Assessing electronic immunization registries: the Pan American Health Organization experience.

OBJECTIVE: To develop a methodology to assess electronic immunization registries (EIRs) in low- and middle-income countries (LMICs) in Latin America and the Caribbean. METHODS: A team from the Immunization Unit at the Pan American Health Organization (PAHO) reviewed existing methodologies to evaluate health information systems, particularly the Performance of Routine Information System Management (PRISM) framework and methodologies used to assess information systems. In 2014, the PAHO team convened a small working group to develop an evaluation approach to be added to the existing World Health Organization immunization data quality self-assessment (DQS) tool. The resulting DQS with an added EIR component was named "DQS Plus." The DQS Plus methodology was used in Panama in May 2014 and in Honduras in November 2015. RESULTS: The DQS Plus tool proved feasible and easy to implement in Panama and Honduras, including by not adding much time or resources to those needed for a usual DQS. The information obtained from the DQS Plus assessment was practical and helped provide health authorities with recommendations to update and improve their EIR, strengthen the use of the registry, and enhance the data the assessment produced, at all levels of the health system. These recommendations are currently being implemented in the two countries. CONCLUSIONS: The DQS Plus proved to be a practical and useful approach for assessing an EIR in an LMIC and generating actionable recommendations. Further work on defining operational and related EIR functional standards in LMICs will help develop an improved EIR assessment tool for Latin America and the Caribbean, and potentially elsewhere.

[Evaluation of the genotoxic effect of malaria in a cohort of patients in Medellín and Quibdó]. / Evaluación del efecto genotóxico en pacientes con malaria de una región de Colombia.

INTRODUCTION: During malaria infection, both parasite and host are under the effects of oxidative stress due to the increased production of reactive oxygen species, which can induce DNA damage by its genotoxic effects. OBJECTIVE: To evaluate genotoxic effects in human lymphocytes in a cohort of patients with malaria from Medellin and Quibdó. METHODS: We performed an observational cross sectional study in 100 individuals with malaria and 100 healthy controls. Patients infected with Plasmodium consulting the Institute Colombiano of Medicina Tropical of Medellin and the Hospital Ismael Roldán Valencia of Quibdó were included. Genotoxic effects (genetic damage) was analysed by electrophoresis using alkaline single cell gel (Commet assay). RESULTS: The average of tail length of malaria samples (26.9±9.8) was significantly higher than of controls (14.8±3.2) (p<0.01). CONCLUSION: In our study population, malaria infection was associated with increased genotoxicity, while other variables such as smoking, antimalarial treatment, and occupation were not.

On manipulation by emotional AI: UK adults' views and governance implications.

With growing commercial, regulatory and scholarly interest in use of Artificial Intelligence (AI) to profile and interact with human emotion ("emotional AI"), attention is turning to its capacity for manipulating people, relating to factors impacting on a person's decisions and behavior. Given prior social disquiet about AI and profiling technologies, surprisingly little is known on people's views on the benefits and harms of emotional AI technologies, especially their capacity for manipulation. This matters because regulators of AI (such as in the European Union and the UK) wish to stimulate AI innovation, minimize harms and build public trust in these systems, but to do so they should understand the public's expectations. Addressing this, we ascertain UK adults' perspectives on the potential of emotional AI technologies for manipulating people through a two-stage study. Stage One (the qualitative phase) uses design fiction principles to generate adequate understanding and informed discussion in 10 focus groups with diverse participants (n = 46) on how emotional AI technologies may be used in a range of mundane, everyday settings. The focus groups primarily flagged concerns about manipulation in two settings: emotion profiling in social media (involving deepfakes, false information and conspiracy theories), and emotion profiling in child oriented "emotoys" (where the toy responds to the child's facial and verbal expressions). In both these settings, participants express concerns that emotion profiling covertly exploits users' cognitive or affective weaknesses and vulnerabilities; additionally, in the social media setting, participants express concerns that emotion profiling damages people's capacity for rational thought and action. To explore these insights at a larger scale, Stage Two (the quantitative phase), conducts a UK-wide, demographically representative national survey (n = 2,068) on attitudes toward emotional AI. Taking care to avoid leading and dystopian framings of emotional AI, we find that large majorities express concern about the potential for being manipulated through social media and emotoys. In addition to signaling need for civic protections and practical means of ensuring trust in emerging technologies, the research also leads us to provide a policy-friendly subdivision of what is meant by manipulation through emotional AI and related technologies.

