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1.
Artículo en Inglés | MEDLINE | ID: mdl-34797028

RESUMEN

Root endospheres house complex and diverse bacterial communities, of which many strains have not been cultivated yet by means of the currently available isolation techniques. The Prospector® (General Automation Lab Technologies, San Carlos, CA, USA), an automated and high-throughput bacterial cultivation system, was applied to analyse the root endomicrobiome of lettuce (Lactuca sativa L.). By using deep sequencing, we compared the results obtained with the Prospector and the traditional solid medium culturing and extinction methods. We found that the species richness did not differ and that the amount of previously uncultured bacteria did not increase, but that the bacterial diversity isolated by the three methods varied. In addition, the tryptic soy broth and King's B media provided a lower, but different, diversity of bacteria than that of Reasoner's 2A (R2A) medium when used within the Prospector system and the number of unique bacterial strains did not weigh up against those isolated with the R2A medium. Thus, to cultivate as broad a variety of bacteria as possible, divergent isolation techniques should be used in parallel. Thanks to its speed and limited manual requirements, the Prospector is a valuable system to enlarge root microbiome culture collections.

2.
J Evid Based Dent Pract ; 21(3): 101616, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34479677

RESUMEN

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Bedran NR, Nadelman P, Magno MB, de Almeida Neves A, Ferreira DM, Braga Pintor AV, Maia LC, Primo LG. Does Calcium Hydroxide Reduce Endotoxins in Infected Root Canals? Systematic Review and Meta-analysis. J Endod. 2020 Aug 11:S0099-2399(20)30582-3. doi:10.1016/j.joen.2020.08.002. Epub ahead of print. PMID: 32795549. SOURCE OF FUNDING: This systematic review was supported in part by the Coordenaçao de Aperfeiçoamento de Pessoal de Nível Superior (finance code 001, 88882.424816/2019-01) and Fundaçao Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro (grant nos. E-26/202.334/2019, E-26/202.399/ 2017, and E-26/210.352/2019). TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.


Asunto(s)
Hidróxido de Calcio , Endotoxinas , Brasil , Clorhexidina , Humanos
3.
Multimedia | Recursos Multimedia | ID: multimedia-8785

