Spatiotemporal and meteorological relationships in dengue transmission in the Dominican Republic, 2015-2019.

Dengue has broadened its global distribution substantially in the past two decades, and many endemic areas are experiencing increases in incidence. The Dominican Republic recently experienced its two largest outbreaks to date with 16,836 reported cases in 2015 and 20,123 reported cases in 2019. With continued increases in dengue transmission, developing tools to better prepare healthcare systems and mosquito control agencies is of critical importance. Before such tools can be developed, however, we must first better understand potential drivers of dengue transmission. To that end, we focus in this paper on determining relationships between climate variables and dengue transmission with an emphasis on eight provinces and the capital city of the Dominican Republic in the period 2015-2019. We present summary statistics for dengue cases, temperature, precipitation, and relative humidity in this period, and we conduct an analysis of correlated lags between climate variables and dengue cases as well as correlated lags among dengue cases in each of the nine locations. We find that the southwestern province of Barahona had the largest dengue incidence in both 2015 and 2019. Among all climate variables considered, lags between relative humidity variables and dengue cases were the most frequently correlated. We found that most locations had significant correlations with cases in other locations at lags of zero weeks. These results can be used to improve predictive models of dengue transmission in the country.

Epidemic Diffusion Network of Spain: A Mobility Model to Characterize the Transmission Routes of Disease.

Human mobility drives the geographical diffusion of infectious diseases at different scales, but few studies focus on mobility itself. Using publicly available data from Spain, we define a Mobility Matrix that captures constant flows between provinces by using a distance-like measure of effective distance to build a network model with the 52 provinces and 135 relevant edges. Madrid, Valladolid and Araba/Álaba are the most relevant nodes in terms of degree and strength. The shortest routes (most likely path between two points) between all provinces are calculated. A total of 7 mobility communities were found with a modularity of 63%, and a relationship was established with a cumulative incidence of COVID-19 in 14 days (CI14) during the study period. In conclusion, mobility patterns in Spain are governed by a small number of high-flow connections that remain constant in time and seem unaffected by seasonality or restrictions. Most of the travels happen within communities that do not completely represent political borders, and a wave-like spreading pattern with occasional long-distance jumps (small-world properties) can be identified. This information can be incorporated into preparedness and response plans targeting locations that are at risk of contagion preventively, underscoring the importance of coordination between administrations when addressing health emergencies.

Understanding the use of evidence in the WHO Classification of Tumours: a protocol for an evidence gap map of the classification of tumours of the lung.

INTRODUCTION: There are gaps in the evidence base of tumour classification despite being essential for cancer diagnosis, treatment and patient care. The WHO in charge of the production of an updated international classification, the WHO Classification of Tumours (WCT), aims to adapt evidence gap map (EGM) methodology to inform future editions of the WCT, by providing a visual summary of the existing evidence. METHODS AND ANALYSIS: Bibliographical references used in the WCT fifth edition of Tumours of the Lung (Thoracic Tumours volume) will be used as search results of a literature search. A descriptive analysis of the cited evidence for tumour types and descriptors will be drafted and plotted in EPPI-Reviewer to develop a visual evidence map. The resulting EGM will reflect the number of cited studies in the size of the spheres, and the level of evidence by applying a four-colour code (red=low level evidence, orange=moderate level, green=high level and blue=unclassifiable). Overview of the findings will be provided in narrative form and a report will discuss the overall stage of cited research in the WCT and will include analysis of gaps, under-researched categories of tumour descriptors and pockets of low-level evidence. ETHICS AND DISSEMINATION: No ethics approval will be required as this is a study of previously published material. Findings of the EGM will be published and used to guide editors, stakeholders and researchers for future research planning and related decision-making, especially for the development of future editions of the WCT. PROSPERO REGISTRATION NUMBER: CRD42022302327.

Secondary Attack Rate, Transmission and Incubation Periods, and Serial Interval of SARS-CoV-2 Omicron Variant, Spain.

Contact tracing data of SARS-CoV-2 Omicron variant cases during December 2021 in Cantabria, Spain, showed increased transmission (secondary attack rate 39%) compared with Delta cases (secondary attack rate 26%), uninfluenced by vaccination status. Incubation and serial interval periods were also reduced. Half of Omicron transmissions happened before symptom onset in the index case-patient.

