RESUMEN

INTRODUCTION: Supplementary immunization activities (SIAs) aim to interrupt measles transmission by reaching susceptible children, including children who have not received the recommended two routine doses of MCV before the SIA. However, both strategies may miss the same children if vaccine doses are highly correlated. How well SIAs reach children missed by routine immunization is a key metric in assessing the added value of SIAs. METHODS: Children aged 9 months to younger than 5 years were enrolled in cross-sectional household serosurveys conducted in five districts in India following the 2017-2019 measles-rubella (MR) SIA. History of measles containing vaccine (MCV) through routine services or SIA was obtained from documents and verbal recall. Receipt of a first or second MCV dose during the SIA was categorized as "added value" of the SIA in reaching un- and under-vaccinated children. RESULTS: A total of 1,675 children were enrolled in these post-SIA surveys. The percentage of children receiving a 1st or 2nd dose through the SIA ranged from 12.8% in Thiruvananthapuram District to 48.6% in Dibrugarh District. Although the number of zero-dose children prior to the SIA was small in most sites, the proportion reached by the SIA ranged from 45.8% in Thiruvananthapuram District to 94.9% in Dibrugarh District. Fewer than 7% of children remained measles zero-dose after the MR SIA (range: 1.1-6.4%) compared to up to 28% before the SIA (range: 7.3-28.1%). DISCUSSION: We demonstrated the MR SIA provided considerable added value in terms of measles vaccination coverage, although there was variability across districts due to differences in routine and SIA coverage, and which children were reached by the SIA. Metrics evaluating the added value of an SIA can help to inform the design of vaccination strategies to better reach zero-dose or undervaccinated children.

Asunto(s)

Sarampión , Rubéola (Sarampión Alemán) , Humanos , Niño , Lactante , Estudios Transversales , Programas de Inmunización , Sarampión/prevención & control , Rubéola (Sarampión Alemán)/prevención & control , Vacunación , Vacuna Antisarampión , Inmunización

RESUMEN

Seed retention has not been evaluated for subterranean clover (Trifolium subterraneum L.), because its geocarpic seed-bearing burrs are currently harvested by suction systems. Development of improved harvest methods requires knowledge of subterranean clover seed retention characteristics and their changes with plant development. This study evaluates burr attachment and peduncle tensile strength during burr maturity until plant senescence across the three subspecies: subterraneum (cv. Dalkeith), yanninicum (cv. Monti) and brachycalycinum (cv. Mawson). Peduncle tensile strength was greater than burr-to-peduncle attachment strength for each subspecies, with peak mean peduncle strength 30-130% greater than peak mean burr-to-peduncle attachment strength. Both strength measurements decreased significantly (greater than 50% for each subspecies) as the plant senesced, which was associated with reductions in burr moisture content, and burr and peduncle diameters. Microscopy indicated a ductile to brittle transition as peduncles senesced, reducing energy absorption and increasing the likelihood of failure at defects. These results are important for the commercial production of subterranean clover seed and suggest it may be possible to harvest seed before plant senescence with dig-invert machinery, similar to that used for peanut harvesting. However, this approach would require harvesting prior to maximum seed development and the implications for seed viability and yield need to be further evaluated.

Asunto(s)

Trifolium , Medicago , Plantas , Semillas

RESUMEN

Measles vaccination is a public health 'best buy', with the highest cost of illness averted of any vaccine-preventable disease (Ozawa et al., Bull. WHO 2017;95:629). In recent decades, substantial reductions have been made in the number of measles cases, with an estimated 20 million deaths averted from 2000 to 2017 (Dabbagh et al., MMWR 2018;67:1323). Yet, an important feature of epidemic dynamics is that large outbreaks can occur following years of apparently successful control (Mclean et al., Epidemiol. Infect. 1988;100:419-442). Such 'post-honeymoon period' outbreaks are a result of the nonlinear dynamics of epidemics (Mclean et al., Epidemiol. Infect. 1988;100:419-442). Anticipating post-honeymoon outbreaks could lead to substantial gains in public health, helping to guide the timing, age-range, and location of catch-up vaccination campaigns (Grais et al., J. Roy. Soc. Interface 2008003B6:67-74). Theoretical conditions for such outbreaks are well understood for measles, yet the information required to make these calculations policy-relevant is largely lacking. We propose that a major extension of serological studies to directly characterize measles susceptibility is a high priority.

