Detection of Mycobacterium tuberculosis Complex Using the Xpert MTB/RIF Ultra Assay on the Stool of Pediatric Patients in Dushanbe, Tajikistan.

We report the findings of a prospective laboratory diagnostic accuracy study to evaluate the sensitivity, specificity, and predictive values of the Xpert MTB/RIF Ultra assay for Mycobacterium tuberculosis detection in fresh stool specimens from children under 15 years of age with confirmed tuberculosis (TB) disease from Dushanbe, Tajikistan. Six hundred eighty-eight (688) participants were enrolled from April 2019 to October 2021. We identified 16 participants (2.3%) with confirmed TB disease, defined as ≥1 TB sign/symptom plus microbiologic confirmation. With the Xpert MTB/RIF Ultra assay for stool, we found a sensitivity of 68.8% (95% CI, 46.0 to 91.5) and a specificity of 98.7% (95% CI, 97.8 to 99.5) in confirmed TB disease. Our results are comparable to other published studies; however, our cohort was larger and our confirmed TB disease rate lower than most. We also demonstrated that this assay was feasible to implement in a centralized hospital laboratory in a low-middle-income Central Asian country. However, we encountered obstacles such as lack of staffing, material ruptures, outdated government protocols, and decreased case presentation due to COVID-19. We found eight patients whose only positive test was an Xpert Ultra stool assay. None needed treatment during the study; however, three were treated later, suggesting such cases require close observation. Our report is the first from Central Asia and one of a few from a low-middle-income country. We believe our study demonstrates the generalizability of the Xpert MTB/RIF Ultra assay on fresh stool specimens from children and provides further evidence supporting WHO's approval of this diagnostic strategy. IMPORTANCE The importance of this report is that it provides further support for WHO's recent recommendation that fresh stool is an acceptable sample for GeneXpert TB testing in children, especially small children who often cannot produce an adequate sputum sample. Diagnosing TB in this age group is difficult, and many cases are missed, leading to unacceptable rates of TB illness and death. In our large cohort of children from Dushanbe, Tajikistan, the GeneXpert stool test was positive in 69% of proven cases of TB, and there were very few false-positive tests. We also showed that this diagnostic strategy was feasible to implement in a low-middle-income country with an inefficient health care delivery system. We hope that many more programs will adopt this form of diagnosing TB in children.

Another Case of Bell's Palsy Recurrence After Pfizer-BioNTech COVID-19 Vaccination.

Twenty-seven months into the current pandemic and 18 months after vaccinations were made available, there are still relatively limited data on the incidence of recurrent Bell's Palsy after the administration of mRNA-based vaccines. The authors continue to believe that it is through rigorous reporting that the true incidence can be tabulated eventually.

De las herramientas de gobierno a los instrumentos de política. Un análisis de las estrategias frente al covid-19 en Sudamérica 1

La transformación del gobierno y de las relaciones entre administración pública, actores económicos y ciudadanía, es el elemento distintivo del análisis de políticas públicas desde hace por lo menos tres décadas. El papel central, rector y directivo del gobierno fue dejando paso paulatinamente a diversas modalidades de gobernanza en red, en la cual las autoridades públicas se convierten en uno más de los actores participantes del proceso de diseño e implementación de políticas públicas. El presente artículo tiene dos objetivos: 1) hacer un recorrido analítico de la transformación de los esquemas de gobernanza y el papel que juegan, en estos cambios, los instrumentos de política pública (Howlett, 2005) - especialmente los orientados a modificar las conductas ciudadanas desde una lógica multiactor y menos jerárquica- por sobre las herramientas de gobierno tradicionales -tesoro, organización, nodalidad y autoridad- (Hood, 1986), y 2) analizar de qué manera tales cambios afectaron las estrategias desplegadas por los gobiernos sudamericanos frente a la primera ola de la pandemia de covid-19, en 2020.Alternate :The transformation of government and of the relationship between public administration, economic actors, and citizens has been the hallmark of public policy analysis for at least three decades. The central, guiding, and directive role of government has gradually ushered various modes of network governance in which public authorities become just one of several actors participating in the process of designing and implementing public policy. This article has two objectives. On the one hand, it seeks to make an analytical review of the transformation of governance schemes and the role public policy instruments play in these changes (Howlett, 2005). We refer to those instruments endeavoring to modifying citizen behavior from a multi-actor and less hierarchical logic over traditional government tools - treasury, organization, nodalidad, and authority (Hood, 1986). On the other hand, it aims to analyze how those changes were manifested in the strategies deployed by South American governments in the face of the Covid-19 pandemic in 2020.Alternate :A transformação do governo e das relações entre administração pública, atores econômicos e cidadania, é o elemento distintivo da análise de políticas públicas desde pelo menos, três décadas. O papel central, reitor e dirigente do governo foi paulatinamente, dando passagem para diversas modalidades de governança em rede, na qual as autoridades públicas se transformam em mais um ator participante do processo de desenho e implementação de políticas públicas. O presente artigo tem dois objetivos: 1) Fazer um percurso analítico da transformação dos esquemas de governança e o papel que desempenham, nestas mudanças, os instrumentos de política pública (Howlett, 2005) - especialmente os que são orientados a modificar as condutas cidadãs desde uma lógica multiator e menos hierárquica-, acima das ferramentas de governo tradicionais, - Nodalidade, Autoridade, Tesouro e Organização - (Hood, 1986), e 2) Analisar de que maneira tais mudanças se manifestaram nas estratégias utilizadas pelos governos sul-americanos diante da pandemia de Covid-19 em 2020.

