Estimating the impact of the COVID-19 pandemic on dengue in Brazil.

Atypical dengue prevalence was observed in 2020 in many dengue-endemic countries, including Brazil. Evidence suggests that the pandemic disrupted not only dengue dynamics due to changes in mobility patterns, but also several aspects of dengue surveillance, such as care seeking behavior, care availability, and monitoring systems. However, we lack a clear understanding of the overall impact on dengue in different parts of the country as well as the role of individual causal drivers. In this study, we estimated the gap between expected and observed dengue cases in 2020 using an interrupted time series design with forecasts from a neural network and a structural Bayesian time series model. We also decomposed the gap into the impacts of climate conditions, pandemic-induced changes in reporting, human susceptibility, and human mobility. We find that there is considerable variation across the country in both overall pandemic impact on dengue and the relative importance of individual drivers. Increased understanding of the causal mechanisms driving the 2020 dengue season helps mitigate some of the data gaps caused by the COVID-19 pandemic and is critical to developing effective public health interventions to control dengue in the future.

Prediction of impending central-line-associated bloodstream infections in hospitalized cardiac patients: development and testing of a machine-learning model.

BACKGROUND: While modelling of central-line-associated blood stream infection (CLABSI) risk factors is common, models that predict an impending CLABSI in real time are lacking. AIM: To build a prediction model which identifies patients who will develop a CLABSI in the ensuing 24 h. METHODS: We collected variables potentially related to infection identification in all patients admitted to the cardiac intensive care unit or cardiac ward at Boston Children's Hospital in whom a central venous catheter (CVC) was in place between January 2010 and August 2020, excluding those with a diagnosis of bacterial endocarditis. We created models predicting whether a patient would develop CLABSI in the ensuing 24 h. We assessed model performance based on area under the curve (AUC), sensitivity and false-positive rate (FPR) of models run on an independent testing set (40%). FINDINGS: A total of 104,035 patient-days and 139,662 line-days corresponding to 7468 unique patients were included in the analysis. There were 399 positive blood cultures (0.38%), most commonly with Staphylococcus aureus (23% of infections). Major predictors included a prior history of infection, elevated maximum heart rate, elevated maximum temperature, elevated C-reactive protein, exposure to parenteral nutrition and use of alteplase for CVC clearance. The model identified 25% of positive cultures with an FPR of 0.11% (AUC = 0.82). CONCLUSIONS: A machine-learning model can be used to predict 25% of patients with impending CLABSI with only 1.1/1000 of these predictions being incorrect. Once prospectively validated, this tool may allow for early treatment or prevention.

Near real-time surveillance of the SARS-CoV-2 epidemic with incomplete data.

Designing public health responses to outbreaks requires close monitoring of population-level health indicators in real-time. Thus, an accurate estimation of the epidemic curve is critical. We propose an approach to reconstruct epidemic curves in near real time. We apply this approach to characterize the early SARS-CoV-2 outbreak in two Spanish regions between March and April 2020. We address two data collection problems that affected the reliability of the available real-time epidemiological data, namely, the frequent missing information documenting when a patient first experienced symptoms, and the frequent retrospective revision of historical information (including right censoring). This is done by using a novel back-calculating procedure based on imputing patients' dates of symptom onset from reported cases, according to a dynamically-estimated "backward" reporting delay conditional distribution, and adjusting for right censoring using an existing package, NobBS , to estimate in real time (nowcast) cases by date of symptom onset. This process allows us to obtain an approximation of the time-varying reproduction number ( R t ) in real-time. At each step, we evaluate how different assumptions affect the recovered epidemiological events and compare the proposed approach to the alternative procedure of merely using curves of case counts, by report day, to characterize the time-evolution of the outbreak. Finally, we assess how these real-time estimates compare with subsequently documented epidemiological information that is considered more reliable and complete that became available later in time. Our approach may help improve accuracy, quantify uncertainty, and evaluate frequently unstated assumptions when recovering the epidemic curves from limited data obtained from public health surveillance systems in other locations.

GC-MS Screening for the Identification of Potential Migrants Present in Polymeric Coatings of Food Cans.

