Control of motivation for sucrose in the paraventricular hypothalamic nucleus by dynorphin peptides and the kappa opioid receptor

The dynorphin peptides are the endogenous ligands for the kappa opioid receptor (KOR) and regulate food intake. Administration of dynorphin-A1-13 (DYN) in the paraventricular hypothalamic nucleus (PVN) increases palatable food intake, and this effect is blocked by co-administration of the orexin-A neuropeptide, which is co-released with DYN in PVN from neurons located in the lateral hypothalamus. While PVN administration of DYN increases palatable food intake, whether it increases food-seeking behaviors has yet to be examined. We tested the effects of DYN and norBNI (a KOR antagonist) on the seeking and consumption of sucrose using a progressive ratio (PR) and demand curve (DC) tasks. In PVN, DYN did not alter the sucrose breaking point in the PR task nor the elasticity or intensity of demand for sucrose in the DC task. Still, DYN reduced the delay in obtaining sucrose and increased licks during sucrose intake in the PR task, irrespective of the co-administration of orexin-A. In PVN, norBNI increased the delay in obtaining sucrose and reduced licks during sucrose intake in the PR task while reducing elasticity but not intensity of demand in the DC task. However, subcutaneous norBNI reduced the breaking point for sucrose and increased the delay in obtaining sucrose in the PR task while reducing the elasticity of demand. Together, these data show different effects of systemic and PVN blockade of KOR on food-seeking, consummatory behaviors, and incentive motivation for sucrose and suggest that KOR activity in PVN is necessary but not sufficient to drive seeking behaviors for palatable food.

Estimating averted illnesses from influenza vaccination for children and pregnant women - El Salvador, Panama, and Peru, 2011-2018

BACKGROUND

Estimating the burden of disease averted by vaccination can assist policymakers to implement, adjust, and communicate the value of vaccination programs. Demonstrating the use of a newly available modeling tool, we estimated the burden of influenza illnesses averted by seasonal influenza vaccination in El Salvador, Panama, and Peru during 2011-2017 among two influenza vaccine target populations: children aged 6-23 months and pregnant women.

METHODS

We derived model inputs, including incidence, vaccine coverage, vaccine effectiveness, and multipliers from publicly available country-level influenza surveillance data and cohort studies. We also estimated changes in illnesses averted when countries' vaccine coverage was achieved using four different vaccine deployment strategies.

RESULTS

Among children aged 6-23 months, influenza vaccination averted an estimated cumulative 2,161 hospitalizations, 81,907 medically-attended illnesses, and 126,987 overall illnesses during the study period, with a prevented fraction ranging from 0.3 % to 12.5 %. Among pregnant women, influenza vaccination averted an estimated cumulative 173 hospitalizations, 6,122 medically attended illnesses, and 16,412 overall illnesses, with a prevented fraction ranging from 0.2 % to 10.9 %. Compared to an influenza vaccine campaign with equal vaccine distribution during March-June, scenarios in which total cumulative coverage was achieved in March and April consistently resulted in the greatest increase in averted illness (23 %-3,129 % increase among young children and 22 %-3,260 % increase among pregnant women).

DISCUSSION

Influenza vaccination campaigns in El Salvador, Panama, and Peru conducted between 2011 and 2018 prevented hundreds to thousands of influenza-associated hospitalizations and illnesses in young children and pregnant women. Existing vaccination programs could prevent additional illnesses, using the same number of vaccines, by achieving the highest possible coverage within the first two months of an influenza vaccine campaign.

WHO's Investigations and Studies, Unity Studies: A global initiative creating equitable opportunities for enhanced surveillance, operational research, capacity building, and global knowledge sharing

The World Health Organization's Unity Studies global initiative provides a generic preparedness and readiness framework for conducting detailed investigations and epidemiological studies critical for the early and ongoing assessment of emerging respiratory pathogens of pandemic potential. During the COVID-19 pandemic, the initiative produced standardized investigation protocols and supported Member States to generate robust and comparable data to inform public health decision making. The subsequent iteration of the initiative is being implemented to develop revised and new investigation protocols, implementation toolkits and work to build a sustainable global network of sites, enabling the global community to be better prepared for the next emerging respiratory pathogen with epidemic or pandemic potential.

Meta-analysis of pre-clinical studies on the effects of opioid receptor ligands on food intake, motivation, and choice

The opioid receptors (OR) regulate food intake. Still, despite extensive pre-clinical research, the overall effects and individual contribution of the mu (MOR), kappa (KOR), and delta (DOR) OR subtypes to feeding behaviors and food intake remain unclear. To address this, we conducted a pre-registered systematic search and meta-analysis of rodent dose-response studies to evaluate the impact of central and peripheral administration of non-selective and selective OR ligands on intake, motivation, and choice of food. All studies had a high bias risk. Still, the meta-analysis confirmed the overall orexigenic and anorexigenic effects of OR agonists and antagonists, respectively. Our results support a larger orexigenic role for central MOR agonists among OR subtypes and that peripheral OR antagonists reduce motivation for and intake of preferred foods. In binary food choice studies, peripheral OR agonists selectively increase the intake of fat-preferred foods; in contrast, they did not increase the intake of sweet carbohydrate-preferred foods. Overall, these data support that OR regulation of intake, motivation, and choice is influenced by food macronutrient composition.

Knowledge, attitudes, and practices regarding seasonal influenza vaccination during pregnancy in Costa Rica: A mixed-methods study

BACKGROUND

Influenza increases stillbirth risk, morbidity and mortality in pregnant women. Vaccination protects pregnant women against severe disease and indirectly protects their infants, but coverage among pregnant women remains low worldwide. We aimed to describe knowledge, attitudes, and practices (KAP) regarding seasonal influenza vaccination among postpartum women and prenatal care physicians in Costa Rica.

METHODS

We conducted cross-sectional KAP surveys to women one to three days after childbirth at Costa Rican Social Security Fund maternity hospitals, and obstetricians and general practitioners who provided prenatal care in 2017. Principal components analysis, multiple imputation, and logistic regression were used to examine associations between influenza vaccination and demographics, prenatal care, and sources of information-separately for postpartum women and physicians. We also held two focus groups of six healthcare workers each to further describe vaccination KAP.

