Seroprevalence of Trypanosoma cruzi among children from Veracruz, Mexico: Epidemiological baseline for a control model based on Chagas disease active transmission / Seroprevalencia de Trypanosoma cruzi en niños de Veracruz, México: línea epidemiológica de base para un modelo de control fundamentado de la transmisión activa de la enfermedad de Chagas.

Introduction. In 2021, the Secretaría de Salud de México and the Pan American Health Organization launched an initiative to interrupt intra-domiciliary vector transmission of Trypanosoma cruzi based on the prevalence of Chagas disease in children. The Mexican State of Veracruz was leading this initiative. Objective. To estimate the seroprevalence of T. cruzi infection among children under 15 years of age from rural areas of Veracruz, México. Materials and methods. We identified eight localities of high priority from the Municipality of Tempoal, Veracruz, for baseline serology. Blood samples were collected on filter paper from 817 individuals between June and August 2017, for screening with a third-generation enzyme immunoassay. Reactive cases were confirmed by indirect hemagglutination, enzyme-linked immunosorbent assay, and indirect immunofluorescence tests on peripheral blood serum samples. We calculated seroprevalence and 95% confidence intervals (CI). Results. We confirmed Chagas disease cases in children under 15 years of age with a seroprevalence of 1,9% (95 % CI = 1,12-3,16) in the localities of Citlaltepetl, Cornizuelo, Cruz de Palma and Rancho Nuevo. Conclusions. These results indicate recent transmission of T. cruzi in these communities and allow to establish an epidemiological baseline for the design and implementation of a model focused on geographical areas with active transmission to advance toward the elimination of intra-domiciliary vector transmission of this parasite in Mexico.

Introducción. En el 2021, la Secretaría de Salud de México y la Organización Panamericana de la Salud lanzaron una iniciativa para interrumpir la transmisión vectorial intradomiciliaria de Trypanosoma cruzi, fundamentada en la prevalencia de la enfermedad de Chagas en la población infantil. El estado mexicano de Veracruz fue el pionero de esta iniciativa. Objetivo. Estimar la seroprevalencia de infección por T. cruzi en menores de 15 años de localidades rurales de Veracruz, México. Materiales y métodos. Se identificaron ocho localidades prioritarias para la serología basal del municipio de Tempoal, Veracruz. Entre junio y agosto de 2017, se recolectaron muestras de sangre en papel filtro de 817 individuos para su tamizaje mediante un inmunoensayo enzimático de tercera generación. Los casos reactivos del tamizaje se confirmaron mediante pruebas de hemaglutinación indirecta, ensayo de inmunoabsorción ligado a enzimas e inmunofluorescencia indirecta en muestras de suero. Se calculó la seroprevalencia y su intervalo de confianza (IC) del 95 %. Resultados. En las localidades de Citlaltépetl, Cornizuelo, Cruz de Palma y Rancho Nuevo se confirmaron casos de la enfermedad de Chagas en menores de 15 años con una seroprevalencia de 1,9 % (IC 95 % = 1,12-3,16). Conclusiones. Los resultados indican que estas comunidades presentan transmisión reciente de T. cruzi y permiten establecer una línea epidemiológica de base para el diseño e implementación de un modelo dirigido a aquellas áreas geográficas con transmisión activa. Se espera que dicho modelo contribuya a la eliminación de la transmisión vectorial intradomiciliaria del tripanosomátido en México.

Fraping: A computational tool for detecting slight differences in fluorescence recovery after photobleaching (FRAP) data for actin polymerization analysis.

Fluorescence recovery after photobleaching (FRAP) is a laser method of light microscopy to evaluate the rapid movement of fluorescent molecules. To have a more reliable approach to analyze data from FRAP, we designed Fraping, a free access R library to data analysis obtained from FRAP. Unlike other programs, Fraping has a new form of analyzing curves of FRAP using statistical analysis based on the average curve difference. To evaluate our library, we analyzed the differences of actin polymerization in real time between dendrites and secondary neurites of cultured neuron transfected with LifeAct to track F-actin changes of neurites. We found that Fraping provided greater sensitivity than the conventional model using mobile fraction analysis. Likewise, this approach allowed us to normalize the fluorescence to the size area of interest and adjust data curves choosing the best parametric model. In addition, this library was supplemented with data simulation to have a more significant enrichment for the analysis behavior. We concluded that Fraping is a method that reduces bias when analyzing two data groups as compared with the conventional methods. This method also allows the users to choose a more suitable analysis approach according to their requirements. RESEARCH HIGHLIGHTS: Fraping is a new programming tool to analyze FRAP data to normalize fluorescence recovery curves. The conventional method uses one-point analysis, and the new one compares all the points to define the similarity of the fluorescence recovery.

