Cytomegalovirus Reactivations in Allogeneic Hematopoietic Stem Cell Transplantation from HLA-Matched and Haploidentical Donors with Post-Transplantation Cyclophosphamide

Cytomegalovirus (CMV) reactivations cause significant morbidity in allogeneic hematopoietic stem cell transplantation (HSCT) recipients. Graft-versus-host disease (GVHD) prophylaxis with post-transplantation cyclophosphamide (PTCy) is associated with an increased risk of CMV infections. Data are limited comparing HSCT with PTCy performed from matched sibling donors (MSDs), matched unrelated donors (MUDs), and haploidentical (Haplo) donors. In the present study, we aimed to characterize CMV reactivation and recurrence in patients with hematologic malignancies undergoing HSCT from MSD, MUD, and Haplo donors using PTCy as GVHD prophylaxis in the pre-letermovir era. We also analyzed risk factors of CMV reactivation, including GVHD as a time-dependent variable, on the incidence and mortality associated with CMV infections. We analyzed CMV reactivation in patients undergoing HSCT from 160 MSDs, 124 MUDs, and 82 Haplo donors from a single institution. Uniform GVHD prophylaxis with PTCy, sirolimus, and mycophenolate mofetil was given irrespective of donor type. Overall, 46% of patients had at least 1 CMV reactivation. The 1-year cumulative incidence of CMV infection was 39% for MSD, 44% for MUD, and 62% for Haplo donors (P < .001), with 96% of reactivations occurring before day +100. Multivariate analysis identified factors associated with the first CMV reactivation, including Haplo donor, positive recipient CMV serology, older patient age, and grade II-IV acute GVHD. The 1-year cumulative incidence of second reactivation from HSCT was 13%. Recipient CMV seropositivity, older patient age, and grade II-IV acute GVHD, but not type of donor, were identified as adverse factors for second CMV reactivation in multivariate analysis. The 1-year cumulative incidence of a third reactivation post HSCT was 4.4%. Ten cases of CMV disease were recorded, with no attributable deaths. Nevertheless, the risk for nonrelapse mortality was greater for patients who experienced CMV reactivation in multivariate time-dependent Cox model analysis. CMV reactivation is frequent in HSCT with PTCy in patients not receiving letermovir prophylaxis. Identified risk factors include the use of a Haplo donor, recipient CMV seropositivity, and grade II-IV acute GVHD. The prevalence of recurrent CMV reactivations is a noteworthy issue, especially after acute GVHD, warranting trials of secondary prophylaxis strategies.

Efficacy and safety of withholding antimicrobial therapy in children with cancer, fever and neutropenia, with a demonstrated viral respiratory infection: a randomized clinical trial

OBJECTIVES

To validate the efficacy and safety of withholding antimicrobial therapy in a new cohort of children with cancer and febrile neutropenia (FN) having a demonstrated viral respiratory tract infection (RTI).

METHODS

Prospective, multicenter, non-inferiority, randomized study, approved by the ethical committee, in children presenting with FN at seven hospitals in Chile, evaluated at admission for diagnosis of bacterial and viral pathogens. Children who were positive for a respiratory virus (RV), negative for a bacterial pathogen and had a favorable evolution after 48-72 hours of antimicrobial therapy were randomized to either maintain or withhold antimicrobial therapy. The primary endpoint was the percentage of episodes with uneventful resolution, whereas the secondary endpoints were days of fever/hospitalization, requirement of antimicrobial treatment readministration, sepsis, pediatric intensive care unit (PICU) admission and death.

RESULTS

A total of 301 of 939 children with FN episodes recruited between March 2021 and December 2023 had a RV as a unique identified microorganism, of which 139 had a favorable evolution at 48-72 hours and were randomized, 70 to maintain and 69 to withdraw antimicrobial therapy. The median days of antimicrobial therapy was 5 (IQR 3-6) versus 3 (IQR 3-6) days (p<0.001), with similar frequency of uneventful resolution (66/70 (94%) and 66/69 (96%), RR 1.01, (95% CI 0.93-1.09), absolute risk difference 0.01, (95% CI -0.05-0.08) and similar number of days of fever and days of hospitalization. No cases of sepsis, PICU admission or death were reported.

CONCLUSIONS

We validated the strategy of withdrawal antimicrobial therapy in children with FN and viral RTI, based on clinical and microbiological/molecular diagnostic criteria. This will enable advances in antimicrobial stewardship strategies with a possible future impact on antimicrobial resistance.

Profiling wastewater characteristics in intra-urban catchments using online monitoring stations

This study aims to investigate the differences in intra-urban catchments with different characteristics through real-time wastewater monitoring. Monitoring stations were installed in three neighbourhoods of Barcelona to measure flow, total chemical oxygen demand (COD), pH, conductivity, temperature, and bisulfide (HS-) for 1 year. Typical wastewater profiles were obtained for weekdays, weekends, and holidays in the summer and winter seasons. The results reveal differences in waking up times and evening routines, commuting behaviour during weekends and holidays, and water consumption. The pollutant profiles contribute to a better understanding of pollution generation in households and catchment activities. Flows and COD correlate well at all stations, but there are differences in conductivity and HS- at the station level. The article concludes by discussing the operational experience of the monitoring stations.

Excess Mortality During 2020 in Spain: The Most Affected Population, Age, and Educational Group by the COVID-19 Pandemic

OBJECTIVE

The objective of this work was to study mortality increase in Spain during the first and second academic semesters of 2020, coinciding with the first 2 waves of the Covid-19 pandemic; by sex, age, and education.

METHODS

An observational study was carried out, using linked populations and deaths' data from 2017 to 2020. The mortality rates from all causes and leading causes other than Covid-19 during each semester of 2020, compared to the 2017-2019 averages for the same semester, was also estimated. Mortality rate ratios (MRR) and differences were used for comparison.

RESULTS

All-cause mortality rates increased in 2020 compared to pre-covid, except among working-age, (25-64 years) highly-educated women. Such increases were larger in lower-educated people between the working age range, in both 2020 semesters, but not at other ages. In the elderly, the MMR in the first semester in women and men were respectively, 1.14, and 1.25 among lower-educated people, and 1.28 and 1.23 among highly-educated people. In the second semester, the MMR were 1.12 in both sexes among lower-educated people and 1.13 in women and 1.16 in men among highly-educated people.

CONCLUSION

Lower-educated people within working age and highly-educated people at older ages showed the greatest increase in all-cause mortality in 2020, compared to the pre-pandemic period.

