Screening strategies for a sustainable endpoint for Gambiense sleeping sickness

Background. Gambiense human African trypanosomiasis (gHAT, sleeping sickness) is a vector-borne disease typically fatal without treatment. Intensified, mainly medical-based, interventions in endemic areas have reduced the occurrence of gHAT to historically low levels. However, persistent regions, mainly in the Democratic Republic of Congo (DRC), remain a challenge to achieving the World Health Organization global elimination of transmission (EOT) target. Methods. Stochastic models of gHAT transmission fitted to DRC case data explored patterns of regional reporting and extinction. The time to EOT at a health zone scale (∼100,000 people) and how an absence of reported cases informs about EOT was quantified. Results. Regional epidemiology and level of active screening (AS) both influenced the predicted time to EOT. Different AS cessation criteria had similar expected infection dynamics and recrudescence of infection was unlikely. However, whether EOT has been achieved when AS ends, is critically dependent on the stopping criteria. Two or three consecutive years of no detected cases provided greater confidence of EOT compared to a single year (66-75% and 82-84% probability of EOT respectively compared to 31-51%). Conclusion. Multiple years of AS without case detections is a valuable measure to assess the likelihood that the EOT target has been met locally

Obtención de anticuerpos monoclonales de ratón contra proteasa de cisteína 5 recombinante de Entamoeba histolytica

Objetivo. Obtener anticuerpos monoclonales de ratón contra la proteasas de cisteína 5 (EhCP5) de Entamoeba histolytica. Materiales y métodos. Se inmunizaron ratones BALB/c por vía intraperitoneal con adyuvante de Freund completo e incompleto con la proteína recombinante EhCP5 obtenida a partir del cultivo de E.coli DH5α trasfectada con el vector recombinante pJC45 que expresa dicha proteína. Se seleccionó el animal con mejor respuesta de anticuerpos. Al cual se le extrajo su bazo como fuente de linfocitos B, los cuales se fusionaron utilizando PEG con células de mieloma de ratón SP2-0/Ag14. Se procedió a selección de los hibridomas y a la evaluación de los sobrenadantes de las colonias que crecieron a los 7 días mediante ELISA. Los hibridomas con valores más altos de anticuerpos específicos contra la proteína EhCP5r se seleccionaron, y los clones obtenidos por diluciones limitantes fueron expandidos. Resultados. A partir de un clon secretor estable se purifico el anticuerpo monoclonal anti EhCP5r del isotipo IgG1 por cromatografía de afinidad con proteína G. Los clones fueron expandidos in vivo e in vitro. Con el anticuerpo purificado se diseñaron tres sistemas de captura para evaluar la aplicabilidad del anticuerpo monoclonal anti EhCP5r como método inmunodiagnóstico. Conclusiones. Se logro la producción de un anticuerpo monoclonal específico contra EhCP5r que permite diferenciar Entamoeba histolytica de Entamoeba dispar

Insights from quantitative and mathematical modelling on the proposed 2030 goal for gambiense human African trypanosomiasis (gHAT)

Gambiense human African trypanosomiasis (gHAT) is a parasitic, vector-borne neglected tropical disease that has historically affected populations across West and Central Africa and can result in death if untreated. Following from the success of recent intervention programmes against gHAT, the World Health Organization (WHO) has defined a 2030 goal of global elimination of transmission (EOT). The key proposed indicator to measure achievement of the goal is to have zero reported cases. Results of previous mathematical modelling and quantitative analyses are brought together to explore both the implications of the proposed indicator and the feasibility of achieving the WHO goal. Whilst the indicator of zero case reporting is clear and measurable, it is an imperfect proxy for EOT and could arise either before or after EOT is achieved. Lagging reporting of infection and imperfect diagnostic specificity could result in case reporting after EOT, whereas the converse could be true due to underreporting, lack of coverage, and cryptic human and animal reservoirs. At the village-scale, the WHO recommendation of continuing active screening until there are three years of zero cases yields a high probability of local EOT, but extrapolating this result to larger spatial scales is complex. Predictive modelling of gHAT has consistently found that EOT by 2030 is unlikely across key endemic regions if current medical-only strategies are not bolstered by improved coverage, reduced time to detection and/or complementary vector control. Unfortunately, projected costs for strategies expected to meet EOT are high in the short term and strategies that are cost-effective in reducing burden are unlikely to result in EOT by 2030. Future modelling work should aim to provide predictions while taking into account uncertainties in stochastic dynamics and infection reservoirs, as well as assessment of multiple spatial scales, reactive strategies, and measurable proxies of EOT

SYZ mirror symmetry for hypertoric varieties

We construct a Lagrangian torus fibration on a smooth hypertoric variety and a corresponding SYZ mirror variety using $T$-duality and generating functions of open Gromov-Witten invariants. The variety is singular in general. We construct a resolution using the wall and chamber structure of the SYZ base.Comment: v_2: 31 pages, 5 figures, minor revision. To appear in Communications in Mathematical Physic

Estudio ecocardiográfico y de la concentración de NT-proBNP en pacientes diabéticos tipo 2 con y sin cardiopatía isquémica

The aim of this study was to determine whether there are differences in echocardiographic findings or in the level of a biochemical marker (i.e. N-terminal probrain natriuretic peptide [NT-proBNP]) between controls and type-2 diabetic patients with or without ischemic heart disease. Echocardiography was used to assess left ventricular function and morphology. In addition, the plasma NT-proBNP concentration was measured. The prevalence of diastolic dysfunction was greater in diabetics without ischemic heart disease than in controls (88% vs. 74%, respectively; P< .001) and the NT-proBNP concentration was higher (350.6+/-197.8 vs. 281.7+/-190.4 fmol/mL; P< .001). Diabetics with ischemic heart disease had a higher NT-proBNP concentration than those without (720.4+/-278.1 vs. 350.6+/-197.8 fmol/mL, respectively; P< .001). An NT-proBNP concentration >490 fmol/mL had a sensitivity of 84% and a specificity of 75% for detecting ischemic heart disease in diabetics

Postpartum sterilization choices made by HIV-infected women.

OBJECTIVE: To assess if HIV-infected women made different choices for postpartum sterilization after implementation of the Pediatric AIDS Clinical Trials Group protocol 076 (November 1, 1994) compared to before implementation. STUDY DESIGN: A retrospective cohort study in which medical records were reviewed to obtain demographic, obstetric and HIV-related data from January 1993 through December 2002. HIV-infected women who completed a pregnancy by birth or abortion were divided into two comparison groups: "Pre-076" and "Post-076". The primary outcome was sterilization by postpartum tubal ligation.Results. Forty-two women (74%) in the Pre-076 group chose sterilization compared to 139 of 310 women (45%) in the Post-076 group (unadjusted OR 3.44, 95% CI 1.83, 6.47). Seventy-one percent of women younger than 21 years of age in the Pre-076 Group chose sterilization compared with only 35% of women younger than 21 years in the Post-076 group (p = 0.0136). Similarly, 78% of primiparous women chose sterilization after their first pregnancy in the Pre-076 group, compared to 14% in the Post-076 group (p < 0.001). CONCLUSIONS: Since the implementation of PACTG 076 protocol in November 1994, fewer HIV-infected women chose postpartum sterilization. The typical woman who now chooses postpartum sterilization is less likely to be young or primiparous than those who chose sterilization before PACTG Protocol 076 implementation