The impact of dengue illness on social distancing and caregiving behavior.

BACKGROUND: Human mobility among residential locations can drive dengue virus (DENV) transmission dynamics. Recently, it was shown that individuals with symptomatic DENV infection exhibit significant changes in their mobility patterns, spending more time at home during illness. This change in mobility is predicted to increase the risk of acquiring infection for those living with or visiting the ill individual. It has yet to be considered, however, whether social contacts are also changing their mobility, either by socially distancing themselves from the infectious individual or increasing contact to help care for them. Social, or physical, distancing and caregiving could have diverse yet important impacts on DENV transmission dynamics; therefore, it is necessary to better understand the nature and frequency of these behaviors including their effect on mobility. METHODOLOGY AND PRINCIPAL FINDINGS: Through community-based febrile illness surveillance and RT-PCR infection confirmation, 67 DENV positive (DENV+) residents were identified in the city of Iquitos, Peru. Using retrospective interviews, data were collected on visitors and home-based care received during the illness. While 15% of participants lost visitors during their illness, 22% gained visitors; overall, 32% of all individuals (particularly females) received visitors while symptomatic. Caregiving was common (90%), particularly caring by housemates (91%) and caring for children (98%). Twenty-eight percent of caregivers changed their behavior enough to have their work (and, likely, mobility patterns) affected. This was significantly more likely when caring for individuals with low "health-related quality of well-being" during illness (Fisher's Exact, p = 0.01). CONCLUSIONS/SIGNIFICANCE: Our study demonstrates that social contacts of individuals with dengue modify their patterns of visitation and caregiving. The observed mobility changes could impact a susceptible individual's exposure to virus or a presymptomatic/clinically inapparent individual's contribution to onward transmission. Accounting for changes in social contact mobility is imperative in order to get a more accurate understanding of DENV transmission.

Manifestación atípica de sarcoidosis: calcificaciones pulmonares / Atypical presentation of sarcoidosis: pulmonary calcifica

Varón de 53 años, exfumador, diagnosticado de EPOC y sarcoidosis sistémica en tratamiento (afectación ganglionar múltiple, cutánea y renal) que presentó un infiltrado parenquimatoso en lóbulo superior izquierdo como hallazgo casual en radiografía de tórax. En TC realizada dada su persistencia, se observó afectación en vidrio deslustrado en campos medios y superiores, aparentemente secundaria a sarcoidosis. Dado el contexto de estabilidad clínica, se decidió realizar un control radiográfico en 6 meses, objetivándose un claro empeoramiento. La nueva TC mostró zonas de consolidación sobre las áreas que previamente presentaban mayor afectación en vidrio deslustrado, mostrando ahora valores de atenuación tan elevados que únicamente podrían corresponder a calcio. La aparición de las calcificaciones sobre tejido pulmonar previamente alterado, así como la ausencia de datos clínicos y analíticos de infección y/o desestabilización del metabolismo del calcio, apoyan que la sarcoidosis sea la causa de estas calcificaciones, lo cual es excepcional

53-year-old man, former smoker, with COPD and systemic sarcoidosis under treatment (multiple lymph nodes, skin and kidney affection). A chest x-ray showed a parenchyma infiltrate in upper left lobe. Chest CT demonstrated areas of ground-glass opacification at middle and upper areas of both lungs. As the patient was clinically stable, we decided to do an X-ray control 6 months later. The new chest X-ray image showed a clear worsening, with more severe infiltrates in middle and upper areas of both lungs. At this time, chest CT demonstrated pulmonary calcifications at the same areas that had been shown affected in the previous CT. These dystrophic calcifications were probably secondary to sarcoidosis. This is further supported by the clinical and analytical stability of the patient during this period, without developing signs of infectious processes or decompensation of calcium metabolic disorders

[Diffuse infiltrative lung disease, pericarditis, pleural effusion and ceritinib hypersensitivity]. / Pneumopathie infiltrative diffuse, péricardite et pleurésie d'hypersensibilité compliquant un traitement par ceritinib.

Tyrosine kinase inhibitors are now major actors for the treatment of non-small-cell metastatic lung cancers where ROS 1 gene rearrangement is present. Because of the rapid development of these new therapies, developing information about their monitoring and knowledge about their potential toxicities is essential. We describe the case of a patient who was treated with ceritinib as a third line approach for a metastatic lung adenocarcinoma with ROS1 rearrangement. After two months, the patient developed acute respiratory distress with pericarditis and pleurisy. A hypersensitivity reaction was suggested and supported by favorable clinical and radiological outcomes within three days following ceritinib discontinuation and systemic corticosteroid introduction. Pleural effusion, pericarditis and diffuse pulmonary infiltration associated to ceritinib have not often been described previously. Despite few data of pulmonary toxicity related to ceritinib, the current observation highlights the need for caution and regular monitoring when using these inhibitors.

