Publications by authors named "Carmen Rodriguez"

376 Publications

Response.

Chest 2021 Jun;159(6):2513

Cardiovascular Medicine Division (B. Bikdeli), Brigham and Women's Hospital Harvard Medical School, Boston, MA; Center for Outcomes Research and Evaluation (CORE), Yale University School of Medicine, New Haven, CT; Cardiovascular Research Foundation, New York, NY.

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http://dx.doi.org/10.1016/j.chest.2021.01.024DOI Listing
June 2021

Identification of CRF89_BF, a new member of an HIV-1 circulating BF intersubtype recombinant form family widely spread in South America.

Sci Rep 2021 Jun 1;11(1):11442. Epub 2021 Jun 1.

HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.

Circulating recombinant forms (CRFs) contribute substantially to the HIV-1 pandemic. Among 105 CRFs described in the literature, 16 are BF intersubtype recombinants, most of South American origin, of which CRF12_BF is the most widely spread. A BF recombinant cluster identified in Bolivia was suggested to represent a new CRF_BF. Here we find that it belongs to a larger cluster incorporating 39 viruses collected in 7 countries from 3 continents, 22 of them in Spain, most from Bolivian or Peruvian individuals, and 12 in South America (Bolivia, Argentina, and Peru). This BF cluster comprises three major subclusters, two associated with Bolivian and one with Peruvian individuals. Near full-length genome sequence analyses of nine viruses, collected in Spain, Bolivia, and Peru, revealed coincident BF mosaic structures, with 13 breakpoints, 6 and 7 of which coincided with CRF12_BF and CRF17_BF, respectively. In a phylogenetic tree, they grouped in a clade closely related to these CRFs, and more distantly to CRF38_BF and CRF44_BF, all circulating in South America. These results allowed to identify a new HIV-1 CRF, designated CRF89_BF. Through phylodynamic analyses, CRF89_BF emergence was estimated in Bolivia around 1986. CRF89_BF is the fifth CRF member of the HIV-1 recombinant family related to CRF12_BF.
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http://dx.doi.org/10.1038/s41598-021-90023-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8169922PMC
June 2021

Radiation Therapy: Predictors of Nonadherence to Treatment Schedules Among Patients With Head and Neck Cancer.

Clin J Oncol Nurs 2021 Jun;25(3):305-313

University of South Florida.

Background: Patients with head and neck cancer (HNC) often undergo a demanding treatment schedule, including radiation therapy (RT). Nonadherence to RT schedules is a documented problem among patients with HNC and can negatively affect patient outcomes.

Objectives: This retrospective, descriptive study aimed to examine whether demographic or clinical characteristics or physical and psychological symptoms were associated with nonadherence to RT among patients with HNC.

Methods: Electronic health records of 262 patients with HNC who received treatment at a cancer center in the southeastern United States were reviewed to determine whether nonadherence was related to symptom scores and other patient- and clinical-related factors.

Findings: Patients at highest risk for nonadherence included women, those admitted as inpatients during treatment, and those who received outpatient IV fluids during treatment. Nonadherent patients reported higher mean scores on 9 of 12 symptoms measured during treatment, indicating a higher symptom burden. Patients with tongue tumors, greater spiritual well-being, and less constipation were less likely to be nonadherent.

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http://dx.doi.org/10.1188/21.CJON.305-313DOI Listing
June 2021

A Review and Conceptual Analysis of Cancer Pain Self-Management.

Pain Manag Nurs 2021 May 16. Epub 2021 May 16.

College of Nursing, University of South Florida, Tampa, Florida.

Objectives: In this concept analysis article, we will clarify the concept "self-management of cancer pain" by identifying related antecedents, attributes, and consequences to further refine the conceptual and operational definitions of the concept.

Design: A review was conducted.

Review/analysis Methods: The Walker and Avant method was used for this concept analysis.

Data Sources: CINAHL, PubMed, and PsycInfo were searched systemically.A total of eight studies on "self-management of cancer pain or self-care of cancer pain" published between 2004 and 2019 were identified.

Results: Attributes for self-management of cancer pain include self-efficacy, integration of methods for pain relief into daily life, decision-making related to pain management, process for solving pain-related issues, and initiation of interactions with healthcare professionals. Antecedents include knowledge regarding pain assessment and management, cognitive abilities, motivation, undergoing pain treatment, patient education and counseling, social support, and accountability from all parties involved. Consequences include pain control, improved quality of life, and increased opioid intake.

Conclusions: Self-management of cancer pain was reported to be a self-regulation process with the aim to encourage patients to use skills attained through development of self-efficacy, so they can actively participate in their pain management. This outcome may enhance their quality of life by decreasing their pain, depression, and anxiety and increasing the availability of social support.
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http://dx.doi.org/10.1016/j.pmn.2021.04.005DOI Listing
May 2021

Part-time cancers and role of melatonin in determining their metabolic phenotype.

Life Sci 2021 Aug 8;278:119597. Epub 2021 May 8.

Departamento de Biologia Estrutural e Funcional, Instituto de Biociencias, Botucatu, Sao Poalo 18618-689, Brazil.

This brief review describes the association of the endogenous pineal melatonin rhythm with the metabolic flux of solid tumors, particularly breast cancer. It also summarizes new information on the potential mechanisms by which endogenously-produced or exogenously-administered melatonin impacts the metabolic phenotype of cancer cells. The evidence indicates that solid tumors may redirect their metabolic phenotype from the pathological Warburg-type metabolism during the day to the healthier mitochondrial oxidative phosphorylation on a nightly basis. Thus, they function as cancer cells only during the day and as healthier cells at night, that is, they are only part-time cancerous. This switch to oxidative phosphorylation at night causes cancer cells to exhibit a reduced tumor phenotype and less likely to rapidly proliferate or to become invasive or metastatic. Also discussed is the likelihood that some solid tumors are especially aggressive during the day and much less so at night due to the nocturnal rise in melatonin which determines their metabolic state. We further propose that when melatonin is used/tested in clinical trials, a specific treatment paradigm be used that is consistent with the temporal metabolic changes in tumor metabolism. Finally, it seems likely that the concurrent use of melatonin in combination with conventional chemotherapies also would improve cancer treatment outcomes.
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http://dx.doi.org/10.1016/j.lfs.2021.119597DOI Listing
August 2021

Placental Transmogrification of the Lung.