Tamizaje en las personas mayores con dependencia de cuidados: clave en la estrategia para mitigar la pandemia por COVID-19 / Screening for care-dependent older people: a key element in the strategy to mitigate COVID-19 pandemic

RESUMEN En la pandemia por la COVID-19, las personas mayores son el grupo que concentra la mayor mortalidad, sobre todo quienes precisan de cuidados de largo plazo por haber perdido su habilidad funcional. Esta población vive en sus domicilios, con la familia o en un centro residencial. Se ha descrito que las personas mayores pueden desarrollar una forma de enfermedad oligosintomática o con una sintomatología clínica particular; por esta razón, las estrategias de tamizaje basadas en síntomas no son las más recomendables. Es necesario detectar de manera precoz a los enfermos en este grupo; por ello, analizamos y proponemos las mejores alternativas disponibles para conseguir este objetivo.

ABSTRACT During the COVID-19 pandemic, older people have been the group with the highest mortality rate, especially those who require long-term care for having lost their functional ability. These people are living at home with their family or in a nursing home. It has been described that older people may develop an oligosymptomatic SARS-CoV-2 infection or particular symptoms of the disease. Therefore, symptom-based screening is not the most recommended strategy in this scenario. Since it is necessary to detect early cases in the elderly population, this research work analyzes and proposes the best available alternatives for attaining such goal.

Outcomes of reoperations after Ross procedure.

BACKGROUND: Potential for difficult reoperations has been a concern for patients undergoing a Ross procedure. Data regarding the outcomes of such reoperations is extremely limited. We examined our experience to define the current scope and risk of these operations. METHODS: Between 1996 and 2020, 83 patients who had a previous Ross procedure underwent 89 reoperative surgeries. There were 72 males and average age was 48 with a range of 18-76. Twenty-four patients had more than one prior reoperation, with five patients having more than one reoperation post Ross. Patients were stratified by primary reason for reoperation including autograft dysfunction, homograft dysfunction, or other cardiac surgical problems. Demographic, operative, and outcomes data were collected from clinical records and placed in a secure data base for analysis. RESULTS: A total of 176 procedures were done in the 89 operations. Autograft dysfunction affected 68 patients. Homograft dysfunction affected 27 patients. Both of these were seen in 17 patients. Other cardiac problems required 79 other procedures. There were two (2.2%) operative deaths, with perioperative morbidity affecting six patients (6.7%). Survival following reoperation after Ross was 82.3% and 77.5% (±2), at ten and fifteen years respectively. CONCLUSIONS: Reoperations after a Ross procedure can be challenging but can be done with a high degree of safety and long-term benefit in experienced hands.

Real time surveillance of COVID-19 space and time clusters during the summer 2020 in Spain.

BACKGROUND: On June 21st de-escalation measures and state-of-alarm ended in Spain after the COVID-19 first wave. New surveillance and control strategy was set up to detect emerging outbreaks. AIM: To detect and describe the evolution of COVID-19 clusters and cases during the 2020 summer in Spain. METHODS: A near-real time surveillance system to detect active clusters of COVID-19 was developed based on Kulldorf's prospective space-time scan statistic (STSS) to detect daily emerging active clusters. RESULTS: Analyses were performed daily during the summer 2020 (June 21st - August 31st) in Spain, showing an increase of active clusters and municipalities affected. Spread happened in the study period from a few, low-cases, regional-located clusters in June to a nationwide distribution of bigger clusters encompassing a higher average number of municipalities and total cases by end-August. CONCLUSION: STSS-based surveillance of COVID-19 can be of utility in a low-incidence scenario to help tackle emerging outbreaks that could potentially drive a widespread transmission. If that happens, spatial trends and disease distribution can be followed with this method. Finally, cluster aggregation in space and time, as observed in our results, could suggest the occurrence of community transmission.

Operative risks of the Ross procedure.