Water-in-oil organogel based emulsions as a tool for increasing bioaccessibility and cell permeability of poorly water-soluble nutraceuticals.

The use of organogels in food and pharmaceutical sciences has several technical problems related with restricted diffusion of the drugs and lack of a proper gelator molecule. These features are important into the new product design. An alternative to improve technological properties in organogels is the use of emulsions. However, there is a lack of knowledge about the behavior on bioaccessibility and permeability of bioactives loaded into organogel-based emulsions. The objective of the present experimental work was to study the physical properties of organogel-based emulsions made with vegetable oil loaded with three different bioactives (betulin, curcumin and quercetin) and the influence on their bioaccessibility. Organogels were made of canola or coconut oils and myverol as gelator (10% w/w). Water-in-oil emulsions (at 5, 10 and 12.5 wt% of water content) were prepared by mixing the melted proper organogel and water (80 °C) under high shear conditions (20,000 rpm). Micrographs, rheological tests (amplitude, frequency, temperature sweeps and creep-compliance measurements), DSC and particle size analysis were performed to samples. In vitro digestion (oral, gastric and intestinal phase), lipolysis assays, bioaccessibility and permeability tests by cell culture of Caco-2 were made. Organogels of coconut oil have shown poor emulsification properties.

Core to shell switching of the conduction channel on SnO2 nanowire sensors.

A sensor based on random connections of single-crystalline SnO2 nanowires (NWs) has been fabricated for ethanol detection. The NW length of ∼10 µm leads to the formation of several random node connections between the Ag electrodes. The samples were subjected to thermal treatments under a reducing atmosphere of H2/Ar, to generate oxygen vacancies at the surface of the NWs. As a result, the core conduction channel of the NWs, where the conduction is based on electron hopping through the potential barriers at the contact nodes, switch to the surface of the NWs by the creation of an impurity band of shallow donors located at 0.347 eV below the conduction band. We suggest that the H2-rich atmosphere of the thermal treatments induced the formation of interstitial hydrogen (H i ) and substitutional hydrogen (HO), which are shallow donors with low formation energy.

Evidence of multi-walled carbon nanotube fragmentation induced by sonication during nanotube encapsulation via bulk-suspension polymerization.

The synthesis of multi-walled carbon nanotube/polystyrene composites, with nanotube concentrations of 0.04, 0.08 and 0.16 wt%, was carried out by in situ bulk-suspension polymerization with the assistance of sonication. By using this method both encapsulation and exfoliation of the nanotubes into the polymer host were achieved. Evidence of significant nanotube fragmentation was found by scanning electron microscopy; the cause of such fragmentation was attributed to the induction of strong cavitation due to the application of ultrasound during the synthesis. Infrared spectroscopy showed no evidence of the formation of covalent bonds between the nanotubes and the polystyrene during the process of synthesis. The thermal stability was not improved by the inclusion of the nanotubes, it was attributed to the low nanotube concentrations; however, composites glass transition temperature showed improvements.

Simplified route to multi-walled carbon nanotube synthesis by aerosol assisted chemical vapor deposition.

Uniform multi-walled carbon nanotubes (MWCNTs) were obtained decomposing toluene inside of fused silica tubing previously covered with Co oxide thin film. The two-step process, ruled successively in the same aerosol assisted chemical vapor deposition (AACVD) set up, constitutes a simplified route to the synthesis of MWCNTs. First, Co oxide thin film was deposited inside of fused silica tubing at 723 K, using a precursor solution of Co acetate in absolute methanol. After Co oxide deposition, the covered tubing was heated up to 1173 K under Ar flow, then a mist of toluene was injected inside the tubing, using also Ar as carrier gas, consequently MWCNTs were obtained in the internal wall of the tubing. The Co oxide film and the MWCNTs were analyzed by scanning electron microscopy (SEM), high resolution transmission electron microscopy (HRTEM) and atomic force microscopy (AFM). Uniform and very long MWCNTs (several tens of microm) with diameters around 20 to 100 nm were observed, with the advantage that the content of Co particles inside the nanotube was very low.