Barriers to Access to Cardiac Surgery: Canadian Situation and Global Context.

Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Cardiovascular care spans primary, secondary, and tertiary prevention and care, whereby tertiary care is particularly prone to disparities in care. Challenges in access to care especially affect low- and middle-income countries (LMICs), however, multiple barriers also exist and persist across high-income countries. Canada is lauded for its universal health coverage but is faced with health care system challenges and substantial geographic barriers. Canada possesses 203 active cardiac surgeons, or 5.02 per million population, ranging from 3.70 per million in Newfoundland and Labrador to 7.48 in Nova Scotia. As such, Canada possesses fewer cardiac surgeons per million population than the average among high-income countries (7.15 per million), albeit more than the global average (1.64 per million) and far higher than the low-income country average (0.04 per million). In Canada, adult cardiac surgeons are active across 32 cardiac centres, representing 0.79 cardiac centres per million population, which is just above the global average (0.73 per million). In addition to centre and workforce variations, barriers to care exist in the form of waiting times, sociodemographic characteristics, insufficient virtual care infrastructure and electronic health record interoperability, and health care governance fragmentation. Meanwhile, Canada has highly favourable surgical outcomes, well established postacute cardiac care infrastructure, considerable spending on health, robust health administrative data, and effective health technology assessment agencies, which provides a foundation for continued improvements in care. In this narrative review, we describe successes and challenges surrounding access to cardiac surgery in Canada and globally.

Capsaicin and 1,25-Dihydroxyvitamin D3 Glycoside: Effects on the Reproductive Performance of Hyper-Prolific Sows.

This study evaluated the effect of a natural source of vitamin D3 [1,25-(OH)2D3] and capsaicin (CAP) in the dietary supplementation of sows in the final phase (85-114 days) of gestation (Gest) and lactation (Lact) on the reproductive performance of the sows and health of piglets through two experiments (Exp I and II). In Exp I, 120 sows were subjected to four treatments: T1-control (without [1,25-(OH)2D3] and supplemental CAP); T2-3.5 µg 1,25-(OH)2D3/Gest/day and 7.0 µg Vit 1,25-(OH)2D3/Lact/day; T3-7.0 µg CAP/Gest/day and 14.0 µg CAP/Lact/day; T4-1.75 µg Vit 1,25-(OH)2D3 + 3.5 µg CAP/Gest/day and 3.5 µg 1,25-(OH)2D3 + 7.0 µg CAP/Lact/day. In Exp II, 200 sows were randomly blocked, factorial 2 × 2 (without or with Vit 1,25-(OH)2D3 and without or with CAP): T1-control (without Vit 1,25-(OH)2D3 and CAP); T2-3.5 µg Vit 1,25-(OH)2D3/Gest/day and 7.0 µg Vit 1,25-(OH)2D3/Lact/day; T3-7.0 µg CAP/Gest/day and 14.0 µg CAP/Lact/day; T4-3.5 µg Vit 1,25-(OH)2D3 + 7 µg CAP/Gest/day; and 7.0 µg Vit 1,25-(OH)2D3 + 14.0 µg CAP/Lact/day. The duration of delivery (3:48 vs. 4:57 h) and the percentage of stillbirths (5.37% vs. 7.61%) were improved (p < 0.05) in the group that received Vit 1,25-(OH)2D3 (Exp II) compared to the control group. Moreover, the dystocia rate decreased (p < 0.05) in Exp II, which received Vit 1,25-(OH)2D3 (4.21 vs. 27.63%), and in Exp I, which received the combination of Vit 1,25-(OH)2D3 + CAP (12 vs. 40%) compared to the respective control groups. Colostrum production was greater (p < 0.05) in sows that received Vit 1,25-(OH)2D3 supplementation compared to the control group, consequently resulting in higher colostrum intake (p < 0.05) of the piglets (330 vs. 258 g/piglet). The additives reduced the incidence of diarrhea (p < 0.05) in piglets (Exp I and II). Thus, the use of additives improved the reproductive performance of sows and contributed to litter growth.

Anaesthetic management of a patient with Gerbode defect.

Gerbode defect is a rare left ventricle to right atrium shunt that can be acquired or congenital. The incidence of acquired defects has been growing and is caused by previous cardiac surgery, endocarditis, trauma and myocardial infarct. It can be challenging and the anesthesiologist should maintain a suspicion when there is circulatory failure after a cardiac surgery. It can be diagnosed by trans-esophageal echocardiography. In this case we presented the anesthetic management and the successful surgical correction of an acquired ventricular-atrial defect secondary to a previous mitral valve replacement.

