Excess mortality during the COVID-19 pandemic: a geospatial and statistical analysis in Mogadishu, Somalia.

BACKGROUND: While the impact of the COVID-19 pandemic has been well documented in high-income countries, less is known about the health effects in Somalia, where health systems are weak and vital registration is underdeveloped. METHODS: We used remote sensing and geospatial analysis to quantify burial numbers from January 2017 to September 2020 in Mogadishu. We imputed missing grave counts using surface area data. Simple interpolation and a generalised additive mixed growth model were used to predict actual and counterfactual burial rates by cemetery and across Mogadishu during the most likely period of COVID-19 excess mortality and to compute excess burials. We undertook a qualitative survey of key informants to determine the drivers of COVID-19 excess mortality. RESULTS: Burial rates increased during the pandemic, averaging 1.5-fold and peaking at a 2.2-fold increase on pre-pandemic levels. When scaled to plausible range of baseline crude death rates, the excess death toll between January and September 2020 was 3200-11 800. Compared with Barakaat Cemetery Committee's burial records, our estimates were lower. CONCLUSIONS: Our study indicates considerable underestimation of the health effects of COVID-19 in Banadir and an overburdened public health system struggling to deal with the increasing severity of the epidemic in 2020.

El proyecto Pixel: una experiencia educativa de learning by doing centrada en el paciente / The Pixel Project: an educational experience of patient-centered learning by doing

La nueva manera de concebir la formación universitaria requiere de metodologías activas con el estudiante como co-creador del proceso de enseñanza-aprendizaje. Una de ellas es learning by doing (aprender-haciendo). En el ámbito sanitario, la educación de sus futuros profesionales requiere del desarrollo de habilidades claves para garantizar una adecuada relación con los pacientes. Con el objetivo de fomentar competencias profesionales esenciales en estudiantes de Enfermería y Medicina, tales como la escucha activa, el reconocimiento de la realidad de la persona, los valores en salud y la integración del paciente a la toma de decisiones, se desarrolla en las titulaciones de Enfermería y de Medicina desde el curso académico 2017-18 el proyecto Pixel, una experiencia de learning by doing centrada en el paciente. Se trabaja con estudiantes de primer y segundo curso de Enfermería, y de segundo curso de Medicina. El proyecto transcurre en cuatro fases: planificación, realización, evaluación, y transferencia y consolidación. Las actividades que abarca son: prácticas tuteladas en asociaciones de pacientes, talleres y seminarios para la elaboración de programas de salud adaptados a cada asociación de pacientes, investigación y divulgación científica sobre las patologías que afectan a sus usuarios y jornada de salud con las asociaciones participantes. Hasta la actualidad participaron de la experiencia 31 asociaciones de pacientes, 629 estudiantes y docentes de ambos grados. La enseñanza orientada a la acción, base de este proyecto, favorece el desarrollo de competencias interprofesionales y promueve la cultura de la dedicación a la sociedad en el alumnado, ofreciendo un modelo innovador y reproducible.(AU)

The new way of understanding university education requires active methodologies with the student as co-creator of the teaching-learning process. One of them is learning by doing. In the healthcare setting, the education of future professionals requires the development of key skills to guarantee an adequate relationship with patients. With the goal to encourage essential professional skills among Nursing and Medicine students, such as active listening, acknowledging the reality of the person, values in health, and the integration of patients into decision-making, the Pixel Project, which is a patient-centered learning by doing experience, has been implemented in the Nursing and Medicine grades since the 2017-18 academic term. This includes first-and second-year Nursing students, and second year Medicine students. The Project is conducted in four stages: planning, implementation, evaluation, and transfer & consolidation. The activities included are: supervised practice sessions in patient associations, workshops and seminars to prepare healthcare programs adapted to each patient association, scientific research and dissemination about the conditions suffered by their users, and a Health Day with the participating associations. So far, 31 associations have participated in this experience, as well as 629 students and professors from both grades. Active learning, which is the basis for this project, encourages the development of interprofessional skills, and promotes the culture of commitment to the society among students, by offering an innovative and reproducible model.(AU)

Tratamiento de la esquizofrenia en México: recomendaciones de un panel de expertos.

