Schizophrenia-like psychosis associated with right lacunar thalamic infarct.

Thalamic dysfunction has been associated with schizophrenia and other psychotic disorders. We describe an adult patient with a lacunar infarct in the posterior region of the right thalamus exhibiting a paranoid schizophrenia-like psychosis as the only clinical manifestation. Neuropsychological assessment showed alterations in visuospatial memory and executive functions at follow up. This case highlights the role of information processing by the thalamus in the development of delusions. We suggest that dysfunction of the right mediodorsal and pulvinar thalamic nuclei disrupts both thalamic sensory processing and thalamo-prefrontal circuits mediating belief evaluation, leading to delusional beliefs.

Adaptation and validation of a TB stigma scale for adolescents in Lima, Peru.

BACKGROUND: TB-related stigma contributes to poor clinical outcomes and reduced wellbeing for affected individuals. Adolescents may be particularly susceptible to TB-related stigma due to their heightened sensitivity to peer acceptance, yet few studies have evaluated TB-related stigma in this group. Without a validated scale, it remains challenging to measure TB-related stigma in adolescents.METHODS: We adapted and validated the Van Rie TB Stigma Scale (VTSS) for adolescents on treatment for rifampicin-susceptible TB in Lima, Peru. The modified stigma scale was administered within a larger survey, which measured other psychosocial factors, including depression, adverse childhood experiences (ACEs), and social support. Data analysis included factor analysis, internal consistency, and convergent validity.RESULTS: From October 2020 to September 2021, 249 adolescents (individuals aged 10-19 years) completed the survey. Preliminary confirmatory factor analysis led to removal of two items. The final 10-item scale demonstrated good internal consistency (Cronbach's α = 0.82) and adequate model fit (χ²/df = 2.0; root mean square error of approximation: 0.06; comparative fit index: 0.94; Tucker-Lewis Index: 0.92: standardized root mean square residual: 0.05). Stigma was positively correlated with ACEs (γ = 0.13), depression (γ = 0.39), and suicidal ideation (γ = 0.27), and negatively correlated with social support (γ = -0.19).CONCLUSION: This adolescent TB stigma scale may serve as a practical tool to measure TB-related stigma and evaluate the impact of stigma-reduction interventions in adolescents.

Genotypic and phenotypic characterization of enterotoxigenic Escherichia coli strains isolated from Peruvian children.

Enterotoxigenic Escherichia coli (ETEC) is a major cause of childhood diarrhea. The present study sought to determine the prevalence and distribution of toxin types, colonization factors (CFs), and antimicrobial susceptibility of ETEC strains isolated from Peruvian children. We analyzed ETEC strains isolated from Peruvian children between 2 and 24 months of age in a passive surveillance study. Five E. coli colonies per patient were studied by multiplex real-time PCR to identify ETEC virulence factors. ETEC-associated toxins were confirmed using a GM1-based enzyme-linked immunosorbent assay. Confirmed strains were tested for CFs by dot blot assay using 21 monoclonal antibodies. We analyzed 1,129 samples from children with diarrhea and 744 control children and found ETEC in 5.3% and 4.3%, respectively. ETEC was more frequently isolated from children >12 months of age than from children <12 months of age (P < 0.001). Fifty-two percent of ETEC isolates from children with diarrhea and 72% of isolates from controls were heat-labile enterotoxin (LT) positive and heat-stable enterotoxin (ST) negative; 25% and 19%, respectively, were LT negative and ST positive; and 23% and 9%, respectively, were LT positive and ST positive. CFs were identified in 64% of diarrheal samples and 37% of control samples (P < 0.05). The most common CFs were CS6 (14% and 7%, respectively), CS12 (12% and 4%, respectively), and CS1 (9% and 4%, respectively). ST-producing ETEC strains caused more severe diarrhea than non-ST-producing ETEC strains. The strains were most frequently resistant to ampicillin (71%) and co-trimoxazole (61%). ETEC was thus found to be more prevalent in older infants. LT was the most common toxin type; 64% of strains had an identified CF. These data are relevant in estimating the burden of disease due to ETEC and the potential coverage of children in Peru by investigational vaccines.