BACKGROUND: The risk of the Ross procedure continues to be debated. We sought to determine the immediate outcomes of the Ross procedure in a large consecutive cohort that included patients undergoing reoperative cardiac surgery and/or concomitant cardiac procedures. METHODS: Between March 1987 and September 2019, 702 patients underwent a full root Ross procedure. There were 530 male patients and 172 female patients, with a mean age of 41.6 years. One hundred and one patients had at least one previous sternotomy; 323 patients had concomitant procedures. Patients were stratified into 2 groups: simple and complex. Simple Ross patients were those who had no previous sternotomy and had only minor concomitant procedures performed at the time of their Ross, such as aortoplasty or closure of patent foramen ovale. The complex Ross group included patients with at least one previous sternotomy and/or additional procedures that we deemed complex, such as ascending aortic replacement and mitral valve repair. Complexity and group outcomes were evaluated in consecutive terciles of time. RESULTS: There were 7 (1%) operative deaths. Morbidity affected 46 other patients (6.6%). The simple Ross group comprised 419 patients (59.7%), with mortality in 3 (0.7%) and morbidity in 20 (4.8%). The complex Ross comprised 283 patients (40.3%), with mortality in 4 (1.4%) and morbidity in 26 (9.2%). Simple Ross cases decreased in volume over time, with complex cases increasing from 34% to 48%. CONCLUSIONS: Excellent results can be achieved with the Ross procedure despite broader indications that include patients with previous sternotomy and with the need for concomitant procedures.

Attempt at off-label balloon valvuloplasty post-dilation for intuity sutureless valve.

Alternatives to traditional aortic valve replacement now form part of the valve surgeon's armamentarium. Sutureless valves offer decreased bypass and crossclamp times, excellent maneuverability, and promising outcomes. We present a case of a sutureless aortic valve replacement for a late failed David procedure, complicated by postoperative development of severe paravalvular regurgitation. We attempted off-label balloon post-dilation to improve expansion of the valve, however paravalvular regurgitation persisted. The patient underwent subsequent aortic valve replacement using a mechanical valve and experienced no further paravalvular leak.

Congenital left ventricular diverticulum repair in an adult with dual patch technique.

Rupture of a congenital left ventricular diverticulum (CLVD), a rare anatomical anomaly, is a catastrophic event, with potential fatal consequences. Repair techniques documented in the literature include primary closure and single patch closure. We describe a case of a 57-year-old woman with symptomatic anterolateral CLVD. Our approach involves a linear incision through the epicardial surface of the diverticulum with exclusion of the cavity, and restoration of normal ventricular geometry via a two-patch technique.

Intermittent upper and lower body perfusion during circulatory arrest is safe for aortic repair.

INTRODUCTION: We report our initial surgical experience of intermittent upper and lower body retrograde perfusion during aortic repair under circulatory arrest. METHODS: Between 2007 and 2015, 148 consecutive patients underwent surgical aortic repair using moderate hypothermic circulatory arrest with intermittent upper and lower body retrograde perfusion. RESULTS: All patients underwent ascending aorta replacement; eight had hemiarch replacement (5.4%) and 92 had aortic root surgery (62.2%). Twenty-nine patients (19.6%) had re-operations and 60 patients (40.5%) had concomitant procedures. The mean duration of circulatory arrest was 23.2 ± 5.4 minutes (range 13-48 minutes). Hospital length of stay was 11.3 ± 16.9 days (median 7.0 days; interquartile range [IQR] 6 days). Complications included death in 0.7%, stroke in 3.4%, respiratory failure in 12.8%, renal replacement therapy in 2.0% and re-exploration for bleeding in 0.7%. Peak renal and hepatic biomarkers were: creatinine 1.2 ± 0.3 mg/dL, aspartate aminotransferase (AST) 291 ± 1112 U/L (IQR 91.8 U/L), alanine aminotransferase (ALT) 212 ± 924 U/L (IQR 43.0 U/L) and total bilirubin 1.2 ± 0.9 mg/dL. Peak lactate was 5.0 ± 3.3 mmol/L (IQR 3.3 mmol/L) and the mean time to normalization (<2 mmol/L) was 14.3 ± 14.0 hours. CONCLUSIONS: Intermittent upper and lower body retrograde perfusion during circulatory arrest is safe for aortic repair, resulting in low morbidity and mortality. There were only modest rises in hepatic and renal injury biomarkers as well as the rapid clearance of lactate. These findings support the continued study of this technique to reduce end-organ dysfunction during circulatory arrest, including expansion to patients with longer circulatory arrest duration and a direct comparison with conventional circulatory arrest without retrograde upper and lower body perfusion.

