Feasibility, drug safety, and effectiveness of etiological treatment programs for Chagas disease in Honduras, Guatemala, and Bolivia: 10-year experience of Médecins Sans Frontières

BACKGROUND: Chagas disease (American trypanosomiasis) is a zoonotic or anthropozoonotic disease caused by the parasite Trypanosoma cruzi. Predominantly affecting populations in poor areas of Latin America, medical care for this neglected disease is often lacking. Médecins Sans Frontières/Doctors Without Borders (MSF) has provided diagnostic and treatment services for Chagas disease since 1999. This report describes 10 years of field experience in four MSF programs in Honduras, Guatemala, and Bolivia, focusing on feasibility protocols, safety of drug therapy, and treatment effectiveness. METHODOLOGY: From 1999 to 2008, MSF provided free diagnosis, etiological treatment, and follow-up care for patients <18 years of age seropositive for T. cruzi in Yoro, Honduras (1999-2002); Olopa, Guatemala (2003-2006); Entre Ríos, Bolivia (2002-2006); and Sucre, Bolivia (2005-2008). Essential program components guaranteeing feasibility of implementation were information, education, and communication (IEC) at the community and family level; vector control; health staff training; screening and diagnosis; treatment and compliance, including family-based strategies for early detection of adverse events; and logistics. Chagas disease diagnosis was confirmed by testing blood samples using two different diagnostic tests. T. cruzi-positive patients were treated with benznidazole as first-line treatment, with appropriate counseling, consent, and active participation from parents or guardians for daily administration of the drug, early detection of adverse events, and treatment withdrawal, when necessary. Weekly follow-up was conducted, with adverse events recorded to assess drug safety. Evaluations of serological conversion were carried out to measure treatment effectiveness. Vector control, entomological surveillance, and health education activities were carried out in all projects with close interaction with national and regional programs. RESULTS: Total numbers of children and adolescents tested for T. cruzi in Yoro, Olopa, Entre Ríos, and Sucre were 24,471, 8,927, 7,613, and 19,400, respectively. Of these, 232 (0.9%), 124 (1.4%), 1,475 (19.4%), and 1,145 (5.9%) patients, respectively, were diagnosed as seropositive. Patients were treated with benznidazole, and early findings of seroconversion varied widely between the Central and South American programs: 87.1% and 58.1% at 18 months post-treatment in Yoro and Olopa, respectively; 5.4% by up to 60 months in Entre Ríos; and 0% at an average of 18 months in Sucre. Benznidazole-related adverse events were observed in 50.2% and 50.8% of all patients treated in Yoro and Olopa, respectively, and 25.6% and 37.9% of patients in Entre Ríos and Sucre, respectively. Most adverse events were mild and manageable. No deaths occurred in the treatment population. CONCLUSIONS: These results demonstrate the feasibility of implementing Chagas disease diagnosis and treatment programs in resource-limited settings, including remote rural areas, while addressing the limitations associated with drug-related adverse events. The variability in apparent treatment effectiveness may reflect differences in patient and parasite populations, and illustrates the limitations of current treatments and measures of efficacy. New treatments with improved safety profiles, pediatric formulations of existing and new drugs, and a faster, reliable test of cure are all urgently needed

Real-time image mosaicking for mapping and exploration purposes

[Abstract] In the last decade, building mosaic images become an active field in several computer vision and graphic applications. In this paper, a panoramic image construction using monocular camera is proposed. In this approach, SURF algorithm is used to extract the keypoints in order to obtain reliable results for real-time applications. In addition, based on the homography between the panoramic and the new image, the rotation matrix is obtained, and the new image can be projected on a plane parallel to panorama. Finally, image illumination is compensated over the whole image and the calculation of the pixels contributed by each frame in the overlapping areas. The proposed approach has been verified with real flights, and the obtained results show the robustness of constructing panoramic image with minimal loosing in the information, furthermore, the results prove the ability of the proposed approach to create panoramic images in real-time applications.Ministerio de Economía, Industria y Competitividad; TRA2015-63708-RMinisterio de Economía y Competitividad; TRA2016-78886-C3-1-RComunidad de Madrid; S2013/MIT-271

Exploring the natural history of intrinsic capacity impairments: longitudinal patterns in the 10/66 study

Backgroundintrinsic capacity (IC) is a construct encompassing people’s physical and mental abilities. There is an implicit link amongst IC domains: cognition, locomotion, nutrition, sensory and psychological. However, little is known about the integration of the domains.Objectivesto investigate patterns in the presentation and evolution of IC domain impairments in low-and-middle-income countries and if such patterns were associated with adverse outcomes.Methodssecondary analyses of the first two waves of the 10/66 study (population-based surveys conducted in eight urban and four rural catchment areas in Cuba, Dominican Republic, Puerto Rico, Venezuela, Peru, Mexico and China). We applied latent transition analysis on IC to find latent statuses (latent clusters) of IC domain impairments. We evaluated the longitudinal association of the latent statuses with the risk of frailty, disability and mortality, and tested concurrent and predictive validity.Resultsamongst 14,923 participants included, the four latent statuses were: high IC (43%), low deterioration with impaired locomotion (17%), high deterioration without cognitive impairment (22%), and high deterioration with cognitive impairment (18%). A total of 61% of the participants worsened over time, 35% were stable, and 3% improved to a healthier status.Participants with deteriorated IC had a significantly higher risk of frailty, disability and dementia than people with high IC. There was strong concurrent and predictive validity. (Mortality Hazard Ratio = 4.60, 95%CI 4.16; 5.09; Harrel’s C = 0.73 (95%CI 0.72;0.74)).Conclusionshalf of the study population had high IC at baseline, and most participants followed a worsening trend. Four qualitatively different IC statuses or statuses were characterised by low and high levels of deterioration associated with their risk of disability and frailty. Locomotion and cognition impairments showed other trends than psychological and nutrition domains across the latent statuses

How can hackathons accelerate corporate innovation?

