ABSTRACT
The first licensed dengue vaccine, CYD-TDV (Dengvaxia) is efficacious in seropositive individuals, but increases the risk for severe dengue in seronegative persons about two years after administration of the first dose. For countries considering the introduction of Dengvaxia, WHO recommends a pre-vaccination screening strategy whereby only persons with evidence of a past dengue infection would be vaccinated. Policy-makers need to consider the risk-benefit of vaccination strategies based on such screening tests, the optimal age to introduce the vaccine, communication and implementation strategies. To address these questions, the Global Dengue and Aedes-transmitted diseases Consortium (GDAC) organized a 3-day workshop in January 2019 with country representatives from Asia and Latin America. The meeting discussions highlighted many challenges in introducing Dengvaxia, in terms of screening test characteristics, costs of such tests combined with a 3-dose schedule, logistics, achieving high coverage rates, vaccine confidence and communication; more challenges than for any other vaccine introduction programme. A screening test would require a high specificity to minimize individual risk, and at the same time high sensitivity to maximize individual and population benefit. The underlying seroprevalence dependent positive predictive value is the best indicator for an acceptable safety profile of a pre-vaccination screening strategy. The working groups discussed many possible implementation strategies. Addressing the bottlenecks in school-based vaccine introduction for Dengvaxia will also benefit other vaccines such as HPV and booster doses for tetanus and pertussis. Levels of public trust are highly variable and context specific, and understanding of population perceptions and concerns is essential to tailor interventions, monitor and mitigate risks.
Subject(s)
Dengue Vaccines/therapeutic use , Adolescent , Adult , Antibodies, Viral/immunology , Child , Dengue/immunology , Dengue/microbiology , Dengue/prevention & control , Dengue Vaccines/immunology , Dengue Virus , Humans , Immunization Programs/methods , Public Health , Seroepidemiologic Studies , Vaccines, Attenuated/therapeutic use , World Health Organization , Young AdultABSTRACT
Se realiza un estudio descriptivo del programa de hepatitis C en el centro penitenciario de Sevilla, desde su inicio en el año 2000 hasta la actualidad. Se han incluido en dicho programa a 291 pacientes, de los cuales 109 iniciaron tratamiento, 58 con interferón convencional más ribavirina (primera época) y 56 (51+ 5 rescates) con interferón pegilado más ribavirina (momentoactual). A fecha de 31 de julio existen 78 pacientes en distintas fases de estudio pendientes de la decisión final de tratar o no.Se hace referencia en esta ponencia a los distintos genotipos encontrados: 51% genotipo 1, 3% genotipo 2, 30% genotipo 3 y 16% genotipo 4, así como a los resultados encontrados en la biopsia realizada a 85 pacientes.Especial mención merece el análisis de las causas de abandono de tratamiento (36), en la idea de evitar en la medida de lo posible aquellas que son susceptibles de ser modificadas (libertad y traslados). También se realiza un recorrido en el porqué no llegaron a iniciar tratamiento algunos internos incluidos en el estudio
A descriptive study of the hepatitis C programme in the Seville penitentiary centre, from its beginning in 2000 until today.This programme was made up of 291 individuals, of whom 109 began treatment, 59 with conventional interferon plus ribavirin (first stage) and 56 (51+5 recoveries) with pegylated interferon plus ribavarin (present day). As of 31st July, there were 78 patients pending a final decision on whether they were to receive treatment or not.Reference is made to the different genotypes encountered: 51% genotype 1, 3% genotype 3 and 16% genotype 4, as well as to the results obtained in biopsies performed on 85 patients. Special mention is made of the causes of abandoning treatment (36), in order to eliminate as far as possible those causes that were likely to be modified (discharge and transfers). The article also examines the reasons why some inmates included in the study did not actually begin treatment
Subject(s)
Humans , Hepatitis C, Chronic/drug therapy , Antiviral Agents/therapeutic use , HIV Infections/complications , Hepacivirus/pathogenicity , Hepatitis C, Chronic/epidemiology , Prisons , Ribavirin/therapeutic use , Interferons/therapeutic useABSTRACT
Objetivo. Analizar nuestros resultados en el tratamiento endovascular de cinco casos con patología de la aorta torácica descendente. Pacientes y métodos. Hemos tratado mediante la colocación de endoprótesis recubierta a cinco pacientes varones, con una edad media de 63 años (54-72) y con diversa patología de la aorta torácica descendente. Las patologías fueron: dos aneurismas de aorta torácica descendente de 7 y 7,5 cm de diámetro, respectivamente, una fístula aortobronquial, una rotura traumática a nivel del itsmo y una disección aguda tipo B. Las endoprótesis implantadas fueron en cuatro tipo TalentÔ y una AneuRxÔ. Resultados. En todos los casos se consiguió el éxito técnico y clínico inmediato. Como complicación postoperatoria se presentó un caso de monoparesia radial no relacionada directamente con el procedimiento. La media de seguimiento ha sido de 11 meses (6-18). En todos los casos se realizó una TAC a los 3, 6 y 12 meses sin que se presentara ninguna complicación. Conclusión. La técnica endovascular ha resultado eficaz y segura para el tratamiento de las patologías de la aorta torácica descendente (AU)
Subject(s)
Aged , Male , Middle Aged , Humans , Aorta, Thoracic/surgery , Aortic Diseases/surgery , Blood Vessel Prosthesis Implantation , Tomography, X-Ray Computed , Follow-Up Studies , Aorta, Thoracic , Aortic Diseases , Treatment OutcomeABSTRACT
The human vas deferens (VD) is often considered simply as a conduit to transfer mature sperm from the epididymis to the ejaculatory duct. The cells that make up the epithelium of the VD, however, exhibit many characteristics of cells found in more complex epithelia, which are involved in absorption and/or secretion. In the present investigation, morphometry was utilized to characterize in detail the changes incurred by the human VD during its development, growth, and aging and to determine if these changes correlate with testicular maturation. In addition, the specific types of keratins present in the epithelial cells were defined, as well as desmin distribution in the muscular layers, during the various phases of the development, growth, and involution of the human VD. Results of the morphometric study are consistent with the interpretation that the development, growth, and aging of the VD are delayed, but parallel to, the identical phases exhibited by the human testis. Further, a differential expression of distinct keratin types was observed in the VD during the various phases examined in this study. Taken together, these two correlations may suggest that the VD is unlikely to function solely as a conduit for sperm. The rationale for this interpretation is as follows: 1) the complex developmental and maturational changes measured in the present investigation in the human VD are common to other absorptive and/or secretory epithelia; and 2) these changes parallel developmental changes observed in other androgen-dependent epithelia of the male reproductive tract, which also function to contribute components to seminal fluid as well as to provide a conduit for sperm.