Publications by authors named "Patricia Garcia"

485 Publications

Pulmonary oxidative stress and apoptosis in mice chronically exposed to hydrothermal volcanic emissions.

Environ Sci Pollut Res Int 2021 Mar 6. Epub 2021 Mar 6.

Faculdade de Ciências e Tecnologia, Universidade dos Açores, Rua da Mãe de Deus, Apartado 1422, 9501-801, Ponta Delgada, Açores, Portugal.

Recent studies have shown that exposure to hydrothermal emissions has a negative impact on the respiratory system. Still, volcanogenic air pollution studies are still outnumbered when compared to anthropogenic studies which can result in an unknown risk to the human populations living near volcanically active areas. This study was carried out in São Miguel Island, with noneruptive volcanically active environments, such as the Furnas volcano caldera. Its noneruptive volcanism presents itself as hydrothermal emissions, mainly by the release of nearly 1000 T d of CO along with HS, and the radioactive gas radon; metals [e.g., mercury (Hg), cadmium (Cd), copper (Cu), and zinc (Zn)] and particulate matter are also released in a daily basis. We test the hypothesis whether chronic exposure to hydrothermal emissions causes pulmonary oxidative stress, using Mus musculus as a surrogate species. Mus musculus was live-captured in two villages with hydrothermal emissions and one village without any type of volcanic activity. The level of pulmonary oxidative stress was immunohistochemically assessed by using an OxyIHC Oxidative stress detection kit, and the detection of terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end-labeling (TUNEL) was used to evaluate apoptosis in lung tissues. Mice chronically exposed to hydrothermal emissions presented increased levels of oxidative stress and amount of apoptotic cells. We demonstrate, for the first time, the high oxidative stress potential in the lungs of mice chronically exposed to hydrothermal emissions. This study highlights the usefulness of M. musculus as a bioindicator species and enforces the necessity of regularly biomonitor the inhabitants of hydrothermal areas to prevent respiratory pathologies.
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http://dx.doi.org/10.1007/s11356-021-13043-0DOI Listing
March 2021

Dementia in Latin America: Paving the way toward a regional action plan.

Authors:
Mario Alfredo Parra Sandra Baez Lucas Sedeño Cecilia Gonzalez Campo Hernando Santamaría-García Ivan Aprahamian Paulo Hf Bertolucci Julian Bustin Maria Aparecida Camargos Bicalho Carlos Cano-Gutierrez Paulo Caramelli Marcia L F Chaves Patricia Cogram Bárbara Costa Beber Felipe A Court Leonardo Cruz de Souza Nilton Custodio Andres Damian Myriam de la Cruz Roberta Diehl Rodriguez Sonia Maria Dozzi Brucki Lais Fajersztajn Gonzalo A Farías Fernanda G De Felice Raffaele Ferrari Fabricio Ferreira de Oliveira Sergio T Ferreira Ceres Ferretti Marcio Luiz Figueredo Balthazar Norberto Anizio Ferreira Frota Patricio Fuentes Adolfo M García Patricia J Garcia Fábio Henrique de Gobbi Porto Lissette Duque Peñailillo Henry Willy Engler Irene Maier Ignacio F Mata Christian Gonzalez-Billault Oscar L Lopez Laura Morelli Ricardo Nitrini Yakeel T Quiroz Alejandra Guerrero Barragan David Huepe Fabricio Joao Pio Claudia Kimie Suemoto Renata Kochhann Silvia Kochen Fiona Kumfor Serggio Lanata Bruce Miller Leticia Lessa Mansur Mirna Lie Hosogi Patricia Lillo Jorge Llibre Guerra David Lira Francisco Lopera Adelina Comas José Alberto Avila-Funes Ana Luisa Sosa Claudia Ramos Elisa de Paula França Resende Heather M Snyder Ioannis Tarnanas Jenifer Yokoyama Juan Llibre Juan Felipe Cardona Kate Possin Kenneth S Kosik Rosa Montesinos Sebastian Moguilner Patricia Cristina Lourdes Solis Renata Eloah de Lucena Ferretti-Rebustini Jeronimo Martin Ramirez Diana Matallana Lingani Mbakile-Mahlanza Alyne Mendonça Marques Ton Ronnielly Melo Tavares Eliane C Miotto Graciela Muniz-Terrera Luis Arnoldo Muñoz-Nevárez David Orozco Maira Okada de Oliveira Olivier Piguet Maritza Pintado Caipa Stefanie Danielle Piña Escudero Lucas Porcello Schilling André Luiz Rodrigues Palmeira Mônica Sanches Yassuda Jose Manuel Santacruz-Escudero Rodrigo Bernardo Serafim Jerusa Smid Andrea Slachevsky Cecilia Serrano Marcio Soto-Añari Leonel Tadao Takada Lea Tenenholz Grinberg Antonio Lucio Teixeira Maira Tonidandel Barbosa Dominic Trépel Agustin Ibanez

Alzheimers Dement 2021 02 20;17(2):295-313. Epub 2020 Nov 20.

Cognitive Neuroscience Center (CNC) Buenos Aires, Argentina; Universidad Autonoma del Caribe, Barranquilla, Colombia; Global Brain Health Institute (GBHI), US, Universidad de San Andres, CONICET, Universidad Autonoma del Caribe, Universidad Adolfo Ibanez, UCSF, USA.

Across Latin American and Caribbean countries (LACs), the fight against dementia faces pressing challenges, such as heterogeneity, diversity, political instability, and socioeconomic disparities. These can be addressed more effectively in a collaborative setting that fosters open exchange of knowledge. In this work, the Latin American and Caribbean Consortium on Dementia (LAC-CD) proposes an agenda for integration to deliver a Knowledge to Action Framework (KtAF). First, we summarize evidence-based strategies (epidemiology, genetics, biomarkers, clinical trials, nonpharmacological interventions, networking, and translational research) and align them to current global strategies to translate regional knowledge into transformative actions. Then we characterize key sources of complexity (genetic isolates, admixture in populations, environmental factors, and barriers to effective interventions), map them to the above challenges, and provide the basic mosaics of knowledge toward a KtAF. Finally, we describe strategies supporting the knowledge creation stage that underpins the translational impact of KtAF.
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http://dx.doi.org/10.1002/alz.12202DOI Listing
February 2021

Northwestern University Feinberg School of Medicine.

