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Group 13 complexes bearing an aminopyridylbisphenol ligand have been prepared [ML-X; L = ligand, M = Al (X = Cl and Br), Ga (X = Cl, Br, and I), or In (X = Cl)]. The structures of the complexes containing the chloride ligand (ML-Cl; M = Al, Ga, and In) have been directly compared through an X-ray crystallography study, with differences in the monomeric or dimeric nature of their structures observed. All of the complexes obtained have been studied as potential catalysts for the synthesis of cyclic carbonates from epoxides and CO2. It has been found that the indium complex, as part of a traditional binary catalyst system (catalyst + tetra-butylammonium halide cocatalyst), displays the highest catalytic activity and is active under rather mild reaction conditions (balloon pressure of CO2). Meanwhile, it has been found that the GaL-I complex is a competent single-component catalyst (no need for addition of a cocatalyst) at more elevated reaction temperatures and pressures. A full substrate scope has been performed with both developed catalyst systems to demonstrate their applicability. In addition to the experimental results, a density functional theory study was performed on both catalyst systems. These results explain both why the indium catalyst is the most active under binary catalyst system conditions and how the gallium catalyst with an iodide (GaL-I) is able to act as a single-component catalyst in contrast to the indium-based complex.
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In February 2023, German public health authorities reported two dengue cases (one confirmed, one probable) and four possible cases who travelled to Ibiza, Spain, in late summer/autumn 2022; the infection was probably acquired through mosquito bites. Case 1 visited Ibiza over 1 week in late August with two familial companions; all three developed symptoms the day after returning home. Only Case 1 was tested; dengue virus (DENV) infection was confirmed by presence of NS1 antigen and IgM antibodies. Case 2 travelled to Ibiza with two familial companions for 1 week in early October, and stayed in the same town as Case 1. Case 2 showed symptoms on the day of return, and the familial companions 1 day before and 3 days after return; Case 2 tested positive for DENV IgM. The most probable source case had symptom onset in mid-August, and travelled to a dengue-endemic country prior to a stay in the same municipality of Ibiza for 20 days, until the end of August. Dengue diagnosis was probable based on positive DENV IgM. Aedes albopictus, a competent vector for dengue, has been present in Ibiza since 2014. This is the first report of a local dengue transmission event on Ibiza.
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Aedes , Vírus da Dengue , Dengue , Animais , Humanos , Dengue/diagnóstico , Dengue/epidemiologia , Vírus da Dengue/genética , Espanha/epidemiologia , Mosquitos Vetores , Surtos de Doenças , Imunoglobulina MRESUMO
Mexico faced a significant burden from the COVID-19 pandemic. Since the pandemic's onset in 2020, numerous studies have underscored the substantial risk of COVID-19 death among Indigenous individuals. This study aims to assess COVID-19 vaccine uptake among Indigenous language speakers in Mexico, focusing on understanding the barriers they face in obtaining access to vaccines. We used Encuesta Nacional de Salud y Nutrición Continua (ENSANUT) 2022, a nationally representative health survey in Mexico to analyze data on self-reported COVID-19 vaccine status, reasons for not getting vaccinated, and other relevant covariates. We employed logistic regression to estimate odds ratios (ORs) for vaccine uptake and uptake barriers, all models were adjusted for potential confounders. Among 34,051 participants, 1793 individuals (5.23%) reported speaking an Indigenous language. Indigenous language speakers were found to have a lower vaccination rate (63%) compared to non-Indigenous language speakers (81%) (p <0.005). They were also 59% less likely to be vaccinated against COVID-19 (OR 0.41, 95% CI 0.27-0.62), even when adjusted for confounders. Among unvaccinated individuals, Indigenous language speakers were more likely to cite negative beliefs about the vaccine or fear as reasons for not being vaccinated (OR 1.82, 95% CI 1.11-3.00) while being less likely to report access barriers (OR 0.62, CI 95% 0.42-0.91). This study highlights disparities in COVID-19 vaccine uptake among Indigenous language speakers in Mexico. The findings underscore the urgent need for targeted, culturally appropriate public health interventions and the consideration of social and ethnic vulnerability in prioritizing vaccinations.
