Nutrition supplementation plus standard of care versus standard of care alone or standard of care plus unconditional cash transfer in the prevention of chronic malnutrition in Southern Angola: study protocol for the MuCCUA study, a cluster randomized controlled trial.

BACKGROUND: Chronic malnutrition is a condition associated with negative impacts on physical and cognitive development. It is multi-causal and can start very early in life, already in utero, thus it is especially challenging to find appropriate interventions to tackle it. The government of Angola is implementing a standard of care program with potential to prevent it, and the provision of cash transfers and the supplementation with small quantity lipid-based nutrients (SQ-LNS) are also promising interventions. We aimed to evaluate the impact of the standard of care program alone and of the standard of care plus a cash transfer intervention in the lineal growth of children less than 2 years old and compare it to the effectiveness of a nutrition supplementation plus standard of care program in Southern Angola. METHODS/DESIGN: The three-arm parallel cluster randomised controlled trial is set in four communes of Huila and Cunene provinces. Clusters are villages or neighbourhoods with a population around 1075 people. A total of twelve clusters were selected per arm and forty pregnant women are expected to be recruited in each cluster. Pregnant women receive the standard of care alone, or the standard of care plus unconditional cash transfer or plus nutritional supplementation during the first 1000 days, from pregnancy to the child reaching 24 months. The primary outcome is the prevalence of stunting measured as height-for-age Z-score (HAZ) < -2 in children below 2 years. Impact will be assessed at 3, 6, 12, 18 and 24 months of children's age. Secondary outcomes include mortality, morbidity, caring, hygiene and nutrition behaviours and practices, and women and children's dietary diversity. Quantitative data are also collected on women's empowerment, household food security, expenditure and relevant clinical and social events at baseline, endline and intermediate time points. DISCUSSION: The results will provide valuable information on the impact of the standard of care intervention alone as well as combined with an unconditional cash transfer intervention compared to a nutrition supplementation plus standard of care intervention, carried out during the first 1000 days, in the children´s growth up to 2 years and related outcomes in Southern Angola. TRIAL REGISTRATION: Clinical Trials NCT05571280. Registered 7 October 2022.

Social distancing to combat COVID-19 led to a marked decrease in food-borne infections and sexually transmitted diseases in Spain.

Data from a recent epidemiological surveillance network showed a decrease in the reported number of sexually transmitted diseases (STDs) and food-borne infections. We reflect on the possible drivers and consequences of a decrease in these transmittable infectious diseases linked to human contact in relation to social distancing due to the COVID-19 pandemic in Madrid (Spain).

Comparison of the toxicity of two treatment schemes with benznidazole for chronic Chagas disease: a prospective cohort study in two Spanish referral centres.

OBJECTIVES: Chagas disease (CD) treatment is limited to two therapeutic options: benznidazole (generally the first option in Spain) and nifurtimox. Both drugs present high rates of adverse reactions and treatment discontinuation and there is no consensus regarding the most effective administration schedule for benznidazole or how to prevent and manage treatment toxicity. We aim to compare the tolerability and treatment discontinuation rate between two different treatment schemes with benznidazole. METHODS: This was a prospective observational study of adult patients with CD, enrolled from January 2014 to March 2018 in two referral centres in Madrid (Spain). Participants were treated either with benznidazole 5 mg/kg/day (full dose) over 60 days (benznidazole standard dose scheme (BSD)), or with an escalating dose lasting 5 days up to a maximum of 300 mg/day (benznidazole increasing dose scheme (BID)). RESULTS: 471 patients were analysed: 201 in the BSD group and 270 in the BID group. There were no significant differences regarding age (40.4 (SD 8.7) vs 41 (SD 8.2) years), sex (74.1% (149/201) vs 68.5% (185/270) women), weight (69.4 (SD 12.8) vs 68.9 (SD 11) kg) or nationality (97.5% (196/201) vs 96.7% (261/270) Bolivians) between groups. There were also no differences in adverse reactions rate (55.2% (111/201) vs 55.6% (150/270)), number of adverse reactions per patient, adverse reactions type (except for arthralgias and myalgias which occurred more frequently in the BID group (0% (0/111) BSD vs 8% (12/150) BID; p 0.002)) and degree and time to first adverse reactions. There was significantly more treatment discontinuation (49.8% (100/201) vs 33.0% (89/270); p <0.001) in the BSD group, but not during the first 30 days of treatment (32.3% (65/201) vs 25.6% (69/270); p 0.08). CONCLUSION: The use of increasing doses of benznidazole for 5 days and a maximum dose of 300 mg, does not significantly improve drug tolerability. However, while the treatment discontinuation rates were similar during the first 30 days of treatment, it may improve the treatment completion rate at 60 days.

