First report of Fusarium wilt of Cavendish bananas caused by Fusarium oxysporum f. sp. cubense Tropical Race 4 in Venezuela.

Fusarium wilt of banana (Musa spp.), caused by the soil-borne fungus Fusarium oxysporum f. sp. cubense (Foc), is a major constraint to banana production worldwide (Dita et al., 2018). A strain of Foc that affects Cavendish (AAA) bananas in the tropics, called Foc tropical race 4 (TR4; VCG 01213), is of particular concern. Foc TR4 was first detected in Malaysia and Indonesia around 1990 but was restricted to Southeast Asia and northern Australia until 2012. The fungus has since been reported from Africa, the Indian subcontinent, and the Middle East (Viljoen et al., 2020). Foc TR4 was detected in Colombia in 2019 and in Perú in 2021 (Reyes-Herrera et al., 2020). The incursions into Latin America and the Caribbean (LAC) triggered global concerns, as 75% of international export bananas are produced in the region. Banana production in Venezuela, however, is primarily intended for domestic consumption (Aular and Casares, 2011). In 2021 the country produced 533,190 metric tons of banana on an area of 35,896 ha, with an approximate yield of 14,853 kg/ha (FAOSTAT, 2023). In July 2022, severe leaf-yellowing, and wilting, along with internal vascular discoloration of the pseudostem, were noted in Cavendish banana plants cultivar 'Valery' in the states of Aragua (10°11'8″N; 67°34'51″W), Carabobo (10º14'24″N; 67º48'51″W), and Cojedes (9°37'44″N; 68°55'4″W). Necrotic strands from the pseudostems of diseased plants were collected for identification of the causal agent using DNA-based techniques, vegetative compatibility group (VCG) analysis and pathogenicity testing. The samples were first surface disinfected and plated onto potato dextrose agar medium. Single-spored isolates were identified as F. oxysporum based on cultural and morphological characteristics, including white colonies with purple centres, infrequent macroconidia, abundant microconidia on short monophialides, and terminal or intercalary chlamydospores (Leslie and Summerell, 2006). Foc TR4 was identified from five isolates by endpoint and quantitative-PCR using four different primer sets (Li et al. 2013; Dita et al. 2010; Aguayo et al. 2017; Matthews et al. 2020). The same isolates were identified as VCG 01213 by successfully pairing nitrate non-utilizing (nit-1) mutants of the unknown strains with Nit-M testers of Foc TR4 available at Stellenbosch University (Leslie and Summerell, 2006). For pathogenicity testing, 3-month-old Cavendish banana plants cultivar 'Williams' were inoculated with isolates from Venezuela grown on sterile millet seed (Viljoen et al., 2017). Plants developed typical Fusarium wilt symptoms 60 days after inoculation, including yellowing of leaves that progressed from the older to the younger leaves, wilting, and internal discoloration of the pseudostem. Koch's postulates were fulfilled by reisolating and identifying Foc TR4 from the plants by qPCR (Matthews et al., 2020). These results provide scientific proof of the presence of Foc TR4 in Venezuela. The Venezuelan Plant Protection Organization (INSAI) has declared Foc TR4 as a newly introduced pest (January 19, 2023), and infested banana fields were placed under quarantine. Comprehensive surveys are now conducted in all production areas in Venezuela to assess the presence and impact of Foc TR4, and information campaigns were started to make farmers aware of biosecurity protocols. Collaborative initiatives and coordinated actions among all stakeholders are needed to prevent the spread of Foc TR4 to other countries in Latin America, and to develop Foc TR4-resistant bananas (Figueiredo et al. 2023).

Comparación de cuatro técnicas quirúrgicas para el manejo de la espondilitis tuberculosa de la columna torácica en adultos.

