Early visual intervention, visual function analysis, and grating visual acuity outcomes in children with congenital Zika syndrome

ABSTRACT Purpose: This study aimed to assess grating visual acuity and functional vision in children with congenital Zika syndrome. Methods: Initial and final grating visual acuity was measured using Teller acuity cards. Cerebral vision impairment standardized tests were used to assess functional vision. Patients were referred to the early visual intervention program for visually disabled children. Neuroimaging was performed. Results: In this study, 10 children were included with an age range of 1-37 months. Eight patients presented with macular atrophic scars. Neuroimaging revealed microcephaly and cerebral abnormalities in all patients. Low vision and cerebral vision impairment characteristics were observed in all children. The final grating visual acuity in this group varied from 3.00 to 0.81 logMAR. Conclusions: The grating visual acuity test revealed low vision in all children with congenital Zika syndrome. Functional vision evaluation revealed cerebral vision impairment characteristics in all patients, who were referred to the early visual intervention program. Visual acuity improved in six children.

Systematic review on molecular detection of congenital and neonatal infections caused by TORCH and SARS-CoV-2 in newborns' cerebrospinal fluid / Revisáo sistemática sobre deteção molecular de infecções congênitas e neonatais causadas por TORCH e SARS-CoV-2 no líquido cefalorraquidiano de recém-nascidos

ABSTRACT Objective: To verify the use and identify advantages of molecular methods for congenital infections diagnosis in cerebrospinal fluid of neonates. Data source: The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO), under CRD42021274210. The literature search was performed in databases: PubMed, Virtual Health Library/ Latin American and Caribbean Center on Health Sciences Information (VHL/BIREME), Scopus, Web of Science, Excerpta Medica database (EMBASE), Cochrane, ProQuest, and EBSCOhost. The search was carried out from August to October 2021 and updated in December 2022, respecting the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The selection sequence was: 1) Duplicate title removal; 2) Examination of titles and abstracts; 3) Full-text retrieval of potentially relevant reports; and 4) Evaluation of the full text according to eligibility criteria by two independent authors. Inclusion criteria considered randomized and non-randomized control trials, longitudinal, cross-sectional, and peer-reviewed studies in humans, published in English, Spanish, Italian, and Portuguese, with newborns up to 28 days old who had congenital neuroinfections by toxoplasmosis, rubella, cytomegalovirus, herpes simplex (TORCH), and others such as Treponema pallidum, Zika, parvovirus B-19, varicella zoster, Epstein-Barr, and SARS-CoV2, diagnosed by polymerase chain reaction (PCR). Two evaluators extracted the following information: author, year of publication, nationality, subjects, study type, methods, results, and conclusion. Data synthesis: The most studied pathogen was herpes simplex. Several articles reported only nonspecific initial symptoms, motivating the collection of cerebrospinal fluid and performing PCR for etiological investigation. Conclusions: Molecular methods are effective to detect pathogen genomes in cerebrospinal fluid, which can impact clinical evolution and neurological prognosis.

RESUMO Objetivo: Verificar a utilização e identificar as vantagens dos métodos moleculares para diagnóstico de infecções congênitas no líquido cefalorraquidiano de neonatos. Fontes de dados: A revisão foi registrada na base PROSPERO (International Prospective Register of Systematic Reviews) sob CRD42021274210. A busca bibliográfica foi realizada nas bases de dados PubMed, Biblioteca Virtual em Saúde/ Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (BVS/BIREME), Scopus, Web of Science, Excerpta Medica database (EMBASE), Cochrane, ProQuest, e EBSCOhost. A busca foi feita no período de agosto a outubro de 2021 e atualizada em dezembro de 2022, respeitando as orientações do Preferred Reporting Items for Systematic Reviews e Meta-Analyises (PRISMA). A sequência da seleção dos estudos foi: 1) Remoção de duplicatas; 2) Exame de títulos e resumos; 3) Recuperação dos textos completos potencialmente relevantes; e 4) Avaliação do texto completo conforme critérios de elegibilidade por dois autores independentes. O critério de inclusão considerou ensaios clínicos randomizados e não randomizados, estudos longitudinais, transversais, revisados por pares, estudos em humanos, publicados em inglês, espanhol, italiano e português, com recém-nascidos de até 28 dias que sofreram neuroinfecções congênitas pelos agentes toxoplasmose, rubéola, citomegalovírus, herpes simples (TORCH), e outros como Treponema pallidum, Zika, parvovírus B-19, varicela zoster, Epstein-Barr, e SARS-CoV-2, diagnosticadas por reação em cadeia de polimerase (PCR). Dois avaliadores extraíram as seguintes informações: autor, ano de publicação, nacionalidade, sujeitos, tipo de estudo, métodos, resultados e conclusão. Síntese dos dados: O patógeno mais estudado foi Herpes Simples. Muitos artigos relataram somente sintomas iniciais inespecíficos, motivando a coleta de líquido cefalorraquidiano e realização da PCR para investigação etiológica. Conclusões: Os métodos moleculares são eficazes para detectar o genoma do patógeno no líquido cefalorraquidiano, o que pode impactar na evolução clínica e no prognóstico neurológico.

Prevalência de Influenza A, vírus sincicial respiratório eSARS-CoV-2 em pacientes com síndrome respiratóriaaguda grave em Passo Fundo, Rio Grande do Sul / Prevalence of Influenza A, respiratory syncytial virus andSARS-CoV-2 in patients with severe acute respiratorysyndrome in Passo Fundo, Rio Grande do Sul

A síndrome respiratória aguda grave (SRAG) é caracterizada por sintomas de febre alta, tosse e dispneia, e, na maioria dos casos, relacionada a uma quantidade reduzida de agentes infecciosos. O objetivo foi avaliar a prevalência dos vírus respiratórios Influenza A (FluA), vírus sincicial respiratório (RSV) e do novo coronavírus (SARS-CoV-2) em pacientes com internação hospitalar por SRAG. Estudo transversal, com pacientes em internação hospitalar com SRAG entre novembro de 2021 e maio de 2022. Dados sociodemográficos e clínicos e amostras da nasofaringe foram coletados/as, as quais foram submetidas à extração de RNA e testadas quanto à positividade para Influenza A, RSV e SARS-CoV-2 por meio da técnica de PCR em tempo real pelo método SYBR Green. Foram incluídos 42 pacientes, sendo 59,5% do sexo feminino, 57,1% idosos, 54,8% com ensino fundamental. A maior parte dos pacientes reportou hábito tabagista prévio ou atual (54,8%), não etilista (73,8%) e 83,3% deles apresentavam alguma comorbidade, sendo hipertensão arterial sistêmica e diabetes mellitus tipo 2 as mais prevalentes. Um total de 10,5% dos pacientes testou positivo para FluA, nenhuma amostra positiva para RSV e 76,3% positivos para SARS-CoV-2. Na população estudada, SRAG com agravo hospitalar foi observado em maior proporção, em mulheres, idosos e pessoas com comorbidades, embora sem significância estatística, sendo o novo coronavírus o agente etiológico mais relacionado, o que evidencia a patogenicidade desse agente e suas consequências ainda são evidentes após quase 2 anos de período pandêmico.

