Objetivo. Determinar la resistencia a insecticidas en Ae. aegypti y Ae. albopictus de Tapachula, Chiapas, México. Material y métodos. Se utilizaron ovitrampas para obtener huevos de mosquitos Aedes ...y se realizaron pruebas de susceptibilidad (CDC) y ensayos enzimáticos con la primera generación. Resultados. Aedes aegypti mostró resistencia a deltametrina, permetrina, malatión, clorpirifos, temefos y a bendiocarb (CARB), mientras que Aedes albopictus a malatión y en menor grado a cloripirifos, temefos, permetrina y deltametrina. Ambas especies mostraron altos niveles de enzimas como citocomo P450 y glutatión S-tranferasa, mientras que los niveles de esterasas variaron por especie y sitio muestreado. Se detectó acetilcolinesterasa insensible a insecticidas en ambas especies. Conclusión. En un hábitat urbano de Tapachula, Chiapas, México donde se aplica control con insecticidas Ae. aegypti y Ae. albopictus sólo son susceptibles al propoxur.
Human papilloma virus (HPV) has been associated with the development and modulation of response in a series of neoplasms. In the case of lung adenocarcinoma, its role in etiology and pathogenesis is ...still controversial. Considering that this infection brings foreign epitopes, it could be of prognostic significance in patients with lung adenocarcinoma treated with immunotherapy.
In a retrospective cohort study we evaluated the presence of HPV genomic material in lung adenocarcinoma primary lesions with the INNO-LiPA platform. Viral replication was also evaluated by detecting the presence of oncoprotein E6/E7 messenger RNA (mRNA) by quantitative RT-PCR. To confirm possible hypotheses regarding viral oncogenesis, vascular endothelial growth factor (VEGF) and hypoxia-inducible factor 1 (HIF1) were evaluated with stromal fibrosis and immunoscore.
A total of 133 patients were included in the analysis, of whom 34 tested positive for HPV, reaching an estimated prevalence of 25.6% 95% confidence interval (CI) 18.2% to 32.9%. E6/7 mRNA was identified in 28 out of the 34 previously positive cases (82.3%). In immune checkpoint inhibitor (ICI)-treated patients, the median overall survival reached 22.3 months 95% CI 19.4 months- not reached (NR) for HPV-negative and was not reached in HPV-positive (HPV+) ones (95% CI 27.7-NR; P = 0.008). With regard to progression-free survival, HPV− patients reached a median of 9.2 months (95% CI 7.9-11.2 months) compared to 14.3 months (95% CI 13.8-16.4 months) when HPV was positive (P = 0.001). The overall response rate for HPV+ patients yielded 82.4% compared to 47.1% in negative ones. No differences regarding programmed death-ligand 1, VEGF, HIF1, stromal fibrosis, or immunoscore were identified.
In patients with HPV+ lung adenocarcinoma, a significant benefit in overall response and survival outcomes is observed.
•HPV infection and its role in lung cancer is controversial.•Positivity is close to 25% of sampled lung cancer tissue biopsies.•HPV+ tumors treated with immunotherapy have better outcomes than their negative counterparts.
Pyrethroids are one of the few classes of insecticides available to control Aedes aegypti, the major vector of dengue, chikungunya, and Zika viruses. Unfortunately, evolving mechanisms of pyrethroid ...resistance in mosquito populations threaten our ability to control disease outbreaks. Two common pyrethroid resistance mechanisms occur in Ae. aegypti: 1) knockdown resistance, which involves amino acid substitutions at the pyrethroid target site-the voltage-gated sodium channel (VGSC)-and 2) enhanced metabolism by detoxification enzymes. When a heterogeneous population of mosquitoes is exposed to pyrethroids, different responses occur. During exposure, a proportion of mosquitoes exhibit immediate knockdown, whereas others are not knocked-down and are designated knockdown resistant (kdr). When these individuals are removed from the source of insecticide, the knocked-down mosquitoes can either remain in this status and lead to dead or recover within a few hours. The proportion of these phenotypic responses is dependent on the pyrethroid concentration and the genetic background of the population tested. In this study, we sequenced and performed pairwise genome comparisons between kdr, recovered, and dead phenotypes in a pyrethroid-resistant colony from Tapachula, Mexico. We identified single-nucleotide polymorphisms (SNPs) associated with each phenotype and identified genes that are likely associated with the mechanisms of pyrethroid resistance, including detoxification, the cuticle, and insecticide target sites. We identified high association between kdr and mutations at VGSC and moderate association with additional insecticide target site, detoxification, and cuticle protein coding genes. Recovery was associated with cuticle proteins, the voltage-dependent calcium channel, and a different group of detoxification genes. We provide a list of detoxification genes under directional selection in this field-resistant population. Their functional roles in pyrethroid metabolism and their potential uses as genomic markers of resistance require validation.