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BACKGROUND: Health misinformation, which was particularly prevalent during the COVID-19 pandemic, hampers public health initiatives. Spanish-speaking communities in the San Francisco Bay Area may be especially affected due to low digital health literacy and skepticism towards science and healthcare experts. Our study aims to develop a checklist to counter misinformation, grounded in community insights. METHODS: We adopted a multistage approach to understanding barriers to COVID-19 vaccine uptake in Spanish-speaking populations in Alameda and San Francisco counties. Initial work included key informant and community interviews. Partnering with a community-based organization (CBO), we organized co-design workshops in July 2022 to develop a practical tool for identifying misinformation. Template analysis identified key themes for actionable steps, such as source evaluation and content assessment. From this, we developed a Spanish-language checklist. FINDINGS: During formative interviews, misinformation was identified as a major obstacle to vaccine uptake. Three co-design workshops with 15 Spanish-speaking women resulted in a 10-step checklist for tackling health misinformation. Participants highlighted the need for scrutinizing sources and assessing messenger credibility, and cues in visual content that could instill fear. The checklist offers a pragmatic approach to source verification and information assessment, supplemented by resources from local CBOs. CONCLUSION: We have co-created a targeted checklist for Spanish-speaking communities to identify and counter health misinformation. Such specialized tools are essential for populations that are more susceptible to misinformation, enabling them to differentiate between credible and non-credible information.
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Idioma , Pandemias , Humanos , Feminino , São Francisco , Vacinas contra COVID-19 , ComunicaçãoRESUMO
PURPOSE: The purpose of the study was to identify non-invasive imaging biomarkers potentially useful for close activity monitoring in birdshot chorioretinitis (BSCR). METHODS: Cross-sectional study of BSCR eyes included as per Levinson's and/or SUN criteria. Eyes were blindly classified into active or inactive groups per clinical inflammatory parameters, ultra-widefield (UWF) pseudocolour images, UWF fluorescein angiography (FA) and macular optical coherence tomography (OCT) cube. Qualitative and quantitative OCT and OCT-angiography (OCT-A) parameters at the fundus, superonasal and inferonasal fields were compared between active and inactive eyes. RESULTS: Thirty consecutive BSCR patients (60 eyes) were analysed. 28 eyes (46.66%) were from women and the overall mean age was 59.7 ± 12.3 years. Active eyes showed an abnormal retinal thickening at inferonasal field (nasal retinal thickness) and a higher averaged thickened retinal index (ATRI) (72.36 active vs. 20.12 inactive, p < 0.0001). A significant moderate correlation was observed between ATRI and FA scores (r = 0.259, p = 0.022). Macular vascular loops were more frequent in the superficial vascular plexus of OCT-A in the active eyes (p = 0.028). The vascular perfusion index tended to be higher in all subfields of active eyes but did not reach statistical significance. CONCLUSION: Multimodal imaging could be key to discerning activity in BSCR eyes. Higher ATRI and the presence of vascular loops in the superficial plexus are potential non-invasive activity biomarkers for the close monitoring of BSCR.
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Coriorretinite , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Coriorretinopatia de Birdshot , Coriorretinite/diagnóstico , Tomografia de Coerência Óptica/métodos , Estudos Transversais , Angiofluoresceinografia/métodos , Vasos Retinianos , BiomarcadoresRESUMO
INTRODUCTION: The clinical effect of domperidone against COVID-19 has been investigated in a double-blind phase III clinical trial (EudraCT number 2021-001228-17). Domperidone has shown in vitro antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and potential immudolatory properties through the stimulation of prolactin secretion. PATIENTS AND METHODS: The efficacy of oral domperidone plus standard of care (SOC; n = 87) versus placebo plus SOC (n = 86) was evaluated in a 28-day randomized double-blind multicentre study in primary health care centres. A total of 173 outpatients with mild-to-moderate COVID-19 were included. Three daily doses of 10 mg (30 mg/day) of domperidone or placebo were administered for 7 days. Reduction of viral load on day 4 was the primary efficay endpoint. It was estimated in saliva samples by reverse transcription-quantitative polymerase chain reaction (RT-qPCR), as the cycle thresholds detected ORF1ab, N Protein and S Protein genes. RESULTS: A significant reduction in the viral load was observed (p < 0.001) from baseline to days 4, 7 and 14 of the three genes studied with non-significant differences between domperidone and placebo groups. Twenty-three patients (13.3%) experienced adverse events, 14 patients in the domperidone group (16.1%) and 9 patients in the placebo group (10.5%). No patients needed to be hospitalized. CONCLUSION: Results do not prove the use of domperidone as antiviral in patients with COVID-19.