Infección por virus Zika durante los Juegos Olímpicos de Río: ¿alarma o riesgo real? / Zika virus infection during the Olympic Games in Rio: A fear or an actual risk?

El brote reciente de infección por virus Zika en Brasil ha despertado gran interés mediático por su asociación a malformaciones neurológicas en niños nacidos de madres infectadas y a síndrome de Guillain-Barré en el adulto. Esta relación ha llevado a la Organización Mundial de la Salud a declarar la actual epidemia como «Emergencia de Salud Pública de Interés Internacional». Incluso surgió la polémica sobre la conveniencia de retrasar o cambiar de ubicación los Juegos Olímpicos y Paralímpicos que se celebraron en el pasado mes de agosto en distintas ubicaciones de Brasil. En el presente artículo se revisa la evidencia disponible sobre el riesgo que existe de infección por virus Zika y Dengue en personas que viajen a países endémicos, especialmente por eventos multitudinarios (AU)

The recent outbreak of Zika virus infection in Brazil has aroused considerable media interest due to its association with neurological malformations in children born from mothers infected by the virus and to its association with Guillain-Barre syndrome in adults. This relationship has led to the World Health Organisation declaring the current epidemic as a "Public Health Emergency of International Concern". Controversy also emerged on the advisability of delaying or changing the location of the Olympic and Paralympic Games, which were held in August at various locations in Brazil. In this article, we review the available evidence on the risk of Zika and dengue virus infection in individuals who travel to endemic countries, especially for multitudinous events (AU)

Zika virus infection during the Olympic Games in Rio: A fear or an actual risk? / Infección por virus Zika durante los Juegos Olímpicos de Río: ¿alarma o riesgo real?

The recent outbreak of Zika virus infection in Brazil has aroused considerable media interest due to its association with neurological malformations in children born from mothers infected by the virus and to its association with Guillain-Barre syndrome in adults. This relationship has led to the World Health Organisation declaring the current epidemic as a "Public Health Emergency of International Concern". Controversy also emerged on the advisability of delaying or changing the location of the Olympic and Paralympic Games, which were held in August at various locations in Brazil. In this article, we review the available evidence on the risk of Zika and dengue virus infection in individuals who travel to endemic countries, especially for multitudinous events.

Living near a freeway is associated with lower bone mineral density among Mexican Americans.

UNLABELLED: We hypothesized that chronic exposures to traffic combustion products may lower bone mineral density (BMD). We found that proximity to freeways was associated with reduced BMD. Our findings suggest that traffic-related pollution may contribute to the occurrence of osteopenia and osteoporosis. INTRODUCTION: Adults residing in rural areas have been linked with higher BMD. We aimed to determine if this difference is due in part to air pollution by examining the relationships between traffic metrics and ambient air pollution with total body and pelvic BMD. METHODS: Mexican American adults (n = 1,175; mean 34 years; 72 % female) who had participated in the BetaGene study of air pollution, obesity, and insulin resistance were included in this analysis. Total body and pelvic BMD were estimated using dual-energy X-ray absorptiometry. Traffic and ambient air pollutant exposures were estimated at residences using location and ambient monitoring data. Variance component models were used to analyze the associations between residential distance to the nearest freeway and ambient air pollutants with BMD. RESULTS: Residential proximity to a freeway was associated with lower total body BMD (p-trend = 0.01) and pelvic BMD (p-trend = 0.03) after adjustment for age, sex, weight, and height. The adjusted mean total body and pelvic BMD in participants living within 500 m of a freeway were 0.02 and 0.03 g/cm(2) lower than participants living greater than 1,500 m from a freeway. These associations did not differ significantly by age, sex, or obesity status. Results were similar after further adjustment for body fat and weekly physical activity minutes. Ambient air pollutants (NO2, O3, and PM2.5) were not significantly associated with BMD. CONCLUSIONS: Traffic-related exposures in overweight and obese Mexican Americans may adversely affect BMD. Our findings indicate that long-term exposures to traffic may contribute to the occurrence of osteoporosis and its consequences.

