Hypertension in Guatemala’s Public Primary Care System: A Needs Assessment Using the Health System Building Blocks Framework

Background: Uncontrolled hypertension represents a substantial and growing burden in Guatemala and other low and middle-income countries. As a part of the formative phase of an implementation research study, we conducted a needs assessment to define short- and long-term needs and opportunities for hypertension services within the public health system. Methods: We conducted a multi-method, multi-level assessment of needs related to hypertension within Guatemala’s public system using the World Health Organization’s health system building blocks framework. We conducted semi-structured interviews with stakeholders at national (n = 17), departmental (n = 7), district (n = 25), and community (n = 30) levels and focus groups with patients (3) and frontline auxiliary nurses (3). We visited and captured data about infrastructure, accessibility, human resources, reporting, medications and supplies at 124 health posts and 53 health centers in five departments of Guatemala. We conducted a thematic analysis of transcribed interviews and focus group discussions supported by matrix analysis. We summarized quantitative data observed during visits to health posts and centers. Results: Major challenges for hypertension service delivery included: gaps in infrastructure, insufficient staffing and high turnover, limited training, inconsistent supply of medications, lack of reporting, low prioritization of hypertension, and a low level of funding in the public health system overall. Key opportunities included: prior experience caring for patients with chronic conditions, eagerness from providers to learn, and interest from patients to be involved in managing their health. The 5 departments differ in population served per health facility, accessibility, and staffing. All but 7 health posts had basic infrastructure in place. Enalapril was available in 74% of health posts whereas hydrochlorothiazide was available in only 1 of the 124 health posts. With the exception of one department, over 90% of health posts had a blood pressure monitor. Conclusions: This multi-level multi-method needs assessment using the building blocks framework highlights contextual factors in Guatemala’s public health system that have been important in informing the implementation of a hypertension control trial. Long-term needs that are not addressed within the scope of this study will be important to address to enable sustained implementation and scale-up of the hypertension control approach.Fil: Fort, Meredith P.. University of Colorado; Estados UnidosFil: Mundo, William. University of Colorado; Estados UnidosFil: Paniagua Avila, Alejandra. No especifíca;Fil: Cardona, Sayra. No especifíca;Fil: Figueroa, Juan Carlos. No especifíca;Fil: Hernández Galdamez, Diego. No especifíca;Fil: Mansilla, Kristyne. No especifíca;Fil: Peralta García, Ana. No especifíca;Fil: Roche, Dina. No especifíca;Fil: Palacios, Eduardo Alberto. No especifíca;Fil: Glasgow, Russell E.. University of Colorado; Estados UnidosFil: Gulayin, Pablo Elías. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: He, Jiang. University of Tulane; Estados UnidosFil: Ramirez Zea, Manuel. No especifíca

Case report: Cytokine hemoadsorption in a case of hemophagocytic lymphohistiocytosis secondary to extranodal NK/T-cell lymphoma

Cytokine hemoadsorption; Hemophagocytic lymphohistiocytosis; Multiorgan dysfunctionHemoadsorció de citocines; Limfohistiocitosi hemofagocítica; Disfunció multiorgànicaHemoadsorción de citoquinas; Linfohistiocitosis hemofagocítica; Disfunción multiorgánicaWe discuss a single case of Hemophagocytic lymphohistiocytosis (HLH) due to NK-type non-Hodgkin lymphoma and Epstein-Barr virus reactivation with multiorgan dysfunction and distributive shock in which we performed cytokine hemoadsorption with Cytosorb ®. A full microbiological panel was carried out, including screening for imported disease, standard serologies and cultures for bacterial and fungal infection. A liver biopsy and bone marrow aspirate were performed, confirming the diagnosis. The patients fulfilled the HLH-2004 diagnostic criteria, and according to the 2018 Consensus Statements by the HLH Steering Committee of the Histiocyte Society, dexamethasone and etoposide were started. There was an associated hypercytokinemia and, due to refractory distributive shock, rescue therapy with cytokine hemoadsorption was performed during 24 h (within day 2 and 3 from ICU admission). After starting this procedure, rapid hemodynamic control was achieved with a significant reduction in vasopressor support requirements. This case report highlights that cytokine hemoadsorption can be an effective since rapid decrease in IL-10 levels and a significant hemodynamic improvement was achieved

