Detection of Leishmania RNA Virus 1 in Leishmania (Viannia) panamensis Isolates, Panama.

We detected Leishmania RNA virus 1 (LRV1) in 11 isolates of Leishmania (Viannia) panamensis collected during 2014-2019 from patients from different geographic areas in Panama. The distribution suggested a spread of LRV1 in L. (V.) panamensis parasites. We found no association between LRV1 and an increase in clinical pathology.

Chronic Chagas Disease-the Potential Role of Reinfections in Cardiomyopathy Pathogenesis.

PURPOSE OF THE REVIEW: Chagas disease is a neglected anthropozoonosis of global importance with significant cardiovascular-associated mortality. This review focuses on the Trypanosoma cruzi reinfections' role in chronic Chagas cardiomyopathy pathogenesis. We discuss and summarize the available data related to pathology, pathogenesis, diagnosis, and treatment of reinfections. RECENT FINDINGS: Reinfections influence the genetic and regional diversity of T. cruzi, tissue tropism, modulation of the host's immune system response, clinical manifestations, the risk for congenital infections, differences in diagnostics performances, response to antiparasitic therapy, and the natural history of the disease. Animal models suggest that reinfections lead to worse outcomes and increased mortality, while other studies showed an association between reinfections and lower parasitemia levels and subsequent infection protection. In some regions, the human risk of reinfections is 14% at 5 years. Evidence has shown that higher anti-T. cruzi antibodies are correlated with an increased rate of cardiomyopathy and death, suggesting that a higher parasite exposure related to reinfections may lead to worse outcomes. Based on the existing literature, reinfections may play a role in developing and exacerbating chronic Chagas cardiomyopathy and are linked to worse outcomes. Control efforts should be redirected to interventions that address structural poverty for the successful and sustainable prevention of Chagas disease.

Physical Growth and Neurodevelopment of a Cohort of Children after 3.5 Years of Follow-up from Mothers with Zika Infection during Pregnancy-Third Report of the ZIKERNCOL Study.

INTRODUCTION: In utero Zika virus (ZIKV) exposure has been related to a group of congenital structural abnormalities called the congenital Zika syndrome, which also has been related to neurodevelopment alterations even in normocephalic children. Physical growth has been less explored, and delayed growth and malnutrition have been reported. OBJECTIVE: The objective of this study is to describe the growth and neurodevelopment features of normocephalic infants born from a cohort of mothers with RT-PCR confirmed ZIKV during pregnancy in Risaralda, Colombia. METHODS: We conducted a retrospective cohort, including normocephalic children born from mothers with RT-PCR confirmed ZIKV infection during pregnancy in Risaralda, Colombia. Physical growth was measured using WHO standards, and neurodevelopment was measured with the abbreviated neurodevelopment scale 2 validated for Colombia. RESULTS: After verifying inclusion and exclusion criteria, 16 children were followed during a median time of 28 months (IQR 23-31 months); for a total of 116 visits, 87.5% (n = 14) of the patients developed a growth alteration. Five presented post-natal microcephaly, and among them, four presented malnutrition or low height. Six patients developed macrocephaly. Patients with a normal head circumference had normal neurodevelopment. Only one patient with microcephaly persisted with impairment of the neurodevelopment at the end of follow-up. All the patients with macrocephaly had normal neurodevelopment. DISCUSSION: Our study suggests that growth could be altered in infants with in utero Zika exposure. We found a high proportion of patients with overgrowth and macrocephaly. Future studies should consider endocrine follow-up of children born with in utero Zika exposure to explore these findings' possible aetiologies. CONCLUSION: We found a high proportion of growth alterations, particularly with overgrowth features and macrocephaly. Our study suggests that in addition to neurodevelopment impairment, growth could be altered in infants and children with in utero Zika exposure, even in those patients born without CZS.

GSP4PDB: a web tool to visualize, search and explore protein-ligand structural patterns.

