Optimización de una metodología para el aislamiento y detección molecular de huevos de Toxocara canis en muestras de suelo

Toxocariasis is a common  zoonosis  in developing countries, such  as Colombia. Accidental ingestion  of Toxocara sp. eggs represents the principal  form of transmission in humans. Therefore, monitoring of environmental contamination is the better strategy for preventing the toxocariasis. The objective  was to optimize a methodology for assessing soil contamination caused by Toxocara canis eggs. The soil samples  were collected  from a public  park in the city of Barranquilla (Colombia). The Toxocara eggs were isolated by centrifugation/flocculation with MgSO4  (r = 1.20),  ZnSO4 (r= 1.18),  NaCl  (r= 1.18)  and Sheather  solution  (r= 1.27).  The parasite  DNA was extracted  and T. canis and subsequent nucleotide sequencing. ANOVA analysis indicates a statistically significant difference (p<0,05) between the DNA concentration obtained with the flocculation used to isolate eggs. The PCR-ITS-2 analysis  showed  positive  results for T. canis in 7 out of 13 samples examined (53.84 %). In conclusion, it is s   T. canisLa toxocariasis es una zoonosis  común  en países  en desarrollo, como  Colombia. La ingesta accidental de huevos de Toxocara sp representa la principal  vía de transmisión al humano, por tanto, la vigilancia de la contaminación ambiental es una de las principales estrategias en la prevención de la toxocariasis. El objetivo fue optimizar una metodología para evaluar la contaminación del suelo por huevos de Toxocara canis. Las muestras de suelo se colectaron en un parque público en la ciudad de con MgSO4 (r=1,20),  ZnSO4 (r=1,18),  NaCl (r=1,18)  y solución  de Sheather  (r=1,27).  El ADN del parasito se extrajo y se identifico mediante amplificacion de del ITS-2-ADNr (PCR-ITS-2) del T. canis y posterior  secuenciación de nucleótidos. El análisis  ANOVA  indicó  diferencia estadísticamente significativa (p<0,05) entre las concentraciones de ADN obtenidos con las soluciones de floculacion utilizadas para aislar los huevos. El analisis de PCR-ITS-2 mostro resultado positivo para T.canis en 7 de 13 muestras examinadas (53,84%). En conclusión, se demuestra que el método propuestoes eficiente para la deteccion T. canis en muestras de campo

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Optimization a Methodology for the Isolation and the Molecular Detection of Toxocara Canis Eggs in Soil Samples.

La toxocariasis es una zoonosis común en países en desarrollo, como Colombia. La ingesta accidental de huevos de Toxocara sp representa la principal vía de transmisión al humano, por tanto, la vigilancia de la contaminación ambiental es una de las principales estrategias en la prevención de la toxocariasis. El objetivo fue optimizar una metodología para evaluar la contaminación del suelo por huevos de Toxocara canis. Las muestras de suelo se colectaron en un parque público en la ciudad de Barranquilla (Colombia). Los huevos de Toxocara se aislaron mediante centrifugación/Floculación con MgSO4 (r=1,20), ZnSO4 (r=1,18), NaCl (r=1,18) y solución de Sheather (r=1,27)

Public Health Academic Alliance for COVID-19 Response: The Role of a National Medical Task Force in Puerto Rico

Alliances between the government and academic communities can be a key component of the public health response to an emergency such as the coronavirus disease 2019 (COVID-19) pandemic. The Governor of Puerto Rico designated the Puerto Rico Medical Task Force (MTF) COVID-19 to provide direct guidance and evaluation of the government response to the epidemic in Puerto Rico. Several work groups were formed within the MTF to create protocols and provide evidence-based recommendations on different public health aspects. The collaboration between the academia and the government enhanced the Puerto Rican public health response and contributed to the reduction seen in the contagion curve. Healthcare services and hospitals have not reached their maximum patient care capacity and the death toll has been controlled. Incorporating a national MTF with members of the academia into the government structure was beneficial during the COVID-19 response in Puerto Rico. A similar strategy could serve as a model for other states or territories and countries in similar scenarios