Risk factors for severe disease in pediatric respiratory syncytial virus infections.

OBJECTIVES: To assess factors associated with the risk of severe disease in children aged 5 years or younger with laboratory-confirmed respiratory syncytial virus (RSV) infection. STUDY DESIGN: We conducted a nationwide retrospective cohort study in Mexico. METHODS: Eligible participants included children aged 5 years or younger with laboratory-confirmed RSV infection January 1, 2023, and May 15, 2024. We collected relevant clinical and epidemiological data. Risk ratios (RR) and 95% confidence intervals (CI) were employed to identify factors associated with the risk of severe disease, characterized by clinical and radiographic evidence of bronchiolitis or pneumonia requiring hospital admission. RESULTS: Data from 2022 children were analyzed and the overall risk of severe disease was 21.0% (n = 424/2022). In multiple generalized linear regression analysis, a personal history of immunosuppression (due to any cause) showed a protective effect (RR = 0.14, 95% CI 0.05-0.42, P = 0.001) against severe RSV disease, while an increased risk was documented for each additional day elapsed between the date of symptom onset and the date of seeking healthcare RR = 1.06, 95% CI 1.02-1.10, P = 0.004). CONCLUSION: These findings provide insights into risk stratification and suggest specific directions for future research. This information informs the development of targeted intervention strategies to mitigate the impact of RSV infections in this vulnerable population.

The burden of COVID-19 in Latin American and Caribbean countries: an analysis based on the Global Burden of Disease Study 2021.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on the countries of Latin America and the Caribbean. This study aims to summarise key findings from the Global Burden of Disease (GBD) 2021 in the region. We also explore disparities in burden rates and the relationship with the Socio-demographic Index (SDI). STUDY DESIGN: A cross-sectional analysis of GBD 2021 results was conducted. METHODS: We obtained the disability-adjusted life years (DALYs) due to COVID-19 for 20 countries, analysing number- and age-adjusted rates. Spearman's correlation (rho) and 95% confidence intervals (CIs) assessed the SDI-DALY rates relationship. RESULTS: COVID-19 was the leading cause disease burden in the region, with 20,437,321 DALYs in 2020 and 31,525,824 in 2021. Premature mortality (years of life lost) accounted for over 95%. Disparities existed across sexes, age groups, and countries, with Bolivia and Peru having the highest rates. A significant 2021 correlation was found (rho = -0.55, 95% CI: -0.90 to 0.19; P = 0.013) but not in 2020 (rho = -0.40, 95% CI: -0.75 to 0.05; P = 0.078). CONCLUSIONS: COVID-19 posed a significant burden in Latin America and the Caribbean, emphasising the need for targeted interventions, especially in socioeconomically disadvantaged regions.

Evaluating the performance of WHO and CDC case definitions for influenza-like illness in diagnosing influenza during the 2022-2023 flu season in Mexico.

OBJECTIVE: This study aimed to evaluate the performance of the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) case definitions for influenza-like illness (ILI) in diagnosing influenza during the 2022-2023 flu season in Mexico. STUDY DESIGN: We conducted a cross-sectional analysis of national epidemiological surveillance data in Mexico, focusing on respiratory viral pathogens. METHODS: We analyzed data from 6027 non-hospitalized patients between 5 and 65 years old who underwent molecular testing for respiratory viral pathogens. The performance of both case definitions was evaluated in terms of sensitivity, specificity, and the area under the receiver operating characteristic (AUROC) curve. RESULTS: Overall, the diagnostic accuracy of the evaluated ILI definitions in identifying influenza patients was low, particularly among older patients. When compared to the CDC, the WHO definition had a lower sensitivity but a higher specificity, resulting in a higher AUROC (P = 0.031) for the WHO criteria. CONCLUSIONS: Our findings suggest that the WHO and CDC ILI case definitions have limited accuracy for diagnosing influenza in non-hospitalized patients and highlight the need for more specific diagnostic tools to improve the detection of influenza cases during the flu season.

Respiratory syncytial virus infection: survival experience in a cohort of children inpatients.