La esquizofrenia es una enfermedad compleja que actualmente no tiene cura. Existen, sin embargo, numerosas terapias que, solas o en combinación, son eficaces para tratar los síntomas de la enfermedad y mantenerla bajo control. La elección del tratamiento debe ser siempre individualizada, y basarse en la presentación clínica de la enfermedad, el estado general del paciente y la eficacia del fármaco, si bien hay que considerar también el costo y el acceso a servicios y al fármaco, que en México tiene algunas limitaciones. Un panel de 12 expertos mexicanos se reunió de forma virtual para revisar los últimos datos publicados y establecer unas recomendaciones de tratamiento en México, basadas en la evidencia, que garanticen una atención médica integral, homogénea, eficiente y con calidad.Schizophrenia is a complex illness that currently has no cure. There are, however, numerous therapies that, alone or in combination, are effective in treating the symptoms of the disease and keeping it under control. The choice of treatment must always be individualized, and based on the clinical presentation of the disease, the general condition of the patient and the efficacy of the drug, although the cost and access to services and to the drug must also be considered, as in Mexico it has some limitations. A panel of 12 Mexican experts met virtually to review the latest published data and establish evidence-based treatment recommendations in Mexico that guarantee comprehensive, homogeneous, efficient, and quality medical care.

Excess mortality during the COVID-19 pandemic: a geospatial and statistical analysis in Aden governorate, Yemen.

BACKGROUND: The burden of COVID-19 in low-income and conflict-affected countries remains unclear, largely reflecting low testing rates. In parts of Yemen, reports indicated a peak in hospital admissions and burials during May-June 2020. To estimate excess mortality during the epidemic period, we quantified activity across all identifiable cemeteries within Aden governorate (population approximately 1 million) by analysing very high-resolution satellite imagery and compared estimates to Civil Registry office records. METHODS: After identifying active cemeteries through remote and ground information, we applied geospatial analysis techniques to manually identify new grave plots and measure changes in burial surface area over a period from July 2016 to September 2020. After imputing missing grave counts using surface area data, we used alternative approaches, including simple interpolation and a generalised additive mixed growth model, to predict both actual and counterfactual (no epidemic) burial rates by cemetery and across the governorate during the most likely period of COVID-19 excess mortality (from 1 April 2020) and thereby compute excess burials. We also analysed death notifications to the Civil Registry office over the same period. RESULTS: We collected 78 observations from 11 cemeteries. In all but one, a peak in daily burial rates was evident from April to July 2020. Interpolation and mixed model methods estimated ≈1500 excess burials up to 6 July, and 2120 up to 19 September, corresponding to a peak weekly increase of 230% from the counterfactual. Satellite imagery estimates were generally lower than Civil Registry data, which indicated a peak 1823 deaths in May alone. However, both sources suggested the epidemic had waned by September 2020. DISCUSSION: To our knowledge, this is the first instance of satellite imagery being used for population mortality estimation. Findings suggest a substantial, under-ascertained impact of COVID-19 in this urban Yemeni governorate and are broadly in line with previous mathematical modelling predictions, though our method cannot distinguish direct from indirect virus deaths. Satellite imagery burial analysis appears a promising novel approach for monitoring epidemics and other crisis impacts, particularly where ground data are difficult to collect.

Tratamiento de la esquizofrenia en México: recomendaciones de un panel de expertos / Treatment of schizophrenia in Mexico: recommendations from an expert panel

Resumen La esquizofrenia es una enfermedad compleja que actualmente no tiene cura. Existen, sin embargo, numerosas terapias que, solas o en combinación, son eficaces para tratar los síntomas de la enfermedad y mantenerla bajo control. La elección del tratamiento debe ser siempre individualizada, y basarse en la presentación clínica de la enfermedad, el estado general del paciente y la eficacia del fármaco, si bien hay que considerar también el costo y el acceso a servicios y al fármaco, que en México tiene algunas limitaciones. Un panel de 12 expertos mexicanos se reunió de forma virtual para revisar los últimos datos publicados y establecer unas recomendaciones de tratamiento en México, basadas en la evidencia, que garanticen una atención médica integral, homogénea, eficiente y con calidad.