OBJETIVO: Comparar la eficiencia de las cuatro técnicas quirúrgicas más utilizadas para el manejo de la espondilitis tuberculosa. MÉTODO: Estudio retrospectivo en el que se incluyeron pacientes adultos con diagnóstico confirmado de espondilitis tuberculosa, afectación de dos niveles vertebrales o menos y sin deformidad vertebral grave. Se recopilaron y revisaron los expedientes médicos, los estudios de imagen y los datos demográficos de los pacientes intervenidos para analizar retrospectivamente los resultados clínicos y funcionales de cada grupo. Las variables primarias fueron la erradicación de la infección, la fusión vertebral y las complicaciones. Entre las variables secundarias se estudiaron el sangrado intraoperatorio, la estancia hospitalaria y el tiempo quirúrgico. RESULTADOS: Entre los grupos analizados no hubo diferencias significativas (p ≥ 0.05) en la mayoría de las variables analizadas, pero sí (p ≤ 0.001) respecto al sangrado, el tiempo quirúrgico, la estancia intrahospitalaria y las complicaciones, a favor del abordaje posterior único. CONCLUSIONES: El abordaje posterior único logró una eficacia clínica similar a la del resto de los abordajes en términos de erradicación de la infección y fusión vertebral; sin embargo, se asoció a menores tiempo quirúrgico, sangrado, estancia hospitalaria y complicaciones. OBJECTIVE: To compare the efficiency of the 4 most used surgical techniques for the management of tuberculous spondylitis. METHOD: Retrospective study in which adult patients with a confirmed diagnosis of tuberculous spondylitis, involvement of two vertebral levels or less, and without severe vertebral deformity were included. The medical records, imaging studies, and demographic data of the operated patients were collected and reviewed to retrospectively analyze the clinical results of each group. The primary variables were cure of infection, spinal fusion, and complications. The secondary variables included intraoperative bleeding, hospital stay, and surgical time. RESULTS: There were no significant differences (p ≥ 0.05) in most of the variables analyzed, however, there were (p ≤ 0.001) regarding bleeding, surgical time, hospital stay and complications between the groups analyzed, with a lower result in all cases for the single posterior approach. CONCLUSIONS: The single posterior approach obtained a clinical efficacy similar to the rest of the approaches in terms of eradication of the infection and vertebral fusion, however, it was associated with less surgical invasion (surgical time and bleeding), a shorter hospital stay and complications.

Zika and dengue but not chikungunya are associated with Guillain-Barré syndrome in Mexico: A case-control study.

Background Zika, dengue and chikungunya viruses (ZIKV, CHIKV and DENV) are temporally associated with neurological diseases, such as Guillain-Barré syndrome (GBS). Because these three arboviruses coexist in Mexico, the frequency and severity of GBS could theoretically increase. This study aims to determine the association between these arboviruses and GBS in a Mexican population and to establish the clinical characteristics of the patients, including the severity of the infection. A case-control study was conducted (2016/07/01-2018/06/30) in Instituto Mexicano del Seguro Social (Mexican Social Security Institute) hospitals, using serum and urine samples that were collected to determine exposure to ZIKV, DENV, CHIKV by RT-qPCR and serology (IgM). For the categorical variables analysis, Pearson's χ2 or Fisher exact tests were used, and the Mann-Whitney U test for continuous variables. To determine the association of GBS and viral infection diagnosis through laboratory and symptomatology before admission, we calculated the odds ratio (OR) and 95% confidence intervals (95%CI) using a 2x2 contingency table. A p-value ≤ 0.05 was considered as significant. Ninety-seven GBS cases and 184 controls were included. The association of GBS with ZIKV acute infection (OR, 8.04; 95% CI, 0.89-73.01, p = 0.047), as well as laboratory evidence of ZIKV infection (OR, 16.45; 95% CI, 2.03-133.56; p = 0.001) or Flavivirus (ZIKV and DENV) infection (OR, 6.35; 95% CI, 1.99-20.28; p = 0.001) was observed. Cases of GBS associated with ZIKV demonstrated a greater impairment of functional status and a higher percentage of mechanical ventilation. According to laboratory results, an association between ZIKV or ZIKV and DENV infection in patients with GBS was found. Cases of GBS associated with ZIKV exhibited a more severe clinical picture. Cases with co-infection were not found.