Non-randomized controlled trial of the long-term efficacy of an Ecohealth intervention against Chagas disease in Yucatan, Mexico.

Non-domiciliated intrusive triatomine vectors are responsible for a low but significant transmission of Trypanosoma cruzi to humans. Their control is a challenge as insecticide spraying is of limited usefulness, and alternative strategies need to be developed for a sustainable control. We performed a non-randomized controlled trial of an Ecohealth intervention based on window insect screens and community participation to reduce house infestation by Triatoma dimidiata in two rural villages in Yucatan, Mexico. Efficacy of the intervention was measured over a three years follow-up period and entomological indicators showed that the proportion of triatomines found inside houses was significantly reduced in houses with insect screens, which effectively kept more bugs on the outside of houses. Using a previously developed model linking entomological data to the prevalence of infection in human, we predicted that the intervention would lead to a 32% reduction in yearly incidence and in the prevalence of T. cruzi infection. The cost for the coverage of all the windows of a house was of comparable magnitude to what families currently spend on various domestic insecticide, and most screens were still in good conditions after three years. In conclusion, the Ecohealth approach proposed here is effective for the long-term and sustainable control of intrusive T. dimidiata vectors in the Yucatan peninsula, Mexico. This strategy may also be easily adapted to other intrusive triatomine species as well as other regions/countries with comparable eco-epidemiological settings, and would be an excellent component of a larger integrated program for the control of a variety of other vector-borne diseases, bringing additional benefits to the communities. Our results should encourage a further scaling-up of our implementation strategy in additional villages in the region.

An innovative ecohealth intervention for Chagas disease vector control in Yucatan, Mexico.

BACKGROUND: Non-domiciliated (intrusive) triatomine vectors remain a challenge for the sustainability of Chagas disease vector control as these triatomines are able to transiently (re-)infest houses. One of the best-characterized examples is Triatoma dimidiata from the Yucatan peninsula, Mexico, where adult insects seasonally infest houses between March and July. METHODS: We focused our study on three rural villages in the state of Yucatan, Mexico, in which we performed a situation analysis as a first step before the implementation of an ecohealth (ecosystem approach to health) vector control intervention. RESULTS: The identification of the key determinants affecting the transient invasion of human dwellings by T. dimidiata was performed by exploring associations between bug presence and qualitative and quantitative variables describing the ecological, biological and social context of the communities. We then used a participatory action research approach for implementation and evaluation of a control strategy based on window insect screens to reduce house infestation by T. dimidiata. CONCLUSIONS: This ecohealth approach may represent a valuable alternative to vertically-organized insecticide spraying. Further evaluation may confirm that it is sustainable and provides effective control (in the sense of limiting infestation of human dwellings and vector/human contacts) of intrusive triatomines in the region.

Analysis of children's perception of triatomine vectors of chagas disease through drawings: opportunities for targeted health education.

BACKGROUND: Chagas disease is a tropical parasitic disease affecting about 10 million people, mostly in the Americas, and transmitted mainly by triatomine bugs. Insect vector control with indoor residual insecticides and the promotion of housing improvement is the main control intervention. The success of such interventions relies on their acceptance and appropriation by communities, which depends on their knowledge and perceptions of both the disease and the vector. In this study, we investigated school-aged children's knowledge and perception on triatomine vectors and Chagas disease to further understand how communities view this vector and the disease in Yucatan, Mexico. METHODOLOGY/PRINCIPAL FINDINGS: We performed an analysis of children's drawings on the theme of triatomines and their house in several rural villages, to explore in an open-ended manner their views, understanding and misconceptions. A total of 261 drawings were collected from children ages 6-12 from four villages. We found that children are very familiar with triatomine vectors, and know very well many aspects of their biology and ecology, and in particular their blood-feeding habits. On the other hand, their drawings suggest that the role of triatomines as vectors of a chronic and severe cardiac disease is less understood, and the main perceived health threat appears limited to the bite itself, as previously observed in adults. CONCLUSIONS/SIGNIFICANCE: These results have important implications for the specific design of future education materials and campaigns, and for the promotion of the inclusion of children in raising Chagas disease awareness in these endemic communities.