Abstract Schizophrenia is a complex illness that currently has no cure. There are, however, numerous therapies that, alone or in combination, are effective in treating the symptoms of the disease and keeping it under control. The choice of treatment must always be individualized, and based on the clinical presentation of the disease, the general condition of the patient and the efficacy of the drug, although the cost and access to services and to the drug must also be considered, as in Mexico it has some limitations. A panel of 12 Mexican experts met virtually to review the latest published data and establish evidence-based treatment recommendations in Mexico that guarantee comprehensive, homogeneous, efficient, and quality medical care.

Protein-conformational diseases in childhood: Naturally-occurring hIAPP amyloid-oligomers and early ß-cell damage in obesity and diabetes.

BACKGROUND AND AIMS: This is the first time that obesity and diabetes mellitus (DM) as protein conformational diseases (PCD) are reported in children and they are typically diagnosed too late, when ß-cell damage is evident. Here we wanted to investigate the level of naturally-ocurring or real (not synthetic) oligomeric aggregates of the human islet amyloid polypeptide (hIAPP) that we called RIAO in sera of pediatric patients with obesity and diabetes. We aimed to reduce the gap between basic biomedical research, clinical practice-health decision making and to explore whether RIAO work as a potential biomarker of early ß-cell damage. MATERIALS AND METHODS: We performed a multicentric collaborative, cross-sectional, analytical, ambispective and blinded study; the RIAO from pretreated samples (PTS) of sera of 146 pediatric patients with obesity or DM and 16 healthy children, were isolated, measured by sound indirect ELISA with novel anti-hIAPP cytotoxic oligomers polyclonal antibody (MEX1). We carried out morphological and functional studied and cluster-clinical data driven analysis. RESULTS: We demonstrated by western blot, Transmission Electron Microscopy and cell viability experiments that RIAO circulate in the blood and can be measured by ELISA; are elevated in serum of childhood obesity and diabetes; are neurotoxics and works as biomarkers of early ß-cell failure. We explored the range of evidence-based medicine clusters that included the RIAO level, which allowed us to classify and stratify the obesity patients with high cardiometabolic risk. CONCLUSIONS: RIAO level increases as the number of complications rises; RIAOs > 3.35 µg/ml is a predictor of changes in the current indicators of ß-cell damage. We proposed a novel physio-pathological pathway and shows that PCD affect not only elderly patients but also children. Here we reduced the gap between basic biomedical research, clinical practice and health decision making.

Circulating miRNome detection analysis reveals 537 miRNAS in plasma, 625 in extracellular vesicles and a discriminant plasma signature of 19 miRNAs in children with retinoblastoma from which 14 are also detected in corresponding primary tumors.

miRNAs regulate post-transcriptional gene expression in metazoans, and thus are involved in many fundamental cellular biological processes. Extracellular miRNAs are also found in most human biofluids including plasma. These circulating miRNAs constitute a long distance inter cellular communication system and are potentially useful biomarkers. High throughput technologies like microarrays are able to scan a complete miRNome providing useful detection scores that are underexplored. We proposed to answer how many and which miRNAs are detectable in plasma or extracellular vesicles as these questions have not yet been answered. We set out to address this knowledge gap by analyzing the mirRNome in plasma and corresponding extracellular vesicles (EVs) from 12 children affected by retinoblastoma (Rb) a childhood intraocular malignant tumor, as well as from 12 healthy similarly aged controls. We calculated an average of 537 detectable miRNAs in plasma and 625 in EVs. The most miRNA enriched compartment were EVs from Rb cases with an average of 656 detectable elements. Using hierarchical clustering with the detection scores, we generated broad detection mirnome maps and identified a plasma signature of 19 miRNAs present in all Rb cases that is able to discriminate cases from controls. An additional 9 miRNAs were detected in all the samples; within this group, miRNA-5787 and miRNA-6732-5p were highly abundant and displayed very low variance across all the samples, suggesting both are good candidates to serve as plasma references or normalizers. Further exploration considering participant's sex, allowed discovering 5 miRNAs which corresponded only to females and 4 miRNAs corresponding only to males. Target and pathway analysis of these miRNAs revealed hormonal function including estrogen, thyroid signaling pathways and testosterone biosynthesis. This approach allows a comprehensive unbiased survey of a circulating miRNome landscape, creating the possibility to define normality in mirnomic profiles, and to locate where in these miRNome profiles promising and potentially useful circulating miRNA signatures can be found.