The coatings used in cans can release complex chemical mixtures into foodstuffs. Therefore, it is important to develop analytical methods for the identification of these potential migrant compounds in packaged food to guarantee the compliance with European food packaging legislation and ensure consumer safety. In the present work, the type of coating in a total of twelve cans collected in Santiago de Compostela (Spain) were evaluated using an ATR (attenuated total reflectance)-FTIR spectrometer. These samples were analysed after extraction with acetonitrile in order to identify potential migrants through a screening method by gas chromatography coupled to mass spectrometry (GC-MS). A total of forty-seven volatile and semi-volatile compounds were identified in these samples, including plasticizers, photoinitiators, antioxidants, lubricants, etc. Then, in a second step, a targeted analysis was carried out for the simultaneous determination of 13 compounds, including bisphenols (BPA, BPB, BPC, BPE, BPF, BPG) and BADGEs (BADGE, BADGE.H2O, BADGE.2H2O, BADGE.HCl, BADGE.2HCl, BADGE.H2O.HCl, cyclo-di-BADGE) by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) with atmospheric pressure chemical ionisation (APCI) source. Among all the bisphenols analysed, only the bisphenol A was detected in four samples; while cyclo-di-BADGE was the predominant compound detected in all the samples analysed.

Cloud-based Electronic Health Records for Real-time, Region-specific Influenza Surveillance.

Accurate real-time monitoring systems of influenza outbreaks help public health officials make informed decisions that may help save lives. We show that information extracted from cloud-based electronic health records databases, in combination with machine learning techniques and historical epidemiological information, have the potential to accurately and reliably provide near real-time regional estimates of flu outbreaks in the United States.

Simultaneous chromatographic analysis of photoinitiators and amine synergists in food contact materials.

Photoinitiators (PIs) are components of UV-cured inks widely used in printing of food packaging. These substances can migrate into food and may be a hazard to human health. High-performance liquid chromatography with diode-array detection (HPLC-DAD) has been used for analysis of PIs and amine synergists in food packaging. Analysis was performed with a Kromasil C18 column (250 mm × 3.2 mm i.d., 5 µm particle size) with a binary mobile phase gradient prepared from acetonitrile and Milli-Q water. The flow rate was 0.5 mL min(-1). The method enables separation of fourteen PIs and amine synergists in a single run. The method was validated for linearity, repeatability, and limits of detection and quantification. Excellent sensitivity (LODs ≤ 1.56 µg dm(2)) and appropriate repeatability (RSD (n = 10) <0.9%) were achieved. Different types of food packaging material including plastic films, cardboard, and cans were analyzed and PIs were detected in 47% of the samples tested (n = 17). Positive samples were confirmed by use of LC-MS-MS in positive electrospray ionization (ESI) mode.

Pivotal role of protein tyrosine phosphatase 1B (PTP1B) in the macrophage response to pro-inflammatory and anti-inflammatory challenge.

Inhibition of protein tyrosine phosphatase 1B (PTP1B) has been suggested as an attractive target to improve insulin sensitivity in different cell types. In the present work, we have investigated the effect of PTP1B deficiency on the response of human and murine macrophages. Using in vitro and in vivo approaches in mice and silencing PTP1B in human macrophages with specific siRNAs, we have demonstrated that PTP1B deficiency increases the effects of pro-inflammatory stimuli in both human and rodent macrophages at the time that decreases the response to alternative stimulation. Moreover, the absence of PTP1B induces a loss of viability in resting macrophages and mainly after activation through the classic pathway. Analysis of early gene expression in macrophages treated with pro-inflammatory stimuli confirmed this exacerbated inflammatory response in PTP1B-deficient macrophages. Microarray analysis in samples from wild-type and PTP1B-deficient macrophages obtained after 24 h of pro-inflammatory stimulation showed an activation of the p53 pathway, including the excision base repair pathway and the insulin signaling pathway in the absence of PTP1B. In animal models of lipopolysaccharide (LPS) and D-galactosamine challenge as a way to reveal in vivo inflammatory responses, animals lacking PTP1B exhibited a higher rate of death. Moreover, these animals showed an enhanced response to irradiation, in agreement with the data obtained in the microarray analysis. In summary, these results indicate that, although inhibition of PTP1B has potential benefits for the treatment of diabetes, it accentuates pro-inflammatory responses compromising at least macrophage viability.

Day and night trophic variations of dominant fish species in a lagoon influenced by freshwater seeps.

The aim of this study was to determine the trophic structure and nycthemeral variations in the diet of dominant fish species (Ariopsis felis, Bairdiella chrysoura, Micropogonias undulatus, Eucinostomus gula, Eucinostomus argenteus, Lagodon rhomboides and Sphoeroides testudineus) in Celestun Lagoon, a biosphere reserve located in the southern Gulf of Mexico, and influenced by freshwater seeps. A total of 1473 stomachs were analysed and nine trophic groups were recorded. Bray-Curtis analyses with analyses of similarity (ANOSIM) statistical tests were used to determine two groups of feeding guilds: zoobenthivores and omnivores, with significant differences between time and habitat. The relationships between fish feeding habits, size class and environmental variables were investigated using canonical correspondence analysis (CCA). Most of the species showed a low niche breadth with high specialization towards amphipod consumption, with the exception of L. rhomboides (0·60), which indicated generalist feeding. This study in a protected area is an important source of information for drawing up conservation policies in relation to the management of aquatic resources, and will aid in the establishment of priority areas for conservation.