Acad Med 2020 Sep;95(9S A Snapshot of Medical Student Education in the United States and Canada: Reports From 145 Schools):S155-S158

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http://dx.doi.org/10.1097/ACM.0000000000003307DOI Listing
September 2020

Health care provider time in public primary care facilities in Lima, Peru: a cross-sectional time motion study.

BMC Health Serv Res 2021 Feb 6;21(1):123. Epub 2021 Feb 6.

School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru.

Background: In Peru, a majority of individuals bypass primary care facilities even for routine services. Efforts to strengthen primary care must be informed by understanding of current practice. We conducted a time motion assessment in primary care facilities in Lima with the goals of assessing the feasibility of this method in an urban health care setting in Latin America and of providing policy makers with empirical evidence on the use of health care provider time in primary care.

Methods: This cross-sectional continuous observation time motion study took place from July - September 2019. We used two-stage sampling to draw a sample of shifts for doctors, nurses, and midwives in primary health facilities and applied the Work Observation Method by Activity Timing tool to capture type and duration of provider activities over a 6-h shift. We summarized time spent on patient care, paper and electronic record-keeping, and non-work (personal and inactive) activities across provider cadres. Observations are weighted by inverse probability of selection.

Results: Two hundred seventy-five providers were sampled from 60 facilities; 20% could not be observed due to provider absence (2% schedule error, 8% schedule change, 10% failure to appear). One hundred seventy-four of the 220 identified providers consented (79.1%) and were observed for a total of 898 h of provider time comprising 30,312 unique tasks. Outpatient shifts included substantial time on patient interaction (110, 82, and 130 min for doctors, nurses, and midwives respectively) and on paper records (132, 97, and 141 min) on average. Across all shifts, 1 in 6 h was spent inactive or on personal activities. Two thirds of midwives used computers compared to half of nurses and one third of doctors.

Conclusions: The time motion study is a feasible method to capture primary care operations in Latin American countries and inform health system strengthening. In the case of Lima, absenteeism undermines health worker availability in primary care facilities, and inactive time further erodes health workforce availability. Productive time is divided between patient-facing activities and a substantial burden of paper-based record keeping for clinical and administrative purposes. Electronic health records remain incompletely integrated within routine care, particularly beyond midwifery.
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http://dx.doi.org/10.1186/s12913-021-06117-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7865111PMC
February 2021

Development and Assessment of an Indirect Vision Training Program for Operatory Dentistry: Effects on working posture.

Eur J Dent Educ 2021 Feb 1. Epub 2021 Feb 1.

Department of Social Dentistry, Araraquara Dental School, UNESP, Univ Estadual Paulista, Araraquara, São Paulo, Brazil.

Objectives: Students experience difficulty working with indirect vision and often adopt inadequate working postures because of it. This study created and then assessed the effects of an indirect vision preclinical training program on dental students' working posture.

Methods: The study enrolled students in the third year of the five-year undergraduate program in dentistry in the School of Dentistry of São Paulo State University (UNESP), Araraquara (N=54). The program consisted of four training sessions in which students performed different types of activities in which only a mirror was used to see the procedure they were performing. To evaluate posture, students were asked to perform class III cavity preparations (distal-palatal and mesial-palatal preparations) on upper central and lateral incisors in a dental mannequin (tooth numbers 11, 12, 21, and 22) both before and after the indirect vision training program. Photographs were taken of the students' working postures. The photographs were assessed by a duly trained researcher using the Compliance Assessment of Dental Ergonomic Posture Requirements (CADEP). A descriptive statistical analysis was performed, and the assumptions of normality were verified. Student's paired t test was also performed. The significance level adopted was 5%.

Results: A significant difference was found between the percentages of correct ergonomic postures adopted before and after the training program (p=0.039).

Conclusions: The preclinical training program for indirect vision was found to have a positive effect on the working postures of the students evaluated herein.
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http://dx.doi.org/10.1111/eje.12670DOI Listing
February 2021

Aging with HIV in Latin America and the Caribbean: a Systematic Review.

Curr HIV/AIDS Rep 2021 Feb 5;18(1):1-47. Epub 2021 Jan 5.

Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, 300 Cedar Street TAC S-525, PO Box 208031, New Haven, CT, 06520-8031, USA.

Purpose Of Review: With the establishment of antiretroviral treatment (ART) programs in low- and middle-income countries, people with HIV (PWH) in Latin America and the Caribbean (LAC) are living longer, subsequently developing chronic non-communicable diseases (NCDs). Few studies focus on the impact of aging among older LAC PWH. This systematic review aims to fill this information gap and understand the burden of aging with HIV in LAC. We identified peer-reviewed literature published in English, Spanish, or Portuguese from several databases to assess currently available evidence on the burden of aging with HIV in LAC and selected six common NCDs found in older PWH (cardiovascular disease [CVD], bone and musculoskeletal [MSK] disorders, cancer, renal disease, neurocognitive impairment [NCI], and depression).

Recent Findings: Of the 5942 publications reviewed, only 53 articles were found with populations 40 years and older or age-related findings (27 CVD, 13 NCI or depression, 6 MSK disorders, 4 renal disease, 3 cancer). Most (79%) publications were from Brazil with few longitudinal studies on aging with HIV. Prevalence of illnesses such as CVD, NCI, depression, or osteoporosis varied widely depending on the screening instrument utilized and geographic population surveyed. Age was a significant predictor of comorbidity in nearly all studies. Our results demonstrate the need for longitudinal studies and validated screening instruments appropriate for use among PWH in LAC. Understanding the mechanisms behind aging in HIV and the roles of sociocultural factors and genetic diversity specific to LAC is needed to appropriately manage chronic comorbidities as PWH age.
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http://dx.doi.org/10.1007/s11904-020-00538-7DOI Listing
February 2021

Unintended pregnancy and viral suppression in pregnant women living with HIV.

Am J Obstet Gynecol MFM 2021 Jan 27;3(2):100300. Epub 2021 Jan 27.

Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL.