OBJECTIVE: The objective of this study was to assess the survival experience of children hospitalized with laboratory-confirmed respiratory syncytial virus (RSV) infection due to bronchiolitis. STUDY DESIGN: This was a nationwide retrospective cohort study conducted in Mexico. METHODS: We analyzed data from 436 children aged 5 years and younger, with symptom onset between August 2021 and November 2022. The Kaplan-Meier method was used to compute survivor functions and their 95% confidence intervals (CI). RESULTS: High survival rates were observed, particularly within the first three weeks of hospital admission. The 3-day survival rate was 99.8% (CI 98.4-99.9%), which decreased to 98.9% (CI 96.5-99.7%), 97.5% (CI 91.9-99.3%), 86.7% (CI 48.2-97.2%), and 69.4% (CI 24.2-91.0%) on days 7, 14, 21, and 28 of hospital stay, respectively. We documented a total of 5 fatal outcomes, resulting in a mortality rate of 2.1 (95% CI 0.9-5.1) per 1,000 person-days. CONCLUSIONS: Our study analyzed a large cohort of pediatric patients with bronchiolitis caused by RSV infection, providing valuable insights into the in-hospital progression of this disease.

Cytomegalovirus reactivation in patients diagnosed with severe COVID-19: A point prevalence study in a general hospital.

OBJECTIVE: To determine the prevalence of CMV reactivation in a population admitted for severe COVID-19 to a general hospital. METHODS: Point prevalence study in all hospitalized patients with severe COVID-19 (admitted either to general wards or ICU). Determination of the presence of CMV DNA in circulating blood. COVID-19 was confirmed in patients with compatible clinical manifestations, usually with pneumonia and a positive nasopharyngeal PCR test. RESULTS: We included 140 hospitalized patients with COVID-19 who consented to participate. A total of 16 patients (11.42%), had circulating CMV-DNA in peripheral blood at the time of the study. Patients with positive CMV viral load were mainly ICU patients (11/37 -29,7%) and only 5/103 cases (4,85%) were hospitalized into general wards. The accumulated doses of corticosteroids (prednisone equivalents) in the study day were (median and IQR) 987.50 mg (396.87-2,454.68) and 187.50 mg (75.00-818.12) respectively in CMV positive and negative patients (p < 0.001). A significant proportion of CMV positive patients were discovered because of the study and were clinically unsuspected by their physicians. The coinfected COVID-CMV positive population had a higher risk of accumulated secondary nosocomially-acquired infections and a worse prognosis. CONCLUSIONS: CMV reactivation should be systematically searched in patients in COVID-19 cases admitted to the ICU.

Comparing the survival of adult inpatients with COVID-19 during the wild-type, Delta, and Omicron emergence.

OBJECTIVE: This study aimed to compare the survival experience of adult inpatients with laboratory-confirmed COVID-19 during the first three waves (wild type, Delta, and Omicron) of the pandemic in Mexico. STUDY DESIGN: A retrospective and nationwide study was conducted. METHODS: Data from 229,311 participants were analyzed using the Kaplan-Meier method, and estimates per each pandemic wave were obtained. A multivariate Cox proportional hazard regression model was fitted, and hazard ratios (HRs) and 95% confidence intervals (CIs) were computed. RESULTS: The overall mortality rate was 49.1 per 1000 person-days. Heterogeneous survival rates were observed during the analyzed emergences (log-rank test, P < 0.001), and the lowest survival functions were computed during the Omicron variant dominance. In multiple analyses and after adjusting by host characteristics and COVID-19 vaccination status, cases occurring during the Delta (vs wild type: HR = 1.03, 95% CI 1.01-1.05) and Omicron emergence were at increased risk for a fatal in-hospital outcome (HR = 1.17, 95% CI 1.13-1.22). CONCLUSIONS: Our results suggest variant-related differences in the survival rates of hospitalized patients with laboratory-positive COVID-19. When compared with the wild-type virus, lower rates were observed during the Delta and Omicron emergence.

The use of readily available laboratory tests for the identification of the emerging yeast Candida auris in Mexico.

Identification of the emerging multidrug-resistant yeast Candida auris is challenging. Here, we describe the role of the Mexico national reference laboratory Instituto de Diagnóstico y Referencia Epidemiológicos Dr. Manuel Martínez Báez (InDRE) and the Mexican national laboratory network in the identification of C. auris. Reference identification of six suspected isolates was done based on phenotypic and molecular laboratory methods, including growth in special media, evaluation of isolate micromorphology, and species-specific PCR and pan-fungal PCR and sequencing. The four C. auris isolates identified were able to grow on modified Sabouraud agar with 10% NaCl incubated at 42 °C. With one exception, isolates of C. auris were spherical to ovoid yeast-like cells and blastoconidia, with no hyphae or pseudohyphae on cornmeal agar. C. auris isolates were resistant to fluconazole. Species-specific and pan-fungal PCR confirmed isolates as C. auris. Sequence analysis revealed the presence of two different C. auris clades in Mexico, clade I (South Asia) and clade IV (South America).