Saberes, tradiciones y prácticas de alimentación materno-infantil en localidades del Carso Huasteco hidalguense / Knowledge, traditions, and practices of maternal and child feeding in localities of the Huasteco hidalguense Carso

Resumen La alimentación durante los primeros 1000 días de vida (desde el vientre materno hasta los dos años) son fundamentales para la salud futura de una persona. Este artículo tiene por objetivo analizar los saberes y prácticas alimentarias materno-infantiles en localidades rurales del Estado de Hidalgo en México. Estudio de corte transversal, descriptivo, observacional desde una perspectiva fenomenológica combinando técnicas cuantitativas y cualitativas en 56 participantes y 7 informantes a quienes se entrevistó. El 48% de las mujeres entrevistadas ofrecieron leche materna exclusivamente durante 4 a 6 meses, el 57% destetó después del año. La familia fue la principal fuente de información de las mujeres (91%), por encima del personal de salud (80%), quien frecuentemente da opiniones contradictorias. El 71% prefirió el uso de conocimientos de herbolaria provenientes de parteras, hijas de parteras o adultas mayores. Los saberes, tradiciones y prácticas alimentarias de las madres de menores de dos años en el Carso Huasteco hidalguense, se basan en conocimientos tradicionales permeados por el discurso del personal de salud y los medios de comunicación, así como el acceso físico y económico a los alimentos procesados y frescos.

Abstract Nutrition during the first 1000 days of life (from the womb to two years of age) is fundamental for the future health of a person. The objective of this article is to analyze maternal and child feeding knowledge and practices in rural localities of the state of Hidalgo in Mexico. A cross-sectional, descriptive, observational study was carried out from a phenomenological perspective combining quantitative and qualitative techniques in 56 participants and 7 informants who were interviewed. 48% of the women interviewed offered breast milk exclusively for 4 to 6 months, 57% weaned after one year. The family was the main source of information for the women (91%), above the health personnel (80%), who frequently gave contradictory opinions. Seventy-one percent preferred the use of herbal knowledge from midwives, daughters of midwives, or older women. The knowledge, traditions, and food practices of mothers of children under two years of age in the Carso Huasteco hidalguense are based on traditional knowledge permeated by the discourse of health personnel and the media, as well as physical and economic access to processed and fresh foods.

Sequence and Structural Motifs Controlling the Broad Substrate Specificity of the Mycobacterial Hormone-Sensitive Lipase LipN.

Mycobacterium tuberculosis has a complex life cycle transitioning between active and dormant growth states depending on environmental conditions. LipN (Rv2970c) is a conserved mycobacterial serine hydrolase with regulated catalytic activity at the interface between active and dormant growth conditions. LipN also catalyzes the xenobiotic degradation of a tertiary ester substrate and contains multiple conserved motifs connected with the ability to catalyze the hydrolysis of difficult tertiary ester substrates. Herein, we expanded a library of fluorogenic ester substrates to include more tertiary and constrained esters and screened 33 fluorogenic substrates for activation by LipN, identifying its unique substrate signature. LipN preferred short, unbranched ester substrates, but had its second highest activity against a heteroaromatic five-membered oxazole ester. Oxazole esters are present in multiple mycobacterial serine hydrolase inhibitors but have not been tested widely as ester substrates. Combined structural modeling, kinetic measurements, and substitutional analysis of LipN showcased a fairly rigid binding pocket preorganized for catalysis of short ester substrates. Substitution of diverse amino acids across the binding pocket significantly impacted the folded stability and catalytic activity of LipN with two conserved motifs (HGGGW and GDSAG) playing interconnected, multidimensional roles in regulating its substrate specificity. Together this detailed substrate specificity profile of LipN illustrates the complex interplay between structure and function in mycobacterial hormone-sensitive lipase homologues and indicates oxazole esters as promising inhibitor and substrate scaffolds for mycobacterial hydrolases.

The Low Variability of Tc24 in Trypanosoma cruzi TcI as an Advantage for Chagas Disease Prophylaxis and Diagnosis in Mexico.