Arch Bronconeumol (Engl Ed) 2021 Apr 20. Epub 2021 Apr 20.

Departamento de Cirugía Torácica, Hospital Universitari de Girona Dr. Josep Trueta, Girona, España.

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http://dx.doi.org/10.1016/j.arbres.2021.04.004DOI Listing
April 2021

Influence of Childhood Adversity and Infection on Timing of Menarche in a Multiethnic Sample of Women.

Int J Environ Res Public Health 2021 04 13;18(8). Epub 2021 Apr 13.

Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA.

Childhood adversities (CAs) and infections may affect the timing of reproductive development. We examined the associations of indicators of CAs and exposure to tonsillitis and infectious mononucleosis (mono) with age at menarche. A multiethnic cohort of 400 women (ages 40-64 years) reported exposure to parental maltreatment and maladjustment during childhood and any diagnosis of tonsillitis and/or mono; infections primarily acquired in early life and adolescence, respectively. We used linear and relative risk regression models to examine the associations of indicators of CAs individually and cumulatively, and history of tonsillitis/mono with an average age at menarche and early onset of menarche (<12 years of age). In multivariable models, histories of mental illness in the household (RR = 1.44, 95% CI: 1.01-2.06), and tonsillitis diagnosis (RR = 1.67, 95% CI: 1.20-2.33) were associated with early menarche (<12 years), and with an earlier average age at menarche by 7.1 months (95% CI: -1.15, -0.02) and 8.8 months (95% CI: -1.26, -0.20), respectively. Other adversities indicators, cumulative adversities, and mono were not statistically associated with menarcheal timing. These findings provided some support for the growing evidence that early life experiences may influence the reproductive development in girls.
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http://dx.doi.org/10.3390/ijerph18084080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070127PMC
April 2021

Effect of spray-drying and ultraviolet C radiation as biosafety steps for CSFV and ASFV inactivation in porcine plasma.

PLoS One 2021 28;16(4):e0249935. Epub 2021 Apr 28.

R&D Department, APC EUROPE, S.L.U., Granollers, Barcelona, Spain.

Spray-dried animal plasma (SDAP) is widely used in diets of domestic animals to improve health status and increase growth and feed efficiency. Individual steps in the SDAP manufacturing process, including spray-drying, have been validated to inactivate potential pathogens. Manufacturing standards have established a minimum exit temperature of 80°C and a minimum post-drying storage period of 14 days at 20°C for production of SDAP. Also, UV-C irradiation has been evaluated as another inactivation step that could be included in the manufacturing process. The aim of this study was to assess the inactivation effectiveness of spray-drying on Classical swine fever virus (CSFV) and African swine fever virus (ASFV) and the effect of UV-C inactivation on ASFV as redundant biosafety steps of the manufacturing process for producing spray-dried porcine plasma (SDPP). This study demonstrated that UV-C treatment of liquid porcine plasma can inactivate more than 4 Log10 TCID50/mL of ASFV at 3000 J/L. Spray-drying effectively inactivated at least 4 Log10 TCID50/mL of both CSFV and ASFV. Incorporating UV-C technology within the SDAP manufacturing process can add another biosafety step to further enhance product safety.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249935PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8081231PMC
April 2021

Refinement of a modified simplified Pulmonary Embolism Severity Index for elderly patients with acute pulmonary embolism.

Int J Cardiol 2021 Jul 20;335:111-117. Epub 2021 Feb 20.

CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Universidad Autónoma de Barcelona, Barcelona, Spain.

Objective: To evaluate the utility of a modified (i.e., without the variable "Age >80 years") simplified Pulmonary Embolism Severity Index (sPESI) in elderly patients with acute symptomatic pulmonary embolism (PE), and to derive and validate a refined version of the sPESI for identification of elderly patients at low risk of adverse events.

Methods: The study included normotensive patients aged >80 years with acute PE enrolled in the RIETE registry. We used multivariable logistic regression analysis to create a new risk score to predict 30-day all-cause mortality. We externally validated the new risk score in elderly patients from the COMMAND VTE registry.

Results: Multivariable logistic regression identified four predictors for mortality: high-risk sPESI, immobilization, coexisting deep vein thrombosis (DVT), and plasma creatinine >2 mg/dL. In the RIETE derivation cohort, the new model classified fewer patients as low risk (4.0% [401/10,106]) compared to the modified sPESI (35% [3522/10,106]). Low-risk patients based on the new model had a lower 30-day mortality than those based on the modified sPESI (1.2% [95% CI, 0.4-2.9%] versus 4.7% [95% CI, 4.0-5.4%]). In the COMMAND VTE validation cohort, 1.5% (3/206) of patients were classified as having low risk of death according to the new model, and the overall 30-day mortality of this group was 0% (95% CI, 0-71%), compared to 5.9% (95% CI, 3.1-10.1%) in the high-risk group.

Conclusions: For predicting short-term mortality among elderly patients with acute PE, this study suggests that the new model has a substantially higher sensitivity than the modified sPESI. A minority of these patients might benefit from safe outpatient therapy of their disease.
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http://dx.doi.org/10.1016/j.ijcard.2021.02.039DOI Listing
July 2021

Estimating and Characterizing COVID-19 Deaths, Puerto Rico, March-July 2020.

Public Health Rep 2021 05 17;136(3):354-360. Epub 2021 Feb 17.

Puerto Rico Department of Health, San Juan, Puerto Rico.

Objectives: Using the Council of State and Territorial Epidemiologists (CSTE) classification guidelines, we characterized coronavirus disease 2019 (COVID-19)-associated confirmed and probable deaths in Puerto Rico during March-July 2020. We also estimated the total number of possible deaths due to COVID-19 in Puerto Rico during the same period.