Purpura Fulminans as a Rare Manifestation of Invasive Haemophilus influenzae Disease: A Case Report.

Haemophilus influenzae (Hi) is a bacterium usually found in the upper respiratory tract of humans. Though it is recognized as a naturally occurring element in the human bacterial reservoir, Hi infections have the potential to be severe and even fatal, particularly when they result in conditions such as meningitis or epiglottitis. Because of this, Hi invasive infections are considered a reportable disease in Portugal. We report a case of a 58-year-old female, chronically adrenally suppressed on long-term steroids, who developed an invasive Hi type b infection that led to purpura fulminans and multiorgan failure after an acute episode of epiglottitis. According to our review of the literature, only three previous cases of invasive Hi type b disease-causing purpura fulminans have been described.

Fosfomycin-Induced Liver Injury: A Case Report.

Fosfomycin is an antibiotic frequently used to treat uncomplicated urinary tract infections. It is normally well-tolerated, but there are some reports of clinically relevant liver injury. We present the case of a 73-year-old female who presented with paucisymptomatic hepatocellular acute liver injury six days after taking fosfomycin. After ruling out viral, ischemic, and autoimmune hepatitis, as well as Wilson disease and biliary disorders, she was diagnosed with drug-induced liver injury (DILI) related to fosfomycin. The patient showed major improvement during the first week and the resolution of liver injury one month after onset. This case report aims to underscore the potential hepatotoxicity of fosfomycin.

Pulmonary and Urologic Sarcoidosis as a Cause of Intermittent Fever of Unknown Origin.

Diagnosing fever of unknown origin (FUO) presents a substantial challenge due to its potential association with various diseases affecting different organs. In 1961, Petersdorf and Beeson initially defined FUO as a condition characterized by a temperature exceeding 38.3 °C on at least three occasions over a minimum three-week period. Despite a week of inpatient investigation, a definitive diagnosis remains unclear.  Sarcoidosis, a granulomatous disease impacting multiple systems, is among the causes of FUO. While the lungs are commonly affected, any organ can be involved, leading to diverse manifestations and clinical courses. Diagnosis relies on clinicopathologic findings and the exclusion of alternative causes of granulomatous disease. The hallmark of sarcoidosis is the development of granulomas in affected organs. Here, we present the case of a 61-year-old man with a history of recurrent spontaneous periurethral abscesses who underwent multiple urological interventions. He developed FUO during hospitalization following treatment for the infectious condition.

Sexual performance and semen quality of pubertal lambs treated with different weaning methods.

The objective of this study was to determine the effect of the weaning method on lamb stress, body weight, sexual behavior, and semen quality of Saint Croix male lambs. The present study was carried out during the late spring and summer of 2018 in the northeast of Mexico. Sixty male lambs born as twins or triplets (3.2  ±  0.6 kg birth weight) and weaned at 60 d of age (19.21  ±  1.8 kg weaning weight) were divided into two weaning methods: complete separation from the dams (CS; the lambs were moved to a pen that was at 500 m of distance from the dams) and separation with contact from the dams (SCD); the lambs were physically separated by a steel mesh that prevented the lambs from having the possibility of sucking milk from their mothers, but they maintained permanent visual and auditory contact. Cortisol levels were determined 3 d before and 7 d after weaning. Lambs were evaluated as 3-month-old lambs for sexual behavior and semen quality for 9 weeks. The effects of the weaning method (M), week (W), and the interaction M  × â€¯W were significant on body weight and cortisol levels ( P < 0.001 ). The SCD lambs had higher cortisol levels at 3, 5, and 7 d after weaning than CS lambs ( P < 0.001 ). The CS lambs had higher body weight during the first 4 weeks after weaning than SCD lambs ( P < 0.001 ). The weaning method had no effect on scrotal circumference, sexual behavior, and semen quality traits, except for progressive sperm motility, being better for the lambs that were completely separated ( P < 0.05 ). The results from this study show that complete separation of lambs and ewes at weaning is an effective method to reduce lamb stress and improve lamb growth after weaning, but it did not have long-term effects on sexual behavior and semen quality of Saint Croix male lambs.