Background: Approximately half of pregnancies in the United States are unintended; the likelihood of unintended pregnancy may be even higher for women living with HIV. Women with unintended pregnancies often have worse obstetrical outcomes than women who planned their pregnancies, although the relationship of unintended pregnancy to outcomes among women living with HIV in the United States is unknown.

Objective: This study aimed to determine whether pregnancy intendedness among women living with HIV attending a specialty obstetrical clinic was associated with achievement of maternal viral suppression by delivery, a key component of preventing perinatal transmission of HIV.

Study Design: This is a retrospective cohort study of pregnant women living with HIV who received prenatal care and had a live-born infant at a single tertiary center (2007-2014). Women were asked as part of routine clinical care whether they intended their current pregnancy. Women who expressed at their initial obstetrician visit that their pregnancy was mistimed or undesired were determined to have an unintended pregnancy. Women were considered virally suppressed when the HIV RNA viral load was <20 copies/mL. We examined whether pregnancy intendedness was associated with whether the viral load was undetectable at the time of delivery. We also determined whether women with unintended pregnancies were less likely to be on antiretroviral therapy at the time of entry to prenatal care. Wilcoxon rank-sum tests and chi-square tests were used for bivariable analyses, and logistic and linear regression were used for multivariable analyses.

Results: Of the 215 women who met inclusion criteria, 201 (93.5%) had complete data on pregnancy intendedness. Of these 201 women, 137 (68.2%) had an unintended pregnancy. Unintended pregnancy was associated with lower odds of viral suppression at delivery (95.3% of women with planned pregnancies were virally suppressed at delivery compared with 76.6% of women with unplanned pregnancies; adjusted odds ratio, 0.22; 95% CI, 0.05-0.89, after adjusting for potential confounders). In this study, 48.9% of women with unintended pregnancies presented later in pregnancy for prenatal care (after the first trimester) compared with 21.9% of women with intended pregnancies (P<.001). Women with unintended pregnancies were also less likely to be on antiretroviral therapy before entry to prenatal care (20.4% of women with unintended pregnancies vs 50.0% of women with intended pregnancies; adjusted odds ratio, 0.35; 95% CI, 0.15-0.81; P<.001).

Conclusion: Among pregnant women living with HIV, women with an unintended pregnancy were less likely to be on antiretroviral therapy before initiating prenatal care and were less likely to be virally suppressed at the time of delivery.
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http://dx.doi.org/10.1016/j.ajogmf.2020.100300DOI Listing
January 2021

Evaluation of the chemopreventive potentials of ezetimibe and aspirin in a novel mouse model of gallbladder preneoplasia.

Mol Oncol 2020 11 17;14(11):2834-2852. Epub 2020 Sep 17.

Departamento de Patología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

Gallbladder stones (cholecystolithiasis) are the main risk factor for gallbladder cancer (GBC), a lethal biliary malignancy with poor survival rates worldwide. Gallbladder stones are thought to damage the gallbladder epithelium and trigger chronic inflammation. Preneoplastic lesions that arise in such an inflammatory microenvironment can eventually develop into invasive carcinoma, through mechanisms that are not fully understood. Here, we developed a novel gallbladder preneoplasia mouse model through the administration of two lithogenic diets (a low- or a high-cholesterol diet) in wild-type C57BL/6 mice over a period of 9 months. Additionally, we evaluated the chemopreventive potentials of the anti-inflammatory drug aspirin and the cholesterol absorption inhibitor ezetimibe. Both lithogenic diets induced early formation of gallbladder stones, together with extensive inflammatory changes and widespread induction of metaplasia, an epithelial adaptation to tissue injury. Dysplastic lesions were presented only in mice fed with high-cholesterol diet (62.5%) in late stages (9th month), and no invasive carcinoma was observed at any stage. The cholesterol absorption inhibitor ezetimibe inhibited gallbladder stone formation and completely prevented the onset of metaplasia and dysplasia in both lithogenic diets, whereas aspirin partially reduced metaplasia development only in the low-cholesterol diet setting. This model recapitulates several of the structural and inflammatory findings observed in human cholecystolithiasic gallbladders, making it relevant for the study of gallbladder carcinogenesis. In addition, our results suggest that the use of cholesterol absorption inhibitors and anti-inflammatory drugs can be evaluated as chemopreventive strategies to reduce the burden of GBC among high-risk populations.
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http://dx.doi.org/10.1002/1878-0261.12766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607176PMC
November 2020

Current and New Biomarkers for Early Detection, Prognostic Stratification, and Management of Gallbladder Cancer Patients.

Cancers (Basel) 2020 Dec 7;12(12). Epub 2020 Dec 7.

Department of Pathology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile.

Gallbladder cancer (GBC) is an aggressive disease that shows evident geographic variation and is characterized by a poor prognosis, mainly due to the late diagnosis and ineffective treatment. Genetic variants associated with GBC susceptibility, including polymorphisms within the toll-like receptors and , the cytochrome P450 1A1 (), and the ATP-binding cassette (ABC) transporter genes, represent promising biomarkers for the stratification of patients at higher risk of GBC; thus, showing potential to prioritize cholecystectomy, particularly considering that early diagnosis is difficult due to the absence of specific signs and symptoms. Similarly, our better understanding of the gallbladder carcinogenic processes has led to identify several cellular and molecular events that may influence patient management, including HER2 aberrations, high tumor mutational burden, microsatellite instability, among others. Despite these reports on interesting and promising markers for risk assessment, diagnosis, and prognosis; there is an unmet need for reliable and validated biomarkers that can improve the management of GBC patients and support clinical decision-making. This review article examines the most potentially significant biomarkers of susceptibility, diagnosis, prognosis, and therapy selection for GBC patients, highlighting the need to find and validate existing and new molecular biomarkers to improve patient outcomes.
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http://dx.doi.org/10.3390/cancers12123670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7762341PMC
December 2020

Repurposed Antiviral Drugs for Covid-19 - Interim WHO Solidarity Trial Results.

N Engl J Med 2021 02 2;384(6):497-511. Epub 2020 Dec 2.