Methods: We described data on COVID-19-associated mortality, in which the lower bound was the sum of confirmed and probable COVID-19 deaths and the upper bound was excess mortality, estimated as the difference between observed deaths and average expected deaths. We obtained data from the Puerto Rico Department of Health COVID-19 Mortality Surveillance System, the Centers for Disease Control and Prevention's National Electronic Disease Surveillance System Base System, and the National Center for Health Statistics.

Results: During March-July 2020, 225 COVID-19-associated deaths were identified in Puerto Rico (119 confirmed deaths and 106 probable deaths). The median age of decedents was 73 (interquartile range, 59-83); 60 (26.7%) deaths occurred in the Metropolitana region, and 140 (62.2%) deaths occurred among men. Of the 225 decedents, 180 (83.6%) had been hospitalized and 93 (41.3%) had required mechanical ventilation. Influenza and pneumonia (48.0%), sepsis (28.9%), and respiratory failure (27.1%) were the most common conditions contributing to COVID-19 deaths based on death certificates. Based on excess mortality calculations, as many as 638 COVID-19-associated deaths could have occurred during the study period, up to 413 more COVID-19-associated deaths than originally reported.

Conclusions: Including probable deaths per the CSTE guidelines and monitoring all-cause excess mortality can lead to a better estimation of COVID-19-associated deaths and serve as a model to enhance mortality surveillance in other US jurisdictions.
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http://dx.doi.org/10.1177/0033354921991521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7890418PMC
May 2021

The Expanding Digital Divide: Digital Health Access Inequities during the COVID-19 Pandemic in New York City.

J Urban Health 2021 04 20;98(2):183-186. Epub 2021 Jan 20.

Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

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http://dx.doi.org/10.1007/s11524-020-00508-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816740PMC
April 2021

Rare immunofluorescence patterns of autoantibodies on HEp-2 cells defined by ICAP identify different autoimmune diseases in the absence of associated specificities: a Spanish multicentre study.

Rheumatology (Oxford) 2021 Jan 13. Epub 2021 Jan 13.

Servicio Inmunología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander.

Objectives: ANA are the most extensively used test for the diagnosis of systemic autoimmune diseases. However, testing by indirect immunofluorescence assays (IIFAs) on HEp-2 cells, the gold standard test, is time-consuming and needs expertise. Thus there is a trend to replace it with other automated solid-phase assays directed against specific ANA. Nonetheless, the Hep-2 cell is an autoantigen array and ANA have been classified into 29 types, some of them with no clear association with a specificity to be detected. It is especially in these uncommon patterns where no clinical relationship is found and no antigenic specificity is detected. Here we retrospectively collected clinical data from patients with confirmed uncommon HEp-2 IIFA patterns to search for an associated clinical condition.

Methods: We conducted an observational retrospective study including 608 patients with organ-specific and non-organ-specific autoimmune diseases (OSADs and NOSADs, respectively) with a confirmed rare pattern of ANA detected by IIFA on HEp-2 cells in the routine practice of the Spanish European Autoantibodies Standardization Initiative laboratories. Inclusion criteria are the existence of a minimum follow-up of 2 years and the availability of clinical data.

Results: Nuclear patterns were more frequent in SLE (P = 0.001) and SS (P = 0.001), whereas the cytoplasmic ones were significantly higher in SSc (P = 0.022) and inflammatory myositis (P = 0.016). Mitotic patterns did not show any preferences for a specific disease and 62.7% of them corresponded to the nuclear mitotic apparatus pattern (AC-26). The most frequent NOSADs in patients with the AC-26 pattern were SLE (28.6%), SS (11.9%) and RA (11.9%). The cytoplasmic HEp-2 IIFA patterns were equally distributed in both groups of patients. In the OSAD patients there was no predominant pattern, except for AC-6 in primary biliary cholangitis due to Sp-100 antibodies (P < 0.001).

Conclusion: Detection of infrequent ANA might be a unique finding with no disease-associated specificities and could lead to the suspicion of an autoimmune disease.
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http://dx.doi.org/10.1093/rheumatology/keaa831DOI Listing
January 2021

Effect of spray-dried porcine plasma in peripartum sow feed on subsequent litter size.

Porcine Health Manag 2021 Jan 11;7(1):11. Epub 2021 Jan 11.

APC LLC, 2425 SE Oak Tree Court, Ankeny, IA, 50021, USA.

Background: Nutritional strategies for sows designed to reduce peripartum stress are suggested to support postpartum recovery and productivity. Spray-dried plasma (SDP) in sow feed has been reported to benefit sow and litter performance. Stressed animals fed diets with SDP have a more efficient immune response supporting animal recovery and health. The objectives of the present study using 452 sows (147 parity 1 sows, 148 parity 2 sows) were to determine if 0, 0.5 or 2.5% spray-dried porcine plasma (SDPP) in peripartum feed provided from entry in maternity through day 5 of lactation affects sow productivity and serological immune and oxidation status markers around parturition. Post-weaning sow productivity parameters including litter size at the next parturition was evaluated, but peripartum diets were only provided during the first parturition.

Results: In the first parturition, total born litter size was lower (P <  0.05) especially for sows allotted to the peripartum diet with 2.5% SDPP. Percentage of stillborn pigs decreased quadratically (P <  0.05) for sows fed 0.5% or 2.5% SDPP compared to 0% SDPP in peripartum feed and this result was not affected by total born litter size. Serum glutathione peroxidase activity linearly increased (P <  0.01) with increased dietary SDPP for both prepartum and postpartum sampling periods. In the next parturition, total born pigs from combined data of parity 1 and 2 sows linearly increased (P <  0.05) and live born pigs tended (P = 0.09) to linearly increase as level of SDPP increased and this result was not affected by total born litter size in the first parturition. The change in total and live born pigs from the first to the next parturition linearly (P <  0.01) increased as dietary SDPP increased for parity 1 and 2 sows.

