Tuberculosis transmission patterns among Spanish-born and foreign-born populations in the city of Barcelona

AbstractDuring a 2-year period (2003–2004), tuberculosis (TB) transmission in Barcelona and the factors related to transmission among the Spanish- and foreign-born populations were studied by molecular epidemiology. Data were obtained from TB cases and Conventional Contact Tracing registries and genotyping was performed using restriction fragment length polymorphism (RFLP)-IS6110 and MIRU12 as a secondary typing method. Of the 892 TB cases reported, 583 (65.3%) corresponded to Spanish-born and 309 (34.6%) to foreign-born. Six hundred and eighty-seven cases (77%) were confirmed by culture. RFLP typing of 463/687 (67.4%) isolates was performed, revealing 280 (60.5%) unique and 183 (39.5%) shared patterns, which were grouped into 65 clusters. Spanish-born individuals were significantly more clustered than foreign-born individuals (44.6% vs. 28.8%; p 0.016). Clustering in foreign-born individuals was associated with HIV (p 0.051, odds ratio = 3.1, 95% confidence interval 1–10.9) and alcohol abuse (p 0.022), whereas, in the Spanish-born individuals, clustering was associated with age in the range 21–50 years, (p 0.024). Of the total clusters, 36/65 (55.3%) included only Spanish-born patients, whereas 22/65 (33.8%) included individuals from both populations. In mixed clusters, the index case was Spanish-born in 53% and foreign-born in 47%. Among the foreign-born, 2.8% were ill on arrival, 30% developed TB within the first year and 50.3% developed TB within the first 2 years; 58.3% were from South America. In conclusion, half of the foreign-born TB patients developed the disease during the first 2 years after arrival, which, in most cases, was the result of endogenous reactivation. Recent TB transmission among Spanish-born and foreign-born populations, as well as bidirectional transmission between communities, contributed significantly to the burden of TB in Barcelona, suggesting the need to improve Public Health interventions in both populations

Early diarrhoea under sorafenib as a marker to consider the early migration to second-line drugs

Background: Despite atezolizumab and bevacizumab (A + B) is currently the first-line treatment for hepatocellular carcinoma (HCC) patients, some patients will not be adequate for this combination. In the setting of sorafenib some adverse events have been proposed as prognostic factors. Objective: To characterize the early diarrhoea development as prognostic factor in 344 HCC patients. Methods: The development of early diarrhoea in sorafenib treatment defined as patients who developed diarrhoea and needed dose modification within the first 60 days of treatment (e-diarrhoea) and 3-grouping variables were analysed: Patients with e-diarrhoea, patients who developed diarrhoea after the first 60 days of treatment (L-diarrhoea) and patients that never developed diarrhoea (never diarrhoea). Results: The median overall survival in sorafenib treated patients was significantly different across groups (6.8 months for e-diarrhoea, 26.7 months for L-diarrhoea and 13.3 months for never-diarrhoea). The emergence of e-diarrhoea was associated with poor outcomes (hazard ratio [HR] 1.84 [95%CI 1.15-2.95]), while there was no increased/decreased risk of dismal evolution in patients with L-diarrhoea (HR 0.66 [95%CI 0.42-1.03]). Conclusion: The emergence of e-diarrhoea in HCC patients treated with sorafenib is an early predictor of dismal evolution under this therapy. Thus, prompt identification of these non-responders may be useful for an early switch to second-line therapies

Radiological response to nivolumab in patients with hepatocellular carcinoma: A multicenter analysis of real-life practice

