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The diagnosis of neurocysticercosis (NCC) depends on neuroimaging and serological confirmation. While antibody detection by enzyme-linked immunoelectrotransfer blot (EITB) fails to predict viable NCC, EITB banding patterns provide information about the host's infection course. Adding antigen enzyme-linked immunosorbent assay (Ag-ELISA) results to EITB banding patterns may improve their ability to predict or rule out of viable NCC. We assessed whether combining EITB banding patterns with Ag-ELISA improves discrimination of viable infection in imaging-confirmed parenchymal NCC. EITB banding patterns were grouped into classes using latent class analysis. True-positive and false-negative Ag-ELISA results in each class were compared using Fisher's exact test. Four classes were identified: 1, EITB negative or positive to GP50 alone (GP50 antigen family); 2, positive to GP42-39 and GP24 (T24/42 family), with or without GP50; and 3 and 4, positive to GP50, GP42-39, and GP24 and reacting to bands in the 8-kDa family. Most cases in classes 3 and 4 had viable NCC (82% and 88%, respectively) compared to classes 2 and 1 (53% and 5%, respectively). Adding positive Ag-ELISA results to class 2 predicted all viable NCC cases (22/22 [100%]), whereas 11/40 patients (27.5%) Ag-ELISA negative had viable NCC (P < 0.001). Only 1/4 patients (25%) Ag-ELISA positive in class 1 had viable NCC, whereas 1/36 patients (2.8%) Ag-ELISA negative had viable NCC (P = 0.192). In classes 3 and 4, adding Ag-ELISA was not contributory. Combining Ag-ELISA with EITB banding patterns improves discrimination of viable from nonviable NCC, particularly for class 2 responses. Together, these complement neuroimaging more appropriately for the diagnosis of viable NCC.

Background: Both pulmonary and mental health are affected following hospitalization for COVID-19 pneumonia. Pulmonary rehabilitation therapy has demonstrated benefits in improving mental health, but no validated combined programs that include mental health have been proposed. Objective: We developed a combined home-based respiratory physiotherapy and telephone-based psychological support intervention aimed at improving pulmonary and mental health outcomes 7-12 weeks after COVID-19 hospitalization discharge. Here we present the design and methodology of the trial. Methods: WAYRA (air in Quechua) was an open-label, unblinded, two-arm feasibility randomized controlled trial. We recruited 108 participants aged 18–75 years who were discharged from the hospital after COVID-19 pneumonia that required >6 L/min of supplemental oxygen during treatment. Participants were randomly assigned to receive the intervention or usual care in a 1:1 ratio. The intervention consisted of twelve at-home respiratory rehabilitation sessions and six telephone-based structured psychological sessions. The primary outcome was the six-minute walk distance. Secondary outcomes included lung function, mental health status (depression, anxiety and trauma) and quality of life. Outcomes were assessed at baseline (before randomization) and at 7 and 12 weeks after hospital discharge. Results: Recruitment and data collection occurred between October 2020 and June 2021 (ethics approval was obtained on September 02, 2020). A total of 103 participants completed the baseline assessments. Analyses of sample characteristics, primary and secondary outcomes are currently underway, with results expected to be published by the end of 2022. Conclusions: WAYRA aims to be the first randomized controlled trial evaluating combined pulmonary-mental health rehabilitation for hospitalized COVID-19 survivors in resource-limited settings, potentially providing a foundation for the cost-effective scaling-up of similar multidisciplinary rehabilitation programs. Clinical Trial: ClinicalTrials.gov,ID:NCT04649736

Identifying unique descriptors for primary colours in EEG signals will open the way to Brain-Computer Interface (BCI) systems that can control devices by exposure to primary colours. This study is aimed to identify such unique descriptors in visual evoked potentials (VEPs) elicited in response to the exposure to primary colours (RGB: red, green, and blue) from 31 subjects. For that, we first created a classification method with integrated transfer learning that can be suitable for an online setting. The method classified between the three RGB classes for each subject, and the obtained average accuracy over 23 subjects was 74.48%. 14 out of 23 subjects were above the average level and the maximum accuracy was 93.42%. When cross-session transfer learning was evaluated, 86% of the subjects tested showed an average variation of 5.0% in the accuracy comparing with the source set.