Clear Cell Carcinoma of the Thymus: An Improbable Enemy.

INTRODUCTION: Thymic clear cell carcinoma is the most uncommon subtype of thymic carcinoma, with 20 cases reported worldwide. CASE DESCRIPTION: We present the case of a 61-year-old female with dyspnoea and chest pain for 2 days. Computed tomography (CT) angiography showed pulmonary thromboembolism and the existence of mediastinal and bilateral hilar lymphadenopathy, the largest infracarinal with an inferior axis of 25 mm, and also, micronodules on the left pulmonary parenchyma. The patient was admitted for aetiological assessment and underwent anticoagulant therapy. After a month, she had an ischaemic stroke, the sequelae of which proved to be fatal. The autopsy showed a mass in the superior-anterior mediastinum, with dimensions of 11×8×6 cm, corresponding to a thymus signet ring cell primary carcinoma. The immunohistochemistry study revealed that this mass was positive for AE1/AE3, CK5/6 and CK7. CONCLUSION: The clinical, morphological and immunophenotypic diversity of this tumour makes its diagnosis a difficult multidisciplinary challenge, which requires a high level of clinical knowledge and accurate imaging and histological investigation. LEARNING POINTS: Thymic clear cell carcinoma is a very rare entity with an aggressive and nonspecific clinical behaviour.There are no defined diagnostic criteria, although diagnosis could be established with histologic/cytology analysis.There are no clear guidelines for treatment, which can include highly invasive surgery and chemotherapy or radiation therapy.

Should the Energy Contribution of Commercial Thickeners Be Considered in the Nutrition Plan of Patients With Dysphagia?

BACKGROUND: Clinical management options for dysphagia include the use of thickeners to increase the consistency of liquids. Health professionals may not be aware of the nutrition value of these products, since there are no such recommendation in clinical guidelines. Our aim was to estimate the added nutrition value of the 2 types of commercial thickeners (starch and xanthan gum) to daily nutrition intake and compare their nutrition value for nectar, honey, and pudding consistencies. Additionally, we compared the nutrition value of both thickeners with a high-energy powder, since they share the same main ingredients. METHODS: We collected recommended dosages for obtaining the 3 different consistencies and nutrition content from the technical food labels. Daily intake of fluids was estimated from the Portuguese National Food, Nutrition and Physical Activity Survey. Total daily amount of thickener needed was estimated, as well as their correspondent nutrition contributions. RESULTS: Estimated daily fluid intake was 2439 mL. Starch thickeners provide significantly more energy at all consistencies than xanthan gum provides (423-846 kcal, P < 0.05, and 103-308 kcal, P < 0.05, respectively). Significantly more fiber is provided by xanthan gum thickeners (9 g in nectar and 27 g in pudding consistencies, P < 0.05). Median energy and carbohydrate values per 100 g of high-energy powder modules and starch thickeners are similar. CONCLUSION: The nutrition value of thickeners should be routinely considered in the nutrition assessment and planning of patients with dysphagia for liquids, since they contribute significantly with energy, carbohydrate, and fiber.

Effectiveness of Acupuncture on Pain, Physical Function and Health-Related Quality of Life in Patients with Rheumatoid Arthritis: A Systematic Review of Quantitative Evidence.

