Strengthening disease surveillance capacity at national level across five countries: a qualitative study.

OBJECTIVES: Disease surveillance is an essential component of public health and a core function of National Public Health Institutes (NPHIs), including to better prepare and respond to infectious diseases outbreaks. Strengthening NPHIs in their efforts to establish and maintain efficient surveillance systems is an opportunity to ensure future outbreak preparedness and response; yet, guidance on how to increase and prioritise capacity building efforts is limited. This study sought to investigate approaches to capacity building and training for disease surveillance at national level and understand the potential role of NPHIs. STUDY DESIGN: Qualitative study. METHODS: This is a qualitative study, based on a literature review and interviews undertaken between June and November 2022. Fifty seven in-depth interviews were conducted in five countries: Côte d'Ivoire, Ecuador, Madagascar, Namibia, and the Kingdom of Saudi Arabia. Participants included a range of professionals from government, NPHIs, academic institutions and the private sector. Interviews were thematically analysed. RESULTS: Selected countries varied in terms of their disease surveillance capacities, as well as in the structure of their surveillance systems and decision-making. Research identified shared priority areas for action at national level, identifying common challenges and opportunities: 1) capacity building, here specifically the need for a training agenda at national level to ensure sustainability and guide donor funded training offers; 2) data tools and technology-to help decision-makers select the best software tool to address countries' identified need; 3) data sharing-the need for clear data sharing standards and norms for national to international data sharing; and 4) genomic sequencing-the need for national genomic surveillance strategies and reporting guidelines. CONCLUSION: Addressing challenges and using opportunities to strengthen disease surveillance at national level is an important step to build capacity in this area and to help prevent future epidemic and pandemics globally. The findings of this study help decision-makers to identify priority areas for capacity building and understand the potential role and significance of NPHIs.

Recomendaciones para la administración de antineoplásicos e inmunomoduladores orales por sonda enteral en oncohematología / Recommendations for using oral antineoplastic and immunomodulating agents in oncohematology by enteral tube administration

Introducción y objetivo: en los últimos años, el número de fármacos antineoplásicos e inmunomoduladores orales (ANIOS) ha crecido enormemente. Con frecuencia, estos fármacos deben administrarse por sonda enteral (SE) o a pacientes con problemas de deglución, planteando un problema respecto a su manipulación (muchos pertenecen al grupo de medicamentos peligrosos). Además, también pueden presentar interacciones cuando se administran con la nutrición enteral (NE). El objetivo ha sido analizar y actualizar las recomendaciones de administración y manipulación de los ANIOS. Métodos: se creó un Grupo de Trabajo formado por farmacéuticos del Grupo de Farmacia de la Sociedad Española de Nutrición Clínica y Metabolismo (SENPE) y del Grupo de Nutrición Clínica de la Sociedad Española de Farmacia Hospitalaria (SEFH). Se realizó una revisión bibliográfica entre 2015 y 2020 de las condiciones de manipulación y administración de los ANIOS en oncohematología, elaborando una tabla que recoge especialidades farmacéuticas, dosis, presentación, nombre comercial, instrucciones para la administración oral y por SE, interacciones con la NE, precauciones y observaciones para su manipulación y administración. Resultados: se elaboró una tabla con 77 principios activos y 84 formas farmacéuticas, recogiendo recomendaciones e instrucciones para su administración por vía oral, sonda nasogástrica y gastrostomía, para la correcta manipulación y para la administración junto a la NE. Conclusiones: la información sobre cómo administrar y manipular los ANIOS en personas con accesos enterales o problemas de deglución es escasa. Consideramos importante incluir en los estudios poscomercialización una investigación dirigida a responder a estas cuestiones para garantizar una administración segura y eficaz de los medicamentos a estos pacientes (AU)

