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Cummings AD, Van Horne B, Correa N, Schwarzwald H, Chapman S. Can Pediatric Primary Care Practices Afford Integrated Behavioral Health? A Comparison of 5 Pediatric Practices. Clin Pediatr (Phila) 2022; 61:850-858. [PMID: 35773977 DOI: 10.1177/00099228221106621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Licensed behavioral health providers (LBHPs) were integrated into 5 pediatric primary care practices in southeast and east Texas from October 2018 through March 2020. LBHPs Licensed behavioral health providers across the sites were 3 licensed clinical social workers (LCSW), 1 psychologist, and 1 nurse practitioner (NP). Practices provided data for 6 to 15 months. Overall, 2769 units of behavioral health services were provided to 746 children over 2243 hours. Across 4 sites, 44.3% of behavioral health patients were diagnosed with trauma disorders, 22.1% with anxiety, 19.3% with attention-deficit hyperactivity disorder, 15.1% with depression, and 10.9% with disruptive behavior disorders. Overall, the model was financially successful at 2 sites (LCSWs) and unsuccessful at 1 site (NP). The other 2 sites demonstrated potential for financial sustainability with increased behavioral health patient volume. Overall, this model is a financially viable option for pediatric primary care practices with adequate patient volumes to provide integrated behavioral health services.
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Affiliation(s)
- A D Cummings
- Public Health Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - B Van Horne
- Public Health Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - N Correa
- Public Health Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - H Schwarzwald
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - S Chapman
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Department of Psychology, Texas Children's Hospital, Houston, TX, USA
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Alabi AS, Picka SW, Sirleaf R, Ntirenganya PR, Ayebare A, Correa N, Anyango S, Ekwen G, Agu E, Cook R, Yarngrorble J, Sanoe I, Dugulu H, Wiefue E, Gahn-Smith D, Kateh FN, Hallie EF, Sidonie CG, Aboderin AO, Vassellee D, Bishop D, Lohmann D, Naumann-Hustedt M, Dörlemann A, Schaumburg F. Implementation of an antimicrobial stewardship programme in three regional hospitals in the south-east of Liberia: lessons learned. JAC Antimicrob Resist 2022; 4:dlac069. [PMID: 35769809 PMCID: PMC9226657 DOI: 10.1093/jacamr/dlac069] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/06/2022] [Indexed: 11/14/2022] Open
Abstract
Background Antimicrobial stewardship (AMS) programmes can improve the use of antimicrobial agents. However, there is limited experience in the implementation of such programmes in low- and middle-income countries (LMICs). Objectives To assess the effect of AMS measures in south-east Liberia on the quality of antimicrobial use in three regional hospitals. Methods A bundle of three measures (local treatment guideline, training and regular AMS ward rounds) was implemented and quality indicators of antimicrobial use (i.e. correct compounds, dosage and duration) were assessed in a case series before and after AMS ward rounds. Primary endpoints were (i) adherence to the local treatment guideline; (ii) completeness of the microbiological diagnostics (according to the treatment guideline); and (iii) clinical outcome. The secondary endpoint was reduction in ceftriaxone use. Results The majority of patients had skin and soft tissue infections (n = 108) followed by surgical site infections (n = 72), pneumonia (n = 64), urinary tract infection (n = 48) and meningitis (n = 18). After the AMS ward rounds, adherence to the local guideline improved for the selection of antimicrobial agents (from 34.5% to 61.0%, P < 0.0005), dosage (from 15.2% to 36.5%, P < 0.0005) and duration (from 13.2% to 31.0%, P < 0.0005). In total, 79.7% of patients (247/310) had samples sent for microbiological analysis. Overall, 92.3% of patients improved on Day 3 (286/310). The proportion of patients receiving ceftriaxone was significantly reduced after the AMS ward rounds from 51.3% to 14.2% (P < 0.0005). Conclusions AMS measures can improve the quality of antimicrobial use in LMICs. However, long-term engagement is necessary to make AMS programmes in LMICs sustainable.