Spray Drying of Blueberry Juice-Maltodextrin Mixtures: Evaluation of Processing Conditions on Content of Resveratrol.

Resveratrol is an antioxidant abundant in red fruits, and one of the most powerful inhibiting reactive oxygen species (ROS) and oxidative stress (OS) produced by human metabolism. The effect of the spray drying processing conditions of blueberry juice (BJ) and maltodextrin (MX) mixtures was studied on content and retention of resveratrol. Quantitatively, analysis of variance (ANOVA) showed that concentration of MX was the main variable influencing content of resveratrol. Response surface plots (RSP) confirmed the application limits of maltodextrins based on their molecular weight, where low molecular weight MXs showed a better performance as carrying agents. After qualitatively comparing results for resveratrol against those reported for a larger antioxidant molecule (quercetin 3-D-galactoside), it was observed a higher influence of the number of active sites available for the chemical interactions, instead of stearic hindrance effects.

Microbial diversity assessment of polychlorinated biphenyl-contaminated soils and the biostimulation and bioaugmentation processes.

The aim of this study was to know the biodiversity of total microorganisms contained in two polychlorinated biphenyl-contaminated aged soils and evaluate the strategies of bioaugmentation and biostimulation to biodegrade the biphenyls. Besides, the aerobic cultivable microorganisms were isolated and their capacity to biodegrade a commercial mixture of six congeners of biphenyls was evaluated. Biodiversity of contaminated soils was dominated by Actinobacteria (42.79%) and Firmicutes (42.32%) phyla, and others in smaller proportions such as Proteobacteria, Gemmatimonadetes, Chloroflexi, and Bacteroidetes. At the genus level, the majority of the population did not exceed 7% of relative abundance, including Bacillus, Achromobacter, Clostridium, and Pontibacter. Furthermore, four autochthonous bacterial cultures were possible isolates from the soils, which were identified by partial sequencing of the 16S rRNA gene, as Bacillus sp., Achromobacter sp., Pseudomonas stutzeri, and Bacillus subtilis, which were used for the bioaugmentation process. The bioaugmentation and biostimulation strategies achieved a biodegradation of about 60% of both soils after 8 weeks of the process; also, the four isolates were used as mixed culture to biodegrade a commercial mix of six polychlorinated biphenyl congeners; after 4 weeks of incubation, the concentration decreased from 0.5 mg/L to 0.23 mg/L.

Airborne Bacterial Diversity from the Low Atmosphere of Greater Mexico City.

Greater Mexico City is one of the largest urban centers in the world, with an estimated population by 2010 of more than 20 million inhabitants. In urban areas like this, biological material is present at all atmospheric levels including live bacteria. We sampled the low atmosphere in several surveys at different points by the gravity method on LB and blood agar media during winter, spring, summer, and autumn seasons in the years 2008, 2010, 2011, and 2012. The colonial phenotype on blood agar showed α, ß, and γ hemolytic activities among the live collected bacteria. Genomic DNA was extracted and convenient V3 hypervariable region libraries of 16S rDNA gene were high-throughput sequenced. From the data analysis, Firmicutes, Proteobacteria, and Actinobacteria were the more abundant phyla in all surveys, while the genera from the family Enterobacteriaceae, in addition to Bacillus spp., Pseudomonas spp., Acinetobacter spp., Erwinia spp., Gluconacetobacter spp., Proteus spp., Exiguobacterium spp., and Staphylococcus spp. were also abundant. From this study, we conclude that it is possible to detect live airborne nonspore-forming bacteria in the low atmosphere of GMC, associated to the microbial cloud of its inhabitants.