A 28-day double-blind clinical trial was performed to investigate the antiviral effect of domperidone, 30 mg/day for 7 days (n = 87) versus placebo (n = 86) in outpatients with mild-to-moderate COVID-19.The primary efficacy endpoint was the reduction of viral load on day 4 as compared with baseline, estimated as the cycle thresholds to detect ORF1ab, N Protein and S Protein genes by RT-qPCR in saliva samples.The study findings do not prove the use of domperidone as antiviral in patients with COVID-19.
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COVID-19 , Humanos , SARS-CoV-2 , Domperidona/uso terapêutico , Método Duplo-Cego , Carga Viral , Resultado do Tratamento , Antivirais/uso terapêutico , Atenção Primária à SaúdeRESUMO
Cyclic thiocarbonates are the sulfur containing analogues of the well-studied cyclic carbonates and are relatively poorly explored despite their potential applications and intriguing reactivities. To date, application of these organosulfur compounds has included their use as monomers for polythiocarbonate synthesis (their ring-opening is more readily achieved and more selective than the corresponding cyclic carbonates) and as reactive intermediates for the preparation of a range of higher-value sulfur containing compounds. Despite these uses, the synthesis of these compounds is far less explored and developed than their non-sulfur analogues. Here, we provide an overview of the state-of-the-art, both recent and historical, for the synthesis of a range of cyclic mono-, di- and tri-thiocarbonates (both five and six-membered rings), with selected examples of their reported applications also highlighted.
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In autumn 2022, the Spanish Influenza National Reference Laboratory (NRL) confirmed the detection of influenza A(H5N1) in samples from two asymptomatic workers linked to an outbreak in a poultry farm in Spain. Nasopharyngeal swabs were taken according to a national screening protocol for exposed workers. Absence of symptoms, low viral load and negative serology in both workers suggested environmental contamination. These findings motivated an update of the early detection strategy specifying timing and sampling conditions in asymptomatic exposed persons.
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Virus da Influenza A Subtipo H5N1 , Influenza Aviária , Influenza Humana , Doenças das Aves Domésticas , Animais , Humanos , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , Influenza Aviária/diagnóstico , Influenza Aviária/epidemiologia , Aves Domésticas , Espanha/epidemiologia , Fazendeiros , Surtos de Doenças/veterinária , Doenças das Aves Domésticas/epidemiologiaRESUMO
Many complexes based on group 13 elements have been successfully applied as catalysts for the synthesis of cyclic carbonates from epoxides and CO2 and to date these have provided some of the most active catalysts developed. It is notable that most reports have focused on the use of aluminium-based compounds likely because of the well-established Lewis acidity of this element and its cost. In comparison, relatively little attention has been paid to the development of catalysts based on the heavier group 13 elements, despite their known Lewis acidic properties. This study describes the synthesis of aluminium, gallium and indium compounds supported by a readily prepared salphen ligand and explores both their comparative structures and also their potential as catalysts for the synthesis of cyclic carbonates. In addition, the halide ligand which forms a key part of the compound has been systematically varied and the effect of this change on the structure and catalytic activity is also discussed. It is demonstrated that the indium compounds are actually, and unexpectedly, the most active for cyclic carbonate synthesis, despite their lower Lewis acidity when compared to their aluminium congeners. The experimental observations from this work are fully supported by a Density Functional Theory (DFT) study, which provides important insights into the reasons as to why the indium catalyst with bromide, [InBr(salphen)], is most active.
