Cadmium (Cd) distribution and soil-plant relationship in cacao farms in Costa Rica.

The current cadmium (Cd) regulations in chocolate threaten the cacao supply chain in several Latin American countries. The factors contributing to Cd accumulation in cacao beans have been poorly studied in Central America. The objective of this research was to identify the location of Cd hotspots as well as soil properties and management practices influencing the Cd concentration in cacao beans. A survey was carried out and soil, leaf, and beans were sampled from 150 farms in the three principal cacao-producing regions in Costa Rica. Total soil Cd concentration ranged from <0.1 to 1.05 (average 0.22 mg kg-1) which is typical of uncontaminated soils. Bean Cd concentration ranged from 0.12 to 3.23 (average 0.56 mg kg-1) and 22% of the samples exceeded the selected threshold of 0.80 mg kg-1, located mostly in the Huetar Caribe and Huetar Norte regions. Variability in bean Cd concentration was better explained by total soil Cd and soil organic carbon (SOC) (R2 = 0.62, p < 0.05). In addition, bean Cd concentration was affected by leaf nutrient content and management practices. Leaf Zn and P were positively correlated with bean Cd while K and Mn were negatively correlated (p < 0.05). Farm altitude and orchard age were also negatively correlated with bean Cd. Overall, this study shows that bean Cd contamination does not reach the extent observed in other Latin American countries such as Ecuador, Colombia, or Honduras. Nevertheless, research is needed in hotspot areas to assess the feasibility of potential mitigation strategies, particularly the use of mineral or organic soil amendments, which may allow better for planning in existing plantations or the expansion into new cacao-growing areas in the country.

Monitoring cadmium concentrations in cacao: inter-laboratory variation and the effect of sample size on variability among ready-for-sale beans.

Since the implementation of new EU limits on cadmium (Cd) in cacao-derived products, reliable measurements of the Cd concentration in cacao samples have become even more important. This study was set up to analyse the robustness of the measured Cd concentrations in cacao as affected by sampling strategy and by the laboratory receiving these samples. Six different homogenised cacao liquor samples were sent to 25 laboratories, mainly located in Latin America. On average, only 76% of the laboratories reported acceptable results per sample using internationally accepted criteria. More unreliable data was obtained when Atomic Absorption Spectroscopy (AAS) rather than Inductively Coupled Plasma (ICP) instruments were used or where concentrations were outside the calibration range. Subsequently, four commercial lots in Ecuadorian warehouses were sampled to identify the variation among beans, bags and replicate chemical analyses of ground samples. Simulations indicate that a composite sample should be made from at least 10 bags on a pallet and at least 60 beans should be ground prior to analysis to obtain an acceptable CV below 15%. This study shows that current Cd analyses in cacao on the market are neither sufficiently accurate nor precise and that more control on laboratory certifications is needed for reliable screening of Cd in cacao.

Heavy metal(loid)s contamination in water and sediments in a mining area in Ecuador: a comprehensive assessment for drinking water quality and human health risk.

Elevated heavy metal(loid)s concentrations in water lower its quality posing a threat to consumers. This study aims to assess the human health risk caused by heavy metal(loid)s in tap water in Santa Rosa city, Ecuador, and the ecological risk of stream water and sediments in the Santa Rosa River. Concentrations of As, Cd, Cr, Cu, Ni, Pb, and Zn were evaluated in tap waters, stream waters, and sediment samples during the rainy and dry seasons. The Metal Index (MI), Geo-accumulation Index (Igeo), Potential Ecological Risk Index (PERI), and the levels of carcinogenic (CR) and non-carcinogenic risk (HQ) were determined. The results revealed severe pollution levels, mainly in Los Gringos and El Panteon streams, both tributaries of the Santa Rosa River, the primary water source for Santa Rosa inhabitants. More than 20% of the surface water samples showed severe contamination (MI > 6), and 90% of the tap water samples presented a MI value between 1 and 4, which indicates slight to moderate pollution. Drinking water displayed high levels of As, with 83% of the tap water samples collected from households in the dry season above the recommended concentration set by the World Health Organization and Ecuadorian legislation. The Igeo-Cd in the sediment samples was significantly high (Igeo > 3), and the PERI showed very high ecological risk (PERI > 600), with Cd as the main pollutant. HQ and CR were above the safe exposure threshold, suggesting that residents are at risk from tap water consumption, with As being the primary concern.

