Exacerbation-like events in the 12 months prior to identification of chronic respiratory conditions in a primary care population.

Initial chronic obstructive lung disease (COPD) pharmacotherapy is based on symptom burden and exacerbation history. Inclusion of inhaled cortico-steroids (ICS) is recommended only for those with a history of exacerbations. This brief report highlights that among individuals with previously unrecognized COPD about 1 in 5 have one or more exacerbation-like events and about 1 in 10 have two or more events in the prior 12 months whether or not they self-report concomitant asthma. Closer attention to prior exacerbation-like event history might lead to more guideline concordant care. In addition, there are two other groups that have impaired but non-obstructive spirometry, some with significant respiratory symptom burden who have frequencies of exacerbation-like events similar to those meeting COPD spirometry criteria. To date we have little guidance for treatment of these individuals.

Evaluation of the safety profile of the quadrivalent vaccine against human papillomavirus in the risk of developing autoimmune, neurological, and hematological diseases in adolescent women in Colombia.

BACKGROUND: Cervical cancer eradication is one of the main goals for 2030 by the World Health Organization, which can only be achieved with high vaccination rates against Human Papilloma Virus. In Colombia, more and better scientific evidence is required to increase confidence in vaccination. The objective of this study is to evaluate the safety profile of the quadrivalent vaccine against HPV in the risk of developing autoimmune, neurological, and hematological diseases in adolescent women in Colombia. METHODS: We designed a cohort study based on national HPV vaccination records and incident diagnostic data for the diseases of special interest during 2012 and 2021. We included adolescent women between 9 and 19 years old and compared vaccinated and non-vaccinated cohorts using an Inverse Probability of Treatment Weighting (IPWT) method for each scenario disease and follow-up period (180 and 360 days). FINDINGS: The Odds Ratio (OR) of developing diseases of interest was estimated during two follow up periods, 180 and 360 days after the follow-up index date (Vaccination Day). The OR for developing rheumatoid arthritis was 4·4; CI95% (1·74 - 11·14), juvenile idiopathic arthritis was 2·76 IC95% (1·50 - 5·11), idiopathic thrombocytopenic purpura was 2·54 IC95% (1·28 - 5·02) and thyrotoxicosis was 2·86 IC95% (1·03 - 7·95), when comparing the vaccinated versus unvaccinated population. However, the temporal distribution of cases incident did not reveal a clear difference between the cohorts, since the rate of appearance of new cases has a constant linear behavior for the two groups. INTERPRETATION: For rheumatoid arthritis, juvenile idiopathic arthritis, idiopathic thrombocytopenic purpura, and thyrotoxicosis; the application of the vaccine had an effect on the development of the disease. Nevertheless, our results should be interpreted with caution and be further studied, considering that the biological plausibility of the events occurred without a clear temporal pattern in relation to the exposure to the vaccine.

Fine-grained mathematical modeling for cost-effectiveness evaluation of public health policies for cervical cancer, with application to a Colombian case study.

BACKGROUND: Cervical cancer (CC) is globally ranked fourth in terms of incidence and mortality among women. Vaccination against Human Papillomavirus (HPV) and screening programs can significantly reduce CC mortality rates. Hence, executing cost-effective public health policies for prevention and surveillance is crucial. However, defining policies that make the best use of the available resources is not easy, as it requires predicting the long-term costs and results of interventions on a changing population. Since the simpler task of predicting the results of public health policies is difficult, devising those that make the best usage of available resources is an arduous challenge for decision-makers. METHODS: This paper proposes a fine-grained epidemiological simulation model based on differential equations, to effectively predict the costs and effectiveness of CC public health policies that include vaccination and screening. The model represents population dynamics, HPV transmission within the population, likelihood of infection clearance, virus-induced appearance of precancerous lesions and eventually CC, as well as immunity gained with vaccination and early detection with screening. RESULTS: We offer a compartmentalized modeling approach that separates population, epidemics, and intervention concerns. We instantiate models with actual data from a Colombian case study and analyze their results to show how our modeling approach can support CEA studies. Moreover, we implement models in an open-source software tool to simultaneously define and evaluate multiple policies. With the support of the tool, we analyze 54 policies within a 30-year time horizon and use as a comparator the CC policy that has been used until recently. We identify 8 dominant policies, the best one with an ICER of 6.3 million COP (Colombian Pesos) per averted DALY. We also validate the modeling approach against the available population and HPV epidemic data. The effects of uncertainty in the values of key parameters (discount rate, sensitivity of screening tests) is evaluated through one-way sensitivity analysis. CONCLUSIONS: Our modeling approach can provide valuable support for healthcare decision-makers. The implementation into an automated tool allows customizing the analysis with country-specific data, flexibly defining public health policies to be evaluated, and conducting disaggregate analyses of their cost and effectiveness.

