.56–4.5) in the controls (P = .27 × 10−6). All patients with elevated PVR were treated pre-OHT with either Sildenafil or Bosentan. Post-OHT, case patients received a combination of sildenafil, iloprost, and inhaled nitric oxide. All 7 case patients survived one year post-OHT, and there was no statistical difference between cases and controls for hospital stay, rejection/readmissions, or graft right ventricular failure. Mean PVR in the cases at one and three months post-OHT was not significantly different between the two groups. Only one of the cases required prolonged treatment with iloprost after OHT. Conclusions. A PVR above 6 WU should not be an absolute contraindication to heart transplantation in children

Impacto de un programa educativo sobre el nivel de conocimiento de higiene oral en niños I. E. “10115” Chiclayo – 2023

Objetivo: Determinar el impacto de un programa educativo sobre el nivel de conocimiento de higiene oral en niños de la I.E. “10115”; Chiclayo – 2023, antes y después de aplicar el programa educativo. Materiales y métodos: Aplicada, de diseño observacional, prospectivo, no experimental, descriptivo en una muestra conformada por 273 estudiantes de la I. E. Santa Julia “10115” que se encuentren matriculados desde 3º a 6º grado de primaria. Se empleó la técnica de encuesta y el instrumento los cuestionarios cuya validez se realizó por 5 especialistas con grado de magister y la confiabilidad mediante Kuder de Richardson obteniendo con un valor de 0.833 considerado como un nivel bueno. Resultados: El nivel de conocimiento sobre la higiene oral en niños de la I.E. “10115”; Chiclayo – 2023, según la edad de 8-9 y 10-12 años después de aplicar el programa educativo fue bueno, al igual que en el género femenino y masculino. El nivel de conocimiento sobre la higiene oral en niños de la I.E. “10115”; Chiclayo – 2023, antes de aplicar el programa fue regular y después de aplicar el programa educativo fue bueno. Conclusión: El impacto de un programa educativo sobre el nivel de conocimiento de higiene oral en niños de la I.E. “10115”; Chiclayo – 2023 fue positivo.TesisCalidad de vida, promoción de la salud del individuo y la comunidad para el desarrollo de la sociedadNuevas alternativas de prevención y el manejo de enfermedades crónicas y/o no transmisibles

Un santuario doméstico del siglo VII a. C. de culto a Hathor-Astarté en el Cerro de San Vicente (Salamanca, España)

Se presentan los resultados de las excavaciones de 2022 en el Cerro de San Vicente (Salamanca), que amplían el área exhumada en 2021. Se discute la secuencia diacrónica de dicho espacio y su interpretación funcional y social. Se aborda la religiosidad doméstica a partir de varios edificios de uso cultual y un abundante elenco de objetos litúrgicos: vajilla torneada egipcia o levantina pintada y fenicia de engobe rojo, un aplique de taracea y abalorios de fayenza con iconografía oriental, pebeteros y terracotas y vajilla local con temas orientalizantes, etc. Además, sobresalen los nuevos indicadores de prácticas aristocráticas: instrumentos para artesanías de alta calidad –alfarería y actividades textiles– y atalajes ecuestres –dos camas de bocados óseos–. El cocinado con bandejas y hornillos de atanor, las artesanías especializadas, los rituales domésticos y la edilicia remiten también al ámbito mediterráneo. Todas estas evidencias permiten interpretar el sector excavado como un espacio ceremonial y a la vez doméstico dedicado a una deidad femenina –probable trasunto local de Hathor-Astarté– integrado en el vecindario de patio central de un grupo residencial virilocal multifamiliar. Se reivindica el protagonismo de las mujeres de aquella unidad corporativa amplia y de alto rango en la transmisión y desempeño de todos esos saberes procedimentales y actividades de mantenimiento espiritual y material

Un santuario doméstico del siglo VII a. C. de culto a Hathor-Astarté en el Cerro de San Vicente (Salamanca, España)