Evaluation of cross-protection afforded by a Salmonella Choleraesuis vaccine against Salmonella infections in pigs under field conditions.

This field study investigated the efficacy of a Salmonella Choleraesuis live vaccine (Argus SC) to reduce the number of infections with Salmonella. Twelve groups of about 380 pigs each were randomly allocated to either vaccination (V) or no vaccination (C). The vaccine was applied orally at 3 and 16 weeks. Forty pigs per group were blood sampled at 3, 10, 16, and 24 weeks to detect possible antibodies against Salmonella. The prevalence of Salmonella in the lymph nodes was the major variable. In the V groups, only 0.6% of the lymph nodes were positive, whereas 7.2% were positive in the C groups (p < 0.001). The percentage of seropositive pigs at 24 weeks (cut-off OD > 10) was 26% and 9% in the V and C groups, respectively (p < 0.001). The present study documented that vaccination with a live modified S. Choleraesuis vaccine is a useful tool to lower the prevalence of Salmonella in swine herds.

Antepartum predictors of the development of type 2 diabetes in Latino women 11-26 months after pregnancies complicated by gestational diabetes.

In this study, we sought to identify antepartum characteristics that predict the de novo development of diabetes 11-26 months after the index pregnancy in a carefully characterized cohort of women with gestational diabetes mellitus (GDM). Oral and frequently sampled intravenous glucose tolerance tests (OGTTs and FSIGTs), hyperinsulinemic-euglycemic clamps with labeled glucose, and body composition studies were performed on 91 islet cell antibody-negative Latino women with GDM during the third trimester of pregnancy. The women were documented to be diabetes-free within 6 months postpartum. Their diabetes status was ascertained again between 11 and 26 months postpartum. Logistic regression analysis was used to identify independent predictors of the development of diabetes within that interval. Fourteen of the women developed diabetes by World Health Organization criteria 11-26 months after delivery of the index pregnancy. Three antepartum variables were independent predictors of diabetes: the 1-h postchallenge plasma glucose concentration from the 100-g OGTT at which GDM was diagnosed (higher = increased risk; P = 0.003); an index of pancreatic beta-cell compensation for insulin resistance, defined as the product of the 30-min incremental plasma insulin:glucose ratio on a 75-g OGTT and the insulin sensitivity index from a hyperinsulinemic-euglycemic clamp (lower = increased risk, P = 0.009); and the basal glucose production rate after an overnight fast (higher = increased risk; P = 0.04). We conclude that postchallenge hyperglycemia, poor pancreatic beta-cell compensation for insulin resistance, and elevated endogenous glucose production during pregnancy precede the development of type 2 diabetes in young Latino women by at least 1-2 years.

Multiple metabolic defects during late pregnancy in women at high risk for type 2 diabetes.

Detailed metabolic studies were carried out to compare major regulatory steps in glucose metabolism in vivo between 25 normal pregnant Latino women without and 150 pregnant Latino women with gestational diabetes mellitus (GDM). The two groups were frequency-matched for age, BMI, and gestational age at testing in the third trimester. After an overnight fast, women with GDM had higher fasting plasma glucose (P = 0.0001) and immunoreactive insulin (P = 0.0003) concentrations and higher glucose production rates (P = 0.01) but lower glucose clearance rates (P = 0.001) compared with normal pregnant women. During steady-state hyperinsulinemia (approximately 600 pmol/l) and euglycemia (approximately 4.9 mmol/l), women with GDM had lower glucose clearance rates (P = 0.0001) but higher glucose production rates (P = 0.0001) and plasma free fatty acid (FFA) concentrations (P = 0.0002) than the normal women. These intergroup differences persisted when a subgroup of 116 women with GDM who were not diabetic < or = 6 months after pregnancy were used in the analysis. When all subjects were considered, there was a very close correlation between glucose production rates and plasma FFA concentrations throughout the glucose clamps in control (r = 0.996) and GDM (r = 0.995) groups. Slopes and intercepts of the relationships were nearly identical, suggesting that blunted suppression of FFA concentrations contributed to blunted suppression of glucose production in the GDM group. In addition to these defects in insulin action, women with GDM had a 67% impairment of pancreatic beta-cell compensation for insulin resistance compared with normal pregnant women. These results demonstrate that women with GDM have multiple defects in insulin action together with impaired compensation for insulin resistance. Our findings suggest that defects in the regulation of glucose clearance, glucose production, and plasma FFA concentrations, together with defects in pancreatic beta-cell function, precede the development of type 2 diabetes in these high-risk women.

Gestational diabetes: antepartum characteristics that predict postpartum glucose intolerance and type 2 diabetes in Latino women.

We examined antepartum clinical characteristics along with measures of glucose tolerance, insulin sensitivity, pancreatic beta-cell function, and body composition in Latino women with gestational diabetes mellitus (GDM) for their ability to predict type 2 diabetes or impaired glucose tolerance (IGT) within 6 months after delivery. A total of 122 islet cell antibody-negative women underwent oral and intravenous glucose tolerance tests (OGTT; IVGTT), hyperinsulinemic-euglycemic clamps, and measurement of body fat between 29 and 36 weeks' gestation and returned between 1 and 6 months postpartum for a 75-g OGTT. Logistic regression analysis was used to examine the relationship between antepartum variables and glucose tolerance status postpartum. At postpartum testing, 40% of the cohort had normal glucose tolerance, 50% had IGT, and 10% had diabetes by American Diabetes Association criteria. Independent antepartum predictors of postpartum diabetes were the 30-min incremental insulin:glucose ratio during a 75-g OGTT (P = 0.0002) and the total area under the diagnostic 100-g glucose tolerance curve (P = 0.003). Independent predictors of postpartum IGT were a low first-phase IVGTT insulin response (P = 0.0001), a diagnosis of GDM before 22 weeks' gestation (P = 0.003), and weight gain between prepregnancy and the postpartum examination (P = 0.03). All subjects had low insulin sensitivity during late pregnancy, but neither glucose clamp nor minimal model measures of insulin sensitivity in the 3rd trimester were associated with the risk of IGT or diabetes within 6 months' postpartum. These results highlight the importance of pancreatic beta-cell dysfunction, detectable under conditions of marked insulin resistance in late pregnancy, to predict abnormalities of glucose tolerance soon after delivery in pregnancies complicated by GDM. Moreover, the association of postpartum IGT with weight gain and an early gestational age at diagnosis of GDM suggests a role for chronic insulin resistance in mediating hyperglycemia outside the 3rd trimester in women with such a beta-cell defect.

Pili of Pasteurella multocida of porcine origin.

Using electron microscopy, pili with at least two distinct morphologies were observed on strains of Pasteurella multocida isolated from pigs with atrophic rhinitis. Rigid pili were found on 60-80% of all cells observed. These pili had a strong tendency to lie flat along the side of the outer cell membrane of P. multocida and as a result frequently were difficult to see. After growth in vitro, piliated P. multocida cells produced few pili (approx. 3-5 per cell). Heavily piliated cells were occasionally observed. The second type of pili were curly and also were difficult to visualize. Cells from cultures containing piliated cells failed to attach to red blood cells and to immobilized mucus.

Expression of iron-regulated outer membrane proteins by porcine strains of Pasteurella multocida.

The outer membrane protein (OMP) profiles of two strains of capsular type A Pasteurella multocida isolated from the lungs of pigs with enzootic pneumonia were studied. Sarkosyl extracted OMPs from P. multocida grown under iron-restricted and iron-replete conditions were subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blot analysis. Results showed that the iron-regulated outer membrane proteins (IROMPs) with molecular masses of 74 kDa, 94 kDa, 99 kDa and 109 kDa were expressed by strain A52, while 74 kDa, 82 kDa, 94 kDa and 99 kDa IROMPs were expressed by strain B80. Swine immune sera, obtained from pigs which were first immunized with a polyvalent P. multocida type A and type D bacterin and subsequently challenged with type A strain of P. multocida, contained antibodies against the IROMPs. These antibodies cross-reacted with the IROMPs expressed by avian strain P1059 of P. multocida. Convalescent-phase serum obtained from turkeys which survived fowl cholera, also cross-reacted with the IROMPs from porcine strains of P. multocida. These results suggested that IROMPs from porcine and avian strains of P. multocida may share common epitopes that were recognized by swine immune serum as well as turkey convalescent-phase serum.

Impaired function of bovine alveolar macrophages infected with parainfluenza-3 virus.

Bovine alveolar macrophages (BAM) were harvested from nonsedated cattle, adhered to glass or plastic surfaces, and infected with parainfluenza-3 (PI-3) virus at a multiplicity of infection of 10. Control and PI-3 virus-infected BAM were compared at 24-hour intervals up to 168 hours for their ability to phagocytize antibody-coated sheep erythrocytes (EAC) and latex particles, to kill Staphylococcus epidermidis, and to alter intracellular acid phosphatase concentrations. The effect of antiviral serum on phagocytic functions of virus-infected cells was also evaluated. Compared with noninfected controls, alveolar macrophages infected with PI-3 virus were 15.3% less adherent to the glass or plastic surfaces at postinoculation hour (PIH) 72 and were 64.0% less adherent at PIH 168. Significant differences (P less than 0.05) between the numbers of control and infected BAM phagocytizing EAC were observed at PIH 24 through 72, with final values differing by approximately 50%. Similar changes were observed in the phagocytic efficiencies of individual cells. The PI-3 virus-infected BAM that were exposed to antiserum or to immunoglobulins against PI-3 virus had approximately a 2-fold greater inhibition in EAC phagocytosis than did infected BAM exposed to serum without PI-3 activity. Significant differences in latex particle phagocytosis were not observed between infected and control BAM. Compared with control BAM, the PI-3 virus-infected BAM contained significantly lower concentrations of acid phosphatase from PIH 48 through 96; at PIH 96, acid phosphatase concentrations were 4-fold less in infected than in control BAM.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of in vitro inoculation of bovine respiratory syncytial virus on bovine pulmonary alveolar macrophage function.

Viruses may predispose the respiratory tract to the development of secondary bacterial pneumonia by impairing functions of alveolar macrophages. The effects of bovine respiratory syncytial virus (BRSV) on selected functions of bovine pulmonary alveolar macrophages (PAM) were examined in vitro. Alveolar macrophages were obtained from nonsedated cattle, using a polypropylene tube passed intranasally into the lung. The PAM lavaged from the lung were allowed to adhere to glass coverslips or plastic tissue culture plates, and were exposed to BRSV for 2 hours. Control and BRSV-inoculated PAM were compared at intervals over a 72-hour period for their abilities to phagocytize and kill Staphylococcus epidermidis, rosette with and phagocytize antibody-coated sheep RBC (SRBC), phagocytize latex particles, and influence lysosomal enzyme activity. Challenge exposure with BRSV did not affect the ability of PAM to adhere and did not affect cell viability. There were numerical differences between control and BRSV-inoculated cell populations in phagocytosis and killing of S epidermidis, but these were not significant (P greater than 0.05). There was less than 5% difference in the abilities of control and BRSV-challenged PAM to phagocytize latex beads. When Fc-receptor-mediated phagocytosis of antibody-coated SRBC was compared with controls, BRSV-challenged PAM had significantly (P less than 0.05) impaired phagocytic function, which was maximal 72 hours after BRSV inoculation; the phagocytic impairment occurred in spite of normal Fc-receptor function, as determined by rosetting with antibody-coated SRBC.(ABSTRACT TRUNCATED AT 250 WORDS)

Bovine pulmonary alveolar macrophages: antemortem recovery and in vitro evaluation of bacterial phagocytosis and killing.

