Neuroinfección por Vibrio cholerae no O1/ no O139 secundaria a la derivación ventriculoperitoneal. Reporte de caso / Vibrio cholerae no o1/ no 0139 neuroinfection secondary to ventriculoperitoneal shunt: case report

RESUMEN La infección de la derivación ventriculoperitoneal es una de las complicaciones más frecuentes en este procedimiento. Vibrio cholerae O1 y O139 es una bacteria gram negativa conocida principalmente por ser la responsable del cólera epidémico. No obstante, existen serotipos no O1/ no O139 capaces de causar afecciones extraintestinales, entre ellas se han reportado casos de neuroinfección. Presentamos el caso de una paciente con 9 meses de edad que posterior a la colocación de una derivación ventriculoperitoneal como tratamiento de hidrocefalia obstructiva congénita, presentó un cuadro de neuroinfección y el síndrome de malfunción valvular; se pudo aislar la Vibrio cholerae no O1/ no O139 en el líquido cefalorraquídeo y en la punta del catéter. Es el primer reporte en la literatura en la que se aísla la Vibrio cholerae no O1/ no O139 en líquido cefalorraquídeo secundario a infección de una derivación ventriculoperitoneal.

SUMMARY The infection of the ventriculoperitoneal shunt is one of most frequent complications for this procedure. Vibrio cholera O1 and O139 is a Gram negative bacteria known mainly for being responsible of the epidemic cholera, however, there are serotypes no O1/ no O139 capable of causing extraintestinal conditions, among them neuroinfection cases have been reported. We present the case of a 9 months old patient who after the placement of a ventriculoperitoneal shunt as treatment for connate obstructive hydrocephalus, presents a neuroinfection condition and valve malfunction syndrome, being able to isolate the Vibrio cholerae no O1/ no O139 in the cerebrospinal fluid and the tip of the catheter. It is the first report in the literature in which the Vibrio cholerae no O1/ no O139 is isolated in the cerebrospinal liquid secondary to an infection from a ventriculoperitoneal shunt.

Elimination of onchocerciasis from Colombia: first proof of concept of river blindness elimination in the world.

BACKGROUND: Onchocerciasis is a chronic parasitic infection originally endemic in 13 discrete regional foci distributed among six countries of Latin America (Brazil, Colombia, Ecuador, Guatemala, Mexico and Venezuela). In Colombia, this disease was discovered in 1965 in the Pacific Coast of the country. The National Onchocerciasis Elimination Program was established in 1993 with the aim of eliminating disease morbidity and infection transmission. In 2013, the World Health Organization (WHO) verified Colombia as free of onchocerciasis, becoming the first country in the world to reach such a goal. This report provides the empirical evidence of the elimination of Onchocerca volvulus transmission by Simulium exiguum (s.l.) after 12 years of 6-monthly mass drug administration of Mectizan® (ivermectin) to all the eligible residents living in this endemic area. METHODS: From 1996 onwards, a biannual community-based mass ivermectin administration programme was implemented, complemented by health education and community participation. In-depth parasitological, serological and entomological surveys were conducted periodically between 1998 and 2007 to evaluate the impact of ivermectin treatment according to the 2001 WHO guidelines. When the interruption of parasite transmission was demonstrated, the drug distribution ceased and a three-year post-treatment surveillance (PTS) period (2008-2010) was initiated. RESULTS: After 23 rounds of treatment, parasitological and ophthalmological assessments showed absence of microfilariae in skin and anterior chamber of the eyes. Serological tests proved lack of antibodies against O. volvulus in children under 10 years-old. A total of 10,500 S. exiguum flies tested by PCR had no L3 infection (infectivity rate = 0.0095%; 95% CI: 0.0029-0.049) during 2004, indicating interruption of parasite transmission. However, biannual ivermectin treatments continued until 2007 followed by a 3-year PTS period at the end of which 13,481 flies were analyzed and no infective flies were found (infectivity rate = 0%; 95% CI: 0.0-0.014). CONCLUSIONS: These results fulfilled the WHO criteria for onchocerciasis elimination. Consequently, in 2013 Colombia was verified as free of onchocerciasis, demonstrating that elimination of this neglected tropical disease is an achievable goal and paving the way for an elimination agenda to be followed by other endemic countries in Latin America and Africa.