Revealing the pathways of cadmium uptake and translocation in cacao trees (Theobroma cacao L.): A 108Cd pulse-chase experiment.

The pathways through which cadmium (Cd) is taken up and loaded into cacao beans (nibs) are yet to be revealed. Previous work suggested that Cd loading into cacao nibs may occur via direct xylem uptake rather than phloem-mediated redistribution from the leaves. A stable isotope (108Cd) pulse-chase experiment was set up to identify the pathways of Cd loading into cacao nibs. The topsoil beneath two mature cacao trees in the field was enriched in 108Cd via surface irrigation with a spiked solution. The increase in 108Cd isotopic abundance (IA) in the plant tissues was followed up for 548 days after spiking. The 108Cd IA in the plant tissues increased from natural abundance (0.89 %) to 7.0 % (tree A) and 10.1 % (tree B) at equilibrium. The tracer was taken up in the plant tissues in the order immature leaves > mature leaves > nibs in both trees, while tracer uptake in flowers and cherelles was less consistent between the trees. Half of the equilibrium 108Cd IA was reached in the nibs at 191 days after spiking, significantly later than corresponding values for mature (151 days) and immature leaves (117 days). Pod maturation from flower stage takes about 6 months with most Cd entering the nibs at the last stage of development. The rather slow rise in the 108Cd IA in the nibs compared to the leaves hence suggests that Cd in cacao nibs likely originates from phloem-redistribution from the stem, branches or mature leaves and not from direct root-to-nib transport via the xylem.

Reducing cadmium bioaccumulation in Theobroma cacao using biochar: basis for scaling-up to field.

The intake of Cd-enriched food is the main Cd pathway for the nonsmoking population. In some cases, Cd bioaccumulates in edible plant parts which comprise risk to consumers, because of Cd is a harmful heavy metal that can cause potent environmental and health hazards. For instance, Cd enrichment of cacao seeds have led to Cd enrichment of cacao-based products. In Latin America and the Caribbean, Cd bioaccumulation in cacao seeds occurs in different regions with diverse edaphoclimatic conditions, which makes it difficult to select soil remediation alternatives. Limited resources require that potential amendments must be carefully investigated through laboratory and/or greenhouse conditions before scaling up to field experiments. In this study, we evaluated the effectiveness of four biochars: coffee-, quinoa-, and inoculated- and palm-biochar, derived from three feedstocks: coffee husk, quinoa straw, and oil palm residues, respectively. Biochars were applied in two rates (1 and 2% w/w) in two soils, one moderately acidic and one slightly alkaline (Cd-spiked and non-spiked). CCN-51 cacao plants were used for the greenhouse experiment. After 130 days, biometric parameters, the bioavailability of Cd in the soil, and the concentration of Cd and mineral nutrients in the plants were measured. Quinoa biochar at the 2% significantly decreased (P < 0.01), by ∼71%, bioavailable Cd in moderately acidic and slightly alkaline soils, and leaf-Cd by ∼48%. Soil pH, electrical conductivity, and effective cation exchange capacity were significantly (P < 0.01) correlated with bioavailable soil and leaf-Cd. Biochar characteristics, such as ash contents, basic cations content, and surface functional groups could be used as indicators for the selection of biochars to reduce Cd uptake by cacao. Additionally, application of quinoa derived biochar provided P and K, which could increase productivity to offset mitigation costs. Overall, incorporation of quinoa biochar at 2% rate is effective for lowering bioavailable Cd in different soil types which reduces leaf-Cd in cacao plants.

A transcytotic transport mechanism across the tympanic membrane.

