The Poor Survival among Pulmonary Tuberculosis Patients in Chiapas, Mexico: The Case of Los Altos Region

Objective. To analyse survival in patients with pulmonary tuberculosis (PTB) and factors associated with such survival. Design. Study of a cohort of patients aged over 14 years diagnosed with PTB from January 1, 1998 to July 31, 2005. During 2004–2006 a home visit was made to each patient and, during 2008-2009, they were visited again. During these visits a follow-up interview was administered; when the patient had died, a verbal autopsy was conducted with family members. Statistical analysis consisted of survival tests, Kaplan-Meier log-rank test and Cox regression. Results. Of 305 studied patients, 68 had died due to PTB by the time of the first evaluation, 237 were followed-up for a second evaluation, and 10 of them had died of PTB. According to the Cox regression, age (over 45 years) and treatment duration (under six months) were associated with a poorer survival. When treatment duration was excluded, the association between poorer survival with age persisted, whereas with having been treated via DOTS strategy, was barely significant. Conclusions. In the studied area it is necessary that patients receive a complete treatment scheme, and to give priority to patients aged over 45 years

Epidemiología i assistència primària

Amb aquest article pretenem presentar, de forma resumida, els elements més rellevants de la sessió dedicada per la Societat a la relació entre l'Epidemiologia i l'Assistència Primària. Hem refusat d'intentar una transcripciò cronològica per tal d'aconseguiruna síntesis més útil. Així després d'una consideració preliminar sobre què és. d'una banda l'Epidemiologiai, de l'altra, L'assistència Primària, passarem a tractar els aspectes de l'organització de la tasca epidemiològica en el context del primer esglaó dels serveis sanitari

Impact of Community-Based Larviciding on the Prevalence of Malaria Infection in Dar es Salaam, Tanzania.

The use of larval source management is not prioritized by contemporary malaria control programs in sub-Saharan Africa despite historical success. Larviciding, in particular, could be effective in urban areas where transmission is focal and accessibility to Anopheles breeding habitats is generally easier than in rural settings. The objective of this study is to assess the effectiveness of a community-based microbial larviciding intervention to reduce the prevalence of malaria infection in Dar es Salaam, United Republic of Tanzania. Larviciding was implemented in 3 out of 15 targeted wards of Dar es Salaam in 2006 after two years of baseline data collection. This intervention was subsequently scaled up to 9 wards a year later, and to all 15 targeted wards in 2008. Continuous randomized cluster sampling of malaria prevalence and socio-demographic characteristics was carried out during 6 survey rounds (2004-2008), which included both cross-sectional and longitudinal data (N = 64,537). Bayesian random effects logistic regression models were used to quantify the effect of the intervention on malaria prevalence at the individual level. Effect size estimates suggest a significant protective effect of the larviciding intervention. After adjustment for confounders, the odds of individuals living in areas treated with larviciding being infected with malaria were 21% lower (Odds Ratio = 0.79; 95% Credible Intervals: 0.66-0.93) than those who lived in areas not treated. The larviciding intervention was most effective during dry seasons and had synergistic effects with other protective measures such as use of insecticide-treated bed nets and house proofing (i.e., complete ceiling or window screens). A large-scale community-based larviciding intervention significantly reduced the prevalence of malaria infection in urban Dar es Salaam

Roles for Treg expansion and HMGB1 signaling through the TLR1-2-6 axis in determining the magnitude of the antigen-specific immune response to MVA85A

© 2013 Matsumiya et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are creditedA better understanding of the relationships between vaccine, immunogenicity and protection from disease would greatly facilitate vaccine development. Modified vaccinia virus Ankara expressing antigen 85A (MVA85A) is a novel tuberculosis vaccine candidate designed to enhance responses induced by BCG. Antigen-specific interferon-γ (IFN-γ) production is greatly enhanced by MVA85A, however the variability between healthy individuals is extensive. In this study we have sought to characterize the early changes in gene expression in humans following vaccination with MVA85A and relate these to long-term immunogenicity. Two days post-vaccination, MVA85A induces a strong interferon and inflammatory response. Separating volunteers into high and low responders on the basis of T cell responses to 85A peptides measured during the trial, an expansion of circulating CD4+ CD25+ Foxp3+ cells is seen in low but not high responders. Additionally, high levels of Toll-like Receptor (TLR) 1 on day of vaccination are associated with an increased response to antigen 85A. In a classification model, combined expression levels of TLR1, TICAM2 and CD14 on day of vaccination and CTLA4 and IL2Rα two days post-vaccination can classify high and low responders with over 80% accuracy. Furthermore, administering MVA85A in mice with anti-TLR2 antibodies may abrogate high responses, and neutralising antibodies to TLRs 1, 2 or 6 or HMGB1 decrease CXCL2 production during in vitro stimulation with MVA85A. HMGB1 is released into the supernatant following atimulation with MVA85A and we propose this signal may be the trigger activating the TLR pathway. This study suggests an important role for an endogenous ligand in innate sensing of MVA and demonstrates the importance of pattern recognition receptors and regulatory T cell responses in determining the magnitude of the antigen specific immune response to vaccination with MVA85A in humans.This work was funded by the Wellcome Trust. MM has a Wellcome Trust PhD studentship and HM is a Wellcome Trust Senior Fello