(1) Background: Chagas disease is the main neglected tropical disease in America. It is estimated that around 6 million people are currently infected with the parasite in Latin America, and 25 million live in endemic areas with active transmission. The disease causes an estimated economic loss of USD 24 billion dollars annually, with a loss of 75,200 working years per year of life; it is responsible for around ~12,000 deaths annually. Although Mexico is an endemic country that recorded 10,186 new cases of Chagas disease during the period of 1990-2017, few studies have evaluated the genetic diversity of genes that could be involved in the prophylaxis and/or diagnosis of the parasite. One of the possible candidates proposed as a vaccine target is the 24 kDa trypomastigote excretory-secretory protein, Tc24, whose protection is linked to the stimulation of T. cruzi-specific CD8+ immune responses. (2) Methods: The aim of the present study was to evaluate the fine-scale genetic diversity and structure of Tc24 in T. cruzi isolates from Mexico, and to compare them with other populations reported in the Americas with the aim to reconsider the potential role of Tc24 as a key candidate for the prophylaxis and improvement of the diagnosis of Chagas disease in Mexico. (3) Results: Of the 25 Mexican isolates analysed, 48% (12) were recovered from humans and 24% (6) recovered from Triatoma barberi and Triatoma dimidiata. Phylogenetic inferences revealed a polytomy in the T. cruzi clade with two defined subgroups, one formed by all sequences of the DTU I and the other formed by DTU II-VI; both subgroups had high branch support. Genetic population analysis detected a single (monomorphic) haplotype of TcI throughout the entire distribution across both Mexico and South America. This information was supported by Nei's pairwise distances, where the sequences of TcI showed no genetic differences. (4) Conclusions: Given that both previous studies and the findings of the present work confirmed that TcI is the only genotype detected from human isolates obtained from various states of Mexico, and that there is no significant genetic variability in any of them, it is possible to propose the development of in silico strategies for the production of antigens that optimise the diagnosis of Chagas disease, such as quantitative ELISA methods that use this region of Tc24.

Yerbamate Tea Consumption: A Protective Factor in Parkinson Disease.

INTRODUCTION: Little is known about the association between Yerbamate (YMT) tea consumption and Parkinson disease (PD). We determined whether there was an association between YMT tea consumption and PD. METHODS: We conducted a multicenter case-control study in 3 countries (Argentina, Paraguay, and Uruguay). We applied a structured questionnaire about YMT tea consumption history. The survey also included information about factors previously associated with a decreased and increased risk of PD, apart from medical and demographic factors. Odds ratios and 95% confidence intervals were calculated using multivariate unconditional binary logistic regression analysis. RESULTS: We included 215 cases and 219 controls. The mean age of the cases was 65.6 ± 10.5 years and that of controls was 63.1 ± 10.5 years (P < 0.02). Years of YMT tea consumption, number of liters drunk per day, and amount of YMT used for preparing the infusion were similar between cases and controls (P > 0.05), but not the number of times the YMT was added into the container (P = 0.003) and the YMT tea concentration per serving (P = 0.02). The multivariate analysis showed that YMT tea concentration per serving lowered the risk for PD, independent of potential confounders (odds ratio, 0.62; 95% confidence interval, 0.47-0.84). CONCLUSIONS: This multicenter study highlights the association between an environmental factor, the YMT tea drinking, and PD. Although more evidence from longitudinal studies is needed, the results obtained here points toward a protective effect of the YMT tea concentration per serving on PD.

Endoscopic submucosal dissection for colorectal lesions: outcomes from a United States experience.

BACKGROUND AND STUDY AIMS: Endoscopic submucosal dissection (ESD) is commonly used in Asia for resection of large non-pedunculated colorectal polyps (LNPCPs) and early (T1) colorectal cancers. It allows for en bloc removal and is often curative. We describe outcomes of colorectal ESD from a United States (US) academic medical center and compare this to international experiences. METHODS: Retrospective review was performed of colonic lesions referred to the University of Chicago Medical Center for ESD from 2012 to 2020. Clinical and procedural data were collected. RESULTS: The study included 78 lesions with mean size of 29.7 mm (range 10-100 mm). The overall en bloc resection rate was 73.1% (n = 57). Between the first and second half of the study, it improved from 61.5 to 84.6% (p = 0.02). Histology showed adenocarcinoma in fifteen lesions (19.2%). Of all neoplastic lesions (n = 68), resection with negative margins (R0) was achieved in 54 cases (79.4%). Adverse events occurred in 9 cases (11.5%), but most (n = 6, 66.7%) were successfully treated endoscopically. Follow-up endoscopy was performed in 46 patients (59.0%) at a mean interval of 6.8 months (SD ± 5.0 months) with two case of recurrent lesion (4.3%). CONCLUSIONS: This study shows successful colorectal ESD outcomes at a US tertiary center. The en bloc resection rate was lower than other cohorts, but a learning curve was demonstrated. The R0 resection, lesion recurrence, and adverse event rates were similar to other non-Asian experiences, but not as favorable as in Asia [Fuccio et al. in Gastrointest Endosc 86:74-86.e17, 2017]. Increased ESD training in the US can help optimize utilization and outcomes.

Economic impact of Juvenile Idiopathic Arthritis: a systematic review.