Migration of bisphenol A from polycarbonate baby bottles purchased in the Spanish market by liquid chromatography and fluorescence detection.

During the last decade the safety of bisphenol A (BPA) monomer in polycarbonate baby bottles has drawn the attention of both the public and the scientific community. This paper presents the results of BPA migration from polycarbonate baby bottles bought in the Spanish market, into simulant B (3% acetic acid), 50% ethanol and into real food (reconstituted infant formula). Furthermore, it was also the objective of this study to assess the suitability of 50% ethanol as a simulant for infant formula. BPA was analysed by a multi-analyte liquid chromatography method with fluorescence detection and mass spectrometry confirmation. The method was in-house validated and accredited by the national accreditation body. The validation results for this analyte in the previous mentioned matrices were: LOD = 0.004-0.007 mg kg(-1); LOQ (validated) = 0.03 mg kg(-1); RSD% = 3.4-5.8; and recovery = 106.6-118.2%. A collection of 72 different baby bottle samples from 12 different brands were analysed. Baby bottle material was identified by FTIR. The migration test conditions used were those recommended for baby bottles in the Guidelines on testing conditions for articles in contact with foodstuffs (with a focus on kitchenware), prepared by the European network of laboratories for food-contact materials. In most of the migration assays the results were below the LOD. In four of the commercial brands there was detectable migration into the simulant 50% ethanol and BPA was detected in only two samples of infant formula (0.01 mg kg(-1)). Migration results obtained were in compliance with European Union regulations.

Determination of furan in jarred baby food purchased from the Spanish market by headspace gas chromatography-mass spectrometry (HS-GC-MS).

The aim of this paper is to offer a method based on headspace gas chromatography-mass (HS-GC-MS) spectrometry technique in-house validated and use to estimate furan concentrations in jarred baby-food samples purchased from the Spanish market. The validation was performed according to ISO 17025 and European Food Safety Authority (EFSA) requirements and the results obtained (limit of detection (LOD) = 0.05 microg kg(-1); limit of quantification (LOQ) = 4 microg kg(-1), lowest validated level; relative standard deviation (RSD) = 3.1-10.5%; recoveries = 85.4-101.5%) confirm that this method is fit for the routine analysis of furan in jarred baby food control. Furan was analysed in 39 different baby-food samples and the mean levels varied between 64.6 microg kg(-1) (rice and chicken samples) and less than or equal to the LOQ (fruit-based samples). The mean concentrations found for the different matrices were 5.0, 37.8, 25.2, 33.8 and 30.5 microg kg(-1) for fruit, vegetables, meat/vegetables, fish/vegetables and dairy-containing baby foods, respectively. According to the statistical analyses, fruit-based baby-food samples had significantly lower concentrations of furan. Mean values for the other matrices were at least five times higher, and this is in accordance with the levels reported in other studies.

Chemical composition and biotechnological properties of a polysaccharide from the peels and antioxidative content from the pulp of Passiflora liguralis fruits.

A new polysaccharide with a high molecular weight (greater than 1 x 106 Da) was extracted and characterized from the peels of Passiflora liguralis (granadilla) fruits. Chemical composition of the biopolymer, performed by using a high pressure anion exchange-pulsed amperometric detector (HPAE-PAD), showed the presence of six different sugar residues: xylose, glucose, galactose, galactosamine, an unknown component, and fucose in the relative ratio of 1:0.5:0.2:0.06:0.05:trace. The optical rotation of this xyloglucan was [alpha](D)(25) degrees C = -186.42 (concentration of 1.4 mg/mL of H(2)O), and the viscosity was dependent on the concentration and pH, showing a maximum value of 1.4 eta at a concentration of 3% in distilled water and a maximum value of 7.0 eta in citrate buffer solution. Thermogravimetric analysis indicated that this biopolymer was very stable at high temperatures, showing a degradation temperature at 280 degrees C. The characterization of the polysaccharide was also investigated by spectroscopic methods (1H NMR and IR) pointing out the complexity of this biopolymer and the presence of sugar residues in alpha-manno, alpha-gluco-galacto, and beta-gluco-galacto configurations. The formation of a biodegradable film using this novel xyloglucan was reported, and the anticytotoxic activity of the polysaccharide was studied in a brine shrimp bioassay. Considerable antioxidant activity (Trolox equivalent antioxidant capacity (TEAC) value of 0.32 microM/mg fresh product) was noted in the lipophilic extracts of Passiflora liguralis fruits, indicating, in this fruit, an alternative source of bioactive compounds.

[Non-compliance with pharmacological treatment in patients with epilepsy]. / Incumplimiento farmacológico en pacientes con epilepsia.