In situ system for X-ray absorption spectroscopy experiments to investigate nanoparticle crystallization.

A new furnace, based on a halogen lamp, and a sample cell have been designed and constructed for in situ X-ray absorption spectroscopy experiments in conventional and dispersive mode (transmission and fluorescence geometries). The main application of the apparatus is thermal treatment studies under controlled conditions for dynamical processes. The sol-gel (gelatin) method has been utilized to synthesize NiO nanoparticles. During this heating process, in situ Ni K-edge X-ray absorption near-edge structural measurements provided evidence of the evolution of a Ni environment until complete NiO nanoparticle crystallization. This case is reported in order to show the furnace performance in dispersive mode.

Anticuerpos antifosfolípidos en nefropatía membranosa idiopática / Antiphospholipid antibodies in idiopathic membranous nephropathy

Background: Antiphospholipid antibodies have been found in the sera from patients with idiopathic and secondary glomerulopathies, mainly related to lupus. No special attention has been devoted to idiopathic membranous nephropathy, a glomerular disease with a high frequency of thrombotic complications, particularly of the renal vein. Aim: To study the presence and significance of antiphospholipid antibodies in idiopathic membranous nephropathy. Material and methods: Anticardiolipin and anti-ß2-glycoprotein-I IgG antibodies were measured in serum samples from 21 patients with idiopathic membranous nephropathy (age range 11-75 years, 5 female). The medical records of 20 of these patients were reviewed, looking for vascular complications and nephrological evolution during a follow-up period that ranged from two to 277 months. Results: Five patients had anticardiolipin antibody titers over the cutoff for normal values, and two others were positive for anti-ß2-glycoprotein-I, without cross-reactivity. There was no difference in the incidence of thrombotic complications in the renal vein, or other locations, between these seven patients and the remaining patients. No differences in the clinical course of the nephropathy were detected either. Conclusions: Antiphospholipid antibodies may be found in patients with primary membranous nephropathy. They are not related to thrombosis or a worse evolution.

Epidemiology of transfusion-transmitted infections among multi-transfused patients in seven hospitals in Peru.

BACKGROUND: Transfusion-transmitted infections (TTIs) constitute a major health problem worldwide where routine screening of blood or blood products is improperly done, and where non-medical injecting medications and/or drug use are prevalent. Prevalence and risk factors vary by geographic location and by the specific TTI (including HIV-1, HBV, HCV and HTLV-I). OBJECTIVE: To determine the prevalence and risk factors associated with TTIs among a sample of multi-transfused adult patients in Peru. STUDY DESIGN: A cross-sectional multi-center study was conducted across seven major hospitals in Peru from February 2003 to September 2004. Self-reported behavior information (medical procedures, number of sexual partners, and drug use history) was analyzed, along with a review of exposure history from hospital medical records. Prevalences were calculated by TTI for different exposures, along with unadjusted and adjusted odds ratios for infection risk. RESULTS: Overall, 192 (54.7%) of 351 multi-transfused patients were found infected with one or more TTIs. Number of transfusion units, years of transfusion history (6 or more), and number of treatment facilities (2 or more) were associated with HCV infection. Hemodialysis history was a common risk factor associated with HBV, HCV and HTLV-I infection. HIV infection was associated only with total number of transfusion units received. CONCLUSIONS: High prevalences of HBV and HCV infection were found among Peruvian multi-transfused patients and were associated with a past history and number of blood transfusions, as well as with past hemodialysis procedures. TTIs continue to represent a significant public health problem in Peru. Continued vigilant attention to blood safety procedures, including universal screening and health care provider education, is recommended.

Economic costs associated with inadequate drug prescribing: an exploratory study in Chiapas, Mexico.

An exploratory study assessing the economic consequences of inadequate prescribing by health-care providers was carried out in two cities of Chiapas State, South Mexico. Two research methods were used: (a) an exit survey with pharmacy users (1190 interviews) and (b) in-depth individual interviews with patients at hospital level (19 interviews). For comparative purposes, three tracer conditions were selected: acute respiratory infection (ARI), diarrhoeal disease (DD) and hypertension. The main findings were that doctors, drug vendors at pharmacies, traditional healers, users of health-care services themselves (through self-prescription) and other health staff are all sources of inadequate prescribing and impose a substantial economic burden of unnecessary cost on health-care users. In general, treatment costs were high compared with standard treatments, and prescriptions included a high proportion of non-essential drugs (50-64%). Additional costs to the standard treatment were particularly high when the prescription was by a medical doctor (US$ 3.57 per ARI prescription and US$ 8.37 for DD). Losses attributable to inadequate prescribing averaged US$ 47 per patient. The study concludes that training programmes on rational drug use aimed exclusively at medical doctors can only have a limited effect in reducing economic losses due to inadequate prescribing. Such efforts should be extended to other providers who are very active in prescribing drugs and providing health advice. The main challenge that the Mexican health system will be facing in the foreseeable future is not only to improve equity of access to essential drugs, but also to improve quality of drug advice and prescription and rational use of drugs by the population.