Asunto(s)

Susceptibilidad a Enfermedades/epidemiología , Vacunación Masiva/estadística & datos numéricos , Vacuna Antisarampión/inmunología , Sarampión/epidemiología , Anticuerpos Antivirales/sangre , Brotes de Enfermedades , Humanos , Salud Pública , Pruebas Serológicas

RESUMEN

OBJECTIVES: The objective of this study is to analyze and report the institution's experience using the Enseal bipolar tissue sealing device to perform endoscopic Zenker's diverticulotomy. Safety and early functional outcomes are presented as primary endpoints of the study. MATERIALS & METHODS: This is a retrospective study of consecutive patients with Zenker's diverticulum (ZD) treated via a transoral approach using a rigid endoscope and a bipolar tissue sealer between 2011 and 2019. Demographic data, ZD size, complications and preoperative versus postoperative symptoms were assessed. The Eating Assessment Tool-10 (EAT-10) questionnaire was used to evaluate functional outcomes, and statistical comparisons were made using the student's t-test. RESULTS: Nineteen ZD patients were identified who underwent rigid endoscopic diverticulotomy using a bipolar tissue sealer. The mean age was 71 years and 74% were male. The mean diverticulum size was 3.1 cm. There were no intraoperative or postoperative complications identified. Average pre-operative EAT-10 score was 21 and post-operative EAT-10 score was 12 at one to two weeks after surgery (p = .05). CONCLUSIONS: Evidence from this preliminary study of endoscopic Zenker's diverticulotomy using the Enseal device indicates that it is both safe and effective. Several features of the device, including its narrow profile, articulation and rotation capability, rapid repeatable activation, and low risk of collateral thermal injury, make it an appealing option for endoscopic Zenker's diverticulotomy.

Asunto(s)

Electrocoagulación/instrumentación , Esofagoscopía/instrumentación , Divertículo de Zenker/cirugía , Anciano , Anciano de 80 o más Años , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos

RESUMEN

OBJECTIVE: The function of Epstein-Barr virus (EBV) stable intronic sequence (sis)RNAs, non-coding RNAs transcribed from a region required for EBV-mediated cellular transformation, remain unknown. To better understand the function of ebv-sisRNA-1 and ebv-sisRNA-2 from the internal repeat (IR)1 region of EBV, we used a combination of bioinformatics and biochemistry to identify associated RNA binding proteins. The findings reported here are part of ongoing studies to determine the functions of non-coding RNAs from the IR1 region of EBV. RESULTS: Human regulatory proteins HNRNPA1 (heterogeneous nuclear ribonucleoprotein A1), HNRNPC, HNRNPL, HuR (human antigen R), and protein LIN28A (lin-28 homolog A) were predicted to bind ebv-sisRNA-1 and/or ebv-sisRNA-2; FUS (fused in sarcoma) was predicted to associate with ebv-sisRNA-2. Protein interactions were validated using a combination of RNA immunoprecipitation and biotin pulldown assays. Both sisRNAs also precipitated with HNRNPD and NONO (non-POU domain-containing octamer-binding protein). Interestingly, each of these interacting proteins also precipitated non-spliced non-coding RNA sequences transcribed from the IR1 region. Our findings suggest interesting roles for sisRNAs (through their interactions with regulatory proteins) and provide further evidence for the existence of non-spliced stable non-coding RNAs.