Drug treatments for middle ear diseases are currently delivered systemically, or locally after opening the impermeable tympanic membrane (TM). We previously used bacteriophage display to discover novel peptides that are actively transported across the intact TM, with a variety of transport rates. Peptide structures were analyzed for evidence regarding the mechanism for this unexpected transport, which was then tested by the application of chemical inhibitors. Primary sequences indicated that trans-TM peptides share one of two amino acid motifs. Secondary structures revealed that linear configurations associate with higher transport rates than coiled structures. Tertiary analysis indicated that the shared sequence motifs are prominently displayed at the free ends of rapidly transported peptide phage. The shared motifs were evaluated for similarity to known motifs. The highest probability matches were for protein motifs involved in transmembrane transport and exosomes. Overall, structural findings suggest that the shared motifs represent binding sequences. They also implicate transcytosis, a polarized cell transport mechanism consisting of endocytosis, transcellular transport, and exocytosis. Inhibitor studies indicated that macropinocytosis, retrograde transport through Golgi and exocytosis participate in transport across the TM, consistent with transcytosis. This process can be harnessed to noninvasively deliver therapeutics to the middle ear.

Probabilistic multi-pathway human health risk assessment due to heavy metal(loid)s in a traditional gold mining area in Ecuador.

Mining operations are important causes of environmental pollution in developing countries where mining waste management is not adequate. Consequently, heavy metal(loid)s are easily released into the environment, being a potential risk to human health. This study carries out a Bayesian probabilistic human health risk assessment, related to multi-pathway exposure to heavy metal(loid)s in a gold mining area in Southern Ecuador. Concentrations of As, Cd, Cr, Cu, Ni, Pb, and Zn in tap water, surface water, and soil samples, were analyzed to assess the potential adverse human health effects based on the Hazard Index (HI) and Total cancer risk (TCR). Adults and children residents were surveyed to adjust their exposure parameters to the site-specific conditions. Exposure to heavy metal(loid)s resulted in unacceptable risk levels for human health in the two age groups, both carcinogenic (TCR > 1 × 10-5) and non-carcinogenic (HI > 1) through ingestion of tap water and incidental ingestion of surface water. Sensitivity analysis showed that As concentration in waters and exposure frequency were the main contributors to risk outcome. Exposure to soil via accidental ingestion and dermal contact was below the safety limit, not posing a risk to human health. These findings can provide a baseline for the environmental management of the mining area and indicate the need for further research on As pollution in water and its implications on the health of the inhabitants of mining communities.

Ecological and probabilistic human health risk assessment of heavy metal(loid)s in river sediments affected by mining activities in Ecuador.

Gold mining is a significant source of metal(loid)s released into the environment. It is an issue of concern due to the potential adverse health effects associated with exposure to toxic elements. This study aimed to assess the ecological and human health risk caused by heavy metal(loid)s exposure in river sediments in Ponce Enríquez, one of the most important mining sites in Ecuador. Concentrations of As, Cd, Cu, Pb, and Zn were evaluated in 172 sediment samples to determine the Potential ecological risk (RI) and the carcinogenic (CR) and non-carcinogenic risk (HQ). The human exposure to polluted sediments during recreational activities was computed using Bayesian probabilistic models. Residents were randomly surveyed to adjust the risk models to the specific population data. More than 68% of the sampling stations pose a severe As and Cd ecological risk index ([Formula: see text] > 320). Likewise, residents exposed to river sediments showed a non-acceptable carcinogenic risk by incidental ingestion, being As the primary contributor to overall cancer in both children and adults receptors. Moreover, non-carcinogenic risk through the incidental ingestion of sediments was above the safe limit for children. This is the first study conducted in a mining region in Ecuador that reveals the severe levels of ecological and human health risk to which the population is exposed. These results can be applied as a baseline to develop public health strategies to monitor and reduce the health hazards of the residents of mining communities.

Surface soil liming reduces cadmium uptake in cacao seedlings but subsurface uptake is enhanced.

