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Abstract:  Rubella, measles, and varicella-zoster can produce exanthematous infections in pregnant women, associated to greater risk or complications, including miscarriage, premature labor, neonatal diseases, and low birth-weight, among others. However, these infections are preventable by means of existing safe and effective vaccines. We intended to determine the prevalence of specific antibodies for rubella, measles and varicella-zoster viruses in a population of pregnant women who attended a private medical center in Córdoba city (Argentina). Retrospective observational study of 826 serum samples from pregnant women aged 18-42 years, collected at the Virology Laboratory Clínica Universitaria Reina Fabiola, from January 1 to December 31, 2020. The population was divided into 5 groups according to age (1 group every 5 years). For determination of antibodies, we used automated Elisa assay (bioMérieux) according to the manufacturer´s instructions. Positive values were defined according to the cut-off points established by the manufacturer for each assay: rubella IgG: ≥15 UI/ml, measles IgG index: ≥0.7 and varicella-zoster IgG index: ≥0.90. The proportion of individuals with immunity against the viruses was compared using Chi square test with 95% CI (p<0.05). Detected prevalence values were rubella IgG: 95.52%, measles IgG: 79.97%, and varicella-zoster IgG: 94.39%. When comparing the global prevalence of rubella and varicella-zoster with respect to global prevalence of measles (p <0.0001), we observed a higher prevalence of anti-rubella and anti-varicella-zoster antibodies in pregnant women and a significantly lower prevalence against measles virus (global susceptibility: 20.03%).  For this reason, it would be advisable to perform serological control of rubella, measles and varicella before conception in order to establish a new preventive strategy to reduce the risk of these infections in newborns and pregnant women of our community.Resumen:  Los virus rubéola, varicela-zóster y sarampión en la mujer embarazada pueden provocar infecciones exantemáticas asociadas a un mayor riesgo de complicaciones que incluyen aborto, parto prematuro, enfermedad neonatal, bajo peso al nacer, entre otros. Estos virus son prevenibles, ya que existe una vacuna segura y eficaz para cada caso. Determinar la prevalencia de anticuerpos específicos para virus rubéola, varicela-zóster y sarampión en una población de mujeres embarazadas que concurrieron a un centro medico privado de la ciudad de Córdoba. Estudio retrospectivo observacional de muestras de suero de mujeres embarazadas de 18 a 42 años de edad, recolectadas en el laboratorio de Virologia de la Clinica Universitaria Reina Fabiola,  desde el 1 de enero al 31 de diciembre del 2020 . Se analizaron 826 sueros. Se dividió la población en 5 grupos cada 5 años de edad. Para la determinación de los diferentes anticuerpos, se utilizó un ensayo de ELISA automatizado (bioMerieux) siguiendo las indicaciones del fabricante. Se consideraron valores positivos según los cortes establecidos por el fabricante para cada ensayo: para IgG rubéola ≥ 15 UI/ml, para IgG sarampión índice  ≥ 0.7 y para IgG varicela índice ≥ 0.90. Se comparó la proporción de individuos con inmunidad frente a estos virus utilizando el test de Chi Cuadrado con un 95% de nivel de confianza (p<0,05).  Las prevalencias observadas fueron: para IgG rubeola del 95.52 %, para IgG varicela-zóster del 94.39 % y para IgG sarampión del 79.97. Al comparar las prevalencias globales de los anticuerpos estudiados, se observó diferencia significativa entre las prevalencias globales de rubéola y varicela-zóster con respecto a la prevalencia global de sarampión (p < 0.0001).  Se observó una elevada prevalencia de anticuerpos anti virus rubéola y varicela-zoster en embarazadas, mientras que se encontró una prevalencia significativamente más baja, con una susceptibilidad global del 20,03% frente al virus sarampión. Por lo cual, sería recomendable realizar el control serológico de rubéola, sarampión y varicela en la etapa preconcepcional, con el fin de establecer una nueva estrategia preventiva para reducir el riesgo de estas infecciones en los recién nacidos y en mujeres embarazadas de nuestra comunidad. 