Edema agudo del pulmón en una gestante / Acute pulmonary edema in a pregnant woman

El edema agudo del pulmón es la acumulación de líquido en los alvéolos pulmonares que impide la normal oxigenación de la sangre y ocasiona hipoxia tisular. Se trata de una urgencia médica que debe identificarse y tratarse rápidamente para evitar una alta mortalidad materna y perinatal. Con el objetivo de describir las características de un caso de edema agudo del pulmón en una gestante, se presentó el tema, ocurrido en el Hospital Docente Ginecobstétrico de Guanabacoa en el mes de febrero del año 2014 y su posterior evolución. La paciente de 39 años de edad, sin antecedentes patológicos personales con historia obstétrica de G5 P1 A3, que a las 36 semanas comenzó con cifras de presión arterial elevadas y acude al cuerpo de guardia por cefalea e hipertensión arterial. A la postre inicia con disnea, tos y expectoración espumosa diagnosticándose un edema agudo del pulmón, para lo cual se aplica tratamiento médico y la interrupción del embarazo por cesárea, obteniéndose recién nacido de 2100g y Apgar 9-9. La evolución de la paciente fue satisfactoria y el recién nacido, aunque bajo peso, evolucionó satisfactorio. El edema agudo del pulmón es una complicación obstétrica en la que siempre debemos pensar.

Acute pulmonary edema is the accumulation of fluid in the alveoli that prevents normal oxygenation of the blood and causes tissue hypoxia. This is a medical emergency that should be promptly identified and treated to avoid high maternal and perinatal mortality. The issue was presented in order to describe the features of a case of acute lung edema in a pregnant woman, who was treated at the Gynecobstetric Teaching Hospital in Guanabacoa from February 2014 and her subsequent evolution. The 39-year-old woman, with no personal medical history and with G5P1A3 obstetric history, began to have high blood pressure at 36 weeks and she came to the emergency room due to headache and hypertension. Eventually she started with dyspnea, cough, and frothy expectoration. Acute lung edema was diagnosed. Medical treatment and pregnancy termination by caesarean section was applied, resulting in a 2100g newborn with Apgar 9-9. This patient´s evolution was satisfactory and the newborn, although underweight, evolved satisfactory. Acute pulmonary edema is an obstetric complication which we should always keep in mind.

Análisis genómico del resistoma de la cepa de Acinetobacter baumannii ABIBUN 107m multi-resistente y persistente en hospitales colombianos / Genomic analysis of the resistome of the strain of Acinetobacter baumannii ABIBUN 107m multi-resistant and persistent in colombian hospitals

Acinetobacter baumannii es una bacteria, causante de infecciones asociadas a la atención en salud como neumonía, septicemia, meningitis e infecciones urinarias entre otras. Se caracteriza por su capacidad para desarrollar y acumular rápidamente una gran variedad de mecanismos de resistencia a antibióticos. En esta investigación se realizó el análisis genómico de una cepa de A. baumannii ABIBUN 107m que forma parte de un clon persistente en hospitales colombianos, resistente a los antibióticos carbapenémicos (imipenem y meropenem), antibióticos de elección en el tratamiento infecciones causadas por este microorganismo. El genoma de esta bacteria fue secuenciado utilizando técnicas de alto rendimiento, ensamblado y anotado, obteniéndose un genoma constituido por 3954000 pb con 56 contigs; consta de 4256 genes con un tamaño promedio de 912 pb; 3796 CDS de los cuales por anotación 2884 se asignaron a COG; 57 tRNA y un porcentaje de GC de 38,74%. A. baumannii ABIBUN 107m es resistente a β-lactámicos, aminoglicósidos, quinolonas, tetraciclina, sulfonamida y colistina. En su genoma se localizaron genes asociados con el perfil de resistencia ya que presenta serin β-lactamasas (blaADC-38, blaOXA-64, blaOXA-23, bla ampC-like, bla amp(H)-like), metalo β-lactamasa_B; proteínas de unión a penicilina de elevada masa molecular, secuencias de inserción tipo ISAba1; mutaciones en los genes de DNA girasa y topoisomerasa IV subunidad A (gyrA y parC); enzimas modificadoras de aminoglicósidos (aphA-like, aad -like); cloranfenicol aciltransferasa (cat) y dehidropteroato sintasa (sul-1). Se identificaron genes pertenecientes a cinco familias de sistemas de eflujo (RND, MATE, MSF, ATP, SMR).