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INTRODUCTION: As of July 2022, a little over one-third of Guatemalans were fully vaccinated. While COVID-19 vaccination rates are not officially reported nationally by racial/ethnic groups, non-governmental organisations and reporters have observed that COVID-19 vaccination rates are especially low among high-risk Indigenous populations. We conducted one of the first studies on COVID-19 vaccine acceptance in Indigenous populations in the Central Highlands of Guatemala, which aimed to better understand the barriers to COVID-19 vaccine uptake and how to improve vaccine promotional campaigns. METHODS: In November 2021, we conducted eight focus group discussions (FGDs) with 42 Indigenous men and women and 16 in-depth interviews (IDIs) with community health workers, nurses and physicians in Chimaltenango and Sololá. Using a participatory design approach, our qualitative analysis used constant comparative methods to understand the inductive and deductive themes from the FGD and IDI transcripts. RESULTS: We found three major overarching barriers to vaccination within the sampled population: (1) a lack of available easily understandable, linguistically appropriate and culturally sensitive COVID-19 vaccine information; (2) vaccine access and supply issues that prevented people from being vaccinated efficiently and quickly; and (3) widespread misinformation and disinformation that prey on people's fears of the unknown and mistrust of the medical establishment and government. CONCLUSION: When developing COVID-19 vaccine messages, content should be culturally relevant, appropriate for low-literacy populations and in the languages that people prefer to speak. Promotional materials should be in multiple modalities (print, radio and social media) and also have specific Maya cultural references (dress, food and concepts of disease) to ensure messaging connects with intended targets. This study supports the need for more robust research into best practices for communicating about COVID-19 vaccines to marginalised communities globally and suggests that policy makers should invest in targeted local solutions to increase vaccine uptake.
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COVID-19 , Vacinas , Masculino , Feminino , Humanos , Vacinas contra COVID-19 , Guatemala , COVID-19/prevenção & controle , Vacinação , Povos IndígenasRESUMO
Populations at high risk for COVID-19- including Spanish speakers-may face additional barriers to obtaining COVID-19 vaccinations; by understanding their challenges, we can create more equitable vaccine interventions. In this study, we used interviews to identify barriers and enablers to COVID-19 vaccine uptake among participants in the San Francisco Department of Public Health contact tracing program. Data analysis employed Capability, Opportunity, Motivation Behavior model (COM-B) and the Behavior Change Wheel framework as guides to target barriers with interventions and supporting policies. This paper presents data from interviews focused on COVID-19 vaccine uptake that was part of a project to improve COVID-19 preventive behaviors in San Francisco. We completed seventeen interviews between February and May 2021; six (35%) were completed in English and 11 (65%) in Spanish. Barriers to vaccine uptake included an unprepared health system, fear of side effects, limited knowledge, and conflicting information. Behavioral factors influencing vaccine uptake were mainly related to physical opportunity, automatic motivation, and psychological capability. Interventions that could address the most significant number of barriers included education, enablement, and environmental restructuring. Finally, communication and marketing policies that use diverse multi-lingual social media and environmental planning that includes accessible vaccine sites for people with disabilities, literacy barriers, and limited English proficiency could significantly increase vaccination. Public health departments should tailor interventions to high-risk populations by understanding the specific barriers they face. This exploratory study suggests how implementation science can provide frameworks to achieve this.
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Introduction: The state of alarm was declared in Spain due to the COVID-19 epidemic on March 14, 2020, and established population confinement measures. The objective is to describe the process of lifting these mitigation measures. Methods: The Plan for the Transition to a New Normality, approved on April 28, contained four sequential phases with progressive increase in socio-economic activities and population mobility. In parallel, a new strategy for early diagnosis, surveillance and control was implemented. A bilateral decision mechanism was established between the Spanish Government and the autonomous communities (AC), guided by a set of qualitative and quantitative indicators capturing the epidemiological situation and core capacities. The territorial units were established ad-hoc and could be from Basic Health Zones to entire AC. Results: The process run from May 4 to June 21, 2020. AC implemented plans for reinforcement of core capacities. Incidence decreased from a median (50% of territories) of 7.4 per 100,000 in 7 days at the beginning to 2.5 at the end. Median PCR testing increased from 53% to 89% of suspected cases and PCR total capacity from 4.5 to 9.8 per 1000 inhabitants weekly; positivity rate decreased from 3.5% to 1.8%. Median proportion of cases with traced contacts increased from 82% to 100%. Conclusion: Systematic data collection, analysis, and interterritorial dialogue allowed adequate process control. The epidemiological situation improved but, mostly, the process entailed a great reinforcement of core response capacities nation-wide, under common criteria. Maintaining and further reinforcing capacities remained crucial for responding to future waves.
