BackgroundWorldwide, acute gastroenteritis causes substantial morbidity and mortality in children less than five years of age. In Bolivia, which has one of the lower GDPs in South America, 16% of child deaths can be attributed to diarrhea, and the costs associated with diarrhea can weigh heavily on patient families. To address this need, the study goal was to identify predictors of cost burden (diarrhea-related costs incurred as a percentage of annual income) and catastrophic cost (cost burden ≥ 1% of annual household income).MethodsFrom 2007 to 2009, researchers interviewed caregivers (n = 1,107) of pediatric patients (<5 years old) seeking treatment for diarrhea in six Bolivian hospitals. Caregivers were surveyed on demographics, clinical symptoms, direct (e.g. medication, consult fees), and indirect (e.g. lost wages) costs. Multivariate regression models (n = 551) were used to assess relationships of covariates to the outcomes of cost burden (linear model) and catastrophic cost (logistic model).ResultsWe determined that cost burden and catastrophic cost shared the same significant (p < 0.05) predictors. In the logistic model that also controlled for child sex, child age, household size, rural residence, transportations taken to the current visit, whether the child presented with complications, and whether this was the child’s first episode of diarrhea, significant predictors of catastrophic cost included outpatient status (OR 0.16, 95% CI [0.07, 0.37]); seeking care at a private hospital (OR 4.12, 95% CI [2.30, 7.41]); having previously sought treatment for this diarrheal episode (OR 3.92, 95% CI [1.64, 9.35]); and the number of days the child had diarrhea prior to the current visit (OR 1.14, 95% CI [1.05, 1.24]).ConclusionsOur analysis highlights the economic impact of pediatric diarrhea from the familial perspective and provides insight into potential areas of intervention to reduce associated economic burden.

Background Ventilator-associated pneumonia caused by Pseudomonas aeruginosa (PA) in hospitalised patients is associated with high mortality. The effectiveness of the bivalent, bispecific mAb MEDI3902 (gremubamab) in preventing PA nosocomial pneumonia was assessed in PA-colonised mechanically ventilated subjects. Methods EVADE (NCT02696902) was a phase 2, randomised, parallel-group, double-blind, placebo-controlled study in Europe, Turkey, Israel, and the USA. Subjects ≥ 18 years old, mechanically ventilated, tracheally colonised with PA, and without new-onset pneumonia, were randomised (1:1:1) to MEDI3902 500, 1500 mg (single intravenous dose), or placebo. The primary efficacy endpoint was the incidence of nosocomial PA pneumonia through 21 days post-dose in MEDI3902 1500 mg versus placebo, determined by an independent adjudication committee. Results Even if the initial sample size was not reached because of low recruitment, 188 subjects were randomised (MEDI3902 500/1500 mg: n = 16/87; placebo: n = 85) between 13 April 2016 and 17 October 2019. Out of these, 184 were dosed (MEDI3902 500/1500 mg: n = 16/85; placebo: n = 83), comprising the modified intent-to-treat set. Enrolment in the 500 mg arm was discontinued due to pharmacokinetic data demonstrating low MEDI3902 serum concentrations. Subsequently, enrolled subjects were randomised (1:1) to MEDI3902 1500 mg or placebo. PA pneumonia was confirmed in 22.4% (n = 19/85) of MEDI3902 1500 mg recipients and in 18.1% (n = 15/83) of placebo recipients (relative risk reduction [RRR]: − 23.7%; 80% confidence interval [CI] − 83.8%, 16.8%; p = 0.49). At 21 days post-1500 mg dose, the mean (standard deviation) serum MEDI3902 concentration was 9.46 (7.91) μg/mL, with 80.6% (n = 58/72) subjects achieving concentrations > 1.7 μg/mL, a level associated with improved outcome in animal models. Treatment-emergent adverse event incidence was similar between groups. Conclusions The bivalent, bispecific monoclonal antibody MEDI3902 (gremubamab) did not reduce PA nosocomial pneumonia incidence in PA-colonised mechanically ventilated subjects. Trial registration Registered on Clinicaltrials.gov (NCT02696902) on 11th February 2016 and on EudraCT (2015-001706-34) on 7th March 2016.

Resumen.-La minería de Tajo abierto se ha extendido como plaga por gran parte del territorio latinoamericano. En México, en particular, el caso es particularmente grave pues, según estimaciones, una cuarta parte de su territorio está concesionado a empresas mineras transnacionales. En este ensayo se estudia el caso de la minera Esperanza Silver, SA de CV, la cual pretendía establecerse en Temixco, Morelos y cuyo permiso de explotación fue recientemente rechazado por la Secretaría de Medio Ambiente y Recursos Naturales de la nación mexicana, no sin antes presentarse una importante oposición a la minera por parte de la sociedad civil organizada y el gobierno local. Palabras clave.-Minería a tajo abierto, colonialismo, cambio climático.Abstract.-Surface mining has spread like a pest on big part of the Latin-American territory. In Mexico the case is particularly serious because the fourth part of his land is awarded to mining transnational companies. In this essay we studied the case of the corporation Esperanza Silver, SA de CV, which was trying to settle in Temixco, Morelos (Mexico) and whose permission of development was pushed back recently by the Ministry of Environment and Natural Resources (SEMARNAT) of the Mexican nation, not without an important opposition to the mine for the civil society and the local government.

Tras una caracterización sobre el discurso oral desde la compleja red de elementos y disciplinas que configuran su estudio, se presenta un software para etiquetado y transcripción de los discursos orales en contextos de ciencias humanas y jurídicas (AVOCES). Este sistema se complementa con un algoritmo de extracción de información que permite una búsqueda de términos por contextos discursivos específicos, facilitando los procesos de almacenamiento y recuperación de información para el investigador. El objetivo de la aplicación informática es proveer a los investigadores de un entorno asistido para el análisis del discurso oral desde técnicas automáticas de etiquetado y extracción más fiables, contribuyendo así no solo a la consolidación de una metodología más consistente de los estudios discursivos orales, sino, al mismo tiempo, a una mejor preservación de la tradición oral.

Giant coronary aneurysms are defined as dilatation greater than 4.0 cm in diameter, or 4 times the normal diameter of the coronary artery. It is a rare pathology in the general popula-tion and most commonly affects the right coronary artery. The most common etiology of this aneurysm subtype is atherosclerosis. The clinical presentation varies, from asymptomatic to acute myocardial infarction with ST-segment elevation. The present case report describes a patient with acute myocardial infarction that underwent coronary cineangiography, which revealed a giant coronary aneurysm in the right coronary ostium, between the aorta and the superior vena cava, measuring 55 mm in diameter. It was compressing the middle portion of the coronary artery. Subsequently, resection of the coronary aneurysm, correction of the aortic defect resulting from the resection, and right coronary artery bypass graft surgery, using an aortovenous graft, were prescribed.