Conclusions: The reduced percentage of stillborn pigs and increased litter size of parity 1 and 2 sows in the next parturition was independent of total born litter size in the first parturition suggesting SDPP in peripartum sow feed may have merit for reducing stillborn pigs and benefit litter size in the next parturition for parity 1 and parity 2 sows.
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http://dx.doi.org/10.1186/s40813-020-00180-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7798288PMC
January 2021

Melatonin synthesis in and uptake by mitochondria: implications for diseased cells with dysfunctional mitochondria.

Future Med Chem 2021 Feb 5;13(4):335-339. Epub 2021 Jan 5.

Departamento de Morfología y Biología Celular, Facultad de Medicina, c/JulianClaveria, 6, Oviedo 33006, Spain.

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http://dx.doi.org/10.4155/fmc-2020-0326DOI Listing
February 2021

Design and rationale for ADAPT+: Optimizing an intervention to promote healthy behaviors in rural, Latino youth with obesity and their parents, using mindfulness strategies.

Contemp Clin Trials 2021 02 8;101:106243. Epub 2020 Dec 8.

Hispanic Services Council, Tampa, FL, United States of America.

Latino youth living in rural areas represent an ethnic and geographical minority population at increased risk for obesity and obesity-related complications. We previously modified our child obesity intervention to be a multi-family behavioral intervention, Adaptando Dieta y Acción Para Todos (ADAPT), to better meet the needs of our target population, rural Latino youth with obesity (8-12 years old) and their parents. Recognizing the role of parent stress on obesity, the main goal of this study is to 1) further refine and optimize the original ADAPT multi-family behavioral obesity intervention protocol to include mindfulness parent stress reduction strategies (now called ADAPT+) and then 2) assess the feasibility of ADAPT+ implementation via a small randomized control trial (RCT) with rural Latino families. Two aims guide the study. For Aim 1 we conduct a series of focus groups with stakeholders and parents, and then conduct a one-arm trial with both parents and their children to obtain feedback for further refining each of our eight integrated ADAPT+ sessions. Aim 2 tests the acceptability and feasibility of our intervention with multi-family groups of Latinos in two rural communities over time (pre-intervention, post-intervention, 3-month follow-up) in a randomized pilot trial (ADAPT+ vs. Enhanced Usual Care [EUC] comparison). This study is intended to set the groundwork for a larger clinical trial to test ADAPT+'s efficacy to improve rural Latino families' eating and physical activity behaviors.
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http://dx.doi.org/10.1016/j.cct.2020.106243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954907PMC
February 2021

Incidence of VTE and Bleeding Among Hospitalized Patients With Coronavirus Disease 2019: A Systematic Review and Meta-analysis.

Chest 2021 03 17;159(3):1182-1196. Epub 2020 Nov 17.

CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain; Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Universidad Católica de Murcia, Murcia, Spain.

Background: Individual studies have reported widely variable rates for VTE and bleeding among hospitalized patients with coronavirus disease 2019 (COVID-19).

Research Question: What is the incidence of VTE and bleeding among hospitalized patients with COVID-19?

Methods: In this systematic review and meta-analysis, 15 standard sources and COVID-19-specific sources were searched between January 1, 2020, and July 31, 2020, with no restriction according to language. Incidence estimates were pooled by using random effects meta-analyses. Heterogeneity was evaluated by using the I statistic, and publication bias was assessed by using the Begg and Egger tests.

Results: The pooled incidence was 17.0% (95% CI, 13.4-20.9) for VTE, 12.1% (95% CI, 8.4-16.4) for DVT, 7.1% (95% CI, 5.3-9.1) for pulmonary embolism (PE), 7.8% (95% CI, 2.6-15.3) for bleeding, and 3.9% (95% CI, 1.2-7.9) for major bleeding. In subgroup meta-analyses, the incidence of VTE was higher when assessed according to screening (33.1% vs 9.8% by clinical diagnosis), among patients in the ICU (27.9% vs 7.1% in the ward), in prospective studies (25.5% vs 12.4% in retrospective studies), and with the inclusion of catheter-associated thrombosis/isolated distal DVTs and isolated subsegmental PEs. The highest pooled incidence estimate of bleeding was reported for patients receiving intermediate- or full-dose anticoagulation (21.4%) and the lowest in the only prospective study that assessed bleeding events (2.7%).

Interpretation: Among hospitalized patients with COVID-19, the overall estimated pooled incidence of VTE was 17.0%, with higher rates with routine screening, inclusion of distal DVT, and subsegmental PE, in critically ill patients and in prospective studies. Bleeding events were observed in 7.8% of patients and were sensitive to use of escalated doses of anticoagulants and nature of data collection. Additional studies are required to ascertain the significance of various thrombotic events and to identify strategies to improve patient outcomes.

Trial Registry: PROSPERO; No.: CRD42020198864; URL: https://www.crd.york.ac.uk/prospero/.
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http://dx.doi.org/10.1016/j.chest.2020.11.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670889PMC
March 2021

Preventive Efficacy of Tenofovir/Emtricitabine Against Severe Acute Respiratory Syndrome Coronavirus 2 Among Pre-Exposure Prophylaxis Users.

Open Forum Infect Dis 2020 Nov 25;7(11):ofaa455. Epub 2020 Sep 25.

Centro Sanitario Sandoval, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain.

Background: The preventive effect that tenofovir/emtricitabine (FTC) could have against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in human immunodeficiency virus-negative people is unknown. The objective of this study was to analyze the seroprevalence and clinical manifestations of COVID-19 among users of pre-exposure prophylaxis (PrEP), disoproxil fumarate/FTC (TDF/FTC), or tenofovir alafenamide (TAF)/FTC and to compare it to that of a control group.

Methods: An observational descriptive study of the seroprevalence of antibodies for SARS-CoV-2 among men who have sex with men and transgender women without use of PrEP (Group 1; n = 250) and PrEP users with TDF/FTC (n = 409) or TAF/FTC (n = 91) (Group 2; n = 500) was conducted from May11, 2020 to June 27, 2020. All participants were provided with a structured questionnaire that collected information on the variables to be analyzed, and testing for immunoglobulin G antibodies to SARS-CoV-2 (chemiluminescent microparticle immunoassay) was then carried out.