BACKGROUND: In the field of protein engineering and biotechnology, the discovery and characterization of structural patterns is highly relevant as these patterns can give fundamental insights into protein-ligand interaction and protein function. This paper presents GSP4PDB, a bioinformatics web tool that enables the user to visualize, search and explore protein-ligand structural patterns within the entire Protein Data Bank. RESULTS: We introduce the notion of graph-based structural pattern (GSP) as an abstract model for representing protein-ligand interactions. A GSP is a graph where the nodes represent entities of the protein-ligand complex (amino acids and ligands) and the edges represent structural relationships (e.g. distances ligand - amino acid). The novel feature of GSP4PDB is a simple and intuitive graphical interface where the user can "draw" a GSP and execute its search in a relational database containing the structural data of each PDB entry. The results of the search are displayed using the same graph-based representation of the pattern. The user can further explore and analyse the results using a wide range of filters, or download their related information for external post-processing and analysis. CONCLUSIONS: GSP4PDB is a user-friendly and efficient application to search and discover new patterns of protein-ligand interaction.

[Usefulness and reliability of point of care ultrasound in Family Medicine: Focused ultrasound in neck and emergency]. / Utilidad y fiabilidad de la ecografía clínica en medicina familiar: ecografía del cuello y ecografía en urgencias.

Ultrasound is a very useful tool for diagnosis and to handle a great sort of daily affaires. The family Doctor, as general specialist, must be competent to carry out almost all kind of wealthy situations that can potentially affect to his population. Because of that, with this tool in his hand, the Doctor can get a higher level of quality in the efficiency of the assistant procedure. This is the last paper of a serial dedicated to show the different applications of clinical ultrasound, in which most of them have been reviewed, such as abdominal, nephrourological, musculoskeletal, cardiac or pulmonary focused ultrasound. We want to finalize with scenarios like neck pathology or applications in urgencies in which we can provide the definitive data to get the right diagnosis orientation, the clinic use, or even patient live, such as the patient under deep vein thrombosis in lower members, thoracoabdominal trauma, hemodynamic compromise situation or cardiac arrest.

[Usefulness and reliability of point of care ultrasound in Family Medicine: Focused cardiac and lung ultrasound]. / Utilidad y fiabilidad de la ecografía clínica en Medicina Familiar: ecocardioscopia y ecografía pulmonar.

The family doctor incorporates clinical ultrasound as an exploration and diagnosis technique in his care activity, the same way as the rest of the specialists. His generalist role makes him a potential user of all possible applications of this technique, which can provide a high impact on his ability to manage, focus and solve a large number of clinical situations. In this article we focus on assessing the usefulness and reliability of clinical ultrasound performed by the family doctor in their most novel aspects such as focused cardiac ultrasound and lung ultrasound.

Mutantelec: An In Silico mutation simulation platform for comparative electrostatic potential profiling of proteins.

The electrostatic potential plays a key role in many biological processes like determining the affinity of a ligand to a given protein target, and they are responsible for the catalytic activity of many enzymes. Understanding the effect that amino acid mutations will have on the electrostatic potential of a protein, will allow a thorough understanding of which residues are the most important in a protein. MutantElec, is a friendly web application for in silico generation of site-directed mutagenesis of proteins and the comparison of electrostatic potential between the wild type protein and the mutant(s), based on the three-dimensional structure of the protein. The effect of the mutation is evaluated using different approach to the traditional surface map. MutantElec provides a graphical display of the results that allows the visualization of changes occurring at close distance from the mutation and thus uncovers the local and global impact of a specific change. © 2017 Wiley Periodicals, Inc.

Predictors of Maternal Mortality and Prognostic Models in Obstetric Patients.

The use of predictive models has been proposed as a potential tool to reduce maternal morbidity and mortality, by aiding in the timely identification of potential high-risk patients. Prognostic models in critical care have been used to characterize the severity of illness of specific diseases. Physiological changes in pregnancy may result in general critical illness prediction models overestimating mortality in obstetric patients. Models that specifically reflect the unique characteristics of obstetric patients may have better prognostic value. Recently developed tools have focused on identifying at-risk patients before they require intensive care unit (ICU) admission to target early interventions and prevent acute clinical decompensation. The aim of the newest scoring systems, specifically designed for groups of obstetric patients receiving non-ICU care, is to reduce maternal morbidity and mortality by identifying early high-risk patients and initiating prompt effective medical responses.

Migrants in transit across Central America and the potential spread of chloroquine resistant malaria-a call for action.