Proyecto IniciaTIC 2020: aprender en casa a enseñar desde casa

During the confinement caused by the Covid-19 pandemic, the implementation of online teaching through the use of educational technology allowed the students of the Early Childhood Education program of the National University of Education (UNAE) to carry out their corresponding period of student practice. On this reality, a single investigative/ exploratory case study was developed whose objective was to identify the strengths and weaknesses found throughout the training process. Results showed that the collective analysis of the virtual sessions allows future early childhood educators to build their own professional identity in this unique educational context.Alternate : Durante el confinamiento provocado por la pandemia del Covid-19, la implementación de docencia online mediante el uso de la tecnología educacional posibilita que las estudiantes de la carrera de Educación Inicial de la Universidad Nacional de Educación (UNAE) puedan realizar su correspondiente periodo de práctica pedagógica. Sobre esta realidad, se desarrolla un estudio de caso único de tipo indagatorio/exploratorio cuyo objetivo es identificar las fortalezas y debilidades encontradas a lo largo del proceso formativo. Los resultados demuestran que el análisis colectivo de las sesiones virtuales permite que las futuras docentes de preescolar vayan construyendo su propia identidad profesional en este singular contexto educativo.

Board Considerations for Covid-19 Vaccine Programs

Erica L. Opitz and Diana Perez Gomez are attorneys with Chamberlain Hrdlicka, a law firm headquartered in Houston, providing expertise on a variety of matters relating to corporate governance;commercial contract, mergers and acquisitions: and privately held securities, among others. In this article, they discuss the key factors that the board should weigh when deciding whether to require their employees to receive the COVID-19 vaccine.

(IN)CAPACIDADES DE POLÍTICA EN TIEMPOS DE COVID-19: COMPRENDIENDO LAS RESPUESTAS ECONÓMICAS DE COLOMBIA Y ECUADOR

Este artículo busca comprender las diferencias y similitudes en las respuestas económicas y de salud adoptadas por los gobiernos de Colombia y Ecuador para hacer frente a la pandemia por Covid-19. Para ello, clasificamos las medidas implementadas y las asociamos a las capacidades fiscales y organizativas en cada país. Los resultados demuestran semejanzas en la implementación de medidas para reducir los impactos negativos sobre el sector empresarial y turístico;mientras que se evidencian grandes contrastes en las medidas de estímulo fiscal, que incluye la renegociación de la deuda externa, y en la distancia temporal para la implementación de medidas sanitarias.Alternate abstract:This article seeks to understand the differences and similarities in the economic and health responses adopted by the governments of Colombia and Ecuador to address the Covid-19 pandemic. Therefore, we classify the measures implemented and associate them with the fiscal and organizational capacities in each country. The results show similarities in the implementation of measures to reduce the negative impacts on the business and tourism sectors, while there are great contrasts in the fiscal stimulus measures, which include the renegotiation of the foreign debt, and in the time frame for the implementation of health measures.