Asunto(s)

Proteína 1 Similar a ELAV , Herpesvirus Humano 4 , Ribonucleoproteína Nuclear Heterogénea A1 , Ribonucleoproteína Heterogénea-Nuclear Grupo C , Intrones , ARN no Traducido , ARN Viral , Proteínas de Unión al ARN , Ribonucleoproteínas , Proteína 1 Similar a ELAV/genética , Herpesvirus Humano 4/genética , Ribonucleoproteína Nuclear Heterogénea A1/genética , Ribonucleoproteína Heterogénea-Nuclear Grupo C/genética , Humanos , Intrones/genética , ARN no Traducido/genética , ARN Viral/genética , Proteínas de Unión al ARN/genética , Ribonucleoproteínas/genética

RESUMEN

Exposure to particulate matter (PM2.5 ) from the burning of biomass is associated with increased risk of respiratory disease. In Dhaka, Bangladesh, households that do not burn biomass often still experience high concentrations of PM2.5 , but the sources remain unexplained. We characterized the diurnal variation in the concentrations of PM2.5 in 257 households and compared the risk of experiencing high PM2.5 concentrations in biomass and non-biomass users. Indoor PM2.5 concentrations were estimated every minute over 24 h once a month from April 2009 through April 2010. We found that households that used gas or electricity experienced PM2.5 concentrations exceeding 1000 µg/m(3) for a mean of 35 min within a 24-h period compared with 66 min in biomass-burning households. In both households that used biomass and those that had no obvious source of particulate matter, the probability of PM2.5 exceeding 1000 µg/m(3) were highest during distinct morning, afternoon, and evening periods. In such densely populated settings, indoor pollution in clean fuel households may be determined by biomass used by neighbors, with the highest risk of exposure occurring during cooking periods. Community interventions to reduce biomass use may reduce exposure to high concentrations of PM2.5 in both biomass and non-biomass using households.

Asunto(s)

Culinaria/estadística & datos numéricos , Vivienda/estadística & datos numéricos , Material Particulado/análisis , Bangladesh , Biomasa , Modelos Estadísticos

RESUMEN

Approximately half of all children under two years of age in Bangladesh suffer from an acute lower respiratory infection (ALRI) each year. Exposure to indoor biomass smoke has been consistently associated with an increased risk of ALRI in young children. Our aim was to estimate the effect of indoor exposure to particulate matter (PM2.5 ) on the incidence of ALRI among children in a low-income, urban community in Bangladesh. We followed 257 children through two years of age to determine their frequency of ALRI and measured the PM2.5 concentrations in their sleeping space. Poisson regression was used to estimate the association between ALRI and the number of hours per day that PM2.5 concentrations exceeded 100 µg/m(3) , adjusting for known confounders. Each hour that PM2.5 concentrations exceeded 100 µg/m(3) was associated with a 7% increase in incidence of ALRI among children aged 0-11 months (adjusted incidence rate ratio (IRR) 1.07, 95% CI 1.01-1.14), but not in children 12-23 months old (adjusted IRR 1.00, 95% CI 0.92-1.09). Results from this study suggest that reducing indoor PM2.5 exposure could decrease the frequency of ALRI among infants, the children at highest risk of death from these infections.

Asunto(s)

Contaminación del Aire Interior/efectos adversos , Material Particulado , Infecciones del Sistema Respiratorio/epidemiología , Bangladesh/epidemiología , Estudios de Cohortes , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Embarazo , Infecciones del Sistema Respiratorio/etiología , Población Urbana

RESUMEN

Supplementary immunization activities (SIAs) are important in achieving high levels of population immunity to measles virus. Using data from a 2006 survey of measles vaccination in Lusaka, Zambia, we developed a model to predict measles immunity following routine vaccination and SIAs, and absent natural infection. Projected population immunity was compared between the current programme and alternatives, including supplementing routine vaccination with a second dose, or SIAs at 1-, 2-, 3-, 4- and 5-year intervals. Current routine vaccination plus frequent SIAs could maintain high levels of population immunity in children aged <5 years, even if each frequent SIA has low coverage (e.g. ≥ 72% for bi-annual 60% coverage SIAs vs. ≥ 69% for quadrennial 95% coverage SIAs). A second dose at 12 months with current coverage could achieve 81% immunity. Circulating measles virus will only increase population immunity. Public health officials should consider frequent SIAs when resources for a two-dose strategy are unavailable.