Commuter's personal exposure to air pollutants after the implementation of a cable car for public transport: Results of the natural experiment TrUST.

Commuters in urban settlements are frequently exposed to high concentrations of air pollutants due to their proximity to mobile sources, making exposure to traffic-related air pollutants an important public health issue. Recent trends in urban transport towards zero- and low-tailpipe emission alternatives will likely result in decreased exposure to air pollutants. The TrUST (Urban transformations and health) study offers a unique opportunity to understand the impacts of a new cable car (TransMiCable) in underserved communities within Bogotá, Colombia. The aims of this study are to assess the personal exposure to fine particulate matter (PM2.5), equivalent Black Carbon (eBC), and Carbon Monoxide (CO) in transport micro-environments and to estimate the inhaled dose per trip during mandatory multimodal trips before and after the implementation of the TransMiCable. We collected personal exposure data for Bus-Rapid-Transit (BRT) feeder buses, regular buses, informal transport, pedestrians, and TransMiCable. TransMiCable showed lower exposure concentration compared to BRT feeder and regular buses (PM2.5: 23.6 vs. 87.0 µg m-3 (P ≤ 0.001) and eBC: 5.2 vs. 28.2 µg m-3 (P ≤ 0.001), respectively). The mean concentration of PM2.5 and eBC inside the TransMiCable cabins were 62 % and 82 % lower than the mean concentrations in buses. Furthermore, using a Monte Carlo simulation model, we found that including the TransMiCable as a feeder is related to a 54.4 µg/trip reduction in PM2.5 inhaled dose and 35.8 µg/trip in eBC per trip. Those changes represent a 27 % and 34 % reduction in an inhaled dose per trip, respectively. Our results show that PM2.5, eBC, and CO inhaled dose for TransMiCable users is reduced due to lower exposure concentration inside its cabins and shorter travel time. The implementation of a cable car in Bogotá is likely to reduce air pollution exposure in transport micro-environments used by vulnerable populations living in semi-informal settlements.

Strategy for Managing Industrial Anaerobic Sludge through the Heterotrophic Cultivation of Chlorella sorokiniana: Effect of Iron Addition on Biomass and Lipid Production.

Microalgae provides an alternative for the valorization of industrial by-products, in which the nutritional content varies substantially and directly affects microalgae system performance. Herein, the heterotrophic cultivation of Chlorella sorokiniana was systematically studied, allowing us to detect a nutritional deficiency other than the carbon source through assessing the oxygen transfer rate for glucose or acetate fermentation. Consequently, a mathematical model of the iron co-limiting effect on heterotrophic microalgae was developed by exploring its ability to regulate the specific growth rate and yield. For instance, higher values of the specific growth rate (0.17 h-1) compared with those reported for the heterotrophic culture of Chlorella were obtained due to iron supplementation. Therefore, anaerobic sludge from an industrial wastewater treatment plant (a baker's yeast company) was pretreated to obtain an extract as a media supplement for C. sorokiniana. According to the proposed model, the sludge extract allowed us to supplement iron values close to the growth activation concentration (KFe ~12 mg L-1). Therefore, a fed-batch strategy was evaluated on nitrogen-deprived cultures supplemented with the sludge extract to promote biomass formation and fatty acid synthesis. Our findings reveal that nitrogen and iron in sludge extract can supplement heterotrophic cultures of Chlorella and provide an alternative for the valorization of industrial anaerobic sludge.

