Quimioterapia metronómica en paciente hematológico como alternativa no curativa, en el Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera” de enero 2016 a diciembre 2019.

La Quimioterapia Metronómica consiste en la administración de quimioterapia a dosis bajas y en intervalos, utilizada en casos de cáncer avanzado con mínimos efectos secundarios, para mantener la enfermedad estable y mejorar la calidad de vida, junto con soporte paliativo. Este es un estudio observacional retrospectivo, que abarca un período de 3 años, de enero de 2016 a diciembre de 2019, a partir del cual se caracterizan los pacientes con enfermedad hematológica que utilizan quimioterapia metronómica como opción no curativa del Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera” de la Caja Costarricense del Seguro Social.  De un total de 52 pacientes, el género que predominó fue el sexo masculino con un 75.0%. En la tasa de incidencia según provincia, Limón fue de mayor auge con 6.9 x 100 000 habitantes menores de 13 años, seguido de San José con 6.4 x 100 000 habitantes menores de 13 años y Guanacaste con 6.2 x 100 000 habitantes menores de 13 años. La sintomatología durante el tratamiento fue dolor articular en 35.2%, inapetencia 21.1%, cansancio 13%, y sangrado en 7.7%. El 92.3% de los pacientes fallecieron antes de los 3 años; 5.8% han tenido una enfermedad estable. El 72.3% de los pacientes fallecieron en la casa y solo un 27.6% en el hospital. Se concluye que el régimen de quimioterapia metronómica fue bien tolerado, con una tendencia positiva para los pacientes que han agotado las posibilidades terapéuticas vigentes; incluyendo un abordaje multidisciplinario con el equipo de cuidado paliativo

Liver fluke infections by Amphimerus sp. (Digenea: Opisthorchiidae) in definitive and fish intermediate hosts in Manabí province, Ecuador

This work is licensed under a Creative Commons Attribution 4.0 International License.Amphimerus sp. is a fluke that dwells in the biliary tracts of vertebrate definitive hosts including humans, domestic, and wild mammals in Latin America. Opisthorchiid liver infections are rarely studied in the Americas confirming its status as a neglected tropical disease. In Ecuador, small trematode eggs were reported in human cases from the province of Manabí in 1949, and recently, Amphimerus sp. adults were recovered from human and reservoir hosts in the province of Esmeraldas. Due to the lack of research on the infectious sources of Amphimerus sp. in the continent, we have developed a series of epidemiological studies with parasitological and molecular techniques to elucidate the endemicity of opisthorchiid fluke infections. We developed a cross-sectional study in three communities at Pedro Pablo Gómez parish in the province of Manabí, Ecuador. We examined a total of 176 fecal samples to detect opisthorchiid eggs, and four fish species to find opisthorchiid metacercariae. To study adult worms, we treated and purged seven patients in a family and dissected the livers of a dog and a cat infected. We observed morphological features of adults and metacercariae and used polymerase chain reaction with restricted fragment length polymorphism (PCR-RFLP) and DNA sequencing of a section of the ITS2 gene for identification. Small trematode eggs were detected in 63 (35.8%) out of 176 fecal samples of residents in the three study sites. Adult opisthorchiid flukes were recovered from human patients, a dog and a cat, and they were morphologically and molecularly identified as Amphimerus sp. Opisthorchiid metacercariae were also identified molecularly as Amphimerus sp. in four fish species, i.e., Rhoadsia altipinna, Bryconamericus bucay, Andinoacara rivulatus, and Piabucina aureoguttata. Metacercariae of the heterophyid Haplorchis pumilio were also found in the four fish species examined. This is the first study to confirm the current endemicity of Amphimerus sp. in Pedro Pablo Gómez, Manabí, Ecuador. The adult worms isolated here shared morphological characteristics with previous Amphimerus sp. descriptions and were molecularly similar to Amphimerus sp. described in the province of Esmeraldas. Moreover, this study is the first to document four fish species as infection sources of Amphimerus sp. detected via a molecular protocol targeting the metacercariae of the parasite. Fish species identified here should be targeted for public health campaigns to avoid further human liver-fluke infections by Amphimerus sp. or potential intestinal-fluke infections by H. pumilio or others.Japan Society for the Promotion of Science (25305011 and 16H05820)Emerging and Re-emerging Infectious Diseases from the Ministry of Health, Labour and Welfare, Japanese government (H23-Shinko-ippan-014 and H26-Shinko-ippan-009)Japan Agency for Medical Research and Development (20fk0108136j0101)Dirección General de Investigaciones, Universidad de las Américas, Quit