Human migration has shaped the distribution and patterns of infectious diseases transmission throughout history. Migration is one of the contributing factors that has played an important role in the dissemination of drug-resistant Plasmodium falciparum. Central America and Mexico are important transit points of an increasing migrant flow originating from countries where chloroquine-resistant P. falciparum and vivax are prevalent. Surveillance systems, as well as detection and diagnostic capacities in the Central American region, are limited. The additional challenges imposed by the increasingly mobile population in the region are creating the perfect scenario for the emergence or re-emergence of infectious diseases, such as the introduction of chloroquine-resistant malaria. The development and implementation of transborder, collaborative, and ethical migrant health initiatives in the region are urgently needed. The health of migrant people in transit during their migratory route is of our collective interest and responsibility; their exclusion from health programs based on their legal status contradicts international human rights treaties and is inconsistent with ethical global public health practice.

Clinical manifestations of Rickettsia rickettsii in a familial outbreak in Panama.

We report an isolated outbreak of Rickettsia rickettsii in the Ngäbe-Buglé indigenous region, located 750 m (tropical wet) above sea level, in a jungle and mountainous area of Western Panama. Seven members of a family were infected simultaneously, resulting in four deaths. Family outbreaks have been previously described and are responsible for 4-8% of the cases described [1-4]. The simultaneous onset of symptoms in the affected population group is extremely unusual [1,5], but it should not dissuade the clinician from considering the possibility of Rickettsia rickettsii infection.

Non-capsulated and capsulated Haemophilus influenzae in children with acute otitis media in Venezuela: a prospective epidemiological study.

BACKGROUND: Non-typeable Haemophilus influenzae (NTHi) and Streptococcus pneumoniae are major causes of bacterial acute otitis media (AOM). Data regarding AOM are limited in Latin America. This is the first active surveillance in a private setting in Venezuela to characterize the bacterial etiology of AOM in children < 5 years of age. METHODS: Between December 2008 and December 2009, 91 AOM episodes (including sporadic, recurrent and treatment failures) were studied in 87 children enrolled into a medical center in Caracas, Venezuela. Middle ear fluid samples were collected either by tympanocentesis or spontaneous otorrhea swab sampling method. Standard laboratory and microbiological techniques were used to identify bacteria and test for antimicrobial resistance. The results were interpreted according to Clinical Laboratory Standards Institute (CLSI) 2009 for non-meningitis isolates. All statistical analyses were performed using SAS 9.1 and Microsoft Excel (for graphical purposes). RESULTS: Overall, bacteria were cultured from 69.2% (63 of the 91 episodes); at least one pathogen (S. pneumoniae, H. influenzae, S. pyogenes or M. catarrhalis) was cultured from 65.9% (60/91) of episodes. H. influenzae (55.5%; 35/63 episodes) and S. pneumoniae (34.9%; 22/63 episodes) were the most frequently reported bacteria. Among H. influenzae isolates, 62.9% (22/35 episodes) were non-capsulated (NTHi) and 31.4% (11/35 episodes) were capsulated including types d, a, c and f, across all age groups. Low antibiotic resistance for H. influenzae was observed to amoxicillin/ampicillin (5.7%; 2/35 samples). NTHi was isolated in four of the six H. influenzae positive samples (66.7%) from recurrent episodes. CONCLUSIONS: We found H. influenzae and S. pneumoniae to be the main pathogens causing AOM in Venezuela. Pneumococcal conjugate vaccines with efficacy against these bacterial pathogens may have the potential to maximize protection against AOM.

Ultralarge Free-Standing Imine-Based Covalent Organic Framework Membranes Fabricated via Compression.

Demand continues for processing methods to shape covalent organic frameworks (COFs) into macroscopic objects that are needed for their practical applications. Herein, a simple compression method to prepare large-scale, free-standing homogeneous and porous imine-based COF-membranes with dimensions in the centimeter range and excellent mechanical properties is reported. This method entails the compression of imine-based COF-aerogels, which undergo a morphological change from an elastic to plastic material. The COF-membranes fabricated upon compression show good performances for the separation of gas mixtures of industrial interest, N2 /CO2 and CH4 /CO2 . It is believed that the new procedure paves the way to a broader range of COF-membranes.