[Efficacy of viscosupplementation with high and medium molecular weight hyaluronic acid in patients with symptomatic gonarthrosis grades II-III]. / Eficacia de la viscosuplementación con ácido hialurónico de alto y de mediano peso molecular en pacientes con gonartrosis sintomática grados II-III.

INTRODUCTION: OA is currently the fifth leading cause of adult disability, its prevalence increases from age 40. Viscosupplementation is a treatment for the early stages of knee OA. OBJECTIVE: To compare efficacy and quality of life in patients with symptomatic gonartrosis, treated with high and low molecular weight hyaluronic acid. MATERIAL AND METHODS: Analytical, retrospective, cross-sectional, observational study of clinical records of patients diagnosed with grade II and grade III gonarthrosis, October 2017 to June 2018, treated with viscosupplementation with high molecular weight hyaluronic acid or low molecular weight; WOMAC quality of life and scale were analyzed prior to the first application and tracked at two, four and six months. RESULTS: 194 patients, aged between 30 to 87 years (promedio 61.85; SD = 11.3); 134 women (69.1%), 60 men (30.9%). In both groups the evolution was towards improvement, with a decrease in the WOMAC score, with no significant difference between groups. The WOMAC score had a minimum increase after 6 months of application in both groups, which is interpreted as decreasing the therapeutic effect. Two patients had localized minimal adverse reactions which were resolved with general measures. CONCLUSION: Hyaluronic acid in both presentations, high and low molecular weight, are effective in the treatment of symptomatic goonarthrosis without difference to molecular weight.

INTRODUCCIÓN: La osteoartrosis es actualmente la quinta causa de discapacidad en el adulto. Su prevalencia aumenta a partir de los 40 años. La viscosuplementación es un tratamiento para las etapas iniciales de la osteoartrosis de rodilla. OBJETIVO: Comparar la eficacia y la calidad de vida en pacientes con gonartrosis sintomática tratados con ácido hialurónico de alto y mediano peso molecular. MATERIAL Y MÉTODOS: Estudio analítico, retrospectivo, transversal, observacional de expedientes clínicos de pacientes con diagnóstico de gonartrosis grado II y grado III, de Octubre de 2017 a Junio de 2018, tratados con viscosuplementación con ácido hialurónico de alto o de mediano peso molecular; se analizó la calidad de vida y la escala de WOMAC de manera previa a la primera aplicación y con seguimiento a los dos, cuatro y seis meses. RESULTADOS: 194 pacientes, con edades entre 30 y 87 años (promedio 61.85; DE = 11.3); 134 mujeres (69.1%) y 60 hombres (30.9%). En ambos grupos la evolución fue hacia la mejoría, con disminución en el puntaje WOMAC, sin diferencia significativa entre grupos. El puntaje de WOMAC tuvo un aumento mínimo pasados seis meses de la aplicación en ambos grupos, lo que se interpreta como disminución del efecto terapéutico. Dos pacientes tuvieron reacciones adversas mínimas localizadas, las cuales se resolvieron con medidas generales. CONCLUSIÓN: El ácido hialurónico en ambas presentaciones, de alto y de bajo peso molecular, es efectivo en el tratamiento de la gonartrosis sintomática sin diferencia con el peso molecular.

[Claudication, functional outcomes and quality of life in primary total hip arthroplasty with minimally invasive anterolateral approach]. / Claudicación, resultados funcionales y calidad de vida en artroplastía total de cadera primaria con abordaje anterolateral mínimamente invasivo.