RESUMEN

0:00:34 CL Hello, good day and welcome to... wherever you are listening to us today from [sic]. It's Monday 19th April 2021. My name is Christian Lindmeier and I'm welcoming you to today's global COVID-19 press conference. The press conference today is on COVID updates with a special focus on the linkages between the climate and the COVID-19 crisis and the role of youth in the response ahead of Earth Day, which is 22nd April, and the first Global Youth Summit organised as part of the global youth mobilisation, which is 23rd to 25th April. Today's press conference will include three special guests and I'm happy to welcome Greta Thunberg, Climate and Environmental Activist, Elahi Rawshan from Bangladesh, volunteer in the International Federation of the Red Cross and Red Crescent Society, supporting young people in Bangladesh, and Daisy Moran from the USA, Global Youth Mobilisation Youth Board Member and World YMCA Representative. Welcome to the three of you. We will have simultaneous interpretation as usual provided in the six official UN languages, Arabic, Chinese, French, English, Spanish and Russian, plus Portuguese and Hindi. Now let me introduce the participants here in the room. Present in the room are Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Dr Maria Van Kerkhove, Technical Lead on COVID-19, Dr Bruce Aylward, Special Advisor to the Director-General and the Lead on the ACT Accelerator. We have Mr Anil Suni, Chief Executive Officer from the WHO Foundation and we have Dr Maria Nera, Director for Health and Environment. We also have joining us remotely today Dr Mike Ryan, Executive Director for the Health Emergencies Programme of WHO, and Dr Mariangela Simao, Assistant Director-General for Access to Medicines and Health Products. With this let me hand over to the Director-General for the introductory remarks. Dr Tedros, the floor is yours. Thank you. Thank you, Christian. Good morning, good afternoon and good evening. Last week new cases of COVID-19 increased for the eighth week in a row with more than 5.2 million cases reported, the most in a single week so far. Deaths rose for the fifth straight week and more than three million deaths have now been reported to WHO. It took nine months to reach one million deaths, four months to reach two million and three months to reach three million deaths. Big numbers can make us numb but each one of these deaths is a tragedy for families, communities and nations. Infections and hospitalisations among people aged 25 to 59 are increasing at an alarming rate, possibly as a result of highly transmissible variants and increased social mixing among younger adults. 00:04:28 Today the emergency committee gave me its advice on vaccines, variants, international travel and other issues. Its full statement is available on our website. We have the tools to bring this pandemic under control in a matter of months if we apply them consistently and equitably. On Friday WHO issued an expression of interest for establishing a COVID-19 technology transfer hub for MRNA vaccines to increase production of those vaccines in low and middle-income countries. We're calling for the original manufacturers of MRNA vaccines to contribute their technology and know-how and for manufacturers in low and middle-income countries to express interest in receiving that technology. We have seen incredible innovation in science. Now we need innovation to ensure as many people as possible benefit from that science. The pandemic will recede but we will still be left with all the other challenges that we had before including the climate crisis. 00:05:58 This week marks Earth Day on 22nd April, a reminder that human health depends on the health of the planet that sustains us. COVID-19 has now killed more than three million people. Air pollution kills more than double that number, seven million people every single year. Despite temporary improvements in air quality last year as a result of so-called lock-downs by September air pollution had returned to pre-pandemic levels. Globally CO2 emissions only decreased by less than 6% last year but by December they had rebounded to their previous levels. The health argument for climate action is crystal-clear. The same unsustainable choices that are killing our planet are killing people. There is no vaccine for climate change but we do have solutions. Last year WHO published our manifesto for a healthy and green recovery, calling on all governments to protect nature, support clean energy sources, develop sustainable food systems and healthier cities and reduce polluting activities. 00:07:36 Together the six prescriptions of the WHO manifesto can not only restore resilient economies; they are a linchpin and essential prerequisite for healthy societies. At the COP26 climate conference in Glasgow this year WHO will deliver a special report with recommendations on how to maximise the health benefits of tackling climate change while avoiding the worst health impacts of the climate crisis. WHO is also spearheading an initiative on promoting climate-resistant health systems in collaboration with the Government of the United Kingdom. Today it's my honour to welcome someone who needs no introduction. Over the past few years Greta Thunberg has become the powerful voice of a young generation demanding climate action. Greta's mobilisation of communities, particularly young people, has been truly inspirational and has brought into sharp focus the impact of the climate crisis on people's lives and the urgent need for transformative action. The awareness she has raised on the links between climate, the environment and health has supported WHO's agenda in these areas, demonstrated the threats all of us face and the role young people can play in building a more sustainable, safer, healthier world. 00:09:33 More recently she has become a powerful advocate for vaccine equity. Tack så mycket, Greta. Today Greta has announced a donation of €100,000 from the Greta Thunberg Foundation to the WHO Foundation in support of COVAX to provide vaccines to people in need. Greta, thank you, tack så mycket for your superb advocacy for climate action and now for vaccine equity. Your contribution makes you the youngest person to contribute to COVAX. Welcome and you have the floor. GT Thank you so much for having me. It is an honour to participate in this event and I will talk briefly now. Science shows that in the future we will most likely experience more frequent and more devastating pandemics unless we drastically change our ways and the way we treat nature. Today up to 75% of all emerging diseases come from animals and as we are cutting down forests and destroying habitats we are creating the ideal conditions for diseases to spill over from one animal to another and then to us. 00:11:08 We can no longer separate the health crisis from the ecological crisis and we cannot separate the ecological crisis from the climate crisis. It's all interlinked in many ways. During this pandemic we have seen what we can achieve when we put resources into science. Vaccines were developed in record time but so far on average one in four people in high-income countries have received a coronavirus vaccine compared with just one in over 500 in low and middle-income countries. The international community, governments and vaccine developers must step up their game and address the tragedy that is vaccine inequity. We have the tools we need to correct this great imbalance that exists around the world today in the fight against COVID-19. Just as with the climate crisis those who are the most vulnerable need to be prioritised and global problems require global solutions. It is completely unethical that high-income countries are now vaccinating young and healthy people if that happens at the expense of people in risk groups and on the front lines in low and middle-income countries. This is a moral test. We talk today about showing solidarity and yet vaccine nationalism is what's running the vaccine distribution. It is only when it really comes down to it that we show our true face and that is why I and many others are supporting WHO, GAVI and all involved in the COVAX initiative, which I believe offers the best path forward to ensure a more equitable global vaccine distribution and a way out of this pandemic. Thank you. 00:13:04 TAG Thank you. Thank you so much, Greta, and thank you for your generosity in donating to the WHO Foundation in support of COVAX. These funds will help us save lives. Around the world young people have been affected by the pandemic in many ways from disruptions in education, loss of employment opportunities, mental health challenges and increased domestic and gender-based violence. WHO is committed to ensuring that the global recovery from COVID-19 includes the voices, energy and ideas of young people. To do that we have partnered with an alliance of the six largest youth development organisations in the world to form the Global Youth Mobilisation, to empower young people to respond to the challenges created by the pandemic in their local communities. 00:14:08 The Global Youth Mobilisation has established a grant mechanism with funds from the Solidarity Response Fund to support innovative local solutions to address the impact of the COVID-19 pandemic. From today young people around the world will be able to apply for grants of between 500 and US$5,000 through the Global Youth Mobilisation. These local solutions will be judged and decided on by young people for young people. To mark the starting point for young people to get involved in the Global Youth Mobilisation a Global Youth Summit will be held virtually from this Friday to Sunday, 23rd to 25th April. Over three days thousands of young people, leaders, policymakers and change-makers will come together in one space to discuss the issues facing young people across the world. On behalf of the Big Six youth organisations, the United Nations Foundation and WHO I invite everyone to join us at the Global Youth Summit. Today I'm delighted to be joined by representatives from two of the Big Six organisations. First it's my honour to welcome Elahi Rawshan, a volunteer with the International Federation of the Red Cross and Red Crescent Societies in Bangladesh. Elahi, thank you for joining us today. You have the floor. 00:16:05 ER Thank you, Dr Tedros, for inviting me here today. I'm really honoured to be here. My name is Elahi Rawshan. I'm a Red Cross/Red Crescent youth volunteer living in Bangladesh. There are about three million young people around the world how have been taking action to respond to the COVID-19 pandemic, driving the response efforts and supporting their local communities. I'd like to share with you my story to help explain why recognising, championing and investing in young people through the Global Youth Mobilisation is important. I led the very first disinfection team of Bangladesh Red Crescent Society in different hospitals for two consecutive months. At the beginning of the pandemic here the hospitals needed more supporting hands and we wanted to make sure the hospital environment was safe for everyone and we did to a great extent. One day when the very first COVID patient died in a hospital and everyone was so frightened to go near him, even his own son was reluctant to take his father's body. We went in, we disinfected the room and made sure the body was safe for carrying. 00:17:31 Another day I carried a critical COVID patient on a wheelchair and put an oxygen mask on her when there was no-one around for the support of that person. But I was not the only one; there are thousands of young people in Bangladesh fighting this battle in many different forms. About 4,500 young volunteers of the Red Crescent Society are supporting the vaccination programme every day in Bangladesh. It's mostly the young people here who are making a difference and again it's the young people here who are mostly infected by the pandemic. Many of my friends, colleagues from the different youth organisations and networks have lost their jobs. Almost everyone here is suffering from mental health issues. The data shows that from March 2020 to February 2021 more than 14,000 have committed suicide, which is 45% higher than the previous year and the majority of them are young people. 00:18:44 My dear friends, I have seen localised action making a positive impact on people's lives during this pandemic. I have been trying to collaborate with the Red Crescent Society with my workplace [unclear] who have been offering an online skills programme for the young people. Now as both parties have agreed the Red Crescent youth volunteers will receive a three-month online skills training on different trades like graphics designing, web development, etc. I believe drives like this will help young people individually and at the same time will contribute to the national economy. There are plenty of organisations and individuals out there who are making many more new initiatives to combat this COVID crisis and I would like to invite them all to collaborate with the Global Youth Mobilisation and it will support, promote and invest in your initiatives for improving more lives and communities. Thank you. TAG Thank you. Thank you so much, Elahi. Next it's my pleasure to introduce Daisy Moran, a representative of the World YMCA and a board member of the Global Youth Mobilisation. Daisy, thank you for joining us and you have the floor. 00:20:16 DM Thank you for giving me this opportunity, Dr Tedros, and greetings to you all. I'm Daisy Moran, proud to be with the YMCA in Illinois, USA and proud to be one of the six youth board representatives of the Global Youth Mobilisation. Here's what youth mobilisation has meant for me as the COVID pandemic has significantly increased the inequities in all of our societies. As a young leader I saw a need in my community to offer relief to essential workers who are undocumented immigrants. Through collaboration with fellow young change-makers and organisations we were able to disburse almost $17,000 in relief funds for 38 families. This is just one of thousands of stories that illustrate the simple and powerful fact; when given access and opportunities young people can make a significant difference. In the YMCA and right across the Big Six youth organisations young people have stepped up during the pandemic by delivering supplies to vulnerable people, looking after each other's mental health, making masks, helping share vital public information and now actively facilitating the COVID vaccine campaign. 00:21:35 As the global pandemic enters the recovery and relief period it is crystal-clear that young people are disproportionately impacted by the immediate and long-term implications of disruption in education, employment opportunities, physical and mental health/well-being, to name a few. These two reasons - young people bearing the brunt of the impact of COVID and young people offering so many of the solutions - are what has inspired the Big Six organisations, the World Health Organization and the United Nations Foundation to support young people around the would in delivering and developing youth-led community solutions through the Global Youth mobilisation. I am so excited and I want young people all over the world to be excited and get involved. They can start by attending the Global Youth Summit, which will be held virtually from 23rd to 25th April. At the summit they will hear about the role of young people in the immediate and long-term COVID recovery. It's a great forum where we can share our thoughts, passions, ideas that will influence policies and decisions that impact all of our lives. 00:22:47 This is a critical time for my generation, for our generation to bring policymakers, change-makers, advocate together to address the major challenges confronting young people by solutions and put them into action in our communities. No matter how big or how small I encourage you to have the confidence to apply for funding. If you have an idea to a challenge created by the pandemic you can apply for funding from $500 to $5,000. It is young people like you and me who will evaluate and agree who gets support for these local solutions. So please visit our website, www.globalyouthmobilisation.org We are the movement by youth, for youth and young people really are the answer. We are not the challenge. We are truly being the change that we want to see in the world. Thank you. TAG Thank you. Thank you so much, Daisy - by youth, for youth - and thank you to both of you for your leadership and vision. I look forward to joining both of you at the World Youth Summit and I look forward to seeing what ideas we can help take forward through the Global Youth Mobilisation. This is a reminder that although we're all living through a dark time there are also many reasons for hope and optimism about the future. Christian, back to you. 00:24:24 CL Thank you very much, all, and thank you very much, Dr Tedros. We will start the round of questions and answers. To remind you, if you want to get into the queue for questions please press the raise your hand icon on your screen. We'll start with the first question from Carlos from El Mundo. Carlos, please unmute yourself. CA Hi. CL Go ahead, please. CA It's a question specifically for Greta. Isn't there a risk that the COP26 will lose its momentum? What should we change in the next three months for example to turn the tide and to put the two goals of climate change and vaccination equality on the same level? CL Thank you very much, Carlos. Yes, Greta Thunberg, please. 00:25:27 GT Of course there's a risk that COP will lose momentum but the most important thing is that everyone is safe and of course safety and health come first in these kinds of situations. Of course there's not just one thing that needs to change in order to break this trend that we are seeing now, there's not just one single thing that we can do to - so-called - solve the climate crisis and the vaccine inequity crisis. Of course it's a bit more complicated than that and I think I may not be the best person to answer that. I think there are lots of experts who are more suited for that question but we do need to change our mindsets, we do need to think globally and not only think about ourselves. That's what these crises come down to, that we only think about ourselves, that we don't think about others. They come down to the way we treat others, the way we treat other human beings, the way we treat other animals and nature itself so we need to change our mindsets, if you want one single thing; it's more complicated than but just one thing. CL Thank you very much, Greta. I'll ask Dr Maria Neira from WHO to add, possibly. 00:26:56 MN Thank you, Christian, and thank you very much, Greta. It's really a pleasure to have you with us. You are an inspiration. You have been driving an incredible movement and many people are behind so certainly the COP26 has to be something very successful. In response to your question, Carlos - hola - I think what will change the mindset and what might have an incredible impact is what the Director-General was saying at the beginning, the health argument of climate change. If we are able to explain to people that climate change is about our health, it is affecting our health and if we stop burning fossil fuels the benefits will be enormous in terms of reducing the process of climate change but as well on reducing air pollution. Air pollution, as mentioned again by the Director-General, is responsible for more than seven million premature deaths every year due to exposure to air pollution and in addition to that it creates an environment that makes our health more vulnerable and creates the perfect conditions for more emerging infectious diseases to occur. 00:28:12 So I think we have a perfect case here for creating more action at the COP26, giving the health benefits that can be obtained in an incredible way. If we tackle the causes of air pollution, if we tackle the causes of climate change that will be an enormous health agenda and talking about health is what can make this change that we all need in terms of ambition to go for more at [?] the COP and in convincing people. If we tell people that this is connected to human health I think this will be the final argument that will create much more motivation and engagement and probably a stronger movement to put political pressure on those who will take decisions and hopefully going for much more. Thank you. CL Thank you very much. This was Dr Maria Neira, Director for Environment, Climate Change and Health. The next question goes to Shoko Koyama from NHK. Shoko, please unmute yourself. SH Hello. Can you hear me? CL Go ahead, please. SH Thank you for taking my question. Regarding COVAX, UNICEF is trying to buy one billion syringes by the end of this year in order to distribute to countries together with vaccines. 00:29:37 One billion syringes in addition to the six to 800 million syringes they procure annually seems to be a large quantity. Is COVAX able to procure this huge number of syringes by the end of this year and what challenges are there regarding the procurement of syringes? Thank you. CL Thank you very much, Shoko. I'll give it to Dr Bruce Aylward. BA Thank you very much, Shoko, for the question and thanks for highlighting that it takes more to get the world vaccinated than simply to make and procure the vaccines because there are all the additional pieces that have to go into this including additional supplies like not just syringes, which you mentioned, but also the vaccination cold chains and other supplies that are necessary to keep them in the right conditions before we get them to the actual people who need to be vaccinated. 00:30:38 In terms of the syringes, just like the cold chain equipment the COVAX facility began working with countries way back in October or even earlier last year to look at what numbers of syringes would be required and to start working with manufactures to ensure that pipeline would be there. You might remember some months ago the Director-General invited Henrietta Fore, who is the Executive Director of UNICEF, to join one of these press conferences and at that time she explained what they were already doing to try and make sure that the necessary syringes would be in place. This will continue to be a challenge, just like all of the supplies necessary to get the world vaccinated, these extraordinary numbers but for the moment the pipelines are there and the producers are doing their part. But it all comes back again also to the COVAX facility having the resources it needs so that it can put the contracts in place up-front to make sure the supplies are there, not just the supplies in terms of the vaccines but, exactly as you highlight, the syringes and the other supplies including, as I mentioned, the cold chain equipment and sometimes very specialised cold chain equipment to get these products to people. 00:31:57 CL Thank you very much, Dr Aylward. We'll move on to Robin Mia from AFP. Robin, please unmute yourself. RO Thank you. A question for Greta, if I may. If vaccine inequity carries on and young people start being offered a vaccine in wealthy countries whilst at the same time elderly and wealthy people remain completely unprotected in poor countries, would you advocate a vaccine strike amongst younger people in rich countries until their governments start sharing more vaccines? Thank you. CL Thank you very much, Robin. Of course, Greta, the floor is yours. GT We must not forget that this is not a problem that is caused by individuals. This is a problem that needs to be addressed by the international community, governments and the vaccine developers. It is wrong; if we should start focusing on individuals and urging individuals not to take the vaccine that would send a very wrong message. 00:33:00 Of course everyone who is offered a vaccine should take it but we need to see the bigger picture here and be able to focus on several things at once. So no, I would not advocate for people not to take the vaccine. CL Thank you so much for that. We'll move to Jamil Chad from O Estado de Sao Paulo. Jamil, please unmute yourself. Jamil, do you hear us? Please unmute yourself. JA Can you hear me, Christian? CL Please go ahead. JA Can you hear me? CL Yes. JA Thank you. This is Jamil Chad, a journalist from Brazil. Ms Greta Thunberg, my question is about vaccines but also on climate change. What is your message to President Bolsonaro at this time when both the pandemic is hitting Brazil hard but also climate change is an issue? You'll note very well what is the position of President Bolsonaro. What is the message you can send him today? Thank you. CL Thank you so much, Jamil. Over to Greta. 00:34:24 GT Of course I don't think we should be focusing on talking about individuals since this is a much larger problem but of course Jair Bolsonaro has a huge responsibility both when it comes to the climate, environment and of course we can see the response that Brazil has had during the corona pandemic. I can only speak for myself but I can safely say that he has failed to take the responsibility that is necessary in order to safeguard present and future living conditions for humanity. CL Thank you very much, Greta. We'll move on to Navas Shah from Xinhua. Navas, please unmute yourself. Navas Shah, do you hear us? Please unmute yourself. It looks as if we're not getting to you so we will continue with Gunila Van Hal from Svenska Dagbladet. Gunila, please unmute yourself. GU Can you hear me? CL Wonderful. Go ahead. GU Thanks for taking my question. It is to Greta Thunberg and I'd like to know your view on the proposal from WHO and many governments, among those your own, the Swedish Government, that richer countries should donate remaining vaccine doses to poorer countries once their own risk groups have been vaccinated and before they vaccinate the rest of the population. 