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1.
J Community Genet ; : 1-5, 2021 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-33717365

RESUMO

The Caribbean part of the Kingdom of the Netherlands consists of six islands: Aruba, Bonaire, Curaçao, St. Maarten, St. Eustatius, and Saba. Because of their small size and relative remoteness, they face several economic and healthcare challenges, including limited access to genetics services. In this article, we provide an overview of the clinical and community genetics services that are available in the Dutch Caribbean. In particular, we describe our joint pediatric-genetics clinic with a visiting clinical geneticist that was established in 2011 to provide clinical genetics services for the pediatric population of the Dutch Caribbean.

2.
J Community Genet ; 2021 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-33751485

RESUMO

The Caribbean part of the Kingdom of the Netherlands consists of six islands: Aruba, Bonaire, Curaçao, St. Maarten, St. Eustatius, and Saba. Because of their small size and relative remoteness, they face several economic and healthcare challenges, including limited access to genetics services. In this article, we provide an overview of the clinical and community genetics services that are available in the Dutch Caribbean. In particular, we describe our joint pediatric-genetics clinic with a visiting clinical geneticist that was established in 2011 to provide clinical genetics services for the pediatric population of the Dutch Caribbean.

3.
Stroke ; 52(3): 1143-1146, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33494639

RESUMO

Brain arteriovenous malformations (bAVMs) are vascular lesions that carry significant morbidity and mortality risk upon rupture. bAVM rupture causes either intracerebral or intraventricular hemorrhage, or both. In 2014, the first results of the ARUBA trial (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) were published in The Lancet, causing a paradigm shift in clinical practice and suggesting the superiority of medical treatment in terms of mortality or stroke compared with any intervention designed to obliterate the AVM. In 2020, the final results of the ARUBA trial were published. In this Viewpoint, we critically review the clinical equipoise behind the trial, highlight issues regarding external validity, and place the results of the trial in the context of other results in scientific literature of bAVMs using Bayesian inference. ARUBA is a trial of decision-making, and only proper knowledge of the nuances of its interpretation within the broader context of bAVM research can lead to proper decision-making when confronted with patients with unruptured bAVMs.

4.
Cardiol Rev ; 29(1): 10-14, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32941265

RESUMO

Cerebral arteriovenous malformations (AVMs) are a complex and heterogeneous pathology which require an understanding of the natural history of these lesions, as well as the potential treatment options in order to manage them safely. While treatment is the agreed upon strategy for most ruptured AVMs, the management of unruptured AVMs continues to be debated. More recently, this debate has been fueled by the A Randomized Trial of Unruptured Arteriovenous Malformations (ARUBA) trial which attempts to define the natural history and treatment risk of AVMs. However, the trial has significant shortcomings which limit its broad applicability. In addition, the breadth, efficacy, and safety of potential treatment options continue to improve. This review focuses on defining the natural history of cerebral AVMs, an overview of the ARUBA trial, and the most current treatment paradigm for cerebral AVMs.

5.
Sci Rep ; 10(1): 21427, 2020 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-33293642

RESUMO

The management of non-hemorrhagic arteriovenous malformations (AVMs) remains a subject of debate, even more since the ARUBA trial. Here, we report the obliteration rate, the risk of hemorrhage and the functional outcomes after Gamma Knife radiosurgery (GKRS) as first-line treatment for non-hemorrhagic AVMs treated before the ARUBA publication, in a reference university center with multimodal AVM treatments available. We retrospectively analyzed data from a continuous series of 172 patients harboring unruptured AVMs treated by GKRS as first-line treatment in our Lille University Hospital, France, between April 2004 and December 2013. The primary outcome was obliteration rate. Secondary outcomes were the hemorrhage rate, the modified Rankin Scale (mRS), morbidity and epilepsy control at last follow-up. The minimal follow-up period was of 3 years. Median age at presentation was 40 years (IQR 28; 51). Median follow-up was 8.8 years (IQR 6.8; 11.3). Median target volume was 1.9 cm3 (IQR 0.8-3.3 cm3), median Spetzler-Martin grade: 2 (IQR 1-2), median Pollock-Flickinger score: 1.07 (IQR 0.82-2.94), median Virginia score: 1 (IQR 1-2). Median treatment dose was 24 Gy at 50% isodose line. Twenty-three patients underwent a second GKRS after a median time of 58 months after first GKRS. The overall obliteration rate was of 76%, based primarily on cerebral angiography and/or rarely only upon MRI. Hemorrhage during the post-treatment follow-up was reported in 18 (10%) patients (annual risk of 1.1%). Transient post-GKRS morbidity was reported in 14 cases (8%) and persistent neurological deficit in 8 (4.6%) of patients. At last follow-up, 86% of patients had a mRS ≤ 1. Concerning patients with pretherapeutic epilepsy, 84.6% of them were seizure-free at last follow-up. GKRS as first-line therapeutic option for unruptured cerebral AVMs achieves high obliteration rates (76%) while maintaining a high-level patient's autonomy. All hemorrhagic events occurred during the first 4 years after the initial GKRS. In cases with epilepsy, there was 84.6% seizure free at last follow-up. Permanent morbidity was reported in only 4.6%.