Cadmium concentrations in cacao (Theobroma cacao L.) beans from South America often exceed trade limits. Liming soil is advocated as a remediation option, but amendments cannot be incorporated into the entire root zone without harming the trees. An experiment was set up to identify how Cd uptake varies within the root zone when surface and subsurface soil layers are either limed or not. The experiment used 22-cm-height pots with top and bottom layers using surface and subsurface soil samples from a cacao field. The potted soils were either surface limed or not or fully limed and layers spiked with stable 108 Cd isotope in various combinations to trace the plant Cd provenance. The root distribution was neither affected by liming nor by soil source; 70% of the root biomass was present in the top layer. Plants grown on the fully limed surface soil had 1.7 times lower Cd concentrations in leaves than the unlimed treatments, whereas this concentration was 1.2 times lower when only the top layer was limed (surface soil used in both layers). The isotope dilution data showed that surface soil liming enhanced Cd uptake from the unlimed bottom layer compared with the unlimed soil, suggesting compensating mechanisms. The pots containing surface soil over subsurface soil also showed that compensating effect but, due to lower phytoavailable Cd in the subsurface soil, surface liming still effectively reduced foliar Cd. We conclude that liming might be a feasible mitigation strategy, but its effectiveness is limited when Cd phytoavailability remains untreated in the subsurface layer.

Selection of a Single Domain Antibody, Specific for an HLA-Bound Epitope of the Mycobacterial Ag85B Antigen.

T cells recognizing epitopes on the surface of mycobacteria-infected macrophages can impart protection, but with associated risk for reactivation to lung pathology. We aimed to identify antibodies specific to such epitopes, which carry potentials for development toward novel therapeutic constructs. Since epitopes presented in the context of major histocompatibility complex alleles are rarely recognized by naturally produced antibodies, we used a phage display library for the identification of monoclonal human single domain antibody producing clones. The selected 2C clone displayed T cell receptor-like recognition of an HLA-A*0201 bound 199KLVANNTRL207 peptide from the Ag85B antigen, which is known to be an immunodominant epitope for human T cells. The specificity of the selected domain antibody was demonstrated by solid phase immunoassay and by immunofluorescent surface staining of peptide loaded cells of the T2 cell line. The antibody affinity binding was determined by biolayer interferometry. Our results validated the used technologies as suitable for the generation of antibodies against epitopes on the surface of Mycobacterium tuberculosis infected cells. The potential approaches forward the development of antibody in immunotherapy of tuberculosis have been outlined in the discussion.

COVID-19. El manejo ambulatorio durante la transmisión comunitaria intensa / COVID-19. Ambulatory management during intense community transmission

RESUMEN La COVID-19, en los escasos seis meses de su presencia, ha provocado una crisis sanitaria mundial, con mayor impacto en los países más pobres. En la actualidad, existe un mejor conocimiento de la clínica de esta enfermedad y su relación con los fenómenos fisiopatológicos; sin embargo, dada la alta letalidad, el mayor enfoque de su manejo se ha orientado hacia el paciente hospitalizado o crítico. Esta información y experiencia se comparte con el fin de lograr reforzar una mejor atención a las personas afectadas por la COVID-19 desde sus primeros síntomas en el hogar, especialmente en estos momentos de amplia transmisión en la comunidad, donde los servicios de salud están seriamente limitados en recursos humanos y materiales. El objetivo es: i) evitar complicaciones más allá de las causadas por la propia evolución de la enfermedad; ii) determinar el momento adecuado para la referencia del paciente al hospital y reducir la letalidad; iii) reforzar el aislamiento de los casos; y iv) posiblemente, disminuir la progresión a una enfermedad severa. Incluye el manejo luego del alta hospitalaria, así como recomendaciones para considerar si los servicios de salud colapsan; indicaciones sobre cuándo dar de alta al paciente para que regrese al trabajo, y destaca la importancia del telemonitoreo para el éxito de este manejo en el contexto epidemiológico actual.

