Pathway towards an ideal and sustainable framework agreement for the public procurement of vaccines in Spain: a multi-criteria decision analysis.

Objective: To advance the development of an ideal and sustainable framework agreement for the public procurement of vaccines in Spain, and to agree on the desirable award criteria and their relative weight. Methods: A multidisciplinary committee of seven health-care professionals and managers developed a partial multi-criteria decision analysis to determine the award criteria that should be considered and their specific weights for the public procurement of routine vaccines and seasonal influenza vaccines, considering their legal viability. A re-test of the results was carried out. The current situation was analyzed through 118 tender specifications and compared to the ideal framework. Results: Price is the prevailing award criterion for the public procurement of both routine (weighting of 60% versus 40% for all other criteria) and influenza (36% versus 64%) vaccines. Ideally, 22 criteria should be considered for routine vaccines, grouped and weighted into five domains: efficacy (weighting of 29%), economic aspects (27%), vaccine characteristics (22%), presentation form and packaging (13%), and others (9%). Per criteria set, price was the most important criterion (22%), followed by effectiveness (9%), and composition/formulation (7%). Regarding influenza vaccines, 20 criteria were selected, grouped, and weighted: efficacy (29%), economic aspects (25%), vaccine characteristics (20%), presentation form and packaging (16%), and others (11%). Per criteria set, price was also the most relevant criterion (19%), followed by composition/formulation (8%), and effectiveness (8%). Conclusions: Contrary to the current approach, technical award criteria should prevail over economic criteria in an ideal and sustainable framework agreement for the public procurement of vaccines.

Early spectra of the gravitational wave source GW170817: Evolution of a neutron star merger.

On 17 August 2017, Swope Supernova Survey 2017a (SSS17a) was discovered as the optical counterpart of the binary neutron star gravitational wave event GW170817. We report time-series spectroscopy of SSS17a from 11.75 hours until 8.5 days after the merger. Over the first hour of observations, the ejecta rapidly expanded and cooled. Applying blackbody fits to the spectra, we measured the photosphere cooling from [Formula: see text] to [Formula: see text] kelvin, and determined a photospheric velocity of roughly 30% of the speed of light. The spectra of SSS17a began displaying broad features after 1.46 days and evolved qualitatively over each subsequent day, with distinct blue (early-time) and red (late-time) components. The late-time component is consistent with theoretical models of r-process-enriched neutron star ejecta, whereas the blue component requires high-velocity, lanthanide-free material.

[Aortic-left ventricular tunnel. Long-term surgical results]. / Túnel aorta-ventrículo izquierdo. Resultados quirúrgicos a largo plazo.

OBJECTIVE: The aim of this work is to describe the different aspects of diagnosis and postoperative follow-up in four patients after surgery for aortic-left ventricular tunnel (ALVT). The surgical techniques and results have been published, in the literature but there are no reports about the progression of aortic regurgitation. METHOD: We reviewed the clinical features of four patients operated with ALVT. The clinical information (electrocar-diograms, echocardiograms and catheterilution) was studied in the preoperative period. Surgical technique and postoperative evolution were analysed. The follow-up period ranged between 4.7 and 13 years. RESULTS: In a 14 years period, four children (2 boys and 2 girls), were operated for ALVT. The mean age at the time of diagnosis was 8.5 years (ranged between 1 month and 14 years). A continuous murmurs was present in all cases, associated to cardiac failure in the youngest patient (1 month old). The clinical diagnosis was ALVT in the four cases but only in two the echocardiographic study showed correctly the anatomic aspects of the malformation. The angiohemodynamic study was correct in three patients and the differential diagnosis was made in last one with rupture of aortic sinuses of Valsalva to the left ventricle. All cases were operated; with direct closure of the aortic orifice (two cases), or with dacron patch (two cases). In one case aortic valve replacement was also performed. There was not mortality and the mean age at the time of surgery was 9 years (1.5 months and 14 years). The mean follow-up was 8.5 years (ranged between 4.7 and 13 years), three patients showed clinically and in the echocardiogram study an aortic valvular regurgitation without ALVT deshiscence. All cases are asymptomatic. No patient was reoperated. CONCLUSION: The surgical treatment of ALVT must be done as soon as the diagnosis is made to prevent left ventricular enlargement, ventriculo-aortic floor distortion and aortic valvular lesion. A precise echocardiographic study is necessary to avoid catheterization. This study provided a clear knowledge of anatomic structure of the ALVT for both clinician and surgeons. This information is important in order to obtain an optimal surgical success, particularly to prevent the valvar aortic regurgitation.