Pyrethroid resistance in Aedes aegypti has become widespread after almost two decades of frequent applications to reduce the transmission of mosquito-borne diseases. Because few insecticide classes ...are available for public health use, insecticide resistance management (IRM) is proposed as a strategy to retain their use. A key hypothesis of IRM assumes that negative fitness is associated with resistance, and when insecticides are removed from use, susceptibility is restored. In Tapachula, Mexico, pyrethroids (PYRs) were used exclusively by dengue control programs for 15 years, thereby contributing to selection for high PYR resistance in mosquitoes and failure in dengue control. In 2013, PYRs were replaced by organophosphates-insecticides from a class with a different mode of action. To test the hypothesis that PYR resistance is reversed in the absence of PYRs, we monitored Ae. aegypti's PYR resistance from 2016 to 2021 in Tapachula. We observed significant declining rates in the lethal concentration 50 (LC50), for permethrin and deltamethrin. For each month following the discontinuation of PYR use by vector control programs, we observed increases in the odds of mosquitoes dying by 1.5% and 8.4% for permethrin and deltamethrin, respectively. Also, knockdown-resistance mutations (kdr) in the voltage-gated sodium channel explained the variation in the permethrin LC50s, whereas variation in the deltamethrin LC50s was only explained by time. This trend was rapidly offset by application of a mixture of neonicotinoid and PYRs by vector control programs. Our results suggest that IRM strategies can be used to reverse PYR resistance in Ae. aegypti; however, long-term commitment by operational and community programs will be required for success.
Background:
Cognition is the ability to learn, process and remember information to be used later.(1) Cognitive impairment reflects a decrease in one or more cognitive domains: memory, language, ...reasoning, among others.(2) It has been reported in rheumatic diseases such as systemic lupus erythematosus, rheumatoid arthritis, fibromyalgia, and it is frequently found in young patients during the first years of their illness correlating the disease progression.(3) This condition can lead to anxiety and depression, compromising the quality of life. Given the lack of consensus regarding the best test to diagnose cognitive impairment, multiple tools have been used to address this problem.
Objectives:
To describe the systematical assessment in a Cognitive Evaluation and Rehabilitation Clinic in rheumatic patients from a University Hospital in Mexico.
Methods:
Observational and descriptive study. A multidisciplinary team met for 6 months to establish the structure a Cognitive Evaluation and Rehabilitation Clinic in a University Hospital in Mexico (Figure 1). As a pilot group we included outpatients from a Rheumatology clinic, referred by their physician (Table 1). The following psychological tests were used: Montreal Cognitive Assessment (MoCA) and Neurobehavioral Cognitive Status Examination (NCSE). After results (Table 2), the team decided to extend the evaluation with Automated Neuropsychological Assessment Metrics (ANAM), Wechsler Adult Intelligence Scale (WAIS-IV) and International Neuropsychiatric Interview (MINI) (Figure 2). Statistical analysis was performed with SPSS v.24, descriptive statistic were used with measures of central frequency trend.
Table 1.
Demographic characteristics
N=21
Age
, mean (SD)
43.62 (14.68)
Female
, n (%)
14 (66.66)
Years of education
, mean (SD)
15.24 (2.70)
Psychiatric disorder
Depression
, n (%)
4 (19.04)
Rheumatic diagnosis
Systemic lupus erythematosus, n (%
)
13 (61.90)
Rheumatoid arthritis, n (%
)
3 (14.30)
Others, n (%
)
5 (23.80)
Table 2.
Comparison of MoCA and NCSE results.
MoCA
N=21
NCSE N=21
Total score, mean (SD
)
24.24 (3.49)
38.52 (1.69
)
Level of cognitive impairment
Normal
, n (%)
7 (33.3)
17 (81)
Mild
, n (%)
13 (61.9
)
1 (4.8
)
Moderate
, n (%)
1(4.8
)
3 (14.2
)
Severe
, n (%)
0 (0)
0 (0)
MoCA, Montreal Cognitive Assessment; NCSE, Neurobehavioral Cognitive Status Examination.
Figure 1.
Pilot program of the Neurocognitive Assessment
Figure 2.
