The accretion disk in the post period-minimum cataclysmic variable SDSS J080434.20+510349.2

This study of SDSS0804 is primarily concerned with the double-hump shape in the light curve and its connection with the accretion disk in this bounce-back system. Time-resolved photometric and spectroscopic observations were obtained to analyze the behavior of the system between superoutbursts. A geometric model of a binary system containing a disk with two outer annuli spiral density waves was applied to explain the light curve and the Doppler tomography. Observations were carried out during 2008-2009, after the object's magnitude decreased to V~17.7(0.1) from the March 2006 eruption. The light curve clearly shows a sinusoid-like variability with a 0.07 mag amplitude and a 42.48 min periodicity, which is half of the orbital period of the system. In Sept. 2010, the system underwent yet another superoutburst and returned to its quiescent level by the beginning of 2012. This light curve once again showed a double-humps, but with a significantly smaller ~0.01mag amplitude. Other types of variability like a "mini-outburst" or SDSS1238-like features were not detected. Doppler tomograms, obtained from spectroscopic data during the same period of time, show a large accretion disk with uneven brightness, implying the presence of spiral waves. We constructed a geometric model of a bounce-back system containing two spiral density waves in the outer annuli of the disk to reproduce the observed light curves. The Doppler tomograms and the double-hump-shape light curves in quiescence can be explained by a model system containing a massive >0.7Msun white dwarf with a surface temperature of ~12000K, a late-type brown dwarf, and an accretion disk with two outer annuli spirals. According to this model, the accretion disk should be large, extending to the 2:1 resonance radius, and cool (~2500K). The inner parts of the disk should be optically thin in the continuum or totally void.Comment: 12 pages, 15 figures, accepted for publication in A&

Quality of life and the relationship with family income in patients with rheumatoid arthritis

Objectives: To evaluate the quality of life (QoL) of patients with rheumatoid arthritis (RA) using the Quality of life in Rheumatoid Arthritis (RAQol) questionnaire. Also, to explore its relationship with income in patients attended at a specialized RA center in Bogotá, Colombia, 2018. Methods: We performed a descriptive study. The RAQol version in Spanish was applied to RA patients. The scale of the RAQol has a score from 1-10, where 10 is associated with better QoL. We excluded patients with psychological or psychiatric disorders. We asked about the monthly family income according to the Colombian minimum wage. Descriptive epidemiology was performed for each variable. A comparison of means regarding age and RAQol score was carried out. Therefore, we performed a bivariate analysis in order to explore the relationship between income and QoL, reporting Odds Ratios (OR) and confidence intervals 95% (CI95%). Results related to family income were reported in US$with the average exchange rate for 2018. Results: We interviewed 310 patients, 92$265, 47% between US$266- US$530, 9% between US$531-US$795 and 3% more than US$1300. Patients with an income greater than US$531 per/month had a higher average score in the RAQoL scale (7.1, SD5.5). The relationship of having a score lower than 6 in the RAQoL and a monthly income lower than US$530 showed an OR of 2.48 IC95% (0.99-6.22) (P=0.03). Conclusions: Our study showed that patient with a low income reports a lower QoL. Further research is needed to evaluate the alternatives that can improve QoL in patients with RA

Costs and disease activity in patients with rheumatoid arthritis treated with biologic dmards: findings in a real-life setting

Objectives: Biological DMARDs have demonstrated to modify the natural course of the disease through the inhibition of specific molecules of the immune and inflammatory responses. The objective of our study is to describe the use of biological therapy, disease activity and costs related to the treatment of patients with RA in a real-life setting in Colombia. Methods: Patients were analyzed retrospectively for 36 months and followed-up under T2T standards with a multidisciplinary approach. DAS28 was used as main clinical outcome. We included patients with severe or moderate disease activity using biological therapy. We described the percentage of patients who reached low disease activity or remission. Most expensive biological therapies were described and costed. Costs were reported in US dollars at the official rate of exchange for December 2018. Statistical analyses were done in Microsoft Excel. Results: We followed-up 1054 patients during three years, 85% were female, mean age was 57 years (SD 7.7). At the beginning of the follow-up, 52% of patients were in MDA and 48% in SDA. The most used treatment regime was certolizumab (24.57%) followed by etanercept (16.51%) and abatacept (12.81%). At the end of the follow-up, 92% patients achieved remission. Regarding costs, the most expensive therapy per/ year was etanercept (USD $12,522.70) followed by golimumab ($11,535.00) and (adalimumab). When we calculated the average cost for all biological therapy and then compared to the number of patients who achieved remission, the costs during three years to achieve remission was $27,738,839.54 USD. Conclusions: Our study showed that biological therapy is effective when is used under a T2T strategy and with a multidisciplinary approach. However, it is an expensive option that might be used in adherent patients and candidates who met the profile for prescribing this type of pharmacological therapy, especially in developing countries where the health budgets are limited