What About the Little Ones? Systematic Review of Cognitive and Behavioral Outcomes Following Early TBI.

There is increasing empirical focus on the effects of early traumatic brain injuries (TBI; i.e., before the age of six years) on child development, but this literature has never been synthetized comprehensively. This systematic review aimed to document the cognitive, academic, behavioral, socio-affective, and adaptive consequences of early TBI. Four databases (Medline, PsycNET, CINAHL, PubMed) were systematically searched from 1990 to 2019 using key terms pertaining to TBI and early childhood. Of 12, 153 articles identified in the initial search, 43 were included. Children who sustain early TBI are at-risk for a range of difficulties, which are generally worse when injury is sustained at a younger age, injury severity is moderate to severe, and injury mechanisms are non-accidental. Early childhood is a sensitive period for the emergence and development of new skills and behaviors, and brain disruption during this time is not benign. Research, clinical management, intervention, and prevention efforts should be further developed with consideration of the unique characteristics of the early childhood period.

Manejo de la patología congénita y adquirida de la vía aérea en el neonato por parte de un comité multidisciplinar en un centro terciario / Management of congenital and acquired airway pathologies in newborns by a cross-disciplinary committee at a third level hospital

Introducción: La exploración de vía aérea mediante broncoscopiaflexible/rígida en el neonato ha demostrado utilidad en el estridor persistente, extubaciones fallidas o para valorar complicaciones tras cirugíacardiaca. En nuestro hospital estas exploraciones son practicadas porun neumólogo, neonatólogo, otorrinolaringólogo y cirujano pediátricodel Comité de Vía Aérea Pediátrica, formado en 2014. Objetivo: Analizar las exploraciones de vía aérea practicadas aneonatos durante su estancia en Neonatología/Unidad de CuidadosIntensivos Neonatales desde la constitución del Comité de Vía Aérea.Materiales. Estudio retrospectivo de exploraciones de vía aéreapracticadas a neonatos en el periodo 2015-2019. Se recogen datosclínicos y demográficos, número de exploraciones, indicación, hallazgos y complicaciones. Se presentan las medias con su desviaciónestándar. Se consideró un resultado estadísticamente significativocuando p < 0,05. Resultados: Se analizaron 92 exploraciones de vía aérea en 51pacientes (género femenino: 54,9%). El 51% de los pacientes fueronprematuros. La extubación fallida y la persistencia de sintomatologíarespiratoria tras una extubación satisfactoria fueron las indicacionesmás frecuentes (35,3%). La estratificación por edad gestacional o porpeso al nacimiento no se asociaba a un mayor riesgo de presentar ha-llazgos patológicos en la exploración. El hallazgo más frecuente fue laparálisis de cuerda vocal (n = 14; 27,5%). En 10 pacientes (19,6%) nose encontraron hallazgos patológicos. Conclusión: La exploración de la vía aérea es útil en pacientes conestridor postextubación y para identificar parálisis de cuerda vocal trasextubación fallida. Además, permite el diagnóstico y tratamiento depatologías congénitas de la vía aérea.(AU)

Introduction: Neonatal airway examination through flexible/rigid bronchoscopy has proved to be useful in the presence of persis-tent stridor and extubation failure, as well as to assess complicationsfollowing cardiac surgery. At our institution, these examinations arecarried out by a pulmonologist, a neonatologist, an otorhinolaryngolo-gist, and a pediatric surgeon from the pediatric airway committee,established in 2014. Objective: To analyze the airway examinations performed in neo-nates during their stay at the neonatology/neonatal intensive care unitsince the airway committee was established.Materials and methods. A retrospective study of the airway ex-aminations conducted in neonates from 2015 to 2019 was carried out.Clinical and demographic data, number of examinations, indications,findings, and complications were collected. Results are presented asmean and standard deviation. Statistical significance was establishedat p < 0.05. Results: 92 airway examinations were analyzed in 51 patients(54.9% of whom were female). 51% of the patients were premature.Extubation failure and persistent respiratory symptoms followingsuccessful extubation were the most frequent indications for airwayexamination (35.3%). Stratification by gestational age or weight atbirth was not associated with an increased risk of pathological findingsat examination (p > 0.05). The most frequent finding was vocal cordparalysis (n = 14; 27.5%). In 10 patients (19.6%), no pathologicalfindings were observed. Conclusion: Airway examination is useful in patients with stridorto identify vocal cord paralysis following extubation failure. It alsoallows congenital airway pathologies to be diagnosed and treated. Thenumber of examinations with no pathological findings was similar tothat reported in international series.(AU)

Management of congenital and acquired airway pathologies in newborns by a cross-disciplinary committee at a third level hospital. / Manejo de la patología congénita y adquirida de la vía aérea en el neonato por parte de un comité multidisciplinar en un centro terciario.