IFIP WG 5.7 International Conference, APMS 2018, Seoul, Korea, August 26-30, 2018, Proceedings, Part I In recent years, the way corporates innovate has changed significantly. Going from ‘behind closed doors’ innovation to open innovation where collaboration with outsiders is encouraged, companies are in the pursuit of more effective ways to accelerate their innovation outcomes. As a result, many companies are investing to create more entrepreneurial environments, which not only empower employees to proactively propose and test new ideas, but also reach beyond company walls to involve many others in the co-creation of new solutions. In this paper, we outline the most notable benefits of hackathons from the perspective of large organizations, and present the benefits and a methodology for organizing hackathons, i.e. competition-based events where participants work in small teams over a short period of time to ideate, design, rapidly prototype and test their ideas with a user-centric approach to solve a determined challenge. This paper also provides a brief insight into the CEMEX Hackathon, which was organized following the aforementioned methodology

Brain status modeling with non-negative projective dictionary learning

Accurate prediction of individuals’ brain age is critical to establish a baseline for normal brain development. This study proposes to model brain development with a novel non-negative projective dictionary learning (NPDL) approach, which learns a discriminative representation of multi-modal neuroimaging data for predicting brain age. Our approach encodes the variability of subjects in different age groups using separate dictionaries, projecting features into a low-dimensional manifold such that information is preserved only for the corresponding age group. The proposed framework improves upon previous discriminative dictionary learning methods by inc

Control strategy to maximize the power capability of PV three-phase inverters during voltage sags

Under voltage sags, grid-tied photovoltaic inverters should remain connected to the grid according to low-voltage ride-through requirements. During such perturbations, it is interesting to exploit completely the distributed power provisions to contribute to the stability and reliability of the grid. In this sense, this paper proposes a low-voltage ride-through control strategy that maximizes the inverter power capability by injecting the maximum-rated current during the sag. To achieve this objective, two possible active power situations have been considered, i.e., high- and low-power production scenarios. In the first case, if the source is unable to deliver the whole generated power to the grid, the controller applies active power curtailment to guarantee that the maximum rated current is not surpassed. In the second case, the maximum allowed current is not reached, thus, the control strategy determined the amount of reactive power that can be injected up to reach it. The control objective can be fulfilled by means of a flexible current injection strategy that combines a proper balance between positive- and negative-current sequences, which limits the inverter output current to the maximum rated value and avoid active power oscillations. Selected experimental and simulation results are reported in order to validate the effectiveness of the proposed control strategy.Peer ReviewedPostprint (author's final draft

CD36 maintains the gastric mucosa and associates with gastric disease

The gastric epithelium is often exposed to injurious elements and failure of appropriate healing predisposes to ulcers, hemorrhage, and ultimately cancer. We examined the gastric function of CD36, a protein linked to disease and homeostasis. We used the tamoxifen model of gastric injury in mice null for Cd36 (Cd3

Burden of Parkinsonism and Parkinson\u27s Disease on Health Service Use and Outcomes in Latin America

\ua9 2023 - The authors. Published by IOS Press.Background: Little is known about the burden of parkinsonism and Parkinson\u27s disease (PD) in Latin America. Better understanding of health service use and clinical outcomes in PD is needed to improve its prognosis. Objective: The aim of the study was to estimate the burden of parkinsonism and PD in six Latin American countries. Methods: 12,865 participants aged 65 years and older from the 10/66 population-based cohort study were analysed. Baseline assessments were conducted in 2003-2007 and followed-up 4 years later. Parkinsonism and PD were defined using current clinical criteria or self-reported diagnosis. Logistic regression models assessed the association between parkinsonism/PD with baseline health service use (community-based care or hospitalisation in the last 3 months) and Cox proportional hazards regression models with incident dependency (subjective assessment by interviewer based on informant interview) and mortality. Separate analyses for each country were combined via fixed effect meta-analysis. Results: At baseline, the prevalence of parkinsonism and PD was 7.9% (n = 934) and 2.6% (n = 317), respectively. Only parkinsonism was associated with hospital admission at baseline (OR 1.89, 95% CI 1.30-2.74). Among 7,296 participants without dependency at baseline, parkinsonism (HR 2.34, 95% CI 1.81-3.03) and PD (2.10, 1.37-3.24) were associated with incident dependency. Among 10,315 participants with vital status, parkinsonism (1.73, 1.50-1.99) and PD (1.38, 1.07-1.78) were associated with mortality. The Higgins I2 tests showed low to moderate levels of heterogeneity across countries. Conclusions: Our findings show that older people with parkinsonism or PD living in Latin America have higher risks of developing dependency and mortality but may have limited access to health services