Universidad Metropolitana de Honduras

Currently, no licensed vaccine is available against chikungunya virus (CHIKV) in children aged less than 12 years. In this phase 2, observer-blind, randomized, dose-response trial we evaluated the tolerability (solicited adverse events (AEs)), safety (unsolicited AEs) and immunogenicity of a live-attenuated CHIKV vaccine (VLA1553) in healthy children aged 1-11 years in endemic countries. Here we provide a prespecified interim analysis to 28 days after vaccination. Participants (n = 304) received either a half dose (n = 119) or a full dose (n = 124) of VLA1553, or active control meningococcal vaccine (Nimenrix) (n = 61). The primary endpoint was the incidence and severity of solicited AEs within 14 days after vaccination. Secondary endpoints included unsolicited AEs, medically attended AEs, serious AEs, AEs of special interest and immunogenicity through 28 days after vaccination. For the primary endpoint, there were no statistically significant differences between the VLA1553 groups and control for each age group nor between age groups (1-2, 3-6 and 7-11 years). Overall, the most frequently reported solicited injection site AEs were tenderness (10.9%) and pain (8.6% of participants); the most frequently reported solicited systemic AEs were fever (12.5%) and headache (11.5%; participants aged 7-11 years and 3-6 years only, (headache was not solicited in participants aged 1-2 years)). For the secondary safety endpoints, the most common unsolicited AEs were infections and infestations (10.0-20.5%) and the most common medically attended AE overall was fever (2.6%), with no differences for unsolicited AEs or medically attended AEs regardless of vaccine and age group (serious AEs and AEs of special interest were too infrequent for meaningful comparisons). Anti-CHIKV neutralizing antibody titers were higher in the full-dose than the half-dose group at days 14 and 28 after vaccination. The trial met its prespecified endpoints and supported the selection of full-dose VLA1553 in future clinical trials in this population, addressing a critical unmet medical need. ClinicalTrials.gov registration: NCT06106581 .

Social innovation in health refers to the community-engaged process that connects health improvement and social change. The aim of this study was to develop a consensus statement on core learning competencies in social innovation in health and pilot them as part of a participatory training workshop. A modified Delphi Process aggregating data from a scoping review, global open call, and participatory process was organized. Participants were recruited from low, middle, and high-income countries with a range of social innovation experiences. Statements focused on social innovation in health core competencies for learning. Consensus was determined using the RAND/UCLA Appropriateness method. After expressing interest in the project, 68 individuals received the survey. 46 participants completed the first survey, and 35 completed the second. All 28 statements reached consensus, and based on the results of this first survey, some statements were added, amended, and merged to reach 30 consensus statements in the second survey. Competencies were categorized into skills, mindsets, and knowledge. Twenty-five statements had a median Likert rating score of >8 indicating strong agreement. Some competencies reached higher levels of agreement. This included community engagement, which can leverage the collective knowledge and problem-solving abilities of a diverse group of individuals to tackle complex challenges; social entrepreneurship skills including business model knowledge, securing funding, team building, and knowledge of intersectional issues and health inequities. Twelve competencies were then piloted as eight one-hour online workshops, which assessed the feasibility of developing them through online open-access social innovation training sessions. Afterwards,137 participants completed a survey rating their competency on a scale from 1 (not competent) to 5 (very competent),most reported a significant 1-point improvement including in entrepreneurship and understanding intersectionality. The results from this study will inform the development of a WHO/TDR conceptual framework which will have implications for training program design and policy.

Introducción: La Transmisión Vertical (TV) del Virus de la Inmunodeficiencia Humana (VIH) constituye la causa principal de transmisión del virus en menores de 15 años. Se define la TV del VIH, como la entidad clínica infecciosa del paso del VIH de una mujer embarazada infectada a su hijo durante el período de la gestación, el trabajo de parto, o durante la lactancia. Objetivo: Describir las características de la transmisión vertical en gestantes infectadas por el virus de la inmunodeficiencia humana, de enero 2019 a diciembre 2021 en el Hospital Escuela (HE). Métodos: Estudio descriptivo retrospectivo. La muestra fue de 42 gestantes infectadas por VIH que asistieron al Servicio Atención Integral (SAI) del HE. Se revisaron expedientes clínicos registrando información sobre características sociodemográficas y clínicas de las pacientes. Los resultados se presentaron en frecuencias y porcentajes de las variables estudiadas. Resultado: el 100% (42) de las madres conocían el diagnóstico de ser VIH positivo, 79% fueron diagnosticadas previo al embarazo, 100% en tratamiento antirretroviral (ARV), 43% con carga viral no detectable, 81% finalizó su embarazo vía cesárea, 55% fueron categorizados como alto riesgo, 52% recibió terapia antirretroviral (ARV) por 4 semanas, incidencia de TV de VIH fue de 2.4%, 1 de los 42 pacientes Discusión: La solicitud de una prueba para el diagnóstico de VIH en control prenatal debe realizarse de forma rutinaria, implementándose cesárea electiva, omisión de lactancia materna y tratamiento ARV prenatal a la culminación del embarazo y en recién nacido para la reducción la transmisión vertical.