Coinfección HIV /Trypanosoma cruzi: dinámica microbiológica y farmacocinética de los medicamentos / HIV/Trypanosoma cruzi co-infection: microbiological dynamics and pharmacokinetics of drugs

INTRODUCCION Los pacientes coinfectados HIV/T. cruzi pueden presentar reactivaciones de la infección por T. cruzi, con severas consecuencias para su salud y alta mortalidad. El tratamiento tripanocida con nifurtimox o benznidazol (BNZ) en la fase crónica podría ser una estrategia para reducir el riesgo de la reactivación de la enfermedad de Chagas en personas HIV positivas. Sin embargo, la información sobre las interacciones entre los fármacos antichagásicos con medicamentos antirretrovirales es inexistente, y es escaso el conocimiento respecto de la cinética parasitaria y viral en los pacientes coinfectados. OBJETIVOS Ampliar el conocimiento de la coinfección HIV/T.cruzi sobre; interacciones entre los fármacos tripanocidas y los antirretrovirales, y la dinámica viral y parasitológica en pacientes que reciban benznidazol durante el tratamiento antirretroviral y en el seguimiento. METODOS Estudio multicéntrico descriptivo observacional prospectivo. Población; pacientes con coinfección por HIV y T. cruzi, bajo tratamiento antirretroviral efectivo, que deseen realizar tratamiento tripanocida y participar de un estudio de investigación. Previo y durante el tratamiento tripanocida se realizan los cuidados estándar para ambas infecciones, y se tomaran muestras para realización de carga viral, recuento de cd4, dosaje de antirretrovirales, carga parasitaria, dosaje de tripanocidas y metabolitos. RESULTADOS Fueron incorporados 8 de 12 pacientes estipulados. Todos tuvieron excelente tolerancia al BNZ, sin modificación de las mediciones de carga viral ni recuento de CD4 durante el tratamiento tripanocida DISCUSIÓN De manera preliminar impresiona que el BNZ es muy bien tolerado, por lo que si hubiese interacción de medicamentos y hubiera mayor concentración de cualquiera de ellos esto no genera toxicidad, y si hubiera menor concentración de los antirretrovirales no ha modificado la carga viral de los participantes

Riesgo de malignidad de los nódulos tiroideos con atipia de significado incierto / Risk of malignancy in thyroid nodules with atipia of undetermined significance

INTRODUCCIÓN: La atipia de significado incierto o lesión folicular de significado incierto (categoría III del sistema de Bethesda, 2007) tiene una prevalencia de malignidad variable en los distintos estudios (5-37%), y por tal motivo no existe en la actualidad un consenso sobre el manejo adecuado de este resultado: repetir PAAF o cirugía. El objetivo del siguiente trabajo es analizar el riesgo de malignidad en nuestro medio de dichos nódulos para determinar la actitud clínica más adecuada. MATERIAL Y MÉTODOS: Desde la implantación del sistema Bethesda en el Hospital Xeral de Vigo (enero de 2011) hasta septiembre de 2014 se analizaron 431 citologías, de las cuales el 7,1% (32/430) fueron etiquetadas de categoría III. Se revisó el resultado de la segunda citología cuando se repitió la PAAF y el resultado histológico posquirúrgico de los operados. RESULTADOS: En 23 (82,1%) pacientes se indicó la realización de una tiroidectomía y en los 5 restantes (17,9%), la repetición de la PAAF. La citología resultó benigna (categoría ii) en 3 de ellos (60%) e insatisfactoria (categoría i) en 2 (40%). De los 25 pacientes tiroidectomizados, incluidos los 2 operados tras el resultado de la segunda PAAF, las piezas quirúrgicas de 13 (52%) fueron benignas y las de otros 12 (48%) demostraron un carcinoma diferenciado de tiroides: 10 (83,3%) con cáncer papilar de tiroides, uno (8,3%) con cáncer folicular de tiroides y uno (8,3%) con cáncer papilar con áreas de patrón folicular. En nuestros pacientes el riesgo de malignidad de las citologías calificadas como categoría III está entre el 42,9 y el 48% . Conclusión Recomendamos que todos los pacientes con citologías categoría III de Bethesda se sometan a tiroidectomía