Hymenolepis nana, the dwarf tapeworm, is a common intestinal infection of children worldwide. We evaluated infection and risk factor data that were previously collected from 14,761 children aged 2-15 years during a large-scale program in northern Peru. We found that 1,124 of 14,761 children (7.61%) had H. nana infection, a likely underestimate given that only a single stool sample was examined by microscopy for diagnosis. The strongest association with infection was lack of adequate water (adjusted prevalence ratio [aPR] 2.22, 95% confidence interval [CI] 1.82-2.48) and sanitation infrastructure in the house (aPR 1.94, 95% CI 1.64-2.29). One quarter of those tested did not have a bathroom or latrine at home, which doubled their likelihood of infection. Similarly, one quarter did not have piped public water to the house, which also increased the likelihood of infection. Continued efforts to improve access to basic water and sanitation services will likely reduce the burden of infection in children for this and other intestinal infections.

Human capital requires opportunities to develop and capacity to overcome challenges, together with an enabling environment that fosters critical and disruptive innovation. Exploring such features is necessary to establish the foundation of solid long-term partnerships. In this paper we describe the experience of the CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Heredia in Lima, Peru, as a case study for fostering meaningful and sustainable partnerships for international collaborative research. The CRONICAS Centre of Excellence in Chronic Diseases was established in 2009 with the following Mission: "We support the development of young researchers and collaboration with national and international institutions. Our motivation is to improve population's health through high quality research." The Centre's identity is embedded in its core values - generosity, innovation, integrity, and quality- and its trajectory is a result of various interactions between multiple individuals, collaborators, teams, and institutions, which together with the challenges confronted, enables us to make an objective assessment of the partnership we would like to pursue, nurture and support. We do not intend to provide a single example of a successful partnership, but in contrast, to highlight what can be translated into opportunities to be faced by research groups based in low- and middle-income countries, and how these encounters can provide a strong platform for fruitful and sustainable partnerships. In defiant contexts, partnerships require to be nurtured and sustained. Acknowledging that all partnerships are not and should not be the same, we also need to learn from the evolution of such relationships, its key successes, hurdles and failures to contribute to the promotion of a culture of global solidarity where mutual goals, mutual gains, as well as mutual responsibilities are the norm. In so doing, we will all contribute to instil a new culture where expectations, roles and interactions among individuals and their teams are horizontal, the true nature of partnerships.

The CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Heredia, was created in 2009 with support from the U.S. National Heart, Lung, and Blood Institute (NHLBI). The vision of CRONICAS is to build a globally recognized center of excellence conducting quality and innovative research and generating high-impact evidence for health. The center's identity is embedded in its core values: generosity, innovation, integrity, and quality. This review has been structured to describe the development of the CRONICAS Centre, with a focus on highlighting the ongoing translational research projects and capacity-building strategies. The CRONICAS Centre of Excellence is not a risk-averse organization: it benefits from past experiences, including past mistakes, and improves upon them and thus challenges traditional research approaches. This ethos and environment are key to fostering innovation in research.

Summary Objective Neurocysticercosis (NCC) is a major cause of seizures and epilepsy in endemic countries. Antiparasitic treatment of brain cysts leads to seizures due to the host's inflammatory reaction, requiring concomitant steroids. We hypothesized that increased steroid dosing will reduce treatment-associated seizures. Methods Open-label randomized trial comparing 6 mg/day dexamethasone for 10 days (conventional) with 8 mg/day for 28 days followed by a 2-week taper (enhanced) in patients with NCC receiving albendazole. Follow-up included active seizure surveillance and brain imaging. Study outcomes were seizure days and patients with seizures, both measured in days 11–42. Additional analyses compared days 1–10, 11–21, 22–32, 33–42, 43–60, and 61–180. Results Thirty-two individuals were randomized into each study arm; two did not complete follow-up. From days 11 to 42, 59 partial and 6 generalized seizure days occurred in 20 individuals, nonsignificantly fewer in the enhanced arm (12 vs. 49, p = 0.114). The numbers of patients with seizures in this period showed similar nonsignificant differences. In the enhanced steroid arm there were significantly fewer days and individuals with seizures during antiparasitic treatment (days 1–10: 4 vs. 17, p = 0.004, and 1 vs. 10, p = 0.003, number needed to treat [NNT] 4.6, relative risk [RR] 0.1013, 95% confidence interval [CI] 0.01–0.74) and early after dexamethasone cessation (days 11–21: 6 vs. 27, p = 0.014, and 4 vs. 12, p = 0.021, NNT 4.0, RR 0.33, 95% CI 0.12–0.92) but not after day 21. There were no significant differences in antiparasitic efficacy or relevant adverse events. Significance Increased dexamethasone dosing results in fewer seizures for the first 21 days during and early after antiparasitic treatment for viable parenchymal NCC but not during the first 11–42 days, which was the primary predetermined time of analysis.

