Managing the Next Wave of Influenza and/or SARS-CoV-2 in the ICU—Practical Recommendations from an Expert Group for CAPA/IAPA Patients

COVID-19; Critical patients; Intensive care unitCOVID-19; Pacientes críticos; Unidad de cuidados intensivosCOVID-19; Pacients crítics; Unitat de cures intensivesThe aim of this study was to establish practical recommendations for the diagnosis and treatment of influenza-associated invasive aspergillosis (IAPA) based on the available evidence and experience acquired in the management of patients with COVID-19-associated pulmonary aspergillosis (CAPA). The CAPA/IAPA expert group defined 14 areas in which recommendations would be made. To search for evidence, the PICO strategy was used for both CAPA and IAPA in PubMed, using MeSH terms in combination with free text. Based on the results, each expert developed recommendations for two to three areas that they presented to the rest of the group in various meetings in order to reach consensus. As results, the practical recommendations for the management of CAPA/IAPA patients have been grouped into 12 sections. These recommendations are presented for both entities in the following situations: when to suspect fungal infection; what diagnostic methods are useful to diagnose these two entities; what treatment is recommended; what to do in case of resistance; drug interactions or determination of antifungal levels; how to monitor treatment effectiveness; what action to take in the event of treatment failure; the implications of concomitant corticosteroid administration; indications for the combined use of antifungals; when to withdraw treatment; what to do in case of positive cultures for Aspergillus spp. in a patient with severe viral pneumonia or Aspergillus colonization; and how to position antifungal prophylaxis in these patients. Available evidence to support the practical management of CAPA/IAPA patients is very scarce. Accumulated experience acquired in the management of CAPA patients can be very useful for the management of IAPA patients. The expert group presents eminently practical recommendations for the management of CAPA/IAPA patients

Clinical effectiveness of pneumococcal vaccination against acute myocardial infarction and stroke in people over 60 years: the CAPAMIS study, one-year follow-up

<p>Abstract</p> <p>Background</p> <p>Conflicting results have been recently reported evaluating the relationship between pneumococcal vaccination and the risk of thrombotic vascular events. This study assessed the clinical effectiveness of the 23-valent polysaccharide pneumococcal vaccine (PPV23) against acute myocardial infarction and ischaemic stroke in older adults.</p> <p>Methods</p> <p>Population-based prospective cohort study conducted from December 1, 2008 until November 30, 2009, including all individuals ≥ 60 years-old assigned to nine Primary Care Centres in Tarragona, Spain (N = 27,204 individuals). Primary outcomes were hospitalisation for acute myocardial infarction and/or ischaemic stroke. All cases were validated by checking clinical records. The association between pneumococcal vaccination and the risk of each outcome was evaluated by Multivariable Cox proportional-hazard models (adjusted by age, sex, influenza vaccine status, presence of comorbidities and cardiovascular risk factors).</p> <p>Results</p> <p>Cohort members were followed for a total of 26,444 person-years, of which 34% were for vaccinated subjects. Overall incidence rates (per 1000 person-years) were 4.9 for myocardial infarction and 4.6 for ischaemic stroke. In the multivariable analysis, vaccination was associated with a marginally significant 35% lower risk of stroke (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.42-0.99; <it>p </it>= 0.046). We found no evidence for an association between pneumococcal vaccination and reduced risk of myocardial infarction (HR: 0.83; 95% CI: 0.56-1.22; <it>p </it>= 0.347).</p> <p>Conclusions</p> <p>Our data supports a benefit of PPV23 against ischaemic stroke among the general population over 60 years, suggesting a possible protective role of pneumococcal vaccination against some acute thrombotic events.</p

Measures of concentration and stability: two pedagogical tools for industrial organization courses

This document describes two pedagogical tools developed for teaching applied microeconomics, specifically the issues related to concentration, dominance, stability and asymmetry of firms. The tools make a compilation of several concentration and stability indexes used in the literature since 1945. Among the benefits of the applications are the ease and agility to perform comparative analyzes of intersectorial and/or intertemporal type in a simple and agile way; and the use of unconventional concentration and stability measures

Cognitive versus emotional modulation within a Stroop paradigm in patients with schizophrenia

