13. Otros

Francesca Schiaffino, Dixner Rengifo Trigoso, Josh M. Colston, Maribel Paredes Olortegui, Wagner V. Shapiama Lopez, Paul F. Garcia Bardales, Nora Pisanic, Meghan F. Davis, Pablo Penataro Yori, and Margaret N. Kosek.

Am. J. Trop. Med. Hyg., 104(1), 2021, pp. 372–381

Abstract. Using previously validated microbial source tracking markers, we detected and quantified fecal contamination from avian species and avian exposure, dogs, and humans on household cooking tables and floors. The association among contamination, infrastructure, and socioeconomic covariates was assessed using simple and multiple ordinal logistic regressions. The presence of Campylobacter spp. in surface samples was linked to avian markers. Using molecular methods, animal feces were detected in 75.0% and human feces in 20.2% of 104 households. Floors were more contaminated than tables as detected by the avian marker Av4143, dog marker Bactcan, and human marker Bachum. Wood tables were consistently more contaminated than non-wood surfaces, specifically with the mitochondrial avian markers ND5 and CytB, fecal marker Av4143, and canine marker Bactcan. Final multivariable models with socioeconomic and infrastructure characteristics included as covariates indicate that detection of avian feces and avian exposure was associated with the presence of chickens, maternal age, and length of tenancy, whereas detection of human markers was associated with unimproved water source. Detection of Campylobacter in surface samples was associated with the avian fecal marker Av4143. We highlight the critical need to detect and measure the burden of animal
fecal waste when evaluating household water, hygiene, and sanitation interventions, and the possibility of decreasing risk of exposure through the modification of surfaces to permit more effective household disinfection practices. Animals may be a more important source of household fecal contamination than humans in many low-resource settings, although interventions have historically focused almost exclusively on managing human waste.

Aizhamal Tabyshova, MD; John R. Hurst, MD, PhD; Joan B. Soriano, MD, PhD; William Checkley, MD, PhD; Erick Wan-Chun Huang, MD; Antigona C. Trofor, MD, PhD; Oscar Flores-Flores, MD; Patricia Alupo, MD; Gonzalo Gianella, MD; Tarana Ferdous, MPH; David Meharg, MPH; Jennifer Alison, PhD; Jaime Correia de Sousa, MD, PhD; Maarten J. Postma, PhD; Niels H. Chavannes, MD, PhD; and Job F. M. van Boven, PharmD, PhD.

CHEST 2021; 159(2):575-584

BACKGROUND: Guidelines are critical for facilitating cost-effective COPD care. Development
and implementation in low-and middle-income countries (LMICs) is challenging. To guide
future strategy, an overview of current global COPD guidelines is required.
RESEARCH QUESTION: We systematically reviewed national COPD guidelines, focusing on
worldwide availability and identification of potential development, content, context, and
quality gaps that may hamper effective implementation.
STUDY DESIGN AND METHODS: Scoping review of national COPD management guidelines. We
assessed: (1) global guideline coverage; (2) guideline information (authors, target audience,
dissemination plans); (3) content (prevention, diagnosis, treatments); (4) ethical, legal, and socioeconomic aspects; and (5) compliance with the eight Institute of Medicine (IOM) guideline
standards. LMICs guidelines were compared with those from high-income countries (HICs).
RESULTS: Of the 61 national COPD guidelines identified, 30 were from LMICs. Guidelines did
not cover 1.93 billion (30.2%) people living in LMICs, whereas only 0.02 billion (1.9%) in HICs
were without national guidelines. Compared with HICs, LMIC guidelines targeted fewer
health-care professional groups and less often addressed case finding and co-morbidities. More
than 90% of all guidelines included smoking cessation advice. Air pollution reduction strategies
were less frequently mentioned in both LMICs (47%) and HICs (42%). LMIC guidelines fulfilled
on average 3.37 (42%) of IOM standards, compared with 5.29 (66%) in HICs (P < .05).
LMICs scored significantly lower compared with HICs regarding conflicts of interest management,
updates, articulation of recommendations, and funding transparency (all, P < .05).

Josh M. Colston, Pablo Peñataro Yori, Lawrence H. Moulton, Maribel Paredes Olortegui, Peter S. Kosek, Dixner Rengifo Trigoso, Mery Siguas Salas, Francesca Schiaffino, Ruthly François, Fahmina Fardus-Reid, Jonathan R. Swann, Margaret N. Kosek.

PLoS Negl Trop Dis. 2019 Nov 15;13(11):e0007851.