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Affiliation(s)
- Abraham S Alabi
- Health Focus GmbH, Friedrich-Ebert-Straße 33, 14469 Potsdam, Germany
| | - Stephen W Picka
- Health Focus GmbH, Friedrich-Ebert-Straße 33, 14469 Potsdam, Germany
| | - Reubvera Sirleaf
- Health Focus GmbH, Friedrich-Ebert-Straße 33, 14469 Potsdam, Germany
| | | | - Arnold Ayebare
- Partners In Health, Sophie Road Oldest, Congo Town, Monrovia, Liberia
| | | | - Sarah Anyango
- Partners In Health, Sophie Road Oldest, Congo Town, Monrovia, Liberia
| | - Gerald Ekwen
- Partners In Health, Sophie Road Oldest, Congo Town, Monrovia, Liberia
| | - Emmanuel Agu
- Ministry of Health, Capitol Bye-Pass, Monrovia, Liberia
| | - Rebecca Cook
- Partners In Health, Sophie Road Oldest, Congo Town, Monrovia, Liberia
| | | | - Ibrahim Sanoe
- Ministry of Health, Capitol Bye-Pass, Monrovia, Liberia
| | - Henry Dugulu
- Ministry of Health, Capitol Bye-Pass, Monrovia, Liberia
| | | | | | | | | | | | | | - David Vassellee
- German Corporation for International Cooperation, GIZ, Tubman Boulevard, Congo Town, Monrovia, Liberia
| | - Damien Bishop
- German Corporation for International Cooperation, GIZ, Tubman Boulevard, Congo Town, Monrovia, Liberia
| | - Daniel Lohmann
- German Corporation for International Cooperation, GIZ, Tubman Boulevard, Congo Town, Monrovia, Liberia
| | | | - Alois Dörlemann
- Health Focus GmbH, Friedrich-Ebert-Straße 33, 14469 Potsdam, Germany
| | - Frieder Schaumburg
- Institute of Medical Microbiology, University of Münster, Münster, Germany
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Correa N, Cerquides J, Arcos J, Vassena R. Supporting first FSH dosage for ovarian stimulation with Machine Learning. Reprod Biomed Online 2022; 45:1039-1045. [DOI: 10.1016/j.rbmo.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/21/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022]
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Roa D, Leon S, Paucar O, Gonzales A, Schwarz B, Olguin E, Moskvin V, Alva-Sanchez M, Glassell M, Correa N, Moyses H, Shankar A, Hamrick B, Sarria GR, Li B, Tajima T, Necas A, Guzman C, Challco R, Montoya M, Meza Z, Zapata M, Gonzales A, Marquez F, Neira R, Vilca W, Mendez J, Hernandez J. Monte Carlo simulations and phantom validation of low-dose radiotherapy to the lungs using an interventional radiology C-arm fluoroscope. Phys Med 2021; 94:24-34. [PMID: 34979431 DOI: 10.1016/j.ejmp.2021.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/30/2021] [Accepted: 12/27/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To use MC simulations and phantom measurements to investigate the dosimetry of a kilovoltage x-ray beam from an IR fluoroscope to deliver low-dose (0.3-1.0 Gy) radiotherapy to the lungs. MATERIALS AND METHODS PENELOPE was used to model a 125 kV, 5.94 mm Al HVL x-ray beam produced by a fluoroscope. The model was validated through depth-dose, in-plane/cross-plane profiles and absorbed dose at 2.5-, 5.1-, 10.2- and 15.2-cm depths against the measured beam in an acrylic phantom. CT images of an anthropomorphic phantom thorax/lungs were used to simulate 0.5 Gy dose distributions for PA, AP/PA, 3-field and 4-field treatments. DVHs were generated to assess the dose to the lungs and nearby organs. Gafchromic film was used to measure doses in the phantom exposed to PA and 4-field treatments, and compared to the MC simulations. RESULTS Depth-dose and profile results were within 3.2% and 7.8% of the MC data uncertainty, respectively, while dose gamma analysis ranged from 0.7 to 1.0. Mean dose to the lungs were 1.1-, 0.8-, 0.9-, and 0.8- Gy for the PA, AP/PA, 3-field, and 4-field after isodose normalization to cover ∼ 95% of each lung volume. Skin dose toxicity was highest for the PA and lowest for the 4-field, and both arrangements successfully delivered the treatment on the phantom. However, the dose distribution for the PA was highly non-uniform and produced skin doses up to 4 Gy. The dose distribution for the 4-field produced a uniform 0.6 Gy dose throughout the lungs, with a maximum dose of 0.73 Gy. The average percent difference between experimental and Monte Carlo values were -0.1% (range -3% to +4%) for the PA treatment and 0.3% (range -10.3% to +15.2%) for the 4-field treatment. CONCLUSION A 125 kV x-ray beam from an IR fluoroscope delivered through two or more fields can deliver an effective low-dose radiotherapy treatment to the lungs. The 4-field arrangement not only provides an effective treatment, but also significant dose sparing to healthy organs, including skin, compared to the PA treatment. Use of fluoroscopy appears to be a viable alternative to megavoltage radiation therapy equipment for delivering low-dose radiotherapy to the lungs.