Background: Schizophrenia is a complex disorder involving deficits in both cognitive and emotional processes. Specifically, a marked deficit in cognitive control has been found, which seems to increase when dealing with emotional information. Aims: With the aim of exploring the possible common links behind cognitive and emotional deficits, two versions of the emotional Stroop task were administered. Method: In the cognitive-emotional task, participants had to name the ink colour (while ignoring the meaning) of emotional words. In contrast, the emotional-emotional task consisted of emotional words superimposed on emotional faces, and the participants had to indicate the emotional valence of the faces. Fifty-eight participants (29 in-patients diagnosed with schizophrenia and 29 controls) took part in the study. Results: Patients and controls showed similar response times in the cognitive-emotional task; however, patients were significantly slower than controls in the emotional-emotional task. This result supports the idea that patients show a more pronounced impairment in conflict modulation with emotional content. Besides, no significant correlations between the tasks and positive or negative symptoms were found. This would indicate that deficits are relatively independent of the clinical status of patients. However, a significant correlation between the emotional-emotional task and cognitive symptoms was found. Conclusions: These findings suggest a restricted capacity of patients with schizophrenia to deal with the attentional demands arising from emotional stimuli.Spanish Ministerio de Ciencia, Innovación y Universidades (PSI2018-098876-B-100Instituto de Salud Carlos III (PI16/00359)Instituto de Salud Carlos III (PI19/00766)5.165 JCR (2021) Q2, 56/155 Psychiatry1.214 SJR (2021) Q1, 106/556 Psychiatry and Mental HealthNo data IDR 2021UE

Adoption of digital tools in the context of the COVID-19 pandemic in the Region of the Americas - the Go.Data experience

The COVID-19 pandemic has accelerated the growth of digital health tools. Although a number of different tools exist to support field data collection in the context of outbreak response, they have not been sufficient. This prompted the World Health Organization (WHO) to collaborate with the Global Outbreak Alert and Response Network (GOARN) and GOARN partners to develop a comprehensive system, Go.Data. Go.Data, a digital tool for outbreak response has simplified how countries operationalize and monitor case and contact data. Since the start of the pandemic, WHO and GOARN partners have provided support to Go.Data projects in 65 countries and territories, yet the demand by countries to have documented success cases of Go.Data implementations continues to grow. This viewpoint documents the successful Go.Data implementation frameworks in two countries, Argentina and Guatemala and an academic institution, the University of Texas at Austin

The adjusted International Prognostic Index and beta-2-microglobulin predict the outcome after autologous stem cell transplantation in relapsing/refractory peripheral T-cell lymphoma

BACKGROUND AND OBJECTIVES: Preliminary data on the use of autologous stem cell transplantation (ASCT) as a salvage therapy for peripheral T-cell lymphoma (PTCL) indicate that the results are similar to those obtained in aggressive B-cell lymphomas. The aim of our study was to analyze outcomes of a large series of patients with PTCL with a prolonged follow-up who received ASCT as salvage therapy. DESIGN AND METHODS: Between 1990 and 2004, 123 patients in this situation were registered in the GELTAMO database. The median age at transplantation was 43.5 years; in 91% of patients the disease was chemosensitive. RESULTS: Seventy-three percent of the patients achieved complete remission, 11% partial remission and the procedure failed in 16%. At a median follow-up of 61 months, the 5-year overall and progression-free survival rates were 45% and 34%, respectively. The presence of more than one factor of the adjusted International Prognostic Index (a-IPI) and a high beta2-microglobulin at transplantation were identified as adverse prognostic factors for both overall and progression-free survival and allowed the population to be stratified into three distinct risk groups. INTERPRETATION AND CONCLUSIONS: Our data show that approximately one third of patients with PTCL in the salvage setting may enjoy prolonged survival following ASCT, provided they are transplanted in a chemosensitive disease state. The a-IPI and beta2-microglobulin level predict the outcome after ASCT in relapsing/refractory PTCL