[Comparative study of 4 methods for identifying species of the genus Aeromonas]. / Estudio comparativo de 4 métodos para la identificación de especies del género aeromonas.

It is given an explanation of the results obtained with the following methods: AEROKEY II, AEROKEY II + Abbot's scheme, Api 20 NE, and the Biolog System. The study was conducted with 38 strains of Aeromonas isolated from children under 5 with acute diarrheal disease (ADD). The AEROKEY II + Abbot's scheme proved to be the best identification method.

[Inhibition ELISA. Its utility for classifying a case of dengue]. / ELISA de inhibición. Su utilidad para clasificar un caso de dengue.

For the classification of dengue cases the WHO/PAHO includes the hemagglutination inhibition test as one of the serological techniques used to this end and it is also accepted the possibility of using the ELISA with a titer equivalent to that established by the IH. In this paper, it is explained the usefulness of the inhibition ELISA for the classification of a probable case, a confirmed case, and type of dengue infection (primary or secondary).

Prevalence of Toxocara canis in dogs in the City of Havana. / Prevalencia de Toxocara canis en perros de Ciudad de La Habana.

A study on the prevalence of Toxocara canis in domestic dogs of City of Havana was carried out for the first time in Cuba. 22 dogs were selected in each municipality, totalling 330 as the study universe. Dogs' feces samples were processed through direct examination using Willis' flotation method (1921). The results attained showed a 17.9% prevalence of Toxocara canis, a high figure constituting an important risk factor for transmission to humans. This was influenced by the age of the animals and the hygienic conditions of the houses, significant factors from the epidemiological point of view. Sex did not play a significant role.

Bioavailability of carbonyl iron: a randomized, double-blind study.

49 female blood donors with iron-deficiency anemia were treated with equal doses of iron either as carbonyl iron or ferrous sulfate in a randomized, double-blind fashion. The prevalence of side-effects was similar in the two groups. Mean values for hemoglobin concentration, mean corpuscular volume, corrected reticulocyte count, platelet count, serum iron, total iron-binding capacity, transferrin saturation or erythrocyte protoporphyrin did not differ significantly between the two groups throughout the study. After 16 weeks of therapy, the mean increase in hemoglobin iron was similar in both groups (p = 0.2). Estimates of net changes in total body iron suggested that the overall bioavailability of carbonyl iron was high, about 70% that of ferrous sulfate.

Red blood cell mass in autologous and homologous blood units. Implications for risk/benefit assessment of autologous blood crossover and directed blood transfusion.

A prospective analysis of 300 consecutively collected homologous blood (HB) units from a regional blood center and an analysis of 188 consecutively collected autologous blood (AB) units from a community hospital was conducted. Analysis of the red blood cell (RBC) mass content of these blood units revealed that HB contained 13 percent more RBC than AB: 200 +/- 1.1 vs 177.1 +/- 1.1 mL, (m +/- SE), respectively (p less than 0.05). Of 174 AB units eligible for crossover by AABB criteria for RBC mass (greater than or equal to 154 mL), 35 (20%) were below the 95 percent confidence interval range for RBC mass of HB units collected; mean RBC mass of 300 HB units was 12 percent greater than that of 174 AB units (200.1 +/- 1.1 vs 178.9 +/- 0.9 mL, p less than 0.001) and 20 percent greater than that of the 35 AB units outside the 95 percent confidence interval (200.1 +/- 1.1 vs 161.2 +/- 0.5 mL, p less than 0.001). These findings indicate that an evaluation of the issues of AB crossover for HB transfusion should include a risk/benefit analysis of AB units with lower RBC mass. These findings also indicate that the proposed changes in AABB standards regarding directed donation (DD) should consider the reduced benefits of DD units with lower RBC mass in a risk/benefit analysis of this practice, and support retention of homologous donor standards for directed donors.