A Knowledge, Attitudes and Practices Survey Conducted Three Years after Halting Ivermectin Mass Treatment for Onchocerciasis in Guatemala.

BACKGROUND: Mass drug administration (MDA) with ivermectin for onchocerciasis was provided in Guatemala's Central Endemic Zone (CEZ) over a 24 year period (1988-2011). Elimination of Onchocerca volvulus transmission was declared in 2015 after a three year post MDA surveillance period (2012-2014) showed no evidence of recrudescence. The purpose of the present study was to evaluate the knowledge, attitudes and practices (KAP) towards onchocerciasis and ivermectin among residents in the post endemic CEZ. A major interest in this study was to determine what community residents thought about the end of the ivermectin MDA program. METHODOLOGY/PRINCIPAL FINDINGS: A total of 148 interviews were conducted in November 2014 in four formerly hyperendemic communities using a standard questionnaire on smart phones. The majority (69%) of respondents knew that the MDA program had ended because the disease was no longer present in their communities, but a slight majority (53%) was personally unsure that onchocerciasis had really been eliminated. Sixty-three percent wanted to continue to receive ivermectin because of this uncertainty, or because ivermectin is effective against intestinal worms. Eighty-nine percent of respondents said that they would seek medical attention immediately if a family member had symptoms of onchocerciasis (especially the presence of a nodule), which is a finding very important for ongoing surveillance. CONCLUSIONS/SIGNIFICANCE: Many respondents wanted to continue receive ivermectin and more than half did not believe onchocerciasis had been eliminated. The ministry of health outreach services should be prepared to address ongoing concerns about onchocerciasis in the post endemic CEZ.

Evidence of suppression of onchocerciasis transmission in the Venezuelan Amazonian focus.

BACKGROUND: The World Health Organization (WHO) has set goals for onchocerciasis elimination in Latin America by 2015. Most of the six previously endemic countries are attaining this goal by implementing twice a year (and in some foci, quarterly) mass ivermectin (Mectizan®) distribution. Elimination of transmission has been verified in Colombia, Ecuador and Mexico. Challenges remain in the Amazonian focus straddling Venezuela and Brazil, where the disease affects the hard-to-reach Yanomami indigenous population. We provide evidence of suppression of Onchocerca volvulus transmission by Simulium guianense s.l. in 16 previously hyperendemic Yanomami communities in southern Venezuela after 15 years of 6-monthly and 5 years of 3-monthly mass ivermectin treatment. METHODS: Baseline and monitoring and evaluation parasitological, ophthalmological, entomological and serological surveys were conducted in selected sentinel and extra-sentinel communities of the focus throughout the implementation of the programme. RESULTS: From 2010 to 2012-2015, clinico-parasitological surveys indicate a substantial decrease in skin microfilarial prevalence and intensity of infection; accompanied by no evidence (or very low prevalence and intensity) of ocular microfilariae in the examined population. Of a total of 51,341 S. guianense flies tested by PCR none had L3 infection (heads only). Prevalence of infective flies and seasonal transmission potentials in 2012-2013 were, respectively, under 1% and 20 L3/person/transmission season. Serology in children aged 1-10 years demonstrated that although 26 out of 396 (7%) individuals still had Ov-16 antibodies, only 4/218 (2%) seropositives were aged 1-5 years. CONCLUSIONS: We report evidence of recent transmission and morbidity suppression in some communities of the focus representing 75% of the Yanomami population and 70% of all known communities. We conclude that onchocerciasis transmission could be feasibly interrupted in the Venezuelan Amazonian focus.

One Hundred Years After Its Discovery in Guatemala by Rodolfo Robles, Onchocerca volvulus Transmission Has Been Eliminated from the Central Endemic Zone.

We report the elimination of Onchocerca volvulus transmission from the Central Endemic Zone (CEZ) of onchocerciasis in Guatemala, the largest focus of this disease in the Americas and the first to be discovered in this hemisphere by Rodolfo Robles Valverde in 1915. Mass drug administration (MDA) with ivermectin was launched in 1988, with semiannual MDA coverage reaching at least 85% of the eligible population in > 95% of treatment rounds during the 12-year period, 2000-2011. Serial parasitological testing to monitor MDA impact in sentinel villages showed a decrease in microfilaria skin prevalence from 70% to 0%, and polymerase chain reaction (PCR)-based entomological assessments of the principal vector Simulium ochraceum s.l. showed transmission interruption by 2007. These assessments, together with a 2010 serological survey in children 9-69 months of age that showed Ov16 IgG4 antibody prevalence to be < 0.1%, meeting World Health Organization (WHO) guidelines for stopping MDA, and treatment was halted after 2011. After 3 years an entomological assessment showed no evidence of vector infection or recrudescence of transmission. In 2015, 100 years after the discovery of its presence, the Ministry of Health of Guatemala declared onchocerciasis transmission as having been eliminated from the CEZ.

Exposure of seasonal migrant workers to Onchocerca volvulus on coffee plantations in Guatemala.

Onchocerciasis (river blindness), which is close to being eliminated from Guatemala through semiannual administration of ivermectin, is still transmitted in one area of the country that coincidentally receives an annual influx of migrant workers to harvest coffee. Migrant workers generally are not included in semiannual ivermectin treatments, but if infected could serve as a reservoir. We report on two studies undertaken to measure the exposure to onchocerciasis (presence of IgG4 antibodies to a recombinant Onchocerca volvulus antigen, OV-16) among migrant workers. During two coffee harvest seasons, 170 migrant workers with a history of working in the disease-endemic area were tested and 1 (0.6%, 95% confidence interval = 0-3.2%) was seropositive. This low rate of exposure in migrant workers indicates that they are unlikely to play a significant role in transmission of onchocerciasis and may indicate that transmission in the last remaining disease-endemic area of Guatemala is decreasing significantly.

Posterior placement of an expandable cage for lumbar vertebral body replacement in oncologic surgery by posterior simple approach: technical note.

STUDY DESIGN: Technical note. OBJECTIVE: To illustrate that posterior placement of expandable cages could be made without any different devices that the ones ordinarily for the procedure. An example case is described. Decompression techniques for vertebral body destruction by tumors and invasion of the spinal canal could need a second surgery for the resection of the tumor and stabilization of the anterior column, which could add morbidity for the patient. The possibility to perform a posterior decompression and anterior reconstruction at the same surgical approach represents an attractive option. SUMMARY OF BACKGROUND DATA: Reconstruction of the anterior column from a posterior approach could be easier for the patient and for the surgeon with this technique. METHODS: A 17-year-old woman with a benign fibrous histiocytoma in L5 with severe bone destruction, anterior and posterior underwent posterior decompression, vertebral body replacement at the same approach with an expandable cage and L4 S1 pedicle screw fixation in a single stage surgery. This technique consist the resection of the tumor was performed under microscopic view and the vertebral body defect in L5 was resized with a high speed drill to allow the placement of the cage. Over the shoulder of the L5 root and with a gentle traction, the expandable cage was placed in situ with the help of 4 silk threads attached to the heads of the cage, passed ventral and lateral to the dural sac, and roots to facilitate its manipulation and rotation similarly to the Hunt-Shen-Arlet technique. (Hunt T, Shen FH, Arlet V. Expandable cage placement via a posterolateral approach in lumbar spine reconstructions. Technical note. J Neurosurg Spine 2006;5:271-4.) Once the expandable cage is in situ, the headpieces of the parallel distractor are placed over the cage, the upper one over the shoulder of the L5 root under gentle traction on the dural sac, and the lower on over the shoulder of the S1 root under gentle traction too. The distractor was used to rotate the cage at its final position and distracted in situ; the current system instruments provided by the manufacturer were used during the procedure. Then apedicular screw fixation was performed between L4 and S1, and fusion was completed with synthetic bone graft substitute (beta-tricalcium phosphate). RESULTS: Using a modification of the Hunt-Shen-Arlet technique, without the use of a special distraction devices, the expandable cage was successfully implanted and expanded in situ. The clinical result was excellent. CONCLUSION: A surgical technique for the replacement of vertebral body by posterior approach is presented. This technique could be used in surgery of vertebral body tumors of the lumbar spine, in a single surgical approach.

Fijación de la columna cervical subaxial con tornillos pediculares: informe de dos casos y revisión de la literatura / Subaxial transpedicular screw fixation on cervical vertebrae

La fijación cervical con tornillos pediculares es una técnica quirúrgica de reciente aparición que fue descrita inicialmente para el manejo de lesiones traumáticas, pero que actualmente se utiliza incluso en tumores de columna y lesiones degenerativas. El autor presenta su experiencia con dos casos de lesión traumática de columna cervical tratados quirúrgicamente con fijación con tornillos pediculares cervicales en la columna subaxial. Se revisa la literatura disponible de estudios antropométricos, técnicas quirúrgicas, ventajas biomecánicas y complicaciones esperables con esta técnica. La fijación cervical con tornillos pediculares para lesiones traumáticas y no traumáticas es una opción quirúrgica demandante, con claras ventajas biomecánicas y riesgos establecidos, que debe ser tenida en cuenta en casos con indicación de doble abordaje anterior y posterior y fijaciones extensas.

A multifaceted intervention to prevent American cutaneous leishmaniasis in Colombia: results of a group-randomized trial / Prevención de leishmaniasis cutánea americana en Colombia mediante una intervención múltiple: resultados de un ensayo de grupos aleatorios

Introducción. La leishmaniasis cutánea americana es endémica en Colombia, donde cada año son notificados aproximadamente 6000 casos nuevos. En la actualidad las medidas de prevención y control están limitadas al diagnóstico y tratamiento de los casos. Objetivo. Evaluar la eficacia de una intervención múltiple para prevenir la transmisión de Leishmania en el foco endémico de Tumaco, costa Pacífica de Colombia. Materiales y métodos. Se realizó un ensayo de grupos aleatorizados. Veinte veredas fueron pareadas según prevalencia de Leishmania, habitantes y participación comunitaria y luego asignadas aleatoriamente a intervención o control. La intervención incluyó toldillos impregnados con deltametrina, repelente (N, N-dietil-m-toluamida 20 por ciento y Permetrina 0,5 por ciento), modificación de lugares de reposo para los vectores y educación. Al cabo de un año se comparó la incidencia de infección y enfermedad producida por Leishmania en los dos grupos, se monitorearon la adherencia a la intervención y la aparición de efectos adversos. Los resultados finales fueron ajustados por el efecto de correlación intra-grupo. Resultados. Se presentaron 10 casos de leishmaniasis cutánea americana en el grupo que recibió la intervención y 23 en el grupo control, OR=0,42, IC95 por ciento 0,14-1,26. La intervención tuvo un mayor efecto en los niños menores de 10 años, en aquellos que residían en la periferia de la vereda y en veredas con una prevalencia de infección en niños pequeños mayor del 1 por ciento. Se reportaron eventos adversos leves asociados con el uso de los toldillos impregnados y el repelente en 2 por ciento de los participantes. Conclusión. Los casos nuevos de Leishmaniasis cutánea americana se redujeron en un 58 por ciento en el grupo que recibió la intervención. Sin embargo, el número pequeño de casos hace que la estimación de la medida de efecto sea imprecisa y no nos permite afirmar que la intervención tiene un efecto protector. Poblaciones específicas podr...