Introduction and objective: in recent years, the number of oral antineoplastic and immunomodulating drugs in oncohematology has increased enormously. Often, these drugs must be administered to patients with enteral tube feeding or swallowing disorders, which causes safety problems when handling these drugs (many of them are classified as hazardous drugs). In addition, it is important to note that the administration of these drugs can also interact with enteral nutrition (EN). The objective of this study was to review and update the recommendations for the administration and handling of oral antineoplastic and immunomodulating drugs. Methods: a Working Group made up of pharmacists from the Pharmacy Group of The Spanish Society of Clinical Nutrition and Metabolism (SENPE) and the Clinical Nutrition Group of The Spanish Society of Hospital Pharmacy (SEFH) was created. A bibliographic review was carried out between 2015 and 2020 on the administration and handling of oral antineoplastic and immunomodulating drugs in oncohematology. The information about pharmaceutical specialties, dosage, presentation, brand names, instructions for oral or enteral tube administration, interactions with EN, precautions, and remarks for handling and administration was analyzed. Results: a total of 77 active principles and 84 pharmaceutical forms were included. Recommendations and instructions for oral, nasogastric tube, and gastrostomy administration, handling of the antineoplastic and immunomodulating drugs, and interactions with EN were described. Conclusions: the handling and administration information about the oral antineoplastic and immunomodulating drugs currently used in oncohematology for people with enteral accesses or swallowing disorders is limited. It is important to perform post-marketing studies to ensure a safe and effective administration of these drugs (AU)

Assessing the spreading potential of an undetected case of COVID-19 in orthopaedic surgery.

BACKGROUND: With the novel coronavirus-induced disease (COVID-19), there is the fear of nosocomial infections and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmissions to healthcare workers (HCW). We report the case of a 64-year-old male patient who underwent explantation of a shoulder prosthesis due to a periprosthetic infection. He was tested SARS-CoV-2 positive 7 days after admission to the orthopaedic department following strict infection control measures, routinely including screening all patients for multi-drug-resistant organism (MDRO) colonization upon admission. Aim of our study is to report on the spreading potential of SARS-CoV-2 in a healthcare setting if standard contact precautions and infection control measures have been established. METHODS: All HCW with exposure to the patient from day of admission until confirmed diagnosis of COVID-19 were identified and underwent oropharyngeal swab testing for SARS-CoV-2 by real-time RT-PCR. RESULTS: Sixty-six HCW were identified: nine orthopaedic surgeons, four anaesthesiologists, 25 orthopaedic nurses, five nurse anesthetists, eight scrub nurses, five nursing students, two medical assistants and seven service employees. Fourteen HCW (21%) showed clinical symptoms compatible with a SARS-CoV-2 infection: cough (n = 4), sore throat (n = 3), nasal congestion (n = 3), dyspnea (n = 2), fever (n = 1), headache and myalgia (n = 1). SARS-CoV-2 was not detected in any of the 66 HCW. CONCLUSION: Hygienic measures and contact precautions, aimed at preventing the spread of MRDO, may have helped to prevent a SARS-CoV-2 transmission to HCW-despite high-risk exposure during intubation, surgical treatment and general care. LEVEL OF EVIDENCE: IV, case series.

A child with soft-tissue infection and lymphadenitis.

We report a case of a soft-tissue infection with Francisella philomiragia, a rare opportunistic pathogen in individuals with chronic granulomatous disease.

Lipids, apoprotein B, and associated coronary risk factors in urban and rural older Mexican populations.

The objective of this comparative cross-sectional study was to determine the prevalence of dyslipidemias and examine its association with food intake and metabolic variables in urban and rural elder Mexican populations. Three different communities (urban areas of medium and low income and a rural area) were studied. A total of 344 subjects aged 60 years and older and 273 aged 35 to 59 years were included. The evaluated parameters were personal medical data, 24-hour diet recall, and fasting plasma lipids, insulin, and glucose levels. Older subjects, especially men, living in the rural area had lower cholesterol levels (5.02 +/- 0.97 v 5.6 +/- 1.07 mmol/L; P <.05) and insulin levels (12 +/- 10 v 42 +/- 68 mU/mL) and higher high-density lipoprotein cholesterol concentrations (1.31 +/- 0.36 v 1.07 +/-0.28 mmol/L) than the elders from the urban medium-income group. Possible explanations for these differences are found in the dietary habits of the groups. Rural elders had higher amounts of fiber (20 +/- 11 v 10 +/- 6 g/d) and carbohydrate (70% +/- 0.08% v 52% +/- 0.11% of calories) and lower fat (18% +/- 0.07% v 33% +/- 0.1% of calories) in their diets. In the urban groups, low-density lipoprotein hypercholesterolemia was present in 17.8% of adult and 39.1% of elderly women (P =.00001). In conclusion, environmental factors still play a prominent role in the pathophysiology of the dyslipidemias in the elderly.