Influence of dengue virus serotypes on the abundance of Aedes aegypti insect-specific viruses (ISVs)

A comprehensive understanding of the virome in mosquito vectors is crucial for assessing the potential transmission of viral agents, designing effective vector control strategies, and advancing our knowledge of insect-specific viruses (ISVs). In this study, we utilized Oxford Nanopore Technologies metagenomics to characterize the virome of Aedes aegypti mosquitoes collected in various regions of Colombia, a country hyperendemic for dengue virus (DENV). Analyses were conducted on groups of insects with previous natural DENV infection (DENV-1 and DENV-2 serotypes), as well as mosquito samples that tested negative for virus infection (DENV-negative). Our findings indicate that the Ae. aegypti virome exhibits a similar viral composition at the ISV family and species levels in both DENV-positive and DENV-negative samples across all study sites. However, differences were observed in the relative abundance of viral families such as Phenuiviridae, Partitiviridae, Flaviviridae, Rhabdoviridae, Picornaviridae, Bromoviridae, and Virgaviridae, depending on the serotype of DENV-1 and DENV-2. In addition, ISVs are frequently found in the core virome of Ae. aegypti, such as Phasi Charoen-like phasivirus (PCLV), which was the most prevalent and showed variable abundance in relation to the presence of specific DENV serotypes. Phylogenetic analyses of the L, M, and S segments of the PCLV genome are associated with sequences from different regions of the world but show close clustering with sequences from Brazil and Guadeloupe, indicating a shared evolutionary relationship. The profiling of the Ae. aegypti virome in Colombia presented here improves our understanding of viral diversity within mosquito vectors and provides information that opens the way to possible connections between ISVs and arboviruses. Future studies aimed at deepening our understanding of the mechanisms underlying the interactions between ISVs and DENV serotypes in Ae. aegypti could provide valuable information for the design of effective vector-borne viral disease control and prevention strategies.IMPORTANCEIn this study, we employed a metagenomic approach to characterize the virome of Aedes aegypti mosquitoes, with and without natural DENV infection, in several regions of Colombia. Our findings indicate that the mosquito virome is predominantly composed of insect-specific viruses (ISVs) and that infection with different DENV serotypes (DENV-1 and DENV-2) could lead to alterations in the relative abundance of viral families and species constituting the core virome in Aedes spp. The study also sheds light on the identification of the genome and evolutionary relationships of the Phasi Charoen-like phasivirus in Ae. aegypti in Colombia, a widespread ISV in areas with high DENV incidence.

Seamless integration of sewer system topology and tree location data: An algorithm to diagnose the potential impact of tree roots on pipes and propose rearrangement solutions

Wastewater networks are subject to several threats leading to wastewater leakages and public health hazards. External elements such as natural factors and human activities are common causes of wastewater leakages and require more in-depth analysis. Prevention and rehabilitation work is essential to secure wastewater networks and avoid pipe failures. This work presents a new algorithm that allows for the seamless integration of sewer topology and tree location data to diagnose the potential impact of tree roots on pipes. The algorithm also proposes tree rearrangement options that balance the cost of tree rearrangement with the cost of pipe repair. The paper also showcases a real-world case study in the city of Girona to evaluate the performance of the presented algorithms for a specific case focusing on tree roots as a natural factor. Results show that it is possible to optimally rearrange a number of the trees with the greatest impact, significantly minimizing pipe failures and wastewater leakages (82% risk reduction with only rearranging a 12% of the most impactful trees). The rearrangement solution not only protects the environment and prevents public health hazards, but also achieves a positive economic payback during the operational period of the pipes, saving up to 1.33M€ for a tree rearrangement of 7%. The presented methodology is applicable to other natural or human factors.

Emergence of Dengue Virus Serotype 2 Cosmopolitan Genotype, Colombia

Using Oxford Nanopore technologies and phylogenetic analyses, we sequenced and identified the cosmopolitan genotype of dengue virus serotype 2 isolated from 2 patients in the city of Villavicencio, Meta department, Colombia. This identification suggests the emergence of this genotype in the country, which warrants further surveillance to identify its epidemic potential.

Characterizing viral species in mosquitoes (Culicidae) in the Colombian Orinoco: insights from a preliminary metagenomic study

Mosquitoes (Diptera: Culicidae) are primary vectors of arthropod-borne viruses (arboviruses) that pose significant public health threats. Recent advances in sequencing technology emphasize the importance of understanding the arboviruses and insect-specific viruses (ISVs) hosted by mosquitoes, collectively called the "virome". Colombia, a tropical country with favorable conditions for the development and adaptation of multiple species of Culicidae, offers a favorable scenario for the transmission of epidemiologically important arboviruses. However, entomovirological surveillance studies are scarce in rural areas of the country, where humans, mosquitoes, and animals (both domestic and wild) coexist, leading to a higher risk of transmission of zoonotic diseases to humans. Thus, our study aimed to perform a preliminary metagenomic analysis of the mosquitoes of special relevance to public health belonging to the genera Ochlerotatus, Culex, Limatus, Mansonia, Psorophora, and Sabethes, within a rural savanna ecosystem in the Colombian Orinoco. We employed third-generation sequencing technology (Oxford Nanopore Technologies; ONT) to describe the virome of mosquitoes samples. Our results revealed that the virome was primarily shaped by insect-specific viruses (ISVs), with the Iflaviridae family being the most prevalent across all mosquito samples. Furthermore, we identified a group of ISVs that were common in all mosquito species tested, displaying the highest relative abundance concerning other groups of viruses. Notably, Hanko iflavirus-1 was especially prevalent in Culex eknomios (88.4%) and Ochlerotatus serratus (88.0%). Additionally, other ISVs, such as Guadalupe mosquito virus (GMV), Hubei mosquito virus1 (HMV1), Uxmal virus, Tanay virus, Cordoba virus, and Castlerea virus (all belonging to the Negevirus genus), were found as common viral species among the mosquitoes, although in lower proportions. These initial findings contribute to our understanding of ISVs within mosquito vectors of the Culicidae family in the Eastern Plains of Colombia. We recommend that future research explore deeper into ISV species shared among diverse vector species, and their potential interactions with arboviruses. In addition, we also showed the need for a thorough exploration of the influence of local rural habitat conditions on the shape of the virome in mosquito vectors.