[Not Available]. / Rehabilitación de la alimentación por vía oral en niños con enfermedades respiratorias crónicas y nutrición enteral prolongada.

Introducción: la rehabilitación de la alimentación por vía oral (RVO) es compleja en pacientes que han recibido nutrición enteral (NE) prolongada. Objetivo: describir este proceso en niños con enfermedades respiratorias crónicas y sonda nasoenteral (SNE) o gastrostomía (GT).Pacientes y métodos: estudio retrospectivo con revisión de registros clínicos de niños con NE mayor a dos meses, ingresados entre 2005 y 2014 al Hospital Josefina Martínez.Resultados: Se incluyeron 116 pacientes, con mediana de edad 10 meses (Rango: 3 a 101), 56% hombres. Diagnóstico: 34,5% Daño pulmonar crónico postinfeccioso (DPC), 29,3% Insuficiencia respiratoria por enfermedad neuromuscular, 19% Displasia broncopulmonar y 17,2% enfermedad de la vía aérea. Con traqueostomía: 82,8%. Eran usuarios de GT 89,7% y de SNG 10,3%, instaladas con mediana de edad 6 meses (0 a 74), por ingesta insuficiente (6,6%) o trastorno de deglución (92,4%). Del grupo total, 36,2% (42/116) tenía indicación de RVO, los cuales habían recibido NE durante 12,2 meses (2 a 41); de estos 50% (21/42) logró alimentarse exclusivamente por vía oral (91% SNG y 35,4% GT, Chi2 p = 0,023), 14% parcialmente y 36% no lo logró. El tiempo para lograr la vía oral exclusiva fue de 9,75 meses (0,5 a 47), sin diferencia por edad, sexo, vía de acceso, duración NE ni presencia de enfermedad neurológica.Conclusión: en pacientes con enfermedades respiratorias crónicas graves y NE prolongada, la RVO es un proceso lento pero posible: 64% lo logra de modo completo o parcial.

Rehabilitación de la alimentación por vía oral en niños con enfermedades respiratorias crónicas y nutrición enteral prolongada / Oral feeding rehabilitation in children with chronic respiratory diseases and long-term enteral nutrition

Introducción: la rehabilitación de la alimentación por vía oral (RVO) es compleja en pacientes que han recibido nutrición enteral (NE) prolongada. Objetivo: describir este proceso en niños con enfermedades respiratorias crónicas y sonda nasoenteral (SNE) o gastrostomía (GT). Pacientes y métodos: estudio retrospectivo con revisión de registros clínicos de niños con NE mayor a 2 meses, ingresados entre 2005 y 2014 al Hospital Josefina Martínez. Resultados: se incluyeron 116 pacientes, con mediana de edad 10 meses (rango: 3 a 101), 56% hombres. Diagnóstico: 34,5% daño pulmonar crónico postinfeccioso (DPC), 29,3% insufi ciencia respiratoria por enfermedad neuromuscular, 19% displasia broncopulmonar y 17,2% enfermedad de la vía aérea. Con traqueostomía: 82,8%. Eran usuarios de GT 89,7% y de SNG 10,3%, instaladas con mediana de edad 6 meses (0 a 74), por ingesta insufi ciente (11,3%) o trastorno de deglución (88,7%). Del grupo total, 36,2% (42/116) tenía indicación de RVO, los cuales habían recibido NE durante 12,2 meses (2 a 41); de estos 50% (21/42) logró alimentarse exclusivamente por vía oral (91% SNG y 35,4% GT, Chi2 p = 0,023), 14% parcialmente y 36% no lo logró. El tiempo para lograr la vía oral exclusiva fue de 9,75 meses (0,5 a 47), sin diferencia por edad, sexo, vía de acceso, duración NE ni presencia de enfermedad neurológica. Conclusión: en pacientes con enfermedades respiratorias crónicas graves y NE prolongada, la RVO es un proceso lento pero posible: 64% lo logra de modo completo o parcial (AU)