Effect of Biodiversity Changes in Disease Risk: Exploring Disease Emergence in a Plant-Virus System

The effect of biodiversity on the ability of parasites to infect their host and cause disease (i.e. disease risk) is a major question in pathology, which is central to understand the emergence of infectious diseases, and to develop strategies for their management. Two hypotheses, which can be considered as extremes of a continuum, relate biodiversity to disease risk: One states that biodiversity is positively correlated with disease risk (Amplification Effect), and the second predicts a negative correlation between biodiversity and disease risk (Dilution Effect). Which of them applies better to different host-parasite systems is still a source of debate, due to limited experimental or empirical data. This is especially the case for viral diseases of plants. To address this subject, we have monitored for three years the prevalence of several viruses, and virus-associated symptoms, in populations of wild pepper (chiltepin) under different levels of human management. For each population, we also measured the habitat species diversity, host plant genetic diversity and host plant density. Results indicate that disease and infection risk increased with the level of human management, which was associated with decreased species diversity and host genetic diversity, and with increased host plant density. Importantly, species diversity of the habitat was the primary predictor of disease risk for wild chiltepin populations. This changed in managed populations where host genetic diversity was the primary predictor. Host density was generally a poorer predictor of disease and infection risk. These results support the dilution effect hypothesis, and underline the relevance of different ecological factors in determining disease/infection risk in host plant populations under different levels of anthropic influence. These results are relevant for managing plant diseases and for establishing conservation policies for endangered plant species

Natural History of MYH7-Related Dilated Cardiomyopathy

BACKGROUND Variants in myosin heavy chain 7 (MYH7) are responsible for disease in 1% to 5% of patients with dilated cardiomyopathy (DCM); however, the clinical characteristics and natural history of MYH7-related DCM are poorly described. OBJECTIVES We sought to determine the phenotype and prognosis of MYH7-related DCM. We also evaluated the influence of variant location on phenotypic expression. METHODS We studied clinical data from 147 individuals with DCM-causing MYH7 variants (47.6% female; 35.6 +/- 19.2 years) recruited from 29 international centers. RESULTS At initial evaluation, 106 (72.1%) patients had DCM (left ventricular ejection fraction: 34.5% +/- 11.7%). Median follow-up was 4.5 years (IQR: 1.7-8.0 years), and 23.7% of carriers who were initially phenotype-negative developed DCM. Phenotypic expression by 40 and 60 years was 46% and 88%, respectively, with 18 patients (16%) first diagnosed at <18 years of age. Thirty-six percent of patients with DCM met imaging criteria for LV noncompaction. During follow-up, 28% showed left ventricular reverse remodeling. Incidence of adverse cardiac events among patients with DCM at 5 years was 11.6%, with 5 (4.6%) deaths caused by end-stage heart failure (ESHF) and 5 patients (4.6%) requiring heart transplantation. The major ventricular arrhythmia rate was low (1.0% and 2.1% at 5 years in patients with DCM and in those with LVEF of <= 35%, respectively). ESHF and major ventricular arrhythmia were significantly lower compared with LMNA-related DCM and similar to DCM caused by TTN truncating variants. CONCLUSIONS MYH7-related DCM is characterized by early age of onset, high phenotypic expression, low left ventricular reverse remodeling, and frequent progression to ESHF. Heart failure complications predominate over ventricular arrhythmias, which are rare. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

New-Onset Diabetes Mellitus after COVID-19: Combined Effects of SARS-CoV-2 Variants, Molecular Mimicry, and m6A RNA Methylation

Post-COVID syndrome, also known as long COVID, includes a range of symptoms that persist for months or even years after initial infection such as fatigue, shortness of breath, joint pain, chest pain, muscle aches, and heart palpitations, among others. In addition, long COVID is related with new-onset diseases such as diabetes mellitus. The association between SARS-CoV-2 infections and the development of diabetes mellitus is complex and not fully understood. Therefore, the objective of this article was to summarize the state of the art in possible mechanisms involved in the development of diabetes mellitus in the post-COVID-19 era, particularly the impact of SARS-CoV-2 variants on molecular mimicry, the role of viral m6A RNA methylation, and the potential associations between these factors. A better understanding of the combinatorial effects of these mechanisms is paramount for both clinicians and researchers alike because it could help tailor more effective treatment strategies, enhance patient care, and guide future research efforts

Global m6A RNA Methylation in SARS-CoV-2 Positive Nasopharyngeal Samples in a Mexican Population: A First Approximation Study

The Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) is the causal agent of COVID-19 (Coronavirus Disease-19). Both mutation and/or recombination events in the SARS-CoV-2 genome have resulted in variants that differ in transmissibility and severity. Furthermore, RNA methylation of the N6 position of adenosine (m6A) is known to be altered in cells infected with SARS-CoV-2. However, it is not known whether this epitranscriptomic modification differs across individuals dependent on the presence of infection with distinct SARS-CoV-2 variants, the viral load, or the vaccination status. To address this issue, we selected RNAs (n = 60) from SARS-CoV-2 sequenced nasopharyngeal samples (n = 404) of 30- to 60-year-old outpatients or hospitalized individuals from the city of Mazatl&aacute;n (Mexico) between February 2021 and March 2022. Control samples were non-infected individuals (n = 10). SARS-CoV-2 was determined with real-time PCR, viral variants were determined with sequencing, and global m6A levels were determined by using a competitive immunoassay method. We identified variants of concern (VOC; alpha, gamma, delta, omicron), the variant of interest (VOI; epsilon), and the lineage B.1.1.519. Global m6A methylation differed significantly across viral variants (p = 3.2 &times; 10&minus;7). In particular, we found that m6A levels were significantly lower in the VOC delta- and omicron-positive individuals compared to non-infected individuals (p = 2.541236 &times; 10&minus;2 and 1.134411 &times; 10&minus;4, respectively). However, we uncovered no significant correlation between global m6A levels and viral nucleocapsid (N) gene expression or age. Furthermore, individuals with complete vaccination schemes showed significantly lower m6A levels than unvaccinated individuals (p = 2.6 &times; 10&minus;4), and differences in methylation levels across variants in unvaccinated individuals were significant (p = 3.068 &times; 10&minus;3). These preliminary results suggest that SARS-CoV-2 variants show differences in global m6A levels

Gaps in the Management of Hypertensive Patients in a Metropolitan Area of Havana

Foundation: knowing and facing the difficulties which appear during the control of the hypertensive patient is a challenge for every health system. Objective: to identify the gaps in the management of hypertensive people in a metropolitan area of Havana. Method: a descriptive and cross-sectional study was conducted between February and June 2016 at the Nguyen Van Troi Polyclinic, in Centro Habana. Out of the total of 18 year-old or older 4480 people, who were identified as hypertensive, a sample of 531 was selected by means of a two-stage cluster sampling, studying 521. They were applied a semi-structured interview and blood pressure measurement, documents of the area were reviewed to identify other gaps. The variables analyzed in the study were: socio-demographic, access to health services, diagnosis and care, monitoring and control treatment. The numerical variables were presented with measures of central tendency and dispersion. Categorical variables were presented as frequencies and percentages. Results: a 92.3 % of the interviewees said they felt the need for care in the last year, of these, 80.7 % had access to health services. 98.1 % had indicated pharmacological treatment, with diuretics being the most used with 61 %. 50.7 % have adherence to treatment according to the Morisky test. 24.2 % were not seen by their doctor in the last year, the main reason was the no programming or appointment to consultation. 56.6 % had their blood pressure figures controlled. Conclusions: access gaps were linked to the lack of attention seeking despite perceiving the need. Poor follow-up and low therapeutic adherences in hypertensive people were the principles that supported the high percentage of individuals with uncontrolled blood pressure figures