RESULTS

We surveyed 642 postpartum women and 146 physicians in maternity hospitals in five Costa Rican provinces of whom 85.5 % (95 % CI: 82.6 %-88.0 %) and 57.9 % (95 % CI: 49.6 %-65.7 %) were vaccinated for influenza, respectively. Factors associated with influenza vaccination for postpartum women included tetanus vaccination (aOR: 3.62, 95 % CI: 1.89-6.92); received vaccination recommendations from clinicians during prenatal check-ups (aOR: 3.39, 95 % CI: 2.06-5.59); had other children in household vaccinated for influenza (aOR: 2.25, 95 % CI: 1.08-4.68); and secondary/university education (aOR: 0.15-0.31) with no formal education as reference. For postpartum women, reasons for vaccination were perceived benefits for mother and infant, whereas not being offered vaccines was most cited for non-vaccination. Most prenatal care physicians recommended influenza vaccines during prenatal check-ups but believed vaccination causes flu-like symptoms.

CONCLUSION

Vaccination campaigns and provisions of free vaccines effectively increased knowledge and coverage among women in Costa Rica. To improve access, women should be offered vaccines during prenatal care appointments. Educating healthcare workers about vaccine benefits for themselves and patients is needed to mitigate safety concerns.

Self-medication and ILI etiologies among individuals presenting at pharmacies with influenza-like illness: Guatemala City, 2018 influenza season

Objectives

We aimed to characterize the proportion of clients presenting to community pharmacies with influenza-like illness (ILI) and the severity of their illness; the proportion with detectable influenza A, influenza B, and other pathogens (i.e., parainfluenza I, II, and III, adenovirus, respiratory syncytial virus, human metapneumovirus); and to describe their self-medication practices.

Methods

A cross-sectional study was conducted in six pharmacies in Guatemala City. Study personnel collected nasopharyngeal and oropharyngeal swabs from participants who met the ILI case definition and who were self-medicating for the current episode. Participants were tested for influenza A and B and other pathogens using real-time RT-PCR. Participants’ ILI-associated self-medication practices were documented using a questionnaire.

Results

Of all patients entering the pharmacy during peak hours who responded to a screening survey (n = 18,016) 6% (n = 1029) self-reported ILI symptoms, of which 45% (n = 470/1029) met the study case definition of ILI. Thirty-one percent (148/470) met inclusion criteria, of which 87% (130/148) accepted participation and were enrolled in the study. Among 130 participants, nearly half tested positive for viral infection (n = 55, 42.3%) and belonged to groups at low risk for complications from influenza. The prevalence of influenza A was 29% (n = 35). Thirteen percent of the study population (n = 17) tested positive for a respiratory virus other than influenza. Sixty-four percent of participants (n = 83) reported interest in receiving influenza vaccination if it were to become available in the pharmacy. Medications purchased included symptom-relieving multi-ingredient cold medications (n = 43/100, 43%), nonsteroidal anti-inflammatory drugs (n = 23, 23%), and antibiotics (n = 16, 16%). Antibiotic use was essentially equal among antibiotic users regardless of viral status. The broad-spectrum antibiotics ceftriaxone and azithromycin were the most common antibiotics purchased.

Conclusions

During a typical influenza season, a relatively low proportion of all pharmacy visitors were experiencing influenza symptoms. A high proportion of clients presenting to pharmacies with ILI tested positive for a respiratory virus. Programs that guide appropriate use of antibiotics in this population are needed and become increasingly important during pandemics caused by respiratory viral pathogens.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13962-8.

Influenza A virus circulation in backyard animals in the Pacific coast of Guatemala, 2013-2014

Due to their documented epidemiological relevance as hosts for influenza A viruses (IAV), humans, poultry and pigs in backyard production systems (BPS) within wetlands could be key to the emergence of novel IAV variants able to transmit between humans or animals. To better understand the circulation of IAV at the human-animal interface of BPS within wetlands, we studied IAV in backyard duck flocks and pig herds in the Pacific Coast of Guatemala. From April 2013 to October 2014, we estimated the monthly IAV per cent seropositive and viral positive flocks and herds in two resource-limited communities. We detected antibodies in sera against the IAV nucleoprotein through ELISA. We also detected IAV viral RNA in respiratory (ducks and pigs) and cloacal (ducks) swabs through rRT-PCR directed at the matrix gene. We attempted viral isolation in eggs or MDCK cells followed by sequencing from swabs positive for IAV. During our study period, IAV seropositivity in duck flocks was 38%, and viral positivity was 23% (n = 86 BPS sampled). IAV seropositivity in pig herds was 42%, and viral positivity was 20% (n = 90 BPS sampled). Both flocks and herds had detectable antibodies against IAV mostly year-round, and IAV was detected in several months. We isolated an H3N2 virus from one pig sampled at the end of 2013. Standard nucleotide BLAST searches indicate that the isolated virus was similar to seasonal viruses circulating in humans, suggesting human-to-pig transmission. Our data show concurrent circulation of IAV in multiple species of poultry and pigs that were commingled in rudimentary conditions in proximity to humans, but no significant risk factors could be identified.

Signature of transition to supershear rupture speed in the coseismic off-fault damage zone

Most earthquake ruptures propagate at speeds below the shear wave velocity within the crust, but in some rare cases, ruptures reach supershear speeds. The physics underlying the transition of natural subshear earthquakes to supershear ones is currently not fully understood. Most observational studies of supershear earthquakes have focused on determining which fault segments sustain fully grown supershear ruptures. Experimentally cross-validated numerical models have identified some of the key ingredients required to trigger a transition to supershear speed. However, the conditions for such a transition in nature are still unclear, including the precise location of this transition. In this work, we provide theoretical and numerical insights to identify the precise location of such a transition in nature. We use fracture mechanics arguments with multiple numerical models to identify the signature of supershear transition in coseismic off-fault damage. We then cross-validate this signature with high-resolution observations of fault zone width and early aftershock distributions. We confirm that the location of the transition from subshear to supershear speed is characterized by a decrease in the width of the coseismic off-fault damage zone. We thus help refine the precise location of such a transition for natural supershear earthquakes.