The affiliations of the members of the writing and steering committees are as follows: the Nuffield Department of Population Health and Medical Research Council Population Health Research Unit, University of Oxford, Oxford (H.P., R.P.), and the University of Bristol, Bristol (E.A., S.B., H.B.C.C.-P., D.H., J.K., C.A.R., J.A.C.S.) - both in the United Kingdom; the World Health Organization, Geneva (A.-M.H.-R., M.-P.P., V.S., P. Lydon, M.C.M.-M., K.S., S.S.), the University of Bern, Bern (S.A., M.B., S. McGinty, S.T.), and Lausanne University Hospital, Lausanne (O.M.) - all in Switzerland; the Centre for the AIDS Programme of Research in South Africa, Durban (Q.A.K.), and the University of the Witwatersrand (J.N.) and the Wits Reproductive Health and HIV Institute (H.R.), Johannesburg - all in South Africa; the Institute of National Epidemiology, National Institutes of Health, University of the Philippines, Manila (M.M.A.); the Agency of Medicine and Medical Devices (C.H.G.) and Hospital Clínico San Carlos, Universidad Complutense de Madrid, Spanish Clinical Research Network, Instituto de Investigación Sanitaria San Carlos (A.P.), Madrid; INSERM, Paris (M.-P.K.), and Hospices Civils de Lyon, Lyon (F.A.) - both in France; the Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran (R.M.); the University of British Columbia, Vancouver (S. Murthy), and the Public Health Agency of Canada, Ottawa (M.I.S.) - both in Canada; the Public Health Foundation of India, New Delhi (K.S.R.), and the Indian Council of Medical Research, National AIDS Research Institute, Pune (S.G.) - both in India; the National Academy of Sciences of Buenos Aires (M.R.P.) and Fundación del Centro de Estudios Infectológicos (G.L.), Buenos Aires; Rafic Hariri University Hospital (P.A.H.) and the Ministry of Public Health (R.H.), Beirut, Lebanon; the Ministry of Health (A.M.A.-B.) and Infectious Diseases Hospital (A. Alhasawi), Kuwait City, Kuwait; Universidad Nacional de Colombia and Clinica Colsanitas (C.A.A.-M.) and the Ministry of Health (M.L.M.R.), Bogota, Colombia; the Ministry for Preventive Health, Riyadh, Saudi Arabia (A. Asiri, A. Alotaibi); Oslo University Hospital (P.A., A.B.-D.) and Research Council of Norway (J.-A.R.), Oslo; Secretaria de Salud de Honduras (N. Cerrato) and the National Autonomous University of Honduras (M.T.M.), Tegucigalpa; Penang Hospital, Penang (T.S.C.), and Hospital Sungai Buloh and Jalan Hospital, Selangor (S.K.) - both in Malaysia; University Hospital Center Mother Theresa (N. Como) and the National Agency for Medicines and Medical Devices (N.S.), Tirana, Albania; the HRB Clinical Research Facility, University College Cork, Cork (J.E.), and the Department of Health and Children, Dublin (P. Lennon, T.M.) - both in Ireland; Universidad Peruana Cayetano Heredia, Lima, Peru (P.J.G., E.G.); Vilnius University Hospital Santaros Klinikos (L.G.) and Vilnius University, Institute of Clinical Medicine (L.J.), Vilnius, Lithuania; Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan (M. Hassan, A.R.); the National Hepatology and Tropical Medicine Research Institute (M. Hassany) and the Ministry of Health and Population (H.Z.), Cairo; the National Institute of Health Research and Development (I.I.) and Rumah Sakit Umum Pusat Persahabatan (M.R.R.), Jakarta, Indonesia; the Italian Medicines Agency, Rome (N.M.), and the University of Verona, Verona (E.T.) - both in Italy; the Ministry of Health (S. Manevska) and the University Clinic of Infectious Diseases and Febrile Conditions (M.S.), Skopje, North Macedonia; the Oswaldo Cruz Foundation, Rio de Janeiro (E.P.N., P.P.S.R.); and the Finnish Institute for Health and Welfare and the University of Finland (M.P.) and Helsinki University Hospital (K.A.O.T.), Helsinki, and South Karelian Central Hospital, Lappeenranta (K.A.O.T.) - all in Finland.

Background: World Health Organization expert groups recommended mortality trials of four repurposed antiviral drugs - remdesivir, hydroxychloroquine, lopinavir, and interferon beta-1a - in patients hospitalized with coronavirus disease 2019 (Covid-19).

Methods: We randomly assigned inpatients with Covid-19 equally between one of the trial drug regimens that was locally available and open control (up to five options, four active and the local standard of care). The intention-to-treat primary analyses examined in-hospital mortality in the four pairwise comparisons of each trial drug and its control (drug available but patient assigned to the same care without that drug). Rate ratios for death were calculated with stratification according to age and status regarding mechanical ventilation at trial entry.

Results: At 405 hospitals in 30 countries, 11,330 adults underwent randomization; 2750 were assigned to receive remdesivir, 954 to hydroxychloroquine, 1411 to lopinavir (without interferon), 2063 to interferon (including 651 to interferon plus lopinavir), and 4088 to no trial drug. Adherence was 94 to 96% midway through treatment, with 2 to 6% crossover. In total, 1253 deaths were reported (median day of death, day 8; interquartile range, 4 to 14). The Kaplan-Meier 28-day mortality was 11.8% (39.0% if the patient was already receiving ventilation at randomization and 9.5% otherwise). Death occurred in 301 of 2743 patients receiving remdesivir and in 303 of 2708 receiving its control (rate ratio, 0.95; 95% confidence interval [CI], 0.81 to 1.11; P = 0.50), in 104 of 947 patients receiving hydroxychloroquine and in 84 of 906 receiving its control (rate ratio, 1.19; 95% CI, 0.89 to 1.59; P = 0.23), in 148 of 1399 patients receiving lopinavir and in 146 of 1372 receiving its control (rate ratio, 1.00; 95% CI, 0.79 to 1.25; P = 0.97), and in 243 of 2050 patients receiving interferon and in 216 of 2050 receiving its control (rate ratio, 1.16; 95% CI, 0.96 to 1.39; P = 0.11). No drug definitely reduced mortality, overall or in any subgroup, or reduced initiation of ventilation or hospitalization duration.