Results: The seroprevalence of SARS-CoV-2 was 9.2% (95% confidence interval [CI], 5.9-13.5) in the group without PrEP and 15.0% (95% CI, 12.0-18.4) in the group with PrEP ( = .026). Among users of TDF/FTC it was 14.7% (95% CI, 11.4-18.5), and in users of TAF/FTC it was 16.5% (95% CI, 9.5-25.7) ( = .661). In those who tested positive for SARS-CoV-2 and receiving PrEP, 57.4% manifested symptoms, compared with 78.3% in the control group ( = .070). In users of TDF/FTC the figure was 53.3% and in users of TAF/FTC the figure was 73.3% ( = .100). The duration of symptoms was 11.5 days in the control group, 9.0 days in PrEP users ( = .116), 7.0 days in users of TDF/FTC, and 13.0 days in users of TAF/FTC ( = .100).

Conclusions: Users of PrEP, TDF/FTC, or TAF/FTC presented a higher seroprevalence to SARS-CoV-2 than the control group. No statistically significant differences were found in relation to clinical manifestations. The PrEP users should use the same prevention measures as those indicated for the general population.
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http://dx.doi.org/10.1093/ofid/ofaa455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543639PMC
November 2020

Prognostic significance of computed tomography-assessed right ventricular enlargement in low-risk patients with pulmonary embolism: Systematic review and meta-analysis.

Thromb Res 2021 01 5;197:48-55. Epub 2020 Nov 5.

Respiratory Department, Ramón y Cajal Hospital and Alcala de Henares University, IRYCIS, Madrid, Spain; Medicine Department, Alcala de Henares University, IRYCIS, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. Electronic address:

Background: For patients with acute low-risk pulmonary embolism (PE), determined by a validated clinical prognostic score, the additive prognostic significance of computed tomography (CT)-assessed right ventricular (RV) enlargement is uncertain.

Methods: We performed a systematic review and meta-analysis of studies that enrolled patients with acute low-risk PE to assess the prognostic value of concomitant CT-assessed RV enlargement for 30-day all-cause mortality and PE-related death. We conducted unrestricted searches of PubMed and Embase through December 2019. We used a random-effects model to pool study results; Begg rank correlation method to evaluate for publication bias; and I testing to assess for heterogeneity.

Results: Of the 7 cohorts with 2197 participants who had low-risk PE and provided results on the primary outcome, 743 (34%; 95% confidence interval [CI], 32-36%) patients had concomitant RV enlargement. Six of 743 (0.8%; 95% CI, 0.3-1.8%) patients with concomitant RV enlargement died 30-days after the diagnosis of PE compared with 3 of 1454 (0.2%, 95% CI, 0-0.6%) without RV enlargement. CT-assessed RV enlargement did not have a significant association with 30-day all-cause mortality (odds ratio [OR], 2.6; 95% CI, 0.7-9.4; I = 0%; P = 0.15) or PE-related mortality (OR, 2.8; 95% CI, 0.7-12.1; I = 0%; P = 0.16).

Conclusions: CT-assessed RV enlargement occurs in a third of PE patients identified as low-risk by clinical scores. Mortality rate in these patients is low, and CT-assessed RV enlargement was not associated with a significantly increased risk of death within 30 days of PE diagnosis.
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http://dx.doi.org/10.1016/j.thromres.2020.10.034DOI Listing
January 2021

Differential epigenetic regulation between the alternative promoters, PRDM1α and PRDM1β, of the tumour suppressor gene PRDM1 in human multiple myeloma cells.

Sci Rep 2020 09 28;10(1):15899. Epub 2020 Sep 28.

Unidad de Investigación, Hospital Universitario Puerta del Mar, Avenida Ana de Viya 21, 11009, Cádiz, Spain.

Multiple myeloma (MM) is a B-cell neoplasm that is characterized by the accumulation of malignant plasma cells in the bone marrow. The transcription factor PRDM1 is a master regulator of plasma cell development and is considered to be an oncosuppressor in several lymphoid neoplasms. The PRDM1β isoform is an alternative promoter of the PRDM1 gene that may interfere with the normal role of the PRDM1α isoform. To explain the induction of the PRDM1β isoform in MM and to offer potential therapeutic strategies to modulate its expression, we characterized the cis regulatory elements and epigenetic status of its promoter. We observed unexpected patterns of hypermethylation and hypomethylation at the PRDM1α and PRDM1β promoters, respectively, and prominent H3K4me1 and H3K9me2 enrichment at the PRDM1β promoter in non-expressing cell lines compared to PRDM1β-expressing cell lines. After treatment with drugs that inhibit DNA methylation, we were able to modify the activity of the PRDM1β promoter but not that of the PRDM1α promoter. Epigenetic drugs may offer the ability to control the expression of the PRDM1α/PRDM1β promoters as components of novel therapeutic approaches.
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http://dx.doi.org/10.1038/s41598-020-72946-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522722PMC
September 2020

Differences in the Loin Tenderness of Iberian Pigs Explained through Dissimilarities in Their Transcriptome Expression Profile.

Animals (Basel) 2020 Sep 22;10(9). Epub 2020 Sep 22.

Departamento de Mejora Genética Animal, INIA, 28040 Madrid, Spain.

Tenderness is one of the most important meat quality traits and it can be measured through shear force with the Warner-Bratzler test. In the current study, we use the RNA-seq technique to analyze the transcriptome of (LD) muscle in two groups of Iberian pigs (Tough and Tender) divergent for shear force breeding values. We identified 200 annotated differentially expressed genes (DEGs) and 245 newly predicted isoforms. The RNAseq expression results of 10 genes were validated with quantitative PCR (qPCR). Functional analyses showed an enrichment of DE genes in biological processes related to proteolysis (, , , , , , and ), skeletal muscle tissue development (, , and ), lipid metabolism ( and ) and collagen metabolism (). The upstream analysis revealed a total of 11 transcription regulatory factors that could regulate the expression of some DEGs. Among them, IGF1, VGLL3 and PPARG can be highlighted since they regulate the expression of genes involved in biological pathways that could affect tenderness. The experiment revealed a set of candidate genes and regulatory factors suggestive to search polymorphisms that could be incorporated in a breeding program for improving meat tenderness.
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http://dx.doi.org/10.3390/ani10091715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7552750PMC
September 2020

Independent and joint cross-sectional associations of statin and metformin use with mammographic breast density.