6.
BMC Neurol ; 20(1): 404, 2020 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-33153456

RESUMO

BACKGROUND: Despite rapid developments in devices used to treat arteriovenous malformation (AVM), a randomised trial of Unruptured Brain Arteriovenous malformations published in 2014 recommended conservative treatment for nonhemorrhagic AVM. The purpose of the current retrospective study was to confirm how AVM treatment in Japan has changed and to assess the safety of treatment for hemorrhagic and nonhemorrhagic AVMs. METHODS: We enrolled 242 consecutive patients with AVM; each patient's treatment was selected and performed at our hospital. The type of onset, Spetzler-Martin (S-M) grade, age, sex, selected treatment, mortality, and morbidity were compared between the first and second periods of our study. RESULTS: In patients with grade I-III AVM, the selected treatment changed between the first and second periods; however, in grade IV and V patients, the selected treatment did not change. Overall, interventions by microsurgery alone decreased (p < 0.001), the proportion of total treatments including microsurgery decreased (p = 0.005), interventions using stereotactic radiosurgery (SRS) alone increased (p = 0.009), and interventions including SRS increased (p = 0.002). Morbidity associated with intervention was 0.92% in the first period and 0% in the second period, and mortality was 0.92% in the first period and 1.67% in the second. CONCLUSIONS: With the development of new devices, the selected treatment was changed in patients with S-M grade I-III AVM, but was not changed in patients with grade IV and V. The complication rate was low and did not change throughout the periods. These findings suggest that the safety of treatment depends on a full understanding of device development and the selection of proper treatment, not on hemorrhagic onset. Further treatment innovations are expected to change the treatment for grade IV and V AVMs.

7.
J Med Invest ; 67(3.4): 222-228, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33148892

RESUMO

Arteriovenous malformations (AVMs) are hemorrhagic vascular diseases in which arteries and veins are directly connected with no capillary bed between the two. We herein introduce the results of basic research of this disease and surgical techniques based on our data and experiences. The results obtained from our research show that cell death- and inflammation-related molecules changed or became activated compared with control specimens. These findings indicate that chronic inflammation occurs in and around the nidus of AVMs. Various molecules are involved in the mechanisms of cell death and angiogenesis during this process. Confirmation of blood flow in the nidus is very important to avoid hemorrhagic complications during surgical removal of the nidus. The risk of hemorrhage increases when the blood flow in the nidus is not reduced. We reported the advantages of serial indocyanine green videoangiography, which is used to assess the blood flow during AVM nidus removal. Since publication of the ARUBA trial and Scottish Audit, treatments with high morbidity have not been allowed. It is especially important for neurosurgeons to treat low Spetzler-Martin grade AVMs with low morbidity. J. Med. Invest. 67 : 222-228, August, 2020.