Leptospirosis in Ecuador: Current Status and Future Prospects

The location of Ecuador—an equatorial nation—favors the multiplication and dispersal of the Leptospira genus both on the Pacific Coast and in the Amazon tropical ecoregions. Nevertheless, leptospirosis epidemiology has not been fully addressed, even though the disease has been recognized as a significant public health problem in the country. The purpose of this literature review is to update knowledge on the epidemiology and geographical distribution of Leptospira spp. and leptospirosis in Ecuador to target future research and develop a national control strategy. A retrospective literature search using five international, regional, and national databases on Leptospira and leptospirosis including humans, animals, and environmental isolations of the bacteria and the disease incidence in Ecuador published between 1919 and 2022 (103 years) with no restriction on language or publication date was performed. We found and analyzed 47 publications including 22 of humans, 19 of animals, and two of the environments; three of these covered more than one of these topics, and one covered all three (i.e., One Health). Most (60%) of the studies were conducted in the Coastal ecoregion. Twenty-four (51%) were published in international journals, and 27 (57%) were in Spanish. A total of 7342 human and 6314 other animal cases were studied. Leptospirosis was a frequent cause of acute undifferentiated febrile illness in the Coast and Amazon and was associated with rainfall. All three major clusters of Leptospira—pathogenic, intermediate, and saprophytic—were identified from both healthy and febrile humans, the environment, and animals; moreover, nine species and 29 serovars were recorded over the three Ecuadorian ecoregions. Leptospira infections were diagnosed in livestock, companion, and wild animals from the Amazon and the Coast regions along with sea lions from the Galápagos Islands. Microscopic-agglutination test was the diagnostic tool most widely used. Three reviews covering national data on outpatients and inpatients determined the varied annual incidence and mortality rate, with males being more commonly affected. No human cases have been reported in the Galápagos Islands. Genomic sequences of three pathogenic Leptospira were reported. No studies on clinical ground, antibiotic resistance, or treatment were reported, nor were control programs or clinical-practice guidelines found. The published literature demonstrated that leptospirosis was and still is an endemic disease with active transmission in the four geoclimatic regions of Ecuador including the Galápagos Islands. Animal infections, distributed in mainland and insular Ecuador, pose a significant health risk for humans. Nationwide epidemiological surveys—encouraging more research on the fauna and environment with appropriate sampling design on risk factors for human and animal leptospirosis, Leptospira genotyping, increased laboratory capability, and readily available official data—are required to improve our understanding of transmission patterns and to develop effective national intervention strategies with the intention of applying One Health approaches

Spread of a SARS-CoV-2 variant through Europe in the summer of 2020

[EN] Following its emergence in late 2019, the spread of SARS-CoV-21,2 has been tracked by phylogenetic analysis of viral genome sequences in unprecedented detail3,4,5. Although the virus spread globally in early 2020 before borders closed, intercontinental travel has since been greatly reduced. However, travel within Europe resumed in the summer of 2020. Here we report on a SARS-CoV-2 variant, 20E (EU1), that was identified in Spain in early summer 2020 and subsequently spread across Europe. We find no evidence that this variant has increased transmissibility, but instead demonstrate how rising incidence in Spain, resumption of travel, and lack of effective screening and containment may explain the variant’s success. Despite travel restrictions, we estimate that 20E (EU1) was introduced hundreds of times to European countries by summertime travellers, which is likely to have undermined local efforts to minimize infection with SARS-CoV-2. Our results illustrate how a variant can rapidly become dominant even in the absence of a substantial transmission advantage in favourable epidemiological settings. Genomic surveillance is critical for understanding how travel can affect transmission of SARS-CoV-2, and thus for informing future containment strategies as travel resumes.S

La ganadería ante escenarios complejos.

La calidad de las contribuciones, producto de la pluma de especialistas en los temas tratados, el presente es un libro que esperamos, basándonos en la importancia de los temas tratados, sea de utilidad y abone a la reflexión de los estudiosos de la ganadería mexicana y, por supuesto, en beneficio de las familias ganaderas y de los consumidores de sus productos.este libro refleja en muchos sentidos la situación de la ganadería mexicana, a la que se le están demandando mayor producción y productividad, que los procesos productivos tengan la menor huella ecológicposible, que los alimentos sean inocuos, que se abatan costos de producción y, cada vez aumentan las presiones de diversos grupos para, que se incluyan los protocolos de bienestar animal, solamente por citar algunos de los retos que tiene. Algunas de estas demandas son complementarias, otras se contraponen, lo que hace valiosos a los estudios que desde las ciencias sociales se realizan y, desde diversas ópticas, se hagan propuestas de política pública balanceadas que consideren lo mejor de cada enfoque, pero sin desechar por completo los antagónicos.Universidad Autónoma Chaping

No trans-pacific partnership? Good or bad for Mexico?

Purpose: The purpose of this paper is as follows: first, it aims to explain the overall economic implications of the trans-pacific partnership (TPP). Second, it aims to provide an in-depth analysis of the TPP’s quantitative impact on an upper-middle economy such as Mexico, as well as on the USA. Design/methodology/approach: The analysis is performed using a computable general equilibrium (CGE) model. Findings: The results suggest that in the short run, both Mexico and the USA would slightly benefit from the TPP. Tariff reductions would lead to less bilateral trade between Mexico and the USA and the stronger integration of both countries with the rest of the TPP members. The opposite is true after a decrease in non-tariff barriers (NTBs). Overall, in terms of the impact on Mexico, trade integration with the rest of the TPP members prevails. This suggests that a TPP without the USA could still be beneficial. Originality/value: Previous studies on the TPP have mainly focused on its impact for the USA, which is also analysed in the present study. The effects of the TPP are estimated for a broad set of micro and macroeconomic variables, paying particular attention to the reductions of NTBs