Clinicians in tropical settings face great challenges when addressing neurological cases. Many parasites have evolved and adapted to infect the central nervous system, but those less common tend to be a major difficulty, due to potentially obscure clinical features or lack of diagnostic methods. Here we present three rare types of cestodiasis that are present across the tropics...

The study aimed to identify the main incentives for attracting and retaining health workers in rural and remote health facilities in Ayacucho, Peru. In-depth interviews were performed with 80 physicians, obstetricians, nurses, and nurse technicians in the poorest areas (20 per group), plus 11 health managers. Ayacucho lacks systematic policies for attracting and retaining human resources. The main incentives, in order of relevance, were higher wages, opportunities for further training, longer/permanent contracts, better infrastructure and medical equipment, and more staff. Interviewees also mentioned improved housing conditions and food, the opportunity to be closer to family, and recognition by the health system. Health workers and policymakers share perceptions on key incentives to encourage work in rural areas. However, there are also singularities to be considered when designing specific strategies. Public initiatives thus need to be monitored and evaluated closely in order to ensure the intended impact. El objetivo fue identificar incentivos de atracción y retención en zonas rurales y distantes de Ayacucho, Perú. Fueron realizadas entrevistas en profundidad con 80 médicos, enfermeras, obstetras y técnicos (20 por grupo) de las zonas más pobres y con 11 funcionarios. No existen políticas sistemáticas de atracción y retención de personal de salud en Ayacucho. Los principales incentivos, en orden de importancia, fueron mejoras salariales, oportunidades de formación y capacitación, estabilidad laboral y nombramiento, mejoras en infraestructura y equipos, e incremento del personal. Se mencionaron también mejoras en la vivienda y alimentación, mayor cercanía con la familia y reconocimiento por el sistema de salud. Existen coincidencias y singularidades entre los distintos grupos sobre los incentivos clave para estimular el trabajo rural, que deben considerarse al diseñar políticas públicas. Las iniciativas del Estado deben comprender procesos rigurosos de monitoreo y evaluación, para asegurar que las mismas tengan el impacto deseado.

Neurocysticercosis is the most common cause of acquired epilepsy in the world. Antiparasitic treatment of viable brain cysts is of clinical benefit, but current antiparasitic regimes provide incomplete parasiticidal efficacy. Combined use of two antiparasitic drugs may improve clearance of brain parasites. Albendazole (ABZ) has been used together with praziquantel (PZQ) before for geohelminths, echinococcosis and cysticercosis, but their combined use is not yet formally recommended and only scarce, discrepant data exist on their pharmacokinetics when given together. We assessed the pharmacokinetics of their combined use for the treatment of neurocysticercosis. METHODS A randomized, double-blind, placebo-controlled phase II evaluation of the pharmacokinetics of ABZ and PZQ in 32 patients with neurocysticercosis was carried out. Patients received their usual concomitant medications including an antiepileptic drug, dexamethasone, and ranitidine. Randomization was stratified by antiepileptic drug (phenytoin or carbamazepine). Subjects had sequential blood samples taken after the first dose of antiparasitic drugs and again after 9days of treatment, and were followed for 3months after dosing. RESULTS Twenty-one men and 11 women, aged 16 to 55 (mean age 28)years were included. Albendazole sulfoxide concentrations were increased in the combination group compared with the ABZ alone group, both in patients taking phenytoin and patients taking carbamazepine. PZQ concentrations were also increased by the end of therapy. There were no significant side effects in this study group. CONCLUSIONS Combined ABZ + PZQ is associated with increased albendazole sulfoxide plasma concentrations. These increased concentrations could independently contribute to increased cysticidal efficacy by themselves or in addition to a possible synergistic effect.