Severe acute respiratory syndrome (SARS) is characterized by symptoms of high fever, cough and dyspnea, and is in most cases related to a reduced amount of infectious agents. The objective was to assess the prevalence of respiratory viruses Influenza A (FluA), respiratory syncytial virus (RSV) and the new coronavirus (SARS-CoV-2) in patients hospitalized for SARS. Cross-sectional study, with patients hospitalized with SARS between November 2021 and May 2022. Sociodemographic and clinical data and nasopharyngeal samples were collected, which were subjected to RNA extraction and tested for positivity for Influenza A, RSV and SARS-CoV-2 using the real-time PCR technique using the SYBR Green method. 42 patients were included, 59.5% female, 57.1% elderly, 54.8% with primary education. Most patients reported previous or current smoking habits (54.8%), non-drinkers (73.8) and 83.3% of them had some comorbidity, with systemic arterial hypertension and type 2 diabetes mellitus being the most prevalent. A total of 10.5% of patients tested positive for FluA, no samples positive for RSV, and 76.3% positive for SARS-CoV-2. In the studied population, SARS with hospital injury was observed more frequently in women and the elderly, with associated comorbidities, with the new coronavirus being the most related etiological agent, which shows, although not statistically significant, that the pathogenicity of this agent and its consequences are still evident after almost 2 years of period pandemic.

Caracterización clínico-epidemiológica y agentes etiológicos de las infecciones respiratorias agudas graves en adultos en Paraguay

Introducción: La Vigilancia Centinela de las Infecciones Respiratorias Agudas Graves (IRAG) incluye el monitoreo y caracterización de casos hospitalizados. Objetivo: Describir las características clínico-epidemiológicas y agentes etiológicos de los adultos con IRAG en un hospital centinela en Paraguay. Metodología: Estudio observacional, descriptivo, de corte transversal, con recolección de datos retrospectivos de los pacientes adultos con IRAG hospitalizados en el Hospital Nacional de Itauguá entre junio de 2022 a agosto de 2023. La información se tomó de la base de datos del Sistema Nacional de Vigilancia Epidemiológica. Resultados: Se analizaron los datos de 1598 pacientes con IRAG, 820 varones (51,3%), 875 (54,8%) con 60 o más años, 1054 (66,0%) del departamento Central. El 79.2% (n=1265) de los pacientes presentaba algún factor de riesgo de gravedad o comorbilidad, 764 (47,8%) con hipertensión arterial. El 38.5% (n=632) fue admitido a UCI y la mortalidad fue de 34,7% (n=554). En el 13,8% (n=353) se confirmó SARSCoV-2, rhinovirus (1,7%), influenza A (1,5%), influenza B (0,6%), parainfluenza 3 (0,6%), VSR (0,2%), bocavirus (0,4%) e influenza AH1N1 (0,6%). Hubo significativamente mayor frecuencia de fallecidos en los de 60 años y más (40,7%), con algún factor de riesgo de gravedad (35,5% vs 25,9%) y en los confirmados con COVID-19 (38,2% vs 30,5%). Discusión: SARSCoV-2 sigue siendo el agente etiológico principal de las IRAG. El conocimiento de la epidemiología y los agentes virales es crucial para desarrollar estrategias de prevención y terapéuticas efectivas.

Introduction: Sentinel Surveillance of Severe Acute Respiratory Infections (SARI) includes the monitoring and characterization of hospitalized cases. Objective: To describe the clinical-epidemiological characteristics and etiological agents of adults with SARI in a sentinel hospital in Paraguay. Methodology: Observational, descriptive, cross-sectional study, with retrospective data collection, of adult patients with SARI hospitalized at the National Hospital of Itauguá between June 2022 and August 2023. The information was taken from the database of the National System of Epidemiological surveillance. Results: The data of 1598 patients with SARI were analyzed, 820 men (51.3%), 875 (54.8%) aged 60 or older, 1054 (66.0%) from the Central department. 79.2% (n=1265) of patients had some risk factor or comorbidity, 764 with hypertension (47.8%). 38.5% (n=632) were admitted to the ICU and mortality was 34.7% (n=554). SARSCoV-2 was confirmed in 13.8% (n=353), rhinovirus (1.7%), influenza A (1.5%), influenza B (0.6%), parainfluenza 3 (0.6%), RSV (0.2%), bocavirus (0.4%) and Influenza AH1N1 (0.6%). There was a significantly higher frequency of deaths in those aged 60 years and over (40.7%), with some risk factor (35.5% vs 25.9%), and in those confirmed with covid-19 (38.2% % vs 30.5%). Discussion: SARSCoV-2 continues to be the main etiological agent of SARI in a sentinel hospital in Paraguay. Continued knowledge of the epidemiology and viral agents involved is crucial to developing effective prevention and treatment strategies.

Prevención de Infecciones Respiratorias por VSR: Consenso Interinstitucional

Las infecciones por el VSR en constituyen una causa importante de morbilidad, hospitalización, ausentismo escolar y laboral, así como de mortalidad, en el mundo, así como en el Paraguay.En la actualidad, existen herramientas para la prevención del VSR. En el año 2012, el Paraguay, ha incorporado el palivizumab (MedImmune, EE. UU.), anticuerpo monoclonal, producido por tecnología de DNA recombinante. Este anticuerpo se administra en 5 dosis, cada 30 días y está indicado en lactantes nacidos prematuros y aquellos con trastornos cardiopulmonares. Por otro lado, actualmente se cuenta con una nueva herramienta para la prevención del VSR. El anticuerpo monoclonal de vida media prolongada Nirsevimab, específico para la conformación de prefusión de la proteína F, aprobado por EMA y FDA. Este monoclonal, está indicado para la prevención de las Infecciones respiratorias agudas bajas, causada por VSR en recién nacidos y lactantes nacidos durante o al ingresar a su primera temporada de VSR, en prematuros y lactantes hasta los 24 meses de edad que siguen siendo vulnerables a la enfermedad grave por VSR durante su segunda temporada de VSR. Luego de analizar la situación epidemiológica del VSR en el país así como la evidencia de eficacia, eficiencia y efectividad de este monoclonal; instituciones académicas, sociedades científicas, organizaciones no gubernamentales y gubernamentales se reunieron y elaboraron un consenso interinstitucional para la prevención de las infecciones por VSR, sugiriendo la incorporación del Nirsevimab, en menores de 12 meses de edad antes de su primera temporada de VSR y en reemplazo del Palivizumab, debido a que el nuevo monoclonal tiene el potencial de cambiar el panorama de las infecciones por VSR en el lactante y producir un impacto en la reducción la mortalidad y morbilidad infantil; reduciendo la carga al sistema de salud, en lo que se refiere a la disminución de la ocupación de camas hospitalarias tanto en sala como en unidades de cuidados intensivos, así como la disminución de la carga para los cuidadores, médicos y proveedores de atención médica y la mortalidad infantil.

Respiratory syncytial virus (RSV) infections constitute a significant cause of morbidity, hospitalization, school and work absenteeism, as well as mortality worldwide, including in Paraguay. Currently, tools for RSV prevention are available. In 2012, Paraguay approved the use of palivizumab (MedImmune, USA), a monoclonal antibody produced through recombinant DNA technology. This antibody is administered in 5 doses, every 30 days and is indicated in infants born prematurely and those with cardiopulmonary disorders. Furthermore, a novel tool for RSV prevention has recently become available. Nirsevimab, a long-acting monoclonal antibody specific to the prefusion conformation of the F protein, has been approved by both the European Medicines Agency (EMA) and the Food and Drug Administration (FDA). This monoclonal antibody is indicated for the prevention of acute lower respiratory tract infections caused by RSV in newborns and infants born during or entering their first RSV season, as well as in premature infants and infants up to 24 months of age who remain vulnerable to severe RSV disease during their second RSV season. After analyzing the epidemiological situation of RSV in our country and evaluating the evidence of efficacy, efficiency, and effectiveness of this monoclonal antibody, academic institutions, scientific societies, and non-governmental and governmental organizations developed consensus guidelines on a new prevention alternative for the prevention of RSV infections, suggesting the incorporation of Nirsevimab in children under 12 months of age before their first RSV season and replacing Palivizumab. The new monoclonal has the potential to change the panorama of RSV infections in infants and produce an impact on the reduction of infant mortality and morbidity reducing the burden on the health system by decreasing hospital bed occupancy both in wards and in intensive care units, as well as the decrease in the burden on caregivers, physicians and health care providers.

