Assessment of the yellow fever outbreak in Angola from December 2015 through December 2016: A retrospective study.

Background and Aims: The acute tropical infectious disease known as yellow fever (YF) is caused by an arbovirus and is characterized by fever, jaundice, hemorrhage, headache, muscle pain, nausea, vomiting, and fatigue. Angola experienced a yellow fever virus (YFV) outbreak that was documented in December 2015. However, little is known about the outcome of this outbreak. We aimed to demonstrate epidemic features and lessons learned during the YF epidemic in Angola. Methods: A total of 4618 blood samples from suspected YF cases were sent to the Instituto Nacional de Investigação em Saúde (INIS), a national referral and public health laboratory, between December 5, 2015, and December 23, 2016. Sample analyses were conducted using enzyme-linked immunosorbent assay (ELISA) and reverse transcription polymerase chain reaction (RT-PCR) assays. Blood samples were sent from 16 out of the 18 provinces of Angola. Results: We detected 884 (19.1%) cases that were positive for ELISA, which were confirmed by RT-PCR assay. Considering the positive cases, the incidence among male patients was around three times higher (n = 223; 10.9%) than in female patients (n = 59; 2.6%) in the 20-29 age group, followed by the age group 10-19 with n = 211 (6.8%) in males versus n = 108 (3.3%) in females; and the age group 30-39 had n = 68 (4.8%) in males versus n = 28 (1.8%) in females. The other groups had an incidence below 3.0%. The case fatality ratio for YF was in young adults in the age group 20-29 with n = 39 cases, followed by the age group 10-19 with n = 16 cases, and finally the age group 0-9 with n = 13 cases. The other age groups had several deaths by YF below 10 cases. Conclusions: This study demonstrates features of the YF epidemic that occurred in Angola. Also, it demonstrates that YF causes deaths in young people but is preventable by high vaccine coverage. Thus, public health laboratory surveillance must be strengthened to reduce the possibility of emerging and re-emerging human infections.

Patrones inflamatorios en niños asmáticos basados en la determinación de óxido nítrico alveolar / Inflammatory Patterns in Asthmatic Children Based on Alveolar Nitric Oxide Determination

Introducción: El óxido nítrico (NO) puede medirse a nivel proximal (flujo máximo NO en vía aérea [J'awNO]) y distal (concentración alveolar de NO [CANO]). Se han descrito 4 patrones inflamatorios en asmáticos, aunque su relevancia no ha sido bien establecida. El objetivo ha sido determinar el J'awNO y la CANO para establecer 4 categorías inflamatorias en asmáticos. Material y métodos: Estudio transversal de una muestra de niños sanos y asmáticos. Determinación de NO exhalado a flujos múltiples. De acuerdo con el modelo bicompartimental se obtuvieron la CANOy el J'awNO. En asmáticos se realizó cuestionario de control de asma (CAN) y espirometría forzada. Categorización de pacientes en tipo i (J'awNO y CANO normal), tipo ii (J'awNO elevado y CANO normal), tipo iii (J'awNO y CANO elevados) y tipo iv (J'awNO normal y CANO elevado). Estudio de correlación entre FENO,50, J'awNO y CANO mediante R de Spearman. Análisis de la varianza y comparaciones pareadas, mediante corrección post hoc de Bonferroni. Resultados: Se estudiaron 162 niños: 49 (32,23%) controles sanos y 103 (67,76%) asmáticos. Se excluyeron 10 niños, 4 (2.4%) porque las eterminaciones fueron incorrectas y 6 (3,7%) porque las determinaciones no siguieron el modelo lineal (valores de CANO negativos). En controles la FENO,50 (ppb) (mediana y rango) fue 11,5 (1,6-27,3), J'awNO (pl/s) 516 (98,3-1.470) y CANO(ppb) 2,2 (0,1-4,5). De los asmáticos, 44 (42,7%) se categorizaron en tipo i, 41 (39,8%) en tipo ii, 14 (13,5%%) en tipo iii y 4 (3,88%) en tipo iv. Buena correlación entre J'awNO y FENO,50(r = 0,97). No hubo asociación entre J'awNO y CANO. Disminución significativa de FEV1/FVC en tipo iii (media 79,8 ± 7,5). La morbilidad fue significativamente superior en tipos iii y iv. Conclusiones: Los valores de normalidad obtenidos son similares a los previamente publicados. Los asmáticos con CANO elevado presentaron mayor morbilidad. No hay correlación entre inflamación proximal y distal