ABSTRACT The COVID-19, in the scant six months of its presence, has caused a global health crisis, with greater impact in the poorest countries. Currently, there is a better understanding of the clinic of this disease and its relationship with physiopathological phenomena; however, given the high lethality, the major focus of its management has been oriented towards the hospitalized or critical patient. This information and experience is shared in order to achieve and strengthen better care for people affected by COVID-19 from their first symptoms at home, especially at these times of extensive community transmission, where health services are seriously limited in human and material resources. The aim is to (i) avoid complications beyond those caused by the evolution of the disease itself; (ii) determine the appropriate time for patient referral to the hospital and reduce lethality; (iii) reinforce the isolation of cases; and (iv) possibly, decrease the progression to severe disease. It includes outpatient management after hospital discharge, as well as recommendations to consider if health services collapse; indications for when to discharge the patient for return to work, and highlights the importance of telemonitoring for the success of this practice in the current epidemiological context.

COVID-19: En este momento podría ser útil el tratamiento antiviral en casos leves / COVID-19: Antiviral treatment in mild cases could be useful at this time

RESUMEN La letalidad por COVID-19 así como su rápida diseminación son responsables de la actual crisis mundial; por ello, desde un inicio se buscaron medicamentos con acción antiviral frente a este agente. Es imposible, por ahora, saber qué persona en estado leve desarrollará una elevada carga viral o tiene una predisposición a desarrollar una respuesta extremada del sistema inmune, pero un tratamiento temprano en los casos leves no sólo garantizaría una mayor eficacia, sino que se evitarían los casos severos. En la actualidad no se dispone de ensayos clínicos, doble ciego, aleatroizados, ni metaanálisis para tomar decisiones seguras; mientras tanto, la pandemia avanza en nuestro país, generando dolor y muerte. En este contexto, en el Perú, las sociedades científicas han manifestado la necesidad del uso de medicamentos antivirales, aún con poca evidencia, basado en la probabilidad de éxito previo a un tratamiento, por sus efectos in vitro y por sus efectos clínicos tempranos, tales como: cloroquina, hidroxicloroquina, azitromicina, lopinavir, ritonavir. De esta manera, en el país desde el 29 de marzo de 2020, se dispone de una norma técnica del Ministerio de Salud, que facilita el uso de estos a nivel nacional para los casos moderados y severos. Consideramos que bajo un sistema estructurado, los centros de primer nivel de atención podrían tratar los casos leves de COVID-19. Nuestro país, a través de las estrategias de prevención y control de TB y de ITS/VIH/SIDA, tiene experiencia en el manejo de programas de tratamiento en dicho nivel. Los costos serán menores que los requeridos en el fortalecimiento del tercer nivel de atención.

ABSTRACT COVID-19's lethality as well as its rapid spread are responsible for the current world crisis; therefore, from the beginning, drugs with antiviral action against this agent were sought. It is impossible, for now, to know which person in a mild state will develop a high viral load or have a predisposition to develop an extreme response from the immune system, but early treatment in mild cases would not only guarantee greater efficacy, but would avoid severe cases. Currently, there are no double blind, randomized clinical trials or meta-analyzes available to make safe decisions; meanwhile, the pandemic is advancing in our country, generating pain and death. In this context, in Peru, scientific societies have expressed the need for the use of antiviral drugs, even with little evidence, based on the probability of success prior to treatment, for their in vitro effects and for their early clinical effects, such as: chloroquine, hydroxychloroquine, azithromycin, lopinavir, ritonavir. Thus, in the country since march 29, 2020, there is a technical standard from the Ministry of Health, which facilitates the use of these at the national level for moderate and severe cases. We believe that under a structured system, first-level care centers could treat mild cases of COVID-19. Our country, through strategies for the prevention and control of TB and ITS/HIV/AIDS, has experience in managing treatment programs at this level. The costs will be less than those required to strengthen the third level of care.

The impact of fermentation on the distribution of cadmium in cacao beans.