This article presents the major outcomes from the excavations undertaken in 2022 at the site of Cerro de San Vicente (Salamanca), enlarging the area unearthed in 2021. The paper discusses the diachronic sequence of this setting and its functional and social interpretation. Household religion is addressed via several cult buildings and a large repertoire of liturgical objects: wheel-thrown painted Egyptian or Levantine and Phoenician red-slip tableware, a faience piece of inlay and faience beads featuring oriental iconography, local terracotta, burners, and tableware with orientalizing motifs, etc. In addition, new indicators of aristocratic practices stand out: instruments for high-quality handicrafts –pottery and textile work– and two equestrian bone items of harnesses. Cooking with ceramic trays and portable tandoor-like stoves, specialized crafts, domestic cults, and buildings refer, as a whole, to the Mediterranean koiné. All these lines of evidence lead to interpret the excavated sector as a domestic sanctuary dedicated to a female deity –likely a local expression of Hathor-Ashtart– integrated into the neighbourhood of a central courtyard compound occupied by a multi-family virilocal residential group. The article reclaims the key role of the women of that broad and high-ranking corporate social unit in the transmission and performance of know-how and practices of spiritual and material maintenance.Se presentan los resultados de las excavaciones de 2022 en el Cerro de San Vicente (Salamanca), que amplían el área exhumada en 2021. Se discute la secuencia diacrónica de dicho espacio y su interpretación funcional y social. Se aborda la religiosidad doméstica a partir de varios edificios de uso cultual y un abundante elenco de objetos litúrgicos: vajilla torneada egipcia o levantina pintada y fenicia de engobe rojo, un aplique de taracea y abalorios de fayenza con iconografía oriental, pebeteros y terracotas y vajilla local con temas orientalizantes, etc. Además, sobresalen los nuevos indicadores de prácticas aristocráticas: instrumentos para artesanías de alta calidad –alfarería y actividades textiles– y atalajes ecuestres –dos camas de bocados óseos–. El cocinado con bandejas y hornillos de atanor, las artesanías especializadas, los rituales domésticos y la edilicia remiten también al ámbito mediterráneo. Todas estas evidencias permiten interpretar el sector excavado como un espacio ceremonial y a la vez doméstico dedicado a una deidad femenina –probable trasunto local de Hathor-Astarté– integrado en el vecindario de patio central de un grupo residencial virilocal multifamiliar. Se reivindica el protagonismo de las mujeres de aquella unidad corporativa amplia y de alto rango en la transmisión y desempeño de todos esos saberes procedimentales y actividades de mantenimiento espiritual y material

An exceptional case of household archaeology from Early Iron Age Central Iberia: House 1 at Cerro de San Vicente (Salamanca, Spain)