Pre-Columbian alloys from the royal tombs of Sipán and from the Museum of Sicán

On the north coast of present-day Peru, approximately between 50 and 700 AD, flourished the Moche civilization. It was an advanced culture, and the Moche were sophisticated metalsmiths. The Moche metal working ability was impressively shown by the excavations of the “Tumbas Reales de Sipán”, discovered by W. Alva and co-workers in 1987. The Sicán culture is a successive civilization (750-1375 AD) which extended as far as present day Piura in the north and Trujillo in the south. The Sicán culture was strongly influenced by the Moche culture, particularly in its metallurgical development (Shimada and Griffin, 1994). The metal objects from the Museums of Sipán and Sicán were analyzed with a portable equipment which uses energy-dispersive X-ray fluorescence (XRF). This portable equipment is composed of a small size X-ray tube and a Si-PIN thermoelectrically cooled X-ray detector. It was determined that the analyzed artefacts are composed of gold, silver and copper alloys, of gilded copper, of silvered gold, and of tumbaga, the last being a poor gold alloy enriched at the surface by depletion gilding, i.e. removing copper from the surface. In the case of gold, silver and copper alloys, their composition was determined by EDXRF analysis employing standard alloys. In the case of gilded copper, silvered copper and of tumbaga, the ratio Cu(Ka/Kb) was accurately determined from the X-ray spectra, first in order to clearly distinguish them, and subsequently in order to determine the thickness of the gilding. Mean values of 0.4 µm and 2.7 µm were determined for gilded copper and tumbaga, respectively. For gilded silver, the ratio Ag(Ka /Kb) was measured. The ratios Au-Ka/Cu-Ka, Ag-Ka/Cu-Ka and Au-Ka/Ag-Ka (gilded copper, silvered copper, and gilded silver, respectively) also depend on the thickness of gilding or silvering, and were employed to this aim.Sur la côte nord de l’actuel Pérou, entre environ 50 et 700 AD, prospérait la civilisation Moche. Cette culture était très avancée et les Moches étaient des métallurgistes avertis. Leur talent pour travailler le métal est illustré par les fouilles du site des “Tumbas Reales de Sipán”, découvert par W. Alva et collaborateurs en 1987. La culture Sicán est une civilisation qui se succède de 750 à 1375 AD et qui s’étend au nord jusqu’à Piura et au sud jusqu’à Trujillo. La culture Sicán a été fortement influencée par la culture Moche, et tout particulièrement leur métallurgie (Shimada et Griffin, 1994). Les objets métalliques des musées de Sipán et Sicán ont été analysés avec un spectromètre portable à fluorescence X à dispersion d’énergie. Cet équipement est constitué d’un tube à rayons-X miniaturisé et d’un détecteur de rayons-X de type Si-PIN à refroidissement thermoélectrique.  Nous avons pu montrer que les objets sont fabriqués avec des alliages d’or, argent et cuivre, avec du cuivre et de l’argent doré ainsi qu’avec du tumbaga, alliage d’or enrichi par mise en couleur, c’est-à-dire par appauvrissement en surface du cuivre. Les compositions des alliages en or, argent et cuivre ont été déterminées par ED-FX au moyen de standards d’or. Pour différencier les cuivres et les argents dorés ainsi que les tumbaga et ensuite déterminer l’épaisseur de la dorure, le rapport Cu(Ka/Kb) a été déterminé avec précision à partir des spectres à rayons X. Des valeurs moyennes de, respectivement, 0,4µm et 2,7µm ont été déterminées pour les cuivres dorés et les tumbaga. Pour les argents dorés, c’est le rapport Ag(Ka/Kb) qui a été mesuré. Les rapports Au-Ka/Cu-Ka, Ag-Ka/Cu-Ka et Au-Ka/Ag-Ka (cuivres dorés, cuivres argentés et argents dorés, respectivement) dépendent aussi de l’épaisseur de la dorure et de l’argenture

Sharing scientific and academic outputs from Cuban universities through a network of digital libraries.

Ponencia presentada en IFLA World Library and Information Congress. 83th IFLA General Conference and Assembly. Polonia.In 2015 libraries from five Cuban universities supported by an international project sponsored by the Flemish Interuniversity Council (VLIR), started the development of digital libraries using Dspace to manage all the scientific and academic outputs stored in their collections with the aim to socialize, preserve and increase the visibility of the scientific and academic production at national and international level. This paper presents the main features of the first Cuban Digital Library Network, the characteristics of each repository and other platforms, their interoperability and the development of a national harvester system to allow the information’s search and retrieval through a single interface. At this moment all five digital libraries are full operating allowing the visibility and socialization of more than nine thousands thesis produced by students and postgraduate's programs from five Cuban universities. During 2017 academic and research’s staff will add their scientific production (journal articles, books and book’s chapter, and other scientific documents) making possible to duplicate the amount early cited. A librarian team defined a metadata set from the Dublin Core Qualified to homogenize the documents description, according to the type of documents that these digital libraries will store and with the Metadata Export Guidelines released by OpenAIRE. Cuban Ministry of High Education, following the experience of the five universities included in the consortial environment it decide to lead a national project to expand this experience to the rest of Cuban universities (more than 21). The interoperability of more than 20 digital libraries will allow the genesis and management in 2018 of the bigger digital collection available in Cuba, including scientific and academic and also other digital collections stored in our libraries. Also a national catalog will be available with the information about all printed collection stored in Cuban universities.International project: Network of University Cooperation "Strengthening the role of ICT in Cuban universities for the development of society". Sponsored by the Flemish Interuniversity Council (VLIR)

Prolonged survival of patients with angioimmunoblastic T-cell lymphoma after high-dose chemotherapy and autologous stem cell transplantation: the GELTAMO experience