Final Program of the Neurocognitive Assessment
Results:
We evaluated 21 patients (66% females) with an average age of 43.62 years (SD 14.6) (Table 1). The total number of patients with cognitive impairment was 15 (71%), 14 (66%) diagnosed with MoCA, 6 (28%) with NCSE and a coincidence of both tests in 4 (19%) patients (Table 2).
Conclusion:
A high percentage of patients with cognitive impairment was found, also a discrepancy between the MoCA and NCSE results. We realized those tests were not enough to get a detail cognitive functioning, for this reason it was decided to make a more extensive evaluation adding ANAM, WAIS-IV and MINI. Neuropsychological evaluation should be performed as part of a multidisciplinary management for the patient and the rheumatologist should be aware of this manifestation and the importance of cognitive testing.
References:
1Gutierrez Rodriguez J, Guzman Gutierrez G. Definition and prevalence of mild cognitive impairment. Rev Esp Geriatr Gerontol. 2017;52 Suppl 1:3-6.
2Quijano JP-CyTdS. Evaluación Neuropsicológica y Funcional de la Demencia. Barcelona1996.
3Wijbrandts CA, Tak PP. Prediction of Response to Targeted Treatment in Rheumatoid Arthritis. Mayo Clin Proc. 2017;92(7):1129-43.
Disclosure of Interests:
None declared
Background:
Pharmacovigilance is the science and activities related to detection, evaluation, understanding and prevention of adverse effects of medications or any other health problem related to ...them. (1)
Within the scope of the pharmacovigilance study, following domains are included: adverse drug reaction, interaction between medications, counterfeit or inferior quality medications, lack of efficacy of medications, misuse or abuse of medications and medication errors (ME). (2)
ME is any preventable incident that can cause harm to the patient or lead to improper use of medications when they are under the control of healthcare professionals or the patient. (3)
Objectives:
To determine the frequency of ME in the prescriptions among rheumatology outpatient’s clinic.
Methods:
Prospective observational study.
Frequency of ME was sought by a randomized review of the prescriptions from rheumatology outpatient’s clinic of the University Hospital “Dr. José Eleuterio González” before and after the implementation of an electronic medical prescription system (REPAIR®) (January 2018-December 2019)
REPAIR® displays an automated menu with the stages of the medical prescription: Name, presentation and dosage of the medicine and duration of the treatment. Figure 1. Once the review began, semiannual reports were made to the doctors involved in which frequency of errors and the stage of medical prescription with highest incidence of ME were reported.
Figure 1
Example image displayed by REPAIR®
Descriptive statistics were performed, reporting frequencies and percentages.
Results:
A total of 1599 medical prescriptions were evaluated. The number of prescriptions with ME was 196 (12.2%). Table 1
Table 1
General description about errors in medical prescriptions
Prescriptions evaluated
1599
Prescription with ME n (%
)
196 (12.2%)
Medications evaluated n
10 413
Medications with ME n (%
)
907(8.7%)
Average medications per prescription
6.4
Average medications with ME per prescription
0.78
Prescription Stage
Name of the drug n (%
)
2/10 413 (0.01%)
Medication presentation n (%
)
77/ 10 413 (0.7%)
Dose of the drug n (%
)
0/10 413 (0%)
Duration of prescription n (%
)
725/10 413 (6.9%)
The incidence of ME decreased, at beginning of the study incidence was reported 31.6%, and at the end were 1.5%. Graph 1
The percentage of medications with ME also decreased from 17.2% to 0.8% at the end of the study. Table 2
Table 2
Errors in prescriptions per semester
January-June 2018
July-December 2018
January-June 2019
July-December 2019
Prescriptions evaluated n
321
411
407
460
Prescriptions with ME n (%
)
73 (31.6%)
93 (22.6%)
23 (5.6%)
7 (1.5%)
Medications evaluated n
2126
2784
2680
2823
Medications with ME n (%
)
367 (17.2%)
469 (16.8%)
36 (1.7%)
35 (0.8%)
Average medications per prescription evaluated
6.6
6.7
6.2
6.4
Average medications per prescription evaluated
1.146
1.143
0.082
0.081
Prescription Stage n (%
)
Name
1/367(0.2%)
1/469 (0.2%)
0
0
Presentation
37/367 (10%)
37/469 (7.8%)
1/36 (2.7%)
2/35 (5.7%)
Dose
0
0
0
0
Duration
290/367 (89%)
367/469 (88.2%)
35/36 (97.2%)
33/35 (94.2%)
Conclusion:
Decrease in the incidence of ME in rheumatology consultation is important because outcome of the patients depends significantly on treatment adherence. This study results shows that through the application of an electronic prescription system, it is possible to reduce the incidence of ME in rheumatology consultation.