Acinetobacter baumannii is a bacterium causing health care associated infections such as pneumonia, septicemia, meningitis and urinary infections amongst others. It has great capacity to quickly develop and gather a big variety of drug resistance mechanisms. In this research, the genome of strain A. baumannii ABIBUN 107m was analyzed wich forms part of a persistent clon in Colombian hospitals and it’s also resistant to carbapenems (imipenem and meropenem), which are the election antibiotics for treatment of infections caused by this microorganism. The genome was sequenced using high performance technology, assembled and annotated. As a result, we obtained a 3954000 bp genome, with 56 contigs; 4256 genes with average size of 912 bp; 3796 CDS; 2884 were assigned to COG; 57 tRNA and GC percentage of 38,74%. The A. baumannii strain ABIBUN 107m, is resistant to the following antibiotic groups: β-lactams, aminoglycosides, quinolones, tetracycline, sulfonamide and colistin. Genes associated with this resistance profile were found in A. baumannii ABIBUN 107m genome serino β-lactamases (blaADC-38, blaOXA-64, blaOXA-23, bla ampC-like, bla amp(H)-like), metallo β-lactamase_B; High Molecular Mass penicillin binding proteins, ISAba1 type insertion sequences, mutations of DNA gyrase and topoisomerase IV subunit A (gyrA and parC); aminoglycoside modifying enzymes (aphA-like, aadA-like); choramphenicol acyltransferase (cat) and dehydropteroate synthase (sul-1). Genes belonging to five different efflux systems were identified (RND, MATE, MSF, ATP, SMR).

[Acute abdomen in patients with HIV/AIDS seen in a national hospital of Lima, Peru]. / Abdomen agudo en pacientes con VIH/SIDA atendidos en un hospital nacional de Lima, Perú

The aim of this study was to describe the features in the presentation and management of acute abdomen (AA) in patients with human immunodeficiency virus (HIV). We reviewed the medical records of 97 HIV patients who presented with AA and were seen in 2006-2011 at Cayetano Heredia National Hospital in Lima, Peru. 1.6% of immunosuppressed patients underwent surgery. Appendectomy was the most common surgical procedure (33.3%). Morbidity was 28.1% and postoperative mortality was 9.4%. Infection by mycobacterium tuberculosis was the most common cause of acute abdominal pain, at 26.8%. Data suggest that an early surgical decision for cases of AA in HIV patients may prevent significant morbidity and mortality.

Abdomen agudo en pacientes con VIH/Sida atendidos en un hospital nacional de Lima, Perú / Acute abdomen in patients with HIV/Aids seen in a national hospital of Lima, Peru

El objetivo del estudio fue describir las características en la presentación y el manejo del abdomen agudo (AA) en pacientes con el virus de la inmunodeficiencia humana (VIH). Se revisaron las historias clínicas de 97 pacientes portadores del VIH que cursaron con un cuadro de AA y que fueron atendidos en el período 2006-2011 en el Hospital Nacional Cayetano Heredia en Lima, Perú. Se encontró que el 1,6% de los pacientes inmunosuprimidos ingresó a sala de operaciones. La apendicectomía fue el procedimiento quirúrgico más frecuentemente (33,3%). La morbilidad fue de 28,1%, y la mortalidad posoperatoria de 9,4%. La infección por Mycobacterium tuberculosis fue la causa más común de dolor abdominal agudo con el 26,8%. Los datos sugieren que una pronta decisión quirúrgica frente a un cuadro compatible con AA en pacientes con VIH podría evitar una importante morbimortalidad...

The aim of this study was to describe the features in the presentation and management of acute abdomen (AA) in patients with human immunodeficiency virus (HIV). We reviewed the medical records of 97 HIV patients who presented with AA and were seen in 2006-2011 at Cayetano Heredia National Hospital in Lima, Peru. 1.6% of immunosuppressed patients underwent surgery. Appendectomy was the most common surgical procedure (33.3%). Morbidity was 28.1% and postoperative mortality was 9.4%. Infection by mycobacterium tuberculosis was the most common cause of acute abdominal pain, at 26.8%. Data suggest that an early surgical decision for cases of AA in HIV patients may prevent significant morbidity and mortality...

