Temephos Resistance Status of Aedes aegypti Populations From Havana, Cuba.

Aedes aegypti chemical control remains an indispensable alternative to prevent dengue, Zika, and chikungunya outbreaks in Havana, Cuba. The city of Havana requires constant surveillance because of its bioecological characteristics that favor the proliferation of mosquito vectors of these viruses, which constitutes a high risk to the health of its inhabitants. The goal of this study was to determine the impact of the stopping of temephos applications during the 2 years of the COVID-19 pandemic on the level of susceptibility of Ae. aegypti in 5 municipalities of Havana, Cuba. Larval susceptibility was evaluated by bioassays as described by the World Health Organization. All Ae. aegypti populations tested showed high resistance to temephos. The National Control Program of Ae. aegypti in Cuba will need to promote insecticide rotation policies to prevent the evolution of temephos resistance in Havana.

Causes and prognosis of adults experiencing a first seizure in adulthood: A pilot cohort study conducted in five countries in Latin America.

There are limited data on first seizure (FS) among adults in low and middle-income countries. We describe findings from a prospective cohort study involving 180 adults presenting with seizures in emergency departments in five Latin American countries. Overall, 102 participants (56.7%) had acute symptomatic seizures (ASyS) while 78 (43.3%) had unprovoked seizures (UPS). Among patients with ASyS, 55 (53.9%) had structural causes, with stroke (n = 24, 23.5%), tumor (n = 10, 9.8%), and trauma (n = 3, 3%) being the most frequent. Nineteen patients (18.6%) had infectious causes, including four (4%) with meningoencephalitis, three (3%) neurocysticercosis, and two (2%) bacterial meningoencephalitis. Twenty patients (19.6%) had metabolic/toxic evidence, including four (4%) with uremic encephalopathy, two (2%) hyponatremia, and three (3%) acute alcohol intoxication. Immune dysfunction was present in seven (7%) patients and neurodegenerative in two (2%). Among participants with UPS, 45 (57.7%) had unknown etiology, 24 (30.7%) had evidence of structural disorders (remote symptomatic), four (5%) were related to infectious etiology (>7 days before the seizure), and five (6.4%) had genetic causes. During the 3- and 6-month follow-up, 29.8% and 14% of patients with UPS, respectively, experienced seizure recurrence, while 23.9% and 24.5% of patients with ASyS had seizure recurrence. Longer follow-up is necessary to assess seizure recurrence for patients with ASyS after the acute cause is resolved and to determine the 10-year risk of recurrence, which is part of the definition of epilepsy. PLAIN LANGUAGE SUMMARY: We monitored 180 adults who presented with their first seizure in emergency departments across five Latin American countries. Among these patients, 57% had acute symptomatic seizures, with structural causes such as stroke (23%), infection (17%), or tumor (10%) being more prevalent. Among the 43% with unprovoked seizures, 58% showed no identifiable acute cause, while 6.4% were due to genetics. Within 3 months after their initial seizure, 26.6% of individuals experienced a second seizure, with 11.9% continuing to have seizures in Months 3-6. Between Months 3 and 6, an additional 20% of patients encountered a second seizure. Research is needed to better understand the cause and prognosis of these patients to improve outcomes.

Treatment outcomes of patients with classic and AIDS-related Kaposi Sarcoma: a single-center real-world experience.

The recommended first-line chemotherapy agents for managing Kaposi sarcoma (KS) in high-income countries are expensive and often unavailable in developing nations such as Peru. Limited data exist on whether management practices in these countries affect patient outcomes. We assessed the real-world treatment approaches and outcomes of patients with KS in Peru. We retrospectively reviewed the medical records of patients with acquired immunodeficiency syndrome-related KS (AIDS-related KS; n = 95) and classic KS (CKS; n = 81) diagnosed at a tertiary center between 2000 and 2014 in Lima, Peru. We used the Kaplan-Meier method to estimate overall survival (OS) rates. The median follow-up was 64 months for AIDS-related KS and 88 months for CKS. The median age of patients with AIDS-related KS was 35 years (range 20-63 years) and 70 years (range 33-91 years) for those with CKS. Most individuals had an Eastern Cooperative Oncology Group performance status of ≥ 2 (AIDS-related KS 75%; CKS 85%). Seventy-six percent and 40% of individuals with AIDS-related KS and CKS, respectively, received systemic chemotherapy. The most common first-line drug was paclitaxel, with relatively optimal overall response rates (ORRs) for AIDS-related KS (n = 64/72, 89%; ORR 61%) and CKS (n = 24/32, 75%; ORR 50%). The 5-year OS rates were 71% in the AIDS-related KS cohort and 81% in the CKS cohort. The findings from this real-world study may inform clinical practices and highlight the need for increased access to effective treatments and clinical trials for patients with KS in Peru and other developing countries.