Description of pathogenic bacteria in patients with respiratory symptoms associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Colombia

Viral respiratory infections may predispose to co-infections with other pathogenic microorganisms. In this study, pathogenic respiratory bacteria were detected using commercial kit Allplex^™ Respiratory Panel 4 from nasopharyngeal samples from individuals suffering respiratory symptoms with and without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients without respiratory symptoms were included as controls. Haemophilus influenzae and Streptococcus pneumoniae were detected from 12 patients (6%) in both, patients with respiratory symptoms (including hospitalized) (n = 6) and individual without symptoms (n = 6). Pathogenic bacteria possibly proliferate due to the limited immune response of patients with SARS-CoV-2, perhaps due to dysbiosis generated by the viral infection.

Employing Oxford Nanopore Technologies (ONT) for understanding the ecology and transmission dynamics of flaviviruses in mosquitoes (Diptera: Culicidae) from eastern Colombia

Studies focused on identifying the viral species of Flavivirus in vectors are scarce in Latin America and particularly in Colombia. Therefore, the frequency of infection of the Flavivirus genus and its feeding preferences were identified in the mosquito species circulating in the municipality of Puerto Carreño-Vichada, located in the Eastern Plains of Colombia. This was done by sequencing the viral NS5 and vertebrate 12S rRNA genes, respectively, using Oxford Nanopore Technologies (ONT). A total of 1,159 mosquitoes were captured, with the most abundant species being Aedes serratus at 73.6% (n=853). All the mosquitoes were processed in 230 pools (2-6 individuals) and 51 individuals, where 37.01% (n=104) were found to be infected with Flavivirus. In these samples, infection by arboviruses of epidemiological importance, such as dengue virus (DENV), Zika virus (ZIKV), and chikungunya virus (CHIKV), was ruled out by PCR. However, through sequencing, infection by different insect-specific viruses (ISFVs) and a medically important virus, West Nile virus (WNV), were identified in a mosquito of the Culex browni species. Additionally, the feeding patterns showed that most species present a generalist behavior. Given the above, conducting entomovirological surveillance studies is crucial, especially in areas of low anthropogenic intervention, due to the high probability that potentially pathogenic viruses could generate spillover events under deforestation scenarios.

Magnetic resonance imaging findings of spontaneous pyomyoma in a premenopausal woman managed with myomectomy: A case report

BACKGROUND

Acute fibroid complications are rare. However, failure to recognize and treat acute complications expeditiously when they occur can lead to catastrophic, even deadly, complications. Pyomyoma is a rare but potentially fatal condition resulting from infarction and infection of a fibroid through bacterial seeding and direct, hematogenous, or lymphatic dissemination. Even though the diagnosis is established through clinical and laboratory findings, imaging is an important complementary method to support the suspected diagnosis.

CASE SUMMARY

Herein, we report a case of a pyomyoma in a nulliparous woman previously diagnosed with uterine leiomyomatosis according to ultrasound findings. The patient had previously attended the emergency room due to hypogastric pain unresponsive to analgesics. After a week of persistent pain, she developed sepsis without any identifiable foci. Magnetic resonance imaging revealed findings compatible with uterine myomatosis with red degeneration, and a possible diagnosis of a pyomyoma was made according to the imaging findings along with the patient’s clinical features. We decided to perform myomectomy (which is an infrequently performed surgical treatment due to the procedure’s intrinsic implications) due to the patient’s desire to preserve fertility. Histopathologic results revealed a uterine leiomyoma with coagulative and liquefactive necrosis, while the tissue culture showed gram-negative cocci bacteria, which were successfully treated using antibiotic therapy. The patient’s health status improved after several days.

CONCLUSION

The main diagnostic tools to evaluate pyomyomas are the clinical and laboratory findings as well as tissue cultures. Nonetheless, magnetic resonance imaging can help to corroborate these findings as well as to better characterize myomas with its different complications.

Optimal design of water reuse networks in cities through decision support tool development and testing

Water scarcity and droughts are an increasing issue in many parts of the world. In the context of urban water systems, the transition to circularity may imply wastewater treatment and reuse. Planning and assessment of water reuse projects require decision-makers evaluating the cost and benefits of alternative scenarios. Manual or semi-automatic approaches are still common practice for planning both drinking and reclaimed water distribution networks. This work illustrates a decision support tool that, based on open data sources and graph theory coupled to greedy optimization algorithms, is able to automatically compute the optimal reclaimed water network for a given scenario. The tool provides not only the maximum amount of served reclaimed water per unit of invested cost, but also the length and diameters of the pipes required, the location and size of storage tanks, the population served, and the construction costs, i.e., everything under the same architecture. The usefulness of the tool is illustrated in two different but complementary cities in terms of size, density, and topography. The construction cost of the optimal water reclaimed network for a city of approximately 100,000 inhabitants is estimated to be in the range of €0.17-0.22/m³ (for a payback period of 30 years).

Arbovirus infection in Aedes aegypti from different departments of Colombia

The lack of precise and timely knowledge about the molecular epidemiology of arboviruses of public health importance, particularly in the vector, has limited the comprehensive control of arboviruses. In Colombia and the Americas, entomovirological studies are scarce. Therefore, this study aimed to describe the frequency of natural infection and/or co-infection by Dengue (DENV), Zika (ZIKV), and Chikungunya (CHIKV) in Aedes spp. circulating in different departments of Colombia (Amazonas, Boyacá, Magdalena, and Vichada) and identifying vector species by barcoding. Aedes mosquitoes were collected in departments with reported prevalence or incidence of arbovirus cases during 2020–2021, located in different biogeographic zones of the country: Amazonas, Boyacá, Magdalena, and Vichada. The insects were processed individually for RNA extraction, cDNA synthesis, and subsequent detection of DENV (serotypes DENV1-4 by multiplex PCR), CHIKV, and ZIKV (qRT-PCR). The positive mosquitoes for arboviruses were sequenced (Sanger method) using the subunit I of the cytochrome oxidase (COI) gene for species-level identification. In total, 558 Aedes mosquitoes were captured, 28.1% (n = 157) predominantly infected by DENV in all departments. The serotypes with the highest frequency of infection were DENV-1 and DENV-2 with 10.7% (n = 58) and 14.5% (n = 81), respectively. Coinfections between serotypes represented 3.9% (n = 22). CHIKV infection was detected in one individual (0.2%), and ZIKV infections were not detected. All infected samples were identified as A. aegypti (100%). From the COI dataset (593 bp), high levels of haplotype diversity (H = 0.948 ± 0.012) and moderate nucleotide diversity (π = 0.0225 ± 0.003) were identified, suggesting recent population expansions. Constructed phylogenetic analyses showed our COI sequences’ association with lineage I, which was reported widespread and related to a West African conspecific. We conclude that natural infection in A. aegypti by arbovirus might reflect the country’s epidemiological behavior, with a higher incidence of serotypes DENV-1 and DENV-2, which may be associated with high seroprevalence and asymptomatic infections in humans. This study demonstrates the high susceptibility of this species to arbovirus infection and confirms that A. aegypti is the main vector in Colombia. The importance of including entomovirological surveillance strategy within public health systems to understand transmission dynamics and the potential risk to the population is highlighted herein.