A system was developed to recover pulmonary alveolar macrophages (PAM) from living cattle and to evaluate the function of these cells by measuring bacterial phagocytosis and killing. For the collection of PAM, single-tube and telescoped double-tube pulmonary lavage devices were compared. The total recovery, using these systems, was 70 +/- 10.7% of infused fluid, yielding approximately 87% PAM. The total number of cells per collection was approximately 5 times higher with the single-tube device (6.87 +/- 0.78 x 10(7) cell/ml) than with the telescoped double-tube device (1.3 +/- 0.1 X 10(7) cells/ml). Phagocytosis and intracellular killing of Staphylococcus epidermidis and Staphylococcus aureus by PAM in media suspension and by plastic-adherent PAM were evaluated. In addition, different bacteria-to-macrophage ratios were assessed, as well as the intracellular killing of S epidermidis at periodic intervals. Results showed that over a 3-hour period, similar numbers of both bacteria were phagocytized, but intracellular killing of S epidermidis was more efficient than intracellular killing of S aureus. It also was found (i) that suspended PAM and adherent PAM phagocytized similar numbers of bacteria; (ii) that when the bacteria-to-cell ratio was 10:1, the numbers of phagocytized bacteria and intracellular killing were higher than when the ratio was 1:10; and (iii) that killing of S epidermidis by adherent PAM was directly proportional to incubation time. The time that PAM are in culture affects the phagocytosis and killing of intracellular bacteria, as shown by increased phagocytosis and by intracellular killing of S epidermidis by PAM in suspension for 48 hours or plastic adherent for 60 hours after collection.

Interaction of bovine respiratory syncytial virus and Pasteurella haemolytica in the ovine lung.

The potential synergistic effect of bovine respiratory syncytial virus (RSV) and Pasteurella haemolytica in the production of pneumonia after aerosol/intranasal infection of conventionally reared lambs was evaluated. A mild clinical response was observed in lambs given virus and/or bacteria. Gross pulmonary lesions were seen in 3 of 6 lambs given RSV and then P haemolytica 3 or 6 days later, respectively (groups D and E), and in 1 lamb of 5 given virus and bacteria simultaneously (group G). Gross lesions were not seen in control sheep (group A), in lambs given virus or bacteria alone (groups B and C), or in lambs exposed to bacteria and then virus 3 days later (group F). Bovine RSV and P haemolytica were recovered from the lungs of 5 of 7 lambs with macroscopic lesions. Gross pulmonary lesions were cranioventral firm areas of red consolidation. Microscopically, the predominant lesion was a suppurative bronchopneumonia. Bovine RSV was recovered from the nasal cavity of 8 of 27 (30%) lambs given RSV during days 3 to 6 after viral inoculation, including 1 lamb in group B, 2 in groups D, E, and F, and 1 in group G. Pasteurella haemolytica was recovered from the nasal cavity of 9 of 28 (32%) inoculated lambs, including 2 lambs from groups C and E, 3 in group D, and 1 in groups F and G. Viral antigen, as determined by immunofluorescence, was concentrated mainly in individual cells in alveolar walls, some alveolar macrophages, and a few bronchiolar epithelial cells. In vitro alveolar macrophage assays indicated decreased numbers of Fc receptors on those macrophages collected from lambs given RSV 6 days before P haemolytica infection, as compared with that in the other groups. These cellular defects disappeared after 24 hours of culture. Seemingly, bovine RSV does facilitate P haemolytica pulmonary infection in conventional, immuno-competent lambs and provides evidence for decreased Fc receptors on alveolar macrophages.

Colangioanastomosis intrahepaticas perifericas. Nuestra experiencia. / Peripheral intra-hepatic cholangioenteric anastomosis

Se presentan 64 pacientes tratados por obstruccion de la via biliar principal, durante el periodo 1960-1981. Dichos pacientes que presentaron signos de colestasis debido a patologia benigna o maligna de la via biliar, fueron sometidos a una colangioanastomosis intrahepatica periferica.Se enfatiza el estudio colangiografico para la localizacion de la obstruccion y los analisis de laboratorio para valorar la funcion hepatica. Se exponen los detalles de la tecnica, los cuales facilitan el procedimiento quirurgico, mejorando asi los resultados obtenidos, se analiza la casuistica, la supervivencia y las causas de muerte

Consideraciones quirurgicas en el feocromocitoma. / Surgical considerations in pheochromacytoma

Se presentan 9 pacientes operados de feocromocitoma durante un periodo de 26 anos.Se analizan aspectos clinicos y los metodos actuales de diagnostico, atribuyendose la mayor importancia a la tomografia computada y a la introduccion del agente radiofarmacologico: la 131 metaiodobencilguanicina (131-IMBG). Se expone el adecuado manejo de los pacientes y las maniobras intraoperatorias que aseguran una extirpacion completa del tumor