00:36:06 What do you think about this and what do you respond to people questioning this, saying, why should we sacrifice our own populations in order to save the world? Thank you. CL Thank you, Gunila. Over to Greta, please. GT I think that is a very reasonable thing to do. We need to protect and prioritise the most vulnerable people in risk groups and working on the front lines, no matter which countries they come from; at least that's my opinion. Of course I understand that people will be frustrated by that. Of course I also want to return to everyday life and everyone I know wants to do that as well but we need to act in solidarity and we need to use common sense when it comes to these issues. As I said, the only sensible thing to do, the only morally right thing to do is to prioritise the people who are the most vulnerable no matter whether they live in a high-income country or a low-income country. 00:37:23 CL Thank you very much, Ms Thunberg. We'll move ahead to Jamie Keaton from AP. Jamie, please unmute yourself. JM Thank you, Christian. My question is both for Ms Thunberg and Ms Moran. What is your message to young people who have become a major driver of COVID-19 infection? We heard the Director-General, Dr Tedros, just mention that increased social mixing among younger adults is possibly one of the reasons for the increase in infections and hospitalisations among people aged 25 to 59. If I could just sneak in a another question to Ms Thunberg, ahead of President Biden's climate summit what do you hope it will achieve? Thank you. CL No small questions today. Thank you very much, Jamie. Let's move to Greta Thunberg first and then on. Thank you. GT Yes, of course it's absolutely crucial that everyone takes our personal responsibility in this crisis. We young people may be the ones who are in general least affected by the virus in a direct way but of course, as I said, we need to act in solidarity with the people in risk groups. 00:38:57 Of course many young people fail to draw that connection maybe; of course not everyone but of course there will always be some. My message to those is that during crises like these we need to take a few steps back and act for the greater good of society and in order to protect our fellow citizens and of course especially people in risk groups because that is the thing you do during crises; you step up for one another. My hopes for the Biden summit; I hope that we will soon in one way or another start treating this crisis like a crisis - the climate crisis, that is - because if we are to be blunt, we can have as many summits as we want, we can have as many meetings and conferences as we want and make nice speeches and nice pledges like next year or 2050 and so on. But as long as those things contain so many loopholes as they do and as long as we are not actually treating the crisis as a crisis of course we won't be able to achieve any major changes. As I mentioned earlier, we need to change our mindsets and we need to change or view of the world. We cannot try to solve this crisis with the same approach that got us into it in the first place so we need to start treating the crisis like a crisis. 00:40:40 Without an increased level of awareness among people in general of course there will be no pressure on world leaders to actually start making the changes that are necessary to safeguard humanity so my hope is that we will start treating the crisis like a crisis. CL Thank you so much, Greta. Let me first give the floor to Daisy Moran from the global youth organisation [unclear]. Daisy. DM Thank you and thank you for your question. I believe my generation, our generation that we are representing is a generation of allyship because we understand our privilege and how to use our privileges to uplift those in the most vulnerable situations. The Global Youth Summit is a platform and a forum for all of youth and stakeholders and supporters to come together to really listen to what are the policy changes that need to be made so that we can have more equitable societies and systems in place. So I hope that you can join us this weekend while we discuss the important issues and challenges facing our generation and how our youth leaders are in a position to create the most innovative solutions to tackle these big issues. Thank you. 00:41:59 CL Thanks so much, Daisy. Now we'll move to Dr Maria Van Kerkhove. MK Thanks, Christian. Those were excellent answers but I did want to clarify something here with regard to increased transmission. We are seeing increased rates of infection across all age groups. Last week there were 5.2 million cases reported to WHO globally, the largest in a single week since this pandemic began, 16 months into the pandemic. That is the largest increase in a week that we have seen to date. We've seen an increase across all age groups. We need to take the blame away and in the question it was meant to blame and we can't do that. Everyone has a role to play in this pandemic. We all have a role to play in keeping ourselves and our loved ones safe. What we are seeing is a slight age shift in some countries driven by social mixing and social mixing doesn't necessarily mean going out and having a party. It means individuals who have to leave their home to go to work, it means individuals have to feed their families and if you increase social mixing for a variety of reasons, whether this is for work or for religious reasons or indeed socialising itself the virus will take advantage of that. 00:43:18 If you add on top of it these variants of concern, variants that are circulating around the world, particularly the B117 variant which is circulating in a large number of countries across the globe that have increased transmissibility; if you add variants that have increased transmissibility with increased mixing this virus will take off and case numbers will increase. In a number of countries we've seen a very, very steep incline due to this. In addition to that we are seeing some countries not able to implement the public health and social measures that are needed to allow for physical distancing and in many parts of the world physical distancing is really not possible but in other parts of the world it is. So we need to do what we can to avoid those crowded settings, avoid those settings where social mixing - particularly indoor, crowded settings where there's poor ventilation, where the virus really likes to spread efficiently between individuals. 00:44:18 We need governments to enable people to carry out those measures; very easy for us to say stay home if you can but we need governments to support individuals to work from home, to stay home if necessary so that we can reduce the possibility for the virus to spread. All of us really have a role to play. Youth, young people, children, young adults are showing us ways in which to be innovative, to remain socially connected yet physically distant. I think what we are seeing with the youth and this youth mobilisation is really energetic. There's a spirit, there's an energy here that is holding leaders accountable and saying, help us help the situation and I'm really inspired to see that. I was really happy to hear the by youth, for youth as you pointed out and showing us that young people, young adults, children can make a significant difference every day. So please let's stop the blame in terms of who is spreading. All of us have a role to play, all of us need to be supported in taking those individual-level measures as well as measures at the family, at the community, at the sub-national, at the international level. 00:45:30 CL Thanks so much, Dr Van Kerkhove. We have Dr Mike Ryan, WHO Health Emergencies Executive Director, to add. MR Thanks, Christian. I just want to reflect on one thing that Daisy said. She said youths are not the problem, youths are the solution and I fundamentally believe in that and thank you, Daisy, for saying that and the energy from everyone today is fantastic. Reflecting on something that Greta said, she spoke about mindset and mindset is everything and Tedros reminds of that every day, I think; it's one of his most common pronouncements about mindset and it doesn't matter what problem you're trying to solve. There's no amount of announcement, there's no amount of recommendations, there's no amount of anything that changes anything until we change our mindset and that can be the mindset about protecting ourselves and our families from COVID and taking precautions. It can be the mindset on government's response to COVID. It can be the mindset driving climate action and reducing climate change. 00:46:37 So I think really we all need to reflect on that. It is our mindsets that drive our behaviour, both positive and negative and they're having a huge impact on the planet and obviously our behaviour's having a huge impact on the trajectory of this pandemic. Thank you. CL Thank you very much, Dr Ryan. The next question in line comes from Isabel Sacco from EFE. Isabel, please unmute yourself. IS Good afternoon, thank you, Christian. I would like to know if you can give us an overview of the proportion of the people under 40 years old who are in ICUs globally or by region. Connected to that, what do we know about mortality among babies? I saw figures from Brazil that indicate that 1,300 babies have died there from COVID. Thank you. CL Thank you very much, Isabel; very detailed questions. Let me give to Dr Maria Van Kerkhove first. MK Thanks for these very important questions. I cannot give you a specific answer of the proportion of those under 40 in ICU but what I can say is that there is an increasing number of hospitalisations among younger individuals and this is driven by what I answered in the last part of the question. 00:48:01 When you have increased transmissibility across all age groups you will see increased rates of hospitalisation, you will see an increased proportion of ICU and you will see increases in death. We are seeing unfortunately a little bit of a shift in the age structure in terms of the median age of individuals who are infected but that is driven by changes in social mixing patterns. If you remember, last spring, in the northern hemisphere's spring we saw a similar situation where as societies were opening up across Europe for example there was an age shift in the median age; it went from an older age group to a slightly younger age group. Again this is driven by people who are leaving their homes to go back to work and if there is the virus that is spreading, if you have virus variants this is a dangerous combination. We are seeing increases in hospitalisation among younger age groups and increased ICU and increased deaths. 00:48:55 With regard to children I did see that report that you mentioned about Brazil. Overall if we look at infection among children, if we look at severity among children still around the world there is a lower proportion of children that experience disease, that experience severe disease and some children do die. If there is a lot of virus that is circulating, if you have millions of cases being reported - and you know so far we've had 140 million cases reported worldwide - we will see deaths in all age groups. With regard to the youngest children, overall they tend to be more mild but again this is not universal. We do see that children, particularly children with underlying conditions but children in general, have died from COVID. So everyone is at risk from this virus. People are at risk of getting infected, at risk of getting severe disease so we do need to do what we can where we can as much as we can to first and foremost prevent infections but also making sure that we use the systems that are in place to get tested, to be able to carry out the public health actions that do prevent the spread from an adult to a child, from a child to an adult; everything that we can to really prevent that level of infection and care for as many people as we can, getting them early into that clinical care pathway to receive the care based on the symptoms that they have. 00:50:28 CL Thank you so much. The next question goes to Akwazi Sarpong from BBC News Africa. Akwazi, please unmute yourself. Akwazi, do you hear us? Yes, please go ahead. AK [Inaudible]. CL Akwazi, the sound is really bad. Please try one more time. AK Yes, [inaudible] in Ghana so [inaudible]. I have two questions. I would like [sound slip] many young people living with disability, particularly visual impairment, have been affected by this virus in Africa and at the global level. The second question is, what programmes are in place to support families with children and young persons with disability and special needs to help us combat this? Thank you. CL Thank you very much, Akwazi; very important questions. I'll hand to Dr Van Kerkhove for a start. 00:51:35 MK I can start. In fact we have departments that are working particularly on persons with disabilities to ensure that persons with disabilities, who are disproportionately affected by COVID-19 in a variety of ways, whether this is about getting the right care, receiving information appropriately so that they know how to keep themselves safe, making sure that they have the ability to receive the materials they need, testing, etc. We have some guidance that is coming out, I hope, today - it was approved yesterday - looking specifically at the more than one billion people worldwide who are living with disabilities, making sure that they have access to vaccination for example. We have seen some innovation in terms of personal protective equipment; if you've noticed, some of the masks for example will have a clear panel so that you can see lips moving for people who have a hearing impairment so there are a number of innovations that are coming online to support individuals with disabilities but also families with disabilities as well because even individuals with disabilities; their caretakers have to be able to care for them. So we need to make sure that those caregivers are protected against the virus as well so there're a number of activities that are underway to ensure those living with disabilities as well as those caring for those with disabilities have the appropriate care and information that they need. 00:53:05 CL Thank you very much, Dr Van Kerkhove. The next question goes to Priti Padnaik from Geneva Health Files. Priti, please unmute yourself. No, Priti lowered her hand apparently in the meantime or we don't find you any more. The next question goes to John Zaracostas from The Lancet. John, please unmute yourself. JO Good afternoon. Can you hear me there? CL Very well. Go ahead. JO I was wondering if you could give me up-to-date estimates on how many vaccine facilities worldwide with excess capacity could be enabled to produce vaccines and secondly, if possible, if Dr Tedros could give us his perspective on what's going on in his homeland where right now they're facing an existential threat. CL Thank you very much. We'll take the first question and I guess we'll see if Mariangela Simao is online... or then... SS I could start. CL Dr Swaminathan; exactly. Please go ahead. SS Thank you. Thank you very much, John, for that question. This is exactly the work that we've started now as part of the COVID vaccine manufacturing taskforce with our COVAX partners, CEPI, GAVI, UNICEF as well as the private sector and regional bodies like the African Union but also other regional organisations. The idea really is to take a short-to-medium-term and a longer-term approach. The short-term and the immediate need is to increase vaccine supplies within the next weeks and months and that can be done by unblocking roadblocks and obstacles that have been identified by the manufacturers and by working with suppliers of those critical ingredients and raw materials so that we can link suppliers and manufacturers as well as work with member states to make sure that export bans and things like that don't interfere with the process of vaccine manufacturing. That's our immediate short-term priority which hopefully will be able to put more doses for COVAX in the coming weeks. The second, more medium-term, is to look at fill and finish capacity to link... 00:55:43 We know that there's a lot of unused fill and finish capacity globally and therefore we need manufacturers who have the capacity to make bulk product and link them with these existing fill and finish capacities in facilities around the world. CEPI already has done a mapping of that and it exists. Then the third, more medium to longer-term, is really to develop new facilities that would build on existing facilities, particularly in low and middle-income countries and get technology transfer, encourage companies. As the DG mentioned, the WHO put out a call on Friday both for owners of technology, particularly MRNA technology to begin with, to come forward to work with us to share that technology, share the know-how and experience with recipient companies that will be selected according to a set of criteria that we are developing. 00:56:40 This will ensure not only supplies for this pandemic - though it may take a few months to get up and running if we start with existing facilities with some expertise - but also will help the future regional health security of regions which currently do not have any manufacturing capacity. This obviously can be extended to vaccines for many other infectious diseases. So that's what the taskforce is looking at and over the coming days we will provide much more detail. Thank you. CL Thank you so much, Dr Swaminathan. I'm calling on Dr Mike Ryan to take the other part. MR Thank you, John; important question. The situation in Tigray in Ethiopia remains very, very dire at the moment. The situation is not improving. We have unpredictable access, increasing humanitarian needs, increasing sexual violence. The response has been hindered by armed clashes throughout the region and many areas are still not receiving food or other assistance. We've got 4.5 million people affected by this crisis. 2.5 million of them have no access to services whatsoever. Half a million people have no access to food. We have a million internally displaced people in 178 sites scattered across the region being served by IOM and UNHCR. 00:58:18 We've had over 800 cases of sexual and gender-based violence reported from just five hospitals alone; that many cases. We've over 62,000 refugees who have crossed into Sudan. That safety valve is very, very difficult to manage and very difficult for us to have access from that side and to support people in the affected area. So, as I said, unpredictable access, displacement, tremendous humanitarian needs but we have 20 health partners working with us who are operational on the ground but they're only accessing about half of the... where aid is concerned. When we look at health facilities, we've done a health facilities survey throughout the region in 264 health facilities. As of now only 72 of those facilities are operational and 40 of those are only partially accessible. 19 hospitals have been completely damaged or destroyed; 15 more with major damage. There're inadequate supply chains across the board. 00:59:23 So the situation in Tigray could not be more dire, the people there could not be in more need of support and help. The situation is deteriorating. The situation is very much a massive concern on a purely humanitarian basis here. There is a health crisis on top of a humanitarian crisis. We're very concerned about malnutrition, about malaria, about cholera, measles, COVID-19 - positivity rates have been rising - and other diseases like meningitis and other diseases that will exploit malnutrition, they will exploit stress and they will exploit all of what's happening in that population. We have resumed surveillance activities but only covering about 30% of the population and again severe, acute malnutrition is a major, major issue. It is very hard to overstate the extent of the humanitarian crisis and the health crisis currently unfolding in Tigray and the WHO and the other UN agencies and NGOs are calling for unfettered humanitarian access and for military conflict and those perpetrating the conflict to remove themselves from civilian areas and those who should not be there should not be there. Thank you. CL Thank you very much. This was Dr Mike Ryan, Executive Director for WHO's Health Emergencies Programme and Dr Bruce Aylward wanted to come in too. 01:00:51 BA Thanks, Christian. I just want to come back to the important point you raised, John, about how much capacity is unused around the world right now because there was huge attention last week at the conference of the African Union on the consultation that was called by the World Trade Organization to try to expand vaccine production globally. But we need to remember that the challenge is how we're actually using the doses that are being made because last week while those conferences were taking place 100 million more doses of vaccine were administered around the world. The issue, John, is where they're being administered because 1% of that 100 million went to low-income countries so 99 million doses of vaccine last week went into high, upper-middle-income and some low-middle-income countries but only 1% of that went to the lowest-income countries. 01:01:48 So every time we bring new capacities online, when we bring new deals online, etc, that you're hearing about we need to ask the question of where those doses are going because those doses are not going to the places that have got the least vaccine today. So we need to be careful in thinking that we can simply build additional capacity because that capacity is still going to the wrong places, quite frankly. While we are giving great attention to how we expand capacity it's going to take weeks and months for that to come online and in the meantime we've got to take some urgent and important decisions about how we are going to use the vaccines that exist today because if we have a lot more weeks where 100, 99% of the vaccine goes to a set of countries that already have most of the vaccine we are not going to get out of this crisis as rapidly and efficiently and with the least lives lost possible. CL Thank you very much for all your answers. With this we're coming to the end of our question-and-answer session. I was very glad to have you all online today and our special guests and I will ask our special guests to start the closing round and we'll go in reverse order. We'll start with Daisy Moran, the Global Youth Mobilisation, Youth [Unclear] and Worldwide YMCA representative. Daisy, please go ahead. 01:03:20 DM Thank you for the opportunity once again and as a reminder, please join us this weekend on April 23rd to 25th to have your voice heard. You have the solutions; please come to the table. We want you to be involved in your local communities and we have the funds to support you. With any questions please visit our website at www.youthglobalmobilisation.org Thank you. CL Fantastic. Thanks so much. Now we go to Elahi Rawshan, volunteer from the International Federation of the Red Cross and Red Crescent Societies, supporting young people in Bangladesh. Elahi, please go ahead. ER Thank you. I would like to thank everyone for inviting me here and I would like to echo the last voice; young people are the solution and I would like to invite all the localised solutions to collaborate with the Global Youth Mobilisation, who have been supporting these local actions and promoting them. 01:04:22 So I would also like to invite everyone to join the Global Youth Summit coming up this week from 23rd to 25th. Thank you once again. CL Thank you so much, Elahi, to you. Last but not least we go to Greta Thunberg, Climate and Environmental Activist. Greta, the floor is yours. GT To be honest I don't really have anything more to add. Just take care, everyone. But also while we have media here, I really urge you to really bring awareness to this issue of vaccine inequity because you have the power to raise awareness about this. When we talk about countries like, for example, the UK and the US - just as a few examples - that they are mass-vaccinating large groups of their populations, even healthier young people, we see it from a different perspective, that we don't always see it from our Western, privileged point of view but rather that we think globally and we need to prioritise those most vulnerable first. Thank you. Take care, everyone. CL Thank you so much, Greta, for these words. Yes, there's hardly anything to add; I agree. From my side let me thank everyone and remind you that the sound files of this press briefing will be shared right afterwards today and the transcript will be available as of tomorrow. Dr Tedros. TAG Thank you. Thank you, Christian. I would like to thank our guests today, Greta, Elahi and Daisy. You have been wonderful. Thank you so much indeed. I would also like to join you in inviting everybody to join on the 23rd to 25th the Global Youth Summit, from Friday to Sunday so I look forward to seeing you there. I would also like to thank our media colleagues who have joined and see you in our upcoming presser. That will be on Friday. Thank you so much. 01:06:54