The role of prenatal exposure to antidepressants, anxiolytic, and hypnotics and its underlying illness on the risk of miscarriage using BIFAP database

Purpose

Despite the notable increase on the prescription of antidepressants and anxiolytics during pregnancy, recommendation on maintaining the treatment during prenatal period is still controversial. We aimed to separately assess the role of effects of the antidepressants and anxiolytic and the underlying illness, controlled by potential confounding associated with miscarriage onset.

Methods

We used data from a validated pregnant cohort aged 15–49 years from 2002 to 2016 using BIFAP database. All confirmed miscarriages were used to perform a nested control analysis using conditional logistic regression. Women were classified according to use of each drug of interest into four mutually exclusive groups: nonusers, users only during prepregnancy, continuers, and initiators during first trimester. Adjusted odds ratios (aORs) for major confounders during pregnancy such as number of visits to primary care practitioners visits, obesity, smoking, HTA, diabetes with 95% confidence intervals were calculated.

Results

Compared with nonusers, antidepressants continuers had the highest increased risk of miscarriage aOR (95%) of 1.29 (1.13–1.46), being continuers of paroxetine and fluoxetine the antidepressants with the strongest association. Likewise, continuers of anxiolytics and initiators showed an increased risk of 1.19 (1.04–1.37) and 1.30 (1.13–1.50). When separating the effect between the condition itself or the treatment, women exposed during first trimester, regardless treatment duration and/or the underlying illness, had the highest risk 1.27 (1.08–1.51) for antidepressants and 1.25 (1.13–1.39) for anxiolytics.

Conclusions

Our analysis showed an association between prenatal exposure to antidepressants and anxiolytics and miscarriage onset after controlling by potential confounding adjusting for confounders and the underlying illness. This association was not supported for hypnotic medications. Further studies are warranted to evaluate the risk of miscarriage among subpopulation of pregnant women requiring these medications.

The fasted and post-prandial physiological responses of the Patagonian blennie Eleginops maclovinus

Eleginops maclovinus is a native species with potential for Chilean aquaculture. Understanding the variations between the post-prandial and fasted metabolic responses can contribute to improving the aquaculture of this species. This study aimed to characterize variations in intermediate metabolism during the course of the day in the liver, serum, and gills of fed and unfed fish. For this, 72 fish were assigned to two experimental groups, "fed" and "fasted". The first group was fed "ad libitum" at 8.30, while the fasted group was not fed for 24 h. Samples were taken from both groups at 9:00, and every 2 h: 11:00, 13:00, 15:00, 17:00, and 19:00. In the fed group, food spent a long time in the gastrointestinal tract, with a large increase in stomach size and without evidence of complete emptying of the stomach at 19:00 (10.5 h post-feeding). In serum, the levels of amino acids, glucose, and triglycerides presented significant differences with peak levels at different times of day in the fed group. The cortisol in the fasted group presented a diurnal pattern with high levels during the morning and very low levels after 13:00, while in the fed group, the high cortisol variability did not allow a clear pattern to be established. In the liver, the effect of time on the enzymatic activity of the intermediary metabolism was greater compared to the effect of feeding. In the liver, enzyme activity decreased at later hours of the day, while glycogen levels increased at later hours of the day in both groups: but its levels were higher in the fed group. In gills, as well as in the liver, time had a greater effect than feeding on intermediate metabolism, since feeding only had a significant effect on the levels of hexokinase, lactate, and amino acids, suggesting an effect on carbohydrate metabolism. Meanwhile, time significantly affected the levels of Na⁺, K⁺-ATPase, glutamate dehydrogenase, aspartate aminotransferase, amino acids, and proteins, suggesting an effect on amino acid metabolism. In conclusion, the intermediate metabolism of E. maclovinus presents variations according to the time of day, with an increased metabolism during the morning and decreased metabolism as the day progresses, especially at the hepatic level. The gill tissue, despite not being a metabolic organ, presents feeding-dependent variations in its metabolism. Additional studies will be required to corroborate if coordinating a feeding strategy during the first hours of the day when metabolism is greater would improve the growth of E. maclovinus.

Classification of Two Volatiles Using an eNose Composed by an Array of 16 Single-Type Miniature Micro-Machined Metal-Oxide Gas Sensors

The artificial replication of an olfactory system is currently an open problem. The development of a portable and low-cost artificial olfactory system, also called electronic nose or eNose, is usually based on the use of an array of different gas sensors types, sensitive to different target gases. Low-cost Metal-Oxide semiconductor (MOX) gas sensors are widely used in such arrays. MOX sensors are based on a thin layer of silicon oxide with embedded heaters that can operate at different temperature set points, which usually have the disadvantages of different volatile sensitivity in each individual sensor unit and also different crossed sensitivity to different volatiles (unspecificity). This paper presents and eNose composed by an array of 16 low-cost BME680 digital miniature sensors embedding a miniature MOX gas sensor proposed to unspecifically evaluate air quality. In this paper, the inherent variability and unspecificity that must be expected from the 16 embedded MOX gas sensors, combined with signal processing, are exploited to classify two target volatiles: ethanol and acetone. The proposed eNose reads the resistance of the sensing layer of the 16 embedded MOX gas sensors, applies PCA for dimensional reduction and k-NN for classification. The validation results have shown an instantaneous classification success higher than 94% two days after the calibration and higher than 70% two weeks after, so the majority classification of a sequence of measures has been always successful in laboratory conditions. These first validation results and the low-power consumption of the eNose (0.9 W) enables its future improvement and its use in portable and battery-operated applications.