Knowledge, attitudes, and practices for the use of seasonal influenza vaccination, healthcare workers, Costa Rica

Introduction:

Annual seasonal influenza vaccination in healthcare workers prevents nosocomial transmission to patients, coworkers, and visitors, and reduces absenteeism. This study aimed to describe knowledge, attitudes, and practices (KAP) of seasonal influenza vaccine among public healthcare workers attending patients in Costa Rica.

Methodology:

We conducted a cross-sectional survey of healthcare personnel attending patients in public hospitals in 2017–2018. Frequency distributions of demographics, vaccination KAP, sources of information, clinical manifestations and reasons for non-vaccination were reported. Logistic regression was used to analyze associations between exposures of interest (demographics, sources of information, knowledge, attitudes towards vaccination) and self-reported influenza vaccination.

Results:

We surveyed 747 healthcare workers in 2017–2018. Of 706 participants who knew their vaccination status, 55.7% were vaccinated for seasonal influenza. Only 20.7% of participants knew the influenza vaccine was an inactivated virus, and 94.6% believed the vaccine causes flu-like symptoms. Factors associated with current influenza vaccination were vaccination in previous year (aOR: 8.13; 95% CI: 5.65–11.71) and believed influenza vaccination may be harmful (aOR: 0.62; 95% CI: 0.44–0.89). Reasons for non-vaccination included fear of adverse effects and access limitations.

Conclusions:

Suboptimal influenza vaccination among healthcare workers may be attributed to misconceptions about the vaccine and limited engagement strategies focusing on healthcare workers. Appropriate interventions are needed to increase healthcare worker vaccination rates and improve their knowledge and beneficence, which would improve patient safety in hospitals.

Seismogenic Potential of the Main Himalayan Thrust Constrained by Coupling Segmentation and Earthquake Scaling

Recent studies have shown that the Himalayan region is under the threat of earthquakes of magnitude nine or larger. These estimates are based on comparisons of the geodetically inferred moment deficit rate with the seismicity of the region. However, these studies did not account for the physics of fault slip, specifically the influence of frictional barriers on earthquake rupture dynamics, which controls the extent and therefore the magnitude of large earthquakes. Here we combine an improved probabilistic estimate of moment deficit rate with results from dynamic models of the earthquake cycle to more fully assess the seismogenic potential of the Main Himalayan Thrust (MHT). We propose a straightforward and efficient methodology for incorporating outcomes of physics-based earthquake cycle models into hazard estimates. We show that, accounting for uncertainties on the moment deficit rate, seismicity and earthquake physics, the MHT is prone to rupturing in M w 8.7 earthquakes every T > 200 years.

Seismic and Aseismic Fault Slip During the Initiation Phase of the 2017 M W = 6.9 Valparaíso Earthquake

Transient deformation associated with foreshocks activity has been observed before large earthquakes, suggesting the occurrence of a detectable preseismic slow slip during the initiation phase. A critical issue consists in discriminating the relative contributions from seismic and aseismic fault slip during the preparation phase of large earthquakes. We focus on the April-May 2017 Valparaíso earthquake sequence, which involved a M W  = 6.9 earthquake preceded by intense foreshock activity. To assess the relative contribution of seismic and aseismic slip, we compare surface displacement predicted from foreshocks source models with transient motion measured prior to the mainshock. The comparison between observed and predicted displacements shows that only half of the total displacement can be explained by the contribution of foreshocks. This result suggests the presence of aseismic pre-slip during an initiation phase preceding the mainshock.

Knowledge, attitudes, and practices of seasonal influenza vaccination in postpartum women, Honduras

Background

Influenza during pregnancy may cause serious neonatal outcomes including stillbirth, fetal distress, preterm birth, congenital abnormalities, and stunted growth. Pregnant women are the highest priority group for seasonal influenza vaccination, but low coverage has been repeatedly reported in this population. Understanding reasons for and for not receiving the seasonal influenza vaccine is needed to design communication strategies to increase vaccination coverage. This study aimed to describe knowledge, attitudes, and practices (KAP) of seasonal influenza vaccination among women giving birth in public maternity hospitals in Honduras.

Methods

From August 20–October 8, 2018, we conducted a cross-sectional KAP survey regarding seasonal influenza vaccinations to a sample of postpartum women who gave birth in maternity hospitals and clinics from the Ministry of Health of Honduras and Honduran Social Security Institute. We reported frequency distributions for demographics, KAP of influenza vaccine, and vaccination coverage. We used logistic regression to analyze unadjusted and adjusted associations between sociodemographic characteristics and influenza vaccination.

Results

We surveyed 842 postpartum women in 17 healthcare facilities. Of 534 postpartum women with term pregnancy and verified vaccinations, 417 (78.1%; 95% CI: 74.6–81.6%) were vaccinated for influenza. Factors associated with verified influenza vaccination included receipt of vaccination recommendations by a healthcare worker during prenatal check-ups (aOR: 16.46; 95% CI: 9.73–27.85), concurrent chronic disease (aOR: 5.00; 95% CI: 1.25–20.07), and influenza vaccination of other children in the household (aOR: 2.28; 95% CI: 1.19–4.39). The most cited reasons for vaccination were perceived benefits for both mother and infant and easy access. Reasons for non-vaccination were: vaccine was not offered and fear of side effects, harm to the infant, and needles or pain caused by injection.

Conclusion

Influenza vaccination was well received among postpartum women in Honduras. Increasing clinician recommendations for vaccination and assuring the vaccine is readily available to women during prenatal visits may increase vaccination rates.

Workflow optimization in a clinical laboratory using Lean management principles in the pre-analytical phase

Background

The application of the Lean methodology in clinical laboratories can improve workflow and user satisfaction through the efficient delivery of analytical results. The purpose of this study was to optimise delivery times of the test results at a clinical laboratory, using Lean management principles in the pre-analytical phase.

Methods

A prospective study with a quasi-experimental design was implemented. Staff functions were restructured and sample flows were modified. Delivery times of clinical results (glucose and haematocrit; 6648 data) from the Medicine and Adult Emergency services for years 2017 and 2018 were compared.

Results

A reduction (p < 0.05) in turnaround times in the delivery of glucose test results at the adult emergency service was observed (84 to 73 min, 13%, pre and post). In addition, there was a non-significant reduction in the turnaround times for glucose (Medicine) and haematocrit in both services. In the analytical and post-analytical phase (not intervened), an increase in turnaround times was observed in some cases.