Lower prevalence of drug resistance mutations at first-line virological failure to first-line therapy with atripla vs. tenofovirRemtricitabine/lamivudineRefavirenz administered on a multiple tablet therapy

Fixed-dose combination antiretroviral therapy administered as a single-tablet regimen (STR) may improve virologic suppression rates. The effect of STRs on development of resistance when virologic failure occurs on STRs is not known

Holographic three-point functions of giant gravitons

Working within the AdS/CFT correspondence we calculate the three-point function of two giant gravitons and one pointlike graviton using methods of semiclassical string theory and considering both the case where the giant gravitons wrap an S^3 in S^5 and the case where the giant gravitons wrap an S^3 in AdS_5. We likewise calculate the correlation function in N=4 SYM using two Schur polynomials and a single trace chiral primary. We find that the gauge and string theory results have structural similarities but do not match perfectly, and interpret this in terms of the Schur polynomials' inability to interpolate between dual giant and pointlike gravitons.Comment: 21 page

Clinical and Immunologic Investigations in Patients With Stiff-Person Spectrum Disorder

Importance: Symptoms of stiff-person syndrome (SPS), stiff-limb syndrome (SLS), or progressive encephalomyelitis with rigidity, myoclonus, or other symptoms (SPS-plus) can occur with several autoantibodies, but the relative frequency of each antibody, syndrome specificity, and prognostic implications are unclear. Objective: To report the clinical and immunologic findings of a large cohort of patients with stiff-person spectrum disorder (SPSD), including SPS, SLS, and SPS-plus. Design, Setting, and Patients: This study retrospectively examined a case series (January 1, 1998, through December 31, 2014) of immunologic investigations performed in a neuroimmunology referral center. The study included 121 patients with clinical features of SPSD. Data analysis was performed from July 1, 2015, through November 1, 2015. Main Outcomes and Measures: Analysis of clinical-immunologic associations, including autoantibodies to 8 proteins expressed in inhibitory synapses. Results: The median age of the patients was 51 years (interquartile range, 40-61 years), and 75 (62.0%) were female. Fifty (41.3%) had SPS, 37 (30.6%) had SPS-plus, 24 (19.8%) had SLS, and 10 (8.3%) had SPS or SLS overlapping with ataxia, epilepsy, or encephalitis. Fifty-two patients (43.0%) had glutamic acid decarboxylase (GAD65) antibodies (2 with γ-aminobutyric acid-A [GABA-A] receptor antibodies), 24 (19.8%) had α1-subunit of the glycine receptor (GlyR) antibodies (2 with GAD65 antibodies), 5 (4.1%) had other antibodies, and 40 (33.1%) tested negative for antibodies. None had gephyrin or glycine transporter antibodies. Among the main immunologic groups (GAD65 antibodies, GlyR antibodies, and antibody negative), those with GAD65 antibodies were more likely to be female (45 [86.5%] of 52, 8 [36.4%] of 22, and 18 [45.0%] of 40, respectively; P < .001), have systemic autoimmunity (34 [65.4%] of 52, 7 [31.8%] of 22, and 13 [32.5%] of 40, respectively; P = .004), and have longer delays in being tested for antibodies (median, 3 vs 0.5 and 1 year; P < .001). Patients with GAD65 antibodies were more likely to develop SPS (27 [51.9%] of 52) or overlapping syndromes (8 [15.4%] of 52) than patients with GlyR antibodies (5 [22.7%] and 0 [0%] of 22, respectively), who more often developed SPS-plus (12 [54.5%] of 22 vs 7 [13.5%] in those with GAD65 antibodies); antibody-negative patients had an intermediate syndrome distribution. In multivariable analysis, symptom severity (P = .001) and immunologic group (P = .01) were independently associated with outcome. Compared with patients with GlyR antibodies, those with GAD65 antibodies (odds ratio, 11.1, 95% CI, 2.3-53.7; P = .003) had worse outcome. Patients without antibodies had similar outcome than patients with GlyR antibodies (odds ratio, 4.2, 95% CI, 0.9-20.0; P = .07). Conclusions and Relevance: In SPSD, symptom severity and presence and type of antibodies are predictors of outcome

