Resumen La hipertensión arterial es el factor de riesgo cardiovascular más importante de las enfermedades crónicas no transmisibles y se estima que es responsable de 10.4 millones de muertes al año. La prevalencia mundial de la hipertensión es del 30%; la mayoría de las personas con hipertensión no tienen una causa claramente identificable y se considera que tienen hipertensión primaria. Las investigaciones experimentales y clínicas de varios grupos de investigación, incluido el nuestro, han establecido que la inflamación y la reactividad autoinmune desempeñan un papel en la retención de sodio y las respuestas hemodinámicas que provocan la hipertensión primaria. La hiperuricemia y las proteínas del estrés por calor (HSP), particularmente HSP70, están asociadas con la activación de la inmunidad innata que juega un papel en el desarrollo de la reactividad inflamatoria en pacientes hipertensos. Estudios clínicos han demostrado asociación entre la expresión de HSP70 y anticuerpos anti-HSP70 y la hipertensión arterial primaria Esta breve revisión tiene como objetivo examinar la interrelación entre la hiperuricemia y la sobreexpresión extracelular de HSP70 en la activación del inflamasoma, así como su probable papel central en la fisiopatología de la hipertensión primaria.

Abstract Arterial hypertension is the most important cardiovascular risk factor in chronic non-communicable diseases and is estimated to be responsible for 10.4 million deaths annually. The global prevalence of hypertension is 30% and the majority of people with hypertension do not have a clear identifiable cause and are considered to have primary hypertension. Experimental and clinical investigations from several research groups, including ours, have established that inflammation and autoimmune reactivity play a role in the sodium retention and hemodynamic responses that drive primary hypertension. Hyperuricemia and heat stress proteins (HSP), particularly HSP70, are both associated with the activation of innate immunity that plays a role in the development of inflammatory reactivity in the hypertensive patient. Clinical studies have shown an association between the expression of HSP70 and anti-HSP70 antibodies and primary hypertension. This brief review aims to examine the interrelation between hyperuricemia and extracellular overexpression of HSP70 in the activation of the inflammasome that may have a central role in the pathophysiology of primary hypertension.

Resumo A hiperuricemia é comum na doença renal crônica (DRC) e pode estar presente em até 50% dos pacientes que se apresentam para diálise. A hiperuricemia pode ser secundária ao comprometimento da taxa de filtração glomerular (TFG) que ocorre na DRC. No entanto, ela também pode preceder o desenvolvimento da doença renal e mesmo prever uma DRC incidente. Estudos experimentais de modelos hiperuricêmicos descobriram que tanto o ácido úrico solúvel quanto o cristalino podem causar danos renais significativos, caracterizados por isquemia, fibrose tubulointersticial e inflamação. Entretanto, a maioria dos estudos de randomização Mendeliana falhou em demonstrar uma relação causal entre o ácido úrico e a DRC, e os ensaios clínicos têm apresentado resultados variáveis. Aqui sugerimos explicações potenciais para os achados clínicos e genéticos negativos, incluindo o papel do ácido úrico cristalino, do ácido úrico intracelular e da atividade da xantina oxidase na lesão renal mediada por ácido úrico. Propomos ensaios clínicos futuros, bem como um algoritmo para o tratamento de hiperuricemia em pacientes com DRC.

Abstract Hyperuricemia is common in chronic kidney disease (CKD) and may be present in 50% of patients presenting for dialysis. Hyperuricemia can be secondary to impaired glomerular filtration rate (GFR) that occurs in CKD. However, hyperuricemia can also precede the development of kidney disease and predict incident CKD. Experimental studies of hyperuricemic models have found that both soluble and crystalline uric acid can cause significant kidney damage, characterized by ischemia, tubulointerstitial fibrosis, and inflammation. However, most Mendelian randomization studies failed to demonstrate a causal relationship between uric acid and CKD, and clinical trials have had variable results. Here we suggest potential explanations for the negative clinical and genetic findings, including the role of crystalline uric acid, intracellular uric acid, and xanthine oxidase activity in uric acid-mediated kidney injury. We propose future clinical trials as well as an algorithm for treatment of hyperuricemia in patients with CKD.

Abstract Background: Embedding pharmacists in general practice has been shown to create cost efficiencies, improve patient care and free general practitioner capacity. Consequently, there is a drive to recruit additional pharmacists to work within general practices. However, equipping pharmacists with behaviour and influencing skills may further optimise their impact. Key elements which may enhance behaviour and influencing skills include self-efficacy and resilience. Objective: This study aimed to: 1) Assess general practice pharmacists' self-efficacy and resilience. 2) Explore differences primarily between pharmacists reporting lower and higher self-efficacy, secondarily for those reporting lower and higher scores for resilience. Methods: All 159 NHS Greater Glasgow and Clyde general practice pharmacists were invited to complete an online survey in May 2019. The survey captured anonymised data covering: demographics; professional experience; qualifications, prescribing status and preferred learning styles. Unconscious learning needs for behavioural and influencing skills were assessed using validated tools: the new general self-efficacy scale (GSES) and short general resilience scale (GRIT). Participants' responses were differentiated by the lowest quartile and higher quartiles of GSES and GRIT scores, and analysed to identify differences. Results: The survey was completed by 57% (91/159) of eligible pharmacists; mean age 38 (range 24-60) years; 91% were of white ethnicity and 89% female. The median time qualified was 14 (1-38) years and 3 (1-22) years working in general practices. Overall pharmacists scored well on the GSES, mean 25 (SD 3; 95%CI 24.4-25.6), and GRIT, mean 30 (SD 4; 95%CI 29.6-30.4), out of a maximum 32 and 40 respectively. A significant positive correlation between GSES and GRIT scores was found (Pearson's r=0.284, p=0.006). However, no significant differences were identified between pharmacists scoring in the lower and upper quartiles by GSES or GRIT. Overall respondents reported their preferred learning styles were activists (46%) or pragmatists (29%). The majority (91%) preferred blended learning methods as opposed to 38% or less for a range of online methods. Conclusions: General practice pharmacists on average scored highly for self-efficacy and resilience. Higher scores did not appear to be associated with demographic, years of practice, professional or educational experience. Prospective interventions to support those with lower scores may enhance and optimise pharmacists' effectiveness in general practice.

Abstract Objective: Explore the perceptions, attitudes and experiences of pharmacists relating to the up-scheduling of low dose codeine containing analgesics and the impact on pharmacy practice. Methods: A mixed design method was used consisting of an anonymous online questionnaire survey to quantitatively capture broad pre-scheduling change perceptions paired with a series of in-depth post-scheduling semi-structured interviews to provide a qualitative picture of the impact of codeine up-scheduling on pharmacy practice in Australia. Results: A total of 191 pharmacists completed the quantitative survey and 10 participated in the in-depth interview. The majority of respondents supported the decision to up-schedule over-the-counter combination products containing codeine to some degree. Three main themes emerged from the data: pharmacists' perceptions of the codeine up-scheduling decision, preparing for the up-schedule and impact of the up-schedule on pharmacy practice. Pharmacists were concerned about the impact of up-scheduling on the pharmacy business, patient access to pain relief and the diminishment of their professional role. Conclusions: There were diverse perceptions, preparedness and impact on practice regarding the up-scheduling of low dose codeine products. Further research should be conducted to gauge if and how these perceptions have changed over time and to identify whether pain is being managed more effectively post codeine up-scheduling.

ABSTRACT Background: Early antibiotic switch and early discharge protocols have not been widely studied in Latin America. Our objective was to describe real-world treatment patterns, resource use, and estimate opportunities for early switch from intravenous to oral antibiotics and early discharge for patients hospitalized with methicillin-resistant Staphylococcus aureus complicated skin and soft-tissue infections. Materials/methods: This retrospective medical chart review recruited 72 physicians from Brazil to collect data from patients hospitalized with documented methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections between May 2013 and May 2015, and discharged alive by June 2015. Data collected included clinical characteristics and outcomes, hospital length of stay, methicillin-resistant Staphylococcus aureus-targeted intravenous and oral antibiotic use, and early switch and early discharge eligibility using literature-based and expert-validated criteria. Results: A total of 199 patient charts were reviewed, of which 196 (98.5%) were prescribed methicillin-resistant Staphylococcus aureus -active therapy. Only four patients were switched from intravenous to oral antibiotics while hospitalized. The mean length of methicillin-resistant Staphylococcus aureus-active treatment was 14.7 (standard deviation, 10.1) days, with 14.6 (standard deviation, 10.1) total days of intravenous therapy. The mean length of hospital stay was 22.2 (standard deviation, 23.0) days. The most frequent initial methicillin-resistant Staphylococcus aureus-active therapies were intravenous vancomycin (58.2%), intravenous clindamycin (19.9%), and intravenous daptomycin (6.6%). Thirty-one patients (15.6%) were discharged with methicillin-resistant Staphylococcus aureus -active antibiotics of which 80.6% received oral antibiotics. Sixty-two patients (31.2%) met early switch criteria and potentially could have discontinued intravenous therapy 6.8 (standard deviation, 7.8) days sooner, and 65 patients (32.7%) met early discharge criteria and potentially could have been discharged 5.3 (standard deviation, 7.0) days sooner. Conclusions: Only 2% of patients were switched from intravenous to oral antibiotics in our study while almost one-third were early switch eligible. Additionally, one-third of hospitalized patients with methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections were early discharge eligible indicating opportunity for reducing intravenous therapy and days of hospital stay. These results provide insight into possible benefits of implementation of early switch/early discharge protocols in Brazil.

Abstract Background: There remains variability in both practice and evidence related to optimal initial empiric dosing strategies for vancomycin. Objective: Our primary objective was to describe the percentage of obese patients receiving vancomycin doses consistent with nomogram recommendations achieving targeted initial steady-state serum vancomycin concentrations. Secondary objectives were to describe the primary endpoint in subgroups based on patient weight and estimated creatinine clearance, to describe the rate of supratherapeutic vancomycin accumulation following an initial therapeutic trough concentration, and to describe the rate of vancomycin-related adverse events. Methods: This single-center, IRB-approved, retrospective cohort included adult patients ≥ 100 kilograms total body weight with a body mass index (BMI) >30 kilograms/m2 who received a stable nomogram-based vancomycin regimen and had at least one steady-state vancomycin trough concentration. Data collected included vancomycin regimens and concentrations, vancomycin indication, serum creatinine, and vancomycin-related adverse events. Patients were divided into two cohorts by goal trough concentration: 10-15 mcg/mL and 15-20 mcg/mL. Results: Of 325 patients screened, 85 were included. Goal steady-state concentrations were reached in 42/85 (49.4%) of total patients. Conclusions: Achievement of initial steady-state vancomycin serum concentrations in the present study (approximately 50%) was consistent with the use of published vancomycin dosing nomograms.

Background: Podocin mutations are characterized by progression to end stage renal disease and histologic findings of Focal Segmental Glomerulosclerosis (FSGS). CD80 is a podocytes protein that may play a role in proteinuria, particularly in Minimal Change Disease whereas the soluble urokinase receptor (suPAR) is characteristically elevated in the serum of FSGS patients. Methods: In a patient with nephrotic syndrome and podocin mutation, urinary and serum CD80 as well as suPAR were measured using commercially available kits. Urinary CD80 molecular size was determined by western blot analysis. Glomerular staining for CD80 and podocin was performed. Results: Patient displayed marked elevated CD80 and mildly increased suPAR urinary levels compared to controls. Serum CD80 level was within the range observed in normal controls. Serum suPAR level was elevated, albeit in the lower range reported for patients with primary FSGS. Immunofluorescence examination of kidney biopsy revealed glomerular CD80 expression. Conclusion: The combination of serum and urinary biomarkers can help differentiate various forms of FSGS. High urinary CD80 and elevated serum and urinary suPAR might represent a profile to differentiate this genetic form of FSGS from primary FSGS.

Antecedentes: Las mutaciones de la podocina están caracterizadas por la progresión hacia enfermedad renal terminal y por hallazgos histológicos de glomeruloesclerosis segmentaria y focal (GSF). CD80 es una proteína podocitaria que parece tener un papel en la proteinuria de la enfermedad de cambios mínimos, mientras que el receptor soluble de la uroquinasa (suPAR) es característicamente elevado en el suero de pacientes con GSF. Métodos: En un paciente con síndrome nefrótico y mutación de la podocina, se cuantificó CD80 y suPAR en suero y orina usando los kits disponibles en el mercado. El peso molecular del CD80 urinario fue determinado mediante Western blot. Se realizó la tinción para CD80 y podocina en el glomérulo. Resultados: El paciente presentó niveles urinarios marcadamente elevados de CD80 y ligeramente elevados de suPAR en comparación con controles. El nivel sérico de CD80 se encontró dentro del rango observado en controles. El nivel sérico de suPAR fue elevado, aunque en el límite inferior del rango publicado para pacientes con GSF primaria. La inmunofluorescencia de la biopsia renal mostró expresión glomerular de CD80. Conclusión: La combinación de biomarcadores séricos y urinarios quizás ayude a diferenciar entre diferentes formas de GSF. Niveles elevados de CD80 en orina y suPAR en suero quizás representen un perfil característico que permita diferenciar entre esta forma genética de GSF y GSF de causa primaria.

OBJECTIVE: To monitor adult mosquito abundance in northern Belize before/after the first tropical storm of the wet season to estimate the time required for development/recovery of potential vector populations; determine which species predominate post-storm; and compare the effectiveness of two types of mosquito traps-octenol-baited Mosquito Magnets® and U.S. Centers for Disease Control and Prevention (CDC) light traps (with/without octenol). METHODS: Field experiments were conducted in Orange Walk Town, Belize, 21 May to 3 June 2008. Incidence rate ratios and exact binomial 95% confidence intervals were reported and trap-nights calculated to compare species abundance pre- and post-storm as well as trap-type effectiveness. RESULTS: Twice as many species and three times more Anopheles spp. were trapped pre-storm versus post-storm. However, greater numbers of Aedes taeniorhynchus and Culex (Culex) spp. were trapped post-storm. Mosquito Magnets® were consistently more effective than the CDC traps, obtaining twice as many Anopheles spp. and four times as many culicine species as the octenol-baited version (which collected 14 times more mosquitoes overall and 3.5 times more culicine species than the unbaited version). The unbaited CDC trap did not trap any Anopheles spp. during the study period. CONCLUSIONS: Results indicated octenol is an effective attractant for An. crucians in northern Belize; malaria risk in Belize declines immediately post-storm (i.e., mosquito abundance drops); and arboviral risk associated with the rapid increase in culicine mosquitoes post-storm may represent a greater public health threat than malaria (although further research and active disease surveillance is necessary to validate this hypothesis).

OBJETIVO: Comprobar la abundancia de mosquitos adultos en el norte de Belice antes y después de la primera tormenta tropical de la temporada de lluvias, para calcular la cantidad de tiempo que necesitan las poblaciones de vectores potenciales para desarrollarse y recuperarse; determinar cuáles son las especies que predominan después de la tormenta; y comparar la eficacia de dos tipos de trampas de mosquitos: las que utilizan cebos de octenol (Mosquito Magnets®) y las trampas de luz con y sin octenol de los Centros para el Control y la Prevención de Enfermedades de los Estados Unidos (CDC). MÉTODOS: Se llevaron a cabo pruebas de campo en Orange Walk Town, Belice, desde el 21 de mayo hasta el 3 de junio del 2008. Se registraron las razones de las tasas de incidencia y los intervalos de confianza binomiales exactos de 95% y se evaluaron las trampas nocturnas para comparar la abundancia de las especies y la eficacia del tipo de trampa antes y después de una tormenta. RESULTADOS: Antes de la tormenta, se atrapó el doble de las especies de mosquitos y el triple de Anopheles spp. en comparación con el período que siguió a la tormenta. Sin embargo, el número de Aedes taeniorhynchus y Culex (Culex) spp. atrapados fue mayor después de la tormenta. Las trampas Mosquito Magnets® demostraron uniformemente ser más eficaces que las trampas de los CDC, ya que el número de Anopheles spp. capturados fue dos veces mayor que el de la trampa con cebo de octenol y el número de especies de culícidos fue cuatro veces mayor. En general, el número de mosquitos capturados por la trampa con octenol fue 14 veces mayor que el de la trampa sin octenol y el número de especies de culícidos fue 3,5 veces mayor. La trampa sin cebo de los CDC no capturó ningún Anopheles spp. durante el período de estudio. CONCLUSIONES: Los resultados demostraron que el octenol es un producto eficaz para atraer a la especie Anopheles crucians en el norte de Belice. En este país, el riesgo de malaria disminuye inmediatamente después de las tormentas (es decir, disminuye la abundancia de mosquitos); y el riesgo de contraer una infección por arbovirus, asociado con el rápido aumento de las especies de culícidos después de las tormentas, podría representar una mayor amenaza para la salud pública que la malaria (aunque se necesitaría más investigación y una vigilancia activa de las enfermedades para validar esta hipótesis).

OBJECTIVE: To describe the declining trend in maternal mortality observed in Mongolia from 1992 to 2007 and its acceleration after 2001 following implementation of the Maternal Mortality Reduction Strategy by the Ministry of Health and other partners. METHODS: We performed a descriptive analysis of maternal mortality data collected through Mongolia's vital registration system and provided by the Mongolian Ministry of Health. The observed declining mortality trend was analysed for statistical significance using simple linear regression. We present the maternal mortality ratios from 1992 to 2007 by year and review the basic components of Mongolia's Maternal Mortality Reduction Strategy for 2001-2004 and 2005-2010. FINDINGS: Mongolia achieved a statistically significant annual decrease in its maternal mortality ratio of almost 10 deaths per 100 000 live births over the period 1992-2007. From 2001 to 2007, the maternal mortality ratio in Mongolia decreased approximately 47%, from 169 to 89.6 deaths per 100 000 live births. CONCLUSION: Disparities in maternal mortality represent one of the major persisting health inequities between low- and high-resource countries. Nonetheless, important reductions in low-resource settings are possible through collaborative strategies based on a horizontal approach and the coordinated involvement of key partners, including health ministries, national and international agencies and donors, health-care professionals, the media, nongovernmental organizations and the general public.

OBJETIVO: Describir la tendencia decreciente de la mortalidad materna observada en Mongolia entre 1992 y 2007 y su aceleración a partir de 2001, después de que el Ministerio de Salud y otros asociados aplicaran la estrategia de reducción de la mortalidad materna. MÉTODOS: Realizamos un análisis descriptivo de los datos de mortalidad materna reunidos a través del sistema de registro civil de Mongolia y proporcionados por el Ministerio de Salud. La tendencia observada de reducción de la mortalidad fue analizada mediante regresión lineal simple para determinar la significación estadística. Presentamos las razones de mortalidad materna entre 1992 y 2007 para cada año y examinamos los componentes básicos de la estrategia de reducción de la mortalidad materna de Mongolia en 2001-2004 y 2005-2010. RESULTADOS: Mongolia logró una disminución anual estadísticamente significativa de su razón de mortalidad materna de casi 10 muertes por 100 000 nacidos vivos durante el periodo 1992-2007. Entre 2001 y 2007, la razón de mortalidad materna disminuyó aproximadamente un 47%, de 169 a 89,6 defunciones por 100 000 nacidos vivos. CONCLUSIÓN: Las disparidades de la mortalidad materna son una de las principales inequidades en salud que aún persisten si se comparan los países de bajos recursos y los que cuentan con altos recursos. Sin embargo, es posible lograr reducciones importantes en los entornos con recursos escasos aplicando estrategias de colaboración basadas en un enfoque horizontal y coordinando la participación de asociados clave, como los ministerios de salud, los organismos y donantes nacionales e internacionales, los profesionales de la salud, los medios de comunicación, las organizaciones no gubernamentales y el público en general.

OBJECTIF: Décrire la tendance à la baisse de la mortalité maternelle observée en Mongolie entre 1992 et 2007 et son accélération après 2001, suite à la mise en œuvre de la Stratégie de réduction de la mortalité maternelle par le Ministère de la santé et d'autres partenaires. MÉTHODES: Nous avons réalisé une analyse descriptive des données de mortalité maternelle collectées par l'intermédiaire du système mongol d'enregistrement de l'état-civil et fournis par le Ministère de la santé mongol. Nous avons analysé la tendance à la baisse de la mortalité pour évaluer sa significativité statistique par régression linéaire simple. Nous présentons les ratio de mortalité maternelle annuels de 1992 à 2007 et passons en revue les composantes de base de la Stratégie de réduction de la mortalité maternelle mongole pour les périodes 2001-2004 et 2005-2010. RÉSULTATS: La Mongolie a obtenu une baisse annuelle statistiquement significative de son ratio de mortalité maternelle de près de 10 décès pour 100 000 naissances vivantes sur la période 1992-2007. De 2001 à 2007, le ratio de mortalité maternelle mongol a diminué d'environ 47 %, passant de 169 à 89,6 décès pour 100 000 naissances vivantes. CONCLUSION: Les disparités en termes de mortalité maternelle représentent l'une des principales sources d'inégalités persistantes entre les pays à faible revenu et les pays riches. Néanmoins, des diminutions importantes de cette mortalité sont possibles dans les régions démunies si l'on fait appel à des stratégies collaboratives reposant sur une approche horizontale et sur la participation coordonnée de partenaires clés, dont les ministères de la santé, les agences et les donateurs nationaux et internationaux, les professionnels de santé, les médias, les organisations non gouvernementales et la population générale.

Nesse artigo analisamos a formação das identidades sexuais de jovens, a partir de uma série de exemplos retirados de trabalhos de campo, no decorrer de vários anos e em diferentes projetos de pesquisa. Argumentamos que os jovens se produzem como atores generificados e sexualizados em e por meio de certas relações centrais. Seus contextos mais imediatos são suas próprias culturas sexuais, formadas em relação a espaços institucionais como escolas, cultura popular comercial e relações domésticas e familiares. Sugerimos que as identidades são poderosamente formadas por meio do que Connell chama de "práticas reflexivas do corpo" - ou seja, o circuito de efeitos entre experiências corporais, vida emocional e explicações culturais. É importante observar, no entanto, que essas experiências e entendimentos são desenvolvidos no contexto de relações sociais de poder. As diferenças sexuais, por exemplo, são sempre acompanhadas e mutuamente moldadas por outras "diferenças que fazem diferença" na vida cotidiana das pessoas, tais como raça, gênero ou corporificação. Interações imediatas, face a face, estão sempre imbuídas de formações culturais mais amplas em torno do sexual, que são reproduzidas e às vezes modificadas em práticas como representação na mídia, processos políticos e legais, venda e consumo de bens, educação e conhecimentos científicos, profissionais e especializados. Sugerimos que tais entendimentos têm implicações consideráveis para práticas profissionais, pois indicam que os praticantes - por exemplo de profissões de cuidado, ensino ou assistência médica - estão direta e ativamente envolvidos na construção da identidade de seus jovens clientes, alunos ou pacientes, ao mesmo tempo em que constroem suas próprias identidades profissionais. Finalizamos argumentando que a prática ética com jovens em relação às suas identidades sexuais emergentes somente é alcançável quando os profissionais são autorreflexivos no que diz respeito às limitações de seus próprios horizontes e cientes de sua parcialidade.

In this presentation, we draw on a number of examples taken from fieldwork over several years and in different projects, in order to explore the formation of young people's sexual identities. We argue that young people produce themselves as gendered and sexualized actors in and through certain key relationships. Their most immediate contexts are the sexual cultures of young people themselves, formed in relation to institutional sites such as schools, commercial popular culture and household and family relations. We suggest that identities are powerfully formed through what R. W. Connell has called "body-reflexive practices" - that is, the circuit of effects between bodily experiences, emotional life and cultural explanations for them. It is important to note, however, that these experiences and understandings are developed in the context of social relations of power. Sexual differences, for example, are always accompanied and mutually shaped by other "differences that make a difference" in people's everyday lives (such as race, gender or embodiment). Immediate, faceto-face interactions are always imbued with larger cultural formations around the sexual, which are reproduced and sometimes changed in such practices as media representation, political and legal processes, the sale and consumption of commodities, education and scientific, professional and expert knowledge. These understandings have considerable implications for professional practices for they indicate that, as practitioners in caring, teaching or medical professions, for instance, we are directly and actively involved in the identity construction of ourselves and our clients, students or patients. We argue that ethical practice with young people in relation to their emergent sexual identities is only achievable when professionals are self-reflective about the limitations of their own horizons and aware of their partiality.

En este artículo la formación de las identidades sexuales de jóvenes, a partir de una serie de ejemplos retirados de trabajos de campo, en el transcurso de varios años y en diferentes proyectos de pesquisa. Argumentamos que los jóvenes se producen como actores generificados y sensualizados en y por medio de ciertas relaciones centrales. Sus contextos más inmediatos son sus propias culturas sexuales, formadas en relación a espacios institucionales como escuelas, cultura popular comercial y relaciones domésticas y familiares. Sugerimos que las identidades son poderosamente formadas por medio do que Connell llama de "prácticas reflexivas del cuerpo" - o sea, el circuito de efectos entre experiencias corporales, vida emocional y explicaciones culturales. Es importante observar, sin embargo, que esas experiencias y entendimientos son desarrollados en el contexto de relaciones sociales de poder. Las diferencias sexuales, por ejemplo, son siempre acompañadas e mutuamente moldadas por otras "diferencias que hacen diferencia" en la vida cotidiana de las personas, tales como raza, género o corporificación. Interacciones inmediatas, cara a cara, están siempre imbuidas de formaciones culturales más amplias en torno de lo sexual, que son reproducidas y a veces modificadas en prácticas como representación en los medios de comunicación, procesos políticos y legales, venta y consumo de bienes, educación y conocimientos científicos, profesionales y especializados. Sugerimos que tales entendimientos tienen implicaciones considerables para prácticas profesionales, pues indican que los practicantes - por ejemplo de profesiones de cuidado, enseñanza o asistencia médica - están directa y activamente envueltos en la construcción de la identidad de sus jóvenes clientes, alumnos o pacientes, al mismo tiempo en que construyen sus propias identidades profesionales. Finalizamos argumentando que la práctica ética con los jóvenes en relación a sus identidades sexuales emergentes solamente es alcanzable cuando los profesionales son auto reflexivos en lo que atañe a las limitaciones de sus propios horizontes y conscientes de su parcialidad.

OBJECTIVE: To assess outcomes after antiretroviral therapy (ART) in adolescents and youth in Haiti, a country with a generalized epidemic of infection with HIV-1. METHODS: An assessment was made of survival, plasma HIV-1 ribonucleic acid (RNA) concentrations and HIV-1 drug resistance patterns after 12 months of ART in patients aged 13-25 years who presented to a clinic in Port-au-Prince, Haiti, with AIDS between 1 March 2003 and 31 December 2005. Participants received ART in accordance with WHO guidelines. Kaplan-Meier analysis was used to estimate survival probabilities and their 95% confidence intervals (CI) for the period from ART initiation to death. FINDINGS: Of a total of 146 patients, 96 (66%) were female; the median CD4+ T-cell count at baseline was 129 cells/ml. By Kaplan-Meier analysis, 13% of the patients had died at 12 months, 17% at 24 months and 20% at 36 months. A plasma HIV-1 RNA concentration > 50 copies/ml was seen in 40 (51%) of 79 patients 12 months after treatment initiation and was associated with poor ART adherence. Among 29 patients with > 1000 copies/ml at 12 months, resistance mutations to non-nucleoside reverse transcriptase inhibitors (NNRTIs) were detected in 23 cases (79%); to both NNRTIs and lamivudine in 21 (72%) cases; and to NNRTIs, lamivudine and other nucleoside reverse transcriptase inhibitors in 10 (35%) cases. One hundred and six participants (73%) reported sexual intercourse without condoms, and 35 of the 96 women (36%) were pregnant during follow-up. CONCLUSION: Adolescents and youth with AIDS receiving ART are at risk of virologic failure and disease progression and can therefore transmit HIV-1 to sexual partners and infants. Strategies to target the special needs of this age group are urgently needed.

OBJETIVO: Evaluar los resultados del tratamiento antirretroviral (TAR) en adolescentes y adultos jóvenes en Haití, país que sufre una epidemia generalizada de infección por VIH-1. MÉTODOS: Se hizo una evaluación de la supervivencia, las concentraciones plasmáticas de ácido ribonucleico (ARN) de VIH-1 y el perfil de farmacorresistencia del VIH-1 a los 12 meses de iniciada la TAR en pacientes de 13 a 25 años que acudieron a un consultorio de Puerto Príncipe, Haití, con SIDA entre el 1 de marzo de 2003 y el 31 de diciembre de 2005. Los participantes recibieron TAR con arreglo a las directrices de la OMS. Se utilizó el método de Kaplan-Meier para estimar las probabilidades de supervivencia y sus intervalos de confianza (IC) del 95% para el periodo transcurrido entre el inicio del TAR y la defunción. RESULTADOS: De un total de 146 pacientes, 96 (66%) eran mujeres; la mediana del recuento de linfocitos T CD4+ al comienzo del estudio fue de 129 células/ml. Según el análisis de Kaplan-Meier, el 13% de los pacientes habían muerto a los 12 meses, el 17% a los 24 meses, y el 20% a los 36 meses. En 40 de 79 pacientes (51%) se detectó una concentración plasmática de ARN de VIH-1 > 50 copias/ml a los 12 meses de iniciado el tratamiento, asociada a un escaso cumplimiento del TAR. Entre los 29 pacientes con más de 1000 copias/ml a los 12 meses, se detectaron mutaciones de resistencia a los inhibidores no nucleósidos de la transcriptasa inversa (NNRTI) en 23 casos (79%); tanto a los NNRTI como a la lamivudina en 21 casos (72%); y a los NNRTI, la lamivudina y otros inhibidores nucleósidos de la transcriptasa inversa en 10 casos (35%). En total, 106 participantes (73%) declararon que habían mantenido relaciones sexuales sin preservativo, y 35 de las 96 mujeres (36%) se encontraban embarazadas durante el seguimiento. CONCLUSIÓN: Los adolescentes y adultos jóvenes con SIDA sometidos a TAR presentan un riesgo especial de fracaso virológico y de progresión de la enfermedad y pueden por consiguiente transmitir el VIH-1 a su pareja y a los lactantes. Se requieren urgentemente estrategias que aborden las necesidades especiales de ese grupo de edad.

OBJECTIF: Evaluer les issues du traitement antirétroviral (ART) chez des adolescents et des jeunes vivant en Haïti, pays victime d'une épidémie généralisée de VIH-1. MÉTHODES: On a effectué une évaluation de la survie, du taux d'acide ribonucléique (ARN) VIH-1 plasmatique et des schémas de pharmacorésistance du VIH-1 après 12 mois de traitement ART chez des jeunes individus de 13 à 25 ans atteints de sida, accueillis dans un dispensaire de Port-au-Prince entre le 1er mars 2003 et le 31 décembre 2005. Les sujets de l'étude ont reçu des antirétroviraux conformément aux recommandations de l'OMS. On a utilisé une analyse de Kaplan-Meier pour estimer les probabilités de survie et les intervalles de confiance à 95 % (IC) correspondants pour la période allant du début du traitement ART au décès des sujets. RÉSULTATS: Sur les 146 malades, 96 (66 %) étaient des femmes ; la valeur médiane de référence pour la numération des lymphocytes CD4+ était de 129 cellules/ml. L'analyse de Kaplan-Meier a montré que 13 % des malades étaient décédés au bout de 12 mois, 17 % au bout de 24 mois et 20 % au bout de 36 mois. On a relevé une concentration d'ARN VIH-1 plasmatique > 50 copies/ml chez 40 malades sur 79 (51 %), 12 mois après le début du traitement, en association avec une mauvaise observance thérapeutique. Chez 29 malades présentant plus de 1000 copies/ml au bout de 12 mois, on a détecté des mutations de résistance aux inhibiteurs non-nucléosidiques de la transcriptase inverse (NNRTI) dans 23 cas (79 %) ; à la fois aux NNRTI et à la lamivudine dans 21 cas (72 %) ; et aux NNRTI, à la lamivudine et à des inhibiteurs nucléosidiques de la transcriptase inverse dans 10 cas (35 %). Cent six participants ont rapporté avoir eu des rapports sexuels non protégés et 35 des 96 femmes (36 %) étaient enceintes pendant le suivi. CONCLUSION: Les adolescents et les jeunes atteints de sida qui reçoivent un traitement ART courent un risque d'échec virologique et de progression de la maladie et peuvent donc transmettre le VIH-1 à leurs partenaires sexuels et le cas échéant à leur enfant à naître. Il est urgent de disposer de stratégies permettant de cibler les besoins spécifiques de cette tranche d'âges.

Mycobacterium ulcerans disease (Buruli ulcer) is an important health problem in several west African countries. It is prevalent in scattered foci around the world, predominantly in riverine areas with a humid, hot climate. We review the epidemiology, bacteriology, transmission, immunology, pathology, diagnosis and treatment of infections. M. ulcerans is an ubiquitous micro-organism and is harboured by fish, snails, and water insects. The mode of transmission is unknown. Lesions are most common on exposed parts of the body, particularly on the limbs. Spontaneous healing may occur. Many patients in endemic areas present late with advanced, severe lesions. BCG vaccination yields a limited, relatively short-lived, immune protection. Recommended treatment consists of surgical debridement, followed by skin grafting if necessary. Many patients have functional limitations after healing. Better understanding of disease transmission and pathogenesis is needed for improved control and prevention of Buruli ulcer.

La enfermedad causada por Mycobacterium ulcerans (úlcera de Buruli) constituye un grave problema de salud en varios países de África occidental, pero es frecuente en focos dispersos en todo el mundo, predominantemente en zonas fluviales con clima cálido y húmedo. Examinamos aquí la epidemiología, bacteriología, transmisión, inmunología, histopatología, diagnóstico y tratamiento de este tipo de infección. M. ulcerans es un microorganismo ubicuo que se alberga en peces, caracoles e insectos acuáticos. Se desconoce el modo de transmisión. Las lesiones aparecen sobre todo en las partes expuestas del cuerpo, en particular en los miembros. A veces se produce una curación espontánea. Muchos de los pacientes de las zonas endémicas acuden al médico cuando presentan ya lesiones muy avanzadas y graves. La vacunación con BCG confiere una protección inmunitaria limitada y relativamente breve. El tratamiento recomendado consiste en el desbridamiento quirúrgico, seguido de injerto cutáneo si es necesario. Muchos pacientes sufren limitaciones funcionales aun después de curados. Es preciso comprender mejor la transmisión y la patogénesis de la enfermedad para poder prevenir y controlar más satisfactoriamente la úlcera de Buruli.

L'infection à Mycobacterium ulcerans (ulcère de Buruli) constitue un important problème sanitaire dans plusieurs pays d'Afrique de l'Ouest. Elle est prévalente sous forme de foyers dispersés à travers le monde, principalement dans les zones fluviales soumises à un climat humide et chaud. L'article examine l'épidémiologie, la bactériologie, la transmission, l'immunologie, la pathologie, le diagnostic et le traitement de cette infection. M. ulcerans est un microorganisme omniprésent. Il est hébergé par des poissons, des escargots et des insectes d'eau. Le mode de transmission n'est pas connu. Les lésions touchent le plus souvent les parties exposées du corps, en particulier les membres. Une guérison spontanée est possible. Dans les zones endémiques, de nombreux malades se présentent tardivement, avec des lésions à un stade avancé et grave. La vaccination par le BCG apporte une protection immunitaire limitée, de durée relativement courte. Le traitement recommandé consiste en un débridage chirurgical des lésions, suivi si nécessaire, d'une greffe de peau. De nombreux malades souffrent de limitations fonctionnelles une fois guéris. Pour combattre et prévenir plus efficacement l'ulcère de Buruli, il convient de mieux comprendre la transmission de cette maladie et sa pathogenèse.