Conclusions

Other studies have indicated that the application of the Lean methodology in clinical laboratories improves workflow, increasing effectiveness and efficiency. This study showed an improvement in the delivery time of test results (glucose - Emergency), giving rise to a culture of cooperation and continuous improvement. It would, however, be essential to address the management model integrating the analytical and post-analytical phases.

Rain and small earthquakes maintain a slow-moving landslide in a persistent critical state

In tectonically active mountain belts, landslides contribute significantly to erosion. Statistical analysis of regional inventories of earthquake-triggered-landslides after large earthquakes (Mw > 5.5) reveal a complex interaction between seismic shaking, landslide material, and rainfall. However, the contributions of each component have never been quantified due to a lack of in-situ data for active landslides. We exploited a 3-year geodetic and seismic dataset for a slow-moving landslide in Peru affected by local earthquakes and seasonal rainfalls. Here we show that in combination, they cause greater landslide motion than either force alone. We also show the rigidity of the landslide’s bulk clearly decreasing during Ml ≥ 5 earthquakes. The recovery is affected by rainfall and small earthquakes (Ml < 3.6), which prevent the soil from healing, highlighting the importance of the timing between forcings. These new quantitative insights into the mechanics of landslides open new perspectives for the study of the mass balance of earthquakes.

In this study, the authors show the interaction between seismic activity and rainfalls on landslide movement and how their timing controls landslide stability and motion.

Progress and Remaining Gaps in Estimating the Global Disease Burden of Influenza

Influenza has long been a global public health priority because of the threat of another global pandemic. Although data are available for the annual burden of seasonal influenza in many developed countries, fewer disease burden data are available for low-income and tropical countries. In recent years, however, the surveillance systems created as part of national pandemic preparedness efforts have produced substantial data on the epidemiology and impact of influenza in countries where data were sparse. These data are leading to greater interest in seasonal influenza, including implementation of vaccination programs. However, a lack of quality data on severe influenza, nonrespiratory outcomes, and high-risk groups, as well as a need for better mathematical models and economic evaluations, are some of the major gaps that remain. These gaps are the focus of multilateral research and surveillance efforts that will strengthen global efforts in influenza control in the future.

Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study

BACKGROUND

We have previously estimated that respiratory syncytial virus (RSV) was associated with 22% of all episodes of (severe) acute lower respiratory infection (ALRI) resulting in 55 000 to 199 000 deaths in children younger than 5 years in 2005. In the past 5 years, major research activity on RSV has yielded substantial new data from developing countries. With a considerably expanded dataset from a large international collaboration, we aimed to estimate the global incidence, hospital admission rate, and mortality from RSV-ALRI episodes in young children in 2015.

METHODS

We estimated the incidence and hospital admission rate of RSV-associated ALRI (RSV-ALRI) in children younger than 5 years stratified by age and World Bank income regions from a systematic review of studies published between Jan 1, 1995, and Dec 31, 2016, and unpublished data from 76 high quality population-based studies. We estimated the RSV-ALRI incidence for 132 developing countries using a risk factor-based model and 2015 population estimates. We estimated the in-hospital RSV-ALRI mortality by combining in-hospital case fatality ratios with hospital admission estimates from hospital-based (published and unpublished) studies. We also estimated overall RSV-ALRI mortality by identifying studies reporting monthly data for ALRI mortality in the community and RSV activity.

FINDINGS

We estimated that globally in 2015, 33·1 million (uncertainty range [UR] 21·6-50·3) episodes of RSV-ALRI, resulted in about 3·2 million (2·7-3·8) hospital admissions, and 59 600 (48 000-74 500) in-hospital deaths in children younger than 5 years. In children younger than 6 months, 1·4 million (UR 1·2-1·7) hospital admissions, and 27 300 (UR 20 700-36 200) in-hospital deaths were due to RSV-ALRI. We also estimated that the overall RSV-ALRI mortality could be as high as 118 200 (UR 94 600-149 400). Incidence and mortality varied substantially from year to year in any given population.

INTERPRETATION

Globally, RSV is a common cause of childhood ALRI and a major cause of hospital admissions in young children, resulting in a substantial burden on health-care services. About 45% of hospital admissions and in-hospital deaths due to RSV-ALRI occur in children younger than 6 months. An effective maternal RSV vaccine or monoclonal antibody could have a substantial effect on disease burden in this age group.

FUNDING

The Bill & Melinda Gates Foundation.

Estimating the burden of influenza-associated hospitalizations and deaths in Central America

Objectives

Our objective was to estimate the incidence of influenza‐associated hospitalizations and in‐hospital deaths in Central American Region.

Design and setting

We used hospital discharge records, influenza surveillance virology data, and population projections collected from Costa Rica, El Salvador, Guatemala, Honduras, and Nicaragua to estimate influenza‐associated hospitalizations and in‐hospital deaths. We performed a meta‐analysis of influenza‐associated hospitalizations and in‐hospital deaths.

Main outcome measures

The highest annual incidence was observed among children aged <5 years (136 influenza‐associated hospitalizations per 100 000 persons).

Results

Annually, 7 625–11 289 influenza‐associated hospitalizations and 352–594 deaths occurred in the subregion.

Conclusions

Our results suggest that a substantive number of persons are annually hospitalized because of influenza. Health officials should estimate how many illnesses could be averted through increased influenza vaccination.

Timing of influenza epidemics and vaccines in the American tropics, 2002-2008, 2011-2014

Background

Influenza‐associated illness results in increased morbidity and mortality in the Americas. These effects can be mitigated with an appropriately chosen and timed influenza vaccination campaign. To provide guidance in choosing the most suitable vaccine formulation and timing of administration, it is necessary to understand the timing of influenza seasonal epidemics.

Objectives

Our main objective was to determine whether influenza occurs in seasonal patterns in the American tropics and when these patterns occurred.

Methods

Publicly available, monthly seasonal influenza data from the Pan American Health Organization and WHO, from countries in the American tropics, were obtained during 2002–2008 and 2011–2014 (excluding unseasonal pandemic activity during 2009–2010). For each country, we calculated the monthly proportion of samples that tested positive for influenza. We applied the monthly proportion data to a logistic regression model for each country.