BACKGROUND: Juvenile Idiopathic Arthritis (JIA) requires complex care that generate elevated costs, which results in a high economic impact for the family. The aim of this systematic review was to collect and cluster the information currently available on healthcare costs associated with JIA after the introduction of biological therapies. METHODS: We comprehensively searched in MEDLINE, EMBASE, Web of Science, Scopus, and Cochrane Databases for studies from January 2000 to March 2021. Reviewers working independently and in duplicate appraised the quality and included primary studies that report total, direct and/or indirect costs related to JIA for at least one year. The costs were converted to United States dollars and an inflationary adjustment was made. RESULTS: We found 18 eligible studies including data from 6,540 patients. Total costs were reported in 10 articles, ranging from $310 USD to $44,832 USD annually. Direct costs were reported in 16 articles ($193 USD to $32,446 USD), showing a proportion of 55 to 98 % of total costs. Those costs were mostly related to medications and medical appointments. Six studies reported indirect costs ($117 USD to $12,385 USD). Four studies reported costs according to JIA category observing the highest in polyarticular JIA. Total and direct costs increased up to three times after biological therapy initiation. A high risk of reporting bias and inconsistency of the methodology used were found. CONCLUSION: The costs of JIA are substantial, and the highest are derived from medication and medical appointments. Indirect costs of JIA are underrepresented in costs analysis.

Characterization of pectin extracted under mild conditions from tempesquistle (Sideroxylon palmeri) fruit at two maturity stages.

BACKGROUND: le tree (Sideroxylon palmeri) belongs to family Sapotaceae, and its fruits contain hydrophilic and hydrophobic gums. Aim of this study was to develop an extraction method for pectin, a hydrophilic gum, from green and ripe tempesquistle fruit. The extraction method was gentle to minimize potential structural changes in pectin, a maceration was used, and then pectin precipitation was induced with acetone at room temperature. Pectin characterization was carried out in two steps. The first step consisted of qualitative tests of Molisch, Fehling and Lugol. The second step consisted of quantitative tests to determine esterification degree (ED) by ATR-FTIR and D-galacturonic acid (D-GalA) content with a colorimetric assay. ATR-FTIR spectroscopic method revealed that green and ripe tempesquistle fruit have an ED of 0% and 30.4%, respectively. Both fruit have a low ED pectin. The content of D-GalA in green and ripe pectins was 18.8 ±2.7% and 20.2 ±0.6%, respectively. The yield obtained in green and ripe fruit samples was 1.6 ±0.2% and 3.0 ±0.1%, respectively. The extraction method allowed two types of pectins obtained in function of maturity stage of tempesquistle fruit distinguishable by. METHODS: istle tree (Sideroxylon palmeri) belongs to family Sapotaceae, and its fruits contain hydrophilic and hydrophobic gums. Aim of this study was to develop an extraction method for pectin, a hydrophilic gum, from green and ripe tempesquistle fruit. The extraction method was gentle to minimize potential structural changes in pectin, a maceration was used, and then pectin precipitation was induced with acetone at room temperature. Pectin characterization was carried out in two steps. The first step consisted of qualitative tests of Molisch, Fehling and Lugol. The second step consisted of quantitative tests to determine esterification degree (ED) by ATR-FTIR and D-galacturonic acid (D-GalA) content with a colorimetric assay. ATR-FTIR spectroscopic method revealed that green and ripe tempesquistle fruit have an ED of 0% and 30.4%, respectively. Both fruit have a low ED pectin. The content of D-GalA in green and ripe pectins was 18.8 ±2.7% and 20.2 ±0.6%, respectively. The yield obtained in green and ripe fruit samples was 1.6 ±0.2% and 3.0 ±0.1%, respectively. The extraction method allowed two types of pectins obtained in function of maturity stage of tempesquistle fruit distinguishable by ATR. RESULTS: istle tree (Sideroxylon palmeri) belongs to family Sapotaceae, and its fruits contain hydrophilic and hydrophobic gums. Aim of this study was to develop an extraction method for pectin, a hydrophilic gum, from green and ripe tempesquistle fruit. The extraction method was gentle to minimize potential structural changes in pectin, a maceration was used, and then pectin precipitation was induced with acetone at room temperature. Pectin characterization was carried out in two steps. The first step consisted of qualitative tests of Molisch, Fehling and Lugol. The second step consisted of quantitative tests to determine esterification degree (ED) by ATR-FTIR and D-galacturonic acid (D-GalA) content with a colorimetric assay. ATR-FTIR spectroscopic method revealed that green and ripe tempesquistle fruit have an ED of 0% and 30.4%, respectively. Both fruit have a low ED pectin. The content of D-GalA in green and ripe pectins was 18.8 ±2.7% and 20.2 ±0.6%, respectively. The yield obtained in green and ripe fruit samples was 1.6 ±0.2% and 3.0 ±0.1%, respectively. The extraction method allowed two types of pectins obtained in function of maturity stage of tempesquistle fruit distinguishable by ATR-FTIR.