Virus Sincicial Respiratorio, la tarea pendiente

Según datos del Servicio de  Epidemiología del Hospital del Niño Doctor José Renán Esquivel (Panamá),  en los últimos 3 años, el VRS ha sido causante del 4.7 al 10.5% de todas las admisiones , siendo el 61% de los casos en menores de 1 año; la letalidad para el 2023 fue del 1.2%. Mientras, hasta agosto de 2024 hay confirmados  514 casos hospitalizados de VRS  y 10 defunciones ( letalidad +/-1.9%) (provisto por Infomedic International)

According to data from the Epidemiology Service of the  Hospital del Niño Doctor José Renán Esquivel (Panama), in the last 3 years, RSV has been the cause of 4.7 to 10.5% of all admissions, accounting for 61% of the cases. in children under 1 year of age; The fatality rate for 2023 was 1.2%. Meanwhile, until August 2024 there are 514 confirmed hospitalized cases of RSV and 10 deaths (fatality +/-1.9%) (provided by Infomedic International)

Cáncer De Laringe En Adolescencia Y Virus De Papiloma Humano: Reporte De Un Caso

Introducción: El carcinoma de células escamosas de cabeza y cuello, es una malignidad rara en la población pediátrica. Su incidencia ha ido en aumento en las últimas décadas y los principales factores de riesgo descritos son inmunosupresión y transmisión vertical del virus del papiloma humano (VPH). Presentación del caso: presentamos a un paciente masculino de 14 años con historia de 2 años de disfonía intermitente que luego progreso a estridor laríngeo por lo cual se le realizo traqueostomía con micro laringoscopia directa, donde se evidenció una lesión de aspecto verrucoso y bordes irregulares comprometiendo hemilaringe derecha y paralizándola. Se le toma biopsia y se reporta carcinoma de células escamosas moderadamente invasor (p16 positivo). Luego de evaluación multidisciplinaria, tratándose de una enfermedad localmente avanzada, se decide tratamiento con quimio radioterapia definitiva con intención de preservación orgánica. Conclusión: debido a lo poco común del cáncer de laringe en la población pediátrica y la poca evidencia que hay en cuanto a opciones de tratamiento, limita nuestro conocimiento de esta patología solo a reporte de casos y revisiones de la literatura. consideramos necesario realizar este reporte de caso para agregar información sobre esta patología poco común (provisto por Infomedic International)

Introduction: Squamous cell carcinoma of the head and neck is a rare malignancy in the pediatric population. Its incidence has been increasing in the last decades and the main risk factors described are immunosuppression and vertical transmission of human papillomavirus (HPV). Case presentation: we present a 14-year-old male patient with a 2-year history of intermittent dysphonia that later progressed to laryngeal stridor, for which he underwent tracheostomy with direct micro laryngoscopy, where a lesion of verrucous aspect and irregular borders was evidenced, compromising the right hemilaringeal region and paralyzing it. A biopsy was taken and a moderately invasive squamous cell carcinoma (p16 positive) was reported. After multidisciplinary evaluation, being a locally advanced disease, it was decided to treat with definitive chemo-radiotherapy with the intention of organ preservation. Conclusion: due to the rarity of laryngeal cancer in the pediatric population and the lack of evidence regarding treatment options, our knowledge of this pathology is limited to case reports and literature reviews. We consider it necessary to make this case report to add information on this uncommon pathology. (provided by Infomedic International)

Neumonía atípica por Lophomonas blattarum en un paciente inmunocomprometido: reporte de un caso / Atypical pneumonia due to Lophomonas blattarum in an immunocompromised patient: case report

Resumen La infección respiratoria por Lophomonas blattarum es una patología oportunista poco frecuente, sin embargo, las personas inmunodeprimidas son susceptibles a contraer esta infección. A continuación, se presenta un caso de neumonía por Lophomonas blattarum en un paciente de 44 años de edad con Virus de Inmunodeficiencia Humana (VIH), quien ingresó al Hospital Militar Regional de Puebla con cuadro de dificultad respiratoria, tos no productiva, dolor torácico y fiebre; durante su abordaje inicial se detecta una prueba de anticuerpos VIH 1-2 con resultado presuntivo positivo. Los estudios de imagen muestran hallazgos característicos de neumonía por microorganismos atípicos por lo que se decide tratamiento empírico a base de cefalosporina, macrólido, triazoles y sulfonamida. El cultivo de secreción bronquial reveló un parásito protozoo multiflagelado (L. blattarum), por lo que se inició manejo farmacológico con metronidazol con una dosis de impregnación de 1500 miligramos, continuando con 500 miligramos cada 8 horas por 2 semanas, con lo que se logró mejoría de los síntomas y función respiratoria. Concluye su estancia en el Hospital Regional de Puebla, para seguimiento y confirmación de VIH en tercer nivel de atención. Finalmente, a pesar del tratamiento antibiótico, los pacientes inmunodeprimidos aunado a cualquier infección oportunista, la mortalidad está presente en más de un 80 %.

Abstract Respiratory infection by Lophomonas blattarum is a rare opportunistic pathology, however, immunocompromised individuals are susceptible to contract this infection. The following is a case of Lophomonas blattarum pneumonia in a 44-year-old patient with Human Immunodeficiency Virus (HIV), who was admitted to the Regional Military Hospital of Puebla with respiratory distress, non-productive cough, chest pain and fever; during his initial approach a presumptive positive HIV 1-2 Ac. test was detected. Imaging studies showed findings characteristic of pneumonia caused by atypical microorganisms, so empirical treatment with cephalosporin, macrolide, triazoles and sulfonamide was decided. The bronchial secretion culture revealed a multiflagellate protozoan parasite (L. blattarum), so pharmacological management was started with metronidazole with an impregnation dose of 1500 milligrams, continuing with 500 milligrams every 8 hours for 2 weeks, which resulted in improvement of symptoms and respiratory function. She concluded her stay at the Regional Hospital of Puebla, for follow-up and confirmation of HIV at the third level of care. Finally, despite antibiotic treatment, immunosuppressed patients, together with any opportunistic infection, mortality is present in more than 80%.