Abstract OBJECTIVES: Angioimmunoblastic T-cell lymphoma (AIL) is a rare lymphoma with a poor prognosis and no standard treatment. Here, we report our experiences with 19 patients treated with high-dose chemotherapy and autologous stem cell transplantation (HDC/ASCT) within the GELTAMO co-operative group between 1992 and 2004. METHODS: The median age at transplantation was 46 yr. Fifteen patients underwent the procedure as front-line therapy and four patients as salvage therapy. Most patients received peripheral stem cells (90%) coupled with BEAM or BEAC as conditioning regimen (79%). RESULTS: A 79% of patients achieved complete response, 5% partial response and 16% failed the procedure. After a median follow-up of 25 months, eight patients died (seven of progressive disease and secondary neoplasia), while actuarial overall survival and progression-free survival at 3 yr was 60% and 55%. Prognostic factors associated with a poor outcome included bone marrow involvement, transplantation in refractory disease state, attributing more than one factor of the age-adjusted-International Prognostic Index, Pretransplant peripheral T-cell lymphoma (PTCL) Score or Prognostic Index for PTCL. CONCLUSIONS: More than half of the patients with AIL that display unfavourable prognostic factors at diagnosis or relapse would be expected to be alive and disease-free after 3 yr when treated with HDC/ASCT. Patients who are transplanted in a refractory disease state do not benefit from this procedure

Relative Efficacy of AS03-Adjuvanted Pandemic Influenza A(H1N1) Vaccine in Children: Results of a Controlled, Randomized Efficacy Trial

Background. the vaccine efficacy (VE) of 1 or 2 doses of AS03-adjuvanted influenza A(H1N1) vaccine relative to that of 2 doses of nonadjuvanted influenza A(H1N1) vaccine in children 6 months to <10 years of age in a multinational study conducted during 2010-2011.Methods. A total of 6145 children were randomly assigned at a ratio of 1: 1: 1 to receive 2 injections 21 days apart of A/California/7/2009(H1N1)-AS03 vaccine at dose 1 and saline placebo at dose 2, 2 doses 21 days apart of A/California/7/2009(H1N1)-AS03 vaccine (the Ad2 group), or 2 doses 21 days apart of nonadjuvanted A/California/7/2009(H1N1) vaccine (the NAd2 group). Active surveillance for influenza-like illnesses continued from days 14 to 385. Nose and throat samples obtained during influenza-like illnesses were tested for A/California/7/2009 (H1N1), using reverse-transcriptase polymerase chain reaction. Immunogenicity, reactogenicity, and safety were assessed.Results. There were 23 cases of confirmed 2009 pandemic influenza A(H1N1) (A[H1N1]pdm09) infection for the primary relative VE analysis. the VE in the Ad2 group relative to that in the NAd2 group was 76.8% (95% confidence interval, 18.5%-93.4%). the benefit of the AS03 adjuvant was demonstrated in terms of the greater immunogenicity observed in the Ad2 group, compared with the NAd2 group.Conclusion. the 4-8-fold antigen-sparing adjuvanted pandemic influenza vaccine demonstrated superior and clinically important prevention of A(H1N1)pdm09 infection, compared with nonadjuvanted vaccine, with no observed increase in medically attended or serious adverse events. These data support the use of adjuvanted influenza vaccines during influenza pandemics.GlaxoSmithKline BiologicalsUniv Melbourne, Murdoch Childrens Res Inst, Carlton, Vic 3010, AustraliaUniv Melbourne, Melbourne Sch Populat & Global Hlth, Carlton, Vic 3010, AustraliaGlaxoSmithKline Vaccines, King of Prussia, PA USANovavax, Rockville, MD USAMary Chiles Gen Hosp, Dept Pediat, Manila, PhilippinesDe La Salle Hlth Sci Inst, Dept Pediat, Dasmarinas City, PhilippinesRes Inst Trop Med, Dept Hlth, Muntinlupa, PhilippinesUniversidade Federal de São Paulo, Dept Pediat, São Paulo, BrazilFac Ciencias Med Santa Casa São Paulo, Dept Pediat, São Paulo, BrazilAssoc Fundo Incent Pesquisa, São Paulo, BrazilInst Costarricense Invest Clin, San Jose, Costa RicaNatl Inst Publ Hlth Mexico, Cuernavaca, Morelos, MexicoUniv Autonoma Nuevo Leon, Serv Med, Monterrey, MexicoInst Nacl Pediat Mexico, Mexico City, DF, MexicoHosp Gen Durango, Durango, MexicoPhramongkutklao Hosp, Infect Dis Unit, Dept Pediat, Bangkok, ThailandKhon Kaen Univ, Dept Pediat, Fac Med, Khon Kaen, ThailandNatl Healthcare Grp Polyclin, Singapore, SingaporeCtr Estudios Infect Pediat, Cali, ColombiaGlaxoSmithKline Vaccines, Wavre, BelgiumGlaxoSmithKline Vaccines, Rixensart, BelgiumUniversidade Federal de São Paulo, Dept Pediat, São Paulo, BrazilWeb of Scienc