COVID-19 vaccination plans in Latin America and the Caribbean: a multi-country comparative analysis of prioritization strategies.

OBJECTIVES: This study aimed to synthesize and compare the prioritization strategies outlined in the national vaccination plans (NVPs) against Coronavirus Disease 2019 (COVID-19) developed by countries in the Latin America and Caribbean (LAC) region. STUDY DESIGN: We conducted a comparative policy analysis based on COVID-19 NVPs. METHODS: We conducted a search strategy in three stages to identify NVPs for COVID-19 across 41 countries/territories in the LAC region. Sources included official governmental repositories, complementary Google searches, and less formal documentation. We extracted key variables and conducted a comparative policy analysis based on the prioritization criteria and specific prioritization groups. RESULTS: The study identified 52 NVPs for COVID-19, corresponding to 27 (65.8 %) out of 41 countries/territories in the LAC region. Official national websites yielded documents for 12 countries. All NVPs included frontline healthcare personnel in the first prioritization phase/stage, whilst some included residents of long-term healthcare facilities, adults aged 60 years or more, and people with disabilities. The decision criteria for prioritization were declared in 14 countries/territories. Ethical considerations declared in five NVPs included human welfare, equality, solidarity, equity, and social justice as values. CONCLUSION: The early stages of vaccination rollout in LAC countries prioritized protection of the healthcare system and epidemiological risk for severe disease. Few countries included ethical considerations in their NVPs, and global inequities in vaccine access and distribution led to varied protections for vulnerable populations across LAC. This analysis highlights the need for improved emergency-response capacity, planning, and enhanced multilateral cooperation in the LAC region for future public health emergencies.

Unacceptable persistence of territorial inequalities in avoidable under-five mortality in Colombia between 2000 and 2019: a multilevel approach.

OBJECTIVES: This study aimed at evaluating territorial inequalities in avoidable mortality in children under 5 years of age in Colombia between 2000 and 2019. STUDY DESIGN: This was an ecological study. METHODS: An ecological, longitudinal, multigroup study was conducted using secondary sources. Because of the hierarchical structure of the data, the effect of territorial characteristics on the count of avoidable under-five deaths was estimated using a three-level negative binomial regression model with random intercepts for municipality and fixed intercepts for time and departments. RESULTS: Between 2000 and 2019, there were 216,809 avoidable under-five deaths in Colombia (91.3% of all registered deaths of children under 5 years of age). A total of 1117 municipalities located in 33 departments were analyzed over five 4-year periods. Ecological relationships were found between avoidable under-five mortality and the percentage of adolescent births, female illiteracy, and multidimensional poverty at the municipal level (standardized mortality ratio: 1.43 95% confidence interval: 1.33-1.54 for the group with the highest level vs the group with the lowest level of poverty). Furthermore, multidimensional poverty was a confounding factor for the association between the percentage of the population living in rural areas and avoidable child mortality. CONCLUSIONS: Systematic and avoidable gaps were observed in mortality in children aged under 5 years in Colombia, where the territory constitutes an axis of inequality. Implementing strategies and programs that contribute to improving the conditions of women and socio-economic conditions in the territories should be a priority.

Effectiveness of contact tracing to reduce fatality from COVID-19: preliminary evidence from Colombia.

OBJECTIVES: Conducting contact tracing (CT) programs in low- and middle-income countries is challenging, and there is no evidence of their effectiveness in Latin America. We evaluated the effectiveness of CT on reducing fatality from COVID-19 in Colombia. STUDY DESIGN: The study design is a retrospective cohort study with nation-wide data of suspected and confirmed cases of severe acute respiratory syndrome (SARS-CoV-2) infection and their registered contacts. METHODS: We analyzed confirmed and suspected COVID-19 cases and their chains of contact using a nation-wide registry from March 28, 2020 to January 13, 2021. To estimate the effect of CT on fatality, we adjusted a multilevel negative binomial model using the number of deaths and the number of people within a chain of contacts as the outcome variable and offset variable, respectively. Sensitivity analysis was conducted using different cutoff values of contacts traced and a logistic model for the effect of CT on death at an individual level. RESULTS: We analyzed 1.4 million cases, 542,936 chains of contact, and 46,087 deaths. Only, 5.8% of total cases and contacts were included in a chain of a case and five or more contacts. We found that tracing of at least five contacts per case reduces fatality by 48% (95% confidence interval: 45-51), and, at the current levels of tracing in Colombia, it prevents 1.8% of deaths. Results obtained from the sensitivity analysis were consistent with the reduction of fatality at an individual level and higher protective effect with the higher number of contacts traced. CONCLUSIONS: In Colombia, tracing of at least five contacts per case reduces fatality from COVID-19. The coverage and intensity of tracing needs to be increased as a strategy to mitigate fatality in Colombia.

Study of the presence of spherical deformations on the Al top electrode due to electroforming in rewritable organic resistive memories.