Asunto(s)

Vacuna Antisarampión/uso terapéutico , Sarampión/prevención & control , Factores de Edad , Anticuerpos Antivirales/inmunología , Preescolar , Estudios Transversales , Humanos , Programas de Inmunización/métodos , Programas de Inmunización/estadística & datos numéricos , Esquemas de Inmunización , Lactante , Sarampión/inmunología , Virus del Sarampión/inmunología , Encuestas y Cuestionarios , Zambia/epidemiología

RESUMEN

The expense in time and money limit the use of randomized clinical trials (RCT) and cohort studies for evaluating long-term AIDS treatment outcomes. We conducted a case-control study to characterize predictors of AIDS mortality after the availability of highly active antiretroviral therapy (HAART) in San Francisco, in which cases were matched with controls on stage of disease, year of AIDS diagnosis and year of HAART initiation. Overall, 266 cases and 1173 controls were included, representing >90% of eligible patients. The class of initial HAART regimen was not associated with mortality. Predictors of mortality were older age ([adjusted odds ratio] AOR 1.23, 95% [confidence interval] CI: 1.13-1.35), public versus private health insurance (AOR 2.80, 95% CI: 1.77-4.42), no versus private insurance (AOR 1.45, 95% CI: 1.02-2.07) and unboosted saquinavir (AOR 2.50, 95% CI: 1.34-4.65). Survival benefit was found in following the 2004 US Department of Health and Human Services preferred treatment guidelines; borderline survival benefits were found in following the guidelines from other years. Similar predictors were found for all-cause and AIDS-specific mortality. Our findings mirrored those of RCT and multi-centre cohort studies, and may be applicable to other settings. Our findings support similar survival benefit to persons initiating HAART with non-nucleoside reverse transcriptase inhibitor- or protease inhibitor-based regimens.

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Fármacos Anti-VIH/uso terapéutico , VIH-1 , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Adolescente , Adulto , Terapia Antirretroviral Altamente Activa , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Ensayos Clínicos Controlados Aleatorios como Asunto , San Francisco/epidemiología , Resultado del Tratamiento

RESUMEN

Remarkable progress has been made in reducing measles incidence and mortality as a consequence of implementing the measles mortality reduction strategy of the World Health Organization (WHO) and United Nations Children's Fund (UNICEF). The revised global measles mortality reduction goal set forth in the WHO-UNICEF Global Immunization Vision and Strategy for 2006-2015 is to reduce measles deaths by 90% by 2010 compared to the estimated 757,000 deaths in 2000. The possibility of measles eradication has been discussed for almost 40 years, and measles meets many of the criteria for eradication. Global measles eradication will face a number of challenges to achieving and sustaining high levels of vaccine coverage and population immunity, including population growth and demographic changes, conflict and political instability, and public perceptions of vaccine safety. To achieve the measles mortality reduction goal, continued progress needs to be made in delivering measles vaccines to the world's children.

Asunto(s)

Salud Global , Control de Infecciones , Sarampión/mortalidad , Sarampión/prevención & control , Humanos , Inmunización , Sarampión/epidemiología , Vacuna Antisarampión/administración & dosificación , Vigilancia de la Población , Organización Mundial de la Salud

RESUMEN

Summary We have developed a three-dimensional (3D) wavelet-based filter for visualizing structural features in volumetric data. The only variable parameter is a characteristic linear size of the feature of interest. The filtered output contains only those regions that are correlated with the characteristic size, thus de-noising the image. We demonstrate the use of the filter by applying it to 3D data from a variety of electron microscopy samples, including low-contrast vitreous ice cryogenic preparations, as well as 3D optical microscopy specimens.

Asunto(s)

Microscopía/métodos , Animales , Centriolos/ultraestructura , Microscopía por Crioelectrón/métodos , Células Eucariotas/ultraestructura , Filtración , Matemática , Microtúbulos/ultraestructura , Tomografía/métodos , Tubulina (Proteína)/ultraestructura

RESUMEN

Trabecular bone structure and bone density contribute to the strength of bone and are important in the study of osteoporosis. Wavelets are a powerful tool to characterize and quantify texture in an image. In this study the thickness of trabecular bone was analyzed in 8 cylindrical cores of the vertebral spine. Images were obtained from 3 Tesla (T) magnetic resonance imaging (MRI) and micro-computed tomography (μCT). Results from the wavelet based analysis of trabecular bone were compared with standard two-dimensional (2D) structural parameters (analogous to bone histomorphometry) obtained using mean intercept length (MR images) and direct three-dimensional (3D) distance transformation methods (μCT images). Additionally, the bone volume fraction was determined from MR images. We conclude that the wavelet based analyses delivers comparable results to the established MR histomorphometric measurements. The average deviation in trabecular thickness was less than one pixel size between the wavelet and the standard approach for both MR and μCT analysis. Since the wavelet based method is less sensitive to image noise, we see an advantage of wavelet analysis of trabecular bone for MR imaging when going to higher resolution.

