Publications by authors named "J Fernandez"

5,312 Publications

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A Machine Learning Model for Evaluating Imported Disease Screening Strategies in Immigrant Populations.

Am J Trop Med Hyg 2021 Sep 20. Epub 2021 Sep 20.

Tropical Medicine Unit, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain.

Given the high prevalence of imported diseases in immigrant populations, it has postulated the need to establish screening programs that allow their early diagnosis and treatment. We present a mathematical model based on machine learning methodologies to contribute to the design of screening programs in this population. We conducted a retrospective cross-sectional screening program of imported diseases in all immigrant patients who attended the Tropical Medicine Unit between January 2009 and December 2016. We designed a mathematical model based on machine learning methodologies to establish the set of most discriminatory prognostic variables to predict the onset of the: HIV infection, malaria, chronic hepatitis B and C, schistosomiasis, and Chagas in immigrant population. We analyzed 759 patients. HIV was predicted with an accuracy of 84.9% and the number of screenings to detect the first HIV-infected person was 26, as in the case of Chagas disease (with a predictive accuracy of 92.9%). For the other diseases the averages were 12 screenings to detect the first case of chronic hepatitis B (85.4%), or schistosomiasis (86.9%), 23 for hepatitis C (85.6%) or malaria (93.3%), and eight for syphilis (79.4%) and strongyloidiasis (88.4%). The use of machine learning methodologies allowed the prediction of the expected disease burden and made it possible to pinpoint with greater precision those immigrants who are likely to benefit from screening programs, thus contributing effectively to their development and design.
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http://dx.doi.org/10.4269/ajtmh.20-1443DOI Listing
September 2021

Evaluation of a new nomogram for Ferrara ring segment implantation in keratoconus.

Int J Ophthalmol 2021 18;14(9):1371-1383. Epub 2021 Sep 18.

Department of Optics, Pharmacology, and Anatomy, University of Alicante, Alicante 03690, Spain.

Aim: To evaluate the short-term clinical outcomes of Ferrara rings in keratoconus using an optimized nomogram developed after several years of research and retrospective analysis of clinical data.

Methods: This prospective longitudinal non-comparative clinical trial evaluated 88 eyes of 88 patients (age 18-62y) with keratoconus diagnosis from two Spanish centers. Ferrara ring segment (AJL Ophthalmic) implantation was performed in all cases, using the mechanical procedure in 25 eyes (28.4%) and a femtosecond laser-assisted procedure in 63 eyes (71.6%). The ring segments implanted in each case were selected using a new optimized nomogram that considered variables such as anterior corneal asphericity and astigmatism or the discrepancy among astigmatism and coma orientations. Visual, refractive, corneal topographic, aberrometric, and pachymetric changes after surgery were evaluated during a 3-month follow-up.

Results: The implants induced a significant refractive change as well as an improvement in uncorrected (UDVA) and corrected distance visual acuity (CDVA; <0.001). Postoperative CDVA of 0.10 logMAR or better was achieved in 28.4% and 46.5% of eyes, respectively. Two eyes (2.3%) lost two or more lines of CDVA whereas a total of 53.5% of eyes gained lines of CDVA. A significant central anterior and posterior corneal flattening was induced (≤0.003), with a significant reduction of anterior (<0.001) and posterior corneal astigmatisms (=0.048), and a change in anterior asphericity (<0.001). Total primary coma (6 mm pupil) change was also statistically significant (preoperative 3.66±3.04 µm postoperative 2.33±2.26 µm, <0.001). No significant differences were found in the effect of ring segments between cases implanted using the mechanical and femtosecond techniques (≥0.101).

Conclusion: The implantation of Ferrara rings based on the nomogram evaluated is safe and effective for promoting a visual rehabilitation in keratoconus, with a relevant control of primary coma aberration.
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http://dx.doi.org/10.18240/ijo.2021.09.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8403859PMC
September 2021

Safety and Immunogenicity of an Inactivated SARS-CoV-2 Vaccine in a Subgroup of Healthy Adults in Chile.

Clin Infect Dis 2021 Sep 19. Epub 2021 Sep 19.

Hospital Clínico Félix Bulnes, Santiago, Chile.

Background: The development of effective vaccines against COVID-19 is a global priority. CoronaVac is an inactivated SARS-CoV-2 vaccine with promising safety and immunogenicity profiles. This article reports safety and immunogenicity results obtained for healthy Chilean adults aged ≥18 in a phase 3 clinical trial.

Methods: Volunteers randomly received two doses of CoronaVac or placebo, separated by two weeks. 434 volunteers were enrolled, 397 aged 18-59 years, and 37 aged ≥60 years. Solicited and unsolicited adverse reactions were registered from all volunteers. Blood samples were obtained from a subset of volunteers and analyzed for humoral and cellular measures of immunogenicity.