INTRODUCTION: Neonatal airway examination through flexible/rigid bronchoscopy has proved to be useful in the presence of persistent stridor and extubation failure, as well as to assess complications following cardiac surgery. At our institution, these examinations are carried out by a pulmonologist, a neonatologist, an otorhinolaryngologist, and a pediatric surgeon from the pediatric airway committee, established in 2014. OBJECTIVE: To analyze the airway examinations performed in neonates during their stay at the neonatology/neonatal intensive care unit since the airway committee was established. MATERIAL AND METHODS: A retrospective study of the airway examinations conducted in neonates from 2015 to 2019 was carried out. Clinical and demographic data, number of examinations, indications, findings, and complications were collected. Results are presented as mean and standard deviation. Statistical significance was established at p < 0.05. RESULTS: 92 airway examinations were analyzed in 51 patients (54.9% of whom were female). 51% of the patients were premature. Extubation failure and persistent respiratory symptoms following successful extubation were the most frequent indications for airway examination (35.3%). Stratification by gestational age or weight at birth was not associated with an increased risk of pathological findings at examination (p > 0.05). The most frequent finding was vocal cord paralysis (n = 14; 27.5%). In 10 patients (19.6%), no pathological findings were observed. CONCLUSION: Airway examination is useful in patients with stridor to identify vocal cord paralysis following extubation failure. It also allows congenital airway pathologies to be diagnosed and treated. The number of examinations with no pathological findings was similar to that reported in international series.

INTRODUCCION: La exploración de vía aérea mediante broncoscopia flexible/rígida en el neonato ha demostrado utilidad en el estridor persistente, extubaciones fallidas o para valorar complicaciones tras cirugía cardiaca. En nuestro hospital estas exploraciones son practicadas por un neumólogo, neonatólogo, otorrinolaringólogo y cirujano pediátrico del Comité de Vía Aérea Pediátrica, formado en 2014. OBJETIVO: Analizar las exploraciones de vía aérea practicadas a neonatos durante su estancia en Neonatología/Unidad de Cuidados Intensivos Neonatales desde la constitución del Comité de Vía Aérea. MATERIAL Y METODOS: Estudio retrospectivo de exploraciones de vía aérea practicadas a neonatos de 2015-2019. Se recogen datos clínicos y demográficos, número de exploraciones, indicación, hallazgos y complicaciones. Se presentan las medias con su desviación estándar. Se consideró un resultado estadísticamente significativo cuando p < 0,05. RESULTADOS: Se analizaron 92 exploraciones de vía aérea en 51 pacientes (género femenino: 54,9%). El 51% de los pacientes fueron prematuros. La extubación fallida y la persistencia de sintomatología respiratoria tras una extubación satisfactoria fueron las indicaciones más frecuentes (35,3%). La estratificación por edad gestacional o por peso al nacimiento no se asociaba a un mayor riesgo de presentar hallazgos patológicos en la exploración. El hallazgo más frecuente fue la parálisis de cuerda vocal (n = 14; 27,5%). En 10 pacientes (19,6%) no se encontraron hallazgos patológicos. CONCLUSION: La exploración de la vía aérea es útil en pacientes con estridor postextubación y para identificar parálisis de cuerda vocal tras extubación fallida. Además, permite el diagnóstico y tratamiento de patologías congénitas de la vía aérea.

Digital microscopic image application (DMIA), an automatic method for particle size distribution analysis in waste activated sludge.