INTRODUCTION: The coxarthrosis has incidence of 88 cases per 100,000 people/year and symptomatic prevalence of 16% men and 6% women aged 65-74 years and increases with age. It is a growing public health disease. Total hip arthroplasty (THA) has become the most successful procedure to increase the quality of life of patients with coxarthrosis. Our objective was to determine the claudication, quality of life and functional results of THA through minimal invasive approach in patients with primary coxarthrosis. MATERIAL AND METHODS: Prospective longitudinal study in patients with unilateral primary coxarthrosis postop of THA with minimally invasive approach from March 2015-February 2016, each patient was analyzed with quality of Life instrument (WOMAC), Functional test for coxarthrosis (HHS) and functional test in patients with hip surgery (OHS) with follow-up of one year. RESULTS: We included 21 patients, 17 female and 4 males corresponding to 80.95% and 19.05% respectively, average age of 59.95 years (ED = 9.64), with excellent functional results to one year according to HHS and OHS, quality of life high in 100% of cases according to WOMAC, with claudication rate of 4.76%. DISCUSSION: The minimal invasive approach is a reproducible surgical technique, with excellent functional results, low claudication rate and high quality of life in postoperative patients of primary ATC at only one year of follow-up.

INTRODUCCIÓN: La coxartrosis tiene incidencia de 88 casos por 100,000 personas/año y prevalencia sintomática de 16% para hombres y 6% para mujeres en edades de 65-74 años e incrementa con la edad. Representa una enfermedad de salud pública que va en aumento, la mujer es quien presenta padecimiento más grave. La ATC (artroplastía total de cadera) se ha convertido en el procedimiento más exitoso para mejorar la calidad de vida de pacientes con coxartrosis. OBJETIVO: Determinar la claudicación, calidad de vida y resultados funcionales de la ATC mediante abordaje mínimo invasivo en pacientes con coxartrosis primaria. MATERIAL Y MÉTODOS: Estudio longitudinal y prospectivo en pacientes con coxartrosis primaria unilateral postoperados de ATC primaria con técnica mínimamente invasiva en el período comprendido de Marzo de 2015 a Febrero de 2016, se analizó a cada paciente con somatometría, calidad de vida (WOMAC), funcionalidad en pacientes con coxartrosis (HHS) y funcionalidad en pacientes con cirugía de cadera (OHS) de manera prequirúrgica y postquirúrgica con seguimiento a un año. RESULTADOS: Se incluyeron 21 pacientes, 17 femeninos y cuatro masculinos que corresponde a 80.95 y 19.05%, respectivamente, edad promedio de 59.95 años (DE = 9.64), con resultados funcionales excelentes a un año, según escalas de HHS y OHS, calidad de vida alta en 100% de los casos según WOMAC, con índice de claudicación bajo de 4.76%. DISCUSIÓN: El abordaje mínimo invasivo es una técnica quirúrgica reproducible con resultados funcionales excelentes, índice de claudicación baja y alta calidad de vida en pacientes postoperados de ATC primaria durante el primer año de seguimiento.

Prevalence of bacterial vaginosis among young women in low-income populations of coastal Peru.

The goal of this study was to determine the prevalence of bacterial vaginosis (BV) in Peruvian women from socioeconomically deprived populations and to determine the association between BV and risk factors for sexually transmitted diseases (STDs). Women were administered an epidemiologic survey to determine sexual risk behaviour and they provided biological samples to test for BV and STDs. The prevalence of BV was high (27%) and was significantly associated with having a bacterial STD or trichomoniasis. Age, marital status, and a history of sex work, but not of sexual experience, frequency of intercourse, and unprotected intercourse, were associated with BV. As BV may be a marker for STDs, screening for STDs should be performed in individuals with BV to promote early detection and treatment of co-infecting sexually transmitted pathogens.

Field evaluation of rapid HIV serologic tests for screening and confirming HIV-1 infection in Honduras.