Results: The primary adverse reaction in the 434 volunteers was pain at the injection site, with a higher incidence in the vaccine than in the placebo arm. Adverse reactions observed were mostly mild and local. No severe adverse events were reported. The humoral evaluation was performed on 81 volunteers. Seroconversion rates for specific anti-S1-RBD IgG were 86.67% in the 18-59 age group and 70.37% in the ≥60 age group, two and four weeks after the second dose. A significant increase in circulating neutralizing antibodies was detected two and four weeks after the second dose. The cellular evaluation was performed on 47 volunteers. We detected a significant induction of T cell responses characterized by the secretion of IFN-γupon stimulation with Mega Pools of peptides from SARS-CoV-2.

Conclusions: Immunization with CoronaVac in a 0-14 schedule in Chilean adults aged ≥18 is safe, induces anti-S1-RBD IgG with neutralizing capacity, activates T cells, and promotes the secretion of IFN-γupon stimulation with SARS-CoV-2 antigens.
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http://dx.doi.org/10.1093/cid/ciab823DOI Listing
September 2021

Venomics of the poorly studied hognosed pitvipers Porthidium arcosae and Porthidium volcanicum.

J Proteomics 2021 Sep 14:104379. Epub 2021 Sep 14.

College of Biochemistry and Pharmacy, Faculty of Chemical Sciences, University of Cuenca, Cuenca, Ecuador. Electronic address:

We report the first proteomics analyses of the venoms of two poorly studied snakes, the Manabi hognosed pitviper Porthidium arcosae endemic to the western coastal province of Manabí (Ecuador), and the Costa Rican hognosed pitviper P. volcanicum with distribution restricted to South Pacific Costa Rica and western Panamá. These venom proteomes share a conserved compositional pattern reported in four other congeneric species within the clade of South American Porthidium species, P. nasutum, P. lansbergii, P. ophryomegas, and P. porrasi. The paraspecific immunorecognition profile of antivenoms produced in Costa Rica (ICP polyvalent), Perú (Instituto Nacional de Salud) and Brazil (soro antibotrópico pentavalente, SAB, from Instituto Butantan) against the venom of P. arcosae was investigated through a third-generation antivenomics approach. The maximal venom-binding capacities of the investigated antivenoms were 97.1 mg, 21.8 mg, and 25.7 mg of P. arcosae venom proteins per gram of SAB, ICP, and INS-PERU antibody molecules, respectively, which translate into 28.4 mg, 13.1 mg, and 15.2 mg of total venom proteins bound per vial of SAB, ICP, and INS-PERU AV. The antivenomics results suggest that 21.8%, 7.8% and 6.1% of the SAB, ICP, and INS-PERU antibody molecules recognized P. arcosae venom toxins. The SAB antivenom neutralized P. arcosae venom's lethality in mice with an ED of 31.3 mgV/g SAB AV. This preclinical neutralization paraspecificity points to Brazilian SAB as a promising candidate for the treatment of envenomings by Ecuadorian P. arcosae. BIOLOGICAL SIGNIFICANCE: Assessing the preclinical efficacy profile of antivenoms against homologous and heterologous medically relevant snake venoms represents an important goal towards defining the biogeographic range of their clinical utility. This is particularly relevant in regions, such as Mesoamerica, where a small number of pharmaceutical companies produce antivenoms against the venoms of a small number of species of maximum medical relevance among the local rich herpetofauna, leaving a wide range of snakes of secondary medical relevance, but also causing life-threatening human envenomings without nominal clinical coverage. This work is part of a larger project aiming at mapping the immunological characteristics of antivenoms generated in Latin American countries towards venoms of such poorly studied snakes of the local and neighboring countries' herpetofauna. Here we report the proteomics characterization of the Manabi hognosed pitviper Porthidium arcosae endemic to the western coastal province of Manabí (Ecuador), and the Costa Rican hognosed pitviper P. volcanicum with distribution restricted to southwestern Costa Rica, the antivenomics assessment of three bothropoid commercial antivenoms produced in Costa Rica, Perú, and Brazil against the venom components of P. arcosae, and the in vivo capacity of the Brazilian soro antibotrópico pentavalente (SAB) from Instituto Butantan to neutralize the murine lethality of P. arcosae venom. The preclinical paraspecific ED of 31.3 mg of P. arcosae venom per gram of antivenom points to Brazilian SAB as a promising candidate for the treatment of envenomings by the Manabi hognosed pitviper P. arcosae.
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http://dx.doi.org/10.1016/j.jprot.2021.104379DOI Listing
September 2021
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