Results

We analyzed 2002–2008 and 2011–2014 influenza surveillance data from the American tropics and identified 13 (81%) of 16 countries with influenza epidemics that, on average, started during May and lasted 4 months.

Conclusions

The majority of countries in the American tropics have seasonal epidemics that start in May. Officials in these countries should consider the impact of vaccinating persons during April with the Southern Hemisphere formulation.

Associations between seasonal influenza and meteorological parameters in Costa Rica, Honduras and Nicaragua

Seasonal influenza affects a considerable proportion of the global population each year. We assessed the association between subnational influenza activity and temperature, specific humidity and rainfall in three Central America countries, i.e. Costa Rica, Honduras and Nicaragua. Using virologic data from each country's national influenza centre, rainfall from the Tropical Rainfall Measuring Mission and air temperature and specific humidity data from the Global Land Data Assimilation System, we applied logistic regression methods for each of the five sub-national locations studied. Influenza activity was represented by the weekly proportion of respiratory specimens that tested positive for influenza. The models were adjusted for the potentially confounding co-circulating respiratory viruses, seasonality and previous weeks' influenza activity. We found that influenza activity was proportionally associated (P&lt;0.05) with specific humidity in all locations [odds ratio (OR) 1.21-1.56 per g/kg], while associations with temperature (OR 0.69-0.81 per °C) and rainfall (OR 1.01-1.06 per mm/day) were location-dependent. Among the meteorological parameters, specific humidity had the highest contribution (~3-15%) to the model in all but one location. As model validation, we estimated influenza activity for periods, in which the data was not used in training the models. The correlation coefficients between the estimates and the observed were ≤0.1 in 2 locations and between 0.6-0.86 in three others. In conclusion, our study revealed a proportional association between influenza activity and specific humidity in selected areas from the three Central America countries.

Influenza Illness among Case-Patients Hospitalized for Suspected Dengue, El Salvador, 2012

We estimate the proportion of patients hospitalized for suspected dengue that tested positive for influenza virus in El Salvador during the 2012 influenza season. We tested specimens from 321 hospitalized patients: 198 patients with SARI and 123 patients with suspected dengue. Among 121 hospitalized suspected dengue (two co-infected excluded) patients, 28% tested positive for dengue and 19% positive for influenza; among 35 with suspected dengue and respiratory symptoms, 14% were positive for dengue and 39% positive for influenza. One percent presented co-infection between influenza and dengue. Clinicians should consider the diagnosis of influenza among patients with suspected dengue during the influenza season.

Demographic and clinical characteristics of deaths associated with influenza A(H1N1) pdm09 in Central America and Dominican Republic 2009-2010

BACKGROUND

The demographic characteristics of pandemic influenza decedents among middle and low-income tropical countries are poorly understood. We explored the demographics of persons who died with influenza A (H1N1)pdm09 infection during 2009-2010, in seven countries in the American tropics.

METHODS

We used hospital-based surveillance to identify laboratory-confirmed influenza deaths in Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and Dominican Republic. An influenza death was defined as a person who died within two weeks of a severe acute respiratory infection (SARI) defined as sudden onset of fever >38 °C, cough or sore-throat, and shortness of breath, or difficulty breathing requiring hospitalization, and who tested positive for influenza A (H1N1)pdm09 virus by real time polymerase chain reaction. We abstracted the demographic and clinical characteristics of the deceased from their medical records.

RESULTS

During May 2009-June 2010, we identified 183 influenza deaths. Their median age was 32 years (IQR 18-46 years). One-hundred and one (55 %) were female of which 20 (20 %) were pregnant and 7 (7 %) were in postpartum. One-hundred and twelve decedents (61 %) had pre-existing medical conditions, (15 % had obesity, 13 % diabetes, 11 % asthma, 8 % metabolic disorders, 5 % chronic obstructive pulmonary disease, and 10 % neurological disorders). 65 % received oseltamivir but only 5 % received it within 48 h of symptoms onset.

CONCLUSIONS

The pandemic killed young adults, pregnant women and those with pre-existing medical conditions. Most sought care too late to fully benefit from oseltamivir. We recommend countries review antiviral treatment policies for people at high risk of developing complications.

What Is the Added Benefit of Oropharyngeal Swabs Compared to Nasal Swabs Alone for Respiratory Virus Detection in Hospitalized Children Aged <10 Years?

We evaluated the added value of collecting both nasal and oropharyngeal swabs, compared with collection of nasal swabs alone, for detection of common respiratory viruses by reverse transcription-polymerase chain reaction in hospitalized children aged <10 years. Nasal swabs had equal or greater sensitivity than oropharyngeal swabs for detection of respiratory syncytial virus, adenovirus, human metapneumovirus, rhinovirus, and influenza virus but not parainfluenza virus. The addition of an oropharyngeal swab, compared with use of a nasal swab alone, increased the frequency of detection of each respiratory virus by no more than 10% in children aged <10 years.

Influenza-associated Hospitalizations and Deaths, Costa Rica, 2009-2012

Data needed to guide influenza vaccine policies are lacking in tropical countries. We multiplied the number of severe acute respiratory infections by the proportion testing positive for influenza. There were ≈6,699 influenza hospitalizations and 803 deaths in Costa Rica during 2009-2012, supporting continuation of a national influenza vaccine program.

The role of temperature and humidity on seasonal influenza in tropical areas: Guatemala, El Salvador and Panama, 2008-2013

Background

The role of meteorological factors on influenza transmission in the tropics is less defined than in the temperate regions. We assessed the association between influenza activity and temperature, specific humidity and rainfall in 6 study areas that included 11 departments or provinces within 3 tropical Central American countries: Guatemala, El Salvador and Panama.

