Ecohealth interventions limit triatomine reinfestation following insecticide spraying in La Brea, Guatemala

In this study, we evaluate the effect of participatory Ecohealth interventions on domestic reinfestation of the Chagas disease vector Triatoma dimidiata after village-wide suppression of the vector population using a residual insecticide. The study was conducted in the rural community of La Brea, Guatemala between 2002 and 2009 where vector infestation was analyzed within a spatial data framework based on entomological and socio-economic surveys of homesteads within the village. Participatory interventions focused on community awareness and low-cost home improvements using local materials to limit areas of refuge and alternative blood meals for the vector within the home, and potential shelter for the vector outside the home. As a result, domestic infestation was maintained at ≤ 3% and peridomestic infestation at ≤ 2% for 5 years beyond the last insecticide spraying, in sharp contrast to the rapid reinfestation experienced in earlier insecticide only interventions. Copyright © 2013 by The American Society of Tropical Medicine and Hygiene

Ecological, social and biological risk factors for continued Trypanosoma cruzi transmission by Triatoma dimidiata in Guatemala

House infestation risk factors for Chagas disease are dog density, mouse presence, interior wall plaster condition, dirt floor, tile roofing and coffee tree presence. The transmission cycle includes mammalian reservoirs of the parasite and triatomine species, such as Triatoma dimidiata and Triatoma infestans, which colonize domestic and peridomestic environments. Traditional house construction styles have been considered risk factors for the presence of triatomines by vector control personnel. Persistent house infestation is related to eco-bio-social factors associated with dogs, chickens and rodents. Integrated disease control should include the role of animals in the transmission process, and community members’ knowledge, attitudes and practices

Distribution and status of living colonies of Acropora spp. in the reef crests of a protected marine area of the Caribbean (Jardines de la Reina National Park, Cuba)

The reef crests of the Jardines de la Reina National Park (JRNP) are largely formed by Acropora palmata, but colonies of A. cervicornis and the hybrid A. prolifera are also present. This study shows spatial distribution of colonies, thickets and live fragments of these species in the fore reefs. Snorkeling was used to perform the direct observations. The maximum diameter of 4,399 colonies of A. palmata was measured and the health of 3,546 colonies was evaluated. The same was done to 168 colonies of A. cervicornis and 104 colonies of A. prolifera. The influence of the location and marine currents on a number of living colonies of A. palmata was analyzed. For such purpose, reef crests were divided into segments of 500 m. The marine park was divided into two sectors: East and West. The Caballones Channel was used as the reference dividing line. The park was also divided into five reserve zones. We counted 7,276 live colonies of Acropora spp. 1.4% was A. prolifera, 3.5% A. cervicornis and 95.1% A. palmata. There were 104 thickets of A. palmata, ranging from eight to 12 colonies, and 3,495 fragments; 0.6% was A. cervicornis and the rest A. palmata (99.4%). In the East sector, 263 colonies (3.8% of the total), six thickets (5.8%) and 32 fragments (1%) of A. palmate were recorded. In the same sector, there were 11 fragments (50%) of A.cervicornis and two (2%) colonies of A. prolifera. Health of A. palmata was evaluated as good and not so good in the study area. Health of A. cervicornis was critical and health of A. prolifera was good in all five reserve zones. There was a significant increase in the number of colonies from east to west (Χ2 = 11.5, gl = 3.0, p = 0.009). This corroborates the existence of an important abundance differences between the eastern and the western region of the JRNP. A negative relationship was observed between the number of colonies and the distance from the channel (Χ2 = 65.0, df = 3.0, p < 0.001). The influence of the channel, for the live colonies of A. palmata is greater within the first 2,000 m. It then decreases until approximately 6,000 m, and no significant increase beyond. The orientation of the reef crests significantly influenced the abundance of the colonies (Χ2 = 15.5, df = 2.9, p = 0.001). The results presented here provide a baseline for future research on the status of the populations of Acropora spp., considering that there has been a certain recovery of the species A. palmata during the last 10–16 years. Given the current status of the populations of Acropora spp., conservation actions focusing A. cervicornis should be prioritized

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

Reaction Norm of Embryo Growth Rate Dependent on Incubation Temperature in The Olive Ridley Sea Turtle, Lepidochelys Olivacea, from Pacific Central America

Olive ridleys (Lepidochelys olivacea) and loggerheads (Caretta caretta) are two closely phylogenetically related sea turtles that nest in very different thermal habitat. Olive ridleys nest in pan-tropical beaches whereas loggerheads nest in more temperate beaches. In the context of climate change, the temperature in temperate beaches will increase much more than for tropical beach due to buffering effect of air humidity in the later. We have determined the thermal reaction norm for embryonic growth in both species using field records of incubation temperatures and incubation length from loggerheads in Western Mediterranean Sea or olive ridleys from Pacific coast of Guatemala. We show that the optimum temperature for the growth of embryos is lower for loggerheads than for olive ridleys. This makes loggerhead turtles particularly sensitive to increase of beach temperature as it is expected due to effect of global warming in temperature regions. Furthermore, olive ridleys are more resilient to increase of temperatures and should not suffer from sublethal incubation temperatures

Annex 3 of the final report

A novel method using vector blood meal sources to assess the impact of control efforts on the risk of transmission of Chagas disease was tested in the village of El Tule, Jutiapa, Guatemala. Control used Ecohealth interventions, where villagers ameliorated the factors identified as most important for transmission. First, after an initial insecticide application, house walls were plastered. Later, bedroom floors were improved and domestic animals were moved outdoors. Only vector blood meal sources revealed the success of the first interventions: human blood meals declined from 38% to 3% after insecticide application and wall plastering. Following all interventions both vector blood meal sources and entomological indices revealed the reduction in transmission risk. These results indicate that vector blood meals may reveal effects of control efforts early on, effects that may not be apparent using traditional entomological indices, and provide further support for the Ecohealth approach to Chagas control in Guatemala

Indicators of <i>T. cruzi</i> transmission in Comapa and Zapotitlán, Jutiapa, Guatemala 2011.

<p>* True prevalence adjusted for test specificity and sensitivity (Blakeŕs 95% Confidence Limits) <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0104599#pone.0104599-Reiczigel1" target="_blank">[61]</a>.</p><p>Indicators of <i>T. cruzi</i> transmission in Comapa and Zapotitlán, Jutiapa, Guatemala 2011.</p