First report of natural Wolbachia infections in mosquitoes from Cuba.

Mosquitoes are extensively responsible for the transmission of pathogens. Novel strategies using Wolbachia could transform that scenario, since these bacteria manipulate mosquito reproduction, and can confer a pathogen transmission-blocking phenotype in culicids. Here, we screened the Wolbachia surface protein region by PCR in eight Cuban mosquito species. We confirmed the natural infections by sequencing and assessed the phylogenetic relationships among the Wolbachia strains detected. We identified four Wolbachia hosts: Aedes albopictus, Culex quinquefasciatus, Mansonia titillans, and Aedes mediovittatus (first report worldwide). Knowledge of Wolbachia strains and their natural hosts is essential for future operationalization of this vector control strategy in Cuba.

Insecticide Resistance Status of Aedes albopictus (Diptera: Culicidae) Populations from Cuba.

Aedes albopictus (Skuse, 1894) is one of the major vectors for arboviruses such as dengue, Zika, and chikungunya. Originally from Southeast Asia, this species has spread to Africa, Europe, and the Americas, including Cuba. This spread has been favored by its great adaptability to variable temperatures and to the resistance of its eggs to desiccation. Chemical control of mosquitoes is an essential alternative to stop arbovirus transmission, but insecticide resistance status of the Cuban Ae. albopictus populations is unknown. For this study, Ae. albopictus larvae and adults were collected from two municipalities in Havana, Cuba in 2019. Adult bioassays for deltamethrin, cypermethrin, lambda-cyhalothrin, chlorpyrifos, propoxur, and bendiocarb susceptibility were conducted according to CDC methodology. Larval bioassays for temephos susceptibility were performed following WHO protocols. Resistance profiles for α and ß-esterases, glutathione S-transferase (GST), and multifunction oxidases (MFO) pathways were constructed and analyzed. Resistance to temephos and deltamethrin was detected in Mulgoba and Plaza field populations, but resistance to lambda-cyhalothrin was only found in the Plaza colony. Plaza colony exhibited a higher expression level to all four metabolic enzymes and α-esterases and GTS were over-expressed in Mulgoba. The development of insecticide resistance in Cuban Ae. albopictus populations makes it imperative that we develop integrated control strategies to minimize the development of resistance and provide effective vector control that prevents the onset of arbovirus epidemics.

Characterization of Insecticide Resistance in Aedes aegypti from the Zoological Garden of Havana, Cuba.

Chemical control of Aedes aegypti continues to be an indispensable alternative to preventing dengue, Zika, and chikungunya outbreaks. The Havana Zoological Garden requires constant vigilance because its special characteristics help in the spread of the causal agents of diseases transmitted by mosquitoes, which put the health of visitors at risk. The goals of this study were to determine the level of susceptibility and insecticide resistance mechanisms in the Ae. aegypti population. Temephos susceptibility in larvae was evaluated with bioassays using the World Health Organization's methodology, and susceptibility of adult mosquitoes was determined by the impregnated bottle bioassay, recommended by the Centers for Disease Control and Prevention. Resistance mechanisms were determined with biochemical assays. Mosquito larvae from the Havana Zoo were found resistant to temephos, which was associated with the activity of the enzymes α- and ß-esterases and mixed function oxidases but not glutathione-S-transferase. Adult mosquitoes were susceptible to pyrethroid (lambda-cyhalothrin, deltamethrin, and cypermethrin), organophosphate (chlorpyrifos), and carbamate (bendiocarb). Temephos resistance detected in the mosquito population from the Havana Zoo is an alert for the Vector Control Program, which must take measures to manage their resistance, relying on the surveillance carried out by Cuba's medical entomology laboratories.

First Record of Natural Transovarial Transmission of Dengue Virus in Aedes albopictus from Cuba.

Transovarial transmission (TOT) of dengue virus (DENV) in Aedes spp. is an important mechanism for DENV maintenance in nature and may be important in initiating outbreaks. The objective of this study was to explore the occurrence of TOT in wild Aedes albopictus populations in Cuba. Mosquito larvae were collected in Cotorro municipality, Havana, Cuba, and identified to species. Fifteen pools of Ae. albopictus each containing 30 larvae were processed for DENV detection by using conventional reverse transcription polymerase chain reaction (RT-PCR) and nested PCR. Four out of 15 pools processed were positive for DENV-3, but no other DENV serotype was detected. This is the first time TOT of DENV detected in Cuban field populations of Ae. albopictus, and this suggests that this species may be an important vector of DENV in Cuba.