Virus prevalence and mixed infections in yellow passion fruit (Passiflora edulis f. flavicarpa) crops in Valle del Cauca, Colombia / Prevalencia e infección mixta de virus en cultivos de maracuyá amarillo (Passiflora edulis f. flavicarpa) en el Valle del Cauca, Colombia

ABSTRACT Yellow passion fruit crop is affected by multiple phytosanitary problems. Among the main ones are viruses of the genera Potyvirus (soybean mosaic virus, SMV), Cucumovirus (cucumber mosaic virus, CMV), Tymovirus (tymovirus passiflorae, PYMV) and Begomovirus (passionfruit leaf distortion virus, PLDV). Information about the prevalence and interaction between these viruses is scarce. The objective of this study was to verify the prevalence and identify the types of mixed viral infections of potyvirus, cucumovirus, tymovirus, and begomovirus in passion fruit crops in Valle del Cauca, Colombia. Passion fruit leaf samples with symptoms were collected and their nucleic acids were purified. Virus identification was performed by PCR using universal primers by viral genus, and specific primers for the SMV, CMV, PFYMV and PLDV viruses. The incidence of each virus by municipality was analyzed and the severity of the symptoms was compared with the diagnosis made. In total, 66 samples were collected in the municipalities of Toro, Dagua, Roldanillo, Bolívar, La Unión and El Cerrito. It was established that the most prevalent viruses are PLDV followed by SMV and CMV. The presence of PYMV was not detected in the samples analyzed. The presence of double and triple infections among potyvirus, cucumovirus and begomovirus were identified for the first time, finding greater severity of symptoms with a greater number of viruses identified per sample. This research provides key results for the design of control strategies for viral diseases in passion fruit.

RESUMEN El cultivo de maracuyá amarillo es afectado por múltiples problemas fitosanitarios. Entre los principales, están los virus de los géneros Potyvirus (soybean mosaic virus, SMV), Cucumovirus (cucumber mosaic virus, CMV), Tymovirus (passion fruit yellow mosaic virus, PFYMV) y Begomovirus (passionfruit leaf distortion virus, PLDV). Información acerca de la prevalencia e interacción entre estos virus es escasa. El objetivo del presente estudio fue verificar la prevalencia e identificar los tipos de infecciones virales mixtas de potyvirus, cucumovirus, tymovirus y begomovirus en cultivos de maracuyá en Valle del Cauca, Colombia. Muestras foliares de maracuyá con síntomas virales fueron recolectadas y se purificaron sus ácidos nucleicos. La identificación de los virus se realizó por PCR empleando cebadores universales por género viral, y cebadores específicos para los virus SMV, CMV, PFYMV y PLDV. Se analizó la incidencia de cada virus por municipio y se comparó la severidad de los síntomas con el diagnóstico realizado. En total se colectaron 66 muestras en los municipios de Toro, Dagua, Roldanillo, Bolívar, La Unión y El Cerrito. Se estableció que los virus con mayor prevalencia fueron PLDV, seguido por SMV y CMV. No se detectó la presencia de PFYMV en las muestras analizadas. Se identificó por primera vez la presencia de infecciones dobles y triples entre potyvirus, cucumovirus y begomovirus, encontrándose mayor severidad de síntomas a mayor número de virus identificado por muestra. La presente investigación provee resultados clave para el diseño de estrategias de control de enfermedades virales en maracuyá.

Análise bibliométrica da produção científica global em chikungunya: perspectiva da Vigilância em Saúde / Bibliometric analysis of global scientific production on chikungunya: Health Surveillance perspective / Análisis bibliométrico de la producción científica mundial sobre chikungunya: una perspectiva de Vigilancia Sanitária

Chikungunya, arbovirose que provoca febre e artralgia debilitante, demonstra potencial crônico e incapacitante por longos períodos, não havendo vacinas ou terapias específicas. Recentemente, a doença evoluiu da condição negligenciada para uma ameaça à saúde pública, impactando milhões de pessoas em regiões tropicais e subtropicais. Este estudo analisa a produção do conhecimento sobre a Chikungunya, na perspectiva da Vigilância em Saúde. Trata-se de metodologia exploratória-descritiva, com análise bibliométrica. Realizou-se a coleta nas bases Scopus e Web of Science para artigos de 2008 a 2022. A análise revelou uma série temporal de produção destacando a contribuição de Estados Unidos, Brasil e França. Identificaram-se como áreas mais produtivas: doenças transmissíveis, medicina tropical e parasitologia, fundamentais à Vigilância em Saúde e ao planejamento de políticas públicas. Quanto aos pesquisadores, Weaver, Scott C., Failloux, Anna-Bella e De Lamballerie, Xavier foram relevantes no cenário global, indicando a importância da colaboração e da abordagem interdisciplinar.

Chikungunya, an arbovirus that causes fever and debilitating arthralgia, has potential to be chronic and incapacitating for long periods, and there are no vaccines or therapies available for it. Recently, the disease has evolved from a neglected condition to public health threat, impacting millions in tropical and subtropical regions. This study analyzed the knowledge production about chikungunya, from the perspective of Health Surveillance, using an exploratory-descriptive methodology and bibliometric analysis. Articles from 2008 to 2022 were collected from Scopus and Web of Science databases. The analysis showed a production time series, highlighting the contribution of United States, Brazil, and France. The most productive areas were identified as: communicable diseases, tropical medicine and parasitology, which are fundamental to Health Surveillance and public policy planning. Regarding researchers, Weaver, Scott C., Failloux, Anna-Bella, and De Lamballerie, Xavier were relevant in the global scenario, indicating the importance of collaboration and of the interdisciplinary approach.

El chikungunya, arbovirus que causa fiebre y artralgia debilitante, tiene potencial de ser crónico e incapacitante por largos periodos, todavía no hay vacunas ni terapias. Recientemente, la enfermedad ha pasado de afección desatendida a amenaza para la salud pública, afectando a millones en regiones tropicales y subtropicales. Este estudio analiza la producción de conocimientos sobre chikungunya, desde la perspectiva de la Vigilancia Sanitaria. Se utilizó una metodología exploratoria-descriptiva con análisis bibliométrico. Se recompilaron artículos de Scopus y Web of Science, 2008-2022. El análisis reveló una serie temporal de producción, destacando la contribución de EEUU, Brasil y Francia. Se identificaron como áreas más productivas: enfermedades transmisibles, medicina tropical y parasitología, fundamentales para la Vigilancia Sanitaria y la planificación de políticas públicas. En cuanto a los investigadores, Weaver, Scott C., Failloux, Anna-Bella y De Lamballeire, Xavier fueron relevantes en el escenario global, indicando la importancia de la colaboración y del enfoque interdisciplinario.

Concepciones de usuarios sobre nuevas vías de administración de profilaxis pre-exposición para el VIH / Users' expectations of the new pre-exposure prophylaxis for the HIV modalities

Resumen Este artículo tiene como objetivo discutir las concepciones de los Hombres Gay, Hombres Bisexuales y una Mujer Transgénero que usan o quieren usar profilaxis previa a la exposición por el virus de la inmunodeficiencia humana oral (PrEP) sobre nuevas vías de administración. Fueron entrevistados 17 usuarios del BCN Checkpoint. Las entrevistas fueron grabadas en audio, sometidas a análisis categorial temático teniendo en cuenta la perspectiva praxeográfica. Todos están adaptados al uso de la PrEP diaria y a demanda. En relación con las nuevas vías de administración (PrEP inyección intramuscular cada dos meses; pastilla mensual; inyección subcutánea cada seis meses) todos son muy receptivos a esas posibilidades, pero les falta información sobre las especificidades de cada una de ellas y una evaluación específica de sus necesidades. Tanto la satisfacción con el uso de PrEP oral, como las expectativas sobre las nuevas vías de administración son positivas. Sin embargo, lo más importante para los/a entrevistados/a es la garantía de que tendrán seguimiento para continuar cuidando de la salud afectivo-sexual, lo que no depende del tipo de vía de administración.