9.
Drug Metab Pers Ther ; 2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33119541

RESUMO

Oxy+ is a natural source of arthrospira found in nature, used as a dietary supplement and manufactured in Aruba for lifefactors. Arthrospira contains good quality of proteins, sulfated polysaccharides, γ-linoleic acid, along with an array of carotene and phytopigments, vitamins, and minerals which are reported to be antioxidant, immunomodulator, antihyperglycemic, antidyslipidemic, cardioprotective, hepatoprotective, antiviral, anticancerous, antihypertensive, anti-inflammatory, analgesic, neuroprotective and renoprotective activities. Several studies have shown arthrospira, and active ingredients of it revealed various pharmacological activities. It can be used for the management of various ailments such as diabetes, dyslipidemia, obesity, hypertension, cancer, arthritis, osteoarthritis, autoimmune disorders, etc. This review attempts to explore the hidden benefits of Oxy+ (arthrospira).

10.
Washington, D.C.; PAHO; 2020-10-15.
em Inglês, Espanhol | PAHO-IRIS | ID: phr-53108

RESUMO

All 54 countries and territories in the Region of the Americas have reported COVID-19 cases and deaths. Since the 18 September 2020 PAHO/WHO Epidemiological Update on COVID-19 and as of 13 October 2020, 3,018,295 additional confirmed cases of COVID-19, including 77,525 deaths, have been reported in the Region of the Americas, representing a 17% increase in cases and a 13% increase in deaths. Across all subregions, a relative increase was observed, both in the number of cases and number of deaths. The highest increase in cases was observed in the Caribbean and the Atlantic Ocean Islands subregion, with a 20% increase in cases and an 18% increase in deaths, followed by the Central America subregion, with a 20% increase in cases and a 16% increase in deaths; the South America subregion, with a 17% increase in cases and a 16% increase in deaths; and the North America subregion, with a 16% increase in cases and a 12% increase in deaths. In the last 60 days, 10 of the 54 countries/territories in the Region reported increased intensity of COVID-19 transmission and modified their COVID-19 transmission classifications accordingly: Aruba, Belize, the British Virgin Islands, Curacao, Guadeloupe, Jamaica, Martinique, Saint Barthelemy, Saint Martin, and Trinidad and Tobago. Five of these had a relative increase in confirmed cases of greater than 90% (range 94% to 97%): Aruba, Belize, Curacao, Guadeloupe, and Trinidad and Tobago. During the same period, 7 of these 10 countries/territories also presented with a relative increase in deaths, ranging from 29% to 93%: Aruba, Belize, Guadeloupe, Jamaica, Martinique, Saint Martin, and Trinidad and Tobago. [...]


Los 54 países y territorios de la Región de las Américas han notificado casos y defunciones de COVID-19. Desde la última actualización epidemiológica publicada por la OPS/OMS el 18 de septiembre de 2020 hasta el 13 de octubre de 2020, fueron notificados 3.018.295 casos confirmados de COVID-19, incluidas 77.525 defunciones adicionales en la región de las Américas, lo que representa un aumento de 17% de casos y de 13% de defunciones. En todas las subregiones se observó un incremento relativo, tanto en el número de casos como en el número de defunciones, siendo el mayor en las Islas del Caribe y del Océano Atlántico con 20% de aumento en casos y 18% de aumento en defunciones. El resto de las subregiones, incrementaron de la siguiente manera, en orden decreciente: América Central con 20 % de aumento en casos y 16% de aumento en defunciones, América del Sur con 17% de aumento en casos y 16% aumento en defunciones y América del Norte8 con 16 % de incremento en casos y 12% de incremento en defunciones (Figuras 2 y 3). Con relación a la intensidad de la transmisión del virus SARS CoV-2, 10 de los 54 países y territorios de la región notificaron un incremento de casos y defunciones de COVID-19 en los últimos 60 días, modificando su escenario de transmisión de menor a mayor intensidad: Aruba, Belice, Curazao, Guadalupe, Jamaica, Martinica, San Bartolomé, San Martín, Trinidad y Tobago e Islas Vírgenes Británicas. En este período, Aruba, Belice, Curazao, Guadalupe y Trinidad y Tobago presentaron un incremento relativo de casos confirmados mayor a 90% (rango 94% a 97%). Respecto de las defunciones, el incremento relativo se observó en 7 de estos 10 países y territorios: Aruba, Belice, Guadalupe, Jamaica, Martinica, San Martín y Trinidad y Tobago en un rango de 29% a 93%. [...]