RESUMEN

Previously we showed the superior in vitro survival of human telomerase reverse transcriptase (hTERT)-transduced human endothelial cells (EC). Here we show that retroviral-mediated transduction of hTERT in human dermal microvascular EC (HDMEC) results in cell lines that form microvascular structures when subcutaneously implanted in severe combined immunodeficiency (SCID) mice. Anti-human type IV collagen basement membrane immunoreactivity and visualization of enhanced green fluorescent protein (eGFP)-labeled microvessels confirmed the human origin of these capillaries. No human vasculature was observed after implantation of HT1080 fibrosarcoma cells, 293 human embryonic kidney cells, or human skin fibroblasts. Intravascular red fluorescent microspheres injected into host circulation were found within green "telomerized" microvessels, indicating functional murine-human vessel anastamoses. Whereas primary HDMEC-derived vessel density decreased with time, telomerized HDMEC maintained durable vessels six weeks after xenografting. Modulation of implant vessel density by exposure to different angiogenic and angiostatic factors demonstrated the utility of this system for the study of human microvascular remodeling in vivo.

Asunto(s)

Endotelio Vascular/enzimología , Endotelio Vascular/trasplante , Microcirculación , Modelos Animales , Telomerasa/metabolismo , Inhibidores de la Angiogénesis/farmacología , Animales , Membrana Basal/química , Capilares/efectos de los fármacos , Capilares/crecimiento & desarrollo , Células Cultivadas , Quimera , Colágeno/análisis , Colágeno/farmacología , Colágeno Tipo XVIII , Dermis/irrigación sanguínea , Endostatinas , Endotelio Vascular/efectos de los fármacos , Endotelio Vascular/metabolismo , Fibroblastos , Humanos , Ratones , Ratones SCID , Microcirculación/efectos de los fármacos , Microcirculación/crecimiento & desarrollo , Microesferas , Neovascularización Fisiológica/efectos de los fármacos , Fragmentos de Péptidos/farmacología , Telomerasa/genética , Telómero/genética , Transducción Genética , Trasplante Heterólogo , Células Tumorales Cultivadas

RESUMEN

A reverse transcriptase-polymerase chain reaction assay was used to detect measles virus RNA in peripheral blood mononuclear cells, urine, and nasopharyngeal specimens from Zambian children during hospitalization and approximately 1-2 months after discharge. Of 47 children, 29 (61.7%) had prolonged measles virus shedding, as defined by detection of measles virus RNA in > or =1 specimen obtained 30-61 days after rash onset. Ten (90.9%) of 11 human immunodeficiency virus (HIV)-infected children had prolonged measles virus shedding, compared with 19 (52.8%) of 36 HIV-uninfected children (P=.02). Prolonged measles virus shedding did not correlate with levels of measles virus-specific antibody. HIV-infected children with measles may have a prolonged infectious period that potentially enhances measles virus transmission and hinders measles control.

Asunto(s)

Infecciones por VIH/complicaciones , Virus del Sarampión/aislamiento & purificación , Sarampión/complicaciones , Esparcimiento de Virus , Adolescente , Anticuerpos Antivirales/sangre , Niño , Preescolar , Femenino , Seronegatividad para VIH , VIH-1/aislamiento & purificación , Humanos , Lactante , Leucocitos Mononucleares/virología , Masculino , Sarampión/virología , Virus del Sarampión/genética , Virus del Sarampión/inmunología , Virus del Sarampión/fisiología , Nasofaringe/virología , ARN Viral/análisis , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Factores de Tiempo , Orina/virología , Esparcimiento de Virus/fisiología , Zambia