Tendinitis aquiliana asociada al uso de levofloxacino: comunicación de cuatro casos / Levofloxacin associated achilles tendinitis: report of 4 cases

Fluoroquinolone-associated tendinitis are well described in the literature, but these are not frequently observed and usually are related to the oldest fluoroquinolones. Levofloxacin is a recently introduced fluoroquinolone. In this paper we report four cases (three female, aged 39 to 70 years old) of Achilles tendinitis occurring in a period of few months. Two patients on chronic dialysis, one kidney transplant recipient, and one patient with chronic vasculitis, both with normal renal function. All were chronically using corticosteroids. In the four cases, tendinitis had an acute onset with bilateral involvement and was invalidating. In 3 cases the onset of tendinitis was early during levofloxacin treatment and in 1 case, it began 10 days after the end of the treatment. All patients were treated with rest and physiotherapy, two were treated with non-steroidal anti-inflammatory drugs. All patients had a complete recovery alter 3-8 weeks

Inadequate drug advice in the pharmacies of Guatemala and Mexico: the scale of the problem and explanatory factors.

A study of urban pharmacies in Guatemala and in Chiapas, southern Mexico, was undertaken to analyse the scale of the inadequate drug advice provided, and to identify the contributing factors. The estimate of the scale of the problem was based on the results of 969 approaches to 191 pharmacies by 'magic clients' (i.e. researchers pretending to be looking for treatment for relatives who had one of three 'tracer' diseases), interviews with 4469 pharmacy users as they left the same 191 pharmacies, and a comparison of the quality of advice offered by public and private pharmacies in Guatemala (based on exit interviews with 150 users). The contributing factors were explored using a provider survey (interviews with 166 pharmacy supervisors and 371 drug vendors), an in-depth study analysing large-chain and independent Mexican pharmacies, and a review of the national drug policies in both countries. Although only about 11% of all drug treatments were recommended in pharmacies (the rest being prescribed by physicians or recommended by kin-groups), this still represents large numbers of treatments. Overall, 501 individuals who visited the 191 study pharmacies over 2 days of observation received drugs recommended by pharmacy staff. Much of the pharmacy advice was revealed to be poor: > 80% of the treatments recommended to the 'magic clients' for diarrhoeal disease or acute respiratory infection included unnecessary or dangerous drugs. Few of those who worked in the pharmacies based their advice on careful case histories. Drug advice in pharmacies was much more likely to be of poor quality than that from physicians or even kin-groups. The factors behind this poor advice were identified as a lack of knowledge about standard treatments and legal regulations, incompetence among pharmacy staff, commercial pressures (particularly in the large-chain pharmacies of Mexico), and a failure to implement the existing regulations covering the drug market and its retail practices. It is recommended that: (1) pharmacy owners and drug vendors be made more aware that the selling of drugs should involve provision of healthcare (as well as reasonable profit-making); (2) existing drug-related legislation be reinforced (through consensus-building rather than coercion); and (3) mass training of pharmacy supervisors and drug vendors, in the standard treatment of common diseases, be undertaken. This process will be challenging and slow.

Sonochemistry of quinones in argon-saturated aqueous solutions: enhanced cytochrome c reduction.

Sonolysis of argon-saturated aqueous quinone solutions resulted in an enhancement in ferricytochrome c (Cyt c) reduction. Upon addition of superoxide dismutase, Cyt c reduction was partially inhibited, thus implying a role of superoxide ion in this reduction process. Neither quinone hydrophobicity nor reduction potential exclusively controls the Cyt c reduction enhancement, although a preference for hydrophobicity versus reduction potential is noted.

Putting evidence into practice.

A training module is described in which experienced health care managers from developing countries explore the challenges to be faced when attempting to use the results of systematic reviews of scientific studies on health care interventions in policy and practice.