Abstract This article aims to discuss the expectations of Homosexual Men, Bisexual Men and a Transgender Woman, who use or want to use an oral pre-exposure prophylaxis (PrEP) for the human immunodeficiency virus (HIV) about PrEP modalities. Sixteen PrEP users, who are followed up in the BCN Checkpoint, were interviewed,. The interviews were audio-recorded, subjected to thematic categorical analysis within the theoretical framework from the praxiographic perspective. They are all adapted to the use of daily oral and event-based PrEP. In relation to the new PrEP modalities (monthly pill; intramuscular injection every two months; subcutaneous injection every six months), they are all very receptive to these possibilities, but they lack information on the specificities of each and specific assessment of their needs. Comments about the use of oral PrEP are positive, and expectations regarding the new PrEP modalities are visibly high. However, the most important thing for the interviewees is the guarantee that they will have follow-up appointments to continue taking care of their affective-sexual health, which is not dependent on the type of PrEP modalities.

Risk factors for acute kidney injury in patients hospitalized with COVID-19 / Fatores de risco para lesão renal aguda em pacientes hospitalizados com COVID-19

Abstract Introduction: Acute kidney injury (AKI) occurs frequently in COVID-19 patients and is associated with greater morbidity and mortality. Knowing the risks of AKI allows for identification, prevention, and timely treatment. This study aimed to identify the risk factors associated with AKI in hospitalized patients. Methods: A descriptive, retrospective, cross-sectional, and analytical component study of adult patients hospitalized with COVID-19 from March 1 to December 31, 2020 was carried out. AKI was defined by the creatinine criteria of the KDIGO-AKI guidelines. Information, regarding risk factors, was obtained from electronic medical records. Results: Out of the 934 patients, 42.93% developed AKI, 60.59% KDIGO-1, and 9.9% required renal replacement therapy. Patients with AKI had longer hospital stay, higher mortality, and required more intensive care unit (ICU) admission, mechanical ventilation, and vasopressor support. Multivariate analysis showed that age (OR 1.03; 95% CI 1.02-1.04), male sex (OR 2.13; 95% CI 1.49-3.04), diabetes mellitus (DM) (OR 1.55; 95% CI 1.04-2.32), chronic kidney disease (CKD) (OR 2.07; 95% CI 1.06-4.04), C-reactive protein (CRP) (OR 1.02; 95% CI 1.00-1.03), ICU admission (OR 1.81; 95% CI 1.04-3.16), and vasopressor support (OR 7.46; 95% CI 3.34-16.64) were risk factors for AKI, and that bicarbonate (OR 0.89; 95% CI 0.84-0.94) and partial pressure arterial oxygen/inspired oxygen fraction index (OR 0.99; 95% CI 0.98-0.99) could be protective factors. Conclusions: A high frequency of AKI was documented in COVID-19 patients, with several predictors: age, male sex, DM, CKD, CRP, ICU admission, and vasopressor support. AKI occurred more frequently in patients with higher disease severity and was associated with higher mortality and worse outcomes.

RESUMO Introdução: Lesão renal aguda (LRA) ocorre frequentemente em pacientes com COVID-19 e associa-se a maior morbidade e mortalidade. Conhecer riscos da LRA permite a identificação, prevenção e tratamento oportuno. Este estudo teve como objetivo identificar fatores de risco associados à LRA em pacientes hospitalizados. Métodos: Realizou-se estudo descritivo, retrospectivo, transversal e de componente analítico de pacientes adultos hospitalizados com COVID-19 de 1º de março a 31 de dezembro, 2020. Definiu-se a LRA pelos critérios de creatinina das diretrizes KDIGO-LRA. Informações sobre fatores de risco foram obtidas de prontuários eletrônicos. Resultados: Dos 934 pacientes, 42,93% desenvolveram LRA, 60,59% KDIGO-1 e 9,9% necessitaram de terapia renal substitutiva. Pacientes com LRA apresentaram maior tempo de internação, maior mortalidade e necessitaram de mais internações em UTIs, ventilação mecânica e suporte vasopressor. A análise multivariada mostrou que idade (OR 1,03; IC 95% 1,02-1,04), sexo masculino (OR 2,13; IC 95% 1,49-3,04), diabetes mellitus (DM) (OR 1,55; IC 95% 1,04-2,32), doença renal crônica (DRC) (OR 2,07; IC 95% 1,06-4,04), proteína C reativa (PCR) (OR 1,02; IC 95% 1,00-1,03), admissão em UTI (OR 1,81; IC 95% 1,04-3,16) e suporte vasopressor (OR 7,46; IC 95% 3,34-16,64) foram fatores de risco para LRA, e que bicarbonato (OR 0,89; IC 95% 0,84-0,94) e índice de pressão parcial de oxigênio arterial/fração inspirada de oxigênio (OR 0,99; IC 95% 0,98-0,99) poderiam ser fatores de proteção. Conclusões: Documentou-se alta frequência de LRA em pacientes com COVID-19, com diversos preditores: idade, sexo masculino, DM, DRC, PCR, admissão em UTI e suporte vasopressor. LRA ocorreu mais frequentemente em pacientes com maior gravidade da doença e associou-se a maior mortalidade e piores desfechos.

Niños hospitalizados con influenza en un hospital pediátrico de Argentina durante 2019-2022: ¿qué ha cambiado luego de la pandemia por COVID-19? / Children with influenza admitted at a children's hospital in Argentina in the 2019­2022 period: What has changed after the COVID-19 pandemic?

Introducción. Durante 2020 y 2021, la circulación de los virus influenza se mantuvo por debajo de lo esperado en todo el mundo. En Argentina, en el año 2022 observamos una circulación ininterrumpida de influenza todo el año. Nuestros objetivos fueron describir los patrones de circulación y las características clínicas de niños internados con influenza. Población y métodos. Estudio retrospectivo, analítico, observacional. Se incluyeron todos los niños internados en un centro pediátrico con detección del virus influenza durante los años 2019-2022. Resultados. Se internaron 138 pacientes en 4 años; en 2019 se observó una tasa del 4,5/1000 egresos hospitalarios mientras que en 2022, fue del 15,1/1000. En 2020 y 2021 no hubo casos. En el 2019 la mayoría de los casos ocurrieron en invierno, la causa de la internación fue la infección respiratoria aguda baja (IRAB) en el 79 % y se detectó influenza A en el 92 % de los casos. En el 2022, la mayoría de los casos ocurrieron en primavera, el 62 % presentó IRAB y en el 56 % se detectó influenza A. Ambos períodos tuvieron similares frecuencias de vacunación y de comorbilidades. Conclusiones. En el 2022 se registraron más internaciones por influenza, lo que podría corresponder a que se realizaron métodos diagnósticos moleculares, que son más sensibles, y se observó un cambio en la estacionalidad con más casos en primavera. En 2019 predominó influenza A en infecciones del tracto respiratorio inferior, mientras que en el 2022 influenza A y B fueron similares, y hubo más formas extrapulmonares.