Method/Findings

Logistic regression was used to model the weekly proportion of laboratory-confirmed influenza positive samples during 2008 to 2013 (excluding pandemic year 2009). Meteorological data was obtained from the Tropical Rainfall Measuring Mission satellite and the Global Land Data Assimilation System. We found that specific humidity was positively associated with influenza activity in El Salvador (Odds Ratio (OR) and 95% Confidence Interval of 1.18 (1.07–1.31) and 1.32 (1.08–1.63)) and Panama (OR = 1.44 (1.08–1.93) and 1.97 (1.34–2.93)), but negatively associated with influenza activity in Guatemala (OR = 0.72 (0.6–0.86) and 0.79 (0.69–0.91)). Temperature was negatively associated with influenza in El Salvador's west-central departments (OR = 0.80 (0.7–0.91)) whilst rainfall was positively associated with influenza in Guatemala's central departments (OR = 1.05 (1.01–1.09)) and Panama province (OR = 1.10 (1.05–1.14)). In 4 out of the 6 locations, specific humidity had the highest contribution to the model as compared to temperature and rainfall. The model performed best in estimating 2013 influenza activity in Panama and west-central El Salvador departments (correlation coefficients: 0.5–0.9).

Conclusions/Significance

The findings highlighted the association between influenza activity and specific humidity in these 3 tropical countries. Positive association with humidity was found in El Salvador and Panama. Negative association was found in the more subtropical Guatemala, similar to temperate regions. Of all the study locations, Guatemala had annual mean temperature and specific humidity that were lower than the others.

Improvements in pandemic preparedness in 8 Central American countries, 2008-2012

BACKGROUND

In view of ongoing pandemic threats such as the recent human cases of novel avian influenza A(H7N9) in China, it is important that all countries continue their preparedness efforts. Since 2006, Central American countries have received donor funding and technical assistance from the U.S. Centers for Disease Control and Prevention (CDC) to build and improve their capacity for influenza surveillance and pandemic preparedness. Our objective was to measure changes in pandemic preparedness in this region, and explore factors associated with these changes, using evaluations conducted between 2008 and 2012.

METHODS

Eight Central American countries scored their pandemic preparedness across 12 capabilities in 2008, 2010 and 2012, using a standardized tool developed by CDC. Scores were calculated by country and capability and compared between evaluation years using the Student's t-test and Wilcoxon Rank Sum test, respectively. Virological data reported to WHO were used to assess changes in testing capacity between evaluation years. Linear regression was used to examine associations between scores, donor funding, technical assistance and WHO reporting.

RESULTS

All countries improved their pandemic preparedness between 2008 and 2012 and seven made statistically significant gains (p < 0.05). Increases in median scores were observed for all 12 capabilities over the same period and were statistically significant for eight of these (p < 0.05): country planning, communications, routine influenza surveillance, national respiratory disease surveillance, outbreak response, resources for containment, community interventions and health sector response. We found a positive association between preparedness scores and cumulative funding between 2006 and 2011 (R2 = 0.5, p < 0.01). The number of specimens reported to WHO from participating countries increased significantly from 5,551 (2008) to 18,172 (2012) (p < 0.01).

CONCLUSIONS

Central America has made significant improvements in influenza pandemic preparedness between 2008 and 2012. U.S. donor funding and technical assistance provided to the region is likely to have contributed to the improvements we observed, although information on other sources of funding and support was unavailable to study. Gains are also likely the result of countries' response to the 2009 influenza pandemic. Further research is required to determine the degree to which pandemic improvements are sustainable.

The marine indo-west pacific break: contrasting the resolving power of mitochondrial and nuclear genes

Simultaneous studies of both nuclear and mitochondrial markers were undertaken in two widespread Indo-West Pacific (IWP) marine invertebrates to compare and contrast the ability of these markers to resolve genetic structure. In particular, we were interested in the resolution of a genetic break between the Indian and Pacific Oceans due to historical isolation. Sequence variation from the nuclear gene encoding myosin heavy chain (MyHC) and the mitochondrial gene cytochrome oxidase I (COI) were examined for the snapping shrimp Alpheus lottini from wide-ranging populations throughout the Indian and Pacific Oceans. A previously identified genetic break between oceans based on COI sequences appears to have been an artifact caused by the inadvertent inclusion of pseudogene sequences; our new COI data provide evidence only of a break between IWP and East Pacific populations. Distribution of a single nucleotide polymorphism in MyHC, on the other hand, shows evidence of a cline between Indian and Pacific Oceans. New allozyme and mtDNA sequence data were also obtained for the starfish Linckia laevigata. Allozyme data show a clear genetic break between Indian Ocean populations and Pacific (including western Australian) populations, whereas the distribution of mtDNA haplotypes shows a region of overlap in the central IWP. Comparisons of our data for both Alpheus and Linckia with data from other population genetic studies in the IWP suggest that nuclear markers (allozymes, sequence data and morphological characters) may in some instances reveal historical patterns of genetic population structure whereas mtDNA variation better reflects present day patterns of gene flow.

Estimated incidence of influenza-virus-associated severe pneumonia in children in El Salvador, 2008-2010

OBJECTIVE

To estimate the incidence of influenza-virus-associated severe pneumonia among Salvadorian children aged < 5 years.

METHODS

Data on children aged < 5 years admitted with severe pneumonia to a sentinel hospital in the western region were collected weekly. Nasal and oropharyngeal swab specimens were collected from a convenience sample of case patients for respiratory virus testing. A health-care utilization survey was conducted in the hospital catchment area to determine the proportion of residents who sought care at the hospital. The incidence of influenza-virus-associated severe pneumonia among all Salvadorian children aged < 5 years was estimated from surveillance and census data, with adjustment for health-care utilization. Influenza virus strains were characterized by the United States Centers for Disease Control and Prevention to determine their correspondence with northern and southern hemisphere influenza vaccine formulations.

FINDINGS

Physicians identified 2554 cases of severe pneumonia. Samples from 608 cases were tested for respiratory viruses and 37 (6%) were positive for influenza virus. The estimated incidence of influenza-virus-associated severe pneumonia was 3.2 cases per 1000 person-years (95% confidence interval, CI: 2.8-3.7) overall, 1.5 cases per 1000 person-years (95% CI: 1.0-2.0) during 2008, 7.6 cases per 1000 person-years (95% CI: 6.5-8.9) during 2009 and 0.6 cases per 1000 person-years (95% CI: 0.3-1.0) during 2010. Northern and southern hemisphere vaccine formulations matched influenza virus strains isolated during 2008 and 2010.

CONCLUSION

Influenza-virus-associated severe pneumonia occurred frequently among young Salvadorian children during 2008-2010. Antigens in northern and southern hemisphere influenza vaccine formulations corresponded to circulating strains.