Efectividad y estabilidad del blanqueamiento dental, una revisión sistemática / Effectiveness and stability of tooth whitening, a systematic review

Introducción. El blanqueamiento dental es de los procedimientos más solicitados a los odontólogos. Desde los años 90 han aumentado las técnicas y presentaciones de los productos usados para este procedimiento. Por el aumento en la demanda del blanqueamiento dental, se puede encontrar gran número de estudios en la literatura, por lo cual es difícil sacar conclusiones válidas sobre la efectividad a largo plazo de las técnicas disponibles. Objetivo. El objetivo de esta revisión sistemática es determinar si el blanqueamiento dental es efectivo a largo plazo, cuál sistema de blanqueamiento es el más efectivo, cuánto perdura en el tiempo y cuáles son las variables que intervienen en el éxito. Materiales y métodos. Los artículos utilizados en esta revisión son ensayos clínicos aleatorizados, buscados electrónica y manualmente entre 1980 y el 2013, en diferentes bases de datos. Resultados. De 4.581 artículos encontrados, se seleccionaron 8 artículos para incluir en la revisión, ya que cumplían con los criterios establecidos. Después de seleccionar los artículos definitivos para la revisión, se hizo una evaluación metodológica de estos, por medio de la cual se encontró que el nivel de evidencia fue alto en tres artículos, medio en cuatro y bajo en uno. Conclusión. Teniendo en cuenta la buena ‘evidencia’ que se encontró, se concluye que: la efectividad del blanqueamiento a largo plazo no depende de la técnica del blanqueamiento empleada. El cambio de color registrado durante el blanqueamiento dental fue similar en todos los grupos evaluados. El blanqueamiento en casa, es un tratamiento efectivo. A pesar de que se mantienen los cambios de color logrados con el blanqueamiento, se presenta una recidiva de leve a moderada.

Introduction: Tooth whitening is one of the most requested treatments in dentistry; since the 90’s the techniques and product presentations used for this procedure have increased. Due to the rise in the demand for tooth whitening, a great number of studies can be found in the literature, for this reason it is hard to draw valid conclusions about long term effectiveness of the different techniques for tooth whitening available in the market. Aim: The objective of this systematic review was to determine the long term effectiveness of tooth whitening, which tooth whitening system is the most effective, how long it endures throughout time, and which variables are involved in its success. Methods: The studies used in this systematic review were randomized clinical trials searched electronically and manually in a period between 1980, and 2013, in different data bases. Results: out of 4.581 articles found, 8 were selected to be included, since they met the inclusion criteria. After choosing the articles to be included, a methodological assessment of them was done, 3 presented high evidence, 4, medium and 1 low. Conclusion: Taking into account the good evidence found it could be concluded that: long-term effectiveness of tooth whitening does not depend on the whitening technique used. The change in color registered during tooth whitening, was similar for all groups. At home tooth whitening is an effective treatment. Even though the changes in color obtained are maintained, a relapse in color from mild to moderate is observed.

Eficacia de las escalas de severidad del PSI y CURB-65 para predecir la mortalidad de la neumonía adquirida en la comunidad, Hospital Nacional Dos de Mayo. Año 2010 / Effectiveness of severity scales of the PSI and CURB-65 in predicting mortality for community-acquired pneumonia, National Hospital Dos de Mayo. Year 2010