Reversal of Resistance to the Larvicide Temephos in an Aedes aegypti (Diptera: Culicidae) Laboratory Strain From Cuba.

The objective of this investigation was to know whether the organophosphate temephos resistance developed in larvae from a laboratory strain of Aedes aegypti (Linnaeus, 1762) from Cuba could be reversed. The resistant laboratory strain of Ae. aegypti, named SAN-F6, was left without temephos selection pressure for 12 generations. The level of temephos resistance was determined using WHO bioassays and mechanisms of metabolic resistance were determined based on enzyme activity levels detected by biochemical assays. Bioassays and biochemical assays were conducted on the SAN-F6 parental strain and every three reversal generations (SANRevF3, SANRevF6, SANRevF9, and SANRevF12) without temephos selection pressure. After 19 yr of keeping the SAN-F6 strain under selection pressure with the LC90 of temephos, the resistance ratio (RR50) was 47.5×. Biochemical assays indicated that esterase and glutathione S-transferase are still responsible for temephos resistance in this strain, but not mixed-function oxidase. Experiments on resistance reversal showed that temephos susceptibility could be recovered as α esterase activity levels decreased. The SAN-F6 strain has provided an essential basis for studies of temephos resistance in Cuba. It was demonstrated that the resistance developed to the larvicide temephos in Ae. aegypti from this Cuban lab strain is a reversible phenomenon, which suggests that similar outcomes might be expected in field populations. As such, the use of temephos alternated with other larvicides recommended by WHO such as Bti or pyriproxyfen is recommended to maintain the effectiveness of temephos and to achieve more effective control of Ae. aegypti.

Vector-borne transmission and evolution of Zika virus.

Zika virus (ZIKV), discovered in the Zika Forest of Uganda in 1947, is a mosquito-borne flavivirus related to yellow fever, dengue and West Nile viruses. From its discovery until 2007, only sporadic ZIKV cases were reported, with mild clinical manifestations in patients. Therefore, little attention was given to this virus before epidemics in the South Pacific and the Americas that began in 2013. Despite a growing number of ZIKV studies in the past three years, many aspects of the virus remain poorly characterized, particularly the spectrum of species involved in its transmission cycles. Here, we review the mosquito and vertebrate host species potentially involved in ZIKV vector-borne transmission worldwide. We also provide an evidence-supported analysis regarding the possibility of ZIKV spillback from an urban cycle to a zoonotic cycle outside Africa, and we review hypotheses regarding recent emergence and evolution of ZIKV. Finally, we identify critical remaining gaps in the current knowledge of ZIKV vector-borne transmission.

Validity of a PCR assay in CSF for the diagnosis of neurocysticercosis.

OBJECTIVE: To prospectively evaluate the validity of a PCR assay in CSF for the diagnosis of neurocysticercosis (NC). METHODS: We conducted a multicenter, prospective case-control study, recruiting participants from 5 hospitals in Cuenca, Ecuador, from January 2015 to February 2016. Cases fulfilled validated diagnostic criteria for NC. For each case, a neurosurgical patient who did not fulfill the diagnostic criteria for NC was selected as a control. CT and MRI, as well as a CSF sample, were collected from both cases and controls. The diagnostic criteria to identify cases were used as a reference standard. RESULTS: Overall, 36 case and 36 control participants were enrolled. PCR had a sensitivity of 72.2% (95% confidence interval [CI] 54.8%-85.8%) and a specificity of 100.0% (95% CI 90.3%-100.0%). For parenchymal NC, PCR had a sensitivity of 42.9% (95% CI 17.7%-71.1%), and for extraparenchymal NC, PCR had a sensitivity of 90.9% (95% CI 70.8%-98.9%). CONCLUSIONS: This study demonstrated the usefulness of this PCR assay in CSF for the diagnosis of NC. PCR may be particularly helpful for diagnosing extraparenchymal NC when neuroimaging techniques have failed. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that CSF PCR can accurately identify patients with extraparenchymal NC.