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Affiliation(s)
- D Roa
- Department of Radiation Oncology, University of California, Irvine Health, Orange, CA 92868, USA.
| | - S Leon
- Department of Radiology, University of Florida, Gainesville, FL 32610, USA
| | - O Paucar
- Facultad de Ingenieria Electrica y Electronica, Universidad Nacional de Ingenieria, Lima, Peru
| | - A Gonzales
- Facultad de Ciencias, Universidad Nacional de Ingenieria, Lima, Peru
| | - B Schwarz
- Department of Radiology, University of Florida, Gainesville, FL 32610, USA
| | - E Olguin
- Department of Radiology, University of Florida, Gainesville, FL 32610, USA
| | - V Moskvin
- Department of Radiation Oncology, St. Judes Children's Research Hospital, Memphis, TN 38105, USA
| | - M Alva-Sanchez
- Department of Exact and Applied Sciences, University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - M Glassell
- Department of Radiology, University of Florida, Gainesville, FL 32610, USA
| | - N Correa
- Department of Radiology, University of Florida, Gainesville, FL 32610, USA
| | - H Moyses
- Department of Radiation Oncology, University of California, Irvine Health, Orange, CA 92868, USA
| | - A Shankar
- Department of Radiology, University of Florida, Gainesville, FL 32610, USA
| | - B Hamrick
- Environmental Health and Safety, University of California, Irvine Health, Orange, CA 92868, USA
| | - G R Sarria
- University Hospital Bonn, Department of Radiation Oncology, University of Bonn, Bonn, Germany
| | - B Li
- Department of Radiation Oncology, University of California, San Francisco, CA 94115, USA
| | - T Tajima
- Department of Physics and Astronomy, University of California, Irvine, CA 92697, USA
| | - A Necas
- TAE Technologies, 1961 Pauling, Foothill Ranch, CA 92610, USA
| | - C Guzman
- Facultad de Medicina Humana, Universidad Ricardo Palma, Lima, Peru
| | - R Challco
- Facultad de Ciencias, Universidad Nacional de Ingenieria, Lima, Peru
| | - M Montoya
- Facultad de Ciencias, Universidad Nacional de Ingenieria, Lima, Peru
| | - Z Meza
- Facultad de Ciencias, Universidad Nacional de Ingenieria, Lima, Peru
| | - M Zapata
- Facultad de Ciencias, Universidad Nacional de Ingenieria, Lima, Peru
| | - A Gonzales
- Clinica Aliada contra el Cancer, Lima, Peru
| | - F Marquez
- Facultad de Ciencias Físicas, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - R Neira
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - W Vilca
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - J Mendez
- Facultad de Ciencias Naturales y Matemática, Universidad Nacional del Callao, Callao, Peru
| | - J Hernandez
- HRS Oncology International, Las Vegas, NV 89119, USA
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Meh C, Sharma A, Ram U, Fadel S, Correa N, Snelgrove JW, Shah P, Begum R, Shah M, Hana T, Fu SH, Raveendran L, Mishra B, Jha P. Trends in maternal mortality in India over two decades in nationally representative surveys. BJOG 2021; 129:550-561. [PMID: 34455679 PMCID: PMC9292773 DOI: 10.1111/1471-0528.16888] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess national and regional trends and causes-specific distribution of maternal mortality in India. DESIGN Nationally representative cross-sectional surveys. SETTING All of India from 1997 to 2020. SAMPLE About 10 000 maternal deaths among 4.3 million live births over two decades. METHODS We analysed trends in the maternal mortality ratio (MMR) from 1997 through 2020, estimated absolute maternal deaths and examined the causes of maternal death using nationally representative data sources. We partitioned female deaths (aged 15-49 years) and live birth totals, based on the 2001-2014 Million Death Study to United Nations (UN) demographic totals for the country. MAIN OUTCOME MEASURES Maternal mortality burden and distribution of causes. RESULTS The MMR declined in India by about 70% from 398/100 000 live births (95% CI 378-417) in 1997-98 to 99/100 000 (90-108) in 2020. About 1.30 million (95% CI 1.26-1.35 million) maternal deaths occurred between 1997 and 2020, with about 23 800 (95% CI 21 700-26 000) in 2020, with most occurring in poorer states (63%) and among women aged 20-29 years (58%). The MMRs for Assam (215), Uttar Pradesh/Uttarakhand (192) and Madhya Pradesh/Chhattisgarh (170) were highest, surpassing India's 2016-2018 estimate of 113 (95% CI 103-123). After adjustment for education and other variables, the risks of maternal death were highest in rural and tribal areas of north-eastern and northern states. The leading causes of maternal death were obstetric haemorrhage (47%; higher in poorer states), pregnancy-related infection (12%) and hypertensive disorders of pregnancy (7%). CONCLUSIONS India could achieve the UN 2030 MMR goals if the average rate of reduction is maintained. However, without further intervention, the poorer states will not. TWEETABLE ABSTRACT We estimated that 1.3 million Indian women died from maternal causes over the last two decades. Although maternal mortality rates have fallen by 70% overall, the poorer states lag behind.