Conclusions: These remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalized patients with Covid-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay. (Funded by the World Health Organization; ISRCTN Registry number, ISRCTN83971151; ClinicalTrials.gov number, NCT04315948.).
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http://dx.doi.org/10.1056/NEJMoa2023184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7727327PMC
February 2021

Elemental profile of native lichens displaying the impact by agricultural and artificial land uses in the Atlantic island of São Miguel (Azores).

Chemosphere 2021 Mar 6;267:128887. Epub 2020 Nov 6.

Faculty of Sciences and Technology, University of the Azores, 9501-801, Ponta Delgada, Portugal; Centre for Ecology, Evolution and Environmental Changes and Azorean Biodiversity Group (cE3c-GBA), University of the Azores, 9501-801, Ponta Delgada, Portugal.

Smaller oceanic islands, often hosting endangered native habitats, are particularly vulnerable to the impact of human activities. Using lichens as bioindicators, this study aimed to test if agricultural (AGR) and artificial (ART) land uses are noticeably more impacted than forest (FOR) land use on an oceanic island (São Miguel, Azores). Livestock and farming practices in AGR areas involve the intensive application of synthetical agrochemicals as well as organic fertilizers and manure. ART areas accommodate vehicular traffic besides industries dedicated to waste management, energy production or exploration and transformation of raw materials. Naturally occurring Parmotrema lichens were collected in 28 sampling sites distributed between each land use. The concentrations of 58 elements as well as the percentage (%N) and the isotopic composition of nitrogen (δN) were determined on lichen samples. An overall pattern of significant elemental enrichment was observed in lichens from AGR and ART sites compared with FOR lichens, including several rare-earth elements. FOR lichens were noticeably cleaner, thus providing background concentrations for the calculation of bioaccumulation ratios. Bioaccumulation levels were generally low to moderate in AGR lichens and moderate to high in ART lichens, including toxic heavy metals. %N was highest in AGR lichens and its isotopic signature was distinguishable from ART lichens by significantly lower δN values. This study provides a comprehensive baseline of bioaccumulation data across major land uses for comparison with other insular regions, highlighting the greater vulnerability of island ecosystems to anthropogenic impacts even if by relatively small-scale human activities.
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http://dx.doi.org/10.1016/j.chemosphere.2020.128887DOI Listing
March 2021

Production of starch-polyester bio-support for lipases immobilization: synergistic action of itaconic acid and nanoclay.

Prep Biochem Biotechnol 2020 Nov 2:1-9. Epub 2020 Nov 2.

Universidade Tecnológica Federal do Paraná, Câmpus Apucarana - Coordenação de Licenciatura em Química (COLIQ), Apucarana, Brazil.

The objective of the present work was to develop biodegradable polymeric films (starch-PBAT) as support for the immobilization of lipases using sodium montmorillonite (MMT) as a reinforcing agent (2% ) and itaconic acid (IA - 0.5-1.5% ) as a compatibilizing agent. The films were produced through a two steps blow-extrusion. The addition of MMT increased the tensile strength and Tg of the films, while the presence of IA made the films more flexible, reducing their Tg. Lipases from LTEB11 were immobilized in the films by the adsorption method. The ester yield (% of ethyl oleate synthesis) has shown best results (96%, 6 h) for immobilized enzyme in the MMT film and six cycles of reuse were carried out until a reduction of 50% in the catalytic activity of the enzyme.
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http://dx.doi.org/10.1080/10826068.2020.1839906DOI Listing
November 2020

"The flu… is a little more complicated than a cold": Knowledge, beliefs, and practices related to influenza and influenza vaccination among at-risk populations and health professionals in Peru.

Vaccine 2020 11 16;38(48):7688-7695. Epub 2020 Oct 16.

Epidemiology, STD/AIDS Unit, School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru. Electronic address:

Background: Influenza is a major source of morbidity and mortality with an annual global attack rate estimated at 5-10% in adults and 20-30% in children. Influenza vaccination is the main strategy for reducing influenza-related morbidity and mortality. Like several other countries, Peru has low vaccination coverage, estimated at 25-50% among young children and older adults. Therefore, the study objective was to explore the knowledge, beliefs, attitudes, and practices related to influenza vaccination among populations at higher risk for infection and/or complications and health professionals in Peru, and their perspectives on health communication channels.

Methods: This qualitative study was carried out in three cities. We held nine focus groups with pregnant and postpartum women, parents of young children, and older adults. We carried out 25 in-depth interviews with health professionals (HPs) working in, leading or advising immunization-related programs.

Results: HPs correctly identified the causes of influenza and HPs and at risk community members identified major symptoms. Community members had poor awareness of the potential severity of influenza and were generally unaware of influenza-related mortality. Both HPs and community members greatly underestimated the prevalence of influenza in Peru. HPs in our study overestimated major side effects of the influenza vaccine and community members perceived that the vaccine caused illness. HPs missed important opportunities to promote vaccination in patients with minor illness (runny nose, allergies, colds) and community members did not understand that the vaccine should be received annually.

Conclusions: There is no single strategy that will increase influenza vaccination rates to World Health Organization recommended levels. Instead, it requires multi-faceted commitment from HPs, other healthcare authorities and the government. Addressing important knowledge barriers, specifically negative views regarding the influenza vaccine and the severe morbidity and mortality associated with influenza illness, both in the community and especially among HPs, could have significant impacts.
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http://dx.doi.org/10.1016/j.vaccine.2020.09.065DOI Listing
November 2020

Bioaccumulation and potential ecotoxicological effects of trace metals along a management intensity gradient in volcanic pasturelands.

Chemosphere 2020 Oct 10:128601. Epub 2020 Oct 10.