A large fraction of the South-American cacao production is affected by new cadmium (Cd) regulations in cacao. This work was set up to characterize the distribution and speciation of Cd within the cacao fruit and to monitor potential Cd redistribution during cacao fermentation. In cacao fruits from four locations, Cd concentrations decreased with testa > nib ~ placenta ~ pod husk > mucilage. The distribution of Cd within cacao beans was successfully visualized using laser ablation inductively coupled plasma spectrometry (LA-ICP-MS) and confirmed higher Cd concentrations in the testa than in the nib. Speciation analysis by X-ray absorption spectroscopy (XANES) of unfermented cacao beans revealed that Cd was bound to O/N-ligands in both nib and testa. Fermentation induced an outward Cd migration from the nibs to the testa, i.e. against the total concentration gradient. This migration occurred only if the fermentation was sufficiently extensive to decrease the pH in the nib to <5.0, likely as a result of increased Cd mobility due to organic acid penetration into the nibs. The change in dry weight based nib Cd concentrations during fermentation was, on average, a factor 1.3 decrease. We propose that nib Cd can be reduced if the nib pH is sufficiently acidified during fermentation. However, a balance must be found between flavor development and Cd removal since extreme acidity is detrimental for cacao flavor.

Soil properties and agronomic factors affecting cadmium concentrations in cacao beans: A nationwide survey in Ecuador.

Recent cadmium (Cd) regulation in chocolate threatens the sustainability of cacao production in Southwest America. Cadmium contamination in cacao beans has not been assessed at a country level. A nationwide survey was conducted in Ecuador to identify the spatial distribution of Cd in cacao beans, as well as soil and agronomic factors involved. Paired soil and plant samples (pods and leaves) were collected at 560 locations. Information on agronomic practices was obtained through a prepared questionnaire for farmers. Total soil Cd averaged 0.44 mg kg-1 which is typical for young and non-polluted soils. Mean Cd concentration in peeled beans was 0.90 mg kg-1 and 45% of samples exceeded the 0.60 mg kg-1 threshold. Bean Cd hotspots were identified in some areas in seven provinces. Multivariate regression analysis showed that bean Cd concentrations increased with increasing total soil Cd and with decreasing soil pH, oxalate-extractable manganese (Mnox) and organic carbon (OC) (R2 = 0.65), suggesting that Cd solubility in soil mainly affects Cd uptake. Bean Cd concentration decreased a factor of 1.4 as the age of the orchard increased from 4 to 40 years. Bean Cd concentration was inconsistently affected by genotype (CCN-51 vs. Nacional), pruning or application of fertilizers. It is concluded that the relatively larger bean Cd concentrations in Ecuador are related to the high Cd uptake capacity of the plants combined with their cultivation on young soils, instead of Cd depleted weathered soils. Mitigation strategies should consider the application of amendments to modify such soil properties to lower soil Cd availability. There is scope for genetic mitigation strategy to reduce bean Cd, but this needs to be properly investigated.

El estigma frente a la tuberculosis en estudiantes de la facultad de medicina de una universidad pública, 2017 / The stigma against tuberculosis in students of the faculty of medicine of a public university, 2017

Introducción. La tuberculosis es un problema de salud pública en nuestro país. Los pacientes afectados tardan en acceder a los servicios de salud entre otros factores por el estigma y discriminación social que se tiene de esta enfermedad en la población. Además, el estigma tiene impacto en la relación social y familiar de los pacientes afectados. El objetivo del presente estudio fue cuantificar el estigma en estudiantes de la facultad de medicina de una universidad pública. Métodos. Se realizó un estudio observacional, descriptivo y transversal. Se aplicó un cuestionario previamente validado a estudiantes de los tres primeros años de la facultad de medicina, con la finalidad de cuantificar el estigma a la tuberculosis. Resultados. Se aplicó el cuestionario a 505 estudiantes de la facultad de medicina. El 39% de la población estudiantil mostró un moderado y gran estigma frente a las personas afectadas por tuberculosis; asimismo, el 38% mostró un leve estigma y 23% no presentó estigma frente a esta enfermedad. Conclusiones. Existe moderado y gran estigma en 39% de los estudiantes de la facultad de medicina estudiados.

Introduction. Tuberculosis is a public health problem in our country. Affected patients are slow to access health services, among other factors due to the stigma and social discrimination that this disease has in the population. In addition, stigma has an impact on the social and family relationship of affected patients. The objective of the present study was to quantify the stigma in students of the faculty of medicine of a public university. Methods. An observational, descriptive and transversal study was carried out. A previously validated questionnaire was applied to students of the first three years of medical school, in order to quantify the stigma of tuberculosis. Results. The questionnaire was applied to 505 students of the medical school. 39% of the student population showed a moderate and great stigma in front of the people affected by tuberculosis; likewise, 38% showed a slight stigma and 23% did not present stigma against this disease. Conclusions. There is moderate and great stigma in 39% of the students of the medical school studied.

Bacteremia por Vibrio cholerae NO-O1/NO-O139 en un paciente cirrótico: Primer reporte de caso en el Perú y revisión de la literatura / Vibrio cholerae NO-O1/NO-O139 bacteremia in a cirrhotic patient: First case report in Peru and literatura review

Vibrio cholerae serogrupo NO-O1/NO-O139 (VCNO) es causa infrecuente de gastroenteritis. Sin embargo, se le asocia a infección extra-intestinal severa en huéspedes inmunocomprometidos, y entre ellas, la bacteremia en pacientes con cirrosis hepática es digna de mención. A continuación, presentamos el caso de una mujer de 58 años, con el diagnóstico de cirrosis hepática de fondo, que desarrolló progresivamente choque séptico, disfunción orgánica múltiple y desenlace fatal al cuarto día de su admisión. Los resultados obtenidos post mortem, de los hemocultivos previamente tomados, aislaron bacilos gram negativos compatibles con Vibrio cholerae. Posteriormente, se identificó el serogrupo NO-O1/NO-O139, a través de aglutinación en placa y PCR negativo para el gen ctxA. El antibiograma mostró susceptibilidad conservada a ampicilina, cloranfenicol, tetraciclina y ciprofloxacino, con resistencia al trimetoprim-sulfametoxazol. El presente caso, descrito en el Hospital Nacional Dos de Mayo, es hasta la fecha, el primer reporte de bacteremia VCNO en el Perú.

Non-O1, non-O139 Vibrio cholerae (NOVC) strains are an uncommon cause of gastroenteritis. However, they have been recently associated with severe extraintestinal infections in immunocompromised hosts. Among them, bacteremia in cirrhotic patients is noteworthy. We present the case of a 58-year-old woman with cirrhosis that developed septic shock, multiple organ failure and died four days after admission. Blood cultures yielded Gram-negative rods identified as Vibrio cholerae. Further serogrouping by slide agglutination and a negative PCR for ctxA gen confirmed the strain to be NOVC. Antimicrobial susceptibility testing showed sensitivity to ampicillin, chloramphenicol, tetracycline and ciprofloxacin; and resistance to trimethoprim-sulfamethoxazole. To the best of our knowledge, this is first report in Peru, described in the Hospital Nacional Dos de Mayo, of NOVC bacteremia.

Estigma relacionado a VIH/SIDA asociado con adherencia al tratamiento antirretroviral en pacientes de un hospital de Lima, Perú 2014 / Stigma related to HIV/AIDS associated with adherence to antiretroviral therapy in patients of a public hospital in Lima, Peru 2014

RESUMEN Objetivos. Determinar el nivel de estigma relacionado a VIH/SIDA y su asociación con la adherencia al tratamiento antirretroviral (TARV) en pacientes de un hospital nacional de Lima, Perú. Materiales y métodos. Estudio transversal que incluyó a pacientes adultos que seguían el programa de TARV con un mínimo de seis meses. Se consideró el estigma como la desvalorización de la persona por tener la infección de VIH y se midió con la escala de Berger para estigma relacionado a VIH, la adherencia a la toma adecuada de los medicamentos fue medida con la encuesta Simplified medication adherence questionaire (SMAQ). Para evaluar los factores asociados a estigma se calcularon razones de prevalencia (RP) usando la regresión de Poisson. Resultados. Se analizaron 339 encuestas, la mediana de edad fue 39 años (RIC: 16) donde 74,0% eran hombres. Se halló un estigma alto en 25,4% y moderado en 47,5% de los encuestados. Una reducción de 10 puntos en la escala de estigma relacionado a VIH/SIDA se asoció a un aumento de 5% de adherencia al TARV en hombres (RPa 0,95, IC95%: 0,91-0,99) y un aumento del 7% en mujeres (RPa 0,93, IC95%: 0,87-0,98). Conclusiones. Existe un alto nivel de estigma relacionado a VIH/SIDA y se asocia a la falta de adherencia al tratamiento con diferencias de acuerdo al sexo. Se recomiendan intervenciones dirigidas a reducir el estigma relacionado a divulgación de estatus en las mujeres y el relacionado a actitudes públicas en hombres.

ABSTRACT Objectives. To determine the level of stigma related to HIV/AIDS and its association with adherence to antiretroviral therapy (HAART). Materials and methods. A cross-sectional study that included adult patients which were part of the HAART program during at least 6 months. Stigma was defined as the loss of value of the person infected with HIV according to Berger scale and treatment adherence as the correct consume of medications which were measured with the Simplified Medication Adherence Questionnaire. Poisson regression test was used to calculate the prevalence ratios (PR) of associated factors. Results. The results of 339 surveys were analyzed. 74% were male and the median age was 39 years (Interquartile Range [IQR]: 16). High stigma was found in 25,4% of respondents, moderate in 47,5%. A reduction of 10 points in the Berger scale was associated with an increase of 5% in adherence to HAART in men (adjusted PR[aPR]: 0.95; 95% confidence interval [CI]: 0.91-0.99), and 7% in women (aPR: 0.92; 95% CI: 0.87-0.98). Conclusions. There is a high level of stigma related to HIV/AIDS and is associated with the lack of adherence to HAART according to gender. We recommend interventions aimed at reducing stigma related to status disclosure in women and related to public attitudes in men.

Niña con erucismo hemorrágico por Lonomia spp.: / Hemorrhagic erucism due to Lonomia spp. in a girl:

RESUMEN Los accidentes causados por las setas urticantes o venenosas de las orugas de lepidópteros, se conocen como erucismo. Estos accidentes se producen por el contacto accidental, especialmente por los niños, con las cerdas sobre el cuerpo del insecto, conectadas con glándulas venenosas. Los síntomas pueden ser locales o sistémicos, con presentaciones clínicas fatales. El accidente ocasionado por las orugas del género Lonomia spp. puede desencadenar síndromes hemorrágicos, constituyendo estos la forma más grave de erucismo. Se reporta el caso de una niña de 5 años, procedente del poblado de Villarondos, en la Amazonía del Perú, departamento de Huánuco, la cual incidentalmente se hinca con las cerdas de una oruga, cursando luego con anemia hemolítica, plaquetopenia y trastorno de la coagulación. El diagnóstico fue establecido por la anamnesis, cuadro clínico, exámenes de laboratorio y respuesta al suero antilonómico. Se discuten los aspectos clínicos, laboratoriales y terapéuticos de erucismo por Lonomia spp.

ABSTRACT Accidents caused by urticating or poisonous setae from lepidoptera caterpillars are known as erucism. These accidents are produced by accidental contact, especially in children, with bristles on the insect's body surface, connected to venom glands. Symptoms may be local or systemic, with deadly clinical presentations. The accident caused by Lonomia spp. caterpillars can trigger bleeding disorders, which is considered the most severe type of erucism. The case of a 5-year-old girl is reported. She was from the town of Villarondos, in the Peruvian Amazon, department of Huánuco, who accidentally knelt down on caterpillar bristles, and subsequently experienced hemolytic anemia, plateletopenia, and coagulation disorder. The diagnosis was made based on the medical history, clinical manifestation, laboratory examination results, and response to antilonomic serum. The clinical, laboratory, and therapeutic aspects of erucism due to Lonomia spp. are discussed.