An important physical property in environmental samples is particle size distribution. Several processes exist to measure particle diameter, including change in electrical resistance, blocking of light, the fractionation of field flow and laser diffraction (these being the most commonly used). However, their use requires expensive and complex equipment. Therefore, a digital microscopic imaging application (DMIA) method was developed adapting the algorithms used in the helminth egg automatic detector software coupled with a neural network (NN) and Bayesian algorithms. This allowed the determination of particle size distribution in samples of waste activated sludge (WAS), recirculated sludge (RCS), and pre-treated sludge (PTS). The recirculation and electro-oxidation pre-treatment processes showed an effect in increasing the degree of solubilization, decreasing particle size and breakage factor with ranges between 44.29%, and 31.89%. Together with a final NN calibration process, it was possible to compare results. For example, the 90th percentile of equivalent diameter value obtained by the DMIA with the corresponding result for the laser diffraction method. DMIA values: 228.76 µm (WAS), 111.18 µm (RCS), and 84.45 µm (PTS). DMIA processing has advantages in terms of reducing complexity, cost and time, and offers an alternative to the laser diffraction method.

Efficiency of integrated electrooxidation and anaerobic digestion of waste activated sludge.

BACKGROUND: Most of the organic content of waste activated sludge (WAS) comprises microbial cells hard to degrade, which must be pre-treated for energy recovery by anaerobic digestion (AD). Electrooxidation pre-treatment (EOP) with boron-doped diamond (BDD) electrode have been considered a promising novel technology that increase hydrolysis rate, by the disintegrating cell walls from WAS. Although electrochemical oxidation could efficiently solubilize organic substances of macromolecules, limited reports are available on EOP of WAS for improving AD. In this endeavour, the mathematical optimization study and the energy analysis of the effects of initial total solids concentrations [TS] of WAS and current density (CD) during EOP on the methane production and removal of chemical oxygen demand (COD) and volatile solids (VS) were investigated. Because limited reports are available on EOP of WAS for improving biogas production, it is not well understood; however, it has started to attract interest of scientists and engineers. RESULTS: In the present work, the energy recovery as biogas and WAS conversion were comprehensively affected by CD and [TS], in an integrated EOP and AD system. When working with WAS at 3% of [TS] pre-treated at current density of 24.1 mA/cm2, the highest COD and VS removal were achieved, making it possible to obtain the maximum methane (CH4) production of 305 N-L/kg VS and a positive energy balance of 1.67 kWh/kg VS. Therefore, the current densities used in BDD electrode are adequate to produce the strong oxidant (hydroxyl radical, ·OH) on the electrode surface, allow the oxidation of organic compounds that favours the solubilization of particulate matter and VS from WAS. CONCLUSIONS: The improvement of VS removal and COD solubilization were due to the effects of pre-treatments, which help to break down the microbial cells for faster subsequent degradation; this allows a decomposition reaction that leads to biodegrade more compounds during AD. The balance was positive, suggesting that even without any optimization the energy used as electricity could be recovered from the increased methane production. It is worth noting that this kind of analysis have not been sufficiently studied so far. It is therefore important to understand how operational parameters can influence the pre-treatment and AD performances. The current study highlights that the mathematical optimization and energy analysis can make the whole process more convenient and feasible.

Helminth Egg Automatic Detector (HEAD): Improvements in development for digital identification and quantification of helminth eggs and their application online.

Helminths are parasitic worms that constitute a major public health problem. Conventional analytical techniques to evaluate helminth eggs in environmental samples rely on different steps, namely sedimentation, filtration, centrifugation, and flotation, to separate the eggs from a variety of particles and concentrate them in a pellet for direct observation under an optical microscope. To improve this process, a new approach was implemented in which various image processing algorithms were developed and implemented by a Helminth Egg Automatic Detector (HEAD). This allowed identification and quantification of pathogenic helminth eggs of global medical importance and it was found to be useful for relatively clean wastewater samples. After the initial version, two improvements were developed: first, a texture verification process that reduced the number of false positive results; and second, the establishment of the optimal thresholds (morphology and texture) for each helminth egg species. This second implementation, which was found to improve on the results of the former, was developed with the objective of using free software as a platform for the system. This does not require the purchase of a license, unlike the previous version that required a Mathworks® license to run. After an internal statistical verification of the system was carried out, trials in internationally recognized microbiology laboratories were performed with the aim of reinforcing software training and developing a web-based system able to receive images and perform the analysis throughout a web service. Once completed, these improvements represented a useful and cheap tool that could be used by environmental monitoring facilities and laboratories throughout the world; this tool is capable of identifying and quantifying different species of helminth eggs in otherwise difficult environmental samples: wastewater, soil, biosolids, excreta, and sludge, with a sensitivity and specificity for the TensorFlow (TF) model in the web service values of 96.82% and 97.96% respectively. Additionally, in the case of Ascaris, it may even differentiate between fertile and non-fertile eggs.