CE3c, Centre for Ecology, Evolution and Environmental Changes, And Azorean Biodiversity Group, University of the Azores, 9501-801, Ponta Delgada, Portugal; Faculty of Sciences and Technology, University of the Azores, 9501-801, Ponta Delgada, Portugal. Electronic address:

The particularities of volcanic soils raise the need to better understand the link between soil agricultural management intensity and trace metal bioaccumulation. The Azores are a region characterized by volcanic soils, which were changed in different degrees according to the intensity of the agricultural practices. The main objective of this study was to assess the potential ecotoxicological effects of the trace metals present in volcanic pastureland soils along a gradient of management intensity (i.e., semi-natural, permanent and reseeded), using earthworms (Eisenia fetida) as biological indicators. For this purpose earthworms were exposed during 7, 14, 28 and 56 days to soils from the three types of pastures. At each exposure time, we quantified trace element bioaccumulation (As, Cd, Co, Cr, Cu, Hg, Li, Mn, Mo, Ni, Pb, Rb, U, V and Zn) and the activities of superoxide dismutase and acetylcholinesterase in earthworm tissues. Overall, the results showed that the type of pastureland management significantly increased the soil contents in trace metals: V, Co, Ni and Zn in semi-natural pasturelands; As, Cd and Hg in reseeded pasturelands; and, Rb and U in both permanent and reseeded pasturelands. The soil physicochemical properties observed in the reseeded pastureland systems (higher electric conductivity values associated with a moderately acid pH value) modulated the metal bioavailability, from soil to biota, leading to a greater Hg bioaccumulation in earthworm tissues. The long-term exposure (56 days) of earthworms to reseeded pastureland soil was associated with adverse biological effects (intensification of AChE activity and decrease of SOD activity), encompassing key processes such as neurotransmission and antioxidant defence mechanisms in resident soil biota (earthworms). This study point towards the increased importance of semi-natural and permanent pastureland management, over the intensive management (reseeded pasturelands), in favour of more sustainable ecosystems.
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http://dx.doi.org/10.1016/j.chemosphere.2020.128601DOI Listing
October 2020

A simple RNA preparation method for SARS-CoV-2 detection by RT-qPCR.

Sci Rep 2020 10 6;10(1):16608. Epub 2020 Oct 6.

Department Clinical Laboratories, School of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4686, Santiago, Chile.

The technique RT-qPCR for viral RNA detection is the current worldwide strategy used for early detection of the novel coronavirus SARS-CoV-2. RNA extraction is a key pre-analytical step in RT-qPCR, often achieved using commercial kits. However, the magnitude of the COVID-19 pandemic is causing disruptions to the global supply chains used by many diagnostic laboratories to procure the commercial kits required for RNA extraction. Shortage in these essential reagents is even more acute in developing countries with no means to produce kits locally. We sought to find an alternative procedure to replace commercial kits using common reagents found in molecular biology laboratories. Here we report a method for RNA extraction that takes about 40 min to complete ten samples, and is not more laborious than current commercial RNA extraction kits. We demonstrate that this method can be used to process nasopharyngeal swab samples and yields RT-qPCR results comparable to those obtained with commercial kits. Most importantly, this procedure can be easily implemented in any molecular diagnostic laboratory. Frequent testing is crucial for individual patient management as well as for public health decision making in this pandemic. Implementation of this method could maintain crucial testing going despite commercial kit shortages.
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http://dx.doi.org/10.1038/s41598-020-73616-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538882PMC
October 2020

Global burden of injuries: it is time to understand the data in order to intervene.

Inj Prev 2020 Oct;26(Supp 1):i1-i2

School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru

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http://dx.doi.org/10.1136/injuryprev-2020-043937DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571359PMC
October 2020

Recurrent small bowel obstruction with intraluminal structures.

J Trauma Acute Care Surg 2021 Jan;90(1):e13-e15

From the Department of Surgery (B.J.S., K.E.K., D.A.S.), and Division of Gastroenterology and Hepatology (P.G.), Stanford University, Stanford, California.

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http://dx.doi.org/10.1097/TA.0000000000002956DOI Listing
January 2021

Availability of essential diagnostics at primary care public clinics in Peru.

Microbes Infect 2021 Jan-Feb;23(1):104761. Epub 2020 Sep 28.

School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru. Electronic address:

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http://dx.doi.org/10.1016/j.micinf.2020.09.007DOI Listing
September 2020

Biodegradable films based on commercial κ-carrageenan and cassava starch to achieve low production costs.

Int J Biol Macromol 2020 Dec 28;165(Pt A):582-590. Epub 2020 Sep 28.

Laboratory of Materials, Macromolecules, and Composites (LaMMAC), Federal University of Technology - Paraná (UTFPR), Apucarana, PR 86812-460, Brazil; Analitycal Applied in Lipids, Sterols, and Antioxidants (APLE-A), State University of Maringá (UEM), Colombo avenue, Maringá, PR 87020-900, Brazil. Electronic address:

Biodegradable films have been a great alternative compared to non-renewable sources because of their cytocompatibility, biodegradability, and antimicrobial features. These properties may raise the foodstuff shelf life, reducing costs and economic losses. Indeed, biodegradable films can also reduce the environmental pollution promoted by non-biodegradable conventional packs. For the first time, biodegradable films were produced by casting commercials kappa-carrageenan (κ-car) and cassava starch at different κ-carrageenan/cassava starch weight ratios. Physical, thermal, and mechanical properties were evaluated. Apparent opacity and color analyses suggest that the films present high transparency. The sample 0κ-c supported a film with high water solubility (39.22%) and a low swelling degree (391.6%). The lowest water vapor permeability (WVP) was observed for 50κ-c (3.01×10g (Pams)). The oil permeability varied from 0.0033 to 0.0043mmm d. The 100κ-c and 75κ-c films (with high κ-carrageenan contents) had higher stiffness (19.23 and 25.88MPa, respectively) than the 25κ-c and 0κ-c films with elongation at break (ε) of 21.60 and 67.65%, respectively. The thermal stability increased as the starch concentration raised in the blend. We produced low-cost biodegradable films from commercial polysaccharides. These films can be used as food packs.
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http://dx.doi.org/10.1016/j.ijbiomac.2020.09.150DOI Listing
December 2020

Magnification loupes in dentistry: A qualitative study of dental students' perspectives.

Eur J Dent Educ 2020 Sep 25. Epub 2020 Sep 25.

Department of Social Dentistry, School of Dentistry, São Paulo State University (Unesp), Araraquara, Brazil.

Introduction: The nature of the oral operating field makes it a challenge for dentists to work while maintaining musculoskeletal health. Strategies have been studied in recent years to improve visualisation of the operating field, and the use of magnification systems has been recommended for providing additional benefits. Despite the growing body of evidence suggesting that the use of magnification improves visual acuity, the dentist's posture and the quality of dental procedures, few studies have analysed users' perspectives on these devices in terms of their adaptation process. These types of studies are important because they provide insight into the reality of the adaptation process required by magnification systems so that adjustments and improvements can be made to adapt these systems to the users' reality. Thus, we sought to explore the perspectives held by second-year students in an undergraduate dental program on the use of dental loupes during pre-clinical laboratory activities.