Optimal selection of monitoring sites in cities for SARS-CoV-2 surveillance in sewage networks

Selecting sampling points to monitor traces of SARS-CoV-2 in sewage at the intra-urban scale is no trivial task given the complexity of the networks and the multiple technical, economic and socio-environmental constraints involved. This paper proposes two algorithms for the automatic selection of sampling locations in sewage networks. The first algorithm, is for the optimal selection of a predefined number of sampling locations ensuring maximum coverage of inhabitants and minimum overlapping amongst selected sites (static approach). The second is for establishing a strategy of iterations of sample&analysis to identify patient zero and hot spots of COVID-19 infected inhabitants in cities (dynamic approach). The algorithms are based on graph-theory and are coupled to a greedy optimization algorithm. The usefulness of the algorithms is illustrated in the case study of Girona (NE Iberian Peninsula, 148,504 inhabitants). The results show that the algorithms are able to automatically propose locations for a given number of stations. In the case of Girona, always covering more than 60% of the manholes and with less than 3% of them overlapping amongst stations. Deploying 5, 6 or 7 stations results in more than 80% coverage in manholes and more than 85% of the inhabitants. For the dynamic sensor placement, we demonstrate that assigning infection probabilities to each manhole as a function of the number of inhabitants connected reduces the number of iterations required to detect the zero patient and the hot spot areas.

Thrombosis in abdominal vessels associated with COVID-19 Infection: A report of three cases

Hypercoagulability related to SARS-CoV-2 infection is one of the main extrapulmonary complications of COVID-19. We present three cases of intrabdominal thrombotic complications related to the state of hypercoagulability of COVID-19 and its tomographic features. Hypercoagulability state should be taking into account in the interpretation of radiological images in all infected patients with COVID-19.

Differences in Physiological Reactions Due to a Competitive Rehabilitation Game Modality

Interpersonal rehabilitation games, compared to single-player games, enhance motivation and intensity level. Usually, it is complicated to restrict the use of the system to pairs of impaired patients who have a similar skill level. Thus, such games must be dynamically adapted. Difficulty-adaptation algorithms are usually based only on performance parameters. In this way, the patient's condition cannot be considered when adapting the game. Introducing physiological reactions could help to improve decision-making. However, it is difficult to control how social interaction influences physiological reactions, making it difficult to interpret physiological responses. This article aimed to explore the changes in physiological responses due to the social interaction of a competitive game modality. This pilot study involved ten unimpaired participants (five pairs). We defined different therapy sessions: (i) a session without a competitor; (ii) two sessions with a virtual competitor with different difficulty levels; (iii) a competitive game. Results showed a difference in the physiological response in the competitive mode concerning single-player mode only due to the interpersonal game modality. In addition, feedback from participants suggested that it was necessary to keep a certain difficulty level to make the activity more challenging, and therefore be more engaging and rewarding.

Evaluation of the diagnostic performance of nine commercial RT-PCR kits for the detection of SARS-CoV-2 in Colombia

The ongoing severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic has led to the design and development of multiple reverse‐transcription polymerase chain reaction kits aimed to facilitate the rapid scale‐up of molecular testing for massive screening. We evaluated the diagnostic performance of nine commercial kits, which showed optimal performance and high discriminatory power. However, we observed differences in terms of sensitivity, specificity, and E gene Ct Values and discuss these results in light of the influence of SARS‐CoV‐2 genetic variability and its potential impact in current molecular diagnostic assays.

Microbial Communities' Characterization in Urban Recreational Surface Waters Using Next Generation Sequencing

Microbial communities in surface waters used for recreational purposes are indicators of contamination and risk of contact with human pathogens. Hence, monitoring microbial communities in recreational waters is important for potential public health threats to humans. Such monitoring is rare in Colombia, even in its capital, Bogotá, the most populous city in the country. This city encompasses metropolitan and linear parks with recreational water bodies that are used frequently by the public, and the presence of pathogens can compromise the health of the citizens. Therefore, we examined the bacterial, and eukaryotic communities in urban recreational lakes (URL) in four metropolitan parks in Bogotá, Colombia. Samples from four metropolitan parks (Los Novios, Simon Bolivar, El Tunal, and Timiza) and one stream contaminated with sewage from a linear park (El Virrey) were collected. We used amplicon next-generation sequencing of the 16S-rRNA gene and 18S-rRNA gene to characterize microbial communities followed by bioinformatics analyses. In addition, general water quality parameters-pH, hardness, acidity, alkalinity, dissolved oxygen, and nitrites-were recorded using a commercial kit. Genera of pathogens, including Legionella, Pseudomonas, Mycobacterium, Candida, and Naegleria, were found in lake waters. The stream El Virrey was, however, the only surface water that showed an abundance of fecal bacteria, often associated with low oxygen concentrations. All water bodies showed a predominance of fungal phyla, except for the lake at Timiza. This lake showed the highest pH, and its ecological dynamics are likely different from other water bodies. Likewise, some URLs displayed a greater abundance of cyanobacteria, including toxin-producing species. Algal genera associated with eutrophication were predominant among primary producing microorganisms. This study shows for the first time the description of the bacterial and eukaryotic communities of some URLs and a stream in Bogotá. The URLs and the stream harbored various pathogens that might pose a risk to the citizen's health.

Identification of cell surface targets for CAR-T cell therapies and antibody-drug conjugates in breast cancer

BACKGROUND

Two promising therapeutic strategies in oncology are chimeric antigen receptor-T cell (CAR-T) therapies and antibody-drug conjugates (ADCs). To be effective and safe, these immunotherapies require surface antigens to be sufficiently expressed in tumors and less or not expressed in normal tissues. To identify new targets for ADCs and CAR-T specifically targeting breast cancer (BC) molecular and pathology-based subtypes, we propose a novel in silico strategy based on multiple publicly available datasets and provide a comprehensive explanation of the workflow for a further implementation.

METHODS

We carried out differential gene expression analyses on The Cancer Genome Atlas BC RNA-sequencing data to identify BC subtype-specific upregulated genes. To fully explain the proposed target-discovering methodology, as proof of concept, we selected the 200 most upregulated genes for each subtype and undertook a comprehensive analysis of their protein expression in BC and normal tissues through several publicly available databases to identify the potentially safest and viable targets.

RESULTS

We identified 36 potentially suitable and subtype-specific tumor surface antigens (TSAs), including fibroblast growth factor receptor-4 (FGFR4), carcinoembryonic antigen-related cell adhesion molecule 6 (CEACAM6), GDNF family receptor alpha 1 (GFRA1), integrin beta-6 (ITGB6) and ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1). We also identified 63 potential TSA pairs that might be appropriate for co-targeting strategies. Finally, we validated subtype specificity in a cohort of our patients, multiple BC cell lines and the METABRIC database.