[Retrospective sero-epidemiologic survey on dengue virus in the municipalities of Cienfuegos and Palmira]. / Encuesta seroepidemiológica retrospectiva a virus dengue en los municipios Cienfuegos y Palmira.

A retrospective seroepidemiologic survey is made in the municipalities of Cienfuegos and Palmira to determine the presence of neutralizing antibodies to Den-1 and -2 virus in the population. It was found that 21.4% of the population studied had antibodies to Den-1, 12.3% to Den-2, and that 5.5% had been infected by the two serotypes (secondary infection). It became apparent that in the Palmira municipality the percentage of infection due to Den-1 was higher and it was found that in 1980-1981 there was a late dengue (Den-1) outbreak. Therefore, this municipality was probably the only in the country with 2 epidemic outbreaks due to two dengue serotypes (1 and 2) in a 6 month interval. The potential relationship between this fact and the high lethality of hemorrhagic dengue fever in this municipality is established. The influence of environmental, social, and sanitary factors on the risk of infection is suggested. It was found that Whites and Blacks are equally infected and that infection is not a random phenomenon, instead it is favored by the presence of vectors in and around the housing.

Dengue haemorrhagic fever/dengue shock syndrome: lessons from the Cuban epidemic, 1981.

Dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS) is one of the principal causes of hospitalization and death among children in several south-east Asian countries. Also, in the Region of the Americas, there has been an increase in the frequency of dengue fever epidemics and in the number of cases of DHF/DSS. In 1981 an epidemic of dengue haemorrhagic fever occurred in Cuba and this suggests that there is a high risk that such epidemics could recur in the region. The article summarizes the main clinical, virological, and epidemiological data obtained during the outbreak, some of which are reported for the first time.

Why dengue haemorrhagic fever in Cuba? 1. Individual risk factors for dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS).

During the dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS) epidemic in Cuba in 1981, we identified some individual risk factors for the development of the severe clinical picture or for the fatal outcome of the disease. The percentage of secondary infection in 3 groups of patients with DHF/DSS was between 95 and 98.3 and it is concluded that secondary infection is an important, but not the only, condition for the development of DHF/DSS. An analysis of these 3 groups of patients and a fourth group of fatal cases showed that chronic diseases such as bronchial asthma, diabetes mellitus and sickle cell anaemia were additional risk factors contributing significantly to the development of DHF/DSS. The study also revealed that race was an individual risk factor, since DHF/DSS was more prevalent in white than in black persons.

Why dengue haemorrhagic fever in Cuba? 2. An integral analysis.

The epidemiological factors present in Cuba in 1981, when the dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS) epidemic occurred, were exceptional when compared to those of other countries in the region. Evidence is presented which demonstrates that virulence of the circulating strain is an important element in the analysis of an epidemic. Although the two current hypotheses to explain the occurrence of DHF/DSS epidemics are valid in well defined but different epidemiological situations, neither Halstead's hypothesis of secondary-type infection or Rosen's hypothesis of the role played by the virulence of the circulating strain can explain all cases. An integrated, multifactorial and unifying hypothesis is presented, which could be applied in different epidemiological situations. It is based mainly on an in-depth analysis of the literature and of the Cuban experience.

Multiple microcrystal deposition disease in a patient with systemic lupus erythematosus.

A 17-year-old female patient with systemic lupus erythematosus (SLE) developed chronic tophaceous gout, chondrocalcinosis and articular capsule calcification in several joints. Analysis of synovial fluid and tophi revealed the coexistence of monosodium urate, calcium pyrophosphate, hydroxyapatite, and cholesterol crystals.