OBJECTIVE: To identify and synthesize the most recent available evidence of effectiveness of acupuncture on pain, physical function and health-related quality of life (HRQoL) in patients with rheumatoid arthritis (RA). METHODS: A comprehensive search of 12 Western and Chinese databases was undertaken from their inception up to end of 2016. Randomized controlled trials (RCTs), concerning patients with RA treated with needle acupuncture, written in English, Portuguese, German or Chinese were included. Primary outcomes included pain, physical function and HRQoL. Secondary outcomes included morning stiffness, functional impairment, number of tender and swollen joints and serum concentrations of inflamatory markers. Methodological quality was assessed by three independent reviewers using the standardized critical appraisal instrument from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. RESULTS: Twenty-two studies met the inclusion criteria. Of those, 9 studies were excluded after assessment of their methodological quality. The remaining 13 original RCTs included 974 patients. Ten of these studies published in China, showed favorable statistical significant effects of acupuncture in relieving symptoms of RA compared with controls. CONCLUSIONS: Evidence suggests that acupuncture interventions may have a positive effect in pain relief, physical function and HRQoL in RA patients. However, due to the heterogeneity and methodologic limitations of the studies included in this systematic review, evidence is not strong enough to produce a best practice guideline.

The Extreme Climate Event Database (EXCEED): Development of a picture database composed of drought and flood stimuli.

The present study introduces the Extreme Climate Event Database (EXCEED), a picture database intended to induce emotionally salient stimuli reactions in the context of natural hazards associated with global climate change and related extreme events. The creation of the database was motivated by the need to better understand the impact that the increase in natural disasters worldwide has on human emotional reactions. This new database consists of 150 pictures divided into three categories: two negative categories that depict images of floods and droughts, and a neutral category composed of inanimate objects. Affective ratings were obtained using online survey software from 50 healthy Brazilian volunteers who rated the pictures according to valence and arousal, which are two fundamental dimensions used to describe emotional experiences. Valence refers to the appraisal of pleasantness conveyed by a stimulus, and arousal involves internal emotional activation induced by a stimulus. Data from picture rating, sex difference in affective ratings and psychometric properties of the database are presented here. Together, the data validate the use of EXCEED in research related to natural hazards and human reactions.

Improving postpartum care delivery and uptake by implementing context-specific interventions in four countries in Africa: a realist evaluation of the Missed Opportunities in Maternal and Infant Health (MOMI) project.

Postpartum care (PPC) has remained relatively neglected in many interventions designed to improve maternal and neonatal health in sub-Saharan Africa. The Missed Opportunities in Maternal and Infant Health project developed and implemented a context-specific package of health system strengthening and demand generation in four African countries, aiming to improve access and quality of PPC. A realist evaluation was conducted to enable nuanced understanding of the influence of different contextual factors on both the implementation and impacts of the interventions. Mixed methods were used to collect data and test hypothesised context-mechanism-outcome configurations: 16 case studies (including interviews, observations, monitoring data on key healthcare processes and outcomes), monitoring data for all study health facilities and communities, document analysis and participatory evaluation workshops. After evaluation in individual countries, a cross-country analysis was conducted that led to the development of four middle-range theories. Community health workers (CHWs) were key assets in shifting demand for PPC by 'bridging' communities and facilities. Because they were chosen from the community they served, they gained trust from the community and an intrinsic sense of responsibility. Furthermore, if a critical mass of women seek postpartum healthcare as a result of the CHWs bridging function, a 'buzz' for change is created, leading eventually to the acceptability and perceived value of attending for PPC that outweighs the costs of attending the health facility. On the supply side, rigid vertical hierarchies and defined roles for health facility workers (HFWs) impede integration of maternal and infant health services. Additionally, HFWs fear being judged negatively which overrides the self-efficacy that could potentially be gained from PPC training. Instead the main driver of HFWs' motivation to provide comprehensive PPC is dependent on accountability systems for delivering PPC created by other programmes. The realist evaluation offers insights into some of the contextual factors that can be pivotal in enabling the community-level and service-level interventions to be effective.

The effectiveness of acupuncture on pain, physical function and health-related quality of life in patients with rheumatoid arthritis: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify and synthesize the best available evidence on the effectiveness of acupuncture on pain, physical function and health-related quality of life in patients with rheumatoid arthritis.More specifically, the review questions are:• Is acupuncture effective in improving health-related quality of life in patients with RA?• Is acupuncture effective in relieving pain in patients with RA?• Is acupuncture effective in improving physical function in patients with RA?