Introducción: Se estima que la prevalencia global de infección por Helicobacter pylori alcanza el 50% de la población, con tasas aún más elevadas en regiones con condiciones sanitarias deficientes. Este patógeno es el principal agente etiológico de la gastritis crónica y está estrechamente relacionado con el desarrollo de adenocarcinoma gástrico. Objetivo: Identificar los hallazgos endoscópicos e histopatológicos más frecuentes y las características sociodemográficas de los pacientes diagnosticados con infección por Helicobacter pylori en el Hospital Regional de Occidente. Métodos: Estudio descriptivo, retrospectivo, basado en la revisión de expedientes y biopsias de pacientes con diagnóstico de Helicobacter pylori entre (enero-julio 2024). Resultados: Se identificaron 71 pacientes con infección por H. pylori; edades entre 18 y 77 años. Predominó el sexo femenino (66%). Las mujeres de 77 años o más y los hombres entre 68 y 77 años constituyeron los grupos más frecuentes. La procedencia más común fue el departamento de Copán (77.5%). La indicación endoscópica principal fue el síndrome anémico en estudio (26.6%). Entre los hallazgos endoscópicos, prevaleció la gastritis erosiva de predominio antral, 28.2%. En los hallazgos histopatológicos se observó atrofia 15.5%, metaplasia intestinal incompleta 25.2%, displasia de bajo grado 9.9% y adenocarcinoma intestinal 8.5%. Discusión: La prevalencia de infecciones por H. pylori fue mayor en mujeres mayores de 77 años. Los hallazgos más comunes incluyen gastritis erosiva antral y difusa. En las biopsias, predominaron los cambios arquitecturales leves, con la metaplasia intestinal incompleta como la lesión más frecuente.

Actualmente, la prisión preventiva se usa y utiliza irracionalmente, vislumbrándose en las audiencias un escenario de reproche político que azuza a diferentes grupos sociales a fin de generar presión en las decisiones judiciales. Esto lesiona la presunción de inocencia del imputado, a tal grado que las repercusiones sociales y mediáticas influyen en decisiones judiciales muchas veces apartadas de motivación. El presente artículo aborda la injerencia en la libertad personal de un individuo que se presupone inocente mientras no se declare su responsabilidad penal. Su estudio se enmarca en las ciencias penales, el derecho procesal penal y el derecho constitucional. El objetivo es analizar cómo los otorgamientos de la prisión preventiva por parte de los administradores de justicia presentan rasgos de irracionalidad, sin proporcionalidad que justifique su aplicación, lo que deriva en la vulneración al principio de inocencia. Se concluye que una aplicación sin la observancia de dichos principios afecta directamente esta garantía fundamental y la libertad del individuo.

BackgroundDigital health interventions, such as electronic immunization registries (eIRs) and electronic logistic management information systems (eLMIS), have the potential to significantly improve immunization data management and vaccine logistics in low- and middle-income countries (LMICs). Despite their growing adoption, there is limited evidence of the financial and economic costs associated with their implementation compared to traditional paper-based systems.ObjectivesWe aimed to measure the costs of implementing eIR and eLMIS systems in LMICs and to estimate their economic costs as compared to the previous paper-based registries.MethodsThe study was conducted across four countries—Guinea, Honduras, Rwanda, and Tanzania—which implemented the tools in 2018, 2012, 2019, and 2014, respectively. A combination of primary and secondary data sources was used for the analysis. Retrospective cost data regarding the design, development, and implementation of the tools were directly obtained from implementers and National Immunization Program offices in all countries. Primary survey data were collected to gauge the operational expenses of immunization information systems, both with and without electronic tools, using an activity-based costing approach in 275 facilities. The annual cost of the immunization information system at the national level was then extrapolated and compared to national spending on immunization as a measure of affordability. Costs were reported in 2023 international dollars (I$)ResultsThe total costs of designing, developing, and deploying eIR, eLMIS, or both were I$ 2.2, 6.4, 6.8, and 44.3 million in Guinea, Honduras, Rwanda, and Tanzania, respectively. Design costs were greatly affected by the degree of customization of the tool, whereas rollout costs were mostly driven by the costs of purchasing hardware and training health workers. Overall, the implementation of the electronic systems was associated with higher costs in Honduras (I$626 per facility, 95% CI 516-821) and Rwanda (I$399, 95% CI I$108-I$691), a cost reduction in Tanzania (−I$2539, 95% CI −I$4290 to −I$789) and no significant cost difference in Guinea. The percentage weight of the cost of managing data with the electronic systems over the total national immunization budgets was estimated at 0.7%, 7.7%, 3.3%, and 4.8% for Guinea, Honduras, Rwanda, and Tanzania, respectively.ConclusionsDigital health interventions such as eIR and eLMIS can potentially reduce costs and improve the efficiency of immunization data management and vaccine logistics in LMICs. However, the extent of cost savings depends on how effectively these digital systems replace traditional paper-based methods and the extent of their use in decision-making, especially at the facility level. Careful planning and investment are essential to unlocking the full economic potential of digital health in LMICs.