Introduction: The rehabilitation of the oral feeding (ROF) is complex in patients who have received prolonged enteral nutrition (EN). Objective: To describe this process in children with chronic respiratory diseases and nasoenteral tube (NET) or gastrostomy (GT). Patients and methods: Retrospective review of clinical records from children with EN at least for two months, admitted between 2005 and 2014 at the Josefi na Martínez Hospital. Results: 116 patients were included, with median age 10 months (range: 3 to 101), 56% male. Diagnosis: 34.5% Post-infectious chronic lung disease, 29,3% respiratory failure secondary to neuromuscular diseases, 19% bronchopulmonary dysplasia and 17,2% airway diseases, 82.8% of them had tracheostomy. Access: 89.7% gastrostomy and 10.3% NET, installed at median age of 6 months (0 a 74), due to low intake (11.3%) or swallow disorders (88.7%). From the total group, 36.2% (42/116) had ROF indication, whose EN length was 12.2 months (2 to 41). Fifty% (21/42) of them achieved total oral feeding (91% SNE and 35.4% GT, Chi2 p = 0.023), 14% partially and 36% failed. The time to achieve total oral feeding was 9.75 months (0.5 to 47), with no difference by age, sex, feeding route, EN duration or presence of neurological disease. Conclusion: In patients with chronic respiratory diseases and long-term enteral nutrition, ROF is possible but slow: 64% achieved it total or partially (AU)

Solvent effects on phytochemical constituent profiles and antioxidant activities, using four different extraction formulations for analysis of Bucida buceras L. and Phoradendron californicum.

BACKGROUND: The present investigation evaluated 4 different solvent compositions for their relative capacity to extract total phenolic and total flavonoid (TF) components of the leaves, trunks, and stems of Bucida buceras L. (Combretaceae), and the stems of Phoradendron californicum (Viscaceae), plus mesquite and oak species endemic to the Southwestern United States, northern Mexico, and tropical regions of Central and South America, as well as to profile the composition of these plant materials and to measure their antioxidant capacity. METHODS: The total phenolic content of plant material used in the present investigation was measured using the Folin-Ciocalteau assay. Total flavonoids were assayed by AlCl3 and 2,4-dinitrophenylhydrazin colorimetry. Nitroblue tetrazolium was utilized for scavenging of superoxide anion, and in vitro antioxidant activity was evaluated using the 2, 2-diphenyl-1-picrylhydrazyl and Ferric Reducing/Antioxidant Power assays. RESULTS: Phytochemical screening of each plant extract evaluated revealed the following major results: (1) No evidence of alkaloids for each of the extraction phases tested was detected in the hexanic, ethanolic, or aqueous phases of Bucida buceras and Phoradendron californicum (oak and mesquite); (2) Analysis of the hexane phase of B. buceras and P. californicum (mesquite) extracts revealed the presence of carotenes, triterpenes/steroids, and lactonic groups; (3) Analysis of the ethanol and aqueous extraction phases for both plants revealed the presence of a diverse range of compounds, including tripterpenes/steroids, lactonics groups, saponins, phenols/tannins, amines and/or amino acids, and flavonoids/anthocyanins; and (4) The highest total phenolic and flavonoid content were observed in P. californicum (oak): 523.886 ± 51.457 µg GAE/mg extract and 409.651 ± 23.091 µg/mg of extract for methanol and aqueous fractions, respectively. The highest flavonoid content was 237.273 ± 21.250 µg PNE/mg extract in the acetone extract of Bucida buceras stems; while the flavonol content (260.685 ± 23.031 µg CE/mg extract) was higher in the ethanol extract of P. californicum (oak). The acetone extract of B. buceras trunk extract showed the highest levels of DPPH radical-scavenging activity (IC50 = 4.136 ± 0.446 µg/mL) and reducing power (4928.392 ± 281.427 µM AAE/mg extract). The highest superoxide radical scavenging activity (IC50) was 55.249 ± 9.829 µg/mL, observed in acetone extracts of B. buceras leaves. CONCLUSIONS: The results of the present investigation demonstrated the effects of extraction solvent on phenolic and flavonoid content yield-and antioxidant activities by Bucida buceras and Phoradendron californicum. The present investigation further revealed that Bucida buceras exhibited optimal antioxidant capacity when acetone was used as extraction solvent; and the highest yield of phenols and flavonoids were obtained from the P. californicum oak, using methanol and aqueous solvents, respectively.