Cost-Effectiveness of Rheumatic Heart Disease Echocardiographic Screening in Brazil: Data from the PROVAR+ Study: Cost-effectiveness of RHD screening in Brazil.

Introduction: In recent years, new technologies - noticeably ultra-portable echocardiographic machines - have emerged, allowing for Rheumatic Heart Disease (RHD) early diagnosis. We aimed to perform a cost-utility analysis to assess the cost-effectiveness of RHD screening with handheld devices in the Brazilian context. Methods: A Markov model was created to assess the cost-effectiveness of one-time screening for RHD in a hypothetical cohort of 11-year-old socioeconomically disadvantaged children, comparing the intervention to standard care using a public perspective and a 30-year time horizon. The model consisted of 13 states: No RHD, Undiagnosed Asymptomatic Borderline RHD, Diagnosed Asymptomatic Borderline RHD, Untreated Asymptomatic Definite RHD, Treated Asymptomatic Definite RHD, Untreated Mild Clinical RHD, Treated Mild Clinical RHD, Untreated Severe Clinical RHD, Treated Severe Clinical RHD, Surgery, Post-Surgery and Death. The initial distribution of the population over the different states was derived from primary echo screening data. Costs of the different states were derived from the Brazilian public health system database. Transition probabilities and utilities were derived from published studies. A discount rate of 3%/year was used. A cost-effectiveness threshold of $25,949.85 per Disability Adjusted Life Year (DALY) averted is used in concordance with the 3x GDP per capita threshold in 2015. Results: RHD echo screening is cost-effective with an Incremental Cost-Effectiveness Ratio of $10,148.38 per DALY averted. Probabilistic modelling shows that the intervention could be considered cost-effective in 70% of the iterations. Conclusion: Screening for RHD with hand held echocardiographic machines in 11-year-old children in the target population is cost-effective in the Brazilian context. Highlights: A cost-effectiveness analysis showed that Rheumatic Heart Disease (RHD) echocardiographic screening utilizing handheld devices, performed by non-physicians with remote interpretation by telemedicine is cost-effective in a 30-year time horizon in Brazil.The model included primary data from the first large-scale RHD screening program in Brazilian underserved populations and costs from the Unified Health System (SUS), and suggests that the Incremental Cost-Effectiveness Ratio of the intervention is considerably below the acceptable threshold for Brazil, even after a detailed sensitivity analysis.Considering the high prevalence of subclinical RHD in Brazil, and the significant economic burden posed by advanced disease, these data are important for the formulation of public policies and surveillance approaches.Cost-saving strategies first implemented in Brazil by the PROVAR study, such as task-shifting to non-physicians, computer-based training, routine use of affordable devices and telemedicine for remote diagnosis may help planning RHD control programs in endemic areas worldwide.

Correlation Between Ankle Brachial Index and Lower Limbs Digital Pulse Oximetry: A Referral Center Experience, Prevalence Study.

Objective Ankle-brachial index (ABI) is widely recommended and used to evaluate peripheral arterial disease. The oxygen saturation (SpO2) has been associated with ABI, showing a promising clinical practice utility; however, little literature regarding this matter has been reported. This study aims to assess the correlation between pulse oximetry and ABI.  Methods A cross-sectional study was conducted using ABI measuring devices, such as the MESI® Ankle Brachial Pressure Index (ABPI) (MESI, Ltd., Slovenia, EU) and pulse oximetry. We compared the SpO2 distribution by using the Wilcoxon test and evaluated its correlation by using logistic regression.  Results From a total of 86 patients, 54 were males (62.8%) and the median age was 54 years old (interquartile range (IQR) = 37 - 65 yrs.). Regarding ABI measurements of the right lower limb (RLL), a total of 20 patients (22.3%) had an abnormal classification. On the other hand, a total of 21 patients (22.1%) had an abnormal classification of the left lower limb (LLL) ABI measurements. The distribution of SpO2 in relation to ABI categories was not statistically different (RLL p = 0.2433; LLL p = 0.1242). The SpO2 classification of ABI and abnormal pulse oximetry for the RLL was at 76.7% and at 77.9% in the LLL (Pearson's goodness-of-fit test: RLL = p < 0.001 and LLL = p < 0.001).  Conclusion Although we didn't observe any statistical differences in the SpO2 distribution regarding ABI measurements, in their correlation, there seems to be a different tendency. The SpO2 might be a useful non-invasive tool to assess asymptomatic patients with risk factors for peripheral arterial disease (PAD).

