Environmental determinants of total IgE among school children living in the rural Tropics: importance of geohelminth infections and effect of anthelmintic treatment

BACKGROUND: The environmental factors that determine the elevated levels of polyclonal IgE observed in populations living in the Tropics are poorly understood but may include geohelminth infections. We investigated the association between geohelminth infections and total IgE levels in school children in rural tropical Ecuador, and assessed the effect on IgE of repeated anthelmintic treatments over a period of 12 months. The study was nested within a cluster-randomized study that randomized 68 schools to receive either 400 mg of albendazole every 2 months over a year or no treatment. We studied random samples of children completing follow-up and representing four groups stratified by the presence of geohelminth infection at baseline and treatment allocation. We measured levels of total IgE and anti-A. lumbricoides IgG (used as a measure of past and current geohelminth infectious exposure) in blood samples collected at the start of the study and after 12 months. RESULTS: We observed elevated levels of total IgE (compared to standard reference values) at the start of the study in this population of school children (geometric mean, 1,004 IU/mL, range 12 to 22,608 IU/mL)) and baseline IgE levels were strongly associated with parameters of geohelminth infection but not with age, nutritional and socioeconomic status. After 12 months, levels of IgE fell significantly in the treatment (by 35.1%) and no treatment (by 10.4%) groups, respectively, but the fall was significantly greater in the treatment group. Falls in IgE were independently associated with albendazole treatment, having a baseline geohelminth infection and with high baseline levels of anti-A. lumbricoides IgG. Increases in IgE at 12 months were associated with the presence of geohelminth infections and increasing levels of anti-A. lumbricoides IgG at 12 months independent of treatment allocation. CONCLUSION: The data provide evidence that geohelminth infections are an important determinant of total IgE in school children in the rural Tropics and that periodic anthelmintic treatments over 12 months are associated with reductions in IgE. The failure of anthelmintic treatment to reduce IgE levels to that considered normal in industrialized countries may be attributed to continued exposure of children to geohelminths or to the effects of infections in early life in programming a long-lasting Th2-biassed immunity

A Single Dose of Oral BCG Moreau Fails to Boost Systemic IFN-γ Responses to Tuberculin in Children in the Rural Tropics: Evidence for a Barrier to Mucosal Immunization

Immune responses to oral vaccines are impaired in populations living in conditions of poverty in developing countries, and there is evidence that concurrent geohelminth infections may contribute to this effect. We vaccinated 48 children living in rural communities in Ecuador with a single oral dose of 100 mg of BCG Moreau RDJ and measured the frequencies of tuberculin-stimulated peripheral blood mononuclear cells expressing IFN-γ before and after vaccination. Vaccinated children had active ascariasis (n = 20) or had been infected but received short- (n = 13) or long-term (n = 15) repeated treatments with albendazole prior to vaccination to treat ascariasis. All children had a BCG scar from neonatal vaccination. There was no evidence of a boosting of postvaccination IFN-γ responses in any of the 3 study groups. Our data provide support for the presence of a barrier to oral vaccination among children from the rural tropics that appeared to be independent of concurrent ascariasis

Risk factors for atopic and non-atopic asthma in a rural area of Ecuador

Background: Asthma has emerged as an important public health problem of urban populations in Latin America. Epidemiological data suggest that a minority of asthma cases in Latin America may be associated with allergic sensitisation and that other mechanisms causing asthma have been overlooked. The aim of the present study was to investigate risk factors for atopic and non-atopic asthma in school-age children. Methods: A cross-sectional study was conducted among 3960 children aged 6–16 years living in Afro-Ecuadorian rural communities in Esmeraldas province in Ecuador. Allergic diseases and risk factors were assessed by questionnaire and allergic sensitisation by allergen skin prick reactivity. Results: A total of 390 (10.5%) children had wheeze within the previous 12 months, of whom 14.4% had at least one positive skin test. The population-attributable fraction for recent wheeze associated with atopy was 2.4%. Heavy Trichuris trichiura infections were strongly inversely associated with atopic wheeze. Non-atopic wheeze was positively associated with maternal allergic symptoms and sedentarism (watching television (>3 h/day)) but inversely associated with age and birth order. Conclusions: The present study showed a predominance of non-atopic compared with atopic wheeze among schoolchildren living in a poor rural region of tropical Latin America. Distinct risk factors were associated with the two wheeze phenotypes and may indicate different causal mechanisms. Future preventive strategies in such populations may need to be targeted at the causes of non-atopic wheeze