OBJECTIVE: To determine the ability of simple, rapid tests to identify HIV-1 antibody-positive specimens in field settings using the World Health Organization's (WHO) alternative testing strategies. DESIGN: Three-phase evaluation of simple, rapid assays using banked specimens and prospectively collected serum specimens at regional hospitals and rural clinics. METHODS: Seven test (Retrocell, Genie, HIVCHEK, SUDS HIV-1, Testpack, Serodia HIV-1, and HIV-1/2 RTD) were evaluated and results compared with standard enzyme immunoassay (EIA) and Western blot results (phase 1). Further evaluation consisted of prospective testing of routine specimens at regional (phase 2; n = 900) and rural, peripheral laboratories (phase 3; n = 1266) throughout Honduras with selected assays. RESULTS: Sensitivity and specificity were calculated for each assay and combination of assays for each phase to evaluate the effectiveness of the WHO alternative testing strategies. All tests in all phases were > 99% sensitive after correcting for technical errors, with two exceptions (SUDS, phase 1; HIVCHEK, phase 3). In phase 3, where the testing algorithm was diagnostic, several combinations of assays were 100% sensitive and specific using WHO strategy II or III. For the Honduras Ministry of Health, the combination of Retrocell and Genie was found to be equally sensitive, more specific (no indeterminate results), and less expensive than EIA/Western blot. CONCLUSION: Combinations of rapid, simple HIV antibody assays provide sensitivity and specificity performance comparable to EIA/Western blot. Application of these combinations in the WHO alternative testing strategies provides an inexpensive and effective method of determining HIV status. Assay combinations using these strategies can be easily performed in small, rural laboratories and have been implemented in routine HIV screening in Honduras.

PIP: In 1992, the World Health Organization (WHO) introduced 3 HIV testing algorithms designed to provide rapid, accurate results equivalent to those obtained by enzyme immunoassay (EIA) and Western blot but at reduced costs. The capability of the WHO strategy to identify HIV-1 antibodies in field settings was evaluated at regional hospitals and rural clinics in Honduras. In the study's first phase, the results of 7 tests (Retrocell, Genie, HIVCHEK, SUDS HIV-1, Testpack, Serodia HIV-1, and HIV-1/2 RTD) were compared with results for 600 sera previously tested by EIA and Western blot. Phase 2 entailed prospective testing of 900 routine specimens at regional laboratories, while phase 3 screened 1266 specimens at rural, peripheral laboratories. In the first phase of the analysis, 5 assays had a sensitivity of 100%; the remaining 2 were 99.7% and 99.3% sensitive and specificities ranged from 92.8 to 100%. In field settings, sensitivities ranged from 96.4 to 99.3%. Moreover, in the third phase, several combinations of tests were 100% sensitive or specific when the WHO strategy of basing the choice of assay on the purpose of the screening (seroprevalence studies, screening of blood, or patient diagnosis) was employed. The combination of Retrocell and Genie was found to be equally sensitive, more specific, and less expensive than EIA or Western blot.

The Rhizobium leguminosarum biovar phaseoli glnT gene, encoding glutamine synthetase III.

Plasmid pGE203 contains the Rhizobium leguminosarum biovar phaseoli glnT locus. Glutamine synthetase III (GSIII) was purified from a glutamine auxotrophic strain of Klebsiella pneumoniae carrying this plasmid. Sequencing of a 2.4-kb fragment containing the glnT locus reveals an open reading frame of 435 amino acids (aa), whose first eight aa are identical to those determined from pure GSIII by direct aa sequencing, thus confirming that glnT indeed codes for GSIII activity. The comparison of the GSIII aa sequence with the reported sequence of GSs from other organisms shows a significant degree of homology. Since the three-dimensional structure of GS from Salmonella typhimurium is known, a three-dimensional model of GSIII was built by homology.

Genetic variability of HIV type 1 in Honduras.

PIP: While Honduras is home to only 15% of Central America's population, it has 60% of the region's AIDS cases. There have been 4973 reported cases of full-blown AIDS in the country and the Health Ministry reports that more than 8000 Hondurans have been infected with HIV since the first Honduran case was diagnosed in 1985. 995 people with AIDS have since died. The authors conducted an investigation to determine which HIV-1 subtype is present in Honduras and the degree of genetic variation among HIV-1 strains by analyzing viral nucleotide sequences from the envelope region of HIV-1 isolates obtained from the two most affected regions of the country. They determined the predominant HIV-1 subtype among 27 HIV-1-infected patients attending sexually transmitted disease clinics in San Pedro Sula and Tegucigalpa by sequencing and analyzing the C2V3 regions of the envelope glycoprotein gp 120. Genomic DNA was isolated from patients' peripheral blood mononuclear cells. Phylogenetic analysis determined that all 27 Honduran sequences clustered with known subtype B sequences.^ieng

Phenotype of a Rhizobium leguminosarum ntrC mutant.