Introduction. During 2020 and 2021, the circulation of influenza virus remained below expectations worldwide. In Argentina, in 2022, we observed an uninterrupted circulation of influenza all year round. Our objectives were to describe the circulation patterns and clinical characteristics of hospitalized children with influenza. Population and methods. Retrospective, analytical, observational study. All children with influenza virus admitted to a children's hospital during the 2019­2022 period were included. Results. A total of 138 patients were admitted over 4 years; in 2019, the rate of hospital discharges was 4.5/1000, compared to 15.1/1000 in 2022. No cases were recorded in 2020 and 2021. In 2019, most cases were observed in the winter; in 79%, the cause was acute lower respiratory tract infection (ALRTI); influenza A was detected in 92%. In 2022, most cases occurred in the spring; 62% developed ALRTI; and influenza A was detected in 56%. Similar rates of vaccination and comorbidities were observed in both periods. Conclusions. In 2022, more hospitalizations due to influenza were recorded, which may have correlated with the use of more sensitive molecular diagnostic testing and a change in seasonality, with more cases observed in the spring. In 2019, influenza A predominated in lower respiratory tract infections, while in 2022, cases of influenza A and B were similar, with more extra-pulmonary forms.

Antibody persistence 7 years after hepatitis-A vaccine in children with human immunodeficiency virus infection / Persistencia de anticuerpos siete años después de la vacuna de la hepatitis A en niños con infección por el virus de la inmunodeficiencia humana

Abstract Background: HIV-infected children have a higher risk of presenting infections, including the hepatitis A virus (HAV). The inactivated HAV vaccine is immunogenic in immunocompetent hosts; however, there are insufficient studies on the duration of seroprotection in HIV-infected children. Methods: An analytical cohort study was conducted. HIV-1-infected children who received the inactivated HAV vaccine (2 doses) were included. Blood samples were taken for antibody measurement, the first one 28 days after the second dose and another 7 years after the vaccination schedule. Information on viral load, immunological category, weight, height, and response to antiretroviral treatment from diagnosis to the last assessment was obtained. Results: 19 patients were included, with a mean age of 12.6 years (SD ± 2.29). 58% were male. 80% of the patients presented protective immunoglobulin G antibodies against HAV 7-year post-vaccination. The antibody concentration was found to be between 13 and 80 mIU/mL (median of 80 mIU/mL). 52% showed some degree of immunosuppression. There was no statistically significant relationship between the presence of seroprotection and viral load, treatment failure, immunological category, and malnutrition. Twelve patients presented with antiretroviral treatment failure, and in 33% of them, the antibodies did not offer satisfactory seroprotection. Conclusion: 7-year post-vaccination, 80% of HIV-infected children maintain seroprotection titers against HAV.

Resumen Introducción: Los niños infectados por el virus de la inmunodeficiencia humana (VIH) tienen mayor riesgo de presentar infecciones, incluyendo hepatitis por virus A (VHA). La vacuna inactivada contra el VHA es inmunógena en el huésped inmunocompetente. No hay estudios suficientes sobre el tiempo de seroprotección en niños infectados por el VIH. Método: Estudio de cohorte, analítico. Se incluyeron niños con infección por VIH-1 que recibieron la vacuna inactivada contra el VHA (dos dosis). Se les tomaron muestras sanguíneas para medición de anticuerpos, una 28 días después de la segunda dosis y otra 7 años después del esquema de vacunación. Se obtuvo información de carga viral, categoría inmunológica, peso y talla, y respuesta al tratamiento antirretroviral desde el diagnóstico hasta la última valoración. Resultados: Se incluyeron 19 pacientes con una edad media de 12.6 años (± 2.29). El 58% fueron del sexo masculino. El 80% de los pacientes presentaron anticuerpos immunoglobulin G (IgG) contra el VHA protectores a los 7 años de la vacunación. La concentración de anticuerpos se encontró entre 13 y 80 mUI/ml (mediana: 80 mUI/ml). El 52% mostraron algún grado de inmunosupresión. No existe relación estadísticamente significativa entre la presencia de seroprotección y la carga viral, la falla al tratamiento, la categoría inmunológica ni la desnutrición. Doce pacientes presentaron falla al tratamiento antirretroviral; en el 33% de ellos los anticuerpos no ofrecían seroprotección satisfactoria. Conclusiones: A 7 años posvacunación, el 80% de los niños con VIH mantienen títulos de seroprotección frente al VHA.

Immune Deficiency/Dysregulation Associated Lymphoid Proliferations, EBV+ In Persons Living With HIV

ABSTRACT Background: The 5th edition of the World Health Organization Classification of Hematolymphoid Tumors recently defined immune deficiency/dysregulation (IDD)-associated-lymphoid-proliferations in HIV settings, where information is scarce, often gone under or misdiagnosed. Objectives: To describe the clinical picture, histopathology, and outcomes of IDD-associated-lymphoid-proliferations Epstein-Barr virus+ (EBV) in people living with HIV without organ transplantation, antiretroviral therapy (ART) treated. Methods: HIV+ patients diagnosed with IDD-associated-lymphoid-proliferations seen at an academic medical center in Mexico from 2016 to 2019 were included. Immunohistochemical studies, in situ hybridization, and polymerase chain reaction analysis for EBV and LMP1 gene deletions were performed and correlated with clinical data. Results: We included 27 patients, all men who have sex with men, median age 36 years (interquartile range [IQR] 22-54). The median baseline CD4+ T cells were 113/mL (IQR 89-243), the CD4+/CD8+ ratio was 0.15 (IQR: 0.09-0.22), and the HIV viral load was 184,280 copies/mL (IQR: 76,000-515,707). Twenty patients (74.07%) had IDD-associated-lymphoid-proliferations hyperplasia plasma cell type EBV+, 3 (11.1%) had hyperplasia mononucleosis-like type (IM-type), 1 patient (3.70%) had florid follicular hyperplasia, 3 (11.1%) IDD-associated-lymphoid-proliferations polymorphic type, and there were 22 cases (81.4%) of synchronic Kaposi Sarcoma. Two patients were diagnosed with Hodgkin lymphoma following a second positron emission tomography-computed tomography scan-guided biopsy. The median follow-up was 228 weeks (IQR 50-269); 6 patients died (22.2%) of causes unrelated to IDD-associated-lymphoid-proliferations related. Conclusion: IDD-associated-lymphoid-proliferations EBV+ occured in severely immunosuppressed HIV+ patients, a high percentage of whom had concomitant Kaposi sarcoma. The prognosis was good in patients treated only with ART.

Comparison of Hybribio-H13 and Hybrid Capture® 2 human papillomavirus tests for detection of CIN2+ and CIN3+ / Comparación de las pruebas para el virus del papiloma humano Hybribio-H13 y Hybrid Capture® 2 para la detección de NIC2+ y NIC3+

Abstract Introduction. Low-cost, accurate high-risk HPV tests are needed for cervical cancer screening in limited-resource settings. Objective. To compare the performance of the low-cost Hybribio-H13 test with the Hybrid Capture® 2 to detect cervical intraepithelial neoplasia grade 2 or 3 (CIN2 and CIN3). Materials and methods. Archived baseline samples tested by the Hybrid Capture® 2 from women of the ASCUS-COL trial, aged 20 to 69 years, with biopsy-colposcopy directed diagnosis of CIN2+ (n = 143), CIN3+ (n = 51), and < CIN2 (n = 632) were blindly tested by the Hybribio-H13 test. Results. The relative sensitivity of the Hybribio-H13 test versus the Hybrid Capture® 2 for detecting CIN2+ was 0.89 (90% CI = 0,80-0,98; NIT = 0,66), and for CIN3+ was 0,92 (90% CI = 0,85-0,98; NIT = 0,35). Relative specificity was 1.19 (90% CI = 1.05-1.33; NIT < 0.00001). In the analysis restricted to women older than 30 years, the relative sensitivity of the Hybribio-H13 for CIN3+ was marginally below unity (ratio = 0.97; 90% CI = 0.95-0.99), and the specificity remained higher than the Hybrid Capture® 2 test. Conclusion. The Hybribio-H13 test was as specific as the Hybrid Capture® 2 for detecting CIN2+ or CIN3+ but less sensitive. Considering these results and the young age of the population recruited for screening because of ASCUS cytology, we suggest our results warrant the evaluation of the Hybribio-H13 for screening cervical cancer, especially in the evaluated population.