RESUMEN: Se presentan los resultados de las excavaciones (2006, 2017 y 2021) en un sector de la aldea del Hierro I del Cerro de San Vicente (Salamanca). Se ha exhumado un agregado informal de edificios y estructuras adjetivas de adobe cuyo patrón espacial es afín al esquema transcultural patrilocal. El artículo se centra en la casa 1 y sus cenizales. Tal vivienda fue excepcional por su larga e ininterrumpida biografía, su mobiliario de barro –con dos poyos que pudieron acoger hasta 20 personas y un hogar con forma de piel de toro extendida– y su abandono ritualizado –quemada c. 650-575 a.C. y recrecida con adobes de sus paredes–. La excavación reveló una alta concentración de molinos y vajilla fina local pintada, así como instrumental de labores especializadas y altamente cualificadas –alfarería e hilado–. Sobresale un lote de hallazgos inéditos en el interior de la península ibérica: exóticos abalorios y vajilla de fayenza del Mediterráneo oriental, cerámica de engobe rojo fenicia y objetos litúrgicos y coroplástica con paralelos tartésicos y mediterráneos. Todos estos hallazgos indican que la casa 1 acogió una asidua actividad social –banquetes y transacciones con huéspedes– como cabaña de reuniones de un grupo corporativo extenso, donde acabaron tan destacados objetosABSTRACT: The excavations undertaken at the Early Iron Age vil¬lage of Cerro de San Vicente (Salamanca) revealed an infor¬mal aggregate of dwellings and ancillary buildings of adobe which matches the cross cultural spatial pattern for patrilo¬cal practices. The paper focuses on house 1 and its adjoin¬ing middens. This dwelling was exceptional due to its long and stable biography, its clay furniture –with two benches for 20 people and a hearth in the shape of an oxhide– and ritualized abandonment using an intense conflagration dated to 650 575 BC and its filling with adobes. The excavations revealed an unusual concentration of querns and fine local hand made pottery. The excavations recovered implements used for specialized and high quality crafts, such as pottery-making and weaving, as well as a set of finds unprecedented in the interior of Iberia stands out: exotic faience beads and tableware from the eastern Mediterranean, Phoenician red slip ceramics, and liturgical terracotta items with Tartes¬sian and Mediterranean parallels. All these findings suggest that house 1 was the gathering hall of an extended corporate group where intense social activities –hosting banquets and transactions with guests– took place and where such star¬tling artefacts ended up.Trabajo realizado en el marco del proyecto “ARQPARENT - Arqueología del parentesco a través de la vivienda en la Submeseta Norte (1800-400 AC)” (PID2019-104349GA-I00) del Plan Estatal de I+D+i del Ministerio de Ciencia e Innovación y con subvenciones de la Junta de Castilla y León (B2017/006589 y SUBV-21086-SA) y del Ayuntamiento de Salamanca

Un singular ambiente doméstico del Hierro I en el interior de la península ibérica: la casa 1 del Cerro de San Vicente (Salamanca, España)

The excavations undertaken at the Early Iron Age village of Cerro de San Vicente (Salamanca) revealed an informal aggregate of dwellings and ancillary buildings of adobe which matches the cross‑cultural spatial pattern for patrilocal practices. The paper focuses on house 1 and its adjoining middens. This dwelling was exceptional due to its long and stable biography, its clay furniture –with two benches for 20 people and a hearth in the shape of an oxhide– and ritualized abandonment using an intense conflagration dated to 650‑575 BC and its filling with adobes. The excavations revealed an unusual concentration of querns and fine local hand‑made pottery. The excavations recovered implements used for specialized and high‑quality crafts, such as potterymaking and weaving, as well as a set of finds unprecedented in the interior of Iberia stands out: exotic faience beads and tableware from the eastern Mediterranean, Phoenician red slip ceramics, and liturgical terracotta items with Tartessian and Mediterranean parallels. All these findings suggest that house 1 was the gathering hall of an extended corporate group where intense social activities –hosting banquets and transactions with guests– took place and where such startling artefacts ended up.Se presentan los resultados de las excavaciones (2006, 2017 y 2021) en un sector de la aldea del Hierro I del Cerro de San Vicente (Salamanca). Se ha exhumado un agregado informal de edificios y estructuras adjetivas de adobe cuyo patrón espacial es afín al esquema transcultural patrilocal. El artículo se centra en la casa 1 y sus cenizales. Tal vivienda fue excepcional por su larga e ininterrumpida biografía, su mobiliario de barro –con dos poyos que pudieron acoger hasta 20 personas y un hogar con forma de piel de toro extendida– y su abandono ritualizado –quemada c. 650-575 a.C. y recrecida con adobes de sus paredes–. La excavación reveló una alta concentración de molinos y vajilla fina local pintada, así como instrumental de labores especializadas y altamente cualificadas –alfarería e hilado–. Sobresale un lote de hallazgos inéditos en el interior de la península ibérica: exóticos abalorios y vajilla de fayenza del Mediterráneo oriental, cerámica de engobe rojo fenicia y objetos litúrgicos y coroplástica con paralelos tartésicos y mediterráneos. Todos estos hallazgos indican que la casa 1 acogió una asidua actividad social –banquetes y transacciones con huéspedes– como cabaña de reuniones de un grupo corporativo extenso, donde acabaron tan destacados objetos