[Characteristics and impact of sedation, analgesia, and neuromuscular blockage in critical patients undergoing prolonged mechanical ventilation]

AIM

To describe use of sedatives, analgesics, and neuromuscular blockers (NMB) in patients undergoing long-term mechanical ventilation and to assess factors associated with their use and their association with mortality at 28 days.

DESIGN

Prospective observational multicenter cohort study.

SETTING

Thirteen intensive care units (ICU) in Chile.

PATIENTS

Patients undergoing mechanical ventilation for more than 48h. We excluded patients with neurological disorders, cirrhosis of the liver, chronic renal failure, suspected drug addiction, and early no resuscitation orders.

INTERVENTION

None.

MAIN MEASUREMENTS

Proportion of use and dosage of sedatives, analgesics, and NMB. Level of sedation observed (SAS). Variables associated with the Sedation Agitation Scale (SAS), use of sedatives, analgesics, and NMB. Multivariate logistic regression of variables associated to mortality at 28 days.

RESULTS

A total of 155 patients participated (60+/-18 years, 57% male, SOFA 7 [6-10], APACHE II 18 [15-22], 63% with sepsis, and 47% with acute lung injury/adult respiratory distress syndrome. The drugs most frequently used were midazolam (85%, 4 [1.9-6.8]mg/hr) and fentanyl (81%, 76 [39-140]microg/hr). NMB were administered at least 1 day in 30% of patients. SAS score was 1 or 2 in 55% of patients. There was an association between NMB use and mortality at 28 days, but it was not consistent in all the models of NMB evaluated.

CONCLUSIONS

Sedatives were frequently employed and deep sedation was common. Midazolam and fentanyl were the most frequently administered drugs. The use of NMB might be independently associated to greater mortality.

Metastatic Crohn's disease

Crohn's disease is a chronic granulomatous disorder, which may involve any segment of the gastrointestinal tract from the mouth to the anus. Although extraintestinal manifestations are frequent, involvement of skin distant to the gastrointestinal tract is uncommon. We report a case of Crohn's disease affecting penile and scrotal skin.

The initial surface composition and topography modulate sphingomyelinase-driven sphingomyelin to ceramide conversion in lipid monolayers

Changes of the initial composition and topography of mixed monolayers of Sphingomyelin and Ceramide modulate the degradation of Sphingomyelin by Bacillus cereus Sphingomyelinase. The presence of initial lateral phase boundary due to coexisting condensed and expanded phase domains favors the precatalytic steps of the reaction. The amount and quality of the domain lateral interface, defined by the type of boundary undulation, appears as a modulatory supramolecular code which regulates the catalytic efficiency of the enzyme. The long range domain lattice structuring is determined by the Sphingomyelinase activity.

[How can we improve symptomatic hypotension in hemodialysis patients: cold dialysis vs isothermic dialysis]

BACKGROUND

Symptomatic hypotension is the most frequent acute complication affecting patients during chronic hemodialysis treatment sessions. Many reports have demonstrated that the use of cool dialysate has a protective effect on blood pressure during hemodialysis treatments. In the present study, we investigated whether preventing the hyperthermic response had favourable effects on hemodynamic stability during the hemodialysis procedure while affording good tolerance to patients.

METHODS

We investigated the effect of thermal control of dialysate on hemodynamic stability in hypotension-prone patients in our center. Patients were eligible for the study if they had symptomatic hypotensive episodes (> 3/12session/ month) during the screening phase. The study was designed with two phases for the same selected patients and two treatment arms, each phase lasting 4 weeks. In the first phase, we adjusted dialysate temperature on 36 masculineC for 12 sessions (cold dialysis) and in the second phase we used a device allowing the regulation of thermal balance (Blood Temperature Monitor; Fresenius Medical Care, Bad Homberg, Germany), that keep body temperature unchanged (isothermic dialysis).

RESULTS

Nine HD patients were enrolled and completed the study. During the screening phase the mean ultrafiltration was 4 1% of dry weight, and blood pressure decreased from 9916 to 8016 mm Hg (p<0.001). In 5.01.7 sessions of 12 treatments were complicated by hypotension. In the first and second phase we observed a decrease of complicated treatments with symptomatic hypotension (5.01.7 versus 2.71.6 y 2.81.7; p<0.01). Both procedures: Cold dialysis and Isothermic dialysis was well tolerated by patients.

CONCLUSION

Results show that active control of body temperature can significantly improve intradialytic tolerance in hypotension-prone patients.

Controlled-release doxazosin in the treatment of benign prostatic hyperplasia

PURPOSE

To evaluate the effectiveness and safety of controlled-release doxazosin for benign prostatic hyperplasia (BPH).

SCOPE

In this open-label, noncontrolled, observational surveillance study, 3684 men with BPH received 4-8 mg of controlled-release doxazosin gastrointestinal therapeutic system (GITS) for 6 months; 3283 (89.1%) patients completed the trial. Changes in urinary symptoms and quality of life were assessed using the International Prostate Symptom Score (IPSS). Blood pressure and adverse events were assessed.

CONCLUSION

After 6 months' treatment with doxazosin GITS resulted in significant improvements in IPSS. BP was reduced only in hypertensive patients. Doxazosin, GITS was well tolerated.

[Venom of Latrodectus mactans from Chile (Araneae, Theridiidae): effect on smooth muscle]

The venoms of Latrodectus sp. have been reported to induce contraction probably mediated by adrenergic and cholinergic transmitters. We have demonstrated that the venom of Chilean Latrodectus mactans contains neurotoxins that induce a contraction partially independent of transmitters release. Transmembrane mobility of Na+ and Ca2+ ions and more specifically, the increase of cytoplasmic calcium concentration are responsible for tonic contraction in smooth muscle. Calcium may enter the cell by several ways, such as the voltage-dependent Ca2+ L-type channels and the Na+/Ca2+ exchanger. This study aimed to examine the participation of this exchanger in the tonic contraction of smooth muscle in vas deferent of rat induced by the venom of the Chilean spider L. mactans. Blockers of Na+ channels (amiloride) and Ca2+ L-type channels (nifedipine), and a stimulator of the exchanger (modified Tyrode, Na+ 80 mM) were used. Simultaneously, variations of the cytoplasmic concentration of Ca2+ were registered by microfluorimetry (Fura-2 indicator) in the presence of nifedipine. In presence of amiloride, dose-dependent inhibition of venom-induced contraction was observed, suggesting the participation of voltage-dependent Ca2+ L-type channels. The contraction was only partially inhibited by nifedipine and the Ca2+ cytoplasmic concentration increased, as assessed by the microfluorimetric registration. Finally, the venom-induced contraction increased in the presence of modified Tyrode, probably due to the action of the Na+/Ca2+ exchanger. Taken together, our results support the idea that the Na+/Ca2+ exchanger is active and may be, at least in part, responsible for the contraction induced by the venom of Chilean L. mactans.