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Affiliation(s)
- C Meh
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - A Sharma
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - U Ram
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - S Fadel
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - N Correa
- Department of Internal Medicine, Western University, London, Ontario, Canada
| | - J W Snelgrove
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - P Shah
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - R Begum
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - M Shah
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - T Hana
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - S H Fu
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - L Raveendran
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - P Jha
- Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Mugunga JC, Tyagi K, Bernal-Serrano D, Correa N, Iberico M, Kateera F, Leandre F, Murray M, Suffrin JCD, Hedt-Gauthier B. SARS-CoV-2 serosurveys in low-income and middle-income countries. Lancet 2021; 397:353-355. [PMID: 33516323 PMCID: PMC7906745 DOI: 10.1016/s0140-6736(21)00188-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/16/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Jean Claude Mugunga
- Partners In Health, Boston, MA 02474, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA; University of Global Health Equity, Boston, MA, USA.
| | - Kartik Tyagi
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel Bernal-Serrano
- Partners In Health, Boston, MA 02474, USA; Instituto Tecnológico y de Estudios Superiores de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
| | | | | | | | - Fernet Leandre
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA
| | - Megan Murray
- Partners In Health, Boston, MA 02474, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Harvard T H Chan School of Public Health, Boston, MA, USA
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Marques S, Cabreira G, Correa N, Lima F, Mackoski F, Ferreira L, Silva E. Sanitary parasitological evaluation in military dogs from the Military Brigade of the state of Rio Grande do Sul, Brazil. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.4129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Monckeberg M, Correa N, Bistolfi G, Jofré M, Tapia J, Donoso MB. Risks Associated with Previous Caesarean Section in Laparoscopic, Abdominal and Vaginal Hysterectomy. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lipnharski I, Quails N, Carranza C, Correa N, Bidari S, Bickelhaup M, Rill L, Arreola M. SU-F-I-36: In-Utero Dose Measurements Within Postmortem Subjects for Estimating Fetal Doses in Pregnant Patients Examined with Pulmonary Embolism, Trauma, and Appendicitis CT. Med Phys 2016. [DOI: 10.1118/1.4955864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Carranza C, Lipnharski I, Quails N, Correa N, Rill L, Arreola M. SU-F-SPS-03: Direct Measurement of Organ Doses Resulting From Head and Cervical Spine Trauma CT Protocols. Med Phys 2016. [DOI: 10.1118/1.4955678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Lipnharski I, Carranza C, Quails N, Correa N, Rajderkar D, Bennett J, Rill L, Arreola M. SU-F-I-46: Optimizing Dose Reduction in Adult Head CT Protocols While Maintaining Image Quality in Postmortem Head Scans. Med Phys 2016. [DOI: 10.1118/1.4955874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Hernández Sarmiento JM, Correa N, Correa M, Franco JG, Alvarez M, Ramírez C, Gómez LM, Toro AC, Londoño NH, Martínez M, Restrepo MA, Zapata E, Mejía GI, Robledo J. Tuberculosis among homeless population from Medellín, Colombia: associated mental disorders and socio-demographic characteristics. J Immigr Minor Health 2014; 15:693-9. [PMID: 23340806 DOI: 10.1007/s10903-013-9776-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Homeless people are highly susceptible to tuberculosis. It has been suggested that this population have high rates of mental disorders associated with tuberculosis. We assessed tuberculosis incidence, its transmission patterns and association with socio-demographic factors and mental disorders in Colombian homeless people. Prospective study which socio-demographic characteristics and mental disorders were assessed through interviews. Sputa from patients with respiratory symptoms were processed and clinical isolates analyzed by IS6110-RFLP. Multivariate analysis performed by logistic regression model. From 426 homeless studied, tuberculosis incidence found was 7.9 %. 44 % of isolates were clustering. It was found high risk of having tuberculosis associated with income from drugs trade (OR: 3.40 [95 % CI: 1.28-9.05]), dysthymia (OR: 2.54 [95 % CI: 1.10-5.86]) and receiving food from other homeless (OR: 2.47 [95 % CI: 1.16-5.25]). Tuberculosis incidence and degree of transmission are high in homeless studied. Implementing programs to better control tuberculosis among homeless population must consider socio-demographic factors and mental disorders associated with the disease.