El Delta del Orinoco es un complejo de humedales y ecosistemas acuáticos tropicales de aguas poco profundas en la planicie costera del oriente de Venezuela, el cual en su mayor parte aún no ha sido desarrollado. Es un sistema dinámico y complejo, vulnerable a las actividades humanas. Este artículo resume resultados de cartografía geo-ambiental en el noroeste del delta. Los geo-ambientes son unidades de recursos terrestres y acuáticos que se definen por las características y los procesos físicos, químicos, hidrológicos, y biológicos que los establecen, mantienen y modifican. Más de 20 geo-ambientes se definieron y delinearon en el formato del Sistema de Información Geográfica (SIG) mediante análisis integrado de información de sensores remotos, estadística y campo. Las unidades cartográficas se agruparon en cinco sistemas geomórfico/ecológicos: 1) costa con influencia marina, 2) canal distributario e isla con influencia marina, 3) fluvio/marino transicional, 4) canal distributario, y 5) cuenca interdistributaria. Los más extensos son las cuencas interdistributarias y los sistemas de canales distributarios, los cuales cubren respectivamente el 44% y el 15% del área cartografiada. Aunque el Delta del Orinoco está sin desarrollar en su mayor parte, la actividad humana en el noroeste del delta, especialmente la construcción de la represa de Volcán, ha modificado considerablemente los geo-ambientes en esta región. La distribución que se determinó y las características de los geo-ambientes proporcionan una base para el diseño de planes estratégicos para el desarrollo prudente y sustentable en esta parte del complejo ecosistema del Delta del Orinoco The Orinoco Delta is a largely undeveloped complex of tropical wetlands and shallow aquatic ecosystems within the coastal plain of eastern Venezuela. It is a dynamic and complex system that is vulnerable to human activities. This article summarizes results of geo-environmental mapping in the northwestern delta. Geo-environments are land- and water-resource units that are defined by the physical, chemical, hydrological, and biological properties and processes that establish, maintain, and modify them. More than 20 geo-environments were defined and delineated in a Geographic Information System (GIS) format through integrated remote sensing, statistical, and field analyses. Map units were grouped into five major geomorphic/ecologic systems: 1) marine-influenced coast, 2) marine-influenced distributary-channel and island, 3) fluvial/marine transitional, 4) distributary-channel, and 5) interdistributary basin. The most extensive are the interdistributary basins and distributary-channel systems, which comprise 44 % and 15 % of the map area, respectively. Although the Orinoco Delta is largely undeveloped, human activity in the northwestern delta, especially construction of the Volcán dam, has substantially altered geo-environments in this region. The defined distribution and characteristics of the geo-environments provide a basis for designing strategic plans for prudent and sustained development of this portion of the Orinoco Delta ecosystem complex O Delta del Orinoco é um complexo de humedales e ecossistemas aquáticos tropicais de aguas pouco profundas na planicie costera do oriente da Venezuela, o qual em sua maior parte ainda não foi desenvolvido. É um sistema dinâmico e complexo, vulnerável às actividades humanas. Este artígo resume resultados de cartografia geo-ambiental no-noroeste do delta. Os geo-ambientes são unidades de recursos terrestres e aquáticos que se definem pelas características e os processos físicos, químicos, hidrológicos, e biológicos que os estabelecem, mantém e modificam. Mais de 20 geo-ambientes se definiram e delinearam na forma do Sistema de información Geográfica (SIG) mediante análise integrado de informação de sensores remotos, estatística e campo. As unidades cartográficas se agruparam em cinco sistemas geomórfico/ecológicos: 1) costa com influência marinha, 2) canal distributario e ilha com influência marinha, 3) fluvio/marinho transicional, 4) canal distributario, e 5) cuenca interdistributaria. Os mais extensos são as cuencas interdistributarias e os sistemas de canais distributarios, os quais cobrem respectivamente o 44% e o 15% da área cartografiada. Ainda que o Delta del Orinoco está sem desenvolver em sua maior parte, a atividade humana no noroeste do delta, especialmente a construção da represa de Volcán, tem modificado consideravelmente os geo-ambientes nesta região. A distribuição que se determinou e as características dos geo-ambientes proporcionam uma base para o desenho de planos estratégicos para o desenvolvimento prudente e sustentável nesta parte do complexo ecossistema do Delta del Orinoco

Raske øyebevegelser (REM) under søvn er en beskrivelse av REM-søvnstadiet, det er velkjent at REM-søvn spiller en viktig rolle i søvn. Derfor å finne nøyaktig hjerne aktivering før REM kan bidra til å belyse hjerneområdene som er involvert for å produsere denne viktige hendelsen. Denne studien tar sikte på å finne hjerne aktivering i før REM aktiviteten. For å gjøre det er det nødvendig å finne start tiden for øyebevegelsene. En algoritme for å oppdage øyets bevegelsesutbrudd ble først utviklet og evaluert i søvn- og våkne data, deretter ble hjerne aktivering av før REM aktiviteten funnet. Etterpå ble en T-test implementert for å finne betydelig aktivering under før REM aktiviteten. Datasettet som ble brukt i studien ble registrert av Human Sleep Lab fra International Institute of Integrative Sleep Medicine og ble analysert ved hjelp av MNE åpen kildekode-python-pakke. Algoritmen er en forbedret metode basert på en tidligere laget øyebevegelsesalgoritme av Takahashi i 1997. Resultatene viste at algoritmen hadde en tilbakekalling på 0,97, en presisjon på 0,69 og en F1-score på 0,80. I tillegg ble den nye algoritmen testet for å kategorisere REM-søvnstadiet, hvor denne tilnærmingen ble funnet å identifisere REM-søvn i hele nattesøvnen. For å lokalisere før REM aktiviteten ble to metoder for hjerne aktivering implementert, og områdene med betydelig aktivering i før REM aktiviteten ble identifisert. Resultatene antyder at før REM aktiviteten har den viktigste aktiviseringen i striatum og de orbitofrontale regionene. Disse resultatene viser at algoritmen kan finne øyebevegelser i REM søvn og finne REM søvn stadiet. Imidlertid er forbedring av algoritmen nødvendig før algoritmens resultat kan stole på uten visuell inspeksjon av resultatene. Hjerne aktivering i striatum og orbitofrontal regioner indikerer hjernens bruk av belønning eller straff, og en beslutningsprosess i hjernen er aktiv. For videre forskning anbefales det å se på algoritmekriteriene og øke algoritmens presisjon. Før REM aktiveringen i REM søvn bør også undersøkes nærmere for å finne flere forbindelser til hjernesykdommer. Rapid eye movements (REM) during sleep is a descriptor of the REM sleep stage, it is well known that REM sleep plays an essential role in sleep. Therefore, precisely locate the source activity before the REM can help elucidate the brain areas involved to produce this important event. This study aims to find the source activation in the pre-REM negativity. To do so, the onsets of the eye movement were required. An algorithm to detect the eye movement onsets was firstly developed and evaluated in sleep and awake data, then, the source reconstruction of the pre-REM activity was found. Afterward, a T-test was implemented to find significant activation during pre-REM negativity. The dataset used in the study was registered by the Human Sleep Lab of the International Institute of Integrative Sleep Medicine and was analyzed using the MNE open-source python package. The algorithm is an improved method based on a previously made eye movement algorithm by Takahashi in 1997. The results showed that the algorithm had a recall of 0.97, a precision of 0.69, and an F1 score of 0.80. Additionally, the new algorithm was tested for categorizing the REM sleep stage, where this approach was found to identify REM sleep in whole night recordings. To localize the pre-REM negativity, two methods of source reconstruction were implemented and the areas with significant activation in the pre-REM negativity were identified. The results suggest that the pre-REM negativity has the most significant activation in the striatum and the orbitofrontal regions. These results show that the algorithm can find eye movements in REM sleep and find the REM sleeping stage. However, improvement of the algorithm is needed before the algorithm's output can be trusted without a visual inspection of the results. Source activation in the striatum and orbitofrontal regions indicates the brain's use of a reward or punishment, and a decision-making process of the brain is active. For further research, looking at the algorithm criteria and increasing the algorithm's precision is recommended. The Pre-REM negativity's effect in REM sleep should also be researched further to find more connections to brain disorders.