Assuntos
Infecções por Coronavirus , Coronavirus , Infecções por Coronavirus , Betacoronavirus , Emergências , Regulamento Sanitário Internacional , Emergências , Regulamento Sanitário Internacional , Infecções por Coronavirus
11.
Washington, D.C.; PAHO; 2020-10-09.
em Inglês, Espanhol | PAHO-IRIS | ID: phr-53107

RESUMO

Since the confirmation of the first COVID-19 cases and until 5 October 2020, a total of 35,109,317 COVID-19 cases have been reported globally, including 1,035,341 deaths. The Region of the Americas accounts for 49% of the total cases and 55% of the total deaths reported globally. The analysis of trends in COVID-19 cases at the global level, by WHO Region, shows a new increase in cases in the WHO European Region and the WHO Western Pacific Region In the Region of the Americas, 10 of the 54 countries and territories reported an increase in COVID-19 cases and deaths in the last 60 days. The countries/territories that modified their COVID-19 transmission classifications due to increased intensity of COVID-19 transmission are Aruba, Belize, the British Virgin Islands, Curaçao, Guadeloupe, Jamaica, Martinique, Saint Barthelemy, Saint Martin, and Trinidad and Tobago. During this period, Aruba, Belize, Curaçao, Guadeloupe, and Trinidad and Tobago had a >90% relative increase in confirmed cases (range 94% to 97%).


Desde la confirmación de los primeros casos de COVID-19 hasta el 5 de octubre, se han notificado a nivel global 35.109.317 casos de COVID-19, incluidas 1.035.341 defunciones. La Región de las Américas concentra 49% del total de casos y 55% de las defunciones acumuladas a nivel mundial. El análisis de las tendencias de casos de COVID-19 a nivel global, según regiones de la OMS, muestra un nuevo incremento de casos en las regiones de Europa y del Pacifico Occidental. En las Américas, 10 de los 54 países y territorios de la región notificaron un incremento de casos y defunciones de COVID-19 en los últimos 60 días1, modificando su escenario de transmisión de casos de menor a mayor intensidad: Aruba, Belice, Curazao, Guadalupe, Islas Vírgenes Británicas, Jamaica, Martinica, San Bartolomé, San Martín y Trinidad y Tobago. En este período, Aruba, Belice, Curazao, Guadalupe y Trinidad y Tobago presentaron un incremento relativo de casos confirmados mayor a 90% (rango 94% a 97%).


Assuntos
Infecções por Coronavirus , Coronavirus , Infecções por Coronavirus , Emergências , Regulamento Sanitário Internacional , Betacoronavirus , Infecções por Coronavirus , Emergências , Regulamento Sanitário Internacional
12.
Preprint | medRxiv | ID: ppmedrxiv-20214189

RESUMO

BackgroundRT-qPCR is the reference test for identification of active SARS-CoV-2 infection, but is associated with diagnostic delay. Antigen detection assays can generate results within 20 minutes and outside of laboratory settings. Yet, their diagnostic test performance in real life settings has not been determined. MethodsThe diagnostic value of the Panbio COVID-19 Ag Rapid Test (Abbott), was determined in comparison to RT-qPCR (Seegene Allplex) in community-dwelling mildly symptomatic subjects in a medium (Utrecht, the Netherlands) and high endemic area (Aruba), using two concurrently obtained nasopharyngeal swabs. Findings1367 and 208 subjects were enrolled in Utrecht and Aruba, respectively. SARS-CoV-2 prevalence, based on RT-qPCR, was 10.2% (n=139) and 30.3% (n=63) in Utrecht and Aruba respectively. Specificity of the Panbio COVID-19 Ag Rapid Test was 100% (95%CI: 99.7-100%) in both settings. Test sensitivity was 72.6% (95%CI: 64.5-79.9%) in the Netherlands and 81.0% (95% CI: 69.0-89.8%) in Aruba. Probability of false negative results was associated with RT-qPCR Ct-values, but not with duration of symptoms. Restricting RT-qPCR test positivity to Ct-values <32 yielded test sensitivities of 95.2% (95%CI: 89.3-98.5%) in the Netherlands and 98.0% (95%CI: 89.2-99.95%) in Aruba. InterpretationIn community-dwelling subjects with mild respiratory symptoms the Panbio COVID-19 Ag Rapid Test had 100% specificity, and a sensitivity above 95% for nasopharyngeal samples when using Ct values <32 cycles as cut-off for RT-qPCR test positivity. Considering short turnaround times, user friendliness, low costs and opportunities for decentralized testing, this test can improve our efforts to control transmission of SARS-CoV-2. FundingUMCU and LABHOH, Aruba