Introducción: El 14 de marzo de 2020 España declaró el estado de alarma por la pandemia por COVID-19 incluyendo medidas de confinamiento. El objetivo es describir el proceso de desescalada de estas medidas. Métodos: Un plan de transición hacia una nueva normalidad, del 28 de abril, incluía 4 fases secuenciales incrementando progresivamente las actividades socioeconómicas y la movilidad. Concomitantemente, se implementó una nueva estrategia de diagnóstico precoz, vigilancia y control. Se estableció un mecanismo de decisión bilateral entre Gobierno central y comunidades autónomas (CCAA), guiado por un panel de indicadores cualitativos y cuantitativos de la situación epidemiológica y las capacidades básicas. Las unidades territoriales evaluadas comprendían desde zonas básicas de salud hasta CCAA. Resultados: El proceso se extendió del 4 de mayo al 21 de junio y se asoció a planes de refuerzo de las capacidades en las CCAA. La incidencia disminuyó de una mediana inicial de 7,4 por 100.000 en 7 días a 2,5 al final del proceso. La mediana de pruebas PCR aumentó del 53% al 89% de los casos sospechosos, y la capacidad total de 4,5 a 9,8 pruebas semanales por 1.000 habitantes; la positividad disminuyó del 3,5% al 1,8%. La mediana de casos con contactos trazados aumentó del 82% al 100%. Conclusión: La recogida y análisis sistemático de información y el diálogo interterritorial logaron un adecuado control del proceso. La situación epidemiológica mejoró, pero sobre todo, se aumentaron las capacidades, en todo el país y con criterios comunes, cuyo mantenimiento y refuerzo fue clave en olas sucesivas.
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INTRODUCTION: The state of alarm was declared in Spain due to the COVID-19 epidemic on March 14, 2020, and established population confinement measures. The objective is to describe the process of lifting these mitigation measures. METHODS: The Plan for the Transition to a New Normality, approved on April 28, contained four sequential phases with progressive increase in socio-economic activities and population mobility. In parallel, a new strategy for early diagnosis, surveillance and control was implemented. A bilateral decision mechanism was established between the Spanish Government and the autonomous communities (AC), guided by a set of qualitative and quantitative indicators capturing the epidemiological situation and core capacities. The territorial units were established ad-hoc and could be from Basic Health Zones to entire AC. RESULTS: The process run from May 4 to June 21, 2020. AC implemented plans for reinforcement of core capacities. Incidence decreased from a median (50% of territories) of 7.4 per 100,000 in 7 days at the beginning to 2.5 at the end. Median PCR testing increased from 53% to 89% of suspected cases and PCR total capacity from 4.5 to 9.8 per 1000 inhabitants weekly; positivity rate decreased from 3.5% to 1.8%. Median proportion of cases with traced contacts increased from 82% to 100%. CONCLUSION: Systematic data collection, analysis, and interterritorial dialogue allowed adequate process control. The epidemiological situation improved but, mostly, the process entailed a great reinforcement of core response capacities nation-wide, under common criteria. Maintaining and further reinforcing capacities remained crucial for responding to future waves.