Clinical and Immunologic Investigations in Patients With Stiff-Person Spectrum Disorder

Importance: Symptoms of stiff-person syndrome (SPS), stiff-limb syndrome (SLS), or progressive encephalomyelitis with rigidity, myoclonus, or other symptoms (SPS-plus) can occur with several autoantibodies, but the relative frequency of each antibody, syndrome specificity, and prognostic implications are unclear. Objective: To report the clinical and immunologic findings of a large cohort of patients with stiff-person spectrum disorder (SPSD), including SPS, SLS, and SPS-plus. Design, Setting, and Patients: This study retrospectively examined a case series (January 1, 1998, through December 31, 2014) of immunologic investigations performed in a neuroimmunology referral center. The study included 121 patients with clinical features of SPSD. Data analysis was performed from July 1, 2015, through November 1, 2015. Main Outcomes and Measures: Analysis of clinical-immunologic associations, including autoantibodies to 8 proteins expressed in inhibitory synapses. Results: The median age of the patients was 51 years (interquartile range, 40-61 years), and 75 (62.0%) were female. Fifty (41.3%) had SPS, 37 (30.6%) had SPS-plus, 24 (19.8%) had SLS, and 10 (8.3%) had SPS or SLS overlapping with ataxia, epilepsy, or encephalitis. Fifty-two patients (43.0%) had glutamic acid decarboxylase (GAD65) antibodies (2 with γ-aminobutyric acid-A [GABA-A] receptor antibodies), 24 (19.8%) had α1-subunit of the glycine receptor (GlyR) antibodies (2 with GAD65 antibodies), 5 (4.1%) had other antibodies, and 40 (33.1%) tested negative for antibodies. None had gephyrin or glycine transporter antibodies. Among the main immunologic groups (GAD65 antibodies, GlyR antibodies, and antibody negative), those with GAD65 antibodies were more likely to be female (45 [86.5%] of 52, 8 [36.4%] of 22, and 18 [45.0%] of 40, respectively; P < .001), have systemic autoimmunity (34 [65.4%] of 52, 7 [31.8%] of 22, and 13 [32.5%] of 40, respectively; P = .004), and have longer delays in being tested for antibodies (median, 3 vs 0.5 and 1 year; P < .001). Patients with GAD65 antibodies were more likely to develop SPS (27 [51.9%] of 52) or overlapping syndromes (8 [15.4%] of 52) than patients with GlyR antibodies (5 [22.7%] and 0 [0%] of 22, respectively), who more often developed SPS-plus (12 [54.5%] of 22 vs 7 [13.5%] in those with GAD65 antibodies); antibody-negative patients had an intermediate syndrome distribution. In multivariable analysis, symptom severity (P = .001) and immunologic group (P = .01) were independently associated with outcome. Compared with patients with GlyR antibodies, those with GAD65 antibodies (odds ratio, 11.1, 95% CI, 2.3-53.7; P = .003) had worse outcome. Patients without antibodies had similar outcome than patients with GlyR antibodies (odds ratio, 4.2, 95% CI, 0.9-20.0; P = .07). Conclusions and Relevance: In SPSD, symptom severity and presence and type of antibodies are predictors of outcome

Simpson's Paradox, Lord's Paradox, and Suppression Effects are the same phenomenon – the reversal paradox

This article discusses three statistical paradoxes that pervade epidemiological research: Simpson's paradox, Lord's paradox, and suppression. These paradoxes have important implications for the interpretation of evidence from observational studies. This article uses hypothetical scenarios to illustrate how the three paradoxes are different manifestations of one phenomenon – the reversal paradox – depending on whether the outcome and explanatory variables are categorical, continuous or a combination of both; this renders the issues and remedies for any one to be similar for all three. Although the three statistical paradoxes occur in different types of variables, they share the same characteristic: the association between two variables can be reversed, diminished, or enhanced when another variable is statistically controlled for. Understanding the concepts and theory behind these paradoxes provides insights into some controversial or contradictory research findings. These paradoxes show that prior knowledge and underlying causal theory play an important role in the statistical modelling of epidemiological data, where incorrect use of statistical models might produce consistent, replicable, yet erroneous results