[Epidemiologic profile of the population displaced by the internal armed conflict of the country in a neighborhood of Cartagena, Colombia, 2000]

Colombia faces internal displacement as a consequence of internal armed conflict. From 1985 to the present, it is estimated that 1,500,000 people have been displaced. A transversal descriptive study aimed at characterizing the health situation of this highly vulnerable and continually growing population was carried out in Cartagena between September and December, 2000. The sample size was calculated to meet a 2% precision, 40% of maximum expected prevalence, design effect of 2 and 15% of information loss, total sample size 1.600 home's interviews. Single-stage sampling with replacement was done by clusters. To socioeconomic, sanitary conditions, morbidity and mental health variables was done univariate analysis, determining frequencies, central trend and dispersion, as well as a bivariate analysis to determine X2 or Fisher exact test, p values and stratified analysis. The study found severe deterioration in socioeconomic conditions, high exposure to violence (80% was exposed to violence before displacement and murder cause 60% of deads in teenagers and adults after displacement but even children under 4 years-old was affected by this phenomenon), family disintegration, bad sanitary conditions, high prevalence of tracing diseases in all ages (80% of under 5 years-old had respiratory symptoms, 30% diarrhoea and 32% purulent lesions in skin), school desertion (20% children between 5 and 11 years and 16% teenagers), late schooling, poor performance at school, high proportion of working children (4% children between 5 and 11 years and 20% teenagers), low affiliation to social security systems (only 20% under 5 years-old children and 50% adults), low coverage and access to health services, among many other factors whose interaction affects this population's physical and mental health. We found that is difficult to make an early detection of internally displaced populations and thus provide adequate health care when such displacements are recent or involve individual persons. Results show that is essential to implement a surveillance system based on community leaders to increase efficiency, access and opportunity in health care for displaced populations.

Characterization of two cysteine proteinases secreted by Fasciola hepatica and demonstration of their kininogenase activity

We have isolated and purified two cysteine proteinases of molecular weights 25 and 26 kDa, secreted by Fasciola hepatica adult worm. Their 15 N-terminal residues were found to be identical to those of earlier described cathepsin L-like enzymes, isolated from the same source, reported as CL1 and CL2. Radioimmunoassay experiments have shown that these CL1- (25 kDa) and CL2-like (26 kDa) cysteine proteinases mediated kinin release from high molecular weight kininogen (HMWK). Lys-bradykinin (KRPPGFSPFR) was characterized as the kinin released from a synthetic fragment of HMWK from Leu373 to Ile393 (Abz-LGMISLMKRPPGFSPFRSSRI-NH2) labeled with the fluorescent group Abz (ortho-aminobenzoic acid). We examined the activity of CL1- and CL2-like on internally quenched fluorescent peptides containing HMWK sequences, in which Met379-Lys380 or Arg389-Ser390 bonds were present in the middle of the molecules. These peptides were flanked by the fluorescent donor-acceptor pair Abz and EDDnp (N-[2,4-dinitrophenyl] ethylenediamine). Peptidyl-methylcoumarin amides (MCA) were used to study the substrate specificity requirements. The enzymes presented significantly lower Km values at pH 8.0. The inverse was observed with the kcat values, which were higher at pH 5.0.

Intracavernous methoxamine in the treatment of priapism

Methoxamine is an alpha-adrenergic drug, its unique pharmacokinetics and mechanism of action on alpha-1 receptors lead to consider it, similarly to phenylephrine, as a first-choice drug for treating drug-induced or veno-occlusive priapism. The experience obtained with its use in the management of three cases of priapism lasting over 7 h and one case of sustained rigid erection caused during anesthetic induction are reported.

Buckling of cylinders may cause prolonged penile pain after prosthesis implantation: a case control study using magnetic resonance imaging of the penis

PURPOSE

We identify risk factors associated with chronic postoperative penile pain after inflatable prosthesis insertion.

MATERIALS AND METHODS

We performed a case control study to determine the incidence of prolonged penile pain in 65 men who underwent prosthesis insertion. The association of various potential risk factors, including diabetes mellitus, incision site, prosthesis type, patient age and history of pelvic surgery, was assessed. In addition, the penis was examined for physical findings, and penile magnetic resonance imaging (MRI) was done as an in situ evaluation of the anatomical position and functional status of the inflatable prosthesis.

RESULTS

A total of 14 patients (21.5%) with prolonged pain were compared to the remaining 51 with no pain. All parameters evaluated were similar in both groups except for MRI findings. Of the 14 patients with pain 12 (85.7%) had buckling of the cylinders in the flaccid state compared to only 1 of the 51 controls (1.9%). Statistical analysis showed a highly significant association between buckling and penile pain (odds ratio 300, p <0.0001). Surgical correction of buckling resolved pain in 5 patients.

CONCLUSIONS

Prolonged postoperative penile pain after prosthesis insertion is strongly associated with cylinder buckling. This buckling may be the consequence of an excessively long cylinder or an appropriate size cylinder that fails to reach the crural end. The method of accurately diagnosing these alterations is MRI of the penis.

Morgagni's hernia resolved by laparoscopic surgery

Morgagni's hernias represent between 2 and 4% of the whole of nontraumatic diaphragmatic hernias in the adult, and the treatment (even with minimal symptoms) is always with surgery. We present the case of a 50-year-old woman with an oppressive, postprandial discomfort in the right side of her thorax and with increased pain when supine. The x-ray examination indicated a large portion of transverse colon inside the thoracic cavity. Once the diagnosis of Morgagni's hernia had been obtained, she was scheduled for laparoscopic surgery to reduce the hernia and to reconstruct the defect of the diaphragm using a polypropylene mesh.