Introduction: Nitric oxide (NO) levels can be measured at proximal (maximum airway NO flux [J’awNO]) and distal (alveolar NO concentration [CANO]) levels. Four inflammatory patterns have been described in asthmatic individuals, although their relevance has not been well established. The objective was to determine J’awNO and CANO in order to establish four inflammatory categories in asthmatics. Material and methods: Cross-sectional study of a sample consisting of healthy and asthmatic children. Exhaled NO was determined at multiple flows. J’awNO and CANO were obtained according to the two-compartment model. The asthma control questionnaire (ACQ) and spirometry were administered to asthmatic children. Patients were categorized as type i (normal J’awNO and CANO), type ii (elevated J’awNO and normal CANO), type iii (elevated J’awNO and CANO) and type iv (normal J’awNO and elevated CANO). Correlation between FENO,50, J’awNO and CANO was analyzed using Spearman’s R Correlation Test. Analysis of variance and paired comparisons were performed using the Bonferroni correction. Results: One hundred sixty-two children were studied, of whom 49 (32.23%) were healthy controls and 103 (67.76%) asthmatics. In the control subjects, FENO,50 (ppb)(median and range) was 11.5 (1.6 to 27.3), J’awNO (pl/s) was 516 (98.3 to 1470) and CANO (ppb) was 2.2 (0.1 to 4.5). Forty-four (42.7%) of the asthmatic participants were categorized as type i, 41 (39.8%) as type ii, 14 (13.5%) as type iii and 4 (3.88%) as type iv. Good correlation was observed between J’awNO and FENO,50 (r = 0.97). There was no association between J’awNO and CANO. FEV1/FVC decreased significantly in type iii (mean 79.8 ± 7.5). Morbidity was significantly higher in types iii and iv. Conclusions: Normal values obtained are similar to those previously reported. Asthmatics with high CANO showed higher morbidity. No correlation was found between proximal and distal inflammation

Polycystic echinococcosis in Pacas, Amazon region, Peru.

In the Peruvian Amazon, paca meat is consumed by humans. To determine human risk for polycystic echinococcosis, we examined wild pacas from 2 villages; 15 (11.7%) of 128 were infected with Echinococcus vogeli tapeworms. High E. vogeli prevalence among pacas indicates potential risk for humans living in E. vogeli-contaminated areas.

Inflammatory patterns in asthmatic children based on alveolar nitric oxide determination.

INTRODUCTION: Nitric oxide (NO) levels can be measured at proximal (maximum airway NO flux [J'aw(NO)]) and distal (alveolar NO concentration [C(ANO)]) levels. Four inflammatory patterns have been described in asthmatic individuals, although their relevance has not been well established. The objective was to determine J'aw(NO) and C(ANO) in order to establish four inflammatory categories in asthmatics. MATERIAL AND METHODS: Cross-sectional study of a sample consisting of healthy and asthmatic children. Exhaled NO was determined at multiple flows. J'aw(NO) and C(ANO) were obtained according to the two-compartment model. The asthma control questionnaire (ACQ) and spirometry were administered to asthmatic children. Patients were categorized as type I (normal J'aw(NO) and C(ANO)), type II (elevated J'aw(NO) and normal C(ANO)), type III (elevated J'aw(NO) and C(ANO)) and type IV (normal J'aw(NO) and elevated C(ANO)). Correlation between FE(NO,50), J'aw(NO) and C(ANO) was analyzed using Spearman's R Correlation Test. Analysis of variance and paired comparisons were performed using the Bonferroni correction. RESULTS: One hundred sixty-two children were studied, of whom 49 (32.23%) were healthy controls and 103 (67.76%) asthmatics. In the control subjects, FE(NO,50) (ppb)(median and range) was 11.5 (1.6 to 27.3), J'aw(NO) (pl/s) was 516 (98.3 to 1470) and C(ANO) (ppb) was 2.2 (0.1 to 4.5). Forty-four (42.7%) of the asthmatic participants were categorized as type I, 41 (39.8%) as type II, 14 (13.5%) as type III and 4 (3.88%) as type IV. Good correlation was observed between J'aw(NO) and FE(NO,50) (r=0.97). There was no association between J'aw(NO) and C(ANO). FEV1/FVC decreased significantly in type III (mean 79.8±7.5). Morbidity was significantly higher in types III and IV. CONCLUSIONS: Normal values obtained are similar to those previously reported. Asthmatics with high C(ANO) showed higher morbidity. No correlation was found between proximal and distal inflammation.