Impact of Long-Term Treatment with Ivermectin on the Prevalence and Intensity of Soil-Transmitted Helminth Infections

Soil-transmitted helminth (intestinal worm) infections are very common in developing countries and are an important cause of illness. Mass de-worming treatments of school children are an important strategy to reduce illness caused by these infections in communities without access to clean water and sanitation. Few studies have examined the effect of repeated mass treatments in the long-term in controlling these infections. The objective of the present study was to assess the impact of the drug ivermectin used for the control of onchocerciasis (river blindness), that has important effects against intestinal worms, on the epidemiology of intestinal worms in children when administered repeatedly for 15–17 years. We compared the epidemiology of infections between children living in communities that received ivermectin with communities that never received the drug. The data suggest that ivermectin has important differential effects on intestinal worms with a greater impact on infections with Trichuris trichiura and little impact on Ascaris lumbricoides and hookworms infections. Our data suggest that long-term ivermectin treatments may provide health benefits through effects on T. trichiura infections but that the addition of second de-worming drug such as albendazole may be required for the control of other intestinal worm infections

Estimating adjusted prevalence ratio in clustered cross-sectional epidemiological data

BACKGROUND: Many epidemiologic studies report the odds ratio as a measure of association for cross-sectional studies with common outcomes. In such cases, the prevalence ratios may not be inferred from the estimated odds ratios. This paper overviews the most commonly used procedures to obtain adjusted prevalence ratios and extends the discussion to the analysis of clustered cross-sectional studies. METHODS: Prevalence ratios(PR) were estimated using logistic models with random effects. Their 95% confidence intervals were obtained using delta method and clustered bootstrap. The performance of these approaches was evaluated through simulation studies. Using data from two studies with health-related outcomes in children, we discuss the interpretation of the measures of association and their implications. RESULTS: The results from data analysis highlighted major differences between estimated OR and PR. Results from simulation studies indicate an improved performance of delta method compared to bootstrap when there are small number of clusters. CONCLUSION: We recommend the use of logistic model with random effects for analysis of clustered data. The choice of method to estimate confidence intervals for PR (delta or bootstrap method) should be based on study design

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Plan de fortalecimiento de una empresa de base tecnológica tipo startup de servicios integrales a domicilio en la ciudad de Cali