Breast Cancer Res 2020 09 15;22(1):99. Epub 2020 Sep 15.

Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, USA.

Background: Well-tolerated and commonly used medications are increasingly assessed for reducing breast cancer risk. These include metformin and statins, both linked to reduced hormone availability and cell proliferation or growth and sometimes prescribed concurrently. We investigated independent and joint associations of these medications with mammographic breast density (MBD), a useful biomarker for the effect of chemopreventive agents on breast cancer risk.

Methods: Using data from a cross-sectional study of 770 women (78% Hispanic, aged 40-61 years, in a mammography cohort with high cardiometabolic burden), we examined the association of self-reported "ever" use of statins and metformin with MBD measured via clinical Breast Imaging Reporting and Data System (BI-RADS) density classifications (relative risk regression) and continuous semi-automated percent and size of dense area (Cumulus) (linear regression), adjusted for age, body mass index, education, race, menopausal status, age at first birth, and insulin use.

Results: We observed high statin (27%), metformin (13%), and combination (9%) use, and most participants were overweight/obese (83%) and parous (87%). Statin use was associated with a lower likelihood of high density BI-RADS (RR = 0.60, 95% CI = 0.45 to 0.80), percent dense area (PD) (β = - 6.56, 95% CI = - 9.05 to - 4.06), and dense area (DA) (β = - 9.05, 95% CI = - 14.89 to - 3.22). Metformin use was associated with lower PD and higher non-dense area (NDA), but associations were attenuated by co-medication with statins. Compared to non-use of either medication, statin use alone or with metformin were associated with lower PD and DA (e.g., β = - 6.86, 95% CI: - 9.67, - 4.05 and β = - 7.07, 95% CI: - 10.97, - 3.17, respectively, for PD) and higher NDA (β = 25.05, 95% CI: 14.06, 36.03; β = 29.76, 95% CI: 14.55, 44.96, respectively).

Conclusions: Statin use was consistently associated with lower MBD, measured both through clinical radiologist assessment and continuous relative and absolute measures, including dense area. Metformin use was associated with lower PD and higher NDA, but this may be driven by co-medication with statins. These results support that statins may lower MBD but need confirmation with prospective and clinical data to distinguish the results of medication use from that of disease.
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http://dx.doi.org/10.1186/s13058-020-01336-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7493153PMC
September 2020

Persistent HIV-controllers are more prone to spontaneously clear HCV: a retrospective cohort study.

J Int AIDS Soc 2020 09;23(9):e25607

Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva. Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain.

Introduction: HIV-controllers have the ability to spontaneously maintain viraemia at low or undetectable levels in the absence of antiretroviral treatment. Furthermore, HIV-controllers seem to have a superior capacity to spontaneously clear hepatitis C virus (HCV) compared to non HIV-controllers. Some of these subjects eventually lose HIV-controller status (transient controllers), whereas some HIV-controllers show a persistent natural HIV control (persistent controllers). We aimed to analyse whether persistent controllers have superior capacity to spontaneously clear HCV compared to transient controllers.

Methods: We recruited HIV-controllers from January 1981 up to October 2016 with available antibodies to HCV (anti-HCV) data (n = 744). Factors associated with HIV spontaneous control in relation to HCV status were analysed in persistent and transient HIV-controllers with anti-HCV positive (n = 202 and n = 138 respectively) in comparison with 1700 HCV positive non HIV-controllers recruited from January 1981 up to March 2018, bivariate and multivariate analyses, following a logistic regression model, were applied. In addition, the factors related to the loss and time to lose HIV-controller status were explored (n = 744) using Log rank test and Kaplan-Meier curves, in this case the multivariate analysis consisted in a Cox regression model.

Results: A higher frequency of HCV spontaneous clearance was found in persistent HIV-controllers (25.5%) compared to non-controllers (10.2%). After adjusting for potential confounders, as sex, age, HIV transmission risk, CD4 T-cell nadir and time of follow-up, HCV clearance was independently associated with persistent HIV spontaneous control (p = 0.002; OR (95% CI) = 2.573 (1.428 to 4.633)), but not with transient spontaneous control (p = 0.119; 1.589 (0.888 to 2.845)). Furthermore, persistent HIV-controllers were more likely to spontaneously clear the HCV in comparison with transient controllers (p = 0.027; 0.377 (0.159 to 0.893). Finally, not to lose or lengthen the time of losing this control was independently associated with HCV spontaneous clearance (p = 0.010; 0.503 (0.297 to 0.850).

Conclusions: This study shows an association between spontaneous persistent HIV-control and HCV spontaneous clearance. The study findings support the idea of preserved immune mechanisms in persistent HIV control implicated in HCV spontaneous clearance. These results highlight persistent HIV-controllers but not transient controllers as a good model of functional HIV cure.
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http://dx.doi.org/10.1002/jia2.25607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507465PMC
September 2020

Genetic parameter estimation and gene association analyses for meat quality traits in open-air free-range Iberian pigs.

J Anim Breed Genet 2020 Nov 6;137(6):581-598. Epub 2020 Aug 6.

Centro de I+D en Cerdo Ibérico, INIA, Zafra, Spain.