Tratamiento endovascular cerebral simultáneo en múltiples vasos: reporte de dos casos y revisión de literatura / Multiple vessel simultaneous cerebral endovascular treatment: report of two cases and literature review

Mediante la práctica adquirida en la aplicación de técnicas de angioplastia endovascular cerebral, cada vez se tienen más casos exitosos, con menos reportes de complicaciones. En la práctica clínica es frecuente encontrar pacientes con estenosis de múltiples vasos extracraneanos o intracraneanos, así que no es inusual enfrentarse a la necesidad de realizar simultáneamente angioplastia de dos o más vasos cerebrales. En este artículo se describen dos casos de pacientes con estenosis de los cuatro vasos cerebrales. El primero fue llevado a angioplastia más colocación de endoprótesis (stent) en la arteria carótida interna izquierda y en la arteria vertebral izquierda. Posteriormente, en un segundo procedimiento se practicó angioplastia de la arteria carótida interna derecha. El segundo requirió angioplastia y colocación de stent en la arteria carótida interna derecha y a arteria vertebral izquierda. Aunque un caso presentó isquemia transitoria debida a vasoespasmo, éste se resolvió completamente; ambos casos se llevaron a término exitosamente.

Analysis and residue levels of forchlorfenuron (CPPU) in watermelons.

This paper describes the application of liquid chromatography-tandem mass spectrometry (LC/MS-MS) for analysis of residues of forchlorfenuron (CPPU), a new plant growth regulator, in watermelons, after a sample preparation step based on the buffered Quick, Easy, Cheap, Effective, Rugged and Safe extraction method. Analytical determinations were carried out in a triple quadrupole system fitted with an electrospray interphase operating in the positive ionisation mode (ESI+). Three simultaneous MS-MS transitions of the quasi-molecular ion m/z 248 (precursor ion) were monitored for data acquisition (248 > 129, 248 > 155, and 248 > 248), using the transition 248 > 129 for quantitation. Recovery studies on watermelons at levels of 1-200 microg/kg, performing five replicates at each level and using bracketing single-level calibration with matrix-matched standards for quantitation, gave forchlorfenuron mean recoveries ranging from 82 to 106% with relative standard deviations (RSD) lower than 18%. The limit of determination was established at 1 microg/kg. The method was applied to evaluate the persistence of forchlorfenuron residues in watermelons grown in plastic greenhouses, after applying an individual spray treatment to the flower ovary at the anthesis stage (45 mu g/flower and 60 mu g/flower for cv "Extazy" and cv "reina de corazones" watermelons, respectively). One month after treatment, 20 "Extazy" watermelon units (1.5-2 kg/unit) and 20 "Reina de corazones" watermelon units (4-5 kg/unit) were collected and analyzed individually. None of the samples contained forchlorfenuron residues higher than 1 microg/kg.

Seroepidemiology of infection with Toxoplasma gondii in healthy blood donors of Durango, Mexico.

BACKGROUND: Toxoplasma gondii (T. gondii) infection in blood donors could represent a risk for transmission in blood recipients. There is scarce information about the epidemiology of T. gondii infection in blood donors in Mexico. Therefore, we sought to determine the prevalence of T. gondii infection and associated socio-demographic and behavioral characteristics in a population of healthy blood donors of Durango City, Mexico. METHODS: Four hundred and thirty two blood donors in two public blood banks of Durango City, Mexico were examined for T. gondii infection between August to September 2006. Blood donors were tested for anti-T. gondii IgG and IgM antibodies by using enzyme-linked immunoassays (Diagnostic Automation Inc., Calabasas, CA, USA). Socio-demographic and behavioral characteristics from each participant were also obtained. RESULTS: Thirty two (7.4%) of 432 blood donors had IgG anti-T. gondii antibodies. Eight (1.9%) of them had also IgM anti-T. gondii antibodies. Multivariate analysis using logic regression showed that T. gondii infection was associated with the presence of cats at home (adjusted OR = 3.81; 95% CI: 1.45-10.01). The age group of 45-60 years showed a significantly higher frequency of T. gondii infection than the group of 25-34 years (p = 0.02). Blood donors without education had a significantly higher frequency of infection (15.8%) than those with 13-19 years of education (4.5%) (p = 0.04). Other characteristics of blood donors including male gender, consumption of undercooked meat or blood transfusion did not show an association with infection. CONCLUSION: The prevalence of T. gondii infection in healthy blood donors of Durango City, Mexico is lower than those reported in blood donors of south and central Mexico, and is one of the lowest reported in blood donors worldwide. T. gondii infection in our blood donors was most likely acquired by contact with cats. Prevalence of infection increased with age and decreased with educational level.

One-year routine application of a new method based on liquid chromatography-tandem mass spectrometry to the analysis of 16 multiclass pesticides in vegetable samples.