Óxido nítrico exhalado e índice predictivo de asma en menores de dos años / Fraction of Exhaled Nitric Oxide and Asthma Predictive Index in Infants Less Than Two Years-Old

Introducción: La fracción exhalada del óxido nítrico (FENO) se considera marcador indirecto de la inflamacióneosinofílica de la vía aérea. En niños colaboradores la metodología habitual es mediante respiraciónúnica. La imposibilidad de realizarla en niños no colaboradores ha permitido desarrollar la técnica a respiracióncorriente on-line y off-line. El objetivo del estudio ha sido analizar la relación entre la FENO on-linea respiraciones múltiples y el índice predictivo de asma (IPA) en niños menores de dos años.Material y métodos: Estudio observacional y transversal en una muestra consecutiva de niños y niñas entredos meses y dos años de edad, durante un período de 4 meses. Se determinó la FENO postprandial onlinea respiración corriente con respiraciones múltiples y flujo espiratorio entre 40 y 60 ml/s, medianteanalizador de quimioluminiscencia estacionario (CLD 88 sp). Variables cuantitativas: edad, peso, IgE,eosinofilia, FENO, flujo espiratorio. Variables cualitativas: sexo, dermatitis atópica, rinitis alérgica, alergiaalimentaria y medicamentosa, antecedentes familiares de asma y atopia, diagnóstico y tratamiento. Seha analizado la asociación entre IPA y FENO mediante test exacto de Fisher y t de Student y el grado deacuerdo entre IPA y FENO mediante Kappa de Cohen. Se ha estudiado la relación entre eosinofilia, IgE,dermatitis atópica y FENO (test exacto de Fisher y t de Student).Resultados: Cohorte constituida por 38 pacientes. Realizaron las determinaciones con éxito 32 (84,21%)casos. Edad media 10,9±5,06 meses. Los casos con IPA positivo tenían valores de FENO significativamentesuperiores a los IPA negativos con grado de acuerdo entre IPA y FENO de 0,71.Conclusiones: Existe asociación significativa y un buen grado de acuerdo entre la FENO a respiracióncorriente online y el IPA(AU)

Introduction: The fraction of exhaled nitric oxide (FENO) is considered as an indirect marker of eosinophilicinflammation of the airway. In collaborating children the usual method is by a single breath. Theimpossibility of performing this in non-collaborating children has led to the development of the onlineand offline tidal breathing technique. The objective of the study has been to analyse the relationshipbetween the multiple breaths online FENO and the asthma predictive index (API) in children less than 2years-old.Material and methods: An observational and cross-sectional study on a consecutive sample of boys andgirls between 2 months and 2 years of age, over a period of 4 months. The post-prandial multiple breathsonline FENO and flow spirometry between 40 and 60 ml/s, using a stationary chemiluminescence analyser(CLD 88 sp). The quantitative variables were: age, weight, IgE, eosinophilia, FENO, flow spirometry. Thequalitative variables were: gender, atopic dermatitis, allergic rhinitis, food and medical allergies, familyhistory of asthma and atopy, diagnosis and treatment. The relationship between API and FENO was analysedusing the exact Fisher and Student t tests and the level of agreement between API and FENO usingCohen’s Kappa. The relationship between eosinophilia, IgE, atopic dermatitis and FENO was also studied(exact Fisher and Student t tests). Results: The cohort consisted of 38 patients. The determinations were successfully carried out on 32(84.21) of the cases. The mean age was 10.9±5.06 months. The cases with a positive API had significantlyhigher FENO values than those with a negative API, with a level of agreement between API and FENO of0.71.Conclusions: There is a significant relationship and a good level of agreement between the online tidalbreathing FENO and the API(AU)

Poliomyelitis outbreaks in Angola genetically linked to India: risk factors and implications for prevention of outbreaks due to wild poliovirus importations.