Incidence and clearance of anal high-risk human papillomavirus in HIV-positive men who have sex with men: Estimates and risk factors

Background: To estimate incidence and clearance of high-risk human papillomavirus (HR-HPV), and their risk factors, in men who have sex with men (MSM) recently infected by HIV in Spain; 2007-2013. Methods: Multicenter cohort. HR-HPV infection was determined and genotyped with linear array. Two-state Markov models and Poisson regression were used. Results: We analysed 1570 HR-HPV measurements of 612 MSM over 13 608 person-months (p-m) of follow-up. Median (mean) number of measurements was 2 (2.6), median time interval between measurements was 1.1 years (interquartile range: 0.89-1.4). Incidence ranged from 9.0 [95% confidence interval (CI) 6.8-11.8] per 1000 p-m for HPV59 to 15.9 (11.7-21.8) per 1000 p-m for HPV51. HPV16 and HPV18 had slightly above average incidence: 11.9/1000 p-m and 12.8/1000 p-m. HPV16 showed the lowest clearance for both 'prevalent positive' (15.7/1000 p-m; 95% CI 12.0-20.5) and 'incident positive' infections (22.1/1000 p-m; 95% CI 11.8-41.1). More sexual partners increased HR-HPV incidence, although it was not statistically significant. Age had a strong effect on clearance (P-value < 0.001) due to the elevated rate in MSM under age 25; the effect of HIV-RNA viral load was more gradual, with clearance rate decreasing at higher HIV-RNA viral load (P-value 0.008). Conclusion: No large variation in incidence by HR-HPV type was seen. The most common incident types were HPV51, HPV52, HPV31, HPV18 and HPV16. No major variation in clearance by type was observed, with the exception of HPV16 which had the highest persistence and potentially, the strongest oncogenic capacity. Those aged below 25 or with low HIV-RNA- viral load had the highest clearanceThis work was supported by grants from the Fondo de Investigacio´n Sanitaria [PI06/0372, PS09/2181], Red de Investigacio´n en SIDA (RIS) [RD06/006/0026 and RD12/0017/0018 to C.G.] and CIBERESP [group 54A-CB06/02/1009

Tarteso. Nuevas Fronteras (II)

El presente volumen recoge las contribuciones presentadas al II Congreso Internacional sobre Tarteso, Nuevas Fronteras, que tuvo lugar en Mérida entre los días 17 y 19 de noviembre de 2021. Su lectura permite un viaje desde el extremo oriental del Mediterráneo hasta el suroeste de la península ibérica, mostrando las diversas realidades históricas acontecidas en este territorio durante la I Edad del Hierro. El objetivo de esta publicación es mostrar la situación que atravesaba el Mediterráneo durante los años de surgimiento y desarrollo de la cultura tartésica para así comprender mejor la formación y evolución de dicha cultura. El conocimiento de Tarteso ha evolucionado sensiblemente en la última década, desde la celebración y publicación de las actas del I Congreso Internacional, Tarteso. El emporio del metal (Almuzara, 2013). La incorporación de nuevas voces y visiones enfocadas al conocimiento de la protohistoria peninsular, así como de algunos temas nunca antes abordados en el conocimiento de Tarteso, permiten presentar en este volumen una visión renovada, donde destaca la incorporación de unos nuevos límites territoriales para esta cultura.Esta publicación se ha beneficiado de las siguientes ayudas para su financiación: Proyecto de Investigación del Plan Nacional I+D+i: “Construyendo Tarteso 2.0: análisis constructivo, espacial y territorial de un modelo arquitectónico en el valle medio del Guadiana” (PID2019-108180GBI00), financiado por MCIN (AEI/10.13039/501100011033). Subvención global de la Secretaría General de Ciencia, Tecnología, Innovación y Universidad de la Junta de Extremadura al Instituto de Arqueología.Peer reviewe

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p &lt; 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication