Diaz Orihuela, Maria Magdalena

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Diaz Orihuela, Maria Magdalena
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magi@upeu.edu.pe
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    Lineage-specific <i>tprK</i> diversification and <i>Treponema pallidum</i> transmission dynamics in Buenos Aires, Argentina
    (2026-01-30)
    Nicole A.P. Lieberman  
    ;
    Luciana García
    ;
    Shah A.K. Mohamed Bakhash
    ;
    Jeffrey C. Furlong
    ;
    B. Ethan Nunley
    Abstract Background Syphilis rates are rising globally, with increases in congenital syphilis in South America particularly concerning. The characterization of contemporary South American Treponema pallidum (Tp) strains is crucial to syphilis vaccine development, yet few genomic epidemiology studies have focused on this region. Here, we performed whole genome sequencing (WGS) of Tp from Buenos Aires, Argentina, as well as deep sequencing of the hypervariable tprK locus, which is critical to Tp immune evasion. Methods People with primary, secondary, or congenital syphilis were enrolled at two clinics in Buenos Aires between October 2018 and January 2023, including individuals associated with intra-household transmission. Hybrid capture WGS was performed and a core genome phylogeny generated. K-mer-based methods using full-length tprK PacBio long reads were used to uncover differences in diversity and detect Tp transmission. Findings Tp genomes were recovered from 70 individuals in Buenos Aires and primarily belonged to globally dominant SS14 sublineage-1 and Nichols sublineage-8, as did Tp from Brazil (n=8). Peruvian samples (n=3) all belonged to sublineage-1. Two individuals from Argentina had co-infections with Nichols- and SS14-lineage strains. Macrolide resistance via A2058G occurred in 27/70 (38.6%) samples. Across 56 samples, tprK allelic diversity was significantly increased in secondary syphilis, oral lesions, and SS14-lineage strains compared to primary syphilis, anogenital lesions, and Nichols-lineage strains, respectively. Increased diversity in SS14-lineage strains is driven by an enhanced repertoire of V7-specific donor sequences. tprK sequences from intra-household transmissions were more similar than unrelated samples with identical core genomes. Interpretation Tp circulating in South America is closely related to dominant global sublineages. Increased tprK diversity in the SS14 lineage may influence Tp’s ability to escape host immunity. tprK profiling is a promising tool to elucidate syphilis transmission networks. This study underscores the utility of genomics to yield insights into Tp pathogenesis. Research in context Evidence before this study Although whole genome sequencing (WGS) and genomic epidemiology have contributed to an understanding of the global diversity of Treponema pallidum ( Tp ), very few strains from South America have been sequenced to date. On January 6 th , 2026, we performed a PubMed search including terms “syphilis genomic epidemiology”, “South America”, “ Treponema pallidum ”, and “Argentina”. We excluded studies of ancient Tp samples found in South American archeological sites. A single Tp sample from Argentina was originally sequenced in 2016 and included in subsequent analyses of global diversity. Nine Peruvian samples were previously sequenced in a study of global diversity on six continents. Thirty-three samples from Cali, Colombia were predominantly SS14-lineage and genotypic macrolide resistance was found in half of strains. Additionally, studies of Tp in Buenos Aires using a multi-locus sequence typing approach have shown circulation of strains belonging to both Nichols and SS14 lineages, with an increasing rate of macrolide resistance over time. Five previous studies have examined tprK in clinical specimens and consistently shown increased tprK diversity in specimens associated with secondary syphilis compared to primary syphilis lesions. One study has shown that loss of tprK donor cassettes is associated with reduced tprK diversity, consistent with results from in vitro experiments. A single study has shown that tprK sequence content is more similar in samples with a suspected epidemiologic link, though no prior studies have looked at tprK diversity in the context of known syphilis transmission events. Added value of this study This study is the first to use WGS to comprehensively examine Tp transmission in a large South American city, yielding 96 samples from 70 individuals. We also add the first contemporary Tp genomes from Brazil. In contrast to findings from England, Australia, and other high-income countries, no Tp sublineages are associated with demographic groups or sexual networks in Buenos Aires. Two of seventy patients were co-infected with both Nichols- and SS14-lineage strains, showing the previously unappreciated frequency of conditions that permit inter-strain recombination-driven diversification of Tp . This study also reveals novel aspects of Tp pathogenesis, including lineage-specific differences in tprK diversity. We also develop methods for the analysis of tprK relatedness between samples and demonstrate that tprK sequences are more similar in samples from individuals within intra-household syphilis transmission chains compared to those from epidemiologically unrelated individuals. Implications of all the available evidence Tp strains circulating in Buenos Aires are genetically similar to those circulating worldwide and in Brazil and Peru but are noteworthy for the low (but rising) rate of macrolide resistance. Lineage-specific patterns of tprK antigenic variation could result in differences between Nichols- and SS14-lineage strains’ interactions with the host immune system. Finally, we show that tprK profiling holds promise to identify samples from within a syphilis transmission chain and could play an important role in public health.
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    The joint impact of temperature, humidity, and air pollution on COVID-19 incidence: a multi-country time-series study in 439 cities
    (2026-01-24)
    Keita Wagatsuma  
    ;
    Denise Feurer
    ;
    Wenhua Yu
    ;
    Rongbin Xu
    ;
    Tim Riffe
    independently increased COVID-19 incidence, highlighting the need to consider both thermal environment and air quality when designing climate-resilient public health responses. These findings enhance understanding of how climate-related environmental stressors influence COVID-19 transmission.
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    Nivel de conocimiento sobre el Proceso de Atención de Enfermería (PAE) en el cuidado de la salud espiritual de los profesionales de Enfermería que laboran en las unidades críticas del Hospital Nacional Hipólito Unanue, Lima 2010
    (2019-08-01)
    María Magdalena Díaz Orihuela  
    ;
    Nira Cutipa Gonzáles
    ;
    Rosa Matos Salgado
    Objetivo: Determinar el nivel de conocimiento sobre el Proceso de Atención de Enfermería (PAE) en el cuidado de la salud espiritual que posee el profesional de enfermería que labora en las unidades críticas: Cirugía, Emergencia y UCI del Hospital Hipólito Unanue”, Lima, 2010. Material y métodos: El estudio fue de diseño no experimental, de enfoque cuantitativo, de tipo descriptivo transversal. La muestra estuvo conformada por 40 enfermeras que laboran en las unidades críticas del Hospital Hipólito Unanue, determinada mediante un muestreo probabilístico aleatorio. Para la recolección de datos se utilizó como instrumento el cuestionario para medir el nivel de conocimiento de los enfermeros sobre el PAE del cuidado de la salud espiritual, el cual fue elaborado por las investigadoras. El instrumento fue sometido a juicio de expertos y a la prueba de confiabilidad de Alpha de Cronbach (0.73). El análisis e interpretación de los mismos se realizó utilizando el paquete estadístico SPSS v. 15. Resultados: Los resultados obtenidos, en cuanto al nivel de conocimiento sobre el PAE del cuidado de la salud espiritual fueron: un 57.5% muestra un nivel de conocimiento deficiente, un 27.5% un nivel regular, un 12.5% un nivel bueno y solo un 2.5% un nivel excelente, esto indica que la mayoría de enfermeras encuestadas tiene un nivel conocimiento deficiente sobre el PAE en el cuidado espiritual. Conclusión: La mayoría de los enfermeros desconoce el fundamento científico del PAE sobre el cuidado de la salud espiritual, siendo esto una limitante para brindar los cuidados de Enfermería de forma integral.