Retino-protective effect of Bucida buceras against oxidative stress induced by H2O2 in human retinal pigment epithelial cells line.

BACKGROUND: Reactive Oxygen Species (ROS) impair the physiological functions of Retinal Pigment Epithelial (RPE) cells, which are known as one major cause of age-related macular degeneration and retinopathy diseases. The purpose of this study is to explore the cytoprotective effects of the antioxidant Bucida buceras extract in co-treatment with hydrogen peroxide (H2O2) delivery as a single addition or with continuous generation using glucose oxidase (GOx) in ARPE-19 cell cultures. The mechanism of Bucida buceras extract is believed to be associated with their antioxidant capacity to protect cells against oxidative stress. METHODS: A comparative oxidative stress H2O2-induced was performed by addition and enzymatic generation using glucose oxidase on human retinal pigment epithelial cells line. H2O2-induced injury was measured by toxic effects (cell death and apoptotic pathway) and intracellular redox status: glutathione (GSH), antioxidant enzymes (catalase and glutathione peroxidase) and reducing power (FRAP). The retino-protective effect of co-treatment with Bucida buceras extract on H2O2-induced human RPE cell injury was investigated by cell death (MTT assay) and oxidative stress biomarkers (H2O2, GSH, CAT, GPx and FRAP). RESULTS: Bucida buceras L. extract is believed to be associated with the ability to prevent cellular oxidative stress. When added as a pulse, H2O2 is rapidly depleted and the cytotoxicity analyses show that cells can tolerate short exposure to high peroxide doses delivered as a pulse but are susceptible to lower chronic doses. Co-treatment with Bucida buceras was able to protect the cells against H2O2-induced injury. In addition to preventing cell death treatment with antioxidant plant could also reverse the significant decrease in GSH level, catalase activity and reducing power caused by H2O2. CONCLUSION: These findings suggest that Bucida buceras could protect RPE against ocular pathogenesis associated with oxidative stress induced by H2O2-delivered by addition and enzymatic generation.

Persistent sepsis-induced hypotension without hyperlactatemia: is it really septic shock?

PURPOSE: The prognostic value of hyperlactatemia in septic shock is unquestionable. However, as current definitions do not include hyperlactatemia as a mandatory criterion, some hypotensive patients may be diagnosed as having septic shock despite exhibiting normolactatemia. The significance of persistent sepsis-induced hypotension without hyperlactatemia is unclear. Is it really septic shock? Our aim was to determine differences in outcome between patients diagnosed as having septic shock but exhibiting normal vs elevated lactate levels during evolution. We also explored the potential implications of including hyperlactatemia as an obligatory diagnostic criterion. METHODS: We performed retrospective analyses on a cohort of 302 septic shock patients. RESULTS: When we divided patients according to the presence of hyperlactatemia, 34% evolved without hyperlactatemia and exhibited a very low mortality risk (7.7% compared with 42.9% of those with hyperlactatemia). These patients also presented less severe organ dysfunctions and higher central venous O(2) saturation values, and required lower norepinephrine doses. The potential inclusion of hyperlactatemia in septic shock definition would reduce incidence in 34% but increase absolute mortality risk in 11%. CONCLUSIONS: Persistent sepsis-induced hypotension without hyperlactatemia may not constitute a real septic shock. Our results support the need to review the current definition of septic shock. Hyperlactatemia could represent an objective parameter worth to be explored as a potential diagnostic criterion for septic shock.