HIV and syphilis in the context of community vulnerability among indigenous people in the Brazilian Amazon.

BACKGROUND: Contextual factors shape the risk of acquiring human immunodeficiency virus (HIV) and syphilis. We estimated the prevalence of both infections among indigenous people in nine indigenous health districts of the Brazilian Amazon and examined the context of community vulnerability to acquiring these infections. METHODS: We trained 509 health care workers to screen sexually active populations in the community for syphilis and HIV using rapid testing (RT). We then assessed the prevalence of HIV and syphilis using RT. A multivariable analysis was used to identify factors associated with syphilis infection (sociodemographic, condom use, intrusion, population mobility, and violence). RESULTS: Of the 45,967 indigenous people tested, the mean age was 22.5 years (standard deviation: 9.2), and 56.5% were female. Overall, for HIV, the prevalence was 0.13% (57/43,221), and for syphilis, the prevalence was 1.82% (745/40,934). The prevalence in men, women, and pregnant women for HIV was 0.16%, 0.11%, and 0.07%, respectively, and for syphilis, it was 2.23%, 1.51%, and 1.52%, respectively. The district Vale do Javari had the highest prevalence of both infections (HIV: 3.38%, syphilis: 1.39%). This district also had the highest population mobility and intrusion and the lowest availability of prenatal services. Syphilis infection was independently associated with age (odds ratio [OR] 1.04, 95% confidence interval [CI]: 1.03-1.05), male sex (OR 1.32, 95% CI: 1.14-1.52), and mobility (moderate: OR: 7.46, 95% CI: 2.69-20.67; high: OR 7.09, 95% CI: 3.79-13.26). CONCLUSIONS: The large-scale integration of RT in remote areas increased case detection among pregnant women, especially for syphilis, in districts with higher vulnerability. Mobility is an important risk factor, especially in districts with higher vulnerability. Contextually appropriate approaches that address this factor could contribute to the long-term success of HIV and syphilis control programs

Valor de la ecografía abdominal en el diagnóstico de la cirrosis hepática

La ecografía es una de las pruebas formadoras de imágenes más empleadas en el estudio de las enfermedades hepáticas, destacándose por ser inocua, accesible y de bajo costo. La presente investigación se desarrolló con el objetivo general de evaluar la ecografía abdominal en el diagnóstico de la cirrosis hepática. Para ello se realizó un estudio analítico de validación de esta prueba diagnóstica en la detección de dicha enfermedad, en el período comprendido desde julio de 2008 hasta enero de 2010, en el Instituto de Gastroenterología. A los pacientes con hepatopatía crónica incluidos en el estudio, previo a la realización de la laparoscopia y/o biopsia de hígado indicadas por su especialista, se les practicó una ecografía abdominal con doppler. La muestra quedó conformada por 173 pacientes (103 con la enfermedad y 70 sin la misma). Se estudiaron variables biológicas, ecográficas (signos sugestivos de cirrosis hepática), laparoscópicas e histológicas, determinándose además la sensibilidad, especificidad, valor predictivo positivo y negativo, exactitud y odds ratio diagnósticas, así como el índice J de Youden Predominó el sexo masculino y las edades comprendidas entre los 48 y 57 años. Los signos ecográficos que prevalecieron fueron superficie hepática irregular o nodular, borde romo y ecoestructura hepática heterogénea, seguidos de dilatación de la vena porta y el aumento de tamaño del lóbulo caudado del hígado. La prueba en estudio resultó de alto valor (S=94,2 %; E=88,6 %) y seguridad (VPP=92,4%; VPN=91,2%) en el diagnóstico de la cirrosis hepática

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

¿Qué nos dicen las proyecciones demográficas para Cuba?

El objetivo de este artículo es sintetizar los resultados fundamentales del análisis de una serie de cuatro proyecciones demográficas para Cuba, elaboradas para satisfacer oportunamente los requerimientos de información sobre las futuras características de la población y los hogares, entre ellas el tamaño, la composición y estructura por sexo y edad, la distribución por zonas urbana y rural y la población económicamente activa, en los diferentes niveles territoriales. Para la elaboración de las proyecciones aquí presentadas se utilizó el método de los componentes principales, a partir de la ecuación compensadora y sobre la base de datos oficiales divulgados por la Oficina Nacional de Estadística e Información cubana. La información proyectada abarca el período de 2015 a 2050. Los resultados ratifican la disminución prevista de la población cubana y cambios en el tamaño y la jefatura de los hogares del país

Cuba: escenario demográfico de un país en vías de desarrollo con decrecimiento poblacional

Un bajo nivel de fecundidad a lo largo de muchos años, sin que medien variaciones sustantivas en otras variables demográficas, condiciona, a mediano plazo, un ritmo de crecimiento poblacional muy lento o negativo, lo que desencadena o acelera, a su vez, otros procesos demográficos con repercusiones socioeconómicas y políticas, como sucede actualmente en muchos países desarrollados. En Cuba comenzó a manifestarse un decrecimiento poblacional sin antecedentes en América Latina, que debe ser evidenciado y analizado, ya que para la región en su conjunto y, en particular, para los países más avanzados en la transición demográfica, las tendencias del índice de la fecundidad cubano pueden servir, en perspectiva, como patrón de análisis o punto de reflexión y debate en torno a un hecho de implicaciones sociales de gran trascendencia potencial

Fluorescence of the Flavin group in choline oxidase. Insights and analytical applications for the determination of choline and betaine aldehyde

et al.Choline oxidase (ChOx) is a flavoenzyme catalysing the oxidation of choline (Ch) to betaine aldehyde (BA) and glycine betaine (GB). In this paper a fundamental study of the intrinsic fluorescence properties of ChOx due to Flavin Adenine Dinucleotide (FAD) is presented and some analytical applications are studied in detail. Firstly, an unusual alteration in the excitation spectra, in comparison with the absorption spectra, has been observed as a function of the pH. This is ascribed to a change of polarity in the excited state. Secondly, the evolution of the fluorescence spectra during the reaction seems to indicate that the reaction takes place in two consecutive, but partially overlapped, steps and each of them follows a different mechanism. Thirdly, the chemical system can be used to determine the Ch concentration in the range from 5×10(-6)M to 5×10(-5)M (univariate and multivariate calibration) in the presence of BA as interference, and the joint Ch+BA concentration in the range 5×10(-6)-5×10(-4)M (multivariate calibration) with mean errors under 10%; a semiquantitative determination of the BA concentration can be deduced by difference. Finally, Ch has been successfully determined in an infant milk sample.The authors thank the MINECO of Spain (project CTQ2012-34774), the Gobierno de Aragon (DGA-FEDER) (Research Group E-74) and UPV/EHU (project GIU13/15) for founding support.Peer reviewe