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Pandemias/prevención & control , Monitoreo Epidemiológico , Américas/epidemiología , Cuarentena/organización & administración , Aislamiento Social , Ecodesarrollo , Betacoronavirus/inmunología , Vacunas Virales/provisión & distribución , Acceso a Medicamentos Esenciales y Tecnologías Sanitarias , Infecciones por Coronavirus/inmunología , Neumonía Viral/inmunología , Cambio Climático , Donaciones , Equidad en Salud , Participación Social , Betacoronavirus/genética , Infecciones por Coronavirus/genética , Neumonía Viral/genética , Mutación/genética , ADN Viral/genética , Sistemas de Salud/organización & administración , Salud de la Persona con Discapacidad
4.
Multimedia | Recursos Multimedia | ID: multimedia-8697

RESUMEN

00:00:17 CL Hello, good day and welcome, wherever you are listening today. It is Tuesday 6th April 2021. My name is Christian Lindmeier and I'm welcoming you to today's global COVID-19 press conference ahead of World Health Day, which we celebrate on 7th April. Therefore we have a list of very special guests online with us today. We'll start with Her Excellency Prime Minister Mia Mottley from Barbados, His Excellency President Carlos Alvarado Quesada from Costa Rica, His Excellency President Hage Geingob from Namibia and His Excellency President Ilham Aliyev from Azerbaijan, who will join us through a video statement. Simultaneous interpretation is provided again in the six official UN languages, Arabic, Chinese, French, English, Spanish and Russian, plus we will have Portuguese and Hindi. Now let me introduce the participants in the room here. We have Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Dr Mike Ryan, Executive Director for WHO's Health Emergencies Programme, Dr Maria Van Kerkhove, Technical Lead on COVID-19, Dr Mariangela Simao, Assistant Director-General for Access to Medicines and Health Products, Dr Bruce Aylward, Special Advisor to the Director-General and Lead on the ACT Accelerator and last but not least Dr Rogerio Gaspar, Director for regulation and Pre-Qualification. Welcome all. Let me now hand over to the Director-General for his opening remarks. 00:02:08 TAG Good morning, good afternoon and good evening. Tomorrow is World Health Day. COVID-19 has exacerbated inequalities both between and within countries. While we have all undoubtedly been impacted by the pandemic the poorest and most marginalised have been hit hardest both in terms of lives and livelihoods lost. In the year ahead the world needs to make five vital changes. First we need to invest in equitable production and access to COVID-19 rapid tests, oxygen treatments and vaccines between and within countries. At the start of the year I made a call for every country to start vaccinating health workers and older people in the first 100 days of 2021. This week will mark the 100th day and 190 countries and economies have now started vaccination. COVAX itself has already delivered 36 million doses to 86 countries and economies. Supply chains are up and running and health systems primed. 00:03:38 Scaling up production and equitable distribution remains the major barrier to ending the acute stage of this pandemic. It is a travesty that in some countries health workers and those at risk groups remain completely unvaccinated. The effort to achieve vaccine equity will not stop this week. WHO will continue to call on governments to share vaccine doses and fill the US$22.1 billion gap in the ACT Accelerator for the equitable distribution of vaccines, rapid tests and therapeutics. We will also look to find new ways to work with manufacturers to boost overall vaccine production. This month individuals around the world will also be able to get involved in accelerating vaccine equity via a new fund-raising campaign. Developed by the WHO Foundation and a range of partners, the campaign will enable individuals an companies to get one, give one and close the overall COVID-19 vaccine gap. Further updates will be shared around the launch. Second, there must be a serious investment in primary healthcare and getting health services to every member of every community. The pandemic has exposed the fragility of our health systems. As essential services were paused many diseases came roaring back. At least half of the world's population still lacks access to essential health services and out-of-pocket expenses on health drive almost 100 million people into poverty each year. 00:05:36 As countries move forward post COVID-19 it will be vital to avoid cuts in public spending on health and other social sectors. Such cuts are likely to increase hardship among already disadvantaged groups. They will weaken health system performance, increase health risks, add to fiscal pressure in the future and undermine development gains. Instead governments should meet WHO's recommended target of spending an additional 1% of GDP on primary healthcare which is central to improving both equity and efficiency. And they must reduce the global shortfall of 18 million health workers needed to achieve universal health coverage by 2030. Third, prioritise health and social protection. Some countries have already put in place expanded social protection schemes to mitigate the negative impact of the pandemic on poverty, education, nutrition and overall health. These schemes should be extended until essential services are up and running again and they must include marginalised groups in planning and implementing future schemes. 00:07:05 Fourth, build safe, healthy and inclusive neighbourhoods. City leaders have often been powerful champions for better health, for example by improving transport systems and water and sanitation facilities. Access to healthy housing in safe neighbourhoods is key to achieving health for all but too often the lack of basic social services for some communities traps them in a spiral of sickness and insecurity. That must change. Meanwhile 80% of the world's populations living in extreme poverty are in rural areas where seven out of ten people lack access to basic sanitation and water services. So countries must intensify efforts to reach rural communities with health and other basic social services. Finally data and health information systems must be enhanced. High-quality and timely disaggregated data by sex, wealth, education, ethnicity, race, gender and place of residence is key to working out where inequities exist and addressing them. Health inequity monitoring has to be an integral part of all national health information systems. At present just half the world's countries have any capacity to do this. 00:08:50 Today I'm happy to welcome four heads of state and government to talk about health equity and changes they have made to achieve it. First Her Excellency Prime Minister Mia Mottley of Barbados will start proceedings and I'm keen to hear of Barbados' experience in the last year and the way ahead. Prime Minister, you have the floor. MM Thank you very much, my brother, Dr Tedros, Your Excellency, Hage Geingob, President of Namibia, who I have not seen since Nairobi in December 2019 - we didn't expect the last year - and to my other brother, Your Excellency, Carlos Alvarado Quesada, we spoke a couple of months ago and equally we didn't expect that this journey would be as long as it is. Also President Aliyev, I want to say how pleasant it is this morning for me to join you because 73 years ago tomorrow the World Health Organization was formed and therefore the commemoration of this day through World Health Day is most appropriate. 00:10:20 It would have been appropriate in any scenario but more relevant and more critical at this point. In the Caribbean we love our proverbs; short, clever phrases packed with the knowledge to last a lifetime and I suspect those in Africa are the people from whom we've got that love of proverbs. One favourite amongst us and especially our schoolteachers in the region was the one that simple said, Peter pays for Paul and Paul pays for all. I start here this morning because it is in the recognition that this is a collective battle that we will win the victory. We have come together globally to try and fight a pandemic but we have to ask ourselves whether we did it in sufficient time and on sufficient scale. We have to ask ourselves whether the five priority actions being focused on this morning - equitable access to COVID-19 vaccines, tests and treatments both within and between countries is being achieved by the countries of the region and the countries of the world. In the Caribbean our journey has been tortuous over the past year and, Dr Tedros, I know that you have tried to intervene on numerous occasions to assist us but the bald reality is that our market size in many instances is simply too small to command the attention of global pharmaceutical companies or indeed of other suppliers of goods in the normal supply chain that will lead the therapeutics distribution, vaccine distribution. 00:11:58 The bottom line is that we have also separately been regarded by the global community as countries that have come out of the depths of poverty and therefore are not deserving of assistance in the traditional ways normally reserved for the most vulnerable. This has made life difficult. We've held on to the promise of COVAX and I've come to you this morning having received the first trance of Barbados' vaccines, 3% of our population with respect to the COVID vaccines this morning. But for many globally this has been a difficult exercise because, as we have seen, the spikes can literally grow. We've not had access even when we are prepared to pay. It is against this background therefore that the first call to action of equitable access to COVID-19 vaccines, tests and treatments within and between countries is one with which we can relate. 00:12:57 Secondly the post COVID-19 recovery budget and plans to protect and prioritise health and social sectors is one that is truly being felt by the majority of us and why? The World Bank estimates that global GDP will fall by about 4% this year with between 40 and 60 million people entering extreme poverty. But our reality also is as a tourism and travel-dependent country the fall in our GDP last year was not 4%, was not 8%, was not even 12 or 16%; it was 18%, threatening to take our country back more than a decade as a result of the loss of production and productive capacity. Regrettably we continue to be treated globally as one of those countries that is not deserving of concessional capital even as we face the most difficult crisis that we have faced in a century. These are issues that I hope that the development committee of the World Bank and the International Monetary Fund that meets later this week and I have the honour of chairing will begin to start to put our case for the need to use different criteria for determining how countries should access serious concessional capital most needed now in order to stave off the worst aspects of this pandemic but more importantly to deal with the long-lasting consequences of the pandemic, which are the social and economic losses that have been sustained in the last decade. 00:14:29 The third aspect of the call to action; equitable services and infrastructure in all communities both urban and rural; this is absolutely critical particularly for the larger countries in the region and globally but even within a small country such as ours we recognise that there are differences and that part of the problem particularly in the urban setting is the density of housing that has existed in many instances pre-independence and post-independence largely because most developing countries in the world have had a significantly broad agenda reflected by many in the SDG agenda but a significant broad agenda that makes it difficult for us to have corrected all of the wrongs that we've needed to correct since independence. It means that in urban communities the density and the exposure is far greater regrettably than in most but equally in rural communities the lack of access to available healthcare for larger countries, not so much small island developing states but larger countries remains a major issue. 00:15:39 Fourthly, the call to action looks at the issue of primary healthcare for everyone everywhere but I like to make the point that the Caribbean more than most has in the post-independence era determined that for us to leave anyone behind is a travesty because our modern settlement was based on discrimination and exclusion and therefore the reality and the imperative of inclusion as well as transparency are absolutely vital if we are to bring our people out of these difficult times in which we live. Finally better data collection and reporting in countries so that we know where the health equalities [sic] are and can address them. My friends, this will not be the last pandemic, it will not be the last one for us. History is replete with examples and we have to determine what we will learn from our experience over the course of the last year. For many the 1918-1920 Spanish flu pandemic is too far in the recesses of our recent memory, such that we made fundamental mistakes that we should never allow anyone to make again. Dr Tedros, you asked me to serve as the Co-Chair on the One Health Global Initiative, which we have dubbed the slow-motion pandemic because we fear that by 2050 more people will die from these super-viruses that the antibiotics and other medication that we have are not allowing us to treat sufficiently. 00:17:13 I pray that we will take in front, as we would say, before in front takes us. What do I mean by that? That we will so sensitise the global population that the basic things that we need to take action, the basic policy instruments necessary to remove people from poverty or necessary to remove the juxtaposition of animals and humans in living conditions, not just working conditions, that have given rise to so many diseases that have caused so much death and so much concern in the world. If we do not get the fundamental development equation correct, if we do not work together, if we do not appreciate that we can only work together if we are to achieve a fairer and healthier world then we run the risk of seeing millions of persons die again in circumstances where different policy responses or similar policy responses with different scale and different pace of execution can hopefully have a different result in ensuring that fewer and fewer people will become victims to awful epidemics and pandemics. 00:18:25 They say politics is the art of repetition and I said so this morning. Over he course of the last year we have said the same thing more often than at any other time. There is no magic bullet and there is no magic recipe. The answer is simply for us to work together to get that fairer world and for there to be a level of global moral leadership, recognising that the singular pursuit of individual countries will not rid the world of the major problems because human beings cannot be contained behind boundaries easily in this globally interdependent world. I pray that we will across the world summon the courage to be able to have co-ordinated action, not just acting together but co-ordinated action such that we are in a position to be able to see the end of this pandemic because we are acting collectively with shut-downs, we're acting collectively with protocols, we're acting collectively with the kinds of policy responses that we now know after a year are critical if we are to put this behind us. I thank the World Health Organization and all of its staff members, the Pan-American Health Organization that serves us in this hemisphere and all of its staff members for continuing to keep the battle on but I recognise that the ball lies in the courts of the political will of member states of the global community. Thank you and may we rise to that point where we summon the courage for that globally co-ordinated action to make a fairer, healthier world. Thank you. 00:20:13 TAG Thank you. Thank you so much, Your Excellency Prime Minister Mottley. Moral leadership and co-ordinated action; I fully agree. Barbados' experience suppressing COVID-19 as well as investing in universal health coverage is an example for the region and the world so thank you so much again. I will now turn to His Excellency, President Carlos Alvarado of Costa Rica, who has been working closely with WHO on how to ensure that new health technologies are available in all countries through his idea, the CTAP, which we have started implementing together. President Alvarado, very nice to see you again even if it's online. The floor is yours. CA Thank you very much, Dr Tedros. TR Thank you very much, Dr Tedros. My greetings to Your Excellency Prime Minister Mia Mottley from Barbados, President Hage Geingob from Namibia and those who are joining us today at the press conference. Indeed, Dr Tedros, the principles of CTAP, which is the technology for healthcare pool; it's continuing this year, one year after the start of this pandemic and one day before World Health Day. 00:21:48 This is linked to access to technologies or treatments in an equal and fair way for people throughout the world without any distinction. As Prime Minister Mottley was saying, this has a great deal to do with moral leadership and with commitment to progress along this way. This pool can bring along technologies to make them available to all countries and to all governments throughout the world. As Dr Tedros has said, we need to keep pushing for this. There's already a team set up within the WHO for this so what we need is governments and the private sector to commit to making it a reality. The first point that was raised by the call of Dr Tedros on equitable access; I'd like to mention two central subjects. One is linked to the strengthening of social security and universal healthcare in countries. In Costa Rica it has been the strength of our universal healthcare system that has protected us and this has ensured that we reduced the differences between those on higher and lower incomes because we've ensured that anyone in any part of the country has the same access to testing, vaccine, treatment and even to hospitalisation with no distinction on geography. 00:23:26 This is difficult and is expensive but this is what makes a difference in a world that needs greater equality and the pandemic, as Dr Tedros has said, has increased inequalities between countries and within countries. The inequalities also have an impact on health. Societies which are more unequal are societies which are most violent and the most violent societies also bring about other phenomena such as migration or clearly the loss of human life. Another very important point in terms of equitable access is the drive that many countries are making for the international treaty for preparation and response to pandemics. Before COVID-19 the globalised world had not experienced such an impact in the effects of a pandemic and we need to learn from this experience and be ready. Above all being ready means being ready for co-ordinated action and action in solidarity which does not distinguish between greater or less development, greater or less wealth, whether one is in an urban or rural area. 00:24:50 We hope that this treaty will achieve these principles but we will also work towards ensuring that the treaty includes principles such as those that we have used in CTAP. On the budgets for post-COVID recovery it has remained clear that health is not just a matter of illness. Healthcare is an all-encompassing subject. We cannot take care of our populations if we don't have guarantees for budgets that provide support to the health sector, community sector and to the infrastructure. It's so important that multilateral organisations can provide means of financing for poor countries, for emerging countries and to assist them in facing up to the medium and long-term effects of the pandemic. Today developed economies have managed to achieve special packages to help their countries to overcome the effects of COVID but that's not something that poorer countries can do. The fact that there will not be a global recovery from COVID whilst the whole planet is not vaccinated; we won't see economic recovery in the planet if the whole world is not economically vaccinated. 00:26:24 So it's extremely important that we look for the subject of financing, whether it's in debt forgiveness or financing in the long term with zero rates or stable rates of interest so that countries can have a margin for manoeuvre. We also need to finance the development and public health infrastructure and recovery so this is more than a subject of finance; it's one of health as well. That's why it's so important that we deal with this. Costa Rica has launched the FACE initiative fund [?] to alleviate... from economics within the United Nations and also with ECLAT [?] to cover those funds to help emerging economies. To give a specific case, the opinions of the qualifying agencies are not taking into account the efforts being made by governments to maintain stable economies and also to assist our populations and every time that there's a negative qualification that makes access to finance more expensive for our countries. 00:27:51 We need to take into account the impact of COVID when countries are assessed because we have to think about the effect of the pandemic on countries' economies. In terms of data collection and the assessment of data mentioned by the Director-General, Costa Rica has a system which is the digital document where each citizen has their digital record and that helps us to keep track of progress whilst maintaining the confidential nature for each citizen. But it helps us to have the management of this data so we can deal with this pandemic and future pandemics. I'd like to turn now to showing my gratitude to the WHO for all its work and I'd like to thank Dr Tedros and mention once more our support from Costa Rica and my support to ensure that treatments, diagnoses and vaccines arrive in an equitable and rapid manner to all those who need them. Once more my greetings, Dr Tedros. TAG Muchas gracias, Your Excellency President Alvarado. I wholeheartedly agree. Equitable sharing of rapid tests, therapeutics, oxygen and vaccines are key to ending the acute phase of the pandemic. That means tech transfer, sharing know-how and waiving intellectual property rights. Thank you so much for your leadership on this, especially on CTAP. 00:29:43 I look forward to now hearing from His Excellency President Hage Geingob of Namibia on their all-of-society efforts to tackle COVID-19 and lessons going forward on health equity. Your Excellency, you have the floor. HG Thank you very much. Your Excellencies, greetings. I saw you last in [inaudible] so as usual, glad to listen to you, [inaudible]. Your Excellencies, it's a great pleasure for me and this important [inaudible] World Health Day. Given the devastating pandemic of the world [inaudible] it is timely [inaudible] regarding this [inaudible] and indeed the ways and means [inaudible] a fairer, healthier world post COVID-19. The fact that the Director-General of WHO has invited us to be part of this year's event speaks to the urgency of fostering the recovery for the entire world from the economic devastation caused by the COVID-19 pandemic. Building a fairer and healthier world will demand joint and concerted action. It will require that we as members of the human family stand resolutely together to do everything that is required to return our societies to normalcy. 00:31:42 Our people young and old have been traumatised. Lives and livelihoods have been disrupted, leaving a country that has been deeply scarred. [Unclear] and racial oppression [inaudible] and healthier societies is an objective that [inaudible]. [Inaudible] Have been aimed at building an equitable [inaudible] in which no-one must feel left out. We here in Namibia applied equally [inaudible]. We got help from our good friends in China and India, who gave us vaccines so far. We had an advance payment at least [?] but there is this exclusion; the COVID apartheid now we're facing [?] [inaudible]. CL Your Excellency, please allow me to come in. The sound is interrupting quite a lot. Is there a chance that on the technical side something can be done? It seems to be interruption in the sound signal at your end. Apologies. We can try again and if possible have your talking points and your elaborations that we can again share in writing also. Please continue, sir, Your Excellency. 00:34:12 HG What I'm trying to say is to address to your number one point; equitable to COVID-19 vaccines, tests and treatment within and between countries. We did apply and paid our deposit for the COVID vaccine but there is a vaccine apartheid, I'm saying, that we, a small country, have paid a deposit but up to now we didn't get any vaccine. What we got were vaccines donated by our friends, China and India, and I really thank them for that. [Unclear] I sense there is a conflict [unclear] spells harmony. We were left out [inaudible]. That I call apartheid [inaudible] and we fought against apartheid for many [inaudible]. After [inaudible]. Am I audible or what is going on? Because we believe that [inaudible] where the wounds of the past are healed [?]. This has laid the foundation [inaudible]. Every tragedy brings [inaudible]. 00:36:02 TAG Your Excellency... When you restarted it was okay and then it started to break up so I think there is a problem in the audio system. The video is okay but the audio system is breaking up so we have heard up to the vaccines you got from India and China. Later I think there was some break-up again. HG Yes, I was talking about vaccine apartheid; I want to make that very clear as a man who suffered from apartheid [?]; that we are here, we [inaudible] but we didn't get any vaccine. Can I talk? TAG Yes, still breaking up but can you go on? Let's see. HG Okay. Every tragedy [inaudible] new insights. This is true for the COVID-19 pandemic. By its speed, velocity the pandemic compelled humanity to act in unison to overcome a common enemy. The public health measures adopted in most if not all countries around the world demonstrated that the international community achieved consensus to address their common [inaudible]. It demonstrated that [inaudible] the world. We are able to stand together [inaudible]. This, I believe, should be a springboard for the concerted efforts and common purpose to address other equally important challenges facing humanity [inaudible]. 00:38:13 The manner in which [inaudible] responded to the COVID-19 pandemic demonstrates the old adage that says where there is a will there is a way. As world leaders [inaudible] the necessary political will to address the devastation brought by COVID-19 [inaudible] meant that we were able to [inaudible] in various aspects such as expanding [inaudible]. [Broken audio] A fairer and healthier world also means that our global approach necessarily address the root causes of unfairness and poor health in all their manifestations. The social [unclear] of face masks [?] therefore received our full attention. In this regard we must speak not only of availability of facilities and health services but of equitable access to essential tools such as COVID-19 vaccines, as I already said. There is no other alternative [inaudible] pandemic and by so doing to get a fairer and healthier world. Since I am being sabotaged I will end here [unclear]. TAG Thank you. Thank you so much, Your Excellency. Where there is a will there is a way, I fully agree and it's great that Namibia is rolling out vaccines. I was informed also that through the COVAX facilities you will have your share in two weeks. 00:40:40 But I fully agree with the problems we're facing with vaccine equity. As you know, we said vaccine nationalism or vaccine apartheid, as you said, is actually the problem with regard to the pandemic response now because unless everyone is safe no-one will be safe. So it's in every nation's interest or in every country's interest to make sure that there is vaccine equity so I fully agree with you. I now welcome His Excellency President Ilham Aliyev of Azerbaijan to reflect on his experience of the pandemic and what's critical to end the acute phase as quickly as possible. He couldn't join us in person so he sent us a video. Please. TR Every year since 1950 we celebrate World Health Day on April 7th but 2021 is a year when the importance of health became even more significant. Having a modern, sustainable, high-quality healthcare system is a priority for every country. Healthcare in Azerbaijan is currently going through a significant change. With implementation of mandatory health insurance Azerbaijan is strengthening the primary healthcare, renovating the emergency medical care services, facilitating the digitalisation by starting an e-health platform and national health accounts within the country. 00:42:28 In the meantime the second year of the COVID-19 pandemic is continuing to put enormous pressure on healthcare systems around the world. Azerbaijan was among the first countries to mobilise global efforts against the COVID-19 pandemic. We initiated the summit of the Turkic Council in April 2020, the summit of the non-aligned movement in May 2020 and a special session of the United Nations General Assembly at the level of the heads of state and government in December 2020. Honouring its international responsibility, Azerbaijan has made voluntary contributions to the World Health Organization in the amount of US$10 million. We have also provided direct humanitarian and financial assistance to more than 30 countries in their fight with the coronavirus. This year's World Health Day is dedicated to building a fairer and healthier world and the question of equal and fair distribution of vaccines is of paramount importance for this cause. 00:43:39 Yet we all are deeply concerned by the unequal and unfair distribution of vaccines among developing and developed countries. Some countries hoard several times more vaccines compared to their actual needs. It is clear that in such circumstances other countries will face vaccine shortage. Supporting fairness in vaccine distribution, Azerbaijan put forward a draft resolution ensuring equitable, affordable, timely and universal access for all countries to vaccines in response to the coronavirus disease pandemic at the UN Human Rights Council. The resolution was adopted by consensus on March 23rd this year. Azerbaijan was also among the first countries to join and support the COVAX initiative. We and the whole international community expect this initiative to become a model of co-operation and solidarity in response to the pandemic. Only together will we overcome the pandemic and return to normal life. Happy World Health Day. TAG Thank you. Thank you, President Aliyev and I welcome your leadership calling for equitable, timely and universal access to vaccines at the UN Human Rights Council and agree we must do more to ensure vaccines are fairly distributed. 00:45:08 Again thank you so much to all heads of state and government for joining us today. We have a lot to do to achieve health equity but I'm proud to see heads of state leading from the front, which will be key to us strengthening health systems overall and preparing for future pandemics. I thank you. If you have a few minutes more, if you join us for the Q&A with the media we would appreciate it. If not we fully understand. Thank you so much again. Christian, back to you. CL Thank you very much, Director-General. Let me now open the floor to questions from the media. We have a long list already but in case you want to get into the queue please press the raise your hand icon on your screen. First is John Miller from Reuters. John, please unmute yourself. JO Thanks for taking my question. Today we heard from EMA officials, who seemed to suggest that there may well be a link between the AstraZeneca vaccine and the rare complications that occur. I'm wondering if you can give us an update on the WHO's own progress in assessing the potential link and when you expect to make your own announcement public. Thanks. 