Uso de dantroleno en profilaxis de hipertermia maligna / Malignant hyperthermia prophylaxis with dantrolene. A case report

La hipertermia maligna es un desorden farmacogenético del músculo esquelético puesto de manifiesto cuando los sujetos susceptibles son expuestos a agentes anestésicos volátiles y/o relajantes musculares despolarizantes. Es uno de los síndromes más graves asociados a la anestesia. Se describe un caso clínico de un paciente propuesto para colectomía izquierda que presentaba antecedentes de crisis de hipertermia maligna en una intervención anterior. La conducta a adoptar ante un paciente susceptible se debe orientar en tres vertientes: a) evitar los agentes desencadenantes; b) profilaxis con dantroleno, y c) tratamiento de la crisis (AU)

Zinc-histidine as nucleation centers for growth of ZnS nanocrystals.

Histidine is a chelator of zinc, most notably in zinc-finger proteins (zinc coordinated by cysteine and histidine) and in hyperaccumulator plants. Sulfide incorporation into molecules containing metal-cysteinyl complexes has been shown to occur in vivo in certain yeasts, leading to enhanced metal tolerance. Demonstrated here for the first time is incorporation of sulfide into zinc-histidine, resulting in histidine-ZnS nanocrystals (NCs) having unique optical properties. Sulfide complexation occurred optimally at alkaline pH into zinc-(histidine)2 species, and UV/Vis absorption maxima were red-shifted as increasing sulfide addition occurred. Intermediate sulfide concentrations led to multiple, thermodynamically preferred NC species within a sample. Fluorescence of histidine-ZnS NCs was greater than ZnS prepared previously with cysteinyl peptides. Transmission electron microscopy and selected-area electron diffraction indicated hexagonal ZnS crystals having an average size of 4.2 nm. A photocatalytic application of histidine-ZnS NCs was shown by efficient degradation of p-nitrophenol and paraquat in the presence of UV irradiation.

The prevalence of obesity and its determinants in urban and rural aging Mexican populations.

OBJECTIVE: To determine the prevalence of obesity and its association to different variables in urban and rural older Mexican populations. METHODS AND PROCEDURES: A cross-sectional study of three different Mexican communities. A total of 121 men and 223 women 60 years and older and 93 men and 180 women aged 35 to 59 years old were selected randomly for inclusion in the survey. A personal interview assessed demographic information, personal medical history and functional status and a 24-hour diet recall was obtained. The physical examination included anthropometric and blood pressure measurements. A fasting blood sample was obtained for measurements of lipids, insulin and glucose. RESULTS: Obesity was highly prevalent in women, in individuals from the urban communities and diminished with advancing age. A BMI > or =30 kg/m2 was observed in 23.6% younger vs. 15.6% older adult men (p=0.21) and 28.4% younger vs. 19.7% older adult women (p = 0.06). The association of obesity with other variables was estimated using a stepwise multivariate logistic regression, increased insulin levels [Odds Ratio (OR) 1.68, p=0.006] and living in an urban area (OR 5.90, p<0.007) were variables independently associated to obesity in adult older individuals. In the younger adults, obesity was associated with hypertension (OR 2.74, p<0.0009), higher insulin levels (OR 1.31, p<0.03) and central adiposity (OR 2.97, p = 0.05), these relationship were not observed with gender, distribution of food or alcohol intake or other coronary risk factors. CONCLUSIONS: The present survey confirms the high prevalence of obesity in the Mexican urban population that declines with advanced age. Studies in elderly population must consider the bias produced by increased early mortality in those individuals with a more unfavorable risk profile.

Basolateral regulation of pHi in proximal tubules of avian loopless and long-looped nephrons in bicarbonate.

In isolated, nonperfused chicken proximal tubules from both loopless reptilian-type and long-looped mammalian-type nephrons, resting intracellular pH (pHi), measured with pH-sensitive fluorescent dye 2',7'-bis(2-carboxyethyl)-5,6-carboxyfluorescein (BCECF), was approximately 7.1 under control HCO3- conditions [20 mM N-2-hydroxyethylpiperazine-N'-2-ethanesulfonic acid (HEPES)/5 mM HCO3(-)-buffered medium with pH 7.4 at 37 degrees C] and was reduced to approximately 6.8 in response to NH4Cl pulse. The rate of recovery of pHi (dpHi/dt) from this level to the resting level in proximal tubules from both nephron types was (1) significantly reduced by the removal of Na+ or both Na+ and Cl- from the bath, and (2) unaffected by the removal of Cl- from the bath or the presence of a high K+ concentration or Ba2+ in the bath. In proximal tubules from long-looped mammalian-type, but not loopless reptilian-type, nephrons, dpHi/dt was significantly reduced by the addition of either 5-(N-ethyl-N-isopropyl) amiloride (EIPA) or 4,4'-diisothiocyanostilbene-2,2'disulfonate (DIDS) to the bath. These data suggest that a Na+/H+ exchanger and most likely a Na(+)-dependent Cl-/HCO3- exchanger are involved in basolateral regulation of pHi in mammalian-type nephrons whereas none of the commonly identified basolateral acid-base transporters appear to be involved in regulation of pHi in reptilian-type nephrons.