CONCLUSIONS

Overall, our in silico analysis provides a framework to identify novel and specific TSAs for the development of new CAR-T and antibody-based therapies in BC.

Theoretical study of electrorheological behavior of a nematic liquid crystal confined by two cylindrical surfaces with different anchoring energies

Electrorheological response of a nematic liquid crystal confined in the region between two coaxial and rotating circular cylinders is studied theoretically. Utilizing weak anchoring conditions, the physical properties of 4-n-pentyl-4-cyanobiphenyl (5CB), nonslip boundary conditions, and contrasting surface anchoring energies, we numerically obtain the equilibrium configurations for the nematic director under the influence of an external low-frequency radial electric field and the corresponding (angular) velocity profiles. The Fréedericksz transition is parametrized by the cylinders' radii ratio for different values of the surface energies. The averaged apparent viscosity of the nematic is calculated also.

Suboptimal Omnidirectional Wheel Design and Implementation

The optimal design of an omnidirectional wheel is usually focused on the minimization of the gap between the free rollers of the wheel in order to minimize contact discontinuities with the floor in order to minimize the generation of vibrations. However, in practice, a fast, tall, and heavy-weighted mobile robot using optimal omnidirectional wheels may also need a suspension system in order to reduce the presence of vibrations and oscillations in the upper part of the mobile robot. This paper empirically evaluates whether a heavy-weighted omnidirectional mobile robot can take advantage of its passive suspension system in order to also use non-optimal or suboptimal omnidirectional wheels with a non-optimized inner gap. The main comparative advantages of the proposed suboptimal omnidirectional wheel are its low manufacturing cost and the possibility of taking advantage of the gap to operate outdoors. The experimental part of this paper compares the vibrations generated by the motion system of a versatile mobile robot using optimal and suboptimal omnidirectional wheels. The final conclusion is that a suboptimal wheel with a large gap produces comparable on-board vibration patterns while maintaining the traction and increasing the grip on non-perfect planar surfaces.

Genomic profiling in non-small-cell lung cancer in young patients. A systematic review

Lung cancer in young patients is an uncommon and understudied entity that harbors distinctive epidemiological, clinic-demographic, and genomic features. We carried out a systematic review of genomic profiling in young patients with lung cancer from 2010 to 2020 in the main electronic databases and selected 23 manuscripts. Lung cancer in young patients occurs more frequently in women with adenocarcinoma histology and at more advanced stages. Some studies report higher oncogenic genomic alteration in this population, with higher anaplastic lymphoma kinase rearrangements, a distinct profile of epidermal growth factor receptor mutations, and other novel genomic alterations. Although still uncommon, the implementation of next-generation sequencing (NGS) has shed some light on germline genomic alterations associated with lung cancer in young patients. Although outcomes when compared with the older population are conflicting, the overall prognosis is still poor in this subset of patients and efforts to find targetable genomic alterations should be made to improve survival.

The osmotic response capacity of the Antarctic fish Harpagifer antarcticus is insufficient to cope with projected temperature and salinity under climate change

Over the last decades, climate change has intensified. Temperatures have increased and seawater has become "fresher" in Antarctica, affecting fish such as Harpagifer antarcticus. Thus, this study aimed to evaluate changes in the osmoregulatory response of the Antarctic notothenioid fish Harpagifer antarcticus and evaluate how it will cope with the future climate change and environmental conditions in the Antarctic, and in the hypothetical case that its geographical distribution will be extended to the Magellanes region. The present study was undertaken to determine the interaction between temperature and salinity tolerance (2 °C and 33 psu as the control group, the experimental groups were 5, 8, and 11 °C and 28 and 23 psu) and their effect on the osmoregulatory status of H. antarcticus. We evaluated changes in gill-kidney-intestine NKA activity, gene expression of NKAα, NKCC, CFTR, Aquaporins 1 and 8 in the same tissues, muscle water percentage, and plasma osmolality to evaluate osmoregulatory responses. Plasma osmolality decreased with high temperature, also the gill-kidney-intestine NKA activity, gene expression of NKA α, NKCC, CFTR, Aquaporins 1, and 8 were modified by temperature and salinity. We demonstrated that H. antarcticus can not live in the Magallanes region, due to its incapacity to put up with temperatures over 5 °C and with over 8 °C being catastrophic.

Social and professional consequences of COVID-19 lockdown in patients with multiple sclerosis from two very different populations

The global lockdown measures implemented due to the COVID-19 pandemic have nearly always had negative consequences for patients with multiple sclerosis (MS).

OBJECTIVE

We compared the social and professional effects of confinement on patients with MS in 2 very different populations, from Spain and China.

METHODS

Questionnaires were administered to a group of patients with MS who consulted at the MS unit of Vithas hospital (DINAC Foundation) in Seville, and patients with MS attended in several provinces of China in April 2020, with the aim of analysing the differences and similarities between populations in the social and professional effects of confinement. To this end, a database was created and subsequently analysed.

RESULTS

The Chinese population includes a higher proportion of younger patients and no differences were identified regarding sex. Most of the variables studied behaved in the same way in both patient populations. Spanish patients presented a lesser impact (30.7%) on their socio-economic situation than Chinese patients (44%) (P < .05). There were no significant differences between populations in the remaining variables. Social networks were widely used in the majority of patients from both populations.

CONCLUSIONS

The social and professional consequences of the pandemic were very similar in both groups; the use of social networks and family support was also similar. Spanish patients seem to present greater economic stability, perhaps due to the social support they receive.

Identification of Aedes (Diptera: Culicidae) Species and Arboviruses Circulating in Arauca, Eastern Colombia

The identification of vector species and their natural infection with arboviruses results in important data for the control of their transmission. However, for the eastern region of Colombia, this information is limited. Therefore, this study morphologically and molecularly identified species of the genus Aedes and the detection of arboviruses (Dengue, Chikungunya, Zika, and Mayaro) in female mosquitoes (individually) present in three municipalities (Saravena, Arauquita, and Tame) by amplifying the genetic material using RT-PCR (reverse transcriptase polymerase chain reaction) in the department of Arauca, eastern Colombia. Inconsistencies between morphological and molecular identification were detected in 13 individuals with Aedes albopictus initially determined as Aedes aegypti based on morphology (n = 13). Molecular identification showed the simultaneous presence of A. aegypti (n = 111) and A. albopictus (n = 58) in the urban municipalities of Saravena and Arauquita. These individuals were naturally infected with Dengue virus type 1 (DENV-1) and Chikungunya virus (CHIKV). The most frequent arbovirus was DENV-1 with an infection rate of 40.7% (11/27) for A. aegypti and 39.7% (23/58) for A. albopictus, which was followed by CHIKV with an infection rate of 1.8% for A. aegypti (2/111) and 6.9% for A. albopictus (4/58). Additionally, a mixed infection of DENV-1 and CHIKV was obtained in 4.5% of A. aegypti (5/111). Zika virus (ZIKV) and Mayaro virus (MAYV) infections were not detected. This study found that barcoding (fragment gene COI) is a successful method for identifying Aedes species. Additionally, we recommend the individual processing of insects as a more accurate strategy for arboviruses detection since the infection rate is obtained and co-infection between DENV-1 and CHIKV is also possible.