00:46:50 CL Thank you very much. Let me give the floor to Dr Rogerio Gaspar, Director for Regulation and Pre-Qualification. RG Good afternoon. Let me just start by being clear and correct. You mention the European Medicines Agency. As you know, as we were here in the meeting already in this press briefing, there was a denial from the European Medicines Agency concerning the existence of the link. What happens is that there are a number of committees right now and regulatory authorities looking at data - and new data is coming every day - and assessing those data. So there's no link for the moment between the vaccine and the thrombolytic events with thrombocytopenia. Of course it's under evaluation and we wait for some feedback from those committees in the coming days and the coming hours. Just to give a full assessment - probably it is good to give also an assessment with some numbers in it - the data are coming, as I said, every day so we are looking at the pharmacovigilance networks globally and WHO of course is relying heavily on the national pharmacovigilance systems but also on the assessment committees from national regulatory authorities and also from regional regulatory authorities like the European Medicines Agency. The two EULs that were issued by WHO on AstraZeneca-based technologies - one from the manufacturer SKBio in the Republic of Korea and an emergency use authorisation given by the Republic of Korea Regulatory Authority, MFDS, and the second one from the SII in India with the correspondent authorisation also for the Indian regulatory authorities. Both of them are based on the core clinical data that was submitted by AstraZeneca to the European Medicines Agency so the regulatory alignment currently is that we'll rely first on the assessment done by the pharmacovigilance risk assessment committee of the European Medicines Agency which started today at 11:00 and is supposed to continue tomorrow and probably the day after, or not; that will depend on the committee. 00:49:14 We are following that meeting, we have observers on the meeting and we are looking at the data jointly and at the same time, as you know, the Medicines and Health Products Regulatory Authority from the United Kingdom, the MHRA, is also looking at the same set of data. So what we can say is that the appraisal that we have for the moment - and this is under consideration by the experts - is that the benefit/risk assessment for the vaccine is still largely positive. We continue to see a number of events that are rare events linking thrombocytopenia to thrombolytic events and those rare events are now being categorised in terms of the diagnostics, in terms of the population, in terms of the distribution within the population. The expert committees will come to decisions in the coming hours and the coming days about what will be the regulatory status of the vaccine. For the time being there's no evidence that the benefit/risk assessment for the vaccine needs to be changed and we know from the data coming from countries like the UK and others that the benefits are really important in terms of reduction of mortality of the populations that are being vaccinated. So one important issue to say also is because in the media and also on the regulatory committees we tend to stress too much the risk when we are discussing these issues and we have to do that, we have also at the same time to balance this with the benefit coming from the vaccine and I think it's important to reiterate this once again. 00:50:48 Another issue which is also important - and that's why WHO is at the same time having a number of information sessions, groups of experts; even this morning we had meetings with several regulatory agencies; during the mid-day break we had a global meeting with experts from different committees for information sharing and disseminating the totality of information that is available. In parallel with current meetings at the European Medicines Agency and the Medicines Health Product Research Authority in the UK we will convene tomorrow also our global advisory committee on vaccine safety that together with other experts will look at those data. So we expect that probably by the end of today or the day after so Wednesday or Thursday we might have a fresh conclusive assessment from our experts but, as I've said already, at the present moment and under the assessment that we have from the data submitted up to yesterday we are confident that the benefit/risk assessment for the vaccine is largely still positive. Thank you. 00:51:54 CL Let me ask Dr Simao... MS Very quickly just to complement because it's very important that everyone is aware, just reinforcing what Dr Rogerio said, that we are collecting data from all regions; the data we have so far is some data observed in the European region because millions and millions of AstraZeneca doses have been distributed and used in Latin America and in Africa, in India and in other countries in Asia. So we are very proactively collecting data from different national regulatory authorities and let me say that we are also in touch with AstraZeneca because AstraZeneca also has an obligation to report, to monitor the safety data and also to report not only to the regulatory authorities but also to WHO. CL Thank you very much. The next question goes to Carmen Pound, Politico. Carmen, please unmute yourself. 00:53:00 CA Thank you so much for giving me the floor and hi, everybody. There've been quite a few reports over the last few days about a number of countries, specifically in Africa, that have received doses through COVAX, in some cases more than a month ago, and either have not deployed them at all or the roll-out is super-slow due to different issues ranging from hesitancy to logistical issues. So I wanted to see if there's any plan to ramp up support for deliveries, if you're looking at what are the specific issues that are impeding the roll-out or faster roll-out in those countries because I've seen that there're even concerns that some of the doses might expire before certain countries are able to inoculate. Thank you. CL Let me ask Dr Bruce Aylward. BA Carmen, thanks so much for the question. It's so important; our goal in rolling out vaccines is to ensure everywhere in the world no doses or vials lie idle and they're out to work as rapidly as possible. 00:54:08 So recognising the challenge it might pose to roll out these vaccines because you're targeting different age groups, different populations than we normally do in many countries that are used to childhood vaccination programmes. As a result there was a huge amount of work that was initiated last fall actually in especially low and low/middle-income countries to try and help first with an assessment across all the different parameters that would need to be optimised to roll out these vaccines, then the development of what we call a national vaccines deployment plan across all of these countries and then a tracking at the international level by region and by country, where countries were in terms of preparedness. So the most important part of this was the huge amount of work that was done in advance and credit really goes to a group of agencies across WHO, UNICEF, the World Bank and others that work together in a concerted effort across countries. Even of course the best-laid plans are going to have challenges. We've seen that in every country in the world that's introduced these vaccines, whether high-income, middle, low-income countries; everyone has struggled in rolling out these vaccines. Part of it is logistical; part of it is related to some of the challenges I just spoke of so in every single country WHO, UNICEF - but not only, also with a broad range of partners - are working with ministries and with communities to try and optimise the roll-out, rapidly identify what are the bottlenecks and as you said even in the question you asked, Carmen, it's a range of issues. 00:55:50 Sometimes it's logistical, sometimes it might be hesitancy. We know that one country suspended the use of one vaccine or didn't want to until some of its concerns were reconciled so there've been a whole range of issues and it really is exactly what you said; a tailored approach in each country to try and help get past any bottlenecks to use so that as rapidly as possible these products can be protecting healthcare workers, protecting in particular the older populations and those at highest risk of the most severe disease. CL Thank you very much, Dr Aylward. With this we come to the next, Gabriela Sotomayor from Notemex, Mexico. 00:56:31 GA Hola, Christian, thanks for taking my question. It's on behalf of Proceso. 2,400 health workers have died in Mexico so my question is about the vaccination of health workers. It is clear that the priority is those who are in the first line of fire, treating patients with COVID. But what happens with the rest of the health personnel, when should they be vaccinated? In Mexico for example 65% of health personnel is under 50 years old and 50% are under 40 so they will be at the end of the line of regular vaccination so there are around one million health workers in this situation. My question is, what is your recommendation because many of them are the first contacts of patients with COVID? Thank you. CL Thank you very much. I will give this to Dr Aylward again, please. BA Thank you, Christian, and thank you, Gabriela, for the question. Clearly, as you've seen and as we've been discussing now for some weeks, certain populations are at higher risk of being exposed to this disease and then certain populations at highest risk of severe disease and death. Of course healthcare workers at the front line are one of the populations that are at highest risk of being exposed and often having high exposures and repeated exposures to the disease. That's the reason that the allocation framework that's been put together prioritises the healthcare workers. 00:58:13 That's healthcare workers irrespective of age. It's actually any healthcare workers that are going to be providing front-line services and at risk. In every country they're sometimes making adjustments in terms of their goals and whether or not the first goal is going to be to reduce the risk in the oldest population and then the healthcare workers or vice versa or by age across both so there is some adaptation or adjustment by country. It's all based on the strength of the healthcare system; it's sometimes based on the clinical outcomes that they're seeing in populations with severe disease in their countries. But in terms of rolling out the healthcare workers generally this has been irrespective of the age. But again as always, Gabriela - and you highlight it - part of the challenge here is just finding the balance with the amount of vaccine that you have available. As everyone knows, we're in an extremely supply-constrained situation so each country has got to make a decision sometimes across these populations; how will I be using these vaccines? 00:59:29 But again healthcare workers, as the Director-General said repeatedly and also our guests today, have to be a top priority as they cannot often protect themselves from being exposed to the disease. CL Thank you very much, Dr Aylward. With this we move to Jamil Chad from Estado Sao Paulo. Jamil, please unmute yourself. JA Hello. Can you hear me? CL All good. JA Dr Tedros, good afternoon. You had a meeting on Saturday with the new Minister of Health of Brazil. My question to you; what was your recommendation to him at this point in time? Thank you very much. TAG Thank you. Thank you so much. Of course we have discussed the measures - starting from the situation, how the situation is serious in Brazil. He started actually by describing the situation, which is really dire, and also what he would like to do. 01:00:48 We agreed on the way forward but to continue also to engage and committed from our side to help him in any way possible. Of course that was my first meeting with the Minister since he was appointed and we will have follow-up meetings, especially to discuss details of the actions that should be taken there will be senior expert-level engagements. Thank you. CL Thank you very much, Dr Tedros. We move to Jenny Layla-Medlow from Devex. Jenny, please unmute yourself. JE Thank you for taking my question. WHO released a statement last week on Ivermectin but as you know, debates continue in a lot of countries. I just want to know, are there plans to include Ivermectin in the Solidarity trials or are you considering other drugs for further trials? Also quickly what are the criteria for including treatments in the Solidarity trials? Thank you very much. CL Thank you very much, Jenny. Who do we have? We were looking to have a colleague online who can answer this. We do not have a colleague available right now to answer this. We'll take your question offline and reply to you by email. With this we move to the next and that will be Jamie Keaton from AP. Jamie, please unmute yourself. 01:02:49 JM Thank you, Christian. Good afternoon, everyone. This question, I think, is for Bruce. Bruce, today all four countries that were represented at this briefing are expected to get AstraZeneca vaccines from SKBio according to GAVI but many other countries are still expecting AstraZeneca vaccines from SII, the Serum Institute. Today we spoke to the CEO, Adar Poonawalla and he said that its exports for COVAX could now resume in June even though GAVI had expressed hope for a resumption in May as the spike in case counts worsens in India. My question; how concerned are you that COVAX will be facing severe supply shortages in the coming months from SII and what can be done about it and how does COVAX survive this major setback that could even last beyond June? Thank you. CL Dr Aylward, please. BA Thanks, Jamie. I think first of all let's not speculate on what's going to happen in terms of future deliveries from any of the companies that we're working with. Right now every country we talk to, every company is trying to make sure that they prioritise COVAX and that we get the vaccines that we need. 01:04:14 Obviously if we have an interruption with any one of our suppliers for a short time, a month or so we can find ways to try and manage as best we can with the countries but if it's longer than that obviously it would be a big challenge. We actually have had some good news over the last few days that some of the additional deliveries from SII have been opened up. You'll remember that there was a challenge but there were some deliveries that have been opened up over the last few days, which will be important to all countries being able to start vaccination by the end of the 100-day period that the Director-General has highlighted. But what I meant by that point, Jamie, was, as you can see, this is a very fluid situation. We've had multiple reports that sometimes vaccine supplies have been cut back by this much or increased by this much and in fact because of the work by the companies and by the governments to increase supply additional supplies have come through. 01:05:20 You'll remember on the AstraZeneca side where we had real challenges with supplies over the last few months, there's been a real pick-up in deliveries with now over 45 countries supplied just from the AstraZeneca side of the supply. So it's a fluid situation; that's the reason why we try and have as robust a portfolio as possible. As you also know, we have got deals with J&J on the Novovax product and other products so part of trying to ensure that if there's a problem with one product, one supplier... making sure that you have other options as well that will come online in the coming weeks and months hopefully. So a range of things to try and address that but clearly were there to be an interruption from any supplier that would be a real problem and that's the reason we're doing so much work to try and look at, as the Director-General said, improving production capacities in the existing suppliers, bringing new suppliers onboard, doing the emergency use listing assessments for yet additional products. All of these steps are to try and mitigate any potential interruption in supply from any supplier. CL Thank you very much, Dr Aylward. Let me call upon Sophie Mkwena from SABC. Sophie, please unmute yourself. 01:06:48 SO My question is around vaccine access, particularly to the developing south or poorer countries. The issue of vaccine passports is becoming more popular and many people are looking at using that to ensure that they are able to manage the spread of COVID-19. What is the position of the WHO on this vaccine passport and also travel restrictions? It's linked also to naming viruses after countries where they are being detected. The issue of 501YV2 still being called a South African virus by even very senior experts in science like Dr Fauci of the United States of America; is this not stigmatising a country that has done so much to try and contribute? CL Thank you very much, Sophie. Dr Van Kerkhove, please. MK Thanks, Sophie. I could start with the second part of your question. I think you know I've been on record talking about the naming of these virus variants and WHO for years has been talking about not including a location as part of a name of a virus, pathogen or the disease caused by that pathogen and SARS-CoV2 variants are no different. 01:08:26 We continue to see people name the variants country X variant or country Y variant and we have been working hard actually on developing a nomenclature with a large group of scientists around the world including the three groups that have developed different nomenclatures for the viruses. I have to admit, I foolishly thought this would be a very simple thing to do. I thought it could be done in a week or two and we're now into, I think, our second month of doing this. We hope to be able to announce the nomenclature very soon because we need to make sure that any of the names that are used do not further stigmatise a person or a last name or a location inadvertently. So we're still working on that but we do hope that countries do not say, the South African variant, including scientists. Unfortunately I hear that on many teleconferences that I'm on and we spend a lot of time talking about these virus variants that are being detected around the world. The more you look the more you will find and with the increases in genomic sequencing that are happening worldwide there are a lot of regional platforms that are being enhanced to make sure that we can find different mutations and different virus variants. 01:09:39 There are a lot of research groups that are out there that are studying each of these mutations and the combinations of mutations, which is what these variants are, to determine if there are any changes in transmissibility, in severity and any potential impact on our available and future diagnostics, therapeutics and vaccines. So it is really important that we do have names of these virus variants. Right now what we're using is the B117, the virus variant first identified in the United Kingdom; the B1351, the virus variant that was first identified in South Africa, and the P1, which is the virus variant that was first detected in Japan but is circulating in Brazil. There should be no stigma associated with these viruses being detected and unfortunately we still see that happening. Countries that are conducting surveillance, that are carrying out sequencing, that are sharing those sequences on publicly available platforms, that are working with WHO and scientists around the world should not be stigmatised for sharing this information. 01:10:39 In fact we need more of this to be happening worldwide and we will continue to work with partners to ensure that that happens. CL Dr Ryan, please. MR Just on your question regarding certification of vaccination, WHO does support certification of vaccination, be it paper or electronic, as a means of providing personal health information to people who are vaccinated and to give them a record of that vaccination but also for monitoring and evaluation purposes and quality assurance purposes in the healthcare system so having proper certification and recording of vaccination is very important. That's a different consideration to what those certificates are used for outside the health space and that would be certification of vaccination being used to attend work, to attend school, to attend events, to travel nationally or internationally. They are not necessarily related to the health of the individual but to other factors. 01:11:38 This is a complex issue. It has both considerations around how such certification could be utilised to reduce transmission but also around knowledge around the impact of vaccination itself and the way in which vaccination may or may not prevent transmission. There are ethical issues here regarding equity. We already have a huge issue with vaccine equity in the world. The imposition of requirements for certification of vaccination before travel could introduce another layer of such inequity. If you don't have access to vaccine in a country then you effectively become isolated as a country as vaccine passports kick in so there are many, many issues. Currently WHO through the emergency committee of the International Health Regulations have made temporary recommendations to the Director-General that proof of vaccination should not be a requirement, be required for purposes of international travel. 01:12:39 That group will meet again, I believe, on 15th April and I'm sure that recommendation will be under consideration. In the meantime we are bringing together our strategic and technical advisory group on infectious hazards with the strategic advisory group on immunisation and the ethics advisory group of WHO together to look at these issues. Currently we have an internal working group really pulling together the scientific data, the social data, the ethical data so we can come and get the best possible external advice in order to advise our member states regarding the potential use of vaccine passports, as you call them. Thank you. CL Thank you very much. For the last question we go to Robin Niya from AFP. Robin, please unmute yourself. RO Hello. Thank you. Can you hear me? CL Yes. Go ahead. RO Thank you. Within the European Union some countries like Spain and Germany have relatively low rates of new infections whilst other countries like Poland, Estonia and Hungary are seeing some of the highest rates in the world. My question is, in big, big areas like, say, Brazil or in this case the European Union would it make sense to divert vaccines away from areas of low infection and concentrate on areas of high infection to tackle the fire where it's burning most strongly? Thank you. 01:14:15 CL Thank you very much, Robin. Dr Simao, please. MS Let me start and then colleagues can complement. I think it's very important, Robin, to clarify that vaccines are not necessarily a good response to an acute problem because vaccines take time to reach immunity and everything else. So it's extremely important that when you have a lot of community transmission, as we're seeing in some of these countries, what we call the public health measures are taken into account and they're strictly followed. These are the consistent use of masks, hand hygiene, ventilation, avoiding crowds and in some specific cases even lock-downs, as we're seeing in Europe. So we have discussed last year what would be the role and whether we should have a buffer for emergency response related to spikes in transmission. The decision that we made collectively last year was not to do that at this stage because, as I said, vaccines are not a good response for immediate situations. 01:15:38 What you need in the case of high transmission in the community is to decrease the possibilities of transmission. That means avoiding that people get in touch with each other and avoiding crowds and everything else. Also from the epidemiologic perspective no-one can predict where it's going to be rising next; we have seen that, that even in countries that have reached a higher vaccination already we are seeing peaks in communities and peaks in cities and provinces. So it's very difficult to predict what's going to happen next, where the next surge will come. So I think the approach right now is that we're pushing for equitable access to vaccines and that we're pushing, as was discussed already today, to ensure that people at high risk of infection or people like, as was mentioned before, the healthcare workers and also people at higher risk of dying, older people and people with comorbidities, associated diseases are put first. We think this should happen; WHO's position is that this should happen in all countries, not only specific countries. Thank you. 01:17:10 CL Thank you very much for this. We have an add-on from Dr Van Kerkhove. MK Yes, thank you. I do want to come in on this because I think we need to remind everybody that vaccination is one element of the response strategy and, as Mariangela has said and as you have heard us say repeatedly, over and over again, we are accused often of being a broken record and we will be happy to continue being this broken record until this pandemic is over. But there are a number of elements, interventions that can be used that drive down transmission. Globally we have passed the sixth week in a row when we have seen a consecutive increase in cases around the world. Last week there were four million new cases reported to WHO and that is likely an underestimate of the true infections that have been occurring globally. We are seeing this in all of our regions. There's a slight decline in Europe but there are still significant increases in a number of countries like France, Turkey, Italy, Ukraine. The US continues to have increased.... Sorry; the Americas continues to have increased transmission driven by Brazil, Canada, Argentina, Colombia, the US; the same thing in South-East Asia, a number of countries; we can go on and on. 01:18:24 All of this data is in our dashboard but we continue to see increases in transmission and we have to remind everyone that there are a number of interventions. This the tried and true measures, these public health measures that drive transmission down. It's this all-of-government, all-of-society approach. It's about knowing where the virus is circulating so having good, strategic testing linked to public health action, ensuring that cases are isolated, that they receive appropriate care. It's contact tracing of contacts of known cases that are in supported quarantine so that they, if they are infected, do not have the possibility to transmit the virus onward. It's about getting into the clinical care pathway early so that individuals who are infected with the SARS-CoV-2 virus are seen and are assessed so that they are treated and cared for appropriately. It is making sure that we have engaged, informed, empowered communities so that they know what they need to do. We understand that the situation is evolving. The situation where you live change so following guidance and following the local recommendations is really important. 01:19:36 There is very good information out there that tells you in the area where you live, in the area where you work what is safe to do and what is not. At an individual level it's about physical distancing, it's about wearing a mask, it's about practising respiratory etiquette, making sure you have clean hands, making sure that you have good ventilation, you avoid crowded areas. All of this matters. This will not change until this pandemic is over so we cannot rely all on vaccines and vaccinations. We have to continue to put in the individual-level measures. We need communities that are supportive. If there is a stay-at-home measure in place we need governments to support individuals to be at home. All of this still matters so we will continue to be this broken record and remind the world that there is a strategy out there about suppressing transmission. 01:20:26 This guidance, this strategy was issued on 4th January last year and it still is the maintained strategy of what we have now to drive transmission down, adding vaccines and vaccination into the mix so that we keep transmission low and we open up our societies. So we cannot forget that there are a number of measures that are in place that we have the power to use now. CL Thank you so much for this and thank you all for your participation, especially our special guests. We will be sending the audio files right after this and we hope to include the speech of the President of Namibia. With this let me hand over to Dr Tedros. MR Christian, can I just... CL Pardon me. MR Just an update on our previous question regarding Ivermectin; just to confirm that Ivermectin is not currently included in the Solidarity trial but there are trials ongoing in other countries. The latest recommendations from WHO indicate that the evidence on the use of Ivermectin is not conclusive and further studies are recommended, particularly in large-scale randomised-control trials. 01:21:46 With regard to the progress within the Solidarity trial an independent panel of experts uses a set of defined criteria to pre-select potential drugs into the trial. A prioritisation working group then reviews the panel of experts' recommendations and then finally what gets through that group goes to the trial steering committee who then endorse those recommendations and introduce those drugs into the trial. So there are three different independent panels of experts who filter all the potential drugs. There's a series of criteria that are used around pharmacokinetics, plausible evidence on the mechanism of action, animal data, safety data, availability of the drug. Currently a number of drugs are under consideration for the trial including three new drugs and we've been really trying to get to this, moving not away from old drugs because old drugs, as we've seen, like dexamethasone have proved life-saving, but really beginning to test the newer molecules and drugs that are coming online so we look forward to the next selection of drugs for the Solidarity trial. 01:22:57 CL Thank you so much, Dr Ryan. This was in clarification to a question from Devex. Now with this let me hand over to the Director-General for closing remarks and to thank the guests. TAG Yes, thank you very much. I would like to invite Her Excellency Prime Minister Mottley to say a few words to close this session. Your Excellency, you have the floor. MM Thank you very much, Dr Tedros. I was very engaged during the course of questioning. This is very much still a fluid event for all of us in the world but it is one that really has the capacity to upend developing countries and we need to ensure that as we fight the pandemic we also put down the tools to avert a debt crisis which is potentially on us if we do not get it right. As I speak to you, the Chairman of the Caribbean Community has regrettably tested positive, Prime Minister Keith Rowley. I know that you have been in contact with him recently and I would therefore want to express our deepest concerns for his urgent and quick recovery. 01:24:10 But this just drives home the point that until we deal with this with all people we haven't dealt with it and I trust and pray that these continued works and the World Health Day tomorrow will remind us of the urgency of co-ordinated action and of the urgency of acting together. We look forward to the continued support of WHO and PAHO, particularly for those countries who have limitations in terms of the depth of technical resources and it is for that we continue to pray that we have access because that makes all of the difference to people living. We heard very clearly that global transmission has increased over the last six weeks and to that extent we continue to remind persons that there is no mechanism at the individual level that is too much to protect your lives from the personal protocols right back through to what we will do at the global level and at the national level to give people access to vaccines ahead of time, ahead of the battle with the variants. 01:25:21 So thank you very much, Dr Tedros, and I look forward to continuing to work with the World Health Organization on PAHO as we come on top and win this battle against COVID-19 which has done so much to decimate so many. The tail of it regrettably is long and we work towards ensuring that we can reduce the consequences of that tail on our people as well. Thank you. TAG Thank you. Thank you so much, Your Excellency. I fully agree with what you said and also I join you in expressing my wishes for fast recovery to His Excellency Prime Minister Rowley. I would also like to thank all heads of state who have joined today; His Excellency President Geingob, His Excellency President Alvarado and also His Excellency President Aliyev. Thank you so much once more and thank you so much for your leadership. Finally tomorrow we will publish an additional shortlist of films for the Health For All film festival. This fourth shortlist is dedicated to health equity. I invite the public to post questions in the comments section of the shortlisted videos, which are available on YouTube and through the WHO website. Some of your questions will be asked to the jurors and winners during the awards ceremony, to be streamed on WHO's YouTube channel on 13th May 2021. Thank you to all journalists also finally for joining and see you in our upcoming presser. Thank you so much. 01:27:26