Antecedentes: Los pacientes con Neumonía Adquirida en la Comunidad que requieren ingreso hospitalario es muy variable según las series (12 por ciento-66 por ciento), la mayor parte de los estudios retrospectivos realizados sugieren que los factores más importantes que afectan al pronóstico y la evolución de la enfermedad son la edad avanzada, la presencia de enfermedades subyacentes, así como un retraso en el diagnóstico y tratamiento por lo que debido a esto y a los altos costos que representa el manejo de estas infecciones es necesario el uso de criterios que predicen la mortalidad y que permiten identificar pacientes con neumonía de pobre pronóstico en un estadio temprano de la enfermedad. Objetivo: Determinar la eficacia de criterios de severidad del PSI y el CURB-65 en los pacientes con NAC para predecir la mortalidad, en los pacientes que ingresan por emergencia y hospitalizados. Materiales y Métodos: Es un estudio descriptivo, retrospectivo, que se realizó en el Hospital Nacional Dos de Mayo durante el periodo del 01 de enero del 2010 al 31 de diciembre del 2010. La muestra estuvo conformada por todos los pacientes con diagnóstico de NAC que ingresaron por el servicio de emergencia y fueron hospitalizados. Se utilizó la prueba estadística de Chi-cuadrado para determinar la asociación entre severidad del PSI y mortalidad; asimismo, entre severidad del CURB-65 y mortalidad. Para las pruebas de significación estadística se utilizó el nivel alfa=0,05; es decir, toda vez que el valor de P resultó menor que 0,05 se consideró el resultados como estadísticamente significativo. Resultados: Del total de pacientes con NAC, el 50 por ciento fue de sexo masculino, el 38,2 por ciento de estos tuvieron más de dos antecedentes patológicos, el 24 por ciento fueron del grupo de fallecidos, el 36,0 por ciento presentaron una clase IV como criterio de severidad del PSI, el 10.5 por ciento presentaron una puntuación de 4-5 como criterio de severidad del CURB-65. Se...

Effect of raloxifene in human neurocysticercosis.

The authors report a patient whose polycystic ovarian syndrome (PCOS) and increased calcitriol level were associated with neurocysticercosis (NCC), for which she refused standard therapy. Based upon a report on treatment with tamoxifen in murine cysticercosis,1 she was offered raloxifene. She began raloxifene 60 mg/day on 21 January 2010. On 17 March 2010 she was pregnant, and was terminated on 14 April 2010. MRI 26 April 2010 showed diminution in size, shrinkage and loss of viability in a number of the cysts. Total lesions fell from 37 to 33, 10 lesions shrunk, 5 resolved, 18 were unchanged, 4 enlarged and 1 new lesion developed. Concomitantly serum calcitriol fell from 81 to 41 pg/ml while 25-OH-vitamin D level fell from 34 to 30 ng/ml. Alteration of the hormonal milieu may reduce cestode burden in human NCC. The pregnancy on raloxifene, though unfortunate, supports the concept that NCC caused the PCOS. Serum calcitriol may be a useful biomarker for assessing disease activity in NCC.

Tipificación del virus del papiloma humano en mujeres con lesión escamosa intraepitelial de bajo grado / Human Papillomavirus DNA in women having low-grade squamous intraepithelial lesion

El embarazo ectópico bilateral espontáneo es una condición clínica infrecuente que ocurre en 1 de cada 1.580 embarazos ectópicos. En los últimos 25 años se han reportado 72 casos de embarazo ectópico bilateral, 31 de los cuales han sido espontáneos y en ninguno de ellos se ha logrObjetivo: determinar la prevalencia y los genotipos de los papillomavirus humanos (PVH) en mujeres con lesiones escamosas intraepiteliales de bajo grado (LEIBG). Métodos: noventa y seis mujeres de la clínica e colposcopia fueron incluidas. La presencia de los PVH en las biopsias fue determinada por ensayo de reacción en cadena de la polimerasa (RCP) con oligonucleótidos para el gen L1. Las muestras fueron coamplificadas con MY09/MY11/HMB01 e iniciadores para betaglobina GH20/PC04. Para tipificar se utilizó hibridación reversa en línea. Resultados: el ADN de PVH fue detectado en 28/96 (29,1 por ciento) pacientes, de las cuales 21/28 (75 por ciento) tuvieron infección con un sólo tipo y 7/28 (25 por ciento); infección múltiple. En 29/39 (74,3 por ciento) fueron de alto riesgo y 10/39 (25,7 por ciento) de bajo riesgo. Encontramos 13 diferentes tipos 9/13 (69,2 por ciento) de ellos de alto riesgo. PVH 58 fue el tipo más frecuente. Conclusiones: la prevalencia de VPH en mujeres con diagnóstico citológico de LEIBG fue menor que la esperada; este resultado sugiere una clasificación inadecuada de los diagnósticos.