Fibrin glue treatment associated or not with diathermy for recurrent tracheoesophageal fistula: our results after more than 20 years' experience. / Tratamiento con adhesivo de fibrina asociado o no a diatermia para las fístulas traqueoesofágicas recurrentes: resultados tras más de 20 años de experiencia.

INTRODUCTION: Recurrent tracheoesophageal fistula (RTEF) is a frequent complication (5-10%) in patients with esophageal atresia (EA). Open RTEF surgery has a high morbidity and mortality, so the endoscopic approach represents a promising alternative. We present the long-term results of fibrin glue (FG) bronchoscopic application in patients with RTEF secondary to EA, which was first used by our team in 1994. MATERIAL AND METHODS: A retrospective review of all patients diagnosed with RTEF following EA repair and treated with FG bronchoscopic application from 1993 to 2019 was carried out. In most cases, diathermy was applied prior to FG sealing. The maximum number of endoscopic sessions was 5. In case of persistent RTEF following the fifth session, open surgery was performed. RESULTS: 14 RTEF patients were treated with FG. In all but the first 3 cases (11 patients, 78.6%), diathermy was applied concomitantly. Mean first treatment day was day 85 of life (range: 14-770). Patients received a mean of 2.1 (1-5) endoscopic sessions. Mean follow-up was 12.1 (10-20) years. Overall success rate was 71.4%, without significant differences according to whether diathermy was concomitantly applied or not (72.7% vs. 66.6%). CONCLUSIONS: Fibrin glue bronchoscopic application associated or not associated with diathermy is an excellent option for RTEF treatment in EA patients. The endoscopic approach should be considered as the first-choice treatment for RTEF.

INTRODUCCION: La fístula traqueoesofágica recurrente (FTER) representa una complicación frecuente (5-10%) en los pacientes con atresia de esófago (AE). La cirugía abierta de FTER implica una alta morbimortalidad, por lo que los abordajes endoscópicos suponen una alternativa prometedora. Presentamos los resultados a largo plazo de la aplicación broncoscópica de adhesivo de fibrina (AF) en pacientes con FTER secundaria a AE, técnica utilizada por primera vez en 1994 por nuestro equipo. METODOS: Revisión retrospectiva de 1993 a 2019, incluyendo a todos los pacientes diagnosticados de FTER tras la reparación de AE, y tratados con aplicación broncoscópica de AF. En la mayoría de los casos se aplicó diatermia previamente al sellado con AF. El número máximo de sesiones endoscópicas se estableció en cinco; en caso de persistir FTER tras la quinta sesión, se procedió a cirugía abierta. RESULTADOS: 14 pacientes con FTER fueron tratados con AF; en todos salvo los primeros 3 casos (11 pacientes, 78,6%) se aplicó diatermia concomitante. El día promedio del primer tratamiento fue el día 85 de vida (14 a 770). Los pacientes recibieron una media de 2,1 (1-5) sesiones endoscópicas. El seguimiento medio fue de 12,1 (10-20) años. El éxito global fue del 71,4%, sin apenas variar con la aplicación o no de diatermia concomitante (72,7% vs. 66,6%). CONCLUSIONES: La aplicación broncoscópica de adhesivo de fibrina asociado o no a diatermia representa una excelente opción para el tratamiento de FTER en pacientes con AE. El abordaje endoscópico debe considerarse como tratamiento de primera elección para FTER.

Inactivation of helminth eggs in an electro-Fenton reactor: Towards full electrochemical disinfection of human waste using activated carbon.

The disinfection of helminth eggs and Escherichia coli contaminated aqueous solutions, was studied using an electro-Fenton reactor equipped with a polarized activated carbon (AC) packed bed and two chambers loaded with cation exchange resins. Experiments using different arrangements and operation conditions, revealed that effective elimination of Escherichia coli takes place in all electrochemical disinfection tests. For the more resistant helminth eggs however, adsorption, electro-oxidation and electro-Fenton experiments showed retention within the reactor and pathogen inactivation values of 0, 16, and 25%, respectively. Using helminth eggs concentration data in different sections of the reactor, optical microscopy analysis and an exploratory computer simulation, differences in the disinfection performance were explained and new recirculation and flow direction and polarization switching operation schemes were defined. The corresponding experiments revealed that the effective coupling between adsorption and electro-Fenton phenomena, all along the AC packed bed compartment, results in 100% inactivation of helminth eggs.