Hypoxia modulates the transcriptional immunological response in Oncorhynchus kisutch

Oncorhynchus kisutch is the third most cultivated salmonid species in the Chilean salmon industry and its farming conditions are characterised by high stocking density leading to the generation of high levels of organic matter (food - feces) and decomposition. In addition to the increasingly frequent hypoxic oceanographic events, these inappropriate farming conditions increase the demand for oxygen within the fish farm pen and lead to the appearance of hypoxic events that are harmful to fish.This study aimed to evaluate the stress response (cortisol) and transcription of genes involved in the immune response in head kidney and spleen of Oncorhynchus kisutch subjected to chronic hypoxic stress conditions. The fish were exposed to 100%, 60%, 50%, 35%, and 25% of DO for 28 days, then the blood (plasma), head kidney and spleen were removed. We observed mortality in the 25% DO group at days 15 and 20. Plasma cortisol increased significantly under 35% and 25% DO conditions compared to control. Transcription of Toll-like receptors (TLR1, TLR5M, TLR8, and TLR9) and cytokines (IL-1β, IL6, IL10, TNF-α) increased in the head kidney only in the 50% DO group, while in spleen there was an increase of these markers in the conditions of 60%, 35%, and 25% DO. As for the markers involved in cell-mediated immunity, CD4-MHCII and CD8-MHCI do not have a clear expression pattern, although there was down-regulation in MHCII transcription in the head kidney, in all the hypoxia conditions evaluated. Finally, IgM transcription was increased in the spleen in all hypoxia conditions, although it wasn't always statistically significant compared to the control. These results indicate that chronic hypoxia induces the stress response, increasing plasma cortisol levels and modulating the transcription of genes involved in the innate and adaptive immune response. The expression patterns were tissue-specific, indicating that the degree of hypoxia differentially affects the transcription of genes involved in the immune response of Oncorhynchus kisutch.

The arrival and spread of SARS-CoV-2 in Colombia

We performed phylogenomic analysis of severe acute respiratory syndrome coronavirus‐2 from 88 infected individuals across different regions of Colombia. Eleven different lineages were detected, suggesting multiple introduction events. Pangolin lineages B.1 and B.1.5 were the most frequent, with B.1 being associated with prior travel to high‐risk areas.

This is the first genomic epidemiology study of SARS‐CoV2 in Colombia.

Clusters formation and fragmentation of nitromethane at 266 nm

We carry out experiments on the fragmentation of nitromethane by multiphoton absorption at the wavelength 266 nm. This was conducted in a reflectron (Jordan), modified in the laboratory. Due to the large number of fragments, special care has been taken into the calibration of the system, in the simultaneity between the laser pulse and the sample, and the associated electronics to ensure that produced fragment spectra arise from the interaction laser-sample. We emphasize the next aspects of the method:•

Simple design for introducing a gas sample at laser interaction region to facilitate the cluster formation

•

Astonishing number of fragments produced by multiphoton absorption.

Smart lanthanide antennas for sensing water

Two new families of lanthanide antennas are described. 8-Methoxy-4,5-dihydrocyclopenta[de]quinolin-2(1H)-one phosphonates or carboxylates behave as selective antennas exhibiting Eu3+ luminescence in organic solvents, while quinolin-2(1H)-one analogues selectively sensitize the Tb3+ emission. These emissions are quenched by H2O addition. Based on this behaviour, the new lanthanide antennas can be used as highly sensitive water sensors.

An interactive database of Leishmania species distribution in the Americas

The Americas have an elevated number of leishmaniasis cases (accounting for two-thirds of the worldwide disease burden) and circulating Leishmania species, and are therefore of interest in terms of epidemiological surveillance. Here, we present a systematic review of Leishmania parasite species circulating in the countries of the American continent, together with complementary information on epidemiology and geospatial distribution. A database was built from data published between 1980 and 2018 on Leishmania species identified in most of the American countries. A total of 1499 georeferenced points were extracted from published articles and subsequently located to 14 countries in the Americas. This database could be used as a reference when surveilling the occurrence of Leishmania species in the continent.

Cellular stress responses of Eleginops maclovinus fish injected with Piscirickettsia salmonis and submitted to thermal stress

Fluctuations in ambient temperature along with the presence of pathogenic microorganisms can induce important cellular changes that alter the homeostasis of ectothermic fish. The aim of this study was to evaluate how sudden or gradual changes in environmental temperature together with the administration of Piscirickettsia salmonis modulate the transcription of genes involved in cellular stress response in the liver of Eleginops maclovinus. Fish were subjected to the following experimental conditions in duplicate: C- 12 °C: Injection only with culture medium, C+ 12 °C: Injection with P. salmonis, AM 18 °C: Injection only with culture medium under acclimation at 18 °C, AB 18 °C: Injection with P. salmonis under acclimation at 18 °C, SM 18 °C: Injection only with culture medium and thermal shock at 18 °C and SB 18 °C: Injection with P. salmonis and thermal shock at 18 °C and sampling at 4-, 8-, 12-, 16- and 20-day post injection (dpi). The genes implied in the heat shock response (HSP70, HSC70, HSP90, and GRP78), apoptosis pathway (BAX and SMAC/Diablo), ubiquitination (E2, E3, ubiquitin, and CHIP), and 26 proteasome complex (PSMB7, PSMC1, and PSMA2) showed expression profiles dependent on time and type of injection applied. All the genes greatly increased their expression levels at day 16 and showed moderate increases at day 20, except for PSMA2 which showed a higher increase between 4- and 12-day post challenges. Our results suggest that the changes observed at the final days of the experiment are due to temperature more than P. salmonis.