13.
Chin Neurosurg J ; 6: 26, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32922955

RESUMO

Background: In the benefit of the large population and rapid economic growth, the interventional techniques and equipment for brain arteriovenous malformations (bAVMs) in mainland China have been rapidly improved. Chinese neurosurgical cerebrovascular physicians have accumulated rich experience and made pioneering explorations. This study aims to summarize the experience and treatment progress of bAVMs in mainland China. Methods: We performed a web-based nationwide questionnaire survey among 67 tertiary neurosurgical institutions that had acknowledged treating bAVMs in the primary survey. Our questionnaire included clinical characteristics, radiological findings, intervention indications/contraindications, intervention timing, and intraoperative management of different treatment modalities. Results: A total of 63 participants from 49 (73.1%) tertiary neurosurgical institutions responded to our questionnaire. Forty-two (66.7%) were neurosurgeons, 13 (20.6%) were neurointerventionists, and 8 (12.7%) were radiosurgeons. Approximately 3500 to 4000 cases of bAVMs were treated annually in these 49 departments. All participants agreed that the conclusions of ARUBA are debatable. Flow-related aneurysms, deep venous drainage, and arteriovenous fistula were considered as common hemorrhagic risk factors. Unruptured SM IV-V bAVMs, giant bAVMs, pediatric bAVMs, elderly bAVMs, and eloquent bAVMs were not absolute contraindications to intervention. Maximum lesion occlusion and minimal functional impairment were the principles of intervention management. Most of the neurosurgeons and neurointerventionists recommended early intervention (< 30 days) for ruptured bAVMs, and the radiosurgeons suggested intervention in the chronic phase or recovery phase (P < 0.01) and preferably 3 months after bleeding. Multi-modality strategies were thought effective for complex bAVMs, and more exploration of individualized intraoperative management was necessary. Conclusions: Intervention was acceptable for specific selected unruptured bAVMs in mainland China, especially in patients with hemorrhagic risk factors. The application of multidisciplinary cerebrovascular team and multicenter large-sample international registry study might be the next work for Chinese neurosurgical cerebrovascular physicians.

14.
Washington, D.C.; PAHO; 2020-09-18.
em Inglês, Espanhol | PAHO-IRIS | ID: phr-53105

RESUMO

Since the 26 August PAHO/WHO Epidemiological Update on COVID-19 and as of 15 September 2020, the five countries/territories in the Americas for which there was a ≥200% relative increase in the number of cases are: Curacao (357%), Guadeloupe (299%), Trinidad and Tobago (254%), the British Virgin Islands (214%), and Jamaica (200%). Those with the greatest relative increase in the number of deaths were Trinidad and Tobago (331%), Belize (280%), and Aruba (233%). Between 22 August and 15 September 2020, the countries/territories that modified their COVID-19 transmission classifications based on increased intensity of COVID-19 transmission were: Curacao and Saint Martin (changing from sporadic cases to community transmission) and Guadeloupe, Jamaica, and Martinique (changing from clusters of cases to community transmission). [...]


En el periodo comprendido entre la última actualización epidemiológica publicada por la OPS/OMS el 26 de agosto y el 15 de septiembre de 2020, los cinco países/territorios en las Américas en los cuales se observa un incremento relativo ≥200% en el número de casos son: Curazao (357%), Guadalupe (299%), Trinidad y Tobago (254%), las Islas Vírgenes Británicas (214%) y Jamaica (200%); mientras que los que presentaron el mayor aumento relativo en el número de defunciones fueron Trinidad y Tobago (331%), Belice (280%) y Aruba (233%). Los países y territorios que modificaron el escenario de transmisión de COVID-19, en este mismo periodo (entre el 22 de agosto y el 15 de septiembre) observándose un incremento en la transmisión de casos de menor a mayor intensidad fueron: Curazao y San Martín (de casos esporádicos a transmisión comunitaria), Guadalupe, Jamaica y Martinica (de conglomerado de casos a transmisión comunitaria). [...]