The economic impact of potential migration policies in the UK after Brexit

The bulk of studies which attempt to quantify the effects of Brexit focus on trade issues; however, very few of them have analysed migration. In this paper, we analyse the impact of several migration policies on GDP, GDP per capita, wages, national income and sectoral production in the UK, using what is technically called a general equilibrium analysis. We also analyse the impact at the macroeconomic level on the EU. We find that migration has the potential of deeply affecting economic activity in the UK. The more restrictive immigration policies are, the greater the losses in terms of GDP and Welfare. However, according to the text of the ‘joint agreement’ reached by the UK and EU on December 8 (2017), very restrictive policies seem to be ruled out. Nevertheless, after the ‘Windrush scandal’ some doubts about the final implementation of future UK migration policies remain. We also analyse mild migration policies which would only reduce the number of migrants received. Reductions in the number of EU immigrants between 42,000 and 87,000 per year would lead to foregone GDP increases in the UK between 0.08% and 0.17%. This impact should be considered cumulative across years in which the net inflows are reduced, so that negative effects for GDP and welfare can be substantial if the reduction in workers takes place during many years in a row. The UK currently has easy access to a large pool of workers coming from other EU member states, and UK managers have expressed that it is hard to replace EU talent in the short term. This suggests that if the political imperative for tighter immigration control cannot be avoided, gradual immigration restrictiveness will be less harmful for the UK’s economy and should be accompanied by additional efforts in education and workers’ training.La mayor parte de los estudios que intentan cuantificar los efectos del Brexit se centran en cuestiones comerciales; sin embargo, muy pocos de ellos han analizado la migración. En este artículo, analizamos el impacto de varias políticas migratorias sobre el PIB, el PIB per cápita, los salarios, la renta nacional y la producción sectorial en el Reino Unido, utilizando lo que técnicamente se denomina análisis de equilibrio general. También analizamos el impacto a nivel macroeconómico en la UE. Encontramos que la migración tiene el potencial de afectar profundamente la actividad económica en el Reino Unido. Cuanto más restrictivas son las políticas de inmigración, mayores son las pérdidas en términos de PIB y Bienestar. Sin embargo, según el texto del ‘acuerdo conjunto’ alcanzado por el Reino Unido y la UE el 8 de diciembre (2017), parecen descartarse políticas muy restrictivas. Sin embargo, tras el ‘escándalo de Windrush’ quedan algunas dudas sobre la implementación final de las futuras políticas migratorias del Reino Unido. También analizamos políticas migratorias suaves que solo reducirían el número de migrantes recibidos. Las reducciones en el número de inmigrantes de la UE entre 42.000 y 87.000 por año darían lugar a aumentos del PIB perdidos en el Reino Unido entre el 0,08 % y el 0,17 %. Este impacto debe considerarse acumulativo a lo largo de los años en los que se reducen las entradas netas, por lo que los efectos negativos para el PIB y el bienestar pueden ser sustanciales si la reducción de trabajadores se produce durante muchos años seguidos. Actualmente, el Reino Unido tiene fácil acceso a una gran cantidad de trabajadores provenientes de otros estados miembros de la UE, y los gerentes del Reino Unido han expresado que es difícil reemplazar el talento de la UE a corto plazo. Esto sugiere que si no se puede evitar el imperativo político de un control más estricto de la inmigración, la restricción gradual de la inmigración será menos dañina para la economía del Reino Unido y debería ir acompañada de esfuerzos adicionales en educación y capacitación de los trabajadores.Depto. de Estadística y Ciencia de los DatosFac. de Estudios EstadísticosTRUEpu

A computable general equilibrium analysis of Brexit: Barriers to trade and immigration restrictions

This paper estimates the economic effects of different types of restrictions on trade and immigration in the United Kingdom after Brexit. Regarding trade restrictions, we focus on UK-EU increases in tariffs and non-tariff barriers. We also analyse the removal of all tariffs in the UK to all its trading partners. Concerning immigration, we run a 5-year cumulative annual reduction in net migrants by 87,000 workers following OECD estimations, which looks realistic even if there is a hard Brexit.The study is conducted using a computable general equilibrium (CGE) model, which allows us to estimate the impact on GDP, welfare, wages and capital remuneration, together with the evolution of aggregate and sectoral output, exports and imports.We obtain a more sizeable negative impact on the UK than other previous influential studies. Trade restrictions would generate welfare reductions between −0.38% and −1.94% for the UK, while they would be between −0.03% and −0.14% in the EU. This is because the EU is a crucial trade partner for the UK, which cannot be easily substituted through trade with other regions in the world. We simulate the impact of both reductions in net inflows and in the stock of EU migrants, accumulated through 5 years. Migration is compatible with wage increases but puts downward pressure on GDPpc. However, migration restrictions would not compensate the overall GDPpc contractions arising from a hard Brexit.Depto. de Estadística y Ciencia de los DatosFac. de Estudios EstadísticosTRUEpu