INTRODUCTION: The factors that affect adherence to pharmacological treatment with anticonvulsive drugs are manifold and can be classified as psychosocial, educational and related to the medication and the relation between physician and patient. Non-compliance with pharmacological treatment leads to: lack of control over seizures, recurrence, increased absenteeism from work and, possibly, injury to oneself or to others. AIMS: To determine and to analyse the variables associated to compliance with pharmacological treatment in a sector of the population in Peru. PATIENTS AND METHODS: The sample consisted of 114 patients evaluated between June 2001 and December 2002 at the Epilepsy and Clinical Electroencephalography Department of the National Neurological Sciences Institute Oscar Trelles Montes in Lima. RESULTS: In this study the rate of non-compliance with the pharmacological regimen was 67.2% and those who did not adhere to the anticonvulsive therapy had poorer control over their seizures. The variables that were significantly associated to non-compliance with the pharmacological treatment were: lack of money to buy the medicine, patient's failure to acknowledge the disease, poor response to treatment, belief that the treatment is of no use or has no beneficial effects, and factors linked to the relationship between physician and patient. Patients who did not comply claimed that not being able to afford the medication was the most frequent reason why they had stopped following the treatment.

Surgical complications of typhoid fever: enteric perforation.

Typhoid fever remains a prevalent disease in developing nations as the result of adverse socioeconomic factors. The most frequent complication, and principal cause of mortality, is perforation of the terminal ileum. This report presents our experience with 96 patients surgically treated at Cayetano Heredia University Hospital in Lima, Peru from 1972 to 1986. The clinical characteristics and the diverse surgical procedures utilized in the management of these patients are reviewed.

Virus expression in different tissues of normal and tumor-bearing mice inoculated with a murine leukemia virus.

Evolution of virus expression in different lymphoid organs as well as in solid syngeneic tumors of mice inoculated with an MuLV was studied with the aid of in vitro XC co-culture technique. When normal adult mice of strain XLII were inoculated intraperitoneally with a cultured Rauscher virus (RC), the virus could be detected, 10 days after inoculation, only in bone marrow in small amounts and thereafter no virus could be found in any of the organs tested, including bone marrow, spleen, thymus, lymph node and kidney. However, when age- and sex-matched parallel mice bearing syngeneic subcutaneous non-viral tumors were inoculated similarly with the RC virus, the virus could be detected abundantly not only in bone marrow and spleen but also in tumors during the first 3 weeks and even 6 weeks after virus inoculation. Transitional decrease or disappearance of the virus was observed around the 25th-31st day in organs and tumors of the inoculated mice. When the tumor mass was removed from these mice by surgery, the virus disappeared rapidly and definitely from all the organs tested. The virus recovered from in vitro explanted and cultured tumors, taken from mice inoculated with the virus, induced typical lymphoid leukemia in BALB/c mice inoculated as newborns. However, from certain aspects (hypertrophy of the thymus and lymph nodes), this virus was different from the original RC virus.

Activation of "eclipsed" lymphoid cells from advanced tumor-bearing mice through adoptive transfer to sublethally irradiated syngeneic hosts.

Immunologically inactive or "eclipsed" lymphoid cells from advanced tumor-bearing mice were investigated following their adoptive transfer to irradiated syngeneic hosts. Experiments were performed with two syngeneic tumor-host system: the T5-BALB/c tumor line chronically infected with a low-leukemogenic Rauscher virus variant and the TM1-C3H tumor line developed from a spontaneous C3H/He mouse mammary tumor. In confirmation of our previous data, peritoneal cells (PC) from advanced tumor-bearing mice (EPC) appeared to have lost any capacity to inhibit specifically the growth of corresponding tumor target cells in vitro colony inhibition (CI) tests, whereas PC from immunized mice (IPC) were perfectly active. When these EPC were adoptively transferred by intraperitoneal inoculation into sublethally irradiated (450 R) syngeneic mice in association with respective tumor extracts (TE), the PC from such recipient mice, taken 5 to 13 days later, were nearly as active in in vitro CI tests as were PC from parallel IPC-recipient mice. For this recovery of specific immunological activity following the adoptive transfer of EPC the adjunction of the TE and irradiation of the recipient animals seem important and may be necessary. On the other hand, no specific immunological activity was seen in PC from irradiated mice to which PC from normal mice had been transferred with TE. In addition to the in vitro results, an effect of adoptive transfer of EPC (retardation of tumor growth) was also observed in vivo. It is concluded that the "eclipsed" immunologically inactive state of the EPC in mice bearing advanced tumor is not irreversible and that activation of these cells can occur in vivo under certain conditions helped by the presence of tumor-specific antigenic stimulus.