Background and aims: Immune-checkpoint inhibitors are effective in many advanced tumors. However, there is scarce information regarding the radiological response to these agents in hepatocellular carcinoma outside clinical trials. We aimed to describe the radiological response in a retrospective cohort of hepatocellular carcinoma patients treated with nivolumab and to analyze the radiological evolution according to tumor response at first post-treatment radiological assessment. Methods: We reviewed pre-treatment and post-treatment images (CT or MRI) obtained at different time-points in patients with hepatocellular carcinoma treated with nivolumab outside clinical trials at seven Spanish centers, assessing the response according to RECIST 1.1 and iRECIST and registering atypical responses. We also analyzed the imaging findings on subsequent assessments according to tumor status on the first posttreatment imaging assessment. Results: From the 118 patients with hepatocellular carcinoma treated with nivolumab, we finally analyzed data from 31 patients (71 % Child-Pugh A; 74 % BCLC-C). Median follow-up was 8.39 months [IQR 5.00-10.92]; median overall survival was 12.82 months (95 %CI 10.92-34.79). According to RECIST 1.1, the objective response rate was 16 % and according to iRECIST, the objective response rate was 22.6 %. Findings at the first post-treatment assessment varied, showing stable disease in 44.8 % of patients; findings during follow-up also varied widely, including 4 hyperprogressions and 3 pseudoprogressions. Conclusion: Imaging findings during nivolumab treatment are heterogeneous between and within patients. Progression of disease does not always signify treatment failure, and surrogate end-points may not reflect survival outcomes, making the management of hepatocellular carcinoma patients under immunotherapy challengin

Hepatocellular carcinoma recurrence after direct-acting antiviral therapy: an individual patient data meta-analysis

Objective: The benefit of direct-acting antivirals (DAAs) against HCV following successful treatment of hepatocellular carcinoma (HCC) remains controversial. This meta-analysis of individual patient data assessed HCC recurrence risk following DAA administration. Design: We pooled the data of 977 consecutive patients from 21 studies of HCV-related cirrhosis and HCC, who achieved complete radiological response after surgical/locoregional treatments and received DAAs (DAA group). Recurrence or death risk was expressed as HCC recurrence or death per 100 person-years (100PY). Propensity score-matched patients from the ITA.LI.CA. cohort (n=328) served as DAA-unexposed controls (no-DAA group). Risk factors for HCC recurrence were identified using random-effects Poisson. Results: Recurrence rate and death risk per 100PY in DAA-treated patients were 20 (95% CI 13.9 to 29.8, I2=74.6%) and 5.7 (2.5 to 15.3, I2=54.3), respectively. Predictive factors for recurrence were alpha-fetoprotein logarithm (relative risk (RR)=1.11, 95% CI 1.03 to 1.19; p=0.01, per 1 log of ng/mL), HCC recurrence history pre-DAA initiation (RR=1.11, 95% CI 1.07 to 1.16; p<0.001), performance status (2 vs 0, RR=4.35, 95% CI 1.54 to 11.11; 2 vs 1, RR=3.7, 95% CI 1.3 to 11.11; p=0.01) and tumour burden pre-HCC treatment (multifocal vs solitary nodule, RR=1.75, 95% CI 1.25 to 2.43; p<0.001). No significant difference was observed in RR between the DAA-exposed and DAA-unexposed groups in propensity score-matched patients (RR=0.64, 95% CI 0.37 to 1.1; p=0.1). Conclusion: Effects of DAA exposure on HCC recurrence risk remain inconclusive. Active clinical and radiological follow-up of patients with HCC after HCV eradication with DAA is justified

Rapid detection of ciguatoxins in Gambierdiscus and Fukuyoa with immunosensing tools

Consumption of seafood contaminated with ciguatoxins (CTXs) leads to a foodborne disease known as ciguatera. Primary producers of CTXs are epibenthic dinoflagellates of the genera Gambierdiscus and Fukuyoa. In this study, thirteen Gambierdiscus and Fukuyoa strains were cultured, harvested at exponential phase, and CTXs were extracted with an implemented rapid protocol. Microalgal extracts were obtained from pellets with a low cell abundance (20,000 cell/mL) and were then analyzed with magnetic bead (MB)-based immunosensing tools (colorimetric immunoassay and electrochemical immunosensor). It is the first time that these approaches are used to screen Gambierdiscus and Fukuyoa strains, providing not only a global indication of the presence of CTXs, but also the ability to discriminate between two series of congeners (CTX1B and CTX3C). Analysis of the microalgal extracts revealed the presence of CTXs in 11 out of 13 strains and provided new information about Gambierdiscus and Fukuyoa toxin profiles. The use of immunosensing tools in the analysis of microalgal extracts facilitates the elucidation of further knowledge regarding these dinoflagellate genera and can contribute to improved ciguatera risk assessment and management.info:eu-repo/semantics/acceptedVersio