The prevalence of diabetes and associated coronary risk factors in urban and rural older Mexican populations.

OBJECTIVE: To determine the prevalence of diabetes and examine its association with food intake, anthropometric and metabolic variables, and other coronary risk factors in urban and rural older Mexican populations. DESIGN: A cross-sectional study. SETTING: Three Mexican communities (urban areas of medium and low income and a rural area). PARTICIPANTS: A total of 121 men and 223 women aged 60 years and older and 93 men and 180 women aged 35 to 59 years were selected randomly for inclusion in the survey, which was derived from the CRONOS study (Cross-Cultural Research on Nutrition in the Older Adult Study Group) promoted by the European Economic Community. MEASUREMENTS: A personal interview assessed demographic information, personal medical history, and functional status, and a 24-hour diet recall was obtained. A physical examination included anthropometric and blood pressure measurements. A fasting blood sample was obtained for measurements of lipids, insulin, and glucose. RESULTS: Diabetes prevalence was higher in men than in women for all age groups: 16.7% versus 9.5% in younger adults and 30.8% versus 22.8% in older adults. For all age groups, diabetes was more highly prevalent in urban communities. Using a multivariate stepwise logistic regression, variables associated independently with diabetes in older individuals were: gender (male sex: OR = 2.1; P < .009); diminished carbohydrate intake in the diet (OR = 0.77; P < .03); central distribution of adiposity (OR = 1.9; P < .03); and functional disability (OR = 2.3; P < .01). This relationship was not observed with living area, income, education, fiber and alcohol intake, body mass index, or age. Individuals 80 years and older had a diminished atherogenic risk profile. Diabetes in older people was associated significantly with hypertriglyceridemia, impaired functional status, and an increased prevalence of ischemic heart disease; in younger adults diabetes was associated with low density lipoprotein (LDL) hypercholesterolemia, hypertriglyceridemia, and a proportionally higher fat intake. CONCLUSION: This survey confirms the high prevalence of diabetes in the older Mexican population - particularly in men and in individuals living in urban areas - associated with an increased prevalence of other coronary risk factors. Diabetes was associated with higher fat, low carbohydrate, low fiber diets and increased prevalence of central distribution of adiposity. In the older subjects, diabetes was associated significantly with hypertriglyceridemia, impaired functional status, and increased prevalence of ischemic heart disease. A bias produced by early mortality and a survivorship effect must be considered in studies of older individuals. The health situation in the older Mexican population presents a complex problem that needs correct diagnosis and better strategies to benefit those segments of the population at increased risk.

Characterization of the bactericidal effects of sodium nitroprusside and other pentacyanonitrosyl complexes on the food spoilage bacterium Clostridium sporogenes.

The potent bactericidal activity of sodium nitroprusside (SNP; Na2[Fe(CN)5(NO)]) towards Clostridium sporogenes has been investigated. SNP inhibited cell growth in the concentration range of 10 to 40 microM. Concentrations above 80 microM caused irreversible loss of cell viability and cell lysis. Inhibition of cell growth was similar in complex and in defined media. SNP was found to be unreactive towards individual components of the defined medium, with the exception of cysteine. The chemical characteristics responsible for the potency of SNP were investigated by synthesizing analogs of SNP in which the Fe was replaced by different metals. The inhibitory potency of the pentacyanonitrosyl complexes decreased in the order Fe > Cr > V, which correlates with N-O stretching frequency (vNO). In contrast, the Ru complex which had a vNO comparable to that of Fe was a poor inhibitor. Electron paramagnetic resonance spectroscopy showed that SNP was rapidly reduced to the paramagnetic Fe(I) compound [Fe(CN)4(NO)](2-) on contact with cells. Analysis of fractions from SNP-treated cells showed 90% oxidation of thiols in the cell walls compared with those in control cells. The toxicity of SNP involves S-nitrosation and reduction, the lack of toxicity of the Ru analog being consistent with the fact that it has poor reactivity towards thiols. When C. sporogenes cells were exposed to sublethal concentrations of SNP and viewed under the electron microscope, they showed blisters on the surface. These results point to the cell wall surface as a primary point of attack of the nitrosyl complex.