Meat quality of Iberian pigs is defined by the combination of their genetic characteristics and the particular production system. To carry out a genetic analysis of the main meat quality traits, we estimated their heritabilities, genetic correlations and the association effects of 32 selected SNPs of 12 candidate genes. A total of ten traits were measured in longissimus dorsi samples from 1,199 Iberian pigs fattened in the traditional free-range system: water holding capacity (thawing, cooking and centrifuge force water losses), instrumental colour (lightness L*, redness a* and yellowness b*), myoglobin content, shear force on cooked meat, and shear force and maximum compression force on dry-cured loin. Estimated heritability values were low to moderate (0.01 to 0.43) being the lowest for L* and the highest for cooking loss. Strong genetic correlations between water holding capacity traits (0.93 to 0.96) and between myoglobin content and a* (0.94) were observed. The association analyses revealed 19 SNPs significantly associated with different traits. Consistent and strong effects were observed between PRKAG3 SNPs (rs319678464G > C and rs330427832C > T), MYH3_rs81437544T > C, CASP3_rs319658214G > T and CTSL_rs332171512A > G and water losses. Also for CAPN1_rs81358667G > A and CASP3_rs319658214G > T and shear force. The SNPs mapping on PRKAG3 showed the highest effects on Minolta colour traits. Genotyping of these SNPs could be useful for the selection of Iberian young boars with similar estimated breeding values for productive traits.
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http://dx.doi.org/10.1111/jbg.12498DOI Listing
November 2020

Low Growth Sensitivity and Fast Replenishment of Non-structural Carbohydrates in a Long-Lived Endangered Conifer After Drought.

Front Plant Sci 2020 3;11:905. Epub 2020 Jul 3.

Centro de Investigación en Ecosistemas de la Patagonia, Coyhaique, Chile.

There is an ongoing debate on whether a drought induced carbohydrate limitation (source limitation) or a direct effect of water shortage (sink limitation) limit growth under drought. In this study, we investigated the effects of the two driest summers recorded in southern Chile in the last seven decades, on the growth and non-structural carbohydrates (NSC) concentrations of the slow-growing conifer . Specifically, we studied the seasonal variation of NSC in saplings and adults one and two years after the occurrence of a 2 year-summer drought at two sites of contrasting precipitation and productivity (mesic-productive vs. rainy-less productive). We also evaluated radial growth before, during and after the drought, and predicted that drought could have reduced growth. If drought caused C source limitation, we expected that NSCs will be lower during the first than the second year after drought. Conversely, similar NSC concentrations between years or higher NSC concentrations in the first year would be supportive of sink limitation. Also, due to the lower biomass of saplings compared with adults, we expected that saplings should experience stronger seasonal NSC remobilization than adults. We confirmed this last expectation. Moreover, we found no significant growth reduction during drought in the rainy site and a slightly significant growth reduction at the mesic site for both saplings and adults. Across organs and in both sites and age classes, NSC, starch, and sugar concentrations were generally higher in the first than in the second year following drought, while NSC seasonal remobilization was generally lower. Higher NSC concentrations along with lower seasonal NSC remobilization during the first post-drought year are supportive of sink limitation. However, as these results were found at both sites while growth decreased slightly and just at the mesic site, limited growth only is unlikely to have caused NSC accumulation. Rather, these results suggest that the post-drought dynamics of carbohydrate storage are partly decoupled from the growth dynamics, and that the rebuild of C reserves after drought may be a priority in this species.
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http://dx.doi.org/10.3389/fpls.2020.00905DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7357304PMC
July 2020

Regulation of cancer cell glucose metabolism is determinant for cancer cell fate after melatonin administration.

J Cell Physiol 2021 Jan 29;236(1):27-40. Epub 2020 Jul 29.

Department of Morphology and Cell Biology, Faculty of Medicine, University of Oviedo, Oviedo, Spain.

Several oncogenic pathways plus local microenvironmental conditions, such as hypoxia, converge on the regulation of cancer cells metabolism. The major metabolic alteration consists of a shift from oxidative phosphorylation as the major glucose consumer to aerobic glycolysis, although most of cancer cells utilize both pathways to a greater or lesser extent. Aerobic glycolysis, together with the directly related metabolic pathways such as the tricarboxylic acid cycle, the pentose phosphate pathway, or gluconeogenesis are currently considered as therapeutic targets in cancer research. Melatonin has been reported to present numerous antitumor effects, which result in a reduced cell growth. This is achieved with both low and high concentrations with no relevant side effects. Indeed, high concentrations of this indolamine reduce proliferation of cancer types resistant to low concentrations and induce cell death in some types of tumors. Previous work suggest that regulation of glucose metabolism and other related pathways play an important role in the antitumoral effects of high concentration of melatonin. In the present review, we analyze recent work on the regulation by such concentrations of this indolamine on aerobic glycolysis, gluconeogenesis, the tricarboxylic acid cycle and the pentose phosphate pathways of cancer cells.
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http://dx.doi.org/10.1002/jcp.29886DOI Listing
January 2021

High-Risk Sexual Practices Contribute to HIV-1 Double Infection Among Men Who Have Sex with Men in Madrid.

AIDS Res Hum Retroviruses 2020 11 19;36(11):896-904. Epub 2020 Aug 19.

Unidad de Virología Molecular, Laboratorio de Referencia e Investigación en Retrovirus, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.

Data on the prevalence of double infection (DI) in HIV individuals are lacking in Spain. To fill this gap, we analyzed the prevalence of DI in a cohort of men who have sex with men (MSM) and examined factors contributing to DI. We selected 81 MSM attending Centro Sanitario Sandoval, a sexually transmitted diseases clinic in Madrid. We obtained by ultra-deep sequencing the proviral sequences in and genes and performed a phylogenetic analysis for the identification of DI. Clinical, behavioral, host, and viral factors were studied for its association with DI. We detected six individuals with DI and one case of superinfection with a global prevalence of 8.6%. The genetic distance among the subtype B viruses in monoinfected individuals (24.4%) was lower than the distance between the two viruses in subtype B DI individuals (29.5%). Individuals with a high number of sexual contacts (>25 partners/year) had an 8.66 times higher risk of DI ( = .017). In this MSM cohort the prevalence of HIV DI was estimated at 8.6%. DI was strongly associated with the number of sexual partners. Because of the pathogenic consequences of HIV DI, this high prevalence should promote public health programs targeted at high-risk population such as MSM for the control of HIV infection and DI. HIV DI should be considered for a better clinical management of these individuals.
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http://dx.doi.org/10.1089/AID.2020.0068DOI Listing
November 2020

Commercial feed containing porcine plasma spiked with African swine fever virus is not infective in pigs when administered for 14 consecutive days.