RESUMEN

Most strategies for reducing global measles morbidity and mortality and eliminating measles are based on the ability to enhance immune responses to measles virus. Challenges to measles elimination and eradication are based in part on the need to sustain high levels of population immunity to interrupt transmission of measles virus. We review aspects of the immunology of measles and measles vaccination with the aim of demonstrating how knowledge of the immune responses is essential to furthering the goals of reducing measles morbidity and mortality and the elimination of measles. Better understanding of the mechanisms of immune suppression after measles, the potential for alternative vaccination strategies to induce immunity in young infants, and the immunologic basis of atypical measles, increased mortality after high-titer measles vaccine, and waning immunity will lead to improved strategies for measles control and elimination.

Asunto(s)

Vacuna Antisarampión/inmunología , Sarampión/inmunología , Animales , Humanos , Inmunidad Activa , Sarampión/prevención & control , Vacuna Antisarampión/administración & dosificación , Vacunación

RESUMEN

Achieving maximal benefit from clinic-based, sexually transmitted infection (STI) control strategies requires that persons seek treatment at public clinics. Community-based, ethnographic research methods were used to examine patterns of health-seeking behavior for sexually transmitted infections in western Kenya. Illness narratives of sexually transmitted infections provided the basis for an analysis of sequential steps in health-seeking behavior, namely recognition, classification, overcoming stigma, identification of treatment options and selection of a course of therapy. A variety of terms were used to identify STI, including multiple terms referring to "women's disease". The stigma associated with STI, reflected in the terminology, was based on a set of beliefs on the causes, contagiousness and sequelae of STI, and resulted in delays in seeking treatment. Five commonly used treatment options were identified, with multiple sources of care often used concurrently. The desire for privacy, cost and belief in the efficacy of traditional medicines strongly influenced health-seeking behaviour. A belief that sexually transmitted infections must be transmitted in order to achieve cure was professed by several respondents and promoted by a traditional healer. Implications for STI control strategies are derived, including the development of educational messages and the design of clinics.

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PIP: Data on health-seeking behavior were collected in Vihiga and Homa Bay Districts of western Kenya, as part of formative research for a sexually transmitted disease (STD) control and HIV/AIDS home care project with the main goal of securing information to guide project design and implementation. Community-based, ethnographic research methods were used from January 1995 to June 1996, including key informant interviews, focus group discussions, and in-depth interviews. Illness narratives of STDs provided the basis for an analysis of sequential steps in health-seeking behavior, namely recognizing, classifying, overcoming stigma, identifying treatment options, and selecting a course of therapy. A range of terms were used to identify STDs, including multiple terms referring to "women's disease." Stigma associated with STDs was based upon a set of beliefs of the causes, contagiousness, and sequelae of STDs, and resulted in treatment seeking delays. 5 commonly used treatment options were identified, with multiple sources of care often used concurrently. The desire for privacy, cost, and belief in the efficacy of traditional medicines strongly influenced health-seeking behavior. The belief that STDs must be transmitted in order to achieve cure was held by several respondents and promoted by a traditional healer. Implications for STD control strategies are considered, including the development of educational messages and clinic design.

Asunto(s)

Salud Rural , Enfermedades de Transmisión Sexual/prevención & control , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antropología Cultural , Control de Enfermedades Transmisibles/organización & administración , Femenino , Infecciones por VIH/prevención & control , Educación en Salud , Humanos , Kenia/epidemiología , Masculino , Medicinas Tradicionales Africanas , Persona de Mediana Edad , Servicios de Salud Rural/organización & administración

RESUMEN

Human immunodeficiency virus (HIV)-infected persons may be important, unrecognized transmitters of measles virus, thwarting eradication efforts. We reviewed the published English-language literature on measles and measles immunization in HIV-infected persons to investigate the clinical features of measles, the responses to measles immunization, and the safety of measles vaccine in HIV-infected persons and, conversely, the effect of measles and measles immunization on HIV infection. HIV-infected persons with measles are likely to have uncharacteristic clinical findings and severe illness, with high rates of pneumonitis and death. Primary and secondary failure of measles vaccine in HIV-infected children may permit transmission of measles virus in spite of high rates of immunization coverage. A factor that complicates measles-control efforts in areas of high prevalence of HIV is the potential for fatal infection with measles vaccine virus. Further research on the impact of the HIV epidemic on measles and measles immunization is necessary to guide strategies for the eradication of measles.