Psychometric properties of a Brazilian Portuguese version of the Children's Revised Impact of Event Scale (CRIES-8)

Abstract Background: Children and adolescents are considered a population at risk for developing posttraumatic stress disorder (PTSD) after a traumatic event. The Children's Revised Impact Scale (CRIES-8) is a self-report scale with 8 items that investigates avoidance and intrusion behaviors related to posttraumatic stress symptoms. Objective: The study consisted of translation and transcultural adaptation of CRIES-8 to Brazilian Portuguese and evaluation of its psychometric properties. Methods: A sample of 235 Brazilian children and adolescents exposed to natural hazards (drought or flood) and non-exposed children participated in the study. The methodological procedure for translation and cultural adaptation were in accordance with the principles described by ISPOR Task Force for Translation and Cultural Adaptation. We also evaluated test reliability and validity based on test content, the relations to other variables, and internal structure. Results: The procedures lead to a final Portuguese version proofread and cultural-adapted. Empirical evidence supports CRIES-8's division in two latent constructs (Intrusion and Avoidance), as well convergence correlations with other measures of child mental health and high reliability. Discussion: A Brazilian-Portuguese version of CRIES-8 is an important tool for a better screening of PTSD among youth who face traumatic events, being a potential informative instrument to identify children at risk.

Assessment of left ventricular diastolic function with cardiovascular MRI: what radiologists should know.

Diastolic dysfunction is a common entity and the predominant cause of heart failure in 40%-50% of patients. Diagnosis of diastolic dysfunction is clinically relevant and associated with a poor prognosis. The aim of this essay was to review the pathophysiology and different grades of diastolic dysfunction and to provide an overview on the role of cardiovascular magnetic resonance imaging in the assessment of diastolic function.

Evaluación del efecto genotóxico en pacientes con malaria de una región de Colombia / Evaluation of the genotoxic effect of malaria in a cohort of patients in Medellín and Quibdó

Introduction: During malaria infection, both parasite and host are under the effects of oxidative stress due to the increased production of reactive oxygen species, which can induce DNA damage by its genotoxic effects. Objective: To evaluate genotoxic effects in human lymphocytes in a cohort of patients with malaria from Medellin and Quibdó. Methods: We performed an observational cross sectional study in 100 individuals with malaria and 100 healthy controls. Patients infected with Plasmodium consulting the Institute Colombiano of Medicina Tropical of Medellin and the Hospital Ismael Roldán Valencia of Quibdó were included. Genotoxic effects (genetic damage) was analysed by electrophoresis using alkaline single cell gel (Commet assay). Results: The average of tail length of malaria samples (26.9 ± 9.8) was significantly higher than of controls (14.8 ± 3.2) (p < 0.01). Conclusion: In our study population, malaria infection was associated with increased genotoxicity, while other variables such as smoking, antimalarial treatment, and occupation were not.

Introducción: Durante la infección de la malaria, tanto el parásito como el hospedero están bajo los efectos de estrés oxidativo, dado que se aumenta la producción de especies reactivas del oxígeno, las cuales pueden inducir daños en el ADN debido a su gran efecto genotóxico. Objetivo: Evaluar el efecto genotóxico en linfocitos humanos en una cohorte de pacientes con malaria de Medellín y Quibdó. Métodos: Se realizó un estudio observacional transversal en 100 personas con malaria y 100 controles sanos. Se incluyeron pacientes infectados con Plasmodium, que consultaron en el Instituto Colombiano de Medicina Tropical de Medellín y el Hospital Ismael Roldán Valencia de Quibdó. Se realizó una valoración transversal del efecto (daño genético) mediante electro-foresis en gel de células individuales (ensayo Cometa). Resultados: El promedio de longitud de la cola de los pacientes (26,9 ± 9,8) fue significativamente mayor que la media de los controles sanos (14,8 ± 3,2) (p < 0,01). Conclusión: Se evidenció en la población de estudio que la infección por malaria generó genotoxicidad, no así variables como tabaquismo, tratamiento antimalárico y ocupación.