Analysis of the efficiency of an emergency network for the treatment of multiple burn victims. / Análise da eficiência de uma rede de urgência para tratamento de múltiplos queimados.

OBJECTIVE: to evaluate the effectiveness of the adopted strategy and the care quality for pediatric trauma in the survival of patients attended after a disaster in a city in the interior of Minas Gerais state, compared to the expected results of studies on infant mortality in major burns. METHODS: retrospective observational analysis of ten patients who were burned and transferred to a trauma reference center. We used the modified R-Baux score to estimate the expected mortality. We compared the expected mortality predicted by R-Baux score and the actual mortality determined from one-ratio test. We also compared time of post-trauma admission with mortality and burned body surface area with mortality. RESULTS: mean R-Baux score was 75.2, which means an expected mortality of 5% among major burn patients. However, in this study, mortality in the group of children with large burned body surface area was of 60%, p=0.001, a rate far beyond that expected in literature. CONCLUSION: despite the innumerable variables, we consider the hypothesis of the pediatric trauma care infrastructure being inferior than the one needed in the state. This study suggests a greater incentive for public policies concerning pediatric trauma care, prepared referral center, well-established transfer agreements, and optimization of catastrophe plans, in order to reduce morbimortality of patients who survive the first hour after trauma.

OBJETIVO: avaliar a eficácia da estratégia adotada e a qualidade do atendimento em trauma pediátrico na sobrevivência dos pacientes atendidos após desastre em uma cidade do interior de Minas Gerais, em comparação a resultados esperados por estudos sobre mortalidade infantil em grandes queimados. MÉTODOS: análise retrospectiva observacional de dez pacientes que sofreram queimaduras e foram transferidos para um centro de referência de trauma. Utilizou-se o escore de R-Baux modificado para estimar a mortalidade esperada. Comparou-se a mortalidade esperada a partir do escore de R-Baux e a mortalidade real, a partir do teste de uma proporção. Comparou-se, também, tempo de admissão pós-trauma com mortalidade e grau de superfície corporal queimada com mortalidade. RESULTADOS: o R-Baux médio foi de 75,2, o que significa uma mortalidade esperada para grandes queimados de 5%. No entanto, a mortalidade do grupo com grande área de superfície corporal queimada desse estudo foi de 60%, valor p=0,001. Observou-se neste caso uma mortalidade muito além da esperada pela literatura. CONCLUSÃO: apesar das inúmeras variáveis, aventa-se a hipótese de infraestrutura de atendimento em trauma pediátrico aquém da necessária no Estado. Este estudo sugere maior incentivo à políticas públicas para atendimento de trauma pediátrico, centro de referência preparado, acordos de transferência bem estabelecidos e otimização de planos de catástrofe para diminuição da morbimortalidade para os pacientes que sobrevivem à primeira hora após o trauma.

Nodule bacteria from the cultured legume Phaseolus dumosus (belonging to the Phaseolus vulgaris cross-inoculation group) with common tropici phenotypic characteristics and symbiovar but distinctive phylogenomic position and chromid.

Phaseolus dumosus is an endemic species from mountain tops in Mexico that was found in traditional agriculture areas in Veracruz, Mexico. P. dumosus plants were identified by ITS sequences and their nodules were collected from agricultural fields or from trap plant experiments in the laboratory. Bacteria from P. dumosus nodules were identified as belonging to the phaseoli-etli-leguminosarum (PEL) or to the tropici group by 16S rRNA gene sequences. We obtained complete closed genomes from two P. dumosus isolates CCGE531 and CCGE532 that were phylogenetically placed within the tropici group but with a distinctive phylogenomic position and low average nucleotide identity (ANI). CCGE531 and CCGE532 had common phenotypic characteristics with tropici type B rhizobial symbionts. Genome synteny analysis and ANI showed that P. dumosus isolates had different chromids and our analysis suggests that chromids have independently evolved in different lineages of the Rhizobium genus. Finally, we considered that P. dumosus and Phaseolus vulgaris plants belong to the same cross-inoculation group since they have conserved symbiotic affinites for rhizobia.

Integration of echocardiographic screening by non-physicians with remote reading in primary care.