Comportamiento productivo inicial del mangostán (Garcinia mangostana L.) en el Soconusco, Chiapas, México

Objective: To evaluate the initial productive behavior of mangosteen plantation in order to have reference elements on the productivity of this fruit tree in the region of Soconusco, Chiapas. Design/ Methodology: Mangosteen plantation was established during the year 2010 in the experimental station Rosario Izapa, Tuxtla Chico, Chiapas. From the beginning of the production stage and during four production cycles corresponding to the years 2015, 2016, 2017 and 2018, production was quantified as the individual production of each of the 196 trees that make up the plantation. The start date of the flowering, beginning and end of the harvest, number of fruits / tree and weight of fruits / tree and yield were recorded. The analysis of variance was performed for the variables fruit / tree and fruit / tree weight, by means of an experimental design of blocks of chance with three repetitions. Results: The plantation began its productive stage at five years and six months of age. Flowering occurs during the January-February period. The harvest begins in the months of May-June and ends in the month of September. The highest volume of production is obtained during the month of August. At the first harvest a yield of 26.3 kg/ ha was obtained and an average of 11 fruits / tree that increases 1.6 ton / ha per year of establishment, with an average of 146 fruits / tree. Predominated the fruits whose weight range is 60 to 80 grams. Limitations of the study/Implications: It is necessary to carry on the evaluation in subsequent years. Findings/Conclusions: It is concluded that the mangosteen represents a viable alternative to diversify fruit growing in the region of Soconusco, Chiapas.Objetivo: Evaluar el comportamiento productivo inicial del mangostán Garcinia mangostana L., para disponer de elementos de referencia sobre la productividad de dicho frutal en la Región del Soconusco, Chiapas. Diseño/metodología: La plantación de mangostán se estableció en el año 2010 en el Campo Experimental Rosario Izapa, Tuxtla Chico, Chiapas. Desde el inicio de la etapa productiva y durante cuatro ciclos de producción correspondientes a los años 2015, 2016, 2017 y 2018, se registró la fecha de inicio de floración, inicio y término de cosecha, número de frutos árbol-1, peso de los frutos árbol-1 y rendimiento de cada uno de los 196 árboles que conforman la plantación. Se realizó el análisis de varianza para la variable frutos árbol-1 mediante un diseño experimental de bloques al azar con tres repeticiones. Resultados: La plantación inició su etapa productiva a los 5.5 años de edad. La cosecha inicia en mayo-junio y concluye en septiembre. El mayor volumen de producción se obtiene durante agosto. A la primera cosecha el rendimiento fue de 26.3 kg ha-1 con promedio de 11 frutos árbol-1 que se incrementa a 1.6 ton ha-1 al año 8 del establecimiento de la plantación, con un promedio de 146 frutos árbol-1. Predominaron frutos con rango de peso de 60 a 80 g. Limitaciones del estudio/implicaciones: Es necesario continuar con la evaluación en años subsiguientes. Hallazgos/conclusiones: El mangostán representa una alternativa productiva viable para diversificar la fruticultura en la región del Soconusco, Chiapas

Parkinsonism caused by adverse drug reactions: a case series

<p>Abstract</p> <p>Introduction</p> <p>Parkinsonism puts a high direct cost burden on both patient and caregiver. Several reports of drug-induced parkinsonism have been published, but to the best of our knowledge, there has not been any report of quinine or halothane inducing parkinsonism.</p> <p>Case presentation</p> <p>We describe two cases of parkinsonism possibly caused by adverse drug reaction to quinine in a 29-year-old black Nigerian woman and to halothane in a 36-year-old black Hausa (Nigerian) man who received it as general anaesthesia for appendicectomy in our teaching hospital.</p> <p>Conclusion</p> <p>These are two unusual cases of parkinsonism caused by adverse drug reactions to high-dose quinine and to halothane as general anaesthesia. We consider that these two cases are important in bringing this potential side-effect to the attention of both pharmacologists and primary care physicians as these are two of the most commonly used medications in our clinics. We conclude that parkinsonism should be included among the adverse drug reactions to high-dose quinine and halothane general anaesthetic.</p

A detailed clinical and molecular survey of subjects with nonsyndromic USH2A retinopathy reveals an allelic hierarchy of disease-causing variants.