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Pandemias/prevención & control , Américas/epidemiología , Equidad en Salud , Oxígeno/provisión & distribución , Betacoronavirus/inmunología , Infecciones por Coronavirus/inmunología , Neumonía Viral/inmunología , Vacunas Virales/provisión & distribución , Programas de Inmunización/organización & administración , Consorcios de Salud , Grupos de Riesgo , Acceso a Medicamentos Esenciales y Tecnologías Sanitarias , Financiación de la Atención de la Salud , Sistemas de Salud/economía , Poblaciones Vulnerables , Cobertura Universal del Seguro de Salud , Sistemas de Información en Salud , Monitoreo Epidemiológico
5.
J Glaucoma ; 30(8): 711-717, 2021 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-33927148

RESUMEN

PRECIS: Vascular diseases have been linked to alterations in optic nerve head perfusion. PURPOSE: The main objective was to investigate the changes in peripapillary vessel density (VD) in post coronavirus disease (COVID-19) patients. METHODS: In this prospective pilot exploratory study, patients with COVID-19 that were attended in the Emergency Department of Hospital Clinico San Carlos (Madrid) were included. All patients underwent optic nerve head optical coherence tomography angiography using the Cirrus HD-OCT 500 with AngioPlex OCTA (Zeiss, Dublin, CA) 4 and 12 weeks after diagnosis by positive reverse transcriptase-polymerase chain reaction test from nasopharyngeal swab at the Emergency Department. Sociodemographic data, medical history, disease severity, and laboratory work-up were collected. RESULTS: One hundred and eighty eyes of 90 patients with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection were included. None of the patients reported visual changes. Severe patients were older, more frequently hispanic, dyslipidemic, and presented lower lymphocytes counts, as well as increased ferritin, D-dimer, fibrinogen, and international normalized ratio levels. No changes in optic nerve head vascularization were observed when both visits were compared. No correlation was found between VD and clinical parameters, disease severity and laboratory work-up. CONCLUSIONS: Changes to peripapillary VD were not observed in patients with COVID-19 in the early months following diagnosis.


Asunto(s)
COVID-19 , Disco Óptico , Angiografía con Fluoresceína , Humanos , Presión Intraocular , Estudios Prospectivos , Vasos Retinianos , SARS-CoV-2 , Tomografía de Coherencia Óptica
6.
Cureus ; 13(3): e13972, 2021 Mar 18.
Artículo en Inglés | MEDLINE | ID: mdl-33880301

RESUMEN

Various small-field radiation dose detectors were systematically compared and their impact on measured beam performance of the ZAP-X® dedicated stereotactic radiosurgery system (ZAP Surgical Systems, Inc., San Carlos, CA, USA) was determined. Three Physikalische Technische Werkstaetten (PTW) diodes, i.e., the microSilicon, the microDiamond, and the Stereotactic Radiosurgery (SRS) diode detectors of (PTW-Freiburg, Freiburg, Germany), as well as Gafchromic™ External Beam Therapy 3 (EBT) film (Ashland, Inc., Wilmington, DE, USA), were used and compared to arrive at a recommended standard for this critical component of small-field beam measurements. Beam profiles, including the dose fall-off region near the edge of the beam, were measured with the PTW diodes and EBT3 film and subsequently contrasted. The impact of detector physical and dosimetric characteristics on the results of the measurements was investigated and compared with film measurements. The beam penumbra was used to quantify the dose fall-off. The measurement acquired with the diodes and film showed the most significant differences in the fall-off region near the field edge. The film-based measurements clearly showed the steepest dose gradient verified by the penumbra value of 1.21 mm, followed by the SRS diode with 1.60 mm, the microSilicon diode with 1.67 mm, and the microDiamond diode with 1.83 mm. A clear correlation of each detector's sensitive area with the penumbra was found, with the microDiamond detector at 2.2 mm diameter sensitive area having the largest penumbra, followed by the microSilicon and SRS diodes. Beam measurements for the purposes of system characterization or treatment planning system beam data acquisition depend, to a large extent, on detector characteristics. This is especially true for small-field dosimetry performed during stereotactic radiosurgery beam measurements. Careful consideration should be practiced which allows for the measurements to represent true beam characteristics and minimize the impact of the detector on the measurements. We conclude that film should be considered the reference method for such measurements with the ZAP-X due to its smallest physical measurement resolution of 23.1 µm. Potential drawbacks to this methodology are the need to calibrate the film relative to the dose and possible problems with saturation and non-linear film response for very high and very low optical densities.

7.
Inorg Chem ; 59(21): 15733-15740, 2020 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-33035421

RESUMEN

Herein, two novel isostructural metal-organic frameworks (MOFs) M-URJC-4 (M = Co, Ni; URJC = "Universidad Rey Juan Carlos") with open metal sites, permanent microposity, and large surface areas and pore volumes have been developed. These novel MOFs, with polyhedral morphology, crystallize in the monoclinic P21/c space group, exhibiting a three-dimensional structure with microporous channels along the c axis. Initially, they were fully characterized and tested in hydrogen (H2) adsorption at different conditions of temperature and pressure. The physisorption capacities of both materials surpassed the gravimetric H2 uptake shown by most MOF materials under the same conditions. On the basis of the outstanding adsorption properties, the Ni-URJC-4 material was used as a catalyst in a one-pot reductive amination reaction using various carbonyl compounds and primary amines. A possible chemical pathway to obtain secondary amines was proposed via imine formation, and remarkable performances were accomplished. This work evidences the dual ability of M-URJC-4 materials to be used as a H2 adsorbent and a catalyst in reductive amination reactions, activating molecular H2 at low pressures for the reduction of C═N double bonds and providing reference structural features for the design of new versatile heterogeneous materials for industrial application.

8.
Multimed (Granma) ; 24(2): 296-308, mar.-abr. 2020. tab
Artículo en Español | LILACS-Express | LILACS | ID: biblio-1125264

RESUMEN

RESUMEN La intensidad y duración del dolor están influenciadas por diferentes factores de los sujetos sometidos a una intervención quirúrgica. Con el objetivo de evaluar la efectividad de la analgesia preventiva con diclofenaco, tramadol, metamizol y dexametasona en el dolor postoperatorio en pacientes operado para cirugía laparoscópica, se realizó un estudio prospectivo, cuasi experimental, controlado, doble ciego en pacientes intervenidas quirúrgicamente de Histerectomía por cirugía video laparoscópica, en el Hospital Universitario Carlos Manuel de Céspedes de Bayamo en el período comprendido desde agosto de 2017 hasta agosto de 2019.Los pacientes fueron distribuidos en dos grupos: el grupo I (Experimental o estudio), formado por 37 pacientes que recibieron analgesia preventiva con diclofenaco 75 mg diluido EV antes de la inducción anestésica, transoperatorio se administra tramadol 100 mg EV , al terminar intervención quirúrgica se administra metamizol sódico 1200 mg IM con dexametasona 4 mg y el grupo II (Control), 37 pacientes en los que se administra diclofenaco 75 mg EV antes de la inducción anestésica y metamizol 1200 mg antes de concluir intervención quirúrgica IM. Se aplicó la escala visual análoga para evaluar la intensidad de dolor. El dolor en el pos operatorio aparece a las 2 horas en el grupo control y a las 4 horas en grupo estudio, 10 pacientes tuvieron dolor en el grupo estudio, 27 en grupo control con este esquema de tratamiento preventivo. La intensidad de dolor fue nula en el 86,4 % en el grupo estudio, 8,1 % en el control, resultados estadísticamente significativos.


ABSTRACT The intensity and duration of pain are influenced by different factors of the subjects undergoing a surgical intervention. In order to evaluate the effectiveness of preventive analgesia with diclofenac, tramadol, metamizole, and dexamethasone in postoperative pain in patients operated on for laparoscopic surgery, a prospective, quasi-experimental, controlled, double-blind study was performed in patients who underwent surgery for hysterectomy due to Laparoscopic video surgery, at the Carlos Manuel de Céspedes University Hospital in Bayamo in the period from August 2017 to August 2019.The patients were divided into two groups: group I (Experimental or study), consisting of 37 patients who received preventive analgesia with diclofenac 75 mg diluted EV before anesthetic induction, tramadol 100 mg EV is administered intraoperatively, metamizole sodium 1200 mg IM with dexamethasone 4 mg and group II (Control) are administered at the end of surgery, 37 patients in whom diclofenac 75 mg EV is administered before anesthetic induction ca and metamizole 1200 mg before concluding IM surgery. The analog visual scale was applied to assess pain intensity. The postoperative pain appears at 2 hours in the control group and at 4 hours in the study group, 10 patients had pain in the study group, 27 in the control group with this preventive treatment scheme. The intensity of pain was null in 86.4% in the study group, 8.1% in the control, statistically significant results.