Breve soluciones urbanas, nace en busca de ofrecer soluciones enfocadas a quienes hoy en día cuentan con poco tiempo libre, haciendo por ellos todas esas diligencias para las que no les alcanza el día. Así como también poder trabajar de la mano con los establecimientos comerciales que no cuentan con el servicio fijo de mensajería, conectándolos con sus clientes, llevando el producto hasta su casa, para aumentar el número de ventas exitosas. En el documento se planteará la idea como negocio productivo, teniendo en cuenta las nuevas tendencias del mercado, evaluando el entorno interno y externo que pueda influir ya sea de manera positiva o negativamente en esta empresa. Diseñando un plan de fortalecimiento el cual permita alcanzar un posicionamiento en el sector de servicios integrales, analizando el perfil del consumidor y la importancia de implementar una estructura organizacional, para así lograr estar al nivel de empresas que prestan actualmente servicios similares, hasta lograr ser un emprendimiento de base tecnológica tipo “Startup” en la ciudad de Cali.Breve soluciones urbanas, was born in search of offering focused solutions to those who today have little free time, doing all those errands for which the day is not enough. As well as being able to work hand in hand with commercial establishments that do not have a fixed messaging service connecting them with their customers, taking the product to their home, to increase the number of successful sales. The document will propose the idea as a productive business, taking into account new market trends, evaluating the internal and external environment that may influence this company either positively or negatively. Designing a strengthening plan which allows to achieve a position in the comprehensive services sector, analyzing the consumer profile and the importance of implementing an organizational structure, in order to be at the level of companies that currently provide similar services, until becoming a technology-based entrepreneurship type "Startup" in the city of Cali.Introducción -- Generalidades -- Planteamiento del problema -- Justificación del proyecto -- Objetivos -- Objetivo general -- Objetivos específicos -- Marcos de referencia -- Marco conceptual -- Marco teórico -- Emprendimientos de base tecnológica -- Aplicaciones móviles (App) -- Startup -- Digitalización -- Marco regulatorio -- Metodología -- Paso 1: Preparación del equipo de investigación -- Especifico 1 -- Actividades -- Especifico 2 -- Actividades -- Especifico 3 -- Actividades -- Paso 2: Diseño de las entrevistas -- Paso 3: Aplicación de las encuestas -- Paso 4: Resultados -- Paso 5: Diseño del plan de acción -- Instrumento de medición -- Cronograma del trabajo de grado -- Capítulo 1: Caracterizar las empresas de base tecnológica en el Valle del Cauca: caso de estudio de la empresa Breve Soluciones Urbanas -- Análisis del mercado -- Análisis del sector -- Estructura del mercado -- Análisis de demanda -- Análisis de la oferta -- Caso de estudio de la empresa Breve Soluciones Urbanas -- Definición de la empresa -- Misión y visión -- Objetivos y metas de la empresa -- Características del servicio -- Descripción de los servicios básicos -- Estructura organizacional -- Proceso productivo -- Capítulo 2: Analizar el perfil del consumidor a través de un estudio de mercado -- Segmentación del mercado -- Impacto del producto o servicio en el cliente -- Investigación y desarrollo del producto o servicio -- Capítulo 3: Proponer estrategias que para encaminar al fortalecimiento del diseño tipo startup de la empresa -- Conclusiones -- Referencias -- Índice de tablas -- Índice de [email protected]@[email protected]

Alteraciones de la tirotropina en niños menores a cinco años con desnutrición crónica y su asociación con el desarrollo neuro-psicomotor

Introducción: La desnutrición tiene una mortalidad del 45% en pre-escolares y predomina en zonas rurales. La carencia de yodo puede llevar al hipotiroidismo, manifestado por elevación de TSH y puede asociarse con retardo del desarrollo neuro psico-motor (DNPM). El objetivo del estudio fue determinar la prevalencia de alteraciones de TSH en niños con desnutrición crónica y su asociación con alteración del DNPM en población indígena menor de 5 años. Métodos: El presente estudio transversal analiza la base los datos del Proyecto “Wawapak-kausay” de población indígena infantil en cuatro cantones de la provincia de Chimborazo-Ecuador durante el periodo 2018 – 2019. Se efectuó un análisis univariado con cálculo de frecuencia, porcentajes; un análisis bivariado con reporte OR e IC 95%, considerando significativo P<0.05. Resultados: Fueron 350 casos con desnutrición crónica, 50.6% fueron hombres, del quartil más bajo del ingreso económico (32%), del cantón Riobamba (44%). El 88.6% reportó TSH normal, el 10.8% TSH alta y el 0.6% TSH baja. El abastecimiento irregular de agua y alteración de TSH fue estadísticamente significativa (P<0.01). A 82 niños se les aplicó el test de Denver II, 70.7% presentaron desarrollo normal, 8.5% sospecha de retraso y 20.7% retraso psicomotor, con predominio en área de lenguaje (15.9%), las mujeres fueron más afectadas (P=0.02). Conclusiones: 1 de cada 10 niños con desnutrición crónica obtuvo TSH elevadas. No se encontró una asociación significativa entre valores de TSH alterados y sospecha o retraso del desarrollo psicomotor