Physical deformations are observed at the top electrodes during the electroforming process in Al/PEDOT:PSS + nitrogen doped multiwalled carbon nanotube (N-MWCNTs)/Al rewritable resistive memory devices. These physical deformations arise from electrochemical reactions, i.e., a reduction reaction in the native Al oxide layer, which are similar to those reported in TiO2-based resistive memory devices. These memory devices are electroformed at the ON state using an ∼-2 V pulse or at the OFF state using an ∼3 V pulse. These processes are current-controlled; a minimum compliance current is necessary to obtain the electroforming of the device, generally between 5 to 10 mA. SEM and AFM micrographs show the presence of spherical deformations at the top electrode due to O2 gas formation generated by the reduction in the native AlOx layer during the electroformation, with a diameter of ∼7 micrometres for positive voltage or a smaller diameter of ∼3 micrometres for negative voltage. After top-electrode delamination, circular craters are found in the active layer in the vicinity of the N-MWCNTs, which only occurs when a negative voltage is used in the electroformation, indicating that film damage is induced by oxygen bubbles created at the bottom electrode/polymeric film interface.

[Magnet intestinal lesions. Case series]. / Lesiones intestinales por imanes. Serie de casos.

The ingestion of foreign bodies is a common trouble in the pediatric population, and most of cases occur between 6 months and 3 years. In general the vast majority of foreign bodies are not associated with morbidity or mortality. Ingestion of two or more magnets can lead to obstruction, fistulas, ulceration, perforation and bowel volvulus. In this series we present 4 cases of patients ingesting multiple magnets and who due to the ingested foreign body characteristics and clinical profile required surgical treatment.

Performance of public health surveillance systems during the influenza A(H1N1) pandemic in the Americas: testing a new method based on Benford's Law.

The A(H1N1) influenza pandemic has been a challenge for public health surveillance systems in all countries. An objective evaluation has not been conducted, as yet, of the performance of those systems during the pandemic. This paper presents an algorithm based on Benford's Law and the mortality ratio in order to evaluate the quality of the data and the sensitivity of surveillance systems. It analyses records of confirmed cases reported to the Pan American Health Organization by its 35 member countries between epidemiological weeks 13 and 47 in 2009. Seventeen countries did not fulfil Benford's Law, and mortality exceeded the regional average in 40% of the countries. The results suggest uneven performance by surveillance systems in the different countries, with the most frequent problem being low diagnostic coverage. Benford's Law proved to be a useful tool for the evaluation of a public health surveillance system's performance.

Microcapsule-gel formulation of promethazine HCl for controlled nasal delivery: a motion sickness medication.

The current method of choice for astronauts to treat space motion sickness is an intra-muscular injection of promethazine hydrochloride (PMZ HCl) which is invasive and causes considerable local irritation and discomfort at the site of injection. Intra-nasal delivery is considered a feasible alternative route for administration of medications to treat space motion sickness. The purpose of this research is to develop a PMZ HCl formulation that can be administered intra-nasally without irritation (i.e. leukocyte infiltration) in the nasal epithelium when dosed at PMZ HCl concentrations greater than the cytotoxic limit. The biocompatibility of PMZ HCl was tested in vitro and was shown to be cytotoxic at concentrations greater than 10(-5) molar regardless of pH. A controlled-release microencapsulated dosage formulation was developed using spinning disk atomization and release rates for the PMZ HCl microcapsules were determined in phosphate buffered saline. An animal study was conducted to determine the irritation response of rat nasal mucosa when dosed with encapsulated and non-encapsulated PMZ HCl.

Mucosal delivery of cytotoxic therapeutic agents: response of rat nasal mucosa to microencapsulated ethopropazine HCl enantiomer.

Use of microencapsulation technology in combination with absorption enhancers eliminated epithelium irritation and necrosis commonly associated with nasal delivery of cytotoxic therapeutic agents. Phenothiazines, such as ethopropazine (ETZ), promethazine, trimeprazine and propiomazine have been used for the treatment of allergenic conditions, motion sickness, nausea, Parkinson's disease, Prion disease and as a sedative for psychiatric disorders. The enantiomers of commercially available racemic phenothiazines were isolated and purified using classical diastereomeric salt techniques. The racemate and the enantiomers of ETZ were tested in vitro for their cellular toxicity using lung fibroblast cells. Each enantiomer was shown to be cytotoxic at concentrations greater than 10(-5) molar. The ETZ enantiomers were encapsulated using spinning disk atomization to prepare a nasal delivery dosage form that does not produce an irritation response. Release rates for the ETZ microcapsules were determined in vitro and an animal study was conducted to determine the irritation response of rat nasal mucosa when dosed with encapsulated vs. non-encapsulated ETZ.

An improved HPLC assay for S-2-(3-aminopropylamino)ethyl phosphorothioate (WR-2721) in plasma.

An HPLC assay is presented for the detection and quantitation of the radioprotective drug S-2-(3-aminopropylamino)ethyl phosphorothioate (WR-2721, ethiofos) present in plasma. Improved selectivity and a 40-fold increase in sensitivity have been demonstrated over the method previously reported by this laboratory. Using precolumn derivatization with fluorescamine and S-3-(4-aminobutylamino)propyl phosphorothioate (WR-80855, a homolog of WR-2721) as the internal standard, drug levels of 0.05 to 1000 micrograms/mL were determined with excellent precision (CV less than or equal to 5% over the concentration range). An isocratic mobile phase of acetonitrile/ethanol/water (16:7:77) modified with 0.01 M tetrabutylammonium phosphate eluted the drug and the internal standard from the C-18 reverse-phase column in 23 minutes and 26 minutes, respectively. Detector response was linear over the entire range. The assay uses 150 microL of plasma and requires a total chromatography time of about 50 minutes. The method was found suitable for pharmacokinetic studies in a preliminary experiment with a beagle dog in which no interferences due to plasma constituents or drug metabolites were observed.