Materials And Methods: A total of 24 second-year dental students participated in semi-structured interviews exploring their perspectives of wearing dental loupes during their pre-clinical activities. Data collection and analysis were consistent with the qualitative content analysis methodology. All interview data were analysed using version 10 of the NVivo analytical software.

Results: Participants described that magnification can lead to the improvement of their work postures, hand skills and quality of dental procedures. Nevertheless, they reported a need for an adaptation period and for adjustments to the technical features of the magnification system.

Conclusion: The students had positive perspectives on the use of magnification in their dentistry training program, including improvements in posture, hand skills and procedure quality.
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http://dx.doi.org/10.1111/eje.12605DOI Listing
September 2020

Socioeconomic factors associated with antimicrobial resistance of , , and in Chilean hospitals (2008-2017).

Rev Panam Salud Publica 2020 23;44:e30. Epub 2020 Sep 23.

Escuela de Gobierno, Pontificia Universidad Católica de Chile Santiago Chile Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Chile.

Objective: To identify socioeconomic factors associated with antimicrobial resistance of and in Chilean hospitals (2008-2017).

Methods: We reviewed the scientific literature on socioeconomic factors associated with the emergence and dissemination of antimicrobial resistance. Using multivariate regression, we tested findings from the literature drawing from a longitudinal dataset on antimicrobial resistance from 41 major private and public hospitals and a nationally representative household survey in Chile (2008-2017). We estimated resistance rates for three priority antibiotic-bacterium pairs, as defined by the Organisation for Economic Co-operation and Development; i.e., imipenem and meropenem resistant cloxacillin resistant and cefotaxime and ciprofloxacin resistant

Results: Evidence from the literature review suggests poverty and material deprivation are important risk factors for the emergence and transmission of antimicrobial resistance. Most studies found that worse socioeconomic indicators were associated with higher rates of antimicrobial resistance. Our analysis showed an overall antimicrobial resistance rate of 32.5%, with the highest rates for (40.6%) and the lowest for (25.7%). We found a small but consistent negative association between socioeconomic factors (income, education, and occupation) and overall antimicrobial resistance in univariate (p < 0.01) and multivariate analyses (p < 0.01), driven by resistant and .

Conclusion: Socioeconomic factors beyond health care and hospital settings may affect the emergence and dissemination of antimicrobial resistance. Preventing and controlling antimicrobial resistance requires efforts above and beyond reducing antibiotic consumption.
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http://dx.doi.org/10.26633/RPSP.2020.30DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498296PMC
September 2020

Landscape of Genome-Wide DNA Methylation of Colorectal Cancer Metastasis.

Cancers (Basel) 2020 Sep 22;12(9). Epub 2020 Sep 22.

Laboratory of Integrative Biology (LIBi), Centro de Excelencia en Medicina Traslacional (CEMT), Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La Frontera, Temuco 4810296, Chile.

Colorectal cancer is a heterogeneous disease caused by both genetic and epigenetics factors. Analysing DNA methylation changes occurring during colorectal cancer progression and metastasis formation is crucial for the identification of novel epigenetic markers of patient prognosis. Genome-wide methylation sequencing of paired samples of colon (normal adjacent, primary tumour and lymph node metastasis) showed global hypomethylation and CpG island (CGI) hypermethylation of primary tumours compared to normal. In metastasis we observed high global and non-CGI regions methylation, but lower CGI methylation, compared to primary tumours. Gene ontology analysis showed shared biological processes between hypermethylated CGIs in metastasis and primary tumours. After complementary analysis with The Cancer Genome Atlas (TCGA) cohort, , , , and genes were found associated with poor survival. We mapped the methylation landscape of colon normal tissues, primary tumours and lymph node metastasis, being capable of identified methylation changes throughout the genome. Furthermore, we found five genes with potential for methylation biomarkers of poor prognosis in colorectal cancer patients.
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http://dx.doi.org/10.3390/cancers12092710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564781PMC
September 2020

Follow-Up Care for Breast and Colorectal Cancer Across the Globe: Survey Findings From 27 Countries.

JCO Glob Oncol 2020 09;6:1394-1411

National Cancer Institute Bethesda, MD.

Purpose: The purpose of this study was to describe follow-up care for breast and colorectal cancer survivors in countries with varying levels of resources and highlight challenges regarding posttreatment survivorship care.

Methods: We surveyed one key stakeholder from each of 27 countries with expertise in survivorship care on questions including the components/structure of follow-up care, delivery of treatment summaries and survivorship care plans, and involvement of primary care in survivorship. Descriptive analyses were performed to characterize results across countries and variations between the WHO income categories (low, middle, high). We also performed a qualitative content analysis of narratives related to survivorship care challenges to identify major themes.

Results: Seven low- or /lower-middle-income countries (LIC/LMIC), seven upper-middle-income countries (UMIC), and 13 high-income countries (HICs) were included in this study. Results indicate that 44.4% of countries with a National Cancer Control Plan currently address survivorship care. Additional findings indicate that HICs use guidelines more often than those in LICs/LMICs and UMICs. There was great variation among countries regardless of income level. Common challenges include issues with workforce, communication and care coordination, distance/transportation issues, psychosocial support, and lack of focus on follow-up care.

Conclusion: This information can guide researchers, providers, and policy makers in efforts to improve the quality of survivorship care on a national and global basis. As the number of cancer survivors increases globally, countries will need to prioritize their long-term needs. Future efforts should focus on efforts to bridge oncology and primary care, building international partnerships, and implementation of guidelines.
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http://dx.doi.org/10.1200/GO.20.00180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529533PMC
September 2020

COVID-19 Response in Latin America.

Am J Trop Med Hyg 2020 11;103(5):1765-1772

Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.