A Tn5 insertion mutant, strain CFN2012, of Rhizobium leguminosarum biovar phaseoli devoid of glutamine synthetase II (GSII) activity was analysed. It was shown to contain Tn5 within an 11-kb BamHI DNA fragment, which was isolated (pSM261) from the wild-type strain and, when introduced into strain CFN2012, was shown to complement the absence of GSII activity. The DNA sequence of the corresponding region from the wild-type allele revealed the presence of an ntrC regulatory gene, and restriction analysis indicated that the mutant allele carried the Tn5 insertion within it. Further analysis of strain CFN2012 indicated that this mutant has reduced levels of the PII regulatory protein and that, in contrast to ntrC mutants of other Rhizobiaceae, it grows on nitrate as the sole nitrogen source.

Diarrheal disease in Peru after the introduction of cholera.

Surveillance was conducted one day each week from December 1992 through May 1993 to determine the clinical features and etiology of diarrhea among a population in a suburban community of Lima, Peru. Patients who had had three or more loose stools during the previous 24 hr were enrolled at a clinic located in the community or at a nearby regional hospital. A total of 143 cases of diarrhea were detected for an overall rate of 7.1 cases per 1,000 population. The enteropathogens isolated were Vibrio cholerae 01 (31%), enterotoxigenic Escherichia coli (22%), and Salmonella, Shigella, Campylobacter, and Aeromonas species (10%). Specimens from the remaining cases were negative for enteropathogens. All isolates of V. cholerae were susceptible to tetracycline, doxycycline, nalidixic acid, norfloxacin, trimethoprim-sulfamethoxazole, trimethoprim, gentamicin, chloramphenicol, and cephalothin. Cases of diarrhea associated with V. cholerae were more common among adults, and more likely to experience severe dehydration and require hospitalization than the non-cholera cases. Data indicated that among the cases diagnosed, V. cholerae and enterotoxigenic E. coli were the more common causes of diarrhea in a suburban community of Lima during the summer season.

Remote sensing as a landscape epidemiologic tool to identify villages at high risk for malaria transmission.

A landscape approach using remote sensing and geographic information system (GIS) technologies was developed to discriminate between villages at high and low risk for malaria transmission, as defined by adult Anopheles albimanus abundance. Satellite data for an area in southern Chiapas, Mexico were digitally processed to generate a map of landscape elements. The GIS processes were used to determine the proportion of mapped landscape elements surrounding 40 villages where An. albimanus abundance data had been collected. The relationships between vector abundance and landscape element proportions were investigated using stepwise discriminant analysis and stepwise linear regression. Both analyses indicated that the most important landscape elements in terms of explaining vector abundance were transitional swamp and unmanaged pasture. Discriminant functions generated for these two elements were able to correctly distinguish between villages with high and low vector abundance, with an overall accuracy of 90%. Regression results found both transitional swamp and unmanaged pasture proportions to be predictive of vector abundance during the mid-to-late wet season. This approach, which integrates remotely sensed data and GIS capabilities to identify villages with high vector-human contact risk, provides a promising tool for malaria surveillance programs that depend on labor-intensive field techniques. This is particularly relevant in areas where the lack of accurate surveillance capabilities may result in no malaria control action when, in fact, directed action is necessary. In general, this landscape approach could be applied to other vector-borne diseases in areas where 1) the landscape elements critical to vector survival are known and 2) these elements can be detected at remote sensing scales.

Isolation of Cry1Ab protein mutants of Bacillus thuringiensis by a highly efficient PCR site-directed mutagenesis system.