An analytical procedure has been developed for determining a group of 16 multiclass pesticides most commonly used in crop protection. The extraction step is performed with a mixture of ethyl acetate and sodium sulphate, in the presence of 6.5 M NaOH. After evaporation, a final extract containing 1 mg sample/ml extract, is obtained in methanol. Analysis of the methanolic extract, without additional clean-up steps, is performed by liquid chromatography-electrospray ionisation-tandem mass spectrometry combining positive and negative ion mode. The analytical performance of the method has been validated for three different matrices: pepper, lettuce and aubergine. Mean recoveries obtained were between 70 and 110% in most of the cases with a precision of <28%. Linearity of response over 2 orders of magnitude was demonstrated (r > or = 0.99) with limits of detection < or = 0.01 mg/kg in all the cases. No significant matrix effects were observed with the exception of triflumizol that presented a drastic decrease in response as a consequence of an ion formation suppression effect in the presence of pepper matrix. The method has been applied to the analysis of 560 vegetable samples, as a part of the monitoring programme of the Association of Producers and Exporters of Fruits and Vegetables of Almería (COEXPHAL). The unambiguous confirmation of the positive findings by comparison of the product ion mass spectra of the peaks in samples and standards, demonstrated the applicability of the method in routine analysis.

Determination of methyl tert.-butyl ether and tert.-butyl alcohol in seawater samples using purge-and-trap enrichment coupled to gas chromatography with atomic emission and mass spectrometric detection.

A rapid and simple analytical method has been established for the determination of methyl tert.-butyl ether (MTBE) and tert.-butyl alcohol (TBA), in seawater. The method involves purge-and-trap enrichment followed by gas chromatographic (GC) determination. Two different detection systems have been compared: atomic emission detection (AED) and MS (selected ion monitoring mode). Validation parameters and possible matrix effects have been evaluated. The linearity and analytical precision was good with both methods, but limits of detection reached by AED (10 microg l(-1)) were not low enough to evaluate current environmental concentrations. GC-MS detection presented much better sensitivity [limits of detection (LODs) of 0.04 microg l(-1) for MTBE and 0.09 microg l(-1) for TBA] and selectivity, providing a more reliable determination. The analysis of samples collected from various marinas in the south of Spain (Almería and Málaga) showed, in all cases, detectable concentrations of MTBE that ranged from below LOD to 1842 microg l(-1), depending on the sampling point and time. TBA was also detected in some cases, with concentration levels that ranged from 400 to 600 microg l(-1). These preliminary results should be followed by monitoring programs in coastal waters, in order to establish real levels of presence of MTBE in our coasts and its possible effect on the marine environment.

Evaluación del servicio de odontología del Centro de Salud de Torrijos Carter en el Distrito de San Miguelito, 1986 / Evaluation of the Odontology Services in the Health Center Torrijos Carter in San Miguelito's District, in 1986

San Miguelito distrito formado por varios corregimientos entre los cuales tenemos el denominado Belisario Porras y donde esta ubicado el Centro de Salud Torrijos Carter el cual brinda los servicios de salud. Entre los servicios de salud que programa se encuentra el materno infantil, el maternal, de adulto, saneamiento ambiental, salud bucal, control de alimentos, salud mental y vigilancia veterinaria. El personal de odontología esta formado por dos odontologos los cuales prestan servicio las doce horas, 1 asistente con amplias funciones y 1 auxiliar de odontología que brinda atención integral básica a la población. Panamá brinda especial atención al programa de salud bucal y tiene como objetivo general, "promover, proteger, conservar, restituir y rehabilitar la salud de la población..." de este objetivo general se derivan otros específicos como es el de : 1- Lograr un alto nivel de salud bucal actuando con mayor prontitud y eficacia, 2- Incrementar el bienestar humano participando en un programa educativo con la finalidad de interesar a la población en el cuidado y la salud bucal, 3- Reducir la incidencia y prevalencia de caries dental, enfermedades periodontales etc., 4- Minimizar las pérdidas de dientes, 5- Limitar el daño en los tejidos de la cavidad bucal, 6- Rehabilitar la capacidad masticatoria. La odontología integral comprende actividades preventivas y curativas de todos los problemas que afectan la salud bucal. En el área de San Miguelito que tiene una población de 221,512 habitantes hay una proporción de 1 odontologo para cada 8,204 habitantes la población que atiende el Centro de Salud Torrijos Carter es de 47,004 habitantes, la proporción por odontologo es de 23,502. En cuanto a la utilización de servicios se observa que los maternales, escolares y manipuladores de alimentos son los grupos que mayormente utilizan los servicios odontológicos en este centro de salud. El promedio de consultas por hora es de 2.0 y el promedio de actividades por hora era de 4.1. En el año de 1986 en el Centro de Salud Torrijos Carter se realizaron 5,064 consultas y 10,294 actividades preventivas y curativas en las 2,520 horas trabajadas por los odontologos de esta instalación. En general se observa que el servicio préstado es poco eficiente