The Vascular Niche for Adult Cardiac Progenitor Cells

Research on cardiac progenitor cell populations has generated expectations about their potential for cardiac regeneration capacity after acute myocardial infarction and during physiological aging; however, the endogenous capacity of the adult mammalian heart is limited. The modest efficacy of exogenous cell-based treatments can guide the development of new approaches that, alone or in combination, can be applied to boost clinical efficacy. The identification and manipulation of the adult stem cell environment, termed niche, will be critical for providing new evidence on adult stem cell populations and improving stem-cell-based therapies. Here, we review and discuss the state of our understanding of the interaction of adult cardiac progenitor cells with other cardiac cell populations, with a focus on the description of the B-CPC progenitor population (Bmi1+ cardiac progenitor cell), which is a strong candidate progenitor for all main cardiac cell lineages, both in the steady state and after cardiac damage. The set of all interactions should be able to define the vascular cardiac stem cell niche, which is associated with low oxidative stress domains in vasculature, and whose manipulation would offer new hope in the cardiac regeneration field

Resistencia a la corrosión de recubrimientos a base de titanio y circonio producidos por magnetrón sputtering DC

Titanium nitride (TiN and TiN/Ti) and titanium zirconium nitride (TiZrN)thin films were deposited on AISI 304 and 316L stainless steels, using DC Magne-tron Sputtering, to evaluate the superficial, mechanical and corrosion resistanceproperties. X Ray Diffraction (XRD) structural analysis performed showed thatin all studied systems had f.c.c crystalline structure, with (111) bragg planepreferential orientation. The TiZrN coating shows compressive stress by theinclusion of Zr atoms in the structure of TiN and peak widening is observeddue to the presence on the film of TiN. Superficial characteristics obtained byprofilometry (roughness (Ra) and thickness) shows Ra values below 100 nm,typical of thin films obtained by this technique. The thickness obtained rangesfrom 364,50 to 580,25 nm.Using nanoindentation, hardness values TiN, TiN/Ti and TiZrN of 16,173,18,524 and 17,307 Gpa were obtained for thin films respectively. Corrosion resistance evaluation (Tafel Polarization), shows a decreasein corrosion speed of steel when the surface is protectedby a coating, fact which was determined by the reductionof the corrosion rate.Se depositaron recubrimientos de nitruro de titanio (TiN y TiN/Ti) y nitrurode titanio circonio (TiZrN) sobre aceros AISI 304 y 316L por medio de la técnicamagnetrón Sputtering DC para evaluar sus propiedades superficiales y mecánicas, así como la resistencia a la corrosión. El análisis estructural realizado por mediode difracción de rayos X (XRD) mostró que todos los materiales estudiados cris-talizaron en una estructura f.c.c, con orientación preferencial en plano de Bragg (111); el recubrimiento de TiZrN, muestra estrés a la compresión por la inclusiónde átomos de Zr en la estructura del TiN y se observa ensanchamiento en lospicos de difracción debido a la presencia de TiN en la película. Las características superficiales medidas por perfilometría (rugosidad Ra y espesor) muestranvalores de Ra inferiores a 100 nm, típicos de capas delgadas sintetizadas por estemétodo. Los espesores obtenidos varían desde 364,50 nm hasta 580,25 nm. Usandonanoindentación se obtuvieron valores de dureza de capa de TiN, TiN/Ti y TiZrN de 16, 173, 18, 524 y 17, 307 Gpa respectivamente; la evaluación de la resistencia ala corrosión (polarización tafel) muestra que la velocidad de corrosión del acerodisminuye cuando la superficie es protegida con un recubrimiento, hecho que sedeterminó por la reducción de la tasa de corrosión