Resumen Introducción. Se necesitan pruebas para detectar genotipos de VPH de alto riesgo, precisas y de bajo costo, para la tamización del cáncer de cuello uterino en entornos de recursos limitados. Objetivo. Comparar el desempeño de la prueba de bajo costo Hybrid-H13 con la de Hybrid Capture® 2 para detectar NIC2+ y NIC3+. Materiales y métodos. Se analizaron en ciego muestras de la línea base provenientes de mujeres del estudio ASCUS-COL, entre los 20 y los 69 años, con diagnóstico dirigido por biopsia-colposcopia de NIC2+ (n = 143), NIC3 + (n = 51) y < NIC2 (n = 632) con la prueba para detección de virus de papiloma humano Hybribio-H13. Estas muestras fueron previamente evaluadas con la prueba Hybrid Capture® 2. Resultados. La sensibilidad relativa de Hybribio-13 versus la de Hybrid Capture® 2 para detectar NIC2+ fue de 0,89 (IC90%: 0,80-0,98; NIT = 0,66) y para NIC3+ fue de 0,92 (IC90%: 0,85-0,98; NIT = 0,35). La especificidad relativa fue de 1,19 (IC90%: 1,05-1,33; NIT < 0,00001). En el análisis restringido a mujeres mayores de 30 años, la sensibilidad relativa de Hybribio-H13 para NIC3+ estuvo marginalmente por debajo de la unidad (proporción = 0,97; IC90%: 0,95-0,99) y la especificidad permaneció más alta que la de la prueba Hybrid Capture® 2. Conclusión. La prueba de Hybribio-H13 fue tan específica como la de Hybrid Capture® 2, pero menos sensible para detectar NIC2+ o NIC3+. Teniendo en cuenta estos resultados y la temprana edad de la población reclutada en la tamización por la presencia de ASCUS en la citología, se sugiere continuar con la evaluación de la prueba Hybribio-H13 para la detección de cáncer de cuello uterino en poblaciones con las mismas características que las de la aquí evaluada.

Características clínicas y respuesta al tratamiento del linfoma en personas que viven con el virus de la inmunodeficiencia humana (VIH) en un centro de referencia de Latinoamérica / Clinical characteristics and response to lymphoma treatment in people living with the human immunodeficiency virus (HIV) in a reference center in Latin America

Resumen Introducción. Los linfomas son neoplasias malignas caracterizadas por la proliferación clonal de linfocitos. Las personas portadoras del virus de inmunodeficiencia humana (VIH) desarrollan los subtipos más agresivos de linfoma. En México se conoce poco acerca de las características clínicas y la respuesta al tratamiento del linfoma en las personas que viven con el VIH. Material y métodos. Un estudio descriptivo, retrospectivo y transversal fue realizado en un hospital de referencia en el estado de Veracruz, México, la tercera entidad federativa mexicana con mayor número de casos de VIH. Pacientes ≥18 años, portadores del VIH y diagnosticados con linfoma no Hodgkin o Hodgkin entre junio 2017 a junio 2022 fueron incluidos en el estudio. Además del análisis descriptivo, se calcularon las curvas de KaplanMeier para la sobrevida y las hazard ratio (HR) mediante regresión de Cox para determinar el riesgo de muerte asociada a los diferentes factores. Resultados. Se analizó una cohorte de 32 personas que viven con el VIH con linfoma no Hodgkin (n= 30) o linfoma de Hodgkin (n= 2). El 90% del total de los pacientes fueron del sexo masculino con una mediana de edad de 39.3 años (25-68). El 40% de los pacientes presentó el linfoma y VIH al mismo tiempo, el 60% restante desarrollaron el linfoma en un período entre 1 y 22 años, con una media de tiempo de 6.8 años, de los cuales el 79% recibió terapia antirretroviral y registraba carga viral indetectable. El linfoma más frecuente fue el linfoma difuso de células grandes B (37.5%). La media de supervivencia global de los pacientes fue 6.65 años, con intervalos de confianza (IC) del 95% de 3.93 a 9.37 años con error estándar de 1.38 años; la probabilidad acumulada de supervivencia fue 0.4, con un error estándar de 0.1. En la regresión de Cox la albúmina ≤ 3 g/ dL tuvo un alto cociente de riesgo (HR= 5.69; IC 95%: 1.38-23.45, p= 0.016) para mortalidad, donde los pacientes con estos niveles de albúmina tuvieron una media de sobrevida de 9.8 meses. Discusión. A pesar de que los linfomas asociados a VIH son agresivos y se presentan en estadios avanzados, la sobrevida global alcanzada en este estudio fue similar a estudios previos. El esquema R-CHOP mostró buena respuesta en el LDCGB, pero continúa siendo controvertido el manejo de los otros tipos de linfoma. La hipoalbuminemia fue un factor de riesgo para mortalidad, por lo que podría incluirse en nuevas escalas pronósticas.

Abstract Introduction. Lymphomas are malignant neoplasms characterized by clonal proliferation of lymphocytes. Persons carrying the human immunodeficiency virus (HIV) develop the most aggressive subtypes of lymphoma. In Mexico, little is known about the clinical characteristics and response to treatment of lymphoma in people living with HIV. Material and methods. A descriptive, retrospective, cross-sectional study was conducted at a referral hospital in the state of Veracruz, Mexico, the third Mexican federative entity with the highest number of HIV cases. Patients ≥18 years old, HIV carriers and diagnosed with non-Hodgkin's or Hodgkin's lymphoma between June 2017 to June 2022 were included in the study. In addition to the descriptive analysis, Kaplan-Meier curves for survival and hazard ratio (HR) by Cox regression were calculated to determine the risk of mortality associated with the different factors. Results. A cohort of 32 people living with HIV with non-Hodgkin's lymphoma (n= 30) or Hodgkin's lymphoma (n= 2) was analyzed. Ninety percent of the total patients were male with a median age of 39.3 (25-68). The remaining 60% developed lymphoma in a period between 1 and 22 years, with a mean time of 6.8 years, of which 79% received antiretroviral therapy and had an undetectable viral load. The most frequent lymphoma was diffuse large B-cell lymphoma (37.5%). The mean overall survival of the patients was 6.65 years, with a 95% confidence interval (CI) of 3.93 to 9.37 years and standard error of 1.38 years; the cumulative probability of survival was 0.4, with a standard error of 0.1. In Cox regression albumin ≤ 3 g/dL had a high hazard ratio (HR= 5.69; 95% CI: 1.38-23.45, p= 0.016) for mortality, where patients with these albumin levels had a mean survival of 9.8 months. Discussion. Despite the fact that HIV-associated lymphomas are aggressive and present in advanced stages, the overall survival achieved in our unit is similar to that reported in the world literature. The R-CHOP scheme has a good response in DLBCL, but the management of other types of lymphoma remains controversial. Hypoalbuminemia was found to be the most important predictor of mortality, so it could be included in new prognostic scales.