Anthropometric and dietary differences among Mexican older adults with and without adequate body image perception.

OBJECTIVE: We compared anthropometric and dietary indicators between groups of older Mexican adults with accurate or inaccurate body image perception (BIP). METHODS: A cross-sectional study was carried out with 201 older adults (age ≥ 60 years) of both sexes who completed the Stunkard scale for BIP, which consists of nine silhouettes with an equivalent of body mass index (BMI) status, then, the accuracy with their real BMI was calculated and reported energy and macronutrient intake through a 24-h dietary recall directed by different geriatric centers in Colima, Mexico. Basic anthropometry and bioelectrical impedance analyses were performed. RESULTS: We found that 71.1% of the older adults had inaccurate BIP; 66.6% underestimated their body mass and 4.5% overestimated their body mass, the other 28.9% hat accurate BIP. The overall concordance between the real nutritional status and BIP was poor (kappa coefficient = 0.03). The inaccurate BIP group had a significantly higher mean body mass index, body fat percentage, muscle mass, and arm and calf circumference compared to the accurate BIP group (p < .001); only 4.3% of the older adults who were overweight and 6.2% who were obese had an accurate BIP. Regarding dietary consumption, we found significant differences only in energy and carbohydrate intake between the two groups. Finally, excess body fat was associated with an inaccurate BIP (OR: 2.8, 95% CI: 1.5-5.5). CONCLUSION: In older adults, an inaccurate BIP is generally associated with high anthropometric values and less than adequate dietary intake.

Test-retest reliability and minimum detectable change for various frontal plane projection angles during dynamic tasks.

OBJECTIVE: Establish between-day test-retest reliability metrics for 2-dimensional frontal plane projection angles (FPPAs) during the lateral step-down (LSD), single-limb squat (SLS), single-limb landing (SLL), and drop vertical jump (DVJ). DESIGN: Test-retest reliability study. SETTING: University laboratory. PARTICIPANTS: 20 healthy adults (12 female, age = 23.60 ±â€¯1.93 years old, body mass index = 24.26 ±â€¯2.54 kg/m2) were tested on 2 separate occasions 7-14 days apart. MAIN OUTCOME MEASURES: Intraclass correlation coefficients (ICC), standard errors of the measurement (SEM), and minimal detectable change (MDC) values across the LSD, SLS, SLL, and DVJ for the following body region variables: trunk, trunk on pelvis, pelvis, hip, thigh to vertical, knee, and shank to vertical. RESULTS: There was moderate-to-substantial between-day test-retest reliability for nearly all body regions across all tasks (ICC = 0.65-0.96). SEM values varied across body regions and tasks (0.9-3.5°). MDCs were variable (2.3-9.8°). Of the body regions, MDCs were largest for the knee and hip. By task, MDCs were lowest for the LSD. CONCLUSIONS: This study identified between-day test-retest reliability metrics for 2-dimensional FPPAs across a variety of body regions during commonly assessed clinical tasks. These data allow clinicians and researchers to more confidently assess true change between assessments or over time.

Psychogenic non-epileptic and epileptic seizures: clues for a differential diagnosis. Findings from a Colombian study. / Crisis psicogenas no epilepticas y crisis epilepticas: pistas para un diagnostico diferencial. Hallazgos de un estudio colombiano.

INTRODUCTION: Psychogenic non-epileptic seizures (PNES) are paroxysmal changes in behavior that resemble epileptic seizures, although they have no electrophysiological correlation or clinical evidence of epilepsy. AIM: To compare clinical and sociodemographic characteristics of patients diagnosed with PNES-alone and PNES-and-epilepsy. PATIENTS AND METHODS: A cross-sectional study of consecutive patients diagnosed with PNES in a 20-month period was carried out. A video-EEG was performed in all patients. Socio-demographical, clinical and semiological characteristics were compared between those patients with and without concomitant epilepsy. RESULTS: Sixty-five patients were included, 35 (53.9%) had PNES-alone and 30 (46.1%) had PNES-and-epilepsy. The proportion of women in the study was 70.8%. The median age at seizure onset was 16 years. A late start was recorded in PNES-alone group (23 years) compared to PNES-and-epilepsy group (11 years), however, it was not significant. There was a lower frequency of antiepileptic drugs use in the PNES-alone group compared with the PNES-and-epilepsy group. The most frequent semiological features were the gradual onset of events (69.2%) and the duration longer than two minutes (63.1%). CONCLUSION: The waxing and waning pattern during paroxysmal events suggest a non-epileptic origin. However, it is not uncommon to find patients with concomitant epileptic seizures.