Regulation of intracellular pH in proximal tubules of avian long-looped mammalian-type nephrons.

In nonperfused proximal tubules isolated from chicken long-looped mammalian-type nephrons, intracellular pH (pHi), measured with the pH-sensitive fluorescent dye 2',7'-bis(2-carboxyethyl)-5(6)-carboxyfluorescein, was approximately 7.3 under control conditions (HEPES-buffered medium with pH 7.4 at 37 degrees C) and was reduced to approximately 7.0 in response to NH4Cl pulse. The rate of recovery of pHi from this level to the resting level was 1) significantly reduced by the removal of Na+ from the bath, 2) significantly increased by the removal of Cl- from the bath, 3) unchanged by the removal of both Na+ and Cl- from the bath, 4) significantly reduced by the addition of either ethylisopropylamiloride or DIDS to the bath, 5) significantly increased by a high bath K+ concentration, and 6) unchanged by the addition of Ba2+ to the bath. These data suggest that both Na+-coupled and Cl--coupled basolateral acid-base fluxes are involved in determining the rate of recovery of pHi after acidification. The most likely ones to be important in regulating pHi are a Na+/H+ exchanger and a Na+-coupled Cl-/HCO-3 exchanger. In birds, long-looped mammalian-type nephrons resemble short-looped transitional nephrons but differ markedly from superficial loopless reptilian-type nephrons.

Regulation of intracellular pH in proximal tubules of avian loopless reptilian-type nephrons.

In proximal tubules isolated from chicken superficial loopless reptilian-type nephrons, intracellular pH (pHi), measured with pH-sensitive fluorescent dye 2',7'-bis(carboxyethyl)-5(6)-carboxyfluorescein, was approximately 7.1-7.2 under control conditions (N-2-hydroxyethylpiperazine-N'-2-ethanesulfonic acid-buffered medium with pH 7.4 at 37 degrees C), and was reduced to approximately 6.9 in response to NH4Cl pulse. The rate of recovery of pHi (control value approximately equal to 5 x 10(-3) pH U/s) from this acid level was 1) significantly decreased by removal of Na+ or both Na+ and Cl- from the bath or addition of 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid (0.25 mM) to the bath, 2) significantly increased by high bath K+ (75 mM), and 3) unchanged by removal of Cl- alone from the bath or addition of ethylisopropylamiloride (1 mM) or Ba2+ (5 mM) to the bath. Resting pHi was 1) significantly decreased by Na+ or simultaneous Na+ and Cl- removal, 2) significantly increased by high K+, and 3) unchanged by Cl- removal alone or addition of Ba2+. The data do not fit the concept of pHi regulation by the most commonly suggested basolateral transporters (Na+/H+ exchanger, Na(+)-dependent and Na(+)-independent Cl-/HCO3- exchangers, or Na(+)-HCO3(-)-CO3(2-) cotransporter).

Effects of nitrogen limitation on the growth and composition of unicellular algae in continuous culture.

Since fat accumulation takes place in many algae as a response to exhaustion of the nitrogen supply, it has been suggested that this may provide a means of enhancing the potential food value of algae. To test this possibility, chemostatic continuous cultures of Chlorella sorokiniana and Oocystis polymorpha were subjected to successive reductions in influent nitrogen. As cellular nitrogen content decreased from about 10 to 4%, oxygen evolution, carbon dioxide uptake, chlorophyll content, and tissue production were drastically reduced, but total lipid content was essentially unchanged. Caloric values and C, H, and N analyses suggested a moderate increase in carbohydrate content, but gas chromatographic analyses revealed no significant qualitative or quantitative changes in the fatty acid fraction. In batch-cultured cells, nitrogen could be reduced to 3% of dry weight, causing a concomitant increase in total fatty acids and pronounced changes in the composition of the fatty acid fraction. These results suggest that cellular nitrogen must fall to approximately 3% of dry weight before appreciable increases in lipid synthesis can occur. Cell nitrogen is then apparently completely bound in essential cell constituents, and carbon subsequently fixed is converted into lipid products. The findings indicate that nitrogen limitation may be useful in increasing the food quality of batch-cultured cells, but the technique has little value for continuous culture systems per se.