Rabia humana: un problema de salud pública en Perú / Human rabies: a public health problem in Peru

Resumen La rabia es una enfermedad vírica prevenible mediante la inmunización. Esta afecta a personas de más de 150 países ocasionando decenas de defunciones, principalmente en los continentes de Asia y África. El 40 % de casos se dan en niños menores de 15 años, siendo el perro la principal fuente de contagio a humanos y del 99% de las muertes por esa causa; así, la vacunación de estos animales resulta la principal medida preventiva que se recomienda.

Abstract Rabies is a viral disease preventable through immunization. This disease affects more than 150 countries, causing dozens of deaths, mainly in the continents of Asia and Africa. 40% of cases occur in children under 15 years of age; the dog is the main source of 99% of deaths from rabies. For this reason, rabies disease can be prevented by vaccinating dogs and avoiding bites.

Cambios percibidos en hábitos de alimentación, composición corporal, condición física y psicológica de deportistas universitarios durante la cuarentena por Covid-19 / Perceived changes in eating habits, body composition, physical and psychological condition of university athletes during the Covid-19 quarantine

RESUMEN Objetivo: Describir los cambios percibidos en hábitos de alimentación, composición corporal, condición física y psicológica de deportistas universitarios durante la cuarentena por Covid-19 en 2020. Materiales y métodos: Estudio transversal, de fuente de información secundaria; 403 deportistas universitarios diligenciaron una encuesta en línea en el segundo semestre de 2020. Se utilizó la estadística descriptiva para analizar los datos, para determinar asociación entre las variables de interés: tipo de deporte, sexo y Covid-19 se utilizó la prueba de significancia estadística Chi X2 de Pearson <0,05. Resultados: Del total de deportistas, el 53,3 eran hombres. La mayoría practicaba deportes individuales (55,3 %). Alrededor del 89 % de atletas no presentó Covid-19. El 59,8 % sintió que el peso empeoró, siendo mayor en los deportes individuales (p= 0,005). Una proporción mayor de mujeres recibió asesoría por parte de un entrenador y de redes sociales (62,7 %) y 7 de cada 10 hombres complementaba su entrenamiento con información proveniente de redes sociales (p=0,001). Las características psicológicas fueron las que mostraron mayores diferencias significativas según sexo y el tipo de deporte. Conclusión: La cuarentena por Covid-19 está asociada con cambios desfavorables en los deportistas universitarios; específicamente, se percibieron cambios en los hábitos de alimentación con un aumento en la cantidad de alimentos de baja calidad nutricional y alta densidad calórica, cambios negativos en el peso y peor condición física. Los deportes individuales se vieron más afectados frente a los deportes de conjunto; en lo psicológico se resalta la mala adaptación a la cuarentena con sentimientos de soledad, ansiedad y mal estado de ánimo, donde las mujeres fueron las más afectadas.

ABSTRACT Objetive: Describe the perceived changes in eating habits, body composition, physical and psychological condition of university athletes during the quarantine by Covid-19, in the year 2020. Materials and methods: Cross-sectional study, from a secondary data source, 403 universitary athletes answered an online survey on 2020's second semester. Descriptive statistics was used to analyze data, Pearson's Chi X2 <0,05 test was used to determine association between variables of interest: Sport type, sex and Covid-19. Results: The majority practiced individual sports (55.3 %). About 89 % of athletes did not present Covid-19 59.8 % felt that body weight worsened, being higher in individual sports (p= 0.005). Most of the athletes trained for at least one hour a day (81.1 %), a higher proportion of women received advice from a coach and from social networks (62.7 %), while 7 out of 10 men only complemented their training with information from social networks (p=0.001), the type of sport also presented an association in this variable (p=0.024) The psychological characteristics were those that showed the greatest significant differences according to gender and type of sport. Conclusion: The Covid-19 quarantine is associated with unfavorable changes in university athletes, specifically changes in eating habits were perceived with an increase in the amount of foods of low nutritional quality, negative changes in weight, worse physical condition, where the individual sports were more affected compared to group sports, feelings of loneliness, anxiety and bad mood, where women were the most affected.

Características de recién nacidos hijos de madre con IgM positiva para el Virus Herpes Simplex

Introducción: El herpes connatal es una entidad infrecuente asociada a elevada morbimortalidad. La probabilidad de transmisión al recién nacido va de 5% al 85%. El diagnóstico se dificulta por falta de clínica, serología no confiable y por la no disponibilidad de PCR en los servicios públicos de países en vías de desarrollo. La IgM en gestantes podría ser utilizada como un marcador de sospecha para evaluar al neonato. Objetivo: Caracterizar a los recién nacidos, hijos de gestantes con IgM positiva para HVS 1-2 y la frecuencia de encefalitis en los infantes. Materiales y métodos : Estudio observacional, descriptivo, prospectivo, realizado de mayo de 2020 a octubre de 2021. Se incluyeron recién nacidos (RN) de madres con IgM positiva para Herpes Virus Simplex (HVS) a partir de la segunda mitad del embarazo. En el RN se realizó serología IgG e IgM, y además, PCR- RT para HVS 1-2 en sangre y/o LCR, excluyéndose los nacidos en otras maternidades y/o sin datos de serología materna. Resultados: 36 pacientes. Edad materna 28 años (DS + 4), 5% con antecedentes de HVS, 61% cesárea. 36% prematuros, 13% RCIU. Síntomas agudos en el RN 22%. De ellos, 19% plaquetopenia, 44% alteración de GOT. 63% PCR HVS en sangre y 44% en LCR. Se encontró hemorragia, hidrocefalia, leucomalacia en 27%. No se encontró diferencias en la expresión clínica por tipo de parto. Conclusiones: Los RN hijos de gestantes con IgM positiva para VHS desde la segunda mitad del embarazo o periparto, presentaron infección por VHS determinada por PCR en sangre o LCR, independiente de la vía del parto. El diagnóstico serológico en embarazadas permite la pesquisa, diagnóstico y tratamiento temprano del RN.

Introduction: neonatal herpes is a rare entity associated with high morbidity and mortality. The probability of transmission to the newborn ranges from 5% to 85%. The diagnosis is difficult due to the lack of clinical signs, unreliable serology and the non-availability of PCR in public services in developing countries. IgM in pregnant women could be used as a suspected marker to evaluate the neonate. Objective: To characterize newborn children of pregnant women with positive IgM for HSV 1-2 and the prevalence of encephalitis in infants. Materials and methods: Observational, descriptive, prospective study, carried out from May 2020 to October 2021. Newborns (NB) of mothers with positive IgM for Herpes Virus Simplex (HSV) from the second half of pregnancy were included. In newborns, IgG and IgM were performed, and in addition, PCR-RT for HSV 1-2 in blood and/or CSF, excluding those born in other hospitales and/or without maternal serology data. Results: We included 36 patients. Maternal age was 28 years (DS + 4), 5% with a history of HSV. 61% were delivered via cesarean section, 36% were premature, 13% had IUGR. 22% of the newborns had acute symptoms. 19% had thrombocytopenia, 44% had GOT alteration. 63% were PCR positive for HSV in serum and 44% were CSF-positive. Hemorrhage, hydrocephalus and leukomalacia were found in 27%. No differences were found in clinical expression by type of delivery. Conclusions: Newborns born to pregnant women with positive IgM for HSV from the second half of pregnancy or peripartum, presented HSV infection as determined by PCR in blood or CSF, regardless of the route of delivery. Serological diagnosis in pregnant women allows early screening, diagnosis and treatment of the NB.