Cardiovascular mortality and risk behaviours by degree of urbanization before, during and after the economic crisis in Spain

BACKGROUND

To estimate the relationship of the degree of urbanization to cardiovascular mortality and to risk behaviours before, during and after the 2008 economic crisis in Spain.

METHODS

In three areas of residence - large urban areas, small urban areas and rural areas - we calculated the rate of premature mortality (0-74 years) from cardiovascular diseases before the crisis (2005-2007), during the crisis (2008-2010 and 2011-2013) and after the crisis (2014-2016), and the prevalence of risk behaviours in 2006, 2011 and 2016. In each period we estimated the mortality rate ratio (MRR) and the prevalence ratio, taking large urban areas as the reference.

RESULTS

In men, no significant differences were observed in mortality between the two urban areas, while the MRR in rural areas went from 0.92 [95% confidence interval, 0.90-0.94) in 2005-2007 to 0.94 (0.92-0.96) in 2014-2016. In women, no significant differences were observed in mortality between the rural and large urban areas, whereas the MRR in small urban areas decreased from 1.11 (1.08-1.14) in 2005-2007 to 1.06 (1.02-1.09) in 2014-2016. The rural areas had the lowest prevalence of smoking, obesity and physical inactivity in men, and of obesity in women. No significant differences were observed in smoking or physical inactivity by area of residence in women.

CONCLUSION

The pattern of cardiovascular mortality by degree of urbanization was similar before and after the crisis, although in women the excess mortality in small urban areas with respect to large urban areas was smaller after the crisis. The different pattern of risk behaviours in men and women, according to area of residence, could explain these findings.

High doses of Francisella noatunensis induces an immune response in Eleginops maclovinus

Francisella noatunensis subsp. noatunensis, the etiological agent of Francisellosis, affects a large number of farmed species such as Salmo salar. This species coexists with several native species in the same ecosystem, including Eleginops maclovinus. Our objective was to evaluate the susceptibility, presence of clinical symptoms, and the ability of Eleginops maclovinus to respond to Francisella infection. For this, healthy individuals were inoculated with 1.5 × 10¹, 1.5 × 10⁵, and 1.5 × 10¹⁰ bact/μL of Francisella by intraperitoneal injection, subsequently the fish were sampled on days 1, 3, 7, 14, 21, and 28 post injection (dpi). At the end of the experiment, no mortality, nor internal and external clinical signs were observed, although in the high dose anaemia was detected. Additionally, bacteria were detected in all three doses, however there was replication at day 28 only in the liver in the high dose. Analysis of gene expression by qPCR showed that the spleen generated an immune response against infection from day 1 dpi, however at day 7 dpi most of the genes suffered repressed expression; observing over expression of the genes C3, NLRC3, NLRC5, MHCI, IgM. In contrast, expression in the anterior kidney did not vary significantly during the challenge. IgM quantification showed the production of antibodies in the medium and high doses. This study provides new knowledge about Francisella infection and the long-lasting and specific immune response generated by Eleginops maclovinus. It also demonstrates its susceptibility to Francisellosis where there is a difference in the immune response according to the tissue.

Prenatal exposure to perfluoroalkyl substances, immune-related outcomes, and lung function in children from a Spanish birth cohort study

BACKGROUND

Prenatal exposure to perfluoroalkyl substances (PFASs) has been associated with impaired immune and respiratory health during childhood but the evidence is inconsistent and limited for lung function. We studied the association between prenatal PFASs exposure and immune and respiratory health, including lung function, up to age 7 years in the Spanish INMA birth cohort study.

METHODS

We assessed four PFASs in maternal plasma samples collected during the 1st trimester of pregnancy (years: 2003-2008): perfluorohexane sulfonate (PFHxS), perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), and perfluorononanoate (PFNA). Mothers reported the occurrence (yes/no) of lower respiratory tract infections, wheezing, asthma, and eczema in the previous 12 months at 1.5 and 4 years of the child (n = 1188) and at 7 years (n = 1071). At ages 4 (n = 503) and 7 (n = 992) years lung function was assessed using spirometry tests.

RESULTS

The most abundant PFASs were PFOS and PFOA (geometric means: 5.80 and 2.31 ng/mL, respectively). The relative risk of asthma during childhood per each doubling in PFNA concentration was 0.74 (95 CI%: 0.57, 0.96). The relative risk of eczema during childhood per every doubling in PFOS concentration was 0.86 (95 CI%: 0.75, 0.98). Higher PFOA concentrations were associated with lower forced vital capacity and lower forced expiratory volume in 1 s z-scores at 4 years [β (95 CI %): -0.17 (-0.34, -0.01) and -0.13 (-0.29, 0.03), respectively], but not at 7 years.

CONCLUSION

This longitudinal study suggests that different PFASs may affect the developing immune and respiratory systems differently. Prenatal exposure to PFNA and PFOS may be associated with reduced risk of respiratory and immune outcomes, particularly asthma and eczema whereas exposure to PFOA may be associated with reduced lung function in young children. These mixed results need to be replicated in follow-up studies at later ages.

Mortality in working-age population during the Great Recession and austerity in Spain

OBJECTIVE

To analyze the mortality trend in Spain before, during and after the economic crisis and austerity policies in the working-age population.

METHODS

From 2005 to 2016 we calculated the annual all-cause mortality rate and the annual mortality rate from the main causes of death in the population aged 15 to 64. We also estimated the linear trends in mortality rates during four time intervals-2005-2007 (before crisis), 2008-2010 (first part of the crisis), 2011-2013 (second part of the crisis and implementation of austerity policies) and 2014-2016 (after the crisis)- by the annual percentage change (APC).

RESULTS

The all-cause mortality rate in men and women showed the greatest decline in 2008-2010 and the smallest decline in 2014-2016. The decline in 2011-2013 was higher than in 2014-2016. The APCs in 2005-2007, 2008-2010, 2011-2013 and 2014-2016 were -2.8, -4.1, -3.0 and -1.5 in men and -1.0. -2.1, -1.1 and -0.6 in women, respectively, although the APC in 2014-2016 in women was not significant. In 2014-2016, cancer mortality showed the largest decrease, mortality from cardiovascular diseases (men), respiratory diseases and traffic accidents reversed and showed an upward trend, and the downward trend in mortality from infectious diseases and digestive diseases was equal to or greater than that observed before the crisis.

CONCLUSION

The decline in all-cause mortality in the working-age population during the economic crisis and the introduction of austerity measures was greater than that observed before and after the economic crisis. The slowing of the decline after the crisis was due to the reversal of the trend in mortality from cardiovascular and respiratory diseases.