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    Temperature frequency and mortality: Assessing adaptation to local temperature
    (2024-05-01)
    Yao Wu  
    ;
    Bo Wen
    ;
    Antonio Gasparrini
    ;
    Ben Armstrong
    ;
    Francesco Sera
    Assessing the association between temperature frequency and mortality can provide insights into human adaptation to local ambient temperatures. We collected daily time-series data on mortality and temperature from 757 locations in 47 countries/regions during 1979-2020. We used a two-stage time series design to assess the association between temperature frequency and all-cause mortality. The results were pooled at the national, regional, and global levels. We observed a consistent decrease in the risk of mortality as the normalized frequency of temperature increases across the globe. The average increase in mortality risk comparing the 10th to 100th percentile of normalized frequency was 13.03% (95% CI: 12.17-13.91), with substantial regional differences (from 4.56% in Australia and New Zealand to 33.06% in South Europe). The highest increase in mortality was observed for high-income countries (13.58%, 95% CI: 12.56-14.61), followed by lower-middle-income countries (12.34%, 95% CI: 9.27-15.51). This study observed a declining risk of mortality associated with higher temperature frequency. Our findings suggest that populations can adapt to their local climate with frequent exposure, with the adapting ability varying geographically due to differences in climatic and socioeconomic characteristics.
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    A scoping review of end-of-life discussions and palliative care: implications for neurological intensive care among Latinos in the U.S.
    (2024-08-24)
    Monica M. Diaz  
    ;
    Lesley A. Guareña
    ;
    Bettsie Garcia
    ;
    Christoper A. Alarcón-Ruiz
    ;
    Stella Seal
    Goals of care (Goals-of-care) discussions and palliative care (PC) are crucial to providing comprehensive healthcare, particularly for acute neurological conditions requiring admission to a neurological intensive care unit. We identified gaps in the literature and describe insight for future research on end-of-life discussions and PC for U.S. Latinos with acute neurological conditions. We searched 10 databases including peer-reviewed abstracts and manuscripts of hospitalized U.S. Latinos with acute neurological and non-neurological conditions. We included 44 of 3231 publications and identified various themes: PC utilization, pre-established advanced directives in Goals-of-care discussions, Goals-of-care discussion outcomes, tracheostomy or percutaneous gastrostomy tube placement rates among hospitalized Latinos. Our review highlights that Latinos appear to have lower palliative care utilization compared with non-Latino Whites and may be less likely to have pre-established advanced directives, more likely to have gastrostomy or tracheostomy placement and less likely to have do-not-resuscitate status.
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    ESTRESSE EM IDOSOS NO CONTEXTO DA PANDEMIA DA COVID-19 E SEUS FATORES ASSOCIADOS
    (2023-01-01)
    Orfelina Arpasi Quispe  
    ;
    Lili Fernandes-Molocho
    ;
    Maria Rosario Mocarro-Aguilar
    ;
    María Magdalena Díaz Orihuela  
    ;
    Jack Roberto Silva Fhon
    RESUMO: Objetivo: identificar o estresse nos idosos que vivem na cidade de Lima e sua associação com fatores demográficos, infodemias, a presença de sintomas físicos e psicológicos e o uso de substâncias ilícitas no contexto da pandemia de COVID-19. Método: estudo quantitativo, transversal e analítico através da pesquisa baseada na web com 384 idosos da cidade de Lima - Peru, entre abril e agosto de 2021. Os instrumentos de perfil demográfico, Escala de Estresse Percebido e sintomas autorrelatados foram utilizados para o estudo. A regressão logística múltipla foi utilizada, considerando o nível de significância de 5%. Resultados: 62% eram mulheres, e a idade variou entre 60 e 95 anos, com uma média de 70,5 anos. A média de estresse foi de 26,8 pontos. O estresse estava associado ao medo da morte de parentes e à preocupação com os idosos. Conclusões: é importante para profissionais de saúde treinados para identificar mudanças de humor nos idosos e criar planos de cuidados individualizados.
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    The burden of cardiovascular events according to cardiovascular risk profile in adults from high-income, middle-income, and low-income countries (PURE): a cohort study
    (2025-07-22)
    Darryl P. Leong  
    ;
    Rita Yusuf
    ;
    Romaina Iqbal
    ;
    Álvaro Avezum
    ;
    Afzalhussein Yusufali
    BACKGROUND: Current strategies to prevent adverse cardiovascular outcomes focus primary prevention in high-risk groups and secondary prevention in people with known cardiovascular disease. We aimed to determine the proportion of events occurring in lower-risk groups globally. METHODS: We included people aged 40 years to younger than 75 years who were enrolled in the Prospective Urban Rural Epidemiology (PURE) study, which is an ongoing, international, prospective, population-based cohort study that started recruiting adults from households selected to be broadly representative of the sociodemographic composition of their communities. We prospectively documented fatal or non-fatal myocardial infarction, stroke, heart failure, or any other fatal cardiovascular event stratified by history of cardiovascular disease and by the 10-year predicted disease risk scores based on WHO 2019 laboratory risk tables (<10% [low], 10% to <20% [intermediate], and ≥20% [high]) in people without previous cardiovascular disease from 26 high-income, middle-income, and low-income countries. Outcome event rates were standardised for the cohort's age and sex distribution. FINDINGS: Between July 11, 2000, and May 6, 2019, 128 973 participants were included from 26 countries (mean age 53·6 years [SD 8·2]; 75 858 [58·8%] were female and 53 115 [41·2%] were male). We observed 11 483 outcome events affecting 8·9% of the cohort during a median follow-up of 12·3 years (IQR 9·8-14·6). Among participants, 89 508 (69·4%) had a low cardiovascular disease risk, 22 363 (17·3%) had an intermediate cardiovascular disease risk, and 5529 (4·3%) had a high cardiovascular disease risk, while 11 573 (9·0%) had known cardiovascular disease. The age-standardised and sex-standardised cardiovascular disease incidence rates per 1000 person-years was 4·1 (95% CI 4·0-4·2) in the low-risk group, 17·7 (15·2-20·2) in the intermediate-risk group, and 40·8 (25·1-56·4) in the high-risk group. Overall, 41% of outcome events occurred in cardiovascular disease-naive participants at low risk. The proportion of adverse cardiovascular outcomes occurring in this low-risk group was inversely related to country income level (32% in high-income, 38% in middle-income, and 54% in low-income countries) and was higher in women (51%) than in men (32%). INTERPRETATION: To achieve a substantial population-level reduction in cardiovascular disease, a fundamental change is needed, so that preventive strategies for cardiovascular disease extend beyond those at high or even intermediate predicted risk to include those at considered to be at low risk. FUNDING: The funding bodies are listed in the appendix (p 29).
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    Short-term association between hot nights and mortality: a multicountry analysis in 178 locations considering hourly ambient temperature
    (2025-08-22)
    Dominic Royé  
    ;
    Francesco Sera
    ;
    Aurelio Tobı́as
    ;
    Masahiro Hashizume
    ;
    Yasushi Honda
    BACKGROUND: The rise in hot nights over recent decades and projections of further increases due to climate change underscores the critical need to understand their impact. This knowledge is essential for shaping public health strategies and guiding adaptation efforts. Despite their significance, research on the implications of hot nights remains limited. OBJECTIVE: This study estimated the association between hot-night excess (the sum of excess heat during the nighttime above a threshold) and duration (the percent of nighttime with a positive excess) based on hourly ambient temperatures and daily mortality in the warm season over multiple locations worldwide. METHODS: We fitted time series regression models to mortality in 178 locations across 44 countries using a distributed lag non-linear model over lags of 0-3 days, controlling for daily maximum temperature and daily mean absolute humidity. Next, we used a multivariate meta-regression model to pool results and estimated attributable burdens. RESULTS: We found a positive, increasing mortality risk with hot-night excess and duration. Assuming 0 as a reference, the pooled relative risks of death associated with extreme excess and duration, defined as the 90th percentile in each index, were both similar at 1.026 (95 % CI, 1.017; 1.036) and 1.026 (95 % CI, 1.013; 1.040). The overall estimated attributable fractions were also observed to be closely similar at 0.60 % (95 % CI, 0.09; 1.10 %) and 0.62 % (95 % CI, 0.00; 1.23 %), respectively. DISCUSSION: This study provides new evidence that hot nights have a specific contribution to heat-related mortality risk. Modeling thermal characteristics' sub-hourly impact on mortality during the night could improve decision-making for long-term adaptions and preventive public health strategies.
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