ÁNTRAX: enfermedad aún vigente.

El ántrax es una zoonosis producida por Bacillus anthracis, único miembro del género Bacillus que es capaz de causar enfermedad epidémica en humanos y otros mamíferos. Afecta principalmente a los animales herbívoros domésticos y silvestres. Los humanos son hospederos accidentales y se infectan por contacto directo o indirecto con animales o productos contaminados. Las esporas pueden vivir en el suelo por años y los humanos pueden contraer el ántrax al tener contacto con animales infectados, productos provenientes de estos que al consumir carne infectada; esto se presenta principalmente en países poco desarrollados donde los niveles de vacunación animal contra esta enfermedad son bajos. Este escrito tiene por objetivo presentar una revisión sobre el tema, especialmente sobre aspectos como el modo de infección, manifestaciones clínicas, diagnóstico y tratamiento de la enfermedad

Antibody to Arenaviruses in Rodents, Caribbean Colombia

Fil: Mattar, Salim. Universidad de Córdoba; Colombia.Fil: Guzman, Camilo. Universidad de Córdoba; Colombia.Fil: Arrazola, Justiniano. Universidad de Córdoba; Colombia.Fil: Soto, Ella. Universidad de Córdoba; ColombiaFil: Barrios, Jose. Universidad de Córdoba; Colombia.Fil: Pini, Noemí. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio L. Maiztegui"; Argentina.Fil: Levis, Silvana. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Virales Humanas "Dr. Julio L. Maiztegui"; Argentina.Fil: Salazar-Bravo, Jorge. Texas Tech University; Estados Unidos.Fil: Mills, James N. Centers for Disease Control and Prevention; Estados Unidos

Assessing the Readiness and Training Needs of Non-urban Physicians in Public Health Emergency and Response

Emergency readiness has become a public health priority for United States communities after the 9/11 attacks. Communities that have a less developed public health infrastructure are challenged to organize preparedness and response efforts and to ensure that health care providers are capable of caring for victims of terrorist acts. A survey was used to assess nonurban physicians’ prior experience with and selfconfidence in treating, and preferred training needs for responding to chemical, biologic, radiologic, nuclear, and explosive (CBRNE) cases. Data were collected through a mailed and Web-based survey. Although the response rate was calculated at 30%, approximately one third of the surveys were not able to be delivered. Most respondents reported never having seen or treated CBRNE-inflicted cases and were not confident in their ability to diagnose or treat CBRNE cases, but many were willing to participate in a state-led response plan. Almost half of the individuals had not participated in any related training but expressed interest in receiving training in small group workshops or through CD-ROM. These results provide potential direction for strategic preparedness planning for non-urban health care providers.Texas Department of Healt

Efectos de la pandemia COVID-19 en la práctica deportiva de jugadoras de hockey sobre césped de la categoría sub-14 y sub-16 del Club Deportivo Universidad Católica y Prince of Wales Country Club

Tesis (Profesor de Educación Física para la Enseñanza Básica, Licenciado en Educación)En el año 2020 la población mundial se vio enfrentada a una nueva pandemia mundial producto del virus COVID-19, el cual inició en Wuhan, China, afectando en pocos meses a todos los rincones del mundo. Esto obligó a tomar una serie de adaptaciones y medidas inmediatas para la contención del virus, entre las que se encuentran el uso obligatorio de mascarillas y a un proceso de cuarentena obligatoria. El mundo deportivo se vio altamente impactado debido a esta última medida, en consecuencia, surge la idea de investigar los efectos de la pandemia COVID-19 en las jugadoras de hockey sobre césped de las categorías sub14 y sub16 del Club Deportivo Universidad Católica y Prince of Wales Country Club. Para esta investigación se utilizó una encuesta, la cual contenía diferentes preguntas para determinar los objetivos específicos del estudio. La población estuvo compuesta por 74 jugadoras, las cuales 62 eran del Club Deportivo Universidad Católica y 12 jugadoras del Prince of Wales Country Club, de las categorías Sub 14 y Sub 16. Es por esto, que la muestra es de carácter no probabilística por conveniencia. Por otro lado, los datos obtenidos fueron traspasados a gráficos a través de la plataforma Excel, para determinar e interpretar los resultados y así dar respuesta a los objetivos planteados en la investigación. Gracias a los resultados arrojados por la encuesta, se pudo evidenciar que la pandemia tuvo efectos negativos en el ámbito físico y a los objetivos competitivos, debido a que bajaron el rendimiento y los resultados esperados se vieron disminuidos, además de que los objetivos se vieron postergados En el ámbito psicológico, los objetivos deportivos y en la modalidad deportiva, se demostraron efectos negativos como consecuencia de la cuarentena, aun cuando se mantuvieron optimistas con relación a seguir.In 2020, the world population was faced with a new global pandemic caused by the COVID-19 virus, which began in Wuhan, China, affecting all corners of the world in a few months. This made it necessary to take a series of adaptations and immediate measures to contain the virus, including the mandatory use of masks and a mandatory quarantine process. The sports world was highly impacted due to this last measure, consequently, the idea arises to investigate the effects of the COVID-19 pandemic on field hockey players in the Under 14 and Under 16 categories of the Club Deportivo Universidad Católica and Prince of Wales Country Club. For this research, a survey was used, which contained different questions to determine the specific objectives of the study. The population consisted of 74 players, of which 62 were from the Club Deportivo Universidad Católica and 12 players from the Prince ofWales Country Club, from the Under 14 and Under 16 categories. This is why the sample is non-probabilistic for convenience. On the other hand, the data obtained was transferred tographs through the Excel platform, to determine and interpret the results and thus respond to the objectives set in the research. Thanks to the results of the survey, it was possible to show that the pandemic had negative effects on the physical environment and competitive objectives, due to the fact that performance dropped, and the expected results were diminished, in addition to the fact that the objectives were postponed. Regarding The Psychological Field, sporting objectives and the sporting modality, negative effects were demonstrated as a consequence of the quarantine, even when they remained optimistic in relation to continuing

Effects of drip irrigation promotion policies on water use and irrigation costs in Valencia, Spain

The aim of this study is to conduct an ex post analysis of the generalized implementation of drip irrigation in the last two decades in the Valencia Region (Spain). Due to the important role played by water users’ associations (WUAs) in this socio-technological change in the region, this research was based on 77 interviews with different WUAs that provided information prior and subsequent to modernization. Firstly, we review the published studies concerning the effects generated by this technological change and describe the drip irrigation promotion policies implemented by national and regional governments. Subsequently, we analyse the consequences for irrigation associations, including effects on water use and irrigation costs. The reduction of water withdrawals has been generally significant. This was possible because the regional contextual factors prevented, in most cases, crop intensification and areal expansion. Nevertheless, due to the enormous investment effort and the resulting maintenance costs, the technological change has increased irrigation costs, generating some uncertainties concerning the financial sustainability of some WUAs. In conclusion, a thorough assessment of contextual factors and accompanying measures such as technical assistance and monitoring appear to be indispensable to avoid unforeseen effects and to achieve the potential goals of conversion to drip technologiesThis study has been supported by the IMPADAPT project (CGL2013-48424-C2-1-R) with Spanish MINECO (Ministerio de Economia y Competitividad) and European FEDER funds.Sanchis Ibor, C.; García Molla, M.; Avellá Reus, LF. (2017). Effects of drip irrigation promotion policies on water use and irrigation costs in Valencia, Spain. Water Policy. 19(1):165-180. https://doi.org/10.2166/wp.2016.025S16518019

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century