Asunto(s)

Infecciones Oportunistas Relacionadas con el SIDA/prevención & control , Brotes de Enfermedades , Infecciones por VIH/epidemiología , Vacuna Antisarampión , Sarampión/prevención & control , Infecciones Oportunistas Relacionadas con el SIDA/fisiopatología , Niño , Seguridad de Productos para el Consumidor , Progresión de la Enfermedad , Humanos , Sarampión/fisiopatología , Vacuna Antisarampión/efectos adversos

RESUMEN

PURPOSE: Compare and contrast reports of random allocation clinical trials of local field radiation therapy of metastases to bone to determine the techniques producing the best results (frequency, magnitude, and duration of benefit), and relate these to the goals of complete relief of pain and prevention of disability for the remaining life of the patient. METHODS AND MATERIALS: Review all published reports of random allocation clinical trials, and perform a systematic analysis of the processes and outcomes of the several trial reports. RESULTS: All trials were performed on selected populations of patients with symptomatic metastases and most studies included widely diverse groups with regard to: (a) site of primary tumor, (b) location, extent, size, and nature of metastases, (c) duration of survival after treatment All trial reports lack sufficient detail for full and complete analysis. Much collected information is not now available for reanalysis and many important data sets were apparently never collected. Several of the variations in patient and tumor characteristics were found to be much more important than treatment dose in the outcome results. Treatment planning and delivery techniques were unsophisticated and probably resulted in a systematic delivery of less than the assigned dose to some metastases. In general the use and benefit of retreatment was greater in those patients who initially received lower doses but the basis and dose of retreatment was not documented. Follow-up of patients was varied with a large proportion of surviving patients lost to follow-up in several studies. The greatest difference in the reports is the method of calculation of results. The applicability of Kaplan-Meier actuarial analysis, censoring the lost and dead patients, as used in studies with loss to follow-up of a large number of patients is questionable. The censoring involved is "informative" (the processes of loss relate to the outcome) and not acceptable since it results in artificial elevation of the frequency of response. Overall, higher dose fractionated treatment regimens produced a better frequency, magnitude, and duration of response than lower dose single-fraction regimens. Relapse after initial response was frequent. The "median duration of relief" was much shorter than the "median duration of survival" post-treatment. Thus the "net pain relief" is far less than the goal of pain relief for the total duration of life after treatment. CONCLUSIONS: The pain relief obtained in all studies is poor and our care practices need to be improved. Many patients never achieved complete relief and for most who did, the duration of relief was much less than their period of survival after treatment. Higher dose, fractionated treatments produced a greater frequency, magnitude, and duration of response with an improved "net pain relief." Additional trials with selection of comparable cases, good definition of extent of disease, exemplary treatment, and complete follow-up are required.

Asunto(s)

Neoplasias Óseas/radioterapia , Neoplasias Óseas/secundario , Dolor/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto , Analgésicos/uso terapéutico , Neoplasias Óseas/mortalidad , Estudios de Seguimiento , Humanos , Dimensión del Dolor , Cuidados Paliativos , Radioterapia/efectos adversos , Dosificación Radioterapéutica , Recurrencia , Resultado del Tratamiento

Asunto(s)

Tuberculosis Pulmonar/epidemiología , Adolescente , Adulto , Niño , Preescolar , Familia , Femenino , Humanos , Lactante , Masculino , Ciudad de Nueva York/epidemiología , Tuberculosis Pulmonar/transmisión

Asunto(s)

Infecciones por VIH/complicaciones , VIH-1/aislamiento & purificación , Choque Séptico/complicaciones , Infecciones Estafilocócicas/complicaciones , Antibacterianos , Niño , Diagnóstico Diferencial , Quimioterapia Combinada/uso terapéutico , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Humanos , Choque Séptico/diagnóstico , Choque Séptico/tratamiento farmacológico , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico