Vacunación contra el Virus de Papiloma Humano en Paraguay, monitoreo de coberturas y datos de seguridad

Introducción: A nivel mundial, el cáncer de cuello uterino es el cuarto cáncer más frecuente en la mujer. Objetivo: Describir las coberturas anuales de vacunación contra VPH y ESAVI. Material y Métodos: Estudio observacional descriptivo transversal, realizado en Paraguay, periodo 2013-2023, variables analizadas: coberturas de vacunación contra VPH en niñas de 10 años, según esquema: 3 dosis (2013-2016), 2 dosis (2017-2023), coberturas de vacunación de seguimiento a los 15 años (1ª dosis y Dosis Final), ESAVI grave y no grave. Resultados: Los intervalos de coberturas de vacunación contra VPH 1ª dosis: 55-73% (periodo no pandémico), 33-53 % (periodo pandémico), mientras que para Dosis Final: 1-64% (periodo prepandémico) y 5-31 % (periodo pandémico). Al analizar las coberturas de vacunación contra VPH Dosis Final según esquema el promedio de deserción fue mayor en esquema de 3 dosis: 42 vs 25% (valor p= 0,001). El intervalo de coberturas de seguimiento a los 15 años Dosis Final: 66 a 77%. Hubo un recupero importante en los años 2019-2021: 71%, 65% y 59% respectivamente. La Tasa de ESAVI: 2,5 x 100.000 dosis administradas. Conclusión: Las coberturas de vacunación de seguimiento a los 15 años fueron < 90%. La tasa de ESAVI por 100.000 fue baja.

Introduction: Worldwide, cervical cancer is the fourth-most frequent cancer in women. Objective : To describe HPV vaccination coverage and Adverse Events Following Immunizations (AEVF). Material and Methods: This was a cross-sectional, descriptive and observational study, carried out in Paraguay during 2013-2023; the variables analyzed were: HPV vaccination coverage in 10-year-old girls, according to the recommended vaccination schedule: 3 doses (2013-2016), 2 doses (2017-2023), follow-up vaccination coverage at 15 years (1st dose and Final Dose), AEVF classification during 2013-2023. Results: The coverage intervals for the 1st dose of the HPV vaccine were: 55-73% during the pre-pandemic period (2013-2019) and 33-55% during the pandemic years (2020-2023); Final HPV Vaccine dose coverage: 1-64% during the pre-pandemic period and 5-31% during the pandemic period. The average dropout was higher during the use of a 3-dose schedule: 42 vs. 25% (p value = 0.001). Follow-up vaccination coverage at 15 years for Final Dose: 66-77%. A significant catch-up was achieved from 2019-2021: 71%, 65% and 59% respectively. Regarding the safety of the vaccine the AEFV rate: 2.1 x 100,000. Conclusions: HPV Vaccination coverage at 15 years was below 90%; the AEFV rate per 100,000 dose was low.

Quiste esplénico epidérmico infectado. Reporte de caso

Los quistes esplénicos son infrecuentes y presentan una baja incidencia (0.07%). Las etiologías son varias, pero en su mayoría se deben a parasitarios y no parasitarios. Entre los primeros se encuentran los quistes hidatídicos por equinococosis que son más comunes sobre todo en zonas endémicas. En el siguiente trabajo se presenta el caso de una paciente de sexo femenino de 17 años de edad que consulta por un cuadro de 6 días de evolución que inicia con dolor, tipo puntada de moderada intensidad, localizado en hipocondrio izquierdo, acompañado de fiebre graduada en 38 grados con escalofríos.

Splenic cysts are uncommon and have a low incidence rate (0.07%). The etiologies are diverse, but mostly attributed to both parasitic and non-parasitic origins. Among the former, hydatid cysts due to echinococcosis are more prevalent, especially in endemic areas. This report describes the case of a 17-year-old female patient who presented with a 6-day history of pain, of moderate intensity and stabbing type, localized in the left hypochondrium. The pain was accompanied by a fever reaching 38 degrees Celsius and chills.

[Pediatric therapeutic options in autoimmune neurologic diseases]. / Opciones terapéuticas para enfermedades neurológicas autoinmunes en pediatría.

The pediatric neuroimmunology field has made significant progress in the last decade. Now, is possible to recognize primary demyelinating diseases, paraneoplastic syndromes, inflammatory (vasculitis), and granulomatous disorders that affect the central nervous system; at the same time, it is important to exclude neurologic manifestations caused by infections, toxic agents, and metabolic problems. An early diagnosis is imperative to institute treatment as soon as possible, improving outcomes. Treatment may include both, specific drugs if the etiology has been established, as well as drugs to treat potential complications, for example anticonvulsants, anti-inflammatory drugs, transfusions, or albumin replenishment within others. The main objective of this review is to provide guidance about the therapeutic options in pediatric autoimmune neurological diseases. We review the evidence and recommendations for the use of steroids in autoimmune demyelinating diseases, acute disseminated encephalomyelitis, optic neuritis, neuromyelitis optica, multiple sclerosis, among others. We will focus on current therapies, including high doses of intravenous methylprednisolone, followed by its progressive reduction, as well as intravenous immunoglobulin or plasmapheresis as second line therapies. Early institution of these treatments can save the patient's life and decrease their risk of permanent disability.

El campo de la pediatría neuro-inmunológica ha progresado significativamente en la última década. Ahora es posible reconocer con prontitud enfermedades desmielinizantes primarias, síndromes para-neoplásicos, enfermedades inflamatorias, autoinmunes y granulomatosas, que afectan el sistema nervioso central. Excluir con gran rapidez posibles causas infecciosas, agentes tóxicos, problemas metabólicos que se presenten con manifestaciones neurológicas es imperativo, ya que al hacer un diagnóstico preciso y temprano del paciente se puede instituir un tratamiento lo más pronto posible e incrementar las probabilidades de éxito. El tratamiento puede ser dirigido a la etiología específica, si se conoce. Adicionalmente, es importante tratar las complicaciones relacionadas a la propia enfermedad o efectos secundarios de los tratamientos que se impongan. El tratamiento puede incluir tanto fármacos específicos si se ha establecido la etiología, así como medicamentos para tratar posibles complicaciones, por ejemplo, anticonvulsivos, antiinflamatorios, transfusiones, o reposición de albúmina dentro de otros. El objetivo principal de esta revisión es brindar una guía sobre las opciones terapéuticas en enfermedades neurológicas autoinmunes en fase aguda. Revisamos la evidencia y recomendaciones acerca del uso de esteroides en enfermedades autoinmunes desmielinizantes, encefalomielitis aguda diseminada, neuritis óptica, neuromielitis óptica, esclerosis múltiple, entre otras, donde altas dosis de metilprednisolona, seguida por su disminución progresiva son esenciales, así como el uso de inmunoglobulina humana intravenosa y plasmaféresis, como tratamiento de segunda línea. La institución temprana de estos tratamientos puede salvar la vida del paciente y disminuir su discapacidad permanente.

Síndrome de Gardner-Diamond. Presentación de un caso / Gardner-Diamond syndrome: A case report

RESUMEN El sindrome de Gardner- Diamond conocido también como púrpura psicógena o síndrome de autosensibilización eritrocitaria es muy poco frecuente. Se presenta el caso de un hombre de 50 años, blanco, ingresado en el Servicio de Medicina Interna del Hospital Clínico Quirúrgico Docente "Faustino Pérez Hernández" por síndrome febril agudo, cefalea holocraneana, epistaxis y hemolacria. En el examen físico realizado se notó la salida de lágrimas con sangre, por el ángulo interno de ambos ojos y epistaxis. La inyección intradérmica en la cara dorsal del muslo izquierdo de 0,1 mL de sangre autóloga, no indujo reacción equimótica. La inyección de 0,1 mL de solución salina al 0,9 % como control en el muslo contralateral resultó negativa. Sobre la base del examen clínico y otras pruebas, se concluyó como un Síndrome de Gardner-Diamond. Esta infrecuente enfermedad debe ser considerada en el diagnóstico diferencial de un síndrome purpúrico de etiología no bien precisada, fundamentalmente en pacientes con problemas psiquiátricos (AU).

ABSTRACT The Gardner-Diamond syndrome, also known as psychogenetic purpura or erythrocyte autosensitization syndrome is very few frequent. The case of a white patient aged 50 years is presented. He entered the Service of Internal Medicine of the Teaching Clinic-surgical Hospital "Faustino Pérez Hernández" because of an acute fever syndrome, holocraneal headache, epistaxis and haemolacria. At the physical examination it was stated the flow of tears with blood, through the internal angle of both eyes and epistaxis. The intradermal injection of 0.1 ml of autologous blood in the left thigh dorsal side did not induce an ecchymotic reaction. The injection of 0.1 ml of 0.9 % saline solution as control in the contralateral side was negative. On the basis of the clinical examination and other tests, the authors arrived to the conclusion it is a Gardner-Diamond syndrome. This infrequent disease should be considered in the differential diagnosis of a purpuric syndrome of non-good précised etiology, mainly in patients with psychiatric problems (AU).

Síndrome de Gardner-Diamond. Presentación de un caso / Gardner-Diamond syndrome: A case report

RESUMEN El sindrome de Gardner- Diamond conocido también como púrpura psicógena o síndrome de autosensibilización eritrocitaria es muy poco frecuente. Se presenta el caso de un hombre de 50 años, blanco, ingresado en el Servicio de Medicina Interna del Hospital Clínico Quirúrgico Docente "Faustino Pérez Hernández" por síndrome febril agudo, cefalea holocraneana, epistaxis y hemolacria. En el examen físico realizado se notó la salida de lágrimas con sangre, por el ángulo interno de ambos ojos y epistaxis. La inyección intradérmica en la cara dorsal del muslo izquierdo de 0,1 mL de sangre autóloga, no indujo reacción equimótica. La inyección de 0,1 mL de solución salina al 0,9 % como control en el muslo contralateral resultó negativa. Sobre la base del examen clínico y otras pruebas, se concluyó como un Síndrome de Gardner-Diamond. Esta infrecuente enfermedad debe ser considerada en el diagnóstico diferencial de un síndrome purpúrico de etiología no bien precisada, fundamentalmente en pacientes con problemas psiquiátricos.

ABSTRACT The Gardner-Diamond syndrome, also known as psychogenetic purpura or erythrocyte autosensitization syndrome is very few frequent. The case of a white patient aged 50 years is presented. He entered the Service of Internal Medicine of the Teaching Clinic-surgical Hospital "Faustino Pérez Hernández" because of an acute fever syndrome, holocraneal headache, epistaxis and haemolacria. At the physical examination it was stated the flow of tears with blood, through the internal angle of both eyes and epistaxis. The intradermal injection of 0.1 ml of autologous blood in the left thigh dorsal side did not induce an ecchymotic reaction. The injection of 0.1 ml of 0.9 % saline solution as control in the contralateral side was negative. On the basis of the clinical examination and other tests, the authors arrived to the conclusion it is a Gardner-Diamond syndrome. This infrequent disease should be considered in the differential diagnosis of a purpuric syndrome of non-good précised etiology, mainly in patients with psychiatric problems.

Tumor odontogénico adenomatoide en la mandíbula de una niña de 11 años de edad / Adenomatoid odontogenic tumor in the jaw of an 11-year-old girl

Presentar un caso de tumor odontogénico adenomatoide y realizar consideraciones relativas a su diagnóstico y prevención. Caso clínico: una paciente de 11 años de edad presentaba intenso dolor y deformación facial a nivel mandibular. El diagnóstico anatomopatológico de certeza fue tumor odontogénico adenomatoide. Conclusiones: el tumor odontogénico adenomatoide es un tumor benigno de los maxilares, frecuentemente asociado a una pieza dentaria retenida. Sus dimensiones pueden ser importantes, lo cual compromete las estructuras vecinas y su funcionalidad. Se enfatiza la importancia del diagnóstico oportuno de parte del médico pediatra, del odontólogo pediatra y del cirujano bucomaxilofacial...

Differential replication of dengue virus serotypes 2 and 3 in coinfections of C6/36 cells and Aedes aegypti mosquitoes.

INTRODUCTION: Different dengue virus (DENV) serotypes have been associated with greater epidemic potential. In turn, the increased frequency in cases of severe forms of dengue has been associated with the cocirculation of several serotypes. Because Colombia is a country with an endemic presence of all four DENV serotypes, the aim of this study was to evaluate the in vivo and in vitro replication of the DENV-2 and DENV-3 strains under individual infection and coinfection conditions. METHODOLOGY: C6/36HT cells were infected with the two strains individually or simultaneously (coinfection). Replication capacity was evaluated by RT-qPCR, and the effects on cell viability were assessed with an MTT (3-(4, 5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay. Additionally, Aedes aegypti mosquitoes were artificially fed the two strains of each serotype individually or simultaneously. The viral genomes were quantified by RT-qPCR and the survival of the infected mosquitoes was compared to that of uninfected controls. RESULTS: In single infections, three strains significantly affected C6/36HT cell viability, but no significant differences were found in the replication capacities of the strains of the same serotype. In the in vivo infections, mosquito survival was not affected, and no significant differences in replication between strains of the same serotype were found. Finally, in coinfections, serotype 2 replicated with a thousandfold greater efficiency than serotype 3 did both in vitro and in vivo. CONCLUSIONS: Due to the cocirculation of serotypes in endemic regions, further studies of coinfections in a natural environment would further an understanding of the transmission dynamics that affect DENV infection epidemiology.

[Guía latinoamericana para el diagnóstico y tratamiento de alergia a las proteínas de la leche de vaca (GL-APLV)].

Cow's milk allergy (CMA) is an immune-based disease that has become an increasing problem. The diagnosis and management of CMA varies from one clinical setting to another and represents a challenge in pediatric practice. In addition, because nonallergic food reactions can be confused with CMA symptoms, there is an overdiagnosis of the disease. In response to these situations, pediatric specialties from recognized institutions throughout Latin America decided to develop a clinical guideline for diagnosis and management of cow's milk allergy. These guidelines include definitions, epidemiology, pathophysiology overview, clinical and evidencebased recommendations for the diagnosis and treatment of CMA. They also include prevention and prognosis sections and identify gaps in the current knowledge to be addressed through future research.

Adenoviral astrocyte-specific expression of BDNF in the striata of mice transgenic for Huntington's disease delays the onset of the motor phenotype.

Huntington's disease (HD) is a neurodegenerative disorder characterized by motor, cognitive, and psychiatric symptoms. The most characteristic structural feature of this disease is neurodegeneration accompanied by gliosis in the striatum. BDNF has been proposed to protect striatal neurons from degeneration, because it is an important survival factor for these neurons from development to adulthood. Considering the extensive gliosis and the survival effects of BDNF, we constructed an adenovirus to express a BDNF cDNA in astrocyte cells using a promoter of the glial fibrillary acidic protein gene. Cells stably transfected in vitro with a BDNF cDNA driven by this promoter expressed BDNF and responded to external stimuli increasing BDNF production. When the vector was applied into the striata of mice transgenic for HD, long-term expression of the transgene was observed, associated with a delay of onset of the motor phenotype of the R6/2 HD transgenic mice. The present data indicate that the striatal expression of BDNF is a potential adjuvant for the treatment of HD.

Adherence to secondary prophylaxis and disease recurrence in 536 Brazilian children with rheumatic fever.

BACKGROUND: More than 15 million people worldwide have rheumatic fever (RF) and rheumatic heart disease due to RF. Secondary prophylaxis is a critical cost-effective intervention for preventing morbidity and mortality related to RF. Ensuring adequate adherence to secondary prophylaxis for RF is a challenging task. This study aimed to describe the rates of recurrent episodes of RF, quantify adherence to secondary prophylaxis, and examine the effects of medication adherence to the rates of RF in a cohort of Brazilian children and adolescents with RF. METHODS: This retrospective study took place in the Pediatric Rheumatology outpatient clinic at a tertiary care hospital (Instituto de Puericultura e Pediatria Martagão Gesteira) in Rio de Janeiro, Brazil, and included patients with a diagnosis of RF from 1985 to 2005. RESULTS: 536 patients with RF comprised the study sample. Recurrent episodes of RF occurred in 88 of 536 patients (16.5%). Patients with a recurrent episode of RF were younger (p < 0.0001), more frequently males (p = 0.003), and less adherent (p < 0.0001) to secondary prophylaxis than patients without RF recurrence. Non-adherence to medication at any time during follow-up was detected in 35% of patients. Rates of non-adherence were higher in the group of patients that were lost to follow-up (42%) than in the group of patients still in follow-up (32%) (p = 0.027). Appointment frequency was inadequate in 10% of patients. Higher rates of inadequate appointment frequency were observed among patients who were eventually lost to follow-up (14.5%) than in patients who were successfully followed-up (8%) (p = 0.022). 180 patients (33.5%) were lost to follow up at some point in time. CONCLUSIONS: We recommend implementation of a registry, and a system of active search of missing patients in every service responsible for the follow-up of RF patients. Measures to increase adherence to secondary prophylaxis need to be implemented formally, once non-adherence to secondary prophylaxis is the main cause of RF recurrence. Detection of irregularity in secondary prophylaxis or in appointments should be an alert about the possibility of loss of follow-up and closer observation should be instituted.

Competencia vectorial: consideraciones entomológicas y suinfluencia sobre la epidemiología del dengue / Vector competence: entomological considerations and its implications on the epidemiology of dengue

Las enfermedades transmitidas por vectores constituyen un complejo problema de salud en el ámbito mundial, especialmente en áreas tropicales y subtropicales, que por sus condiciones ambientales favorecen la supervivencia del vector. El dengue es la principal enfermedad transmitida por vectores en el mundo, cuyo agente etiológico es el Virus Dengue, el cual es transmitido por la picadura de mosquitos hematófagos de la especie Aedes aegypti. La interacción virus-vector es esencial para una transmisión efectiva y depende de factores tanto virales como vectoriales. Entre los factores relacionados con el vector, la competencia vectorial es considerada de gran importancia, pues se refiere a la capacidad intrínseca del vector para infectarse con el virus, permitir su replicación y posteriormente su transmisión a un huésped susceptible. A su vez, la habilidad para ser un buen vector depende principalmente de barreras naturales a la infección, barreras inmunológicas y presencia de receptores específicos para el virus. Todas estas características, sumadas a las características propias del virus, favorecerán o no la transmisión del mismo. Un estudio integral dela relación virus-vector permitirá comprender sus implicaciones en la epidemiología de la enfermedad. Estos temas han sido revisados en el presente documento, discutiendo su importancia dentro del contexto entomológico y epidemiológico.

Vector-borne diseases are a serious problem in public health, especially in tropical and subtropical areas where environmental conditions favor the survival and expansion of vectors into new habitats. Dengue fever is one of the most important vector-borne diseases transmitted by arthropods (arbovirosis) worldwide. The etiologic agent of the disease is the dengue virus, which is transmitted by the bite of bloodsucking Aedes aegypti mosquitoes. The virus-vector interaction is essential for the efficient transmission of the disease, and depends on both, viral factors and vector competence or intrinsic vector capacity to be infected with the virus. Vector competence allows virus replication and subsequent transmission to susceptible hosts. Factors that influence vector capacity include: natural barriers to infection, immunological defenses as well as the presence of receptors for the virus. All these factors inaddition to the viral characteristics will determine the degree of transmission. There is a need for a better understanding of the virus-vector relationship and its epidemiological implications. These issues are addressed in this article.

Gas1 inhibits cell proliferation and induces apoptosis of human primary gliomas in the absence of Shh.

Growth arrest specific1 (Gas1) is a protein expressed during development and when cells arrest their growth. The potential of Gas1 as an adjuvant in the treatment of cancer, and its role as a tumor suppressor have also been proposed. In this work we are addressing the molecular mechanisms by which Gas1 induces cell arrest and apoptosis of cancer cells, using primary cultures of human gliomas as a model. We had previously demonstrated the structural relationship between Gas1 and the alpha receptors for the Glial-cell line-Derived Neurotrophic Factor (GDNF) family of ligands, and showed that Gas1 acts by inhibiting the intracellular signaling induced by GDNF. There are also reports indicating that Gas1 positively cooperates with Sonic Hedgehog (Shh) during embryonic development and in this paper we analyzed the potential interactions between Gas1 and Shh. We show that human gliomas do not express Shh, whereas GDNF and the molecular components necessary to transduce its signaling are present in human gliomas. Furthermore, the over-expression of Gas1 induces cell arrest, apoptosis and prevents the activation of Akt, a crucial mediator of survival and cellular proliferation pathways. In the present work, we present evidence demonstrating that Gas1 exerts its effects inhibiting cell growth and inducing apoptosis of glioma cells in the absence of Shh.

Displasia fibrosa poliostótica: caso clínico / Polyostotic fibrous dysplasia: a clinical case

La Displasia Fibrosa (DF) es una lesión ósea benigna, en la que el hueso sano es sustituido por tejido fibro-óseo. El diagnóstico se realiza mediante la clínica, diagnóstico por imágenes y anatomía patológica. El tratamiento es quirúrgico cuando existen casos con signos y/o síntomas. Se presenta el caso de una mujer de 20 años, que consulta por una expansión de su hemicara izquierda

Erroneous diagnoses in children referred with acute rheumatic fever.

We reviewed 53 patients referred to a pediatric rheumatology clinic in Asuncion, Paraguay. In 6 patients, a diagnosis of rheumatic fever was confirmed and in 47 patients other clinically significant diagnoses were made. Eighteen children had nonspecific findings and did not develop a rheumatologic condition on follow-up. Overdiagnosis of rheumatic fever can falsely inflate incidence and prevalence statistics and clinically significant diagnoses may be overlooked.