Seroprevalence and risk factors associated with bovine herpesvirus 1 in dairy herds of Colombia

BACKGROUND AND AIM: Infectious bovine rhinotracheitis (IBR) is an infectious disease widely distributed globally and is considered the main cause of various reproductive and respiratory tract diseases in cattle and buffaloes. This study aimed to estimate seroprevalence and determine risk factors associated with the presentation of IBR in the municipality of Sotaquirá, Boyacá (Colombia). MATERIALS AND METHODS: A descriptive cross-sectional study with simple random sampling was performed, and the sample size was 1,000 cattle. Blood samples were obtained by coccygeal venipuncture and processed through indirect enzyme-linked immunosorbent assay using the Synbiotics(®) kit (Zoetis, New Jersey, USA) with a sensitivity and specificity of 96% and 98%, respectively. Data were processed using the statistical program EpiInfo(®) (Centers for Disease Control and Prevention; Atlanta, Georgia). RESULTS: A high seroprevalence of 57.5% was established. Seroprevalence was the highest in cattle >4 years of age (65.0% apparent seroprevalence [AS]; 67% true seroprevalence [TS]) and in the Holstein breed (65.5% AS; 67.8% TS). The breed and age of the animals were significantly associated with each other. The Holstein breed, age group >4 years, uncertified semen, and fetal death were established as risk factors for IBR. In comparison, the age groups of <1 and 1–2 years and the Normande breed were established as protective factors against the bovine herpesvirus-1 virus. CONCLUSION: Management factors, such as livestock from other owners and animal purchases, which affect disease presentation, are evident. The implementation and development of novel prevention and control measures for IBR at the national level are necessary

Mental health of migrants with pre-migration exposure to armed conflict: a systematic review and meta-analysis.

BACKGROUND Exposure to armed conflict has been associated with negative mental health consequences. We aimed to estimate the prevalence of generalised anxiety disorder, major depressive disorder, and post-traumatic stress disorder among migrants exposed to armed conflict. METHODS In this systematic review and meta-analysis, we searched online databases (Cochrane Library, Embase, LILACS, PsycInfo [via Ovid], PubMed, and Web of Science Core Collection) for relevant observational studies published between Jan 1, 1994, and June 28, 2021. We included studies that used standardised psychiatric interviews to assess generalised anxiety disorder, major depressive disorder, or post-traumatic stress disorder among migrants (refugees or internally displaced persons; aged ≥18 years) with pre-migration exposure to armed conflict. We excluded studies in which exposure to armed conflict could not be ascertained, studies that included a clinical population or people with chronic diseases that can trigger the onset of mental disease, and studies published before 1994. We used a random effects model to estimate each mental health disorder's pooled prevalence and random effects meta-regression to assess sources of heterogeneity. Two independent reviewers assessed the risk of bias for each study using the Joanna Briggs Institute Checklist for Prevalence Studies. The protocol was registered with PROSPERO, CRD42020209251. FINDINGS Of the 13 935 studies identified, 34 met our inclusion criteria; these studies accounted for 15 549 migrants. We estimated a prevalence of current post-traumatic stress disorder of 31% (95% CI 23-40); prevalence of current major depressive disorder of 25% (17-34); and prevalence of generalised anxiety disorder of 14% (5-35). Younger age was associated with a higher prevalence of current post-traumatic stress disorder (odds ratio 0·95 [95% CI 0·90-0·99]), lifetime post-traumatic stress disorder (0·88 [0·83-0·92]), and current generalised anxiety disorder (0·87 [0·78-0·97]). A longer time since displacement was associated with a lower lifetime prevalence of post-traumatic stress disorder (0·88 [0·81-0·95]) and major depressive disorder (0·81 [0·77-0·86]). Migrating to a middle-income (8·09 [3·06-21·40]) or low-income (39·29 [11·96-129·70]) country was associated with increased prevalence of generalised anxiety disorder. INTERPRETATION Migrants who are exposed to armed conflict are at high risk of mental health disorders. The mental health-care needs of migrants should be assessed soon after resettlement, and adequate care should be provided, with particular attention paid to young adults. FUNDING Marie Skłodowska-Curie Actions (Horizon 2020-COFUND), MinCiencias (Colombia), and Swiss National Science Foundation