Assuntos
Infecções por Coronavirus , Coronavirus , Infecções por Coronavirus , Controle de Infecções , Betacoronavirus , América , Região do Caribe , Emergências , Regulamento Sanitário Internacional , Infecções por Coronavirus , Controle de Infecções , América , Região do Caribe , Emergências , Regulamento Sanitário Internacional
15.
World Neurosurg ; 144: e227-e236, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32827741

RESUMO

OBJECTIVE: To analyze the results of microsurgery for Spetzler-Martin (SM) grade I-III AVMs and evaluate the correlation of the Lawton-Young (LY) supplementary grade, supplemented Spetzler-Martin (SM-Supp/combined) score with the functional outcome. METHODS: A total of 42 patients with SM grade I-III AVMs who had undergone surgery at our institute during a 3-year period (June 2013 to May 2016) were included in the present study. RESULTS: All 42 patients had undergone primary surgery without previous embolization. Three patients (7.1%) had died due to surgical site hematoma in the postoperative period. One patient was lost to follow-up. The mean follow-up period for the remaining patients was 27 ± 14 months (range, 12-62 months). At the final follow-up examination of ≥12 months (FFU), 92.7% of the patients had a good outcome (modified Rankin scale [mRS] score ≤1), with an improved or unchanged mRS score in 87.8%. An AVM size >3 cm, diffuse AVM, SM grade III, and SM-Supp score >5 were associated with worsened mRS score at discharge and FFU. Higher LY grade (IV and V), eloquent AVM location, deep venous drainage, age >40 years, and unruptured presentation were not associated with worsened mRS score at both discharge and FFU. Of the 20 ARUBA-eligible patients, 19 (95%) had good outcomes. Postoperative angiograms for 39 patients revealed complete excision of the AVM in 37 (94.9%) and a residual AVM in 2 (5.1%). CONCLUSIONS: High cure rates and excellent clinical outcomes can be expected with microsurgery for most patients with SM grade I-III AVMs. An AVM size >3 cm, diffuse AVM nidus, SM grade III, and SM-Supp score >5 are associated with postoperative worsening of functional scores in patients with SM grade I-III AVMs.

16.
Ann Thorac Surg ; 2020 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-32721454

RESUMO

BACKGROUND: Small island developing states (SIDS) make up nearly 1% of the world's population, with 65 million people across 58 countries. Small island developing states have some of the highest rates of rheumatic heart disease in addition to a substantial burden of congenital heart defects and a growing burden of ischemic heart disease. Here, we present an overview of cardiac surgical services in SIDS, with a focus on Papua New Guinea, the Maldives, and Aruba. METHODS: We performed a literature review using the PubMed/MEDLINE and Google Scholar databases to identify articles describing cardiac surgery services in SIDS. Case studies of the history and current state of cardiac surgery in Papua New Guinea, the Maldives, and Aruba were developed and informed by local clinical experience. RESULTS: Nine SIDS have independent cardiac surgical centers and 5 SIDS have local centers supported by visiting teams. Papua New Guinea started cardiac surgery in 1993 and is served by a public center, performing nearly 100 cardiac surgeries per year. The Maldives introduced cardiac surgery services in 2018, with 1 local cardiac surgeon supported by Nepalese cardiac surgeons, performing 33 cardiac surgeries in 15 months. In Aruba, no local cardiac center exists and over 150 patients are sent abroad for cardiac surgery, representing 12% of total health spending. CONCLUSIONS: Small island developing states have limited availability of cardiac surgery but pressing clinical needs. Independent cardiac centers exist with acceptable outcomes and lower costs than foreign treatment, which suggests the need to strengthen regionalization models to deliver cardiac surgical care in SIDS.

17.
Virol J ; 17(1): 90, 2020 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-32615978

RESUMO

BACKGROUND: Three different genotypes of chikungunya virus (CHIKV) have been classified: East/Central/South African (ECSA), West African (WA), and Asian. Previously, a rapid immunochromatographic (IC) test detecting CHIKV E1-antigen showed high sensitivity for certain ECSA-genotype viruses, but this test showed poor performance against the Asian-genotype virus that is spreading in the American continents. We found that the reactivity of one monoclonal antibody (MAb) used in the IC rapid diagnostic test (RDT) is affected by a single amino acid substitution in E1. Therefore, we developed new MAbs that exhibited specific recognition of all three genotypes of CHIKV. METHODS: Using a combination of the newly generated MAbs, we developed a novel version of the IC RDT with improved sensitivity to Asian-genotype CHIKV. To evaluate the sensitivity, specificity, and cross-reactivity of the new version of the IC RDT, we first used CHIKV isolates and E1-pseudotyped lentiviral vectors. We then used clinical specimens obtained in Aruba in 2015 and in Bangladesh in 2017 for further evaluation of RDT sensitivity and specificity. Another alphavirus, sindbis virus (SINV), was used to test RDT cross-reactivity. RESULTS: The new version of the RDT detected Asian-genotype CHIKV at titers as low as 10^4 plaque-forming units per mL, a concentration that was below the limit of detection of the old version. The new RDT had sensitivity to the ECSA genotype that was comparable with that of the old version, yielding 92% (92 out of 100) sensitivity (95% confidence interval 85.0-95.9) and 100% (100 out of 100) specificity against a panel of 100 CHIKV-positive and 100 CHIKV-negative patient sera obtained in the 2017 outbreak in Bangladesh. CONCLUSIONS: Our newly developed CHIKV antigen-detecting RDT demonstrated high levels of sensitivity and lacked cross-reactivity against SINV. These results suggested that our new version of the CHIKV E1-antigen RDT is promising for use in areas in which the Asian and ECSA genotypes of CHIKV circulate. Further validation with large numbers of CHIKV-positive and -negative clinical samples is warranted. (323 words).

18.
Lancet Neurol ; 19(7): 573-581, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32562682

RESUMO

BACKGROUND: In A Randomized trial of Unruptured Brain Arteriovenous malformations (ARUBA), randomisation was halted at a mean follow-up of 33·3 months after a prespecified interim analysis showed that medical management alone was superior to the combination of medical management and interventional therapy in preventing symptomatic stroke or death. We aimed to study whether these differences persisted through 5-years' follow-up. METHODS: ARUBA was a non-blinded, randomised trial done at 39 clinical centres in nine countries. Adults (age ≥18 years) diagnosed with an unruptured brain arteriovenous malformation, who had never undergone interventional therapy, and were considered by participating clinical centres to be suitable for intervention to eradicate the lesion, were eligible for inclusion. Patients were randomly assigned (1:1) by a web-based data collection system, stratified by clinical centre in a random permuted block design with block sizes of two, four, and six, to medical management alone or with interventional therapy (neurosurgery, embolisation, or stereotactic radiotherapy, alone or in any combination, sequence, or number). Although patients and investigators at a given centre were not masked to treatment assignment, investigators at other centres and those in the clinical coordinating centre were not informed of assignment or outcomes at any of the centres. The primary outcome was time to death or symptomatic stroke confirmed by imaging, assessed by a neurologist at each centre not involved in the management of participants' care, and monitored by an independent committee using an adaptive approach with interim analyses. Enrolment began on April 4, 2007, and was halted on April 15, 2013, after which follow-up continued until July 15, 2015. All analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, NCT00389181. FINDINGS: Of 1740 patients screened, 226 were randomly assigned to medical management alone (n=110) or medical management plus interventional therapy (n=116). During a mean follow-up of 50·4 months (SD 22·9), the incidence of death or symptomatic stroke was lower with medical management alone (15 of 110, 3·39 per 100 patient-years) than with medical management with interventional therapy (41 of 116, 12·32 per 100 patient-years; hazard ratio 0·31, 95% CI 0·17 to 0·56). Two patients in the medical management group and four in the interventional therapy group (two attributed to intervention) died during follow-up. Adverse events were observed less often in patients allocated to medical management compared with interventional therapy (283 vs 369; 58·97 vs 78·73 per 100 patient-years; risk difference -19·76, 95% CI -30·33 to -9·19). INTERPRETATION: After extended follow-up, ARUBA showed that medical management alone remained superior to interventional therapy for the prevention of death or symptomatic stroke in patients with an unruptured brain arteriovenous malformation. The data concerning the disparity in outcomes should affect standard specialist practice and the information presented to patients. The even longer-term risks and differences between the two therapeutic approaches remains uncertain. FUNDING: National Institute of Neurological Disorders and Stroke for the randomisation phase and Vital Projects Fund for the follow-up phase.