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Realpe T, Correa N, Rozo JC, Ferro BE, Gomez V, Zapata E, Ribon W, Puerto G, Castro C, Nieto LM, Diaz ML, Rivera O, Couvin D, Rastogi N, Arbelaez MP, Robledo J. Population structure among mycobacterium tuberculosis isolates from pulmonary tuberculosis patients in Colombia. PLoS One 2014; 9:e93848. [PMID: 24747767 PMCID: PMC3991582 DOI: 10.1371/journal.pone.0093848] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 03/08/2014] [Indexed: 11/30/2022] Open
Abstract
Background Phylogeographic composition of M. tuberculosis populations reveals associations between lineages and human populations that might have implications for the development of strategies to control the disease. In Latin America, lineage 4 or the Euro-American, is predominant with considerable variations among and within countries. In Colombia, although few studies from specific localities have revealed differences in M. tuberculosis populations, there are still areas of the country where this information is lacking, as is a comparison of Colombian isolates with those from the rest of the world. Principal Findings A total of 414 M. tuberculosis isolates from adult pulmonary tuberculosis cases from three Colombian states were studied. Isolates were genotyped using IS6110-restriction fragment length polymorphism (RFLP), spoligotyping, and 24-locus Mycobacterial interspersed repetitive units variable number tandem repeats (MIRU-VNTRs). SIT42 (LAM9) and SIT62 (H1) represented 53.3% of isolates, followed by 8.21% SIT50 (H3), 5.07% SIT53 (T1), and 3.14% SIT727 (H1). Composite spoligotyping and 24-locus MIRU- VNTR minimum spanning tree analysis suggest a recent expansion of SIT42 and SIT62 evolved originally from SIT53 (T1). The proportion of Haarlem sublineage (44.3%) was significantly higher than that in neighboring countries. Associations were found between M. tuberculosis MDR and SIT45 (H1), as well as HIV-positive serology with SIT727 (H1) and SIT53 (T1). Conclusions This study showed the population structure of M. tuberculosis in several regions from Colombia with a dominance of the LAM and Haarlem sublineages, particularly in two major urban settings (Medellín and Cali). Dominant spoligotypes were LAM9 (SIT 42) and Haarlem (SIT62). The proportion of the Haarlem sublineage was higher in Colombia compared to that in neighboring countries, suggesting particular conditions of co-evolution with the corresponding human population that favor the success of this sublineage.
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Affiliation(s)
- Teresa Realpe
- Corporación para Investigaciones Biológicas, CIB, Medellín, Colombia
- Universidad Pontificia Bolivariana, Medellín, Colombia
- Centro Colombiano de Investigación en Tuberculosis, CCITB, Medellín, Colombia
| | - Nidia Correa
- Corporación para Investigaciones Biológicas, CIB, Medellín, Colombia
- Universidad Pontificia Bolivariana, Medellín, Colombia
- Centro Colombiano de Investigación en Tuberculosis, CCITB, Medellín, Colombia
| | - Juan Carlos Rozo
- Centro Internacional de Entrenamiento e Investigaciones Médicas, CIDEIM, Cali, Colombia
- Instituto Nacional de Salud, Bogotá, Colombia
- Centro Colombiano de Investigación en Tuberculosis, CCITB, Medellín, Colombia
| | - Beatriz Elena Ferro
- Centro Internacional de Entrenamiento e Investigaciones Médicas, CIDEIM, Cali, Colombia
- Centro Colombiano de Investigación en Tuberculosis, CCITB, Medellín, Colombia
| | - Verónica Gomez
- Corporación para Investigaciones Biológicas, CIB, Medellín, Colombia
| | - Elsa Zapata
- Corporación para Investigaciones Biológicas, CIB, Medellín, Colombia
| | - Wellman Ribon
- Instituto Nacional de Salud, Bogotá, Colombia
- Centro Colombiano de Investigación en Tuberculosis, CCITB, Medellín, Colombia
- Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Gloria Puerto
- Instituto Nacional de Salud, Bogotá, Colombia
- Centro Colombiano de Investigación en Tuberculosis, CCITB, Medellín, Colombia
| | - Claudia Castro
- Instituto Nacional de Salud, Bogotá, Colombia
- Centro Colombiano de Investigación en Tuberculosis, CCITB, Medellín, Colombia
| | - Luisa María Nieto
- Centro Internacional de Entrenamiento e Investigaciones Médicas, CIDEIM, Cali, Colombia
- Centro Colombiano de Investigación en Tuberculosis, CCITB, Medellín, Colombia
| | - Maria Lilia Diaz
- Universidad del Cauca, Popayán, Colombia
- Centro Colombiano de Investigación en Tuberculosis, CCITB, Medellín, Colombia
| | - Oriana Rivera
- Universidad del Cauca, Popayán, Colombia
- Centro Colombiano de Investigación en Tuberculosis, CCITB, Medellín, Colombia
| | - David Couvin
- WHO Supranational TB Reference Laboratory, TB & Mycobacteria Unit, Institut Pasteur de la Guadeloupe, Abymes Guadeloupe, France
| | - Nalin Rastogi
- WHO Supranational TB Reference Laboratory, TB & Mycobacteria Unit, Institut Pasteur de la Guadeloupe, Abymes Guadeloupe, France
| | - Maria Patricia Arbelaez
- Universidad de Antioquia, Medellín, Colombia
- Centro Colombiano de Investigación en Tuberculosis, CCITB, Medellín, Colombia
| | - Jaime Robledo
- Corporación para Investigaciones Biológicas, CIB, Medellín, Colombia
- Universidad Pontificia Bolivariana, Medellín, Colombia
- Centro Colombiano de Investigación en Tuberculosis, CCITB, Medellín, Colombia
- * E-mail:
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14
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Gomez DI, Fisher-Hoch SP, Bordt AS, Quitugua TN, Robledo J, Alvarez N, Correa N, McCormick JB, Restrepo BI. Systematic interpretation of molecular beacon polymerase chain reaction for identifying rpoB mutations in Mycobacterium tuberculosis isolates with mixed resistant and susceptible bacteria. Diagn Microbiol Infect Dis 2010; 67:37-46. [PMID: 20227226 DOI: 10.1016/j.diagmicrobio.2009.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 11/11/2009] [Accepted: 12/11/2009] [Indexed: 10/19/2022]
Abstract
Detection of multidrug-resistant tuberculosis (MDR-TB), a frequent cause of treatment failure, takes 2 or more weeks to identify by culture. Rifampicin (RIF) resistance is a hallmark of MDR-TB, and detection of mutations in the rpoB gene of Mycobacterium tuberculosis using molecular beacon probes with real-time quantitative polymerase chain reaction (qPCR) is a novel approach that takes </=2 days. However, qPCR identification of resistant isolates, particularly for isolates with mixed RIF-susceptible and RIF-resistant bacteria, is reader dependent and limits its clinical use. The aim of this study was to develop an objective, reader-independent method to define rpoB mutants using beacon qPCR. This would facilitate the transition from a research protocol to the clinical setting, where high-throughput methods with objective interpretation are required. For this, DNAs from 107 M. tuberculosis clinical isolates with known susceptibility to RIF by culture-based methods were obtained from 2 regions where isolates have not previously been subjected to evaluation using molecular beacon qPCR: the Texas-Mexico border and Colombia. Using coded DNA specimens, mutations within an 81-bp hot spot region of rpoB were established by qPCR with 5 beacons spanning this region. Visual and mathematical approaches were used to establish whether the qPCR cycle threshold of the experimental isolate was significantly higher (mutant) compared to a reference wild-type isolate. Visual classification of the beacon qPCR required reader training for strains with a mixture of RIF-susceptible and RIF-resistant bacteria. Only then had the visual interpretation by an experienced reader had 100% sensitivity and 94.6% specificity versus RIF resistance by culture phenotype and 98.1% sensitivity and 100% specificity versus mutations based on DNA sequence. The mathematical approach was 98% sensitive and 94.5% specific versus culture and 96.2% sensitive and 100% specific versus DNA sequence. Our findings indicate the mathematical approach has advantages over the visual reading, in that it uses a Microsoft Excel template to eliminate reader bias or inexperience, and allows objective interpretation from high-throughput analyses even in the presence of a mixture of RIF-resistant and RIF-susceptible isolates without the need for reader training.
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Affiliation(s)
- Diana I Gomez
- The University of Texas Health Science Center Houston, School of Public Health at Brownsville, Brownsville, TX 78520, USA
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15
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Trujillo M, Correa N, Olsen K, Trujillo H, Realpe T, Mejia GI, Robledo J, McCracken GH. Cefprozil concentrations in middle ear fluid of children with acute otitis media. Pediatr Infect Dis J 2000; 19:268-70. [PMID: 10749480 DOI: 10.1097/00006454-200003000-00026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- M Trujillo
- Department of Pediatrics and Medical Microbiology, Corporación para Investigaciones Biológicas Medellín, Colombia.
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16
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Abdala G, Miersch O, Correa N, Rosas S. Detection of Jasmonic Acid in Cultures ofEscherichia ColiandSaccharomyces Cerevisiae. ACTA ACUST UNITED AC 1999. [DOI: 10.1080/10575639908045435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Abstract
Jasmonates and salicylic acid are considered to be signal molecules that induce a variety of plant genes involved in wound or defence response, as well as affecting nos promoter activity. In this paper we examined whether these chemicals could also affect nod genes from isogenic rhizobia strains. Isogenic strains contain the Rhizobium leguminosarum nodA promoter fused to the lacZ gene of Escherichia coli and differ only in the source of the regulatory nodD gene. Naringenin, jasmonic acid and methyl jasmonate induced expression of nod genes in strain RBL1284 and salicylic acid showed no activity alone or when used in combination with other compounds; addition of naringenin + jasmonic acid produced a synergistic effect. Results obtained with strain RBL5284 were similar to those for RBL1284 albeit the combination of naringenin with the other compounds markedly inhibited nod gene expression. Whereas RBL5283 responded to naringenin with a strong induction, jasmonic acid, methyl jasmonate or salicylic acid showed no significant responses. The inhibitory effect of salicylic acid on nod gene expression indicates that the induction mechanism of jasmonic acid, methyl jasmonate, N-propyldihydrojasmonate and naringenin is probably different from that of salicylic acid.
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Affiliation(s)
- S Rosas
- Fisiología Vegetal, Departamento de Ciencias Naturales, Facultad de Ciencias Exactas, Universidad Nacional de Río Cuarto, Argentina
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18
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Rosenberg GA, Dencoff JE, Correa N, Reiners M, Ford CC. Effect of steroids on CSF matrix metalloproteinases in multiple sclerosis: relation to blood-brain barrier injury. Neurology 1996; 46:1626-32. [PMID: 8649561 DOI: 10.1212/wnl.46.6.1626] [Citation(s) in RCA: 203] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Contrast-enhanced MRI in patients with MS shows that increased permeability of the blood-brain barrier (BBB) commonly occurs. The changes in capillary permeability often precede T2-weighted MRI evidence of tissue damage. In animal studies, intracerebral injection of the matrix metalloproteinase (MMP) 72-kDa type IV collagenase (gelatinase A) opens the BBB by disrupting the basal lamina around capillaries. Steroids affect production of endogenous MMPs and tissue inhibitors to metalloproteinases (TIMPs). To determine the role of MMP activity in BBB damage during acute exacerbations of MS, we measured MMPs in the CSF of patients with MS. Patients (n = 7) given steroids to treat an acute episode of MS had CSF sampled before and after 3 days of methylprednisolone (1 g/day). Patients had a graded neurologic examination and gadolinium-enhanced MRI before treatment. CSF studies included total protein, cell count, and a demyelinating profile. We measured levels of MMPs, urokinase-type plasminogen activator (uPA), and TIMPs by zymography, reverse zymography, and Western blots. The MMP, 92-kDa type IV collagenase (gelatinase B), fell from 216 +/- 70 before steroids to 54 +/- 26 relative lysis zone units (p < 0.046) after treatment. Similarly, uPA dropped from 3880 +/- 800 to 2655 +/- 353 (p < 0.03). Four patients with gadolinium enhancement on MRI had the most pronounced drop in gelatinase B and uPA. Western immunoblots showed an increase in a complex of gelatinase B and TIMPs after treatment, suggesting an increase in a TIMP (p < 0.05). Reverse zymography of CSF samples showed that steroids increased a TIMP with a molecular weight similar to that of mouse TIMP-3 (p = 0.053). Our results suggest that increased gelatinase B is associated with an open BBB on MRI. Steroids may improve capillary function by reducing activity of gelatinase B and uPA and increasing levels of TIMPs.
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Affiliation(s)
- G A Rosenberg
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, USA
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19
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Abstract
A Group B Streptococcus Type III (GBS) mutant which, when grown in Todd Hewitt broth (THB), does not produce any detectable capsule, produced a clearly visible polysaccharide capsule when grown in human serum. We isolated cytoplasmic membranes from GBS and separated the component membrane proteins by polyacrylamide gel electrophoresis. A significant change in membrane composition was found during growth in human serum. Several unique proteins were produced on serum growth and there was both up- and down-regulation of other proteins. We measured the intracellular levels of sialic acid for a variety of GBS serotype III isolates. Interestingly, while there was little difference between the intracellular sialic levels of most isolates, the sialic acid level of COH31-15 grown in THB was over 100% higher than that of any other isolate. When grown in serum this pool was reduced to a level similar to that in other strains. The concentration of bacterial cell sialic acid was directly correlated with the sialic acid content of the serum. Exogenous sialic acid content, in concert with other serum factors, plays a role in determining the capsular size in GBS.
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Affiliation(s)
- M W Platt
- Department of Microbiology, School of Medicine, University of New Mexico, Albuquerque 87131
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20
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Platt MW, Correa N, Mold C. Growth of group B streptococci in human serum leads to increased cell surface sialic acid and decreased activation of the alternative complement pathway. Can J Microbiol 1994; 40:99-105. [PMID: 8019940 DOI: 10.1139/m94-016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Group B streptococcus type III is a major cause of neonatal death. The terminal sialic acid moiety of the group B streptococcus type specific capsule has been shown to be an important virulence factor. We demonstrate here that bacteria grown in human serum have increased cell surface sialic acid content compared with cells grown in common laboratory media. This sialic acid was removed by incubation with neuraminidase, showing that it was on the bacterial surface. Serum-dependent sialylation was dependent on metabolic activity, as the addition of chloramphenicol reduced the amount of added sialic acid by more than 90%. Probing the cell surface with an antibody specific for group B streptococcus type III capsular sialic acid showed an increase in antibody binding after growth in human serum. This effect could be lowered by incubating serum-grown cells in neuraminidase prior to antibody exposure. A group B streptococcus mutant that when grown in laboratory media lacks cell surface sialic acid showed significant cell surface sialic acid when grown in human serum. This increase was associated with a significantly decreased ability to bind C3 and hence activate the alternative complement pathway.
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Affiliation(s)
- M W Platt
- Department of Microbiology, School of Medicine, University of New Mexico, Albuquerque 87131
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21
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Correa N, Opler LA, Kay SR, Birmaher B. Amantadine in the treatment of neuroendocrine side effects of neuroleptics. J Clin Psychopharmacol 1987; 7:91-5. [PMID: 2884239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
An open-label reversal drug study was undertaken on 10 neuroleptic-treated schizophrenic inpatients to assess the impact of amantadine hydrochloride on presumed prolactin-mediated neuroendocrine side effects. Measures were conducted across 7 weeks, including a 2-week neuroleptic baseline, a 3-week neuroleptic-plus-amantadine phase, and a 2-week return to the baseline regimen. Significant reduction with amantadine was observed on all six indices of neuroendocrine side effects: serum prolactin levels, body weight, gynecomastia/galactorrhea, breast tenderness, decreased libido, and amenorrhea. Improvement on these parameters was noted for as many as nine or all 10 patients, while in no cases was there worsening. In terms of motor and clinical effects, significant diminution of extrapyramidal and psycho-pathological symptoms was also achieved during this phase. The results suggested that amantadine may be beneficial for the treatment of neuro-endocrine side effects of antipsychotic medication owing to its ability to reverse neuroleptic-induced hyperprolactinemia.
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22
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Meza C, Contreras MC, Correa N, Schenone H. [Chagas disease in Chile. Urban sections. I. Prevalence of Chagasic infection in blood donors from a hospital in the north section of the metropolitan region, 1982]. Bol Chil Parasitol 1982; 37:63-5. [PMID: 6821234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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23
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Armanet L, Ling C, Correa N, Islas E, Valenzuela CY, Harb Z. [Genetic frequencies for Kell, Duffy, Xg, Lutheran, Diego, MNSs and Rh blood group systems in a hospital of Santiago, Chile (author's transl)]. Rev Med Chil 1980; 108:103-8. [PMID: 7244453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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24
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Correa N, Figueroa R, Bernier L. [Poisoning in childhood]. Rev Chil Pediatr 1979; 50:18-26. [PMID: 552647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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