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COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Teste para COVID-19 , SARS-CoV-2 , Espanha/epidemiologiaRESUMO
OBJECTIVES: To evaluate the impact of culturally and linguistically tailored informational videos delivered via social media campaigns on COVID-19 vaccine uptake in Indigenous Maya communities in Guatemala. METHODS: Our team designed a series of videos utilising community input and evaluated the impact using a pre-post intervention design. In-person preintervention surveys were collected from a sample of respondents in four rural municipalities in Guatemala in March 2022. Facebook, Instagram and browser ads were flooded with COVID-19 vaccine informational videos in Spanish, Kaqchikel and Kiche for 3 weeks. Postintervention surveys were conducted by telephone among the same participants in April 2022. Logistic regression models were used to estimate the OR of COVID-19 vaccine uptake following exposure to the intervention videos. RESULTS: Preintervention and postintervention surveys were collected from 1572 participants. The median age was 28 years; 63% (N=998) identified as women, and 36% spoke an Indigenous Mayan language. Twenty-one per cent of participants (N=327) reported watching the intervention content on social media. At baseline, 89% (N=1402) of participants reported having at least one COVID-19 vaccine, compared with 97% (N=1507) in the follow-up. Those who reported watching the videos had 1.78 times the odds (95% CI 1.14 to 2.77) of getting vaccinated after watching the videos compared with those who did not see the videos when adjusted by age, community, sex and language. CONCLUSION: Our findings suggest that culturally and linguistically tailored videos addressing COVID-19 vaccine misinformation deployed over social media can increase vaccinations in a rural, indigenous population in Guatemala, implying that social media content can influence vaccination uptake. Providing accurate, culturally sensitive information in local languages from trusted sources may help increase vaccine uptake in historically marginalised populations.
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COVID-19 , Mídias Sociais , Feminino , Humanos , Adulto , Vacinas contra COVID-19 , Guatemala , COVID-19/prevenção & controle , Povos IndígenasRESUMO
The potential for application of bio-derived molecules in our everyday lives is attracting vast interest as attention moves towards development of a truly circular and sustainable economy. Whilst a large number of molecules are naturally available and contain a variety of functional groups, few of these compounds are able to be immediately transferred to applications where they can directly replace established oil-derived species. This issue presents both a challenge and an opportunity for the synthetic chemistry community. This study demonstrates how erucic acid, a molecule containing an olefin and a carboxylic acid, which is readily available from commonly cultivated rapeseed oils, can be used as a platform to be chemoselectively converted into a range of value-added compounds using established and high yielding synthetic procedures. In particular, the work showcases approaches towards the chemoselective (and in cases regioselective) oxidation with m-CPBA and incorporation of cyclic carbonate and cyclic dithiocarbonate functionalities which have potential to be employed in a range of applications. Expedient routes to unusual derivatives containing both cyclic carbonate and cyclic dithiocarbonates are also presented taking advantage of the distinct reactivities of the two different epoxides in the intermediate compounds. This work also provides a rare example of the synthesis of internal cyclic dithiocarbonates. These new products have potential to be applied as monomers in the growing field of bio-based non-isocyanate polyurethane synthesis.
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Dióxido de Carbono , Compostos de Epóxi , Compostos de Epóxi/química , Reação de Cicloadição , Ácidos ErúcicosAssuntos
Monkeypox virus , Mpox , Criança , Surtos de Doenças , Humanos , Mpox/epidemiologia , Espanha/epidemiologiaRESUMO
In this article we provide the most important epidemiological aspects in the first phases of the pandemic and some preliminary reflections from the Coordinating Centre for Health Alerts and Emergencies, the unit that has coordinated surveillance at the national level. COVID-19 has brought to light the weaknesses in the surveillance system and how difficult it is to manage a health crisis in the absence of a robust public health structure. The commitment of public health professionals during this epidemic has made up for the lack of resources in many occasions, and has evidenced the need to incorporate new professional profiles to surveillance teams. The need to rapidly adapt has achieved an improvement in existing systems and the development of new tools and new systems. These need to turn into structural changes that improve the quality of surveillance, decreasing territorial gaps and ensuring a better and coordinated response to future health crises. It is urgent to incorporate tools for process automation and to grant timely availability of data. To that end, public health and epidemiological surveillance must participate in the process of digital development within the National Health System. Profound changes are needed in public health surveillance, which has to be integrated in all healthcare levels. It is also important to strengthen the capacity for analysis by promoting alliances and joint actions. During this alert, the importance of coordination in public health in a decentralized country has been evident. At international level, it is necessary to review the tools to share data to coordinate an alert from the early stages.