Human T-lymphotropic virus type 1 infection is frequent in rural communities of the southern Andes of Peru.

OBJECTIVES: To evaluate the presence of human T-lymphotropic virus type 1 (HTLV-1) infection in isolated rural communities in the southern Andes of Peru. METHODS: We conducted a cross-sectional study in five communities located in three provinces in Ayacucho, Peru. The five communities are located at >3000 meters above sea level and are mainly rural, and more than 85% of the population speaks Quechua. Volunteers aged 12 years and older were included. Clinical and epidemiological data were collected, along with a blood sample for serological testing. RESULTS: We included 397 participants; their median age was 41 years (interquartile range 31-57 years) and 69% were women. According to our definitions, 98% were of Quechua origin. HTLV-1 was diagnosed in 11 people: 0/164 in Cangallo, 3/154 (2%) in Vilcashuaman, and 8/79 (10%) in Parinacochas. There were no cases of HTLV-2. All the HTLV-1-positive participants were born in Ayacucho and were of Quechua origin; they ranged in age from 29 to 87 years (median 56 years) and 10/11 were women. Ten were apparently healthy, and one woman was diagnosed with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Three out of 11 had a family member with a lower limb impairment compatible with HAM/TSP. CONCLUSION: The fact that HTLV-1 infection was present in two out of three provinces suggests that HTLV-1 could be highly endemic in the southern Andes in the Quechua population.

Draft Genome Sequences of Multidrug-Resistant Acinetobacter sp. Strains from Colombian Hospitals.

The draft genome sequences of the strains Acinetobacter baumannii 107m, Acinetobacter nosocomialis 28F, and Acinetobacter pittii 42F, isolated from Colombian hospitals, are reported here. These isolates are causative of nosocomial infections and are classified as multidrug resistant, as they showed resistance to four different antibiotic groups.

Duration of anti-tuberculosis therapy and timing of antiretroviral therapy initiation: association with mortality in HIV-related tuberculosis.

BACKGROUND: Antiretroviral therapy (ART) decreases mortality risk in HIV-infected tuberculosis patients, but the effect of the duration of anti-tuberculosis therapy and timing of anti-tuberculosis therapy initiation in relation to ART initiation on mortality, is unclear. METHODS: We conducted a retrospective observational multi-center cohort study among HIV-infected persons concomitantly treated with Rifamycin-based anti-tuberculosis therapy and ART in Latin America. The study population included persons for whom 6 months of anti-tuberculosis therapy is recommended. RESULTS: Of 253 patients who met inclusion criteria, median CD4+ lymphocyte count at ART initiation was 64 cells/mm(3), 171 (68%) received >180 days of anti-tuberculosis therapy, 168 (66%) initiated anti-tuberculosis therapy before ART, and 43 (17%) died. In a multivariate Cox proportional hazards model that adjusted for CD4+ lymphocytes and HIV-1 RNA, tuberculosis diagnosed after ART initiation was associated with an increased risk of death compared to tuberculosis diagnosis before ART initiation (HR 2.40; 95% CI 1.15, 5.02; P = 0.02). In a separate model among patients surviving >6 months after tuberculosis diagnosis, after adjusting for CD4+ lymphocytes, HIV-1 RNA, and timing of ART initiation relative to tuberculosis diagnosis, receipt of >6 months of anti-tuberculosis therapy was associated with a decreased risk of death (HR 0.23; 95% CI 0.08, 0.66; P=0.007). CONCLUSIONS: The increased risk of death among persons diagnosed with tuberculosis after ART initiation highlights the importance of screening for tuberculosis before ART initiation. The decreased risk of death among persons receiving > 6 months of anti-tuberculosis therapy suggests that current anti-tuberculosis