We conducted an investigation of two outbreaks of poliomyelitis in Angola during 2007-2008 due to wild poliovirus (WPV) genetically linked to India. A case-control study including 27 case-patients and 76 age- and neighborhood-matched control-subjects was conducted to assess risk factors associated with paralytic poliomyelitis, and epidemiologic links to India were explored through in-depth case-patient interviews. In multivariable analysis, case-patients were more likely than control-subjects to be undervaccinated with fewer than four routine doses of oral poliovirus vaccine (adjusted matched odds ratio [aMOR], 4.1; 95% confidence interval [CI], 1.2-13.6) and have an adult household member who traveled outside the province of residence in the 2 months preceding onset of paralysis (aMOR, 3.2; 95% CI, 1.2-8.6). No epidemiologic link with India was identified. These findings underscore the importance of routine immunization to prevent outbreaks following WPV importations and suggest a possible role of adults in sustaining WPV transmission.

Fraction of exhaled nitric oxide and asthma predictive index in infants less than two years-old.

INTRODUCTION: The fraction of exhaled nitric oxide (FE(NO)) is considered as an indirect marker of eosinophilic inflammation of the airway. In collaborating children the usual method is by a single breath. The impossibility of performing this in non-collaborating children has led to the development of the online and offline tidal breathing technique. The objective of the study has been to analyse the relationship between the multiple breaths online FE(NO) and the asthma predictive index (API) in children less than 2 years-old. MATERIAL AND METHODS: An observational and cross-sectional study on a consecutive sample of boys and girls between 2 months and 2 years of age, over a period of 4 months. The post-prandial multiple breaths online FE(NO) and flow spirometry between 40 and 60 ml/s, using a stationary chemiluminescence analyser (CLD 88 sp). The quantitative variables were: age, weight, IgE, eosinophilia, FE(NO), flow spirometry. The qualitative variables were: gender, atopic dermatitis, allergic rhinitis, food and medical allergies, family history of asthma and atopy, diagnosis and treatment. The relationship between API and FE(NO) was analysed using the exact Fisher and Student t tests and the level of agreement between API and FE(NO) using Cohen's Kappa. The relationship between eosinophilia, IgE, atopic dermatitis and FE(NO) was also studied (exact Fisher and Student t tests). RESULTS: The cohort consisted of 38 patients. The determinations were successfully carried out on 32 (84.21) of the cases. The mean age was 10.9±5.06 months. The cases with a positive API had significantly higher FE(NO) values than those with a negative API, with a level of agreement between API and FE(NO) of 0.71. CONCLUSIONS: There is a significant relationship and a good level of agreement between the online tidal breathing FE(NO) and the API.

Cartel del pase: salidas de análisis

Documentos del dispositivo del pase en la EOL. Carteles 1996 - 1998

Creer o saber

Documentos del dispositivo del pase en la EOL. Carteles 1996 - 1998

Excepción y nominación

Conferencia dictada en la EOL en agosto de 1998

¿Por qué la Escuela Una?

Pronunciado en la noche de la EOL del 19 de octubre de 1998

Las garantías

Presentación en la mesa "El psicoanálisis en el mundo" del ciclo Opción Abierto de la EOL, 1994

Los Carteles y la Escuela

Publicado en Uno por Uno, número especial, marzo de 1991

El malestar contemporáneo

Mesa redonda en la Biblioteca Nacional, el 29 de septiembre de 1998

Repetición de lo nuevo

Presentación en la apertura del Ateneo "Lecturas de lo nuevo" de "El malestar en la Cultura", en agosto de 1999

La época y la pulsión

Disertación de apertura de las Jornadas del Ateneo sobre "El malestar en la cultura actual", en la EOL en mayo de 1009. Publicado en Más Uno Nº 4

Pragmatismo y metafísica

Inédito, 1998

Síntoma y modernidad

Intervención en la mesa redonda "Síntoma y modernidad" de las Jornadas Anuales de la EOL "Satisfacciones del síntoma", publicado por la Colección Orientación Lacaniana