Worldwide vaccine inequality threatens to unleash the next COVID-19 variant.

The emergence of the Omicron variant (B.1.1.529 BA.1) near Johannesburg heralded the development of an unprecedented number of new COVID-19 infections across South Africa in November 2021. Omicron and its subvariants would soon become the dominant strains across Africa, Europe, and the United States. As with the Delta variant (B.1.617.2), Omicron emerged from an industrialized nation with one of the lowest vaccination rates of any well-developed country. The emergence of variants from undervaccinated regions is a direct consequence of the virus replicating unchecked through an unprotected population. Despite this, the United States and other higher-income nations have adopted a strategy of preferentially inoculating their citizens with multiple and booster doses, whereas lower-income nations struggle with vaccine availability, infrastructure, and their own vaccine manufacturing capability. Much more needs to be done to address worldwide vaccine inequities and prevent the emergence of the next devastating variant. The persistence of the pandemic anywhere remains an ongoing threat to citizens everywhere.

Proposal for the functional assessment of acute inflammatory neuropathy (FAAIN) in Guillain-Barré syndrome.

BACKGROUND: Guillain Barré syndrome (GBS) functional assessment is necessary in clinical practice, research and clinical trials. Existing instruments are not sensitive to change and are not applicable to the current GBS clinical spectrum. OBJECTIVE: To construct a functional assessment for acute inflammatory neuropathies (FAAIN-GBS), inclusive for current GBS spectrum that assesses extension and intensity separately. METHODS: FAAIN-GBS subscales were constructed. Its structure and interpretation were defined. It was validated using data from medical record of 167 GBS patients admitted to the Institute of Neurology and Neurosurgery. Cronbach α was used for items reduction and reliability analysis. Bartlett sphericity test was performed. Exploratory factor analysis (EFA) of the main components, with varimax rotation, was applied to evaluate dimensionality and content validity. Hughes scale was used as gold standard for criterion validity. Sensitivity, specificity and area under the receiver operating characteristic curves (AUROC), were calculated. Construct validity was assessed by confirmatory factor analysis (CFA). RESULTS: FAAIN-GBS is made up of two subscales (extension and intensity). The final score is obtained by averaging both dimensions. Internal consistency was acceptable (Cronbach 0.745). EFA showed three dimensions: intensity, spinal extension and cranial extension. Spearman correlation between FAAIN-GBS and Hughes scale was 0.463. Sensitivity (0.714) and specificity (0.986) values showed the good behavior of the scale; AUROC was 0.93. CONCLUSION: FAAIN-GBS was constructed and a first step of validation was made, showing good internal consistency and validity. New prospective studies with large populations will be necessary to perfect this instrument that could be useful in neurological practice.

Conquering COVID: How Global Vaccine Inequality Risks Prolonging the Pandemic.

The development of effective vaccines during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been deemed a towering achievement in modern science. Since the end of 2020, the vaccine rollout has offered the promise of vanquishing the pandemic in the United States and other developed countries. Even as the United States and other wealthier nations encounter both setbacks and successes in their coronavirus disease 2019 (COVID-19) eradication efforts, developing countries around the world are likely to face far less fortunate fates. With much of the world's vaccine production and distribution capacity reserved by wealthier nations, impoverished countries stand to face devastating financial, social, and health-related impacts. The consequences of this disparity will resonate deeply into the collective fabric of these countries, ensuring that the economic and geopolitical imbalance between developed and developing nations will widen even more substantially. Wealthier countries must do more to eliminate the inequality that exists in widespread SARS-CoV-2 vaccine availability in less-developed nations. Like HIV, tuberculosis, malaria, and other global epidemics, COVID-19 cannot be forgotten just because the pandemic is eventually contained from the shores of wealthier nations. For as long as the pandemic rages in any corner of the globe, the world will never be truly rid of COVID-19. And all nations, rich or poor, will suffer the consequences.

Pancreatitis and Acute Liver Failure From Coricidin® HBP Intoxication.

The use of over-the-counter medications as recreational drugs of abuse in adolescents is increasing. We present the case of a patient who presented with abdominal pain after the ingestion of Coricidin®, an over-the-counter cold medication that contains acetaminophen, chlorpheniramine maleate, and dextromethorphan hydrobromide. The case was complicated by acute liver failure and concomitant pancreatitis that, in a few reported cases, has been associated with high doses of acetaminophen.

A Neonate With Annular Cutaneous Lesions.

Neonatal lupus erythematosus is a rare disorder with a wide spectrum of clinical presentations. The disease can affect several systems, including the skin, heart, liver, and bone marrow. Thus, a recognition of its different presentations is vital for making a diagnosis. We describe the case of a neonate diagnosed with neonatal lupus, presenting with an acute onset of erythematous skin lesions as the sole manifestation. The patient's mother was healthy with no known medical history or relevant family history.

Elvitegravir: a once-daily inhibitor of HIV-1 integrase.