Detection of Mansonella ozzardi in peripheral blood in two malaria-endemic areas in Panama.

Introduction: Studies conducted in 1984 demonstrated the presence of Mansonella ozzardi in the Darien and Colon provinces. Since then, there have not been further reports of this parasitic infection in Panama. Methodology: We conducted a cross-sectional assessment of peripheral blood samples of individuals across Panama over a 4-year period (2013-2016) as part of malaria surveillance activities. Results: We identified microfilaria in 96 cases. Most of these cases were found in East Panama (78%) followed by the Darien region (22%). Mansonella ozzardi was the filarial parasite identified by morphological features in all cases. Conclusion: After 36 years of epidemiological silence, we identified human cases of Mansonella ozzardi infection in Panama. This is, however, the first report of this filarial parasite's presence in the Eastern region of Panama. There is a need for further surveillance efforts to elucidate the epidemiology associated with Mansonella infections in Panama.

Human monkeypox disease (MPX).

Monkeypox is a rare viral infection, endemic in many central and western African countries. The last international outbreak of monkeypox reported outside Africa occurred back in 2003. However, monkeypox has reemerged at a global scale with numerous confirmed cases across the globe in 2022. The rapid spread of cases through different countries has raised serious concerns among public health officials worldwide prompting accelerated investigations aimed to identify the origins and cause of the rapid expansion of cases. The current situation is reminiscent of the very early stages of the still ongoing COVID-19 pandemic. Overlapping features between these, two seemingly alike viral entities include the possibility for airborne transmission and the currently unexplained and rapid spread across borders. Early recognition of cases and timely intervention of potential transmission chains are necessary to contain further outbreaks. Measures should include rapid and accurate diagnosis of cases meeting case definitions, active surveillance efforts, and appropriate containment of confirmed cases. Governments and health policymakers must apply lessons learned from previous outbreaks and start taking active steps toward limiting the recent global spread of monkeypox. Herein, we discuss the status of the current monkeypox outbreaks worldwide, the epidemiological and public health situation at a global scale and what can be done to keep at bay its further expansion and future global implications.

U.S. bound journey of migrant peoples InTransit across Dante's Inferno and Purgatory in the Americas.

Rapid rise of population migration is a defining feature of the 21st century due to the impact of climate change, political instability, and socioeconomic downturn. Over the last decade, an increasing number of migrant peoples travel across the Americas to reach the United States seeking asylum or cross the border undocumented in search of economic opportunities. In this journey, migrant people experience violations of their human rights, hunger, illness, violence and have limited access to medical care. In the 'Divine Comedy', the Italian poet Dante Alighieri depicts his allegorical pilgrimage across Hell and Purgatory to reach Paradise. More than 700 years after its publication, Dante's poem speaks to the present time and the perilious journey of migrant peoples to reach safehavens. By exploring the depths and heights of the human condition, Dante's struggles resonate with the multiple barriers and the unfathomable experiences faced by migrant peoples in transit across South, Central, and North America to reach the United States. Ensuring the safety of migrant peoples across the Americas and elsewhere, and attending to their health needs during their migratory paths represent modern priorities to reduce social injustices and achieving health equity.

Large urban outbreak of orally acquired acute Chagas disease at a school in Caracas, Venezuela.

BACKGROUND: Trypanosoma cruzi oral transmission is possible through food contamination by vector's feces. Little is known about the epidemiology and clinical features of microepidemics of orally acquired acute Chagas disease (CD). METHODS: A case-control, cohort-nested, epidemiological study was conducted during an outbreak of acute CD that affected a school community. Structured interviews were designed to identify symptoms and sources of infection. Electrocardiograms were obtained for all patients. Specific serum antibodies were assessed by immunoenzimatic and indirect hemagglutination tests. In some cases, parasitemia was tested directly or by culture, animal inoculation, and/or a polymerase chain reaction technique. RESULTS: Infection was confirmed in 103 of 1000 exposed individuals. Of those infected, 75% were symptomatic, 20.3% required hospitalization, 59% showed ECG abnormalities, parasitemia was documented in 44, and 1 child died. Clinical features differed from those seen in vectorial transmission. The infection rate was significantly higher among younger children. An epidemiological investigation incriminated contaminated fresh guava juice as the sole source of infection. CONCLUSIONS: This outbreak was unique, because it affected a large, urban, predominantly young, middle-class, otherwise healthy population and resulted in an unprecedented public health emergency. Rapid diagnosis and treatment avoided higher lethality. Food-borne transmission of T. cruzi may occur more often than is currently recognized.