INTRODUCTION: Heart disease (HD) accounts for high morbidity and mortality in Brazil. Underserved populations often suffer long delays in diagnosis. We aimed to evaluate the feasibility of integrating screening echocardiography (echo) with remote interpretation in the established primary care system (PC) in Brazil and to assess HD prevalence. METHODS: Over 11 months, 20 healthcare workers (four physicians, four nurses, and 12 technicians) at 16 PC centres were trained on simplified handheld echo protocols. Three screening (SC) groups, including all consented patients aged 17-20, 35-40 and 60-65 years, and patients referred (RF) for clinical indications underwent focused echo. Studies were remotely interpreted through telemedicine. Significant HD was defined as moderate/severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion, wall-motion abnormalities and congenital heart disease. RESULTS: Total 1004 patients underwent echo; 299 (29.8%) in the SC group. Median age was 51±18 years, 63.9% females; 42.7% had cardiovascular symptoms. Significant HD was found in 354 (35.3%) patients (23.4% in SC vs 40.3% in RF group, p<0.001). Prevalence was higher in patients in the SC group aged >60 years (29.2%), compared with 35-40 (14.9%) and under 20 (16.5%), p=0.012. Comparing SC to RF groups, moderate/severe left ventricular dysfunction was observed in 4.1% vs 8.1%, p=0.03, mitral regurgitation in 8.9% vs 20.3%, p<0.001 and aortic stenosis in 5.4% vs 4.3%, p=0.51. CONCLUSIONS: Integration focused echo into PC is feasible in Brazil as a strategy to deliver cardiovascular care to low-resourced areas through task shifting. The burden of HD observed suggests this tool may improve early diagnosis and referral.

Tendencia de los años perdidos de vida potencial por trauma en Colombia: análisis de un periodo de nueve años / Trend of lost years of potential life due to trauma in Colombia: Analysis of a nine-year period

Introducción. El trauma es reconocido como una epidemia global que varía según las regiones donde se presenta. Una parte de la carga de la enfermedad está determinada por los años perdidos de vida potencial, la cual es una estimación de amplio uso para la vigilancia en salud pública; sin embargo, existe poca información disponible en relación a esto. El objetivo de este estudio fue determinar la tendencia de los años perdidos de vida potencial por el trauma en un período de nueve años.Métodos. La información se obtuvo del Instituto Nacional de Medicina Legal y Ciencias Forenses en un período de nueve años (2007-2015). La población de referencia se determinó con base en las proyecciones del Departamento Administrativo Nacional de Estadística, que indicaron una expectativa de vida de 75 años.Resultados. En el 2015, a las lesiones por traumatismos en Colombia les correspondieron 1.920,7 años perdidos de vida potencial por cada 100.000 personas. Durante el período de estudio, las principales causas fueron los homicidios (rango, 51 a 68 %) y los accidentes de tránsito (rango, 19 a 28 %); la relación entre hombres y mujeres fue de 7:1, y la tendencia estadística fue hacia la disminución de los años perdidos de vida potencial.Conclusiones. Los homicidios siguen aportando el mayor número de lesiones por trauma y años perdidos de vida potencial. Los hombres jóvenes continuaron siendo la población mayormente afectada. Se conceptúa la necesidad de incrementar los esfuerzos para mejorar la vigilancia en salud pública y ahondar en las intervenciones oportunas relacionadas con el trauma (AU)

Introduction: Trauma is a worldwide leading cause of external injuries that varies according to the regions. In 2015, trauma injuries were the third cause of Disability Adjusted Life Years (DALYs) with the 9% of the total global burden of disease. A portion of the burden of disease is determined by the Years of Potential Life Lost (YPLL). In Colombia in 2015, from the total of deaths due to external cause injuries, homicides had the highest number of YPLL with a total of 495.667; traffic accidents had 236.237 YPLL and accidental deaths 90.745 YPLL. The YPLL trauma trends and baselines are important to public health surveillance but there's no consolidated description. The aim of this study is to determine trauma trends in a five-year period.Material and methods: The information was obtained from the reports of Instituto Nacional de Medicinal Le-gal y Ciencias Forenses in a nine-year period (2007-2015). The reference population was identified through the population projections from the Departmento Administrativo Nacional de Estadística (DANE). YPLL calculation was compared to a 75 years life expectancy.Results: In 2015 trauma injuries in Colombia had a total of 1.920,7 YPLL per 100.000 people. Overall the study period, leading cause of YPLL was homicides (range= 51-68%) and traffic accidents (range= 19-28%), ratio male: female was 7:1 and YPLL observed had decreased. The percentage of the total decrease was 6.3%, the highest increase was observed in 2009 with a raise of 30.5%.Conclusions: Homicides are a major public health issue such as the leading cause in YPLL of trauma injuries. Despite there was no increase in sex ratio, younger males are getting more affected through the time increasing YPLL in this population group. More efforts are needed to improve public health surveillance for assessing baselines, DALYs, policies and evidence for interventions in trauma-related injuries (AU)