A site-directed mutagenesis method was designed and used to create Cry1Ab mutant proteins in two of the five highly conserved blocks present in the Cry protein family. Region 1 comprises the central alpha-helix 5 of domain I and has been implicated in the pore formation activity of the toxin. Substitution of arginine by serine at position 173 (R173S) affects neither structural integrity nor toxicity. Region 2 comprises the major part of the domain I/domain II interface, characterized by the presence of numerous hydrogen bonds and electrostatic interactions. Mutations in the salt bridge formed by aspartic acid 242 and arginine 265 (D242N, D242C, R265C, and D242C/R265C) resulted in structurally unstable mutant proteins as is shown by their increased protease sensitivity and lack of biological activity.

Immunological response to Vibrio cholerae O1 infection and an oral cholera vaccine among Peruvians.

A 'double-blind', randomized, placebo controlled study of an oral inactivated whole cell plus recombinant B subunit (WC/rBS) cholera vaccine was conducted during February-March 1992 in Peru in 346 military recruits, 307 (89%) of whom received 2 oral doses of vaccine or Escherichia coli K12 placebo, 2 weeks apart. Paired serum samples were obtained from 155 (50%) of the recipients of 2 doses. An epidemic of cholera took place between doses. No difference in cholera attack rates was detected between vaccine and placebo recipients after one dose (8% versus 14%). Seroconversion (4-fold or higher increase in vibriocidal antibody titres) was detected in 90% and 80% of vaccine and placebo recipients, respectively, with low pre-existing vibriocidal titres (< 0.01). The anti-cholera toxin seroconversion rate among those with low pre-existing titres was higher in vaccinated subjects (97%) than in placebo recipients (68%) (P < 0.01). Administration of 2 doses of WC/rBS vaccine concomitantly with natural V. cholerae O1 infection enhanced the serum anti-cholera toxin response. The immune response to the whole cell component of the vaccine was reduced by high pre-existing vibriocidal antibody titres.

Dynamics of population densities and vegetation associations of Anopheles albimanus larvae in a coastal area of southern Chiapas, Mexico.

Spatial and seasonal variations on Anopheles albimanus larval densities and their plant associations were investigated in larval habitats in southern Mexico between April 1989 and May 1990. Thirty-four plant groups were dominant in larval habitats. Dense larval populations were associated with 3 genera of plants, Cynodon, Echinocloa and Fimbristylis and no larvae were found in habitats with Salvinia and Rhizophora. Low significant positive or negative associations were documented with the other 12 plant genera. Larval habitats were classified according to the morphology of their dominant plants. Higher larval densities were observed in the groups characterized by relatively short emergent vegetation. The distribution of habitat-types within 5 identified vegetation units showed a significantly dependent relationship. For the entire study period, highest larval densities were detected in flooded pasture/grassland vegetation units. For all vegetation units, higher larval densities were found when the dominant plant type covered between 25-50% of the breeding site. The integration of data from habitat-types into vegetation units did not result in loss of information.

The management of arthritis in general practice. Results from the Australian morbidity and treatment survey, 1990-1991.

Arthritis is the ninth most commonly managed problem in general practice in Australia. This paper provides an overview of its management in general practice and draws some comparisons with an earlier study.

The management of osteoarthritis in general practice. Results from the Australian Morbidity and Treatment Survey, 1990-1991.

Osteoarthritis is the fourth most commonly managed problem in general practice in Australia. This paper provides an overview of its management in general practice.

The management of URTI in general practice. Results from the Australian Morbidity and Treatment Survey, 1990-1991.

Upper respiratory tract infection is the second most frequently managed problem in general practice in Australia. This paper provides an overview of its management in general practice and compares the results with those of an earlier study.

The management of acute bronchitis in general practice: results from the Australian Morbidity and Treatment Survey, 1990-1991.

Acute bronchitis is the fifth most commonly managed problem in general practice in Australia. This paper provides an overview of its management in general practice and compares the results with those of an earlier study.

The management of sprains and strains in general practice. Results from the Australian Morbidity and Treatment Survey, 1990-1991.

Sprains and strains were the eighth most commonly managed problem in general practice in Australia. This paper provides an overview of their management in general practice.