Arbovirus Rash in the Febrile Returning Traveler as a Diagnostic Clue.

Purpose of Review: This review aims to describe briefly the general information of arboviruses dengue, Zika, and chikungunya infections and emphasize the clinical manifestations of each, to help identify and make a quick diagnosis of each. Recent Findings: The most relevant advances in the study of these arboviruses' infections have been in the epidemiological distribution, mainly due to international travel, migration, and climate change; in the clinical manifestations of these diseases, the development of clinical decision-making software, which can help improve the management and outcomes of these patients; and in the prevention of this disease. Summary: Although arboviruses infections constitute a clinical challenge for the attending physician in the scope of a febrile returning traveler, a thorough clinical history and exam can help to aid diagnostic reasoning. The characteristics of the rash are a very helpful clue in the evaluation of these patients. Currently, there are clinical decision aid tools that help to get the diagnosis more quickly.

Common Dermatologic Conditions in Returning Travelers.

PURPOSE OF REVIEW: Travel medicine practitioners often are confronted with returning travelers with dermatologic disorders that could be of infectious causes or inflammatory or allergic. Some dermatologic processes are the result of exposure to insects or acquired due to environmental exposures. There is a broad range of dermatosis of infectious and non-infectious etiologies that clinicians need to consider in the differential diagnosis of dermatosis in travelers. RECENT FINDINGS: With increasing international travel to tropical destinations, many individuals may be exposed to rickettsia (i.e., African tick bite fever, scrub typhus, or Mediterranean spotted fever), parasitic infections (i.e., cutaneous larva migrans, cutaneous leishmaniasis, African trypanosomiasis, or American trypanosomiasis), viral infections (i.e., measles or Zika virus infection), bacterial (i.e., Buruli ulcer) or ectoparasites (scabies or tungiasis), and myiasis. Cutaneous lesions provide clinical clues to the diagnosis of specific exposures during travel among returned travelers. SUMMARY: Dermatologic disorders represent the third most common health problem in returned travelers, after gastrointestinal and respiratory illness. Many of these conditions may pose a risk of severe complications if there is any delay in diagnosis. Therefore, clinicians caring for travelers need to become familiar with the most frequent infectious and non-infectious skin disorders in travelers.

Should we be concerned about Venezuelan hemorrhagic fever? - A reflection on its current situation in Venezuela and potential impact in Latin America amid the migration crisis.

Venezuelan Haemorrhagic Fever is an endemic zoonosis exhibiting a high lethality. Discovered decades ago, it is still causing seasonal hemorrhagic fever outbreaks. With the ongoing migration crisis, transmission and spreading to other countries in Latin America remains a latent threat that should be monitored, particularly in light of recent cases.

Ischemic Stroke in a Child after a Probable Scorpion Sting.

Scorpion stings are common emergencies in the tropics. Species-specific antivenom therapies are available. However, fatalities resulting from scorpion stings remain a public health concern in many settings. Children residing in rural towns and peri-urban areas represent the most vulnerable populations. Delays in the diagnosis of scorpion stings often occur as a result of the non-specific clinical presentations, which then lead to life-threatening complications. We report a 2-year-old Venezuelan boy presenting with acute pancreatitis and pulmonary edema without an identifiable cause 48 hours after his initial symptoms. We administered antivenom therapy when an undetected scorpion sting was suspected. Despite some initial clinical improvement with respect to his acute pancreatitis, pulmonary edema, and coagulation abnormalities, our patient experienced an ischemic stroke. Fortunately, our patient did demonstrate some neurological improvement. Although acute pancreatitis and pulmonary edema are known end-organ damage manifestations of the sting of Tityus in the Americas, our particular case illustrates the risk of ischemic stroke.