RESUMO A intensidade e a duração da dorsão influenciadas por diferentes fatores dos sujeitos submetidos a uma intervenção cirúrgica. Para avaliar a eficácia da analgesia preventiva com diclofenaco, tramadol, metamizol e dexametasonana dor pós-operatória em pacientes operados para cirurgia laparoscópica, foi realizado umestudo prospectivo, quase experimental, controlado e duplo-cegoem pacientes submetidos à cirurgia para histerectomía devido a Acirurgia videolaparoscópica, realizada no Hospital Universitário Carlos Manuel de Céspedes, em Bayamo, no período de agosto de 2017 a agosto de 2019, foi dividida em dois grupos: grupo I (experimental ouestudo), composto por 37 pacientes que receberam analgesia preventiva com diclofenaco 75 mg EV diluído antes da indução anestésica, tramadol 100 mg EV é administrado no intraoperatório, metamizol sódico 1200 mg IM com dexametasona 4 mg e grupo II (Controle) são administrados no final da cirurgia, 37 pacientes nos quais diclofenaco 75 mg EV é administrado antes da indução anestésica ca e metamizol 1200 mg antes de concluir a cirurgia IM. A escala visual analógica foi aplicada para avaliar a intensidade da dor. A dorpós-operatória aparece às 2 horas no grupo controle e às 4 horas no grupo de estudo, 10 pacientes a presentaram dor no grupo de estudo, 27 no grupo controle comesse esquema de tratamento preventivo. A intensidade da dorfoi nula em 86,4% no grupo de estudo, 8,1% no controle, resultados estatisticamente significantes.

9.
Crit Care Med ; 48(4): 545-552, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32205601

RESUMEN

OBJECTIVES: To evaluate the performance of commercially available seizure detection algorithms in critically ill children. DESIGN: Diagnostic accuracy comparison between commercially available seizure detection algorithms referenced to electroencephalography experts using quantitative electroencephalography trends. SETTING: Multispecialty quaternary children's hospital in Canada. SUBJECTS: Critically ill children undergoing electroencephalography monitoring. INTERVENTIONS: Continuous raw electroencephalography recordings (n = 19) were analyzed by a neurophysiologist to identify seizures. Those recordings were then converted to quantitative electroencephalography displays (amplitude-integrated electroencephalography and color density spectral array) and evaluated by six independent electroencephalography experts to determine the sensitivity and specificity of the amplitude-integrated electroencephalography and color density spectral array displays for seizure identification in comparison to expert interpretation of raw electroencephalography data. Those evaluations were then compared with four commercial seizure detection algorithms: ICTA-S (Stellate Harmonie Version 7; Natus Medical, San Carlos, CA), NB (Stellate Harmonie Version 7; Natus Medical), Persyst 11 (Persyst Development, Prescott, AZ), and Persyst 13 (Persyst Development) to determine sensitivity and specificity in comparison to amplitude-integrated electroencephalography and color density spectral array. MEASUREMENTS AND MAIN RESULTS: Of the 379 seizures identified on raw electroencephalography, ICTA-S detected 36.9%, NB detected 92.3%, Persyst 11 detected 75.9%, and Persyst 13 detected 74.4%, whereas electroencephalography experts identified 76.5% of seizures using color density spectral array and 73.7% using amplitude-integrated electroencephalography. Daily false-positive rates averaged across all recordings were 4.7 with ICTA-S, 126.3 with NB, 5.1 with Persyst 11, 15.5 with Persyst 13, 1.7 with color density spectral array, and 1.5 with amplitude-integrated electroencephalography. Both Persyst 11 and Persyst 13 had sensitivity comparable to that of electroencephalography experts using amplitude-integrated electroencephalography and color density spectral array. Although Persyst 13 displayed the highest sensitivity for seizure count and seizure burden detected, Persyst 11 exhibited the best trade-off between sensitivity and false-positive rate among all seizure detection algorithms. CONCLUSIONS: Some commercially available seizure detection algorithms demonstrate performance for seizure detection that is comparable to that of electroencephalography experts using quantitative electroencephalography displays. These algorithms may have utility as early warning systems that prompt review of quantitative electroencephalography or raw electroencephalography tracings, potentially leading to more timely seizure identification in critically ill patients.


Asunto(s)
Algoritmos , Ondas Encefálicas/fisiología , Cuidados Críticos/métodos , Electroencefalografía/métodos , Convulsiones/diagnóstico , Adolescente , Canadá , Niño , Enfermedad Crítica/terapia , Humanos , Unidades de Cuidado Intensivo Pediátrico/organización & administración , Sensibilidad y Especificidad , Procesamiento de Señales Asistido por Computador/instrumentación
10.
Cambios rev. méd ; 18(2): 32-38, 2019/12/27. graf., tab.
Artículo en Español | LILACS | ID: biblio-1097727

RESUMEN

INTRODUCCIÓN. El síndrome de superposición en pacientes con lupus eritematoso sistémico no ha sido caracterizado en nuestro país. OBJETIVO. Cuantificar la prevalencia de síndrome de superposición en pacientes con lupus eritematoso sistémico, analizar los factores de riesgo y ca-racterizar los pacientes lúpicos puros y con superposición. MATERIALES Y MÉTODOS. Estudio observacional, analítico de prevalencia, con población de 324 y una muestra de 308 pacientes que cumplieron con los criterios de inclusión de diagnóstico definitivo de lupus eritematoso sis-témico, de los cuales 118 tuvieron síndrome de superposición y 190 fueron lúpicos puros, en la consulta externa de la Unidad Técnica de Reumatología del Hospital de Especialidades Carlos Andrade Marín entre enero de 2015 y abril de 2018. RESULTADOS. La prevalencia global de superposición fue de 38,30% (118; 308), de éstos el 43,20% (51; 118) presentaron lupus eritema-toso sistémico con síndrome de anticuerpos antifosfolipídicos. Se encontró que los pacientes con síndrome de superposición presentó un mayor porcentaje diagnóstico en mujeres, edad mayor al hallazgo de lupus eritematoso sistémico, mayores manifestaciones articulares y cutáneas; y porcentajes mayores de positividad de anti-DNA e hipocomplementemia al diagnóstico de lupus eritematoso sistémico (p<0,05). No obstante, presentaron menores complicaciones como la ne-fropatía lúpica, alteraciones hematológicas y neuropsiquiátricas (p<0,05). La razón de momios de prevalencia estableció que la edad temprana al diagnóstico de lupus eritematoso sistémico, menor a 50 años, [RMP=0,51 IC 95% (0,26-0,98)] y la nefropatía lúpica [RMP=0,45 IC 95% (0,23-0,86)] constituyeron factores protectores para desarrollo de síndrome de superposición. CON-CLUSIÓN. Se cuantificó que el síndrome de superposición fue de alta frecuencia en pacientes con lupus eritematoso sistémico y de prevalencia similar en estudios internacionales. La edad, sexo fueron factores relevantes para el diagnóstico oportuno a edades tempranas, que no modifi-có la mortalidad con menor aparición de complicaciones renales y extrarrenales.


INTRODUCTION. The overlap syndrome in patients with systemic lupus erythematosus has not been characterized in our country. OBJECTIVE. To quantify the prevalence of overlap syndrome in patients with systemic lupus erythematosus, to analyze risk factors and characterize pure and overlapping patients. MATERIALS AND METHODS. Study observational, analytical prevalence, with population of 324 and a sample of 308 patients who met the inclusion inclusion criteria for a definitive diagnosis of systemic lupus erythematosus, of whom 118 had overlap syndrome and 190 were pure lupus, in the external consultation of the Rheumatology Technical Unit of the Carlos Andrade Marín Specialties Hospital between January 2015 and April 2018. RESULTS. The overall prevalence of overlap was 38,30% (118; 308), 43,20% (51; 118) presented lupus erythematosus systemic with antiphospholipid antibody syndrome. It was found that patients with overlap syn-drome presented a higher diagnostic percentage in women, older than the finding of systemic lupus erythematosus, greater joint and skin manifestations; and higher percentages of anti-DNA positivy and hypocomplementemia at the diagnosis of lupus systemic erythematosus (p<0,05). However, they presented fewer complications such as kidney disease lupus, hematological and neuropsychiatric disorders (p <0.05). The Odds ratio of prevalence established that the early age at diagnosis of systemic lupus erythematosus, less than 50 years, [RMP = 0.51 IC 95% (0.26-0.98)] and lupus nephropathy [RMP = 0 , 45 IC 95% (0.23-0.86)] constituted protective factors for the development of overlap syndrome. CONCLUSION. Overlap syndrome was quantified as high frequency in patients with systemic lupus erythematosus and of similar prevalence in international studies. Age, sex were relevant factors for timely diagnosis at early ages, which did not change mortality with less occurrence of renal and extrarenal complications.


Asunto(s)
Prevalencia , Tejido Conectivo , Enfermedades Indiferenciadas del Tejido Conectivo , Inmunidad , Lupus Eritematoso Sistémico , Anticuerpos , Patología , Artritis Reumatoide , Esclerodermia Sistémica , Enfermedades Autoinmunes , Síndrome de Sjögren , Mortalidad , Anticuerpos Antifosfolípidos , Diagnóstico , Sistema Inmunológico , Enfermedades Musculares
11.
Cureus ; 11(3): e4275, 2019 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-31183264

RESUMEN

The purpose of this article is to investigate and characterize from a physics perspective the Zap-X (ZAP Surgical Systems, Inc., San Carlos, CA), a new, dedicated self-contained and self-shielded radiosurgery system, focusing on beam energy and performance, leakage, radiation safety, dose delivery accuracy, regulations, quality assurance, and treatment planning. This investigation is required to establish the mechanical and overall performance specifications of the system and to establish baseline parameters for future clinical usage. The applied methods include measurements of energy, focal spot size, beam performance, dosimetry, beam data, treatment planning system, leakage radiation, acceptance testing, and commissioning. The results of the characterization reveal a 3 megavolt (MV) linear accelerator (linac) with a focal spot size of 2 mm, a dose rate of 1,500 MU/min at the isocenter with a dose linearity of 3%, a beam penumbra of less than 3 mm, and beam symmetry of less than 2%. Beam performance, as well as dosimetry characteristics, are suitable for intracranial radiosurgery. It can be concluded that the system was found to meet safety, accuracy, and performance requirements widely accepted in the radiation oncology and radiosurgery industry. Furthermore, the system was shown to meet the practical, clinical needs of the radiosurgery community.

12.
EBioMedicine ; 40: 406-421, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30594553

RESUMEN

BACKGROUND: Even though liver kinase B1 (LKB1) is usually described as a tumor suppressor in a wide variety of tissues, it has been shown that LKB1 aberrant expression is associated with bad prognosis in Hepatocellular Carcinoma (HCC). METHODS: Herein we have overexpressed LKB1 in human hepatoma cells and by using histidine pull-down assay we have investigated the role of the hypoxia-related post-translational modification of Small Ubiquitin-related Modifier (SUMO)ylation in the regulation of LKB1 oncogenic role. Molecular modelling between LKB1 and its interactors, involved in regulation of LKB1 nucleocytoplasmic shuttling and LKB1 activity, was performed. Finally, high affinity SUMO binding entities-based technology were used to validate our findings in a pre-clinical mouse model and in clinical HCC. FINDINGS: We found that in human hepatoma cells under hypoxic stress, LKB1 overexpression increases cell viability and aggressiveness in association with changes in LKB1 cellular localization. Moreover, by using site-directed mutagenesis, we have shown that LKB1 is SUMOylated by SUMO-2 at Lys178 hampering LKB1 nucleocytoplasmic shuttling and fueling hepatoma cell growth. Molecular modelling of SUMO modified LKB1 further confirmed steric impedance between SUMOylated LKB1 and the STe20-Related ADaptor cofactor (STRADα), involved in LKB1 export from the nucleus. Finally, we provide evidence that endogenous LKB1 is modified by SUMO in pre-clinical mouse models of HCC and clinical HCC, where LKB1 SUMOylation is higher in fast growing tumors. INTERPRETATION: Overall, SUMO-2 modification of LKB1 at Lys178 mediates LKB1 cellular localization and its oncogenic role in liver cancer. FUND: This work was supported by grants from NIH (US Department of Health and Human services)-R01AR001576-11A1 (J.M.M and M.L.M-C.), Gobierno Vasco-Departamento de Salud 2013111114 (to M.L.M.-C), ELKARTEK 2016, Departamento de Industria del Gobierno Vasco (to M.L.M.-C), MINECO: SAF2017-87301-R and SAF2014-52097-R integrado en el Plan Estatal de Investigación Cientifica y Técnica y Innovación 2013-2016 cofinanciado con Fondos FEDER (to M.L.M.-C and J.M.M., respectively), BFU2015-71017/BMC MINECO/FEDER, EU (to A.D.Q. and I.D.M.), BIOEF (Basque Foundation for Innovation and Health Research): EITB Maratoia BIO15/CA/014; Instituto de Salud Carlos III:PIE14/00031, integrado en el Plan Estatal de Investigación Cientifica y Técnica y Innovacion 2013-2016 cofinanciado con Fondos FEDER (to M.L.M.-C and J.M.M), Asociación Española contra el Cáncer (T.C.D, P·F-T and M.L.M-C), Daniel Alagille award from EASL (to T.C.D), Fundación Científica de la Asociación Española Contra el Cancer (AECC Scientific Foundation) Rare Tumor Calls 2017 (to M.L.M and M.A), La Caixa Foundation Program (to M.L.M), Programma di Ricerca Regione-Università 2007-2009 and 2011-2012, Regione Emilia-Romagna (to E.V.), Ramón Areces Foundation and the Andalusian Government (BIO-198) (A.D.Q. and I.D.M.), ayudas para apoyar grupos de investigación del sistema Universitario Vasco IT971-16 (P.A.), MINECO:SAF2015-64352-R (P.A.), Institut National du Cancer, FRANCE, INCa grant PLBIO16-251 (M.S.R.), MINECO - BFU2016-76872-R to (E.B.). Work produced with the support of a 2017 Leonardo Grant for Researchers and Cultural Creators, BBVA Foundation (M.V-R). Finally, Ciberehd_ISCIII_MINECO is funded by the Instituto de Salud Carlos III. We thank MINECO for the Severo Ochoa Excellence Accreditation to CIC bioGUNE (SEV-2016-0644). Funding sources had no involvement in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.


Asunto(s)
Carcinoma Hepatocelular/metabolismo , Neoplasias Hepáticas/metabolismo , Proteínas Oncogénicas/metabolismo , Proteínas Serina-Treonina Quinasas/metabolismo , Acetilación , Animales , Carcinoma Hepatocelular/genética , Carcinoma Hepatocelular/mortalidad , Línea Celular Tumoral , Supervivencia Celular , Modelos Animales de Enfermedad , Xenoinjertos , Humanos , Hipoxia/metabolismo , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/mortalidad , Ratones , Modelos Moleculares , Proteínas Oncogénicas/química , Proteínas Oncogénicas/genética , Unión Proteica , Conformación Proteica , Transporte de Proteínas , Proteínas Serina-Treonina Quinasas/química , Proteínas Serina-Treonina Quinasas/genética , Estrés Fisiológico , Relación Estructura-Actividad , Sumoilación
13.
J Sport Rehabil ; 26(3)2017 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-28095109

RESUMEN

CONTEXT: Postural control plays an essential role in concussion evaluation. The Stability Evaluation Test (SET) aims to objectively analyze postural control by measuring sway velocity on the NeuroCom VSR portable force platform (Natus, San Carlos, CA). OBJECTIVE: To assess the test-retest reliability and practice effects of the SET protocol. DESIGN: Cohort. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: 50 healthy adults (20 men, 30 women, age 25.30 ± 3.60 y, height 166.60± 12.80 cm, mass 68.80 ± 13.90 kg). INTERVENTIONS: All participants completed 4 trials of the SET. Each trial consisted of six 20-s balance tests with eyes closed, under the following conditions: double-leg firm (DFi), single-leg firm (SFi), tandem firm (TFi), double-leg foam (DFo), single-leg foam (SFo), and tandem foam (TFo). Each trial was separated by a 5-min seated rest period. MAIN OUTCOME MEASURES: The dependent variable was sway velocity (deg/s), with lower values indicating better balance. Sway velocity was recorded for each of the 6 conditions as well as a composite score for each trial. Test-retest reliability was analyzed across 4 trials with intraclass correlation coefficients (ICCs). Practice effects analyzed with repeated measures analysis of variance, followed by Tukey post hoc comparisons for any significant main effects (P < .05). RESULTS: Sway-velocity reliability values were good to excellent: DFi (ICC = .88; 95%CI: .81, .92), SFi (ICC = .75; 95%CI: .61, .85), TFi (ICC = .84; 95%CI: .75, .90), DFo (ICC = .83; 95%CI: .74, .90), SFo (ICC = .82; 95%CI: .72, .89), TFo (ICC = .81; 95%CI: .69, .88), and composite score (ICC = .93; 95%CI: .88, .95). Significant practice effects (P < .05) were noted on the SFi, DFo, SFo, TFo conditions and composite scores. CONCLUSIONS: Our results suggest the SET has good to excellent reliability for the assessment of postural control in healthy adults. Due to the practice effects noted, a familiarization session is recommended (ie, all 6 conditions) before data are recorded. Future studies should evaluate injured patients to determine meaningful change scores during various injuries.