Assuntos
Fístula Arteriovenosa/tratamento farmacológico , Fístula Arteriovenosa/cirurgia , Malformações Arteriovenosas Intracranianas/tratamento farmacológico , Malformações Arteriovenosas Intracranianas/cirurgia , Adulto , Fístula Arteriovenosa/mortalidade , Embolização Terapêutica/métodos , Feminino , Seguimentos , Humanos , Malformações Arteriovenosas Intracranianas/mortalidade , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Radiocirurgia/métodos , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento
19.
Rev Panam Salud Publica ; 44: e38, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32435265

RESUMO

Objective: To identify specific health care areas whose optimization could improve population health in the Dutch Caribbean islands of Aruba and Curaçao. Methods: Comparative observational study using mortality and population data of the Dutch Caribbean islands and the Netherlands. Mortality trends were calculated, then analyzed with Joinpoint software, for the period 1988-2014. Life expectancies were computed using abridged life tables for the most recent available data of all territories (2005-2007). Life expectancy differences between the Dutch Caribbean and the Netherlands were decomposed into cause-specific contributions using Arriaga's method. Results: During the period 1988-2014, levels of amenable mortality have been consistently higher in Aruba and Curaçao than in the Netherlands. For Aruba, the gap in amenable mortality with the Netherlands did not significantly change during the study period, while it widened for Curaçao. If mortality from amenable causes were reduced to similar levels as in the Netherlands, men and women in Aruba would have added, respectively, 1.19 years and 0.72 years to their life expectancies during the period 2005-2007. In Curaçao, this would be 2.06 years and 2.33 years. The largest cause-specific contributions were found for circulatory diseases, breast cancer, perinatal causes, and nephritis/nephrosis (these last two causes solely in Curaçao). Conclusions: Improvements in health care services related to circulatory diseases, breast cancer, perinatal deaths, and nephritis/nephrosis in the Dutch Caribbean could substantially contribute to reducing the gap in life expectancy with the Netherlands. Based on our study, we recommend more in-depth studies to identify the specific interventions and resources needed to optimize the underlying health care areas.

20.
World Neurosurg ; 141: e261-e265, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32442730

RESUMO

OBJECTIVE: Treatment of unruptured intracranial arteriovenous malformations (AVMs) has become controversial since the ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) study was published in 2014. We sought to analyze changes in the demographics, clinical presentation, and treatment strategies in 2 patient cohorts from the same institution separated by 40 years. METHODS: We retrospectively reviewed the electronic medical records for a consecutive series of patients with unruptured intracranial AVMs seen at the Mayo Clinic between 2003 and 2017 and compared them with a previously published historical cohort from the same institution seen between 1974 and 1985. RESULTS: There were 273 patients in the contemporary cohort, of which discovery of the AVM was incidental in 123 (45.1%), a 3.5-fold increase compared with the 13.1% out of 168 patients in the historical cohort (P < 0.0001). Consequently, the percentage of patients with seizures as the presenting symptom leading to the diagnosis of AVM decreased from 57.7% in the historical cohort to 28.9% in the contemporary cohort (P < 0.0001). Interventional treatment was utilized in 220 (81.5%) contemporary patients compared with 49 (29.2%) historical patients (P < 0.0001). CONCLUSIONS: Compared to 40 years ago, more patients are presenting with incidentally discovered intracranial AVMs and are undergoing interventional treatment. Better understanding of the natural history, developments in endovascular therapy, and stereotactic radiosurgery, as well as improvements in microsurgical techniques have led to a substantial increase in patients undergoing invasive treatment.

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