Global trends in scientific production in enology and viticulture in selected emerging economies (BRIC)

[EN] The aim of this study was to analyse the scientific productivity of the BRIC countries (Brazil, Russia, India and China) in viticulture and oenology through bibliometric analyses of articles in the Science Citation Index Expanded database for the period 1993-2012. A total of 1067 research articles were published in 363 domestic and international journals. We highlight important growth during the mentioned period in the published research papers, particularly in China and Brazil over the last 5 years. Papers have been published in numerous journals in a number of subject areas, such as Revista Brasileira de Fruticultura and Pesquisa Agropecuaria Brasileira, which are the most productive among the BRIC countries. A social network analysis of collaboration between each of the four BRIC countries was also performed.Aleixandre Benavent, JL.; Aleixandre Tudo, J.; Bolaños-Pizarro, M.; Aleixandre-Benavent, R. (2015). Global trends in scientific production in enology and viticulture in selected emerging economies (BRIC). Scientometrics. 103(2):649-668. https://doi.org/10.1007/s11192-015-1543-46496681032Albornoz, M. (2014). Política Científica y Tecnológica: Una visión desde América Latina. Revista Iberoamericana de Ciencia, Tecnología, Sociedad e Innovación. Nº 1. http://www.oei.es/revistactsi/numero1/albornoz.htm . Accessed 28 January, 2014Aleixandre, J. L., Bordeu, E., Aleixandre-Tudó, J. L., Bolaños, M., & Aleixandre-Benavent, R. (2013). Scientific productivity and collaboration in viticulture and enology in Latin American countries. Ciencia e Investigación Agraria, 40, 429–443.Aleixandre-Benavent, R., Aleixandre-Tudó, J. L., González Alcaide, G., Ferrer Sapena, A., Aleixandre, J. L., & Du Toit, W. (2012). Bibliometric analysis of publications by South African viticulture and oenology research centres. South African Journal of Science, 108, 74–84.Aleixandre-Benavent, R., Valderrama Zurian, J. C., & González Alcaide, G. (2007). The impact factor of scientific journals: Limitations and alternative indicators (vol. 16, pp. 4–11).Babini, D. (2011). Acceso abierto a la producción científica de América Latina y el Caribe. Revista Iberoamericana de Ciencia, Tecnología y Sociedad, 17, 1–24.Cassi, L., Morrison, A. & Rabellotti, R. (2014). Proximity and scientific collaboration: Evidence from the global wine industry. Papers in Evolutionary Economic Geography, 14(05). Accessed 1 December, 2014. http://econ.geo.uu.nl/peeg/peeg1405.pdfCassi, L., Morrison, A., & Ter Wal, A. L. J. (2012). The evolution of trade and scientific collaboration networks in the global wine sector: A longitudinal study using network analysis. Ecomomic Geography, 83, 311–334.CIA World Factbook. (2011): Statistic. On line, 25th May 2011. https://www.cia.gov/library/publications/the-world-factbook/geos/br.html . Accessed 22 November, 2013Cunningham, S. J., & Dillon, S. M. (1997). Authorship patterns in information systems. Scientometrics, 39, 19–27.Cusmano, L., Morrison, A., & Rabellotti, R. (2010). Catching-up trajectories in the wine sector: A comparative study of Chile, Italy and South Africa. World Development, 38, 1588–1602.Glänzel, W., & Veugelers, R. (2006). Science for wine: A bibliometric assessment for wine and grape research for wine-producing and consuming countries. American Journal of Enology and Viticulture, 57, 23–32.González-Alcaide, G., Alonso Arroyo, A., González de Dios, J., Pérez Sempere, A., Valderrama-Zurian, J. C., & Aleixandre-Benavent, R. (2008a). Coauthorship networks and institutional collaboration in Revista de Neurología. Revista de Neurologia, 46, 642–651.González-Alcaide, G., Valderrama-Zurian, J. C., & Aleixandre-Benavent, R. (2008b). Research fronts and collaboration patterns in Reproductive Biology. Coauthorship networks and institutional collaboration. Fertility and Sterility, 90, 941–956.Guilford, J. M., & Pezzuto, J. M. (2011). Wine and health: A review. American Journal of Enology and Viticulture, 62, 471–486.Katz, J. S., & Martin, B. R. (1997). What is research collaboration? Research Policy, 26, 1–18.Kretschmer, H. (1994). Coautorship network of invisible-college and institutionalized communities. Scientometrics, 30, 363–369.Newman, M. E. J. (2004). Coauthorship networks and patterns of scientific collaboration. Proceeding of the National Academy of Science, USA, 101, 5200–5205.O’Neill, J., & Stopnytska A. (2011). Linking GDP growth and equity return. Goldman Sachs. Monthly insights from the office of the chairman.OIV. (2007). International organization of vine and wine. Paris: Statistics.Pichon-Riviere, A., Ceballos, R. M., & Briones, E. (2009). Health technology assessment in Latin-America and the Caribbean, facilitators and barriers for international collaboration: A survey. Value in Health, 12, 488–2009.Rojas-Sola, J. I., & Jordá-Albiñana, B. (2009). Análisis bibliométrico de las publicaciones científicas españolas en la categoría materials science, ceramics de la base de datos JCR (SCI) (1997–2008). Boletín de la Sociedad Española de Ceramica y Vidrio, 48, 255–260.Sánchez Sosa, J. J. (2008). Professional collaboration between psychologists and other health professionals in healthcare settings in Latin America. International Journal of Psychology, 43, 171–179.Scherngell, T., & Hu, Y. (2011). Collaborative knowledge production in China. Regional evidence from a gravity model approach. Regional Studies, 45(6), 755–772.Sidone, O., Haddad, E., & Mena-Chalco, J. (2014). Scholarly publication and collaboration in Brazil: The role of geography. ERSA Conference Papers, 14, 187. Accessed 01 December, 2014. http://www.usp.br/nereus/wp-content/uploads/TD_Nereus_01_2014.pdfSlobodniková, O., & Nagyová, R. (2011). Global influence of the BRIC countries. In The scale of globalization. Think globally, act locally, change individually in the 21st century (pp. 303–311). Ostrava: University of Ostrava.Vera-Villarroel, P., López-López, W., Lillo, S., & Silva, L. (2011). La producción científica en psicología latinoamericana: Un análisis de la investigación por países. Revista Latinoamericana de Psicología, 43, 95–104.White, H. D., & McCain, K. (1989). Bibliometrics. Annual Review of Information Science and Technology, 24, 119–186.World Bank. (2011). Data Word Bank. http://data.worldbank.org/indicator/NY.GDP.MKTP.C

How to: identify non-tuberculous Mycobacterium species using MALDI-TOF mass spectrometry.

The implementation of MALDI-TOF MS for microorganism identification has changed the routine of the microbiology laboratories as we knew it. Most microorganisms can now be reliably identified within minutes using this inexpensive, user-friendly methodology. However, its application in the identification of mycobacteria isolates has been hampered by the structure of their cell wall. Improvements in the sample processing method and in the available database have proved key factors for the rapid and reliable identification of non-tuberculous mycobacteria isolates using MALDI-TOF MS. The main objective is to provide information about the proceedings for the identification of non-tuberculous isolates using MALDI-TOF MS and to review different sample processing methods, available databases, and the interpretation of the results. Results from relevant studies on the use of the available MALDI-TOF MS instruments, the implementation of innovative sample processing methods, or the implementation of improved databases are discussed. Insight about the methodology required for reliable identification of non-tuberculous mycobacteria and its implementation in the microbiology laboratory routine is provided. Microbiology laboratories where MALDI-TOF MS is available can benefit from its capacity to identify most clinically interesting non-tuberculous mycobacteria in a rapid, reliable, and inexpensive manner

Doença pulmonar por Mycobacterium tuberculosis e micobactérias não-tuberculosas entre pacientes recém-diagnosticados como HIV positivos em Moçambique, África Mycobacterium tuberculosis and nontuberculous mycobacterial isolates among patients with recent HIV infection in Mozambique

OBJETIVO: A micobacteriose é frequentemente diagnosticada entre pacientes infectados pelo HIV. Em Moçambique, onde apenas um pequeno número de pacientes encontra-se sob tratamento anti-retroviral, e a tuberculose tem alta prevalência, existe a necessidade de melhor caracterização destes agentes bacterianos, em nível de espécie, bem como de se caracterizar os padrões de resistência às drogas antituberculosas. MÉTODOS: Em uma coorte de 503 indivíduos HIV positivos suspeitos de tuberculose pulmonar, 320 apresentaram positividade para baciloscopia ou cultura no escarro e no lavado brônquico. RESULTADOS: Bacilos álcool-ácido resistentes foram detectados no escarro em 73% dos casos com cultura positiva. De 277 isolados em cultura, apenas 3 mostraram-se tratar de micobactérias não-tuberculosas: 2 Mycobacterium avium e uma M. simiae. Todos os isolados de M. tuberculosis inicialmente caracterizados através de reação em cadeia de polimerase (RCP) do gene hsp65 foram posteriormente caracterizados como tal através de RCP do gene gyrB. Resistência à isoniazida foi encontrada em 14% dos casos; à rifampicina em 6%; e multirresistência em 5%. Pacientes previamente tratados para tuberculose mostraram tendência a taxas maiores de resistência às drogas de primeira linha. O padrão radiológico mais freqüente encontrado foi o infiltrado intersticial (67%), seguido da presença de linfonodos mediastinais (30%), bronquiectasias (28%), padrão miliar (18%) e cavidades (12%). Os pacientes infectados por micobactérias não-tuberculosas não apresentaram manifestações clínicas distintas das apresentadas pelos outros pacientes. A mediana de linfócitos CD4 entre todos os pacientes foi de 134 células/mm³. CONCLUSÕES: Tuberculose e AIDS em Moçambique estão fortemente associadas, como é de se esperar em países com alta prevalência de tuberculose. Embora as taxas de resistência a drogas sejam altas, o esquema isoniazida-rifampicina continua sendo a escolha apropriada para o início do tratamento.<br>OBJECTIVE: Mycobacteriosis is frequently diagnosed among HIV-infected patients. In Mozambique, where few patients are under antiretroviral therapy and the prevalence of tuberculosis is high, there is need for better characterization of mycobacteria at the species level, as well as for the identification of patterns of resistance to antituberculous drugs. METHODS: We studied a sample of 503 HIV-infected individuals suspected of having pulmonary tuberculosis. Of those 503, 320 tested positive for mycobacteria through sputum smear microscopy or culture of bronchoalveolar lavage fluid. RESULTS: Acid-fast bacilli were observed in the sputum of 73% of the individuals presenting positive cultures. Of 277 isolates tested, only 3 were nontuberculous mycobacteria: 2 were identified as Mycobacterium avium and one was identified as M. simiae. Strains initially characterized as M. tuberculosis complex through polymerase chain reaction restriction analysis (PRA) of the hsp65 gene were later confirmed as such through PRA of the gyrB gene. Among the M. tuberculosis isolates, resistance patterns were as follows: to isoniazid, 14%; to rifampin, 6%; and multidrug resistance, 5%. Previously treated cases showed significantly higher rates of resistance to first-line antituberculous drugs. The most common radiological pattern was interstitial infiltrate (in 67%), followed by mediastinal lymph node enlargement (in 30%), bronchiectasis (in 28%), miliary nodules (in 18%) and cavitation (in 12%). Patients infected with nontuberculous mycobacteria presented clinical profiles indistinguishable from those of other patients. The median CD4 lymphocyte count in this group was 134 cells/mm³. CONCLUSIONS: There is a strong association between tuberculosis and AIDS in Mozambique, as expected in a country with a high prevalence of tuberculosis. Although drug resistance rates are high, the isoniazid-rifampin regimen continues to be the appropriate choice for initial therapy