INTRODUCTION: Elvitegravir (EVG) is a potent inhibitor of HIV-1 integrase (IN) undergoing Phase III clinical trials. It blocks the strand-transfer step in a multi-step process that allows double-stranded cDNA to be irreversibly incorporated within the host DNA. It is the second member of the HIV-1 IN inhibitor class, following raltegravir. Co-administration with a CYP3A inhibitor, such as ritonavir or cobicistat, substantially increases EVG plasma exposure and prolongs elimination half-life. AREAS COVERED: A Medline review of Phase II and III trials involving EVG as well as a review of abstracts from major HIV and infectious disease conferences from 2010 to 2011 was conducted. EVG produces rapid and durable virologic suppression when combined with active background therapy. Trials investigating the efficacy of once-daily co-formulated elvitegravir/cobicistat/emtricitabine/tenofovir (EVG/COBI/FTC/TDF) demonstrate a high rate of virologic suppression with fewer CNS and psychiatric adverse events compared with co-formulated efavirenz/emtricitabine/tenofovir. The resistance profile for EVG is similar to raltegravir. EXPERT OPINION: Co-formulated EVG/COBI/FTC/TDF is an option for the treatment of antiretroviral naïve and experienced patients. Once-daily dosing offers an advantage over raltegravir, but the requirement for pharmacologic boosting increases regimen complexity. Dolutegravir in development offers a favorable resistance profile and no requirement for pharmacologic boosting.

Fenotipo electrorretinográfico en pacientes con Retinosis Pigmentaria / Electroretinography phenotype in retinitis pigmentosa patients

Para describir el fenotipo electrorretinográfico en pacientes con Retinosis Pigmentaria y determinar su relación con el modo de herencia y la edad de comienzo de los síntomas, se estudiaron 74 pacientes en estadio I de la enfermedad, a los cuales se les realizó electrorretinograma estandarizado. El 64(percent) de los pacientes tuvieron un electrorretinograma no registrable y el 36(percent) mostró registros. El patrón electrorretinográfico más frecuente fue el bastón-cono (63(percent), seguido por el cono-bastón (22(percent) en los pacientes con registros. El 100(percent) de los pacientes con herencia ligada al cromosoma X no presentaron registros y no se observó el patrón electronegativo. El patrón cono-bastón se asoció al modo de herencia autosómico recesivo, que fue el más frecuente, seguido por el autosómico dominante y, por último, el recesivo ligado al cromosoma X. El comportamiento del electrorretinograma en el estadio I de la enfermedad, evidencia que este es el primer nivel de expresión de las mutaciones de cualquiera de los tipos hereditarios de Retinosis Pigmentaria y muestra diferente grado de afectación de acuerdo con el modo de herencia…(AU)

El dolor en afecciones vasculares periféricas: factores psicosociales asociados / Pain peripheral vascular affections: associated psychosocial factors

El presente trabajo se propuso caracterizar el dolor en afecciones vasculares periféricas e identificar los factores psicosociales asociados a él. El grupo de estudio se conformó por 33 pacientes con afecciones vasculares periféricas: 9 pacientes arteríticos, 9 con pie diabético isquémico, 9 con úlceras posflebíticas y 6 pacientes con ateroesclerosis. Se emplearon: el McGill Pain Questionnaire de Melzack, la escala de malestar por dolor de Rial y otros, y un sistema computadorizado cubano que permite evaluar los factores psicosociales asociados al dolor. De acuerdo con los resultados obtenidos, el dolor en el grupo estudiado se caracterizó por tiempos de evolución prolongados, alta frecuencia y intensidad y se vivencia dramáticamente; se asocia a un malestar apreciable, mayores limitaciones de la actividad, alta vivencia de limitación o sufrimiento por estas limitaciones, presencia marcada de estados emocionales negativos y tendencia a la insatisfacción en diversas áreas básicas de la vida(AU)

Construcción de tablas de valores de pruebas funcionales respiratorias según edad, talla y peso en niños cubanos / Building up of tables of values for respiratory functional tests according to age, height and weight in cuban children

El objetivo de la investigación fue el de normalizar un conjunto de ecuaciones de variables respiratorias (volumen espiratorio forzado al 1er. segundo (FEV 1), flujo pico espiratorio (PEF), flujo espiratorio máximo al 25% (Vmáx 25%) y flujo máximo promedio entre el 25 y el 75% de la capacidad vital forzada (MMEF) que anteriormente habían demostrado sensibilidad para detectar niños asmáticos sin síntomas, ni signos. El trabajo expone, en detalle, las condiciones del espirómetro utilizado y el procedimiento de las pruebas, premisas necesarias para establecer valores de predicción, pues las mediciones posteriores han de reproducir estos métodos. Se discute el método estadístico del proceso de normalización y se presentan las tablas en dependencia de la edad y 2 variables corporales: talla y peso. (AU)

Construcción de tablas de valores de pruebas funcionales respiratorias según edad, talla y peso en niños cubanos / Building up of tables of values for respiratory functional tests according to age, height and weight in cuban children

El objetivo de la investigación fue el de normalizar un conjunto de ecuaciones de variables respiratorias (volumen espiratorio forzado al 1er. segundo (FEV 1), flujo pico espiratorio (PEF), flujo espiratorio máximo al 25% (Vmáx 25%) y flujo máximo promedio entre el 25 y el 75% de la capacidad vital forzada (MMEF) que anteriormente habían demostrado sensibilidad para detectar niños asmáticos sin síntomas, ni signos. El trabajo expone, en detalle, las condiciones del espirómetro utilizado y el procedimiento de las pruebas, premisas necesarias para establecer valores de predicción, pues las mediciones posteriores han de reproducir estos métodos. Se discute el método estadístico del proceso de normalización y se presentan las tablas en dependencia de la edad y 2 variables corporales: talla y peso.