References:
1Jeetu G, Anusha G. Pharmacovigilance: a worldwide master key for drug safety monitoring. J Young Pharm. 2010;2(3):315-20.
2Organization WH. WHO pharmacovigilance indicators: a practical manual for the assessment of pharmacovigilance systems. 2015.
3Elden NM, Ismail A. The Importance of Medication Errors Reporting in Improving the Quality of Clinical Care Services. Glob J Health Sci. 2016;8(8):54510.
Graph 1
Disclosure of Interests:
None declared
Background:
Medication error can be defined as a failure in the treatment process that leads to or has the potential to lead to harm to the patient, this fault can happen in two different phases: ...prescribing and prescription.
Prescribing is the process of deciding what to prescribe and naming it. Various types of faults can occur in the decision-making process: underprescribing, overprescribing, irrational, inappropriate and ineffective prescribing. All these covers one type of errors, but these are different kind of errors that those that occur in the act of writing a prescription. This leads to the distinct concepts of ‘prescribing faults’ and ‘prescription errors’
A prescription is ‘a written order, which includes detailed instructions of what medicine should be given, to whom, in what formulation and dose, by what route, when, how frequently, and for how long’. Thus, a prescription error can be defined as ‘a failure in the prescription writing process that results in a wrong instruction about one or more of the normal features of a prescription’. The ‘normal features’ include the identity of the patient, the identity of the drug, the formulation and dose, and the route, timing, frequency, and duration of administration. (1)
It is not record about the rate of medication errors in rheumatology consultation.
Objectives:
To evaluate whether there is a relationship between prescribing errors and the number of drugs in the prescription.
Methods:
A descriptive, observational, and retrospective study was made.
It was carried out a random search of medical prescriptions, generated by the electronic records (REPAIR®) of the rheumatology consultation of the Hospital Universitario “Dr. José Eleuterio González” during 2019, in which the prescriptions that contained any error were identified
T student test was performed to see the difference in the prescription error based on the number of medications. P <0.05 was taken as statistically significant.
Results:
A review of 867 medical prescriptions was performed, among which 5503 medications were indicated with an average of 6.34 medications per prescription, a total of 30 (6.9%) prescriptions were found with error, where a total of 71 (3.9%) medications had errors. In the prescriptions with medication error, all the errors were prescription type; 68 (95.7%) had a mistake in the duration of administration and 3 (4.22%) in the identity of the drug.
In the prescriptions with medical errors the average number of prescription drugs was 7.50, only 2/30 (0.6%) had less than 7 indicated medications (4 and 6), meanwhile the prescriptions in which no error was found had a mean of 6.30 indicated medications. P < 0.001.
Conclusion:
According to the study findings, it could be established that when the number of prescribed medications is greater than 7, there is an increased risk of making a prescription error. Further studies should carry out to look for other factors that influence medical errors in rheumatology clinics.
References:
1Aronson JK. Medication errors: definitions and classification. Br J Clin Pharmacol. 2009;67(6):599-604.
Acknowledgments
Disclosure of Interests:
None declared
Background:
Rheumatoid Arthritis (RA) has been associated with depression by up to 46% (1)
Within the universe of manifestations of depression is learned helplessness (LH)
LH is defined as an ...inadequate perception of the disease, generating feelings of defenselessness, loss of self-esteem, pessimism, and negativity. This leads to passivity, surrendering to fate, and thoughts that nothing within their power can change their situation, this condition produces a rapid deterioration which prevents responding adaptively to a traumatic situation, increasing the frequency of anxiety and depression. (2)
Objectives:
To assess the relationship between depression, LH, disability and disease activity among patients with RA
Methods:
Descriptive observational study included RA patients diagnosed according to ACR / EULAR 2010 randomly recruited between June and September 2019 at University Hospital “Dr. José Eleuterio González” in Monterrey, México.
Beck Depression Inventory (BDI) and Rheumatology Attitude Index (RAI) were applied for measure depression and LH, to measure disability Health Assessment Questionnaire (HAQ-DI) was applied. CDAI and DAS28-PCR scales were used for measure disease activity.
Descriptive analysis was carried out with measures of central tendency and dispersion. Spearman correlation were used for comparisons, according to the distribution of the variables. A p <0.05 was considered statistically significant.
Results:
A total of 177 patients were included, demographic and clinic features are presented in table 1. Prevalence of LH was 94.5% (167/177); 60% (100/167) mild levels (9-15) and 33% (67/167) high levels (>15). A significant correlation was found between higher levels of dysfunctionality and BDI and higher levels of LH (rho = 0.338; p = 0.001). There was a positive association when measuring CDAI (rho = 0.235; p = 0.002) BDI (rho=0.278 P=<0.001) and DAS28-PCR (rho=0.166; p=0.027) with higher levels of LH. There was no association found between other variables as gender, years of diagnosis of RA, years of study or presence of comorbidities like fibromyalgia or osteoarthritis.
Table 1.
Demographic and clinical characteristics of the patients. HAQ-DI Health Assessment Questionnaire RAI Rheumatology attitude index, DAS28-PCR Disease Activity Score CDAI Clinical disease activity index BDI Beck Depression Inventory
Demographics
n = 177
Gender
Female n, %
165 (93.3%).
Male n, %
12 (6.8%)
Age (mean), SD.
52.16 (12.8)
Years of study (average), SD.
8.3 (3.6)
Years with RA (mean), SD.
8.2 (8.0)
RAI (mean), SD
13.83 (3.9)
HAQ-DI (mean), SD
0.67 (0.77)
CDAI (mean), SD
12.0 (11.4)
DAS28-PCR (mean), SD
2.4 (0.6)
BDI (mean), DE
9.30 (9.7)
LH, n (%)
168/177 (94.5%)
High levels 108/177 (61%)
Low levels 60/177 (33%)
Conclusion:
In this study the prevalence of LH was high >90%, mainly in mild levels. Dysfunctionality seems to be the factor most associated with the presence of depression and LH.
Rheumatologist should consider the high levels of LH, to assess patients in order to obtain a better outcome.
Table 2.
Correlation between learned helplessness and clinical variables LH Learned Helplessness HAQ-DI Health Assessment Questionnaire RAI Rheumatology Attitude Index DAS28-PCR Disease Activity Score CDAI Clinical Disease Activity Index BDI Beck Depression Inventory
rho
p
LH –HAQ-DI
0.338
<0.001
LH-CDAI
0.235
0.002
LH-DAS28PCR
0.166
0.027
LH-BDI
0.278
<0.001
1Margaretten M, Julian L, Katz P, Yelin E. Depression in patients with rheumatoid arthritis: description, causes and mechanisms. Int J Clin Rheumtol. 2011;6(6):617-23.
2Moyano S, Scolnik M, Vergara F, Garcia MV, Sabelli MR, Rosa JE, et al. Evaluation of Learned Helplessness, Perceived Self-efficacy, and Functional Capacity in Patients With Fibromyalgia and Rheumatoid Arthritis. J Clin Rheumatol. 2019;25(2):65-8.
Disclosure of Interests:
None declared
To evaluate indoor use of commercial aerosols for dengue vector mosquito control, and estimate the number of treatable houses per can.
Four aerosol products containing combinations of pyrethroids ...(two containing propoxur and one containing synergists too), were evaluated with mosquitoes in a room of a Tapachulastyle house. Eight cages containing 20 insecticide susceptible or resistant females were hung from tripods, another set was placed in sheltered areas of the room. From the entrance of the room, one of 4-9 concentrations was sprayed for each aerosol, leaving the mosquitoes for 30 min after sprayed. Mortality was recorded after 24 h and lethal concentrations were calculated.
Aerosol A had the highest LC50, with 0.308 g for mosquitoes hanging from tripods and 0.453 g for sheltered mosquitoes; followed by aerosols C, D and B, with statistical differences between types of exposure.
Aerosols B-D could spray 20-25 3-room houses (56 m3-room), killing all resistant mosquitoes. Aerosols may become a good tool for indoor mosquito control, if the optimal concentration and correct spray method are used.
Either the triggering of large earthquakes on a fault hosting aseismic slip or the triggering of slow slip events (SSE) by passing seismic waves involve seismological questions with important hazard ...implications. Just a few observations plausibly suggest that such interactions actually happen in nature. In this study we show that three recent devastating earthquakes in Mexico are likely related to SSEs, describing a cascade of events interacting with each other on a regional scale via quasi-static and/or dynamic perturbations across the states of Guerrero and Oaxaca. Such interaction seems to be conditioned by the transient memory of Earth materials subject to the "traumatic" stress produced by seismic waves of the great 2017 (Mw8.2) Tehuantepec earthquake, which strongly disturbed the SSE cycles over a 650 km long segment of the subduction plate interface. Our results imply that seismic hazard in large populated areas is a short-term evolving function of seismotectonic processes that are often observable.
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