Introduction. American cutaneous leishmaniasis is endemic in Colombia, where approximately 6.000 new cases are reported every year. Current prevention and control measures are restricted to the diagnosis and treatment of cases. Objective. To evaluate the efficacy of a multifaceted intervention to prevent the transmission of Leishmania in the endemic focus of Tumaco, on the Pacific Coast of Colombia. Materials and methods. A group-randomized trial was conducted. Twenty villages were matched according to prevalence of Leishmania infection, number of inhabitants and level of community participation, and then randomly assigned to intervention or control. The intervention included deltamethrin-impregnated bednets, repellent (20% diethyltoluamide and 0.5% permethrin), modification of sand fly resting sites, and health education. Villages were under surveillance for one year and the use of the intervention measures monitored. The incidence of American cutaneous leishmaniasis and Leishmania infection in the two groups were compared, adherence to the intervention and adverse events were monitored, and the results were adjusted for village intraclass correlation. Results. Ten cases of American cutaneous leishmaniasis were confirmed in the intervention and 23 in the control group, OR = 0.42, 95% CI 0.14-1.26. The intervention had a greater effect in children < 10 years old, in people living on the periphery of the village and in villages with a prevalence of infection in small children > 1%. Adverse events associated with the use of the bednets and the repellent were reported in 2% of the participants and were always mild. Conclusion. Incident cases of American cutaneous leishmaniasis were reduced by 58% in the intervention group. However, the small number of cases renders the effect estimate imprecise and precludes us to claim a protective effect for the intervention. Specific populations could be the targets of simpler and more cost-effective interventions in the future.

A multifaceted intervention to prevent American cutaneous leishmaniasis in Colombia: results of a group-randomized trial.

INTRODUCTION: American cutaneous leishmaniasis is endemic in Colombia, where approximately 6.000 new cases are reported every year. Current prevention and control measures are restricted to the diagnosis and treatment of cases. OBJECTIVE: To evaluate the efficacy of a multifaceted intervention to prevent the transmission of Leishmania in the endemic focus of Tumaco, on the Pacific Coast of Colombia. MATERIALS AND METHODS: A group-randomized trial was conducted. Twenty villages were matched according to prevalence of Leishmania infection, number of inhabitants and level of community participation, and then randomly assigned to intervention or control. The intervention included deltamethrin-impregnated bednets, repellent (20% diethyltoluamide and 0.5% permethrin), modification of sand fly resting sites, and health education. Villages were under surveillance for one year and the use of the intervention measures monitored. The incidence of American cutaneous leishmaniasis and Leishmania infection in the two groups were compared, adherence to the intervention and adverse events were monitored, and the results were adjusted for village intraclass correlation. RESULTS: Ten cases of American cutaneous leishmaniasis were confirmed in the intervention and 23 in the control group, OR = 0.42, 95% CI 0.14-1.26. The intervention had a greater effect in children < 10 years old, in people living on the periphery of the village and in villages with a prevalence of infection in small children > 1%. Adverse events associated with the use of the bednets and the repellent were reported in 2% of the participants and were always mild. CONCLUSION: Incident cases of American cutaneous leishmaniasis were reduced by 58% in the intervention group. However, the small number of cases renders the effect estimate imprecise and precludes us to claim a protective effect for the intervention. Specific populations could be the targets of simpler and more cost-effective interventions in the future.

Death caused by hyperglycemic hyperosmolar state at the onset of type 2 diabetes.

Seven obese African American youth were considered to have died from diabetic ketoacidosis (DKA) due to type 1 diabetes, despite meeting the criteria for hyperglycemic hyperosmolar state and not for DKA. All had previously unrecognized type 2 diabetes, and death may have been prevented with earlier diagnosis or treatment.

Legislación sanitaria en México (1797-1810) / Health legislation in Mexico (1797-1810)

A finales del periodo colonial, se realizaron un conjunto de acciones para mejorar la salud y el bienestar de los habitantes de la Nueva España. Las autoridades metropolitanas y virreinales dictaron diversas disposiciones encaminadas a mejorar las condiciones de vida de la población. Propone analisar la legislación emitida en materia de sanidad entre los años de 1797 a 1810, se pretende poner de manifesto los rasgos más importantes de dicha legislación, los setores a los que va dirigida, así como los principales intereses políticos involucrados en ella. (AU)