PLoS One 2020 22;15(7):e0235895. Epub 2020 Jul 22.

APC EUROPE S.L.U., Granollers, Barcelona, Spain.

The objective of this study was to determine if commercially collected liquid porcine plasma contaminated with African swine fever virus (ASFV) and fed for 14 consecutive days would infect pigs. Commercially collected liquid porcine plasma was mixed with the serum from an ASFV experimentally infected pig. To simulate the potential of pigs slaughtered being ASFV viremic but asymptomatic and passing antemortem inspection, the ratio of liquid plasma from healthy animals to serum from an ASFV infected pig used in this study represented 0.4% or 2.0% of the pigs slaughtered being viremic (Studies 1 or 2, respectively). The contaminated liquid plasma was mixed on commercial feed and pigs were fed for 14 consecutive days providing to each pig 104.3 or 105.0 TCID50 ASFV daily (Studies 1 or 2, respectively). Pigs were observed for an additional 5 or 9 days (Studies 1 or 2, respectively). In both experiments, the pigs did not become infected with ASFV during the 14d feeding period or during the subsequent observation period. In these experiments, unprocessed liquid plasma contaminated with ASFV mixed on commercial feed and fed for 14 consecutive days did not infect pigs. From our results we can conclude that the infectious dose of ASFV on feed is much higher than that previously reported, at least with ASFV-spiked raw plasma.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235895PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7375527PMC
September 2020

Biosafety steps in the manufacturing process of spray-dried plasma: a review with emphasis on the use of ultraviolet irradiation as a redundant biosafety procedure.

Porcine Health Manag 2020 16;6:16. Epub 2020 Jul 16.

APC EUROPE, S.L., Avda, Sant Julià 246-258, Pol. Ind. El Congost, E-08403 Granollers, Spain.

Spray dried plasma (SDP) is a functional protein source obtained from blood of healthy animals, approved by the veterinary authorities from animals declared to be fit for slaughter for human consumption. Blood of these animals is collected at the slaughterhouse, treated with an anticoagulant, chilled and transported to industrial facilities in which blood is centrifuged to separate the red blood cells from the plasma fraction. Plasma is then concentrated, and spray dried at high temperatures (80 °C throughout its substance) to convert it in a powder. Such method preserves the biological activity of its proteins, mainly albumins and globulins. SDP is mainly used in pig feed diets to significantly improve daily gain, feed intake, production efficiency, and to reduce post-weaning lag caused by the appearance of post-weaning diarrhea. Although SDP is considered a safe product and its manufacturing process consists of several biosafety steps, the security of the SDP is often questioned due to its nature as raw blood by-product, especially when emergent or re-emergent pathogens appear. This review provides an evaluation and validation of the different safety steps present in the manufacturing process of SDP, with special focus on a new redundant pathogen inactivation step, the UV-C irradiation, that may be implemented in the manufacturing process of the SDP. Overall results showed that the manufacturing process of SDP is safe and the UV-C radiation was effective in inactivating a wide range of bacteria and viruses spiked and naturally present in commercially collected liquid animal plasma and it can be implemented as a redundant biosafety step in the manufacturing process of the SDP.
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http://dx.doi.org/10.1186/s40813-020-00155-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363457PMC
July 2020

[Ready-to-use parenteral nutrition in a preterm infant with necrotizing enterocolitis and related complications: case report].

Recenti Prog Med 2020 Jun;111(6):13e-16e

UOC di Neonatologia e TIN, Ospedale dei Bambini, ASST Spedali Civili, Brescia.

Introduction: Necrotizing enterocolitis (NEC) is a very aggressive, destructive and sometimes lethal disease, which mainly affects infants born with severe prematurity. These patients need a complex multidisciplinary approach. The clinical course is often long and complicated, and nutritional approach should ensure a balance between the need for nutrients and the risk of complications.

Clinical Case: We describe the case of a preterm female infant born at 24 weeks and 5 days of gestational age transferred to our intensive care unit for NEC complicated with intestinal perforation. Subsequently, she developed short bowel syndrome. In terms of nutrition, the baby was treated with the use of standard parenteral nutrition (PN) solutions for preterm infants, which were prescribed immediately after passing the critical and metabolically unstable phase of disease. It was possible to use these standard PN solutions also during a period of cholestasis and after the hospital discharge.

Conclusions: The use of ready-to-use bags with standard solutions for PN in preterm infants complicated with surgical pathology is possible, feasible, safe and effective; it is recommendable to perform periodic clinical and laboratory evaluations.
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http://dx.doi.org/10.1701/3394.33767DOI Listing
June 2020

Developing Adaptando Dieta Y Acción Para Todos (ADAPT): An Intervention to Improve Healthy Lifestyle Behaviors Among Latino Parents and Children Living in Rural Communities.

J Immigr Minor Health 2021 Feb;23(1):88-94

College of Nursing, University of South Florida, Tampa, FL, USA.

Latino migrant farmworkers are at great risk of obesity and its concomitant negative health impacts. Obesity interventions for this underserved, minority population are limited. We expanded upon our prior intervention work in childhood obesity to develop a multi-family, behavioral intervention, ADAPT. We conducted three phases in the development of the ADAPT program: Phase 1, a needs assessment, Phase 2, in-depth focus groups with Latino parents, their children, and stakeholders, and Phase 3, a feasibility and acceptability trial to inform program optimization. Acceptability and feasibility of ADAPT promoting healthier eating and physical activity behaviors was found. Each phase of the project led to implementation changes to ADAPT, resulting in greater intervention optimization. Participants reported key facilitators and barriers to our intervention, expressing great interest in participation. They particularly liked our mindfulness session. We are currently examining the feasibility of integrating mindfulness to optimize ADAPT efficacy.
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http://dx.doi.org/10.1007/s10903-020-01037-yDOI Listing
February 2021