Identification of Brucella by MALDI-TOF Mass Spectrometry. Fast and Reliable Identification from Agar Plates and Blood Cultures

BACKGROUND: MALDI-TOF mass spectrometry (MS) is a reliable method for bacteria identification. Some databases used for this purpose lack reference profiles for Brucella species, which is still an important pathogen in wide areas around the world. We report the creation of profiles for MALDI-TOF Biotyper 2.0 database (Bruker Daltonics, Germany) and their usefulness for identifying brucellae from culture plates and blood cultures. METHODOLOGY/PRINCIPAL FINDINGS: We created MALDI Biotyper 2.0 profiles for type strains belonging to B. melitensis biotypes 1, 2 and 3; B. abortus biotypes 1, 2, 5 and 9; B. suis, B. canis, B ceti and B. pinnipedialis. Then, 131 clinical isolates grown on plate cultures were used in triplicate to check identification. Identification at genus level was always correct, although in most cases the three replicates reported different identification at species level. Simulated blood cultures were performed with type strains belonging to the main human pathogenic species (B. melitensis, B. abortus, B. suis and B. canis), and studied by MALDI-TOF MS in triplicate. Identification at genus level was always correct. CONCLUSIONS/SIGNIFICANCE: MALDI-TOF MS is reliable for Brucella identification to the genus level from culture plates and directly from blood culture bottles

Redefining Palliative Care-A New Consensus-Based Definition.

The International Association for Hospice and Palliative Care developed a consensus-based definition of palliative care (PC) that focuses on the relief of serious health-related suffering, a concept put forward by the Lancet Commission Global Access to Palliative Care and Pain Relief. The main objective of this article is to present the research behind the new definition. The three-phased consensus process involved health care workers from countries in all income levels. In Phase 1, 38 PC experts evaluated the components of the World Health Organization definition and suggested new/revised ones. In Phase 2, 412 International Association for Hospice and Palliative Care members in 88 countries expressed their level of agreement with the suggested components. In Phase 3, using results from Phase 2, the expert panel developed the definition. The consensus-based definition is as follows: Palliative care is the active holistic care of individuals across all ages with serious health-related suffering due to severe illness and especially of those near the end of life. It aims to improve the quality of life of patients, their families and their caregivers. The definition includes a number of bullet points with additional details as well as recommendations for governments to reduce barriers to PC. Participants had significantly different perceptions and interpretations of PC. The greatest challenge faced by the core group was trying to find a middle ground between those who think that PC is the relief of all suffering and those who believe that PC describes the care of those with a very limited remaining life span

Prevalence and etiology of community-acquired pneumonia in immunocompromised patients

Background. The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia. Methods. We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor. Results. At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CAP) pathogens were the most frequently identified, and prevalences did not differ from those in immunocompetent patients. Risk factors for immunocompromise were independently associated with neither Pseudomonas aeruginosa nor non\u2013community-acquired bacteria. Specific risk factors were independently associated with fungal infections (odds ratio for AIDS and hematological cancer, 15.10 and 4.65, respectively; both P = .001), mycobacterial infections (AIDS; P = .006), and viral infections other than influenza (hematological cancer, 5.49; P < .001). Conclusions. Our findings could be considered by clinicians in prescribing empiric antibiotic therapy for CAP in immunocompromised patients. Patients with AIDS and hematological cancer admitted with CAP may have higher prevalences of fungi, mycobacteria, and noninfluenza viruses