Effective management of a pandemic due to a respiratory virus requires public health capacity for a coordinated response for mandatory restrictions, large-scale testing to identify infected individuals, capacity to isolate infected cases and track and test contacts, and health services for those infected who require hospitalization. Because of contextual and socioeconomic factors, it has been hard for Latin America to confront this epidemic. In this article, we discuss the context and the initial responses of eight selected Latin American countries, including similarities and differences in public health, economic, and fiscal measures, and provide reflections on what worked and what did not work and what to expect moving forward.
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http://dx.doi.org/10.4269/ajtmh.20-0765DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646820PMC
November 2020

Respuestas rápidas a la pandemia de COVID-19 a través de la ciencia y la colaboración global: el ensayo clínico Solidaridad.

Rev Peru Med Exp Salud Publica 2020 Apr-Jun;37(2):356-360. Epub 2020 Aug 28.

Organización Mundial de la Salud, Ginebra, Suiza.

COVID-19 represents a global crisis. Rapidly conducting a clinical trial with the rigor necessary to obtain reliable results requires the collaboration of various participants involved in the development, evaluation and authorization of clinical trials (CT) such as the trial sponsor, researchers, regulatory authority and the ethics committee (EC). Carrying out these studies is not only scientifically appropriate, but an ethical and moral obligation to guarantee our patients effective treatment. SOLIDARITY is a mega clinical trial that recruited thousands of subjects with moderate to severe disease, who were randomly assigned to one of the treatment groups under evaluation, including hydroxychloroquine, lopinavir/ritonavir associated or not with interferon; or remdesivir compared to standard therapy. Peru has joined the list of countries where the trial will be reproduced, through which it will be possible to quickly identify if any of these drugs offers a real benefit to patients.
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http://dx.doi.org/10.17843/rpmesp.2020.372.5546DOI Listing
September 2020

[Identification of mycobacteria species through mass spectrometry (MALDI-TOF)].

Rev Chilena Infectol 2020 Jun;37(3):252-256

Departamento de Laboratorios Clínicos, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

Background: Mycobacterial diseases are very important both clinically and epidemiologically. Mycobacterium tuberculosis complex (MTBc) infections confer higher morbidity and mortality rate than non-tuberculous mycobacteria (NTM) infections. Traditional species identification techniques are based on phenotypic characteristics which take a long time by laborious processes and in occasions are no conclusive. Currently, most used techniques are based on molecular methods, which are accurate but are expensive and complex. Matrix Assisted Laser Desorption/Ionization Time-of-Flight mass spectrometry (MALDI-TOF MS) is a simple, cheap and fast identification method based on comparing protein spectra with a reference database.

Aim: To assess the performance of MALDI-TOF MS in the identification of MTBc and NTM, compared with molecular methods.

Methods: For that purpose, 28 isolates of 9 different species were analyzed through MALDI-TOF MS.

Results: 78.5% (22/28) of isolates were correctly identified, 100% (9/9) of rapidly growers NTM, 60% (9/15) of slow growing NTM and 100% (4/4) of MTBc. Every unidentified isolate (6/6) corresponded to M. avium/intracellulare complex.

Conclusion: MALDI-TOF MS is fast, simple and cheaper than molecular methods and also has adequate accuracy.
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http://dx.doi.org/10.4067/s0716-10182020000300252DOI Listing
June 2020

Integrated genomic analysis reveals mutated ELF3 as a potential gallbladder cancer vaccine candidate.

Nat Commun 2020 08 24;11(1):4225. Epub 2020 Aug 24.

Molecular Biology Department, Genentech Inc., South San Francisco, CA, 94080, USA.

Gallbladder cancer (GBC) is an aggressive gastrointestinal malignancy with no approved targeted therapy. Here, we analyze exomes (n = 160), transcriptomes (n = 115), and low pass whole genomes (n = 146) from 167 gallbladder cancers (GBCs) from patients in Korea, India and Chile. In addition, we also sequence samples from 39 GBC high-risk patients and detect evidence of early cancer-related genomic lesions. Among the several significantly mutated genes not previously linked to GBC are ETS domain genes ELF3 and EHF, CTNNB1, APC, NSD1, KAT8, STK11 and NFE2L2. A majority of ELF3 alterations are frame-shift mutations that result in several cancer-specific neoantigens that activate T-cells indicating that they are cancer vaccine candidates. In addition, we identify recurrent alterations in KEAP1/NFE2L2 and WNT pathway in GBC. Taken together, these define multiple targetable therapeutic interventions opportunities for GBC treatment and management.
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http://dx.doi.org/10.1038/s41467-020-17880-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445288PMC
August 2020

Obesity is associated with postural balance on unstable surfaces but not with fear of falling in older adults.

Braz J Phys Ther 2020 Aug 13. Epub 2020 Aug 13.

Universidade Estadual de Goiás (UEG), Goiânia, GO, Brazil.

Background: There are inconsistent findings regarding the relationship between body mass index (BMI), fear of falling and body balance, especially on unstable surfaces.

Objectives: To investigate whether obesity is associated with worse postural balance and fear of falling in older adults.

Methods: A cross-sectional study was conducted with 201 older adults, classified as normal weight, overweight, or obese according to BMI. Postural balance was evaluated on stable and unstable surfaces on the Biodex Balance System platform under three visual conditions: with and without visual feedback and with eyes closed. Fear of falling was identified by a dichotomous question and the Falls Efficacy Scale. These data were compared between groups and included in adjusted multiple linear regression analysis.

Results: The study showed no significant differences (p > 0.05) in body oscillations on a stable surface between the three groups. On an unstable surface, the obese older adults exhibited body oscillations from 0.61° [95% CI 0.07, 1.30] to 1.63° [95% CI 0.84, 2.41] greater than those with normal weight in the three visual conditions. The obese older adults also displayed larger mediolateral oscillations with visual feedback (mean difference: 0.50° [95% CI 0.01, 0.98]) as well as greater global oscillations without visual feedback (mean difference of 0.82° [95% CI 0.18, 1.81]) and with progressive instability (mean difference: 0.80° [95% CI 0.05, 1.66]) than the overweight older adults. BMI explained from 6 to 12% of body swings investigated on unstable surface. Obesity was not associated with fear of falling.

Conclusion: Obesity was associated with reduced postural stability on unstable surfaces but not with fear of falling in older adults.
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http://dx.doi.org/10.1016/j.bjpt.2020.08.003DOI Listing
August 2020