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COVID-19 , Vigilância em Saúde Pública , COVID-19/epidemiologia , Pessoal de Saúde , Humanos , Pandemias , Saúde PúblicaRESUMO
PURPOSE: To report the 24-month outcomes of vascular endothelial growth factor (VEGF) inhibitors for myopic choroidal neovascularization (mCNV) in predominantly Caucasian eyes in routine clinical practice. METHODS: Retrospective analysis of treatment-naïve eyes starting intravitreal injection of VEGF inhibitors of either bevacizumab (1.25 mg) or ranibizumab (0.5 mg) for mCNV from 1 January 2006 to 31 May 2018 that were tracked in the Fight Retinal Blindness! registry. RESULTS: We identified 203 eyes (bevacizumab-85 and ranibizumab-118) of 189 patients. The estimated mean (95% CI) change in VA over 24 months for all eyes using longitudinal models was +8 (5, 11) letters with a median (Q1, Q3) of 3 (2, 5) injections given mostly during the first year. The estimated mean change in VA at 24 months was similar between bevacizumab and ranibizumab [+9 (5, 13) letters for bevacizumab versus +9 (6, 13) letters for ranibizumab; p = 0.37]. Both agents were also similar in the mCNV activity outcomes, treatment frequency and visit frequency. CONCLUSIONS: The 24-month treatment outcomes of VEGF inhibitors for mCNV were favourable in this largest series yet reported of predominantly Caucasian eyes in routine clinical practice, with approximately two lines of visual gain and a median of three injections given mostly during the first year. These outcomes are similar to those reported for predominantly Asian eyes. Bevacizumab appeared to be as safe and effective as ranibizumab.
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Bevacizumab/administração & dosagem , Cegueira/prevenção & controle , Neovascularização de Coroide/tratamento farmacológico , Miopia Degenerativa/complicações , Ranibizumab/administração & dosagem , Sistema de Registros , População Branca , Idoso , Inibidores da Angiogênese/administração & dosagem , Cegueira/diagnóstico , Cegueira/etnologia , Neovascularização de Coroide/complicações , Neovascularização de Coroide/etnologia , Feminino , Angiofluoresceinografia/métodos , Seguimentos , Fundo de Olho , Humanos , Incidência , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Miopia Degenerativa/fisiopatologia , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade VisualRESUMO
BACKGROUND: Contact investigation, the systematic evaluation of individuals in close contact with an infectious tuberculosis (TB) patient, is a key active case-finding strategy for global TB control. Better estimates of the yield of contact investigation can guide strategies to reduce the number of underreported and underdiagnosed TB cases, approximately three million cases per year globally. A systematic review (Prospero ID # CRD42019133380) and meta-analysis was conducted to update and enhance the estimates of the yield of TB contact investigation in low- and middle-income countries (LMIC). Pubmed, Web of Science, Embase and the WHO Global Index Medicus were searched for peer-reviewed studies (published between January 2006-April 2019); studies reporting the number of active TB or latent tuberculosis infection (LTBI) found through contact investigation were included. Pooled data were meta-analyzed using a random effects model and risk of bias was assessed. RESULTS: Of 1,644 unique citations obtained from database searches, 110 studies met eligibility criteria for descriptive data synthesis and 95 for meta-analysis. The pooled yields of contact investigation activities for different outcomes were: secondary cases of all active TB (defined as those bacteriologically confirmed or clinically diagnosed) 2.87% (2.61-3.14, I2 97.79%), bacteriologically confirmed active TB 2.04% (1.77-2.31, I2 98.06%), and LTBI 43.83% (38.11-49.55, I2 99.36%). Yields are interpreted as the percent of contacts screened who are diagnosed with active TB as a result of TB contact investigation activities. Pooled estimates were substantially heterogenous (I2 ≥ 75%). CONCLUSIONS: This study provides methodologically rigorous and up-to-date estimates for the yield of TB contact investigation activities in low- and middle-income countries (LMIC). While the data are heterogenous, these findings can inform strategic and programmatic planning for scale up of TB contact investigation activities.