14.
Cureus ; 9(11): e1889, 2017 Nov 29.
Artículo en Inglés | MEDLINE | ID: mdl-29392101

RESUMEN

Introduction Accurate dose delivery is critical to the success of stereotactic radiosurgery. Unfortunately, verification of the accuracy of treatment delivery remains a challenging problem. Existing radiosurgery delivery paradigms are limited in their ability to verify the accurate delivery of radiation beams using data sampled from the beam after it has traversed the patient. The Zap-X Radiosurgery System (Zap Surgical Systems, San Carlos, CA) addresses this issue by implementing a fully integrated treatment delivery system that utilizes a factory commissioned megavoltage (MV) imager to measure the transmitted beam. The measured intensity is then compared with an expected value in order to confirm that treatment is proceeding as expected. The purpose of this study was to evaluate a prototype system and investigate the accuracy of an attenuation model used in generating the expected transmitted intensity values. Methods A prototype MV imager was used to measure transmitted beam intensities at various exposure levels and through several thicknesses of solid water. The data were used to evaluate imager linearity and model accuracy. Results Experimental results indicate that a quadratic attenuation model is appropriate for predicting beam attenuation and that the imager exhibits excellent dose linearity. Conclusions The MV imager system is shown to be capable of accurately acquiring the data needed to confirm treatment validity.

15.
Hum Reprod ; 31(9): 2005-16, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-27209341

RESUMEN

STUDY QUESTION: Does hysteroscopic proximal tubal occlusion by intratubal devices as a treatment for hydrosalpinges result in comparable ongoing pregnancy rates following IVF/ICSI when compared with laparoscopic salpingectomy? SUMMARY ANSWER: Hysteroscopic proximal tubal occlusion by intratubal devices is inferior to laparoscopic salpingectomy in the treatment of hydrosalpinges in women undergoing IVF/ICSI with respect to ongoing pregnancy rates. WHAT IS KNOWN ALREADY: It is known that women with hydrosalpinges undergoing IVF have poorer pregnancy outcomes compared with women with other forms of tubal infertility. In these women, both laparoscopic salpingectomy and laparoscopic proximal tubal ligation are known to improve IVF outcomes. At present, it is unclear whether a less-invasive hysteroscopic treatment with intratubal devices leads to similar ongoing pregnancy rates following IVF when compared with laparoscopic salpingectomy. STUDY DESIGN, SIZE, DURATION: A two-centre, randomized, controlled, non-inferiority trial. Between October 2009 and December 2014 a total of 85 women were included in this study; of whom, 42 were randomized to hysteroscopic proximal occlusion by intratubal device placement and 43 were randomized to laparoscopic salpingectomy. Randomization was based on a computer-generated randomization list. The study was unblinded. The primary outcome was ongoing pregnancy rate, defined as a fetal heartbeat on ultrasound beyond 10-week gestation following one IVF/ICSI treatment (fresh and frozen-thawed embryo transfers). PARTICIPANTS/MATERIALS, SETTING, METHODS: We studied women aged 18-41 years, with uni- or bilateral ultrasound visible hydrosalpinges who were scheduled for an IVF/ICSI treatment. MAIN RESULTS AND THE ROLE OF CHANCE: The ongoing pregnancy rates per patient according to the intention-to-treat principle were 11/42 (26.2%) after hysteroscopic proximal occlusion by intratubal devices (intervention group) versus 24/43 (55.8%) after laparoscopic salpingectomy (control group) (P = 0.008) [absolute difference: 26.1%; 95% confidence interval (CI): 0.5-51.7, relative risk (RR): 0.56; 95% CI: 0.31-1.03, P = 0.01]. In the per protocol analysis, the ongoing pregnancy rate per patient following hysteroscopic proximal occlusion by intratubal devices was 9/27 (33.3%) compared with 19/32 (59.4%) following laparoscopic salpingectomy (P = 0.067) (absolute difference: 29.6%; 95% CI: 7.1 to 49.1, RR: 0.47; 95% CI: 0.27-0.83, P = 0.062). LIMITATIONS, REASONS FOR CAUTION: Masking participants and investigators would be difficult due to the nature of both interventions. Since we had objective outcome measurements, we withheld sham procedures, leaving the study unblinded. Furthermore, our low sample size resulted in wide CIs. A larger sample size would result in a more accurate treatment effect; however, this was non-feasible for recruitment and inclusion. WIDER IMPLICATIONS OF THE FINDINGS: In the treatment of hydrosalpinges prior to IVF/ICSI, hysteroscopic proximal occlusion by intratubal devices is inferior to laparoscopic salpingectomy. STUDY FUNDING/COMPETING INTERESTS: The intratubal devices were received from Conceptus, Inc., San Carlos, CA, USA, which was acquired by Bayer HealthCare Pharmaceuticals, Inc., Whippany, NJ, USA in 2013. Conceptus, Inc./Bayer HealthCare Pharmaceuticals, Inc. had no role in the study design, data collection and analyses, decision to publish or preparation of the manuscript. The study as a whole was funded by the SWOG (foundation for scientific investigation in obstetrics and gynaecology of the VU University Medical Centre, Amsterdam, the Netherlands). P.G.A.H. has received non-financial support from Conceptus, Inc. during the conduct of this study. He has received grants from Ferring B.V., Merck Serono and Abbott outside the submitted work. M.H.E. has received personal fees from Smith and Nephew and IQ Medical Ventures outside the submitted work. TRIAL REGISTRATION NUMBER: The Dutch Trial Register: NTR 2073. TRIAL REGISTRATION DATE: October 21, 2009. DATE OF FIRST PATIENT'S ENROLMENT: October 26, 2009.


Asunto(s)
Enfermedades de las Trompas Uterinas/cirugía , Fertilización In Vitro/métodos , Salpingectomía/métodos , Inyecciones de Esperma Intracitoplasmáticas/métodos , Esterilización Tubaria/métodos , Adolescente , Adulto , Enfermedades de las Trompas Uterinas/diagnóstico por imagen , Femenino , Humanos , Embarazo , Resultado del Embarazo , Índice de Embarazo , Resultado del Tratamiento , Adulto Joven
16.
J Altern Complement Med ; 21(10): 598-603, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26230989

RESUMEN

OBJECTIVES: The purpose of this study was to examine the effectiveness and safety of combined treatment using acupuncture and bee venom acupuncture (BVA) as an adjunctive treatment for idiopathic Parkinson's disease (PD). METHODS: Eleven patients (7 men and 4 women) with idiopathic PD who had been receiving a stable dose of anti-parkinsonian medication for at least 4 weeks. Participants received conventional treatment for 12 weeks. Subsequently, they received additional treatment with acupuncture and BVA twice weekly for 12 weeks while still maintaining conventional treatment. All participants were assessed at baseline, 12 weeks, and 24 weeks by using the Unified Parkinson's Disease Rating Scale (UPDRS), the Parkinson's Disease Quality of Life Questionnaire (PDQL), the speed and number of steps required to walk 20 m, and the Beck Depression Inventory (BDI). Maximum excursion and directional control, measured by computerized dynamic posturography (Balance Master(®) System, NeuroCom, San Carlos, CA), were used to assess postural stability. RESULTS: Patients who underwent 12 weeks of twice-weekly combined treatment with acupuncture and BVA showed significant improvements in gait speed, PDQL score, activities of daily living (UPDRS part II), motor symptoms (UPDRS part III), and combined UPDRS part II+III scores compared with assessments after conventional treatment. CONCLUSIONS: Combined treatment with acupuncture and BVA showed promising results as a safe adjunctive therapy for PD.


Asunto(s)
Actividades Cotidianas , Terapia por Acupuntura , Venenos de Abeja/uso terapéutico , Marcha , Enfermedad de Parkinson/terapia , Calidad de Vida , Caminata , Anciano , Apiterapia , Terapia Combinada , Humanos , Persona de Mediana Edad , Enfermedad de Parkinson/complicaciones , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Resultado del Tratamiento
17.
Spine J ; 15(3 Suppl): S23-S32, 2015 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-25579423

RESUMEN

BACKGROUND CONTEXT: Prior studies have demonstrated the superiority of decompression and fusion over decompression alone for the treatment of lumbar degenerative spondylolisthesis with spinal stenosis. More recent studies have investigated whether nonfusion stabilization could provide durable clinical improvement after decompression and fusion. PURPOSE: To examine the clinical safety and effectiveness of decompression and implantation of a novel flexion restricting paraspinous tension band (PTB) for patients with degenerative spondylolisthesis. STUDY DESIGN: A prospective clinical study. PATIENT SAMPLE: Forty-one patients (7 men and 34 women) aged 45 to 83 years (68.2 ± 9.0) were recruited with symptomatic spinal stenosis and Meyerding Grade 1 or 2 degenerative spondylolisthesis at L3-L4 (8) or L4-L5 (33). OUTCOME MEASURES: Self-reported measures included visual analog scale (VAS) for leg, back, and hip pain and the Oswestry Disability Index (ODI). Physiologic measures included quantitative and qualitative radiographic analysis performed by an independent core laboratory. METHODS: Patients with lumbar degenerative spondylolisthesis and stenosis were prospectively enrolled at four European spine centers with independent monitoring of data. Clinical and radiographic outcome data collected preoperatively were compared with data collected at 3, 6, 12, and 24 months after surgery. This study was sponsored by the PTB manufacturer (Simpirica Spine, Inc., San Carlos, CA, USA), including institutional research support grants to the participating centers totaling approximately US $172,000. RESULTS: Statistically significant improvements and clinically important effect sizes were seen for all pain and disability measurements. At 24 months follow-up, ODI scores were reduced by an average of 25.4 points (59%) and maximum leg pain on VAS by 48.1 mm (65%). Back pain VAS scores improved from 54.1 by an average of 28.5 points (53%). There was one postoperative wound infection (2.4%) and an overall reoperation rate of 12%. Eighty-two percent patients available for 24 months follow-up with a PTB in situ had a reduction in ODI of greater than 15 points and 74% had a reduction in maximum leg pain VAS of greater than 20 mm. According to Odom criteria, most of these patients (82%) had an excellent or good outcome with all except one patient satisfied with surgery. As measured by the independent core laboratory, there was no significant increase in spondylolisthesis, segmental flexion-extension range of motion, or translation and no loss of lordosis in the patients with PTB at the 2 years follow-up. CONCLUSIONS: Patients with degenerative spondylolisthesis and spinal stenosis treated with decompression and PTB demonstrated no progressive instability at 2 years follow-up. Excellent/good outcomes and significant improvements in patient-reported pain and disability scores were still observed at 2 years, with no evidence of implant failure or migration. Further study of this treatment method is warranted to validate these findings.


Asunto(s)
Descompresión Quirúrgica/métodos , Vértebras Lumbares/cirugía , Estenosis Espinal/cirugía , Espondilolistesis/cirugía , Anciano , Anciano de 80 o más Años , Evaluación de la Discapacidad , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Prospectivos , Prótesis e Implantes , Radiografía , Rango del Movimiento Articular , Estenosis Espinal/diagnóstico por imagen , Espondilolistesis/diagnóstico por imagen , Resultado del Tratamiento
18.
Artículo en Inglés | MEDLINE | ID: mdl-26736218

RESUMEN

Microbubbles are used in medical ultrasound imaging as contrast agents to image the vascular bed under the mode of Ultrasound Contrast Imaging (UCI). The microbubble shell determines the acoustic response and hence the signal that is utilized to form the images in UCI. Single microbubble signals from BiSphere™ (POINT Biomedical, San Carlos, CA, USA) microbubbles were captured using a clinical ultrasound system. Three main typical responses of microbubbles were identified, a) full duration echo, b) echo with duration shorter than the incident pulse and c) echo that in part resembles that in (b) and in addition prior to that another short duration initial lower amplitude signal. These data corroborate that the shell structural and nanomechanical property provide the different responses at different microbubble sizes. These different signals present an opportunity for tracking the movement of well differentiated single microbubbles particularly with novel super-resolution imaging methods that require sparse microbubble populations.


Asunto(s)
Acústica , Medios de Contraste , Microburbujas , Ultrasonografía/métodos , Acústica/instrumentación , Medios de Contraste/química , Diagnóstico por Imagen , Diseño de Equipo , Humanos , Ultrasonografía/instrumentación
19.
J Minim Invasive Gynecol ; 22(3): 504-8, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25460518

RESUMEN

The Essure permanent birth control system (Conceptus Inc, San Carlos, CA) is currently the only Food and Drug Administration-approved hysteroscopic sterilization method and has been widely accepted as a safe and effective procedure. We present a rare case of tubal perforation, coil fragmentation, and distal migration into small and large bowel mesentery 8 days after the insertion of the Essure device. We describe the successful management of this complication using laparoscopy and intraoperative fluoroscopy. Providers using Essure must be aware of the possibility of fragmentation of the Essure coils. Intraoperative imaging, ideally fluoroscopy, should be strongly considered in the management of Essure migration to ensure localization and full retrieval of Essure material.


Asunto(s)
Trompas Uterinas , Migración de Dispositivo Intrauterino , Laparoscopía/métodos , Mesenterio/diagnóstico por imagen , Esterilización Tubaria , Adulto , Trompas Uterinas/diagnóstico por imagen , Trompas Uterinas/lesiones , Trompas Uterinas/cirugía , Femenino , Fluoroscopía/métodos , Humanos , Cuidados Intraoperatorios/métodos , Dispositivos Intrauterinos/efectos adversos , Rotura , Salpingectomía/métodos , Esterilización Tubaria/efectos adversos , Esterilización Tubaria/instrumentación , Esterilización Tubaria/métodos , Resultado del Tratamiento , Ultrasonografía
20.
Environ Sci Technol ; 49(2): 767-76, 2015 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-25489982

RESUMEN

The goal of this study was to investigate the Hg stable isotope signatures of sediments in San Carlos Creek downstream of the former Hg mine New Idria, CA, USA and to relate the results to previously studied Hg isotope signatures of unroasted ore waste and calcine materials in the mining area. New Idria unroasted ore waste was reported to have a narrow δ(202)Hg range (−0.09 to 0.16‰), while roasted calcine materials exhibited a very large variability in δ(202)Hg (−5.96 to 14.5‰). In this study, creek sediment samples were collected in the stream bed from two depths (0­10 and 10­20 cm) at 10 locations between the mine adit and 28 km downstream. The sediment samples were size-fractionated into sand, silt, and (if possible) clay fractions as well as hand-picked calcine pebbles. The sediment samples contained highly elevated Hg concentrations (8.2 to 647 µg g(­1)) and displayed relatively narrow mass-dependent fractionation (MDF, δ(202)Hg; ± 0.08‰, 2SD) ranges (−0.58 to 0.24‰) and little to no mass-independent fractionation (MIF, Δ(199)Hg; ± 0.04‰, 2SD) (0.00 to 0.10‰), similar to what was observed previously for the unroasted ore waste. However, due to the highly variable and overlapping δ(202)Hg signatures of the calcines, they could not be ruled out as source of Hg to the creek sediments. Overall, our results suggest that analyzing creek sediments downstream of former Hg mines can provide a more reliable Hg isotope source signature for tracing studies at larger spatial scales, than analyzing the isotopically highly heterogeneous tailing piles typically found at former mining sites. Creek sediments carry an integrated isotope signature of Hg transported away from the mine with runoff into the creek, eventually affecting ecosystems downstream.


Asunto(s)
Agua Dulce/química , Sedimentos Geológicos/química , Mercurio/análisis , Minería , Contaminantes Químicos del Agua/análisis , California , Fraccionamiento Químico , Ecosistema , Monitoreo del Ambiente/métodos , Isótopos de Mercurio
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