Environmental enteric dysfunction (EED) is associated with chronic undernutrition. Efforts to identify minimally invasive biomarkers of EED reveal an expanding number of candidate analytes. An analytic strategy is reported to select among candidate biomarkers and systematically express the strength of each marker’s association with linear growth in infancy and early childhood. 180 analytes were quantified in fecal, urine and plasma samples taken at 7, 15 and 24 months of age from 258 subjects in a birth cohort in Peru. Treating the subjects’ length-for-age Z-score (LAZ-score) over a 2-month lag as the outcome, penalized linear regression models with different shrinkage methods were fitted to determine the best-fitting subset. These were then included with covariates in linear regression models to obtain estimates of each biomarker’s adjusted effect on growth. Transferrin had the largest and most statistically significant adjusted effect on short-term linear growth as measured by LAZ-score-a coefficient value of 0.50 (0.24, 0.75) for each log2 increase in plasma transferrin concentration. Other biomarkers with large effect size estimates included adiponectin, arginine, growth hormone, proline and serum amyloid P-component. The selected subset explained up to 23.0% of the variability in LAZ-score. Penalized regression modeling approaches can be used to select subsets from large panels of candidate biomarkers of EED. There is a need to systematically express the strength of association of biomarkers with linear growth or other outcomes to compare results across studies.

Md Ahshanul Haque, James A. Platts-Mills, Estomih Mduma, Ladaporn Bodhidatta, Pascal Bessong, Sadia Shakoor, Gagandeep Kang, Margaret N. Kosek, Aldo A. M. Lima, Sanjaya K. Shrestha, Md. Ashraful Alam , Alexandre Havt, Amidou Samie, Richard L. Guerrant, Dennis Lang, Mustafa Mahfuz, Zulfqar A. Bhutta, Eric R. Houpt & Tahmeed Ahmed.

Sci Rep. 2019 Nov 20;9(1):17124

Campylobacter species infections have been associated with malnutrition and intestinal inflammation among children in low-resource settings. However, it remains unclear whether that association is specific to Campylobacter jejuni/coli. The aim of this study was to assess the association between both all Campylobacter species infections and Campylobacter jejuni/coli infections on growth and enteric inflammation in children aged 1-24 months. We analyzed data from 1715 children followed from birth until 24 months of age in the MAL-ED birth cohort study, including detection of Campylobacter species by enzyme immunoassay and Campylobacter jejuni/coli by quantitative PCR in stool samples. Myeloperoxidase (MPO) concentration in stool, used as a quantitative index of enteric inflammation, was measured. The incidence rate per 100 child-months of infections with Campylobacter jejuni/coli and Campylobacter species during 1-24 month follow up were 17.7 and 29.6 respectively. Female sex of child, shorter duration of exclusive breastfeeding, lower maternal age, mother having less than 3 living children, maternal educational level of <6 years, lack of routine treatment of drinking water, and unimproved sanitation were associated with Campylobacter jejuni/coli infection. The cumulative burden of both Campylobacter jejuni/coli infections and Campylobacter species were associated with poor growth and increased intestinal inflammation.

Schiaffino, F., Lee, G. O., Paredes-Olortegui, M., Cabrera, L., Peñataro-Yori, P., Gilman, R. H., Kosek, M. N.

Am J Perinatol. 2019 Oct;36(12):1264-1270.

Bacillus Calmette-Guerin (BCG) scar formation is considered a visual marker of vaccination and cell-mediated immune response. This study characterized the association between pregnancy and birth characteristics with BCG scar formation.

Pregnant women were enrolled prospectively. Infants were followed up for the first 6 months of life, and the diameter of the BCG scar was recorded. Marginal models were fitted to assess the association of BCG scar diameter with pregnancy and birth characteristics using linear regressions with generalized estimating equations.

The immune reaction to the BCG vaccination is affected by gestational age at birth and systemic inflammatory episodes during pregnancy.

Correa M, Zimic M, Barrientos F, Barrientos R, Román-Gonzalez A, Pajuelo MJ, Anticona C, Mayta H, Alva A, Solis-Vasquez L, Figueroa DA, Chavez MA, Lavarello R, Castañeda B, Paz-Soldán VA, Checkley W, Gilman RH, Oberhelman R.

PloS one, 13(12), e0206410. doi:10.1371/journal.pone.0206410

Pneumonia is one of the major causes of child mortality, yet with a timely diagnosis, it is usually curable with antibiotic therapy. In many developing regions, diagnosing pneumonia remains a challenge, due to shortages of medical resources. Lung ultrasound has proved to be a useful tool to detect lung consolidation as evidence of pneumonia. However, diagnosis of pneumonia by ultrasound has limitations: it is operator-dependent, and it needs to be carried out and interpreted by trained personnel. Pattern recognition and image analysis is a potential tool to enable automatic diagnosis of pneumonia consolidation without requiring an expert analyst.