Defects in USH2A cause both isolated retinal disease and Usher syndrome (ie, retinal disease and deafness). To gain insights into isolated/nonsyndromic USH2A retinopathy, we screened USH2A in 186 probands with recessive retinal disease and no hearing complaint in childhood (discovery cohort) and in 84 probands with recessive retinal disease (replication cohort). Detailed phenotyping, including retinal imaging and audiological assessment, was performed in individuals with two likely disease-causing USH2A variants. Further genetic testing, including screening for a deep-intronic disease-causing variant and large deletions/duplications, was performed in those with one likely disease-causing change. Overall, 23 of 186 probands (discovery cohort) were found to harbour two likely disease-causing variants in USH2A. Some of these variants were predominantly associated with nonsyndromic retinal degeneration ('retinal disease-specific'); these included the common c.2276 G>T, p.(Cys759Phe) mutation and five additional variants: c.2802 T>G, p.(Cys934Trp); c.10073 G>A, p.(Cys3358Tyr); c.11156 G>A, p.(Arg3719His); c.12295-3 T>A; and c.12575 G>A, p.(Arg4192His). An allelic hierarchy was observed in the discovery cohort and confirmed in the replication cohort. In nonsyndromic USH2A disease, retinopathy was consistent with retinitis pigmentosa and the audiological phenotype was variable. USH2A retinopathy is a common cause of nonsyndromic recessive retinal degeneration and has a different mutational spectrum to that observed in Usher syndrome. The following model is proposed: the presence of at least one 'retinal disease-specific' USH2A allele in a patient with USH2A-related disease results in the preservation of normal hearing. Careful genotype-phenotype studies such as this will become increasingly important, especially now that high-throughput sequencing is widely used in the clinical setting.European Journal of Human Genetics advance online publication, 4 February 2015; doi:10.1038/ejhg.2014.283

Composición nutricional en hojas de 20 genotipos de Moringa oleifera Lam

Objective: Determine the nutritional composition of fresh and dehydrated leaves of 20 Moringa oleifera Lam genotypes. Design/morphology/approach: The vegetative material was obtained from three-year-old trees of 20 genotypes of Moringa oleifera, stablished in the Experimental station Rosario Izapa of INIFAP. For the proximal analysis, the standardized methods recommended by national and international standards were used. Results: The highest nutrient content was found in the dehydrated leaves, in which high average contents of crude protein were found (26.9 g/100g); calcium (2560.8 mg/100g); iron (12.5 mg/100g) and potassium (1976 mg/100g), as well as acceptable average crude fiber contents (9.5 g/ 100/g); fat (5.7 g/100g); carbohydrates (42.9 g/100g); energy value (330.4 kcal/ 100g); zinc (4.9 mg/100g); sodium (95.1 mg/100g); magnesium (408.3 mg/100g) and phosphorus (271.6 mg/100g). The highest contents of crude protein, zinc, potassium and phosphorus, iron and calcium were registered in the genotypes RIMOR10 and RIMOR 6. Limitations on the study /implications:&nbsp; It is necessary to verify the nutritional content of moringa leaves in other environmental conditions different from the study area. Findings/conclusions: Dehydrated moringa leaves have a high content of crude protein, iron, calcium and potassium, as well as acceptable contents of crude fiber, fat, carbohydrates, energy value, zinc, sodium, magnesium and phosphorus, higher than other foods, so that its consumption is considered a viable alternative to complement the traditional diet to reduce the problem of malnutrition in Mexico.Objetivo: Determinar la composición nutricional de hojas frescas y deshidratadas de 20 genotipos de Moringa Moringa oleifera Lam. Diseño/metodología/: El material vegetal se obtuvo de árboles de tres años de edad de 20 genotipos de Moringa oleifera, establecidos en el Campo Experimental Rosario Izapa del INIFAP. Para el análisis proximal se utilizaron los métodos estandarizados y recomendados por las normas nacionales e internacionales. Resultados: El mayor contenido de nutrientes se encontró en las hojas deshidratadas, con contenidos promedio altos de proteína cruda (26.9 g/100/g); calcio (2560.8 mg/100g); hierro (12.5 mg/100g) y potasio (1976 mg/100g), así como contenidos promedio aceptables de fibra cruda (9.5 g/100/g); grasa (5.7 g/100g); carbohidratos (42.9 g/100/g); valor energético (330.4 Kcal/100g); zinc (4.9 mg/100g); sodio (95.1 mg/100g); magnesio (408.3 mg/100g) y fósforo (271.6 mg/100g). Los mayores contenidos de proteína cruda, zinc, potasio y fósforo, hierro y calcio se registraron en los genotipos RIMOR 10 y RIMOR 6. Limitaciones del estudio/implicaciones: Se considera necesario verificar el contenido nutricional de hojas de moringa, en otras condiciones de ambiente diferentes a las del área de estudio. Hallazgos/conclusiones: Las hojas deshidratadas de moringa poseen un alto contenido de proteína cruda, hierro, calcio y potasio, así como contenidos aceptables de fibra cruda, grasa, carbohidratos, valor energético, zinc, sodio, magnesio y fósforo, superior al de otros alimentos, por lo que su consumo se considera una alternativa viable como complemento de la dieta tradicional para reducir el problema de desnutrición en México

Caracterización morfoagronómica de coyol (Acrocomia aculeata Jacq.) para determinar su potencial productivo de aceite para biodiesel

Objective: To characterize morphologically natural populations of Acrocomia aculeata to determine the potential production of oil for biodiesel. Design/morphology/approach: Eight natural populations of the species were selected in the states of Chiapas and Oaxaca. As descriptors 25 quantitative and qualitative characters were selected. The analysis of the main components and hierarchical conglomerates was performed with the PRINCOMP and PROC CLUSTER procedures of SAS, respectively. The dendrogram of groups of populations with morphological similarities was generated. Results: The first three main components explain 69.4% of the total morphological variation. CP1 explained 29.6% of the total variation with the characters stem diameter, mesocarp thickness, seed length, seed width, seed length-width ratio, seed thickness and seed weight. CP2 explained 26.1% of the variation, with the characters fruit width, fruit length, mesocarp color, and oil content in the mesocarp. CP3 explained 13.7% of the variation with the length of the rachis, epicarp color and endocarp color. The eight populations were integrated into five morphologically distinct groups. Limitations on the study/implications: It is necessary to expand the number of populations for greater precision on the diversity of the species in Mexico. Findings/conclusions: A wide genetic diversity of A. culeata was found. The variables that mostly explain this diversity correspond to the fruit and seed. The species represents a viable alternative for obtaining inputs for the production of biodiesel in Mexico.Objetivo: Caracterizar morfológicamente poblaciones naturales de Acrocomia aculeata para determinar su potencial para la producción de aceite para biodiesel. Diseño/metodología/aproximación: Se seleccionaron ocho poblaciones naturales de la especie en los estados de Chiapas y Oaxaca. Como descriptores se seleccionaron 25 caracteres cuantitativos y cualitativos. El análisis de componentes principales y conglomerados jerárquico se realizó con los procedimientos PRINCOMP y PROC CLUSTER de SAS, respectivamente. Se generó el dendograma de grupos de poblaciones con similitudes morfológicas. Resultados: Los tres primeros componentes principales explican el 69.4% de la variación morfológica total. El CP1 explicó el 29.6% de la variación total con los caracteres diámetro del tallo, grosor del mesocarpio, longitud de semilla, ancho de semilla, relación longitud-ancho de semilla, grosor de la semilla y peso de semilla. El CP2 explicó el 26.1% de la variación, con los caracteres ancho del fruto, largo del fruto, color del mesocarpio y contenido de aceite en el mesocarpio. El CP3 explicó el 13.7% de la variación con los caracteres longitud de raquis, color de epicarpio y color de endocarpio. Las ocho poblaciones se integraron en cinco grupos morfológicamente distintos. Limitaciones del estudio/implicaciones: Es necesario ampliar el número de poblaciones para una mayor precisión sobre la diversidad de la especie en México. Hallazgos/conclusiones: Se encontró una amplia diversidad genética en A. aculeata. Las variables que mayormente explican dicha diversidad corresponden al fruto y semilla. La especie representa una opción viable para la obtención de aceite para la producción de biodiesel en México