TITLE: Crisis psicogenas no epilepticas y crisis epilepticas: pistas para un diagnostico diferencial. Hallazgos de un estudio colombiano.Introduccion. Las crisis psicogenas no epilepticas (CPNE) son cambios paroxisticos en el comportamiento que se asemejan a las crisis epilepticas, aunque no tienen correlacion electrofisiologica ni evidencia clinica de epilepsia. Objetivo. Comparar las caracteristicas clinicas y sociodemograficas entre pacientes diagnosticados con CPNE, con y sin epilepsia concomitante. Pacientes y metodos. Estudio transversal de pacientes consecutivamente diagnosticados de CPNE durante un periodo de 20 meses. A todos los participantes se les realizo un videoelectroencefalograma (video-EEG). Se compararon las caracteristicas sociodemograficas, clinicas y semiologicas entre los que presentaban y los que no presentaban epilepsia concomitante. Resultados. Se incluyo a 65 pacientes, 35 con CPNE (53,9%), y 30 con CPNE y epilepsia (46,1%). La edad mediana en el inicio del video-EEG fue de 33 años, y un 70,8% eran mujeres. La edad mediana de inicio de las crisis fue de 16 años. En el grupo de CPNE hubo un inicio mas tardio (23 años) en comparacion con el grupo de CNPE y epilepsia (11 años), pero la diferencia no fue significativa. La proporcion de pacientes en terapia con farmacos antiepilepticos fue significativamente mayor en el grupo con CPNE y epilepsia comparado con el grupo con CPNE. Las caracteristicas semiologicas mas frecuentemente encontradas fueron el inicio gradual de las crisis (69,2%) y una duracion de mas de dos minutos (63,1%). Conclusion. La variabilidad en los sintomas sugiere un origen no epileptico de los eventos paroxisticos, los cuales se presentan frecuentemente en pacientes con epilepsia.

Solubilization of organic matter by electrochemical treatment of sludge: Influence of operating conditions.

Sludge generated after wastewater treatment represents an important challenge due to the large amounts produced and the need to adequately treat it. Anaerobic digestion is the preferred treatment process to obtain renewable energy as well as a biosolid with the potential to be reused in land application. This process generates biogas (methane and carbon dioxide) that may be used for energy co-generation. However, anaerobic digestion is limited by the hydrolysis step since bacteria need to break down organic matter and large molecules to allow conversion into biogas. In this study, electrochemical treatment of sludge is proposed to solubilize organic matter. Boron-doped diamond electrodes were used to treat waste activated sludge under different experimental conditions (current density, flow rate, time) to evaluate their influence on the solubilization of organic matter (in terms of chemical oxygen demand). The degree of solubilization ranged between 0.31 and 1.78%. Based on the results, optimal operating conditions were current density of 19.3 mA cm-2, flow rate of 4 L min-1, and treatment time of 30 min. Furthermore, treatment flow rate was found to play a key role in solubilization, as the process is controlled by mass transfer.

Quick incubation process to determine inactivation of Ascaris and Toxocara eggs.

Helminth eggs are among the most important biological contaminants in environmental engineering. They pose a significant health risk associated with poor sanitation, the use of contaminated water for irrigation, and the disposal of excreta or sludge to land. Helminths are parasitic worms transmitted to humans via their eggs, which is the infective stage of their life cycle. They are therefore relevant to public health and environmental fields due to their low infectious dose, their persistence in the environment (up to several years), and their high resistance to conventional disinfection processes. The evaluation of the efficiency of any process of inactivation, through the determination of the viability of these parasites, is fundamental, but the traditional incubation technique requires 20 days to determine both the viability and the infectivity of nematode eggs. However, the present study found that, using an inactivation process at a temperature of 60 °C for 1 hour and incubation at 28 °C and 34 °C, the absence of division of the nucleus of eggs of species from two genera, Ascaris lumbricoides and Toxocara canis, showed them to be inactivated following only 48 hours of incubation. Similar inactivation results were observed using an automatic system as long as the eggs were inactivated. The minimum time required to evaluate the inactivation of nematode eggs through the incubation technique was 48 hours.