INTRODUCTION: Prevalence of malignancy among cytologies with atypia of undetermined significance (Bethesda category iii) is variable, ranging from 5%-37% in the different studies. There is thus no agreement on whether FNA should be repeated or surgery should be performed in these cases. The aim of this paper was to analyze the risk of malignancy in order to establish the most adequate clinical approach. MATERIAL AND METHODS: We analyzed 431 thyroid cytologies performed at our hospital since the introduction of Bethesda System (from January 2011 to September 2014), of which 32 (7.1%) were labeled as category III. The second FNA, when performed, and the histological results after surgery were reviewed. RESULTS: Twenty-three patients (82.1%) underwent thyroidectomy, while repeat FNA was performed in the remaining 5 patients (17.9%). Cytology was reported as benign (category ii) in 3 (60%) and as unsatisfactory (category i) in 2 (40%), who underwent thyroidectomy. Thirteen of the 25 (52%) surgical thyroid specimens showed no malignancy, while differentiated thyroid carcinomas were found in 12 (48%): papillary cancer in 10 (83.3%), follicular cancer in 1 (8.3%), and papillary cancer with follicular areas in 1 (8.3%). The risk of malignancy of Bethesda category III in our patients was 42.9%-48.0%. CONCLUSION: We recommend thyroidectomy for all patients with of cytological Bethesda category iii

Risk of malignancy in thyroid nodules with atipia of undetermined significance.

INTRODUCTION: Prevalence of malignancy among cytologies with atypia of undetermined significance (Bethesda category III) is variable, ranging from 5%-37% in the different studies. There is thus no agreement on whether FNA should be repeated or surgery should be performed in these cases. The aim of this paper was to analyze the risk of malignancy in order to establish the most adequate clinical approach. MATERIAL AND METHODS: We analyzed 431 thyroid cytologies performed at our hospital since the introduction of Bethesda System (from January 2011 to September 2014), of which 32 (7.1%) were labeled as category III. The second FNA, when performed, and the histological results after surgery were reviewed. RESULTS: Twenty-three patients (82.1%) underwent thyroidectomy, while repeat FNA was performed in the remaining 5 patients (17.9%). Cytology was reported as benign (category II) in 3 (60%) and as unsatisfactory (category I) in 2 (40%), who underwent thyroidectomy. Thirteen of the 25 (52%) surgical thyroid specimens showed no malignancy, while differentiated thyroid carcinomas were found in 12 (48%): papillary cancer in 10 (83.3%), follicular cancer in 1 (8.3%), and papillary cancer with follicular areas in 1 (8.3%). The risk of malignancy of Bethesda category III in our patients was 42.9%-48.0%. CONCLUSION: We recommend thyroidectomy for all patients with of cytological Bethesda category III.

Investigación clinicoepidemiológica en envejecimiento: metodología del proyecto encuesta salud, bienestar y envejecimiento (SABE) en México / Epidemiological clinical research in aging: methodology of the project survey health, wellbeing and ageing in Mexico

La población de personas adultas mayores crece de forma paulatina y sostenida en el mundo y por ende en nuestro país. Sin embargo, la información que se tiene sobre la forma de vida, salud y bienestar de este grupo poblacional es limitada debido a que la mayor parte de las investigaciones en adultos mayores es derivada del estudio de grupos pequeños con patología bien circunscrita y características especiales. Por otro lado, la realización de estudios, en la población abierta, que permitan establecer la demografía y epidemiología de las personas mayores de 60 años requieren de una gran infraestructura y recursos tanto humanos como económicos. El Proyecto-Encuesta Salud Bienestar y Envejecimiento (SABE), mediante la realización de un estudio tipo encuesta, tiene la finalidad de obtener dicha información contando con la participación del Sector Salud, instituciones de educación superior así como organizaciones no gubernamentales lo que constituye un logro interinstitucional. Para la realización del proyecto SABE se ha seguido con rigurosidad científica el protocolo y para su puesta en marcha hubo la necesidad de la integración intersectorial de las instituciones que brindan atención a los adultos mayores mexicanos, ya sea dentro del contexto de la seguridad o asistencia social. Los alcances de SABE permitirán la creación y difusión del conocimiento derivado del mismo. En este documento, se expone y analiza de forma breve y concreta la metodología operativa de SABE México, lo que significa dar el primer paso para que otros investigadores interesados en el tema, realicen este tipo de estudios. Dada la experiencia que se ha ido generando en la realización de SABE México, este tipo de documentos sirven como base para proponer e iniciar las acciones al respecto.

The elderly population grows so gradual and sustained in the world and therefore in our country. However, information that is on the way of life, health and well-being of this population group is limited since most of the research in older adults is derived from the study of small groups with well circumscribed pathology and special features. On the other hand, open population studies to establish the demography and epidemiology of people older than 60 years require a large infrastructure and resources both human and financial. Project- Survey Health, Wellbeing and Ageing (SABE, in Spanish)), through a study type survey, has the purpose of obtaining such information with the participation of the Health Sector, institutions of higher education as well as organizations NGO constituting an interinstitutional achievement. For the implementation of the project SABE the Protocol has been followed with scientific rigor and for it simplementation underway there was the need to cross-sectoral integration of institutions providing care to Mexican older adults, either within the context of the social security or welfare. The reaches of SABE will enable the creation and dissemination of the knowledge derived from it. In this document, it exposes and analyzes operational methodology of a brief and concrete way of SABE Mexico, which means the first step so that other researchers interested in the topic, take place this type of study. Given the experience that has been generated in the implementation of SABE Mexico, this type of documents serves as the basis to propose and initiate actions in this regard.

Quantitative measurement of Plasmodium-infected erythrocytes in murine models of malaria by flow cytometry using bidimensional assessment of SYTO-16 fluorescence.

Flow cytometry is a powerful tool for measuring parasitemias in murine malaria models used to test new antimalarials. Measurement of the emission of the nonpermeable nucleic acid dye YOYO-1 (at 530 and 585 nm after excitation at 488 nm) allowed the unambiguous detection of low parasitemias (> or =0.01%) but required prolonged fixation and permeabilization of the sample. Thus, we tested whether this issue could be overcome by use of the cell-permeant dye SYTO-16 with this same bidimensional method. Blood samples from CD1 mice infected with Plasmodium yoelii, Plasmodium vinckei, or Plasmodium chabaudi or from NOD(scidbeta2m-/-) engrafted with human erythrocytes and infected with P. falciparum were stained with SYTO-16 in the presence or absence of TER-119 mAb (for engrafted mice) in 96-well plate format and acquired in Trucount tubes. Bidimensional analysis with SYTO-16 was quantitatively equivalent to YOYO-1. Moreover, by combining SYTO-16 with the use of TER-119-PE antimouse erythrocyte mAb and Trucount tubes, the measurement of the concentration of P. falciparum-infected erythrocytes over a range of five orders of magnitude was achieved. Bidimensional analysis using SYTO-16 can be used to accurately measure the concentration of Plasmodium spp.-infected erythrocytes in mice without complex sample preparation.

Bisacridines with aromatic linking chains. Synthesis, DNA interaction, and antitumor activity.

Synthesis of a series of bisacridine derivatives containing rigid aromatic linking chains is described. Their DNA interaction and in vitro cytotoxicity against HT-29 human carcinoma cells are reported.

Resistencia a antimicrobianos y perfil plasmídico de Salmonella enterica de origen pediátrico / Bacterial resistance and plamid profile of pediatricïs origin Salmonella enterica

El género Salmonella es un grupo de microorganismos ubicuos en humanos y animales. En los primeros puede ocasionar cuadros clínicos del tipo de la gastroenteritis, aunque ocasionalmente es causa de infecciones sistémicas que ponen en peligro la vida del paciente. La participación de Salmonella se ha incrementado a nivel mundial, ocasionando brotes epidémicos en unidades de atención pediátrica, en las que se han aislando cepas resistentes a más de un antimicrobiano. El objetivo de este trabajo fue determinar la sensibilidad a un grupo de antimicrobianos y el perfil plasmídico de cepas de Salmonella aisladas de pacientes pediátricos. Los resultados obtenidos mostraron alta resistencia a estreptomicina, ampicilina, cefalotina y tetraciclina. Se observó un plásmido de 20.5 Md en cepas de Salmonella enterica, subespecie typhimurium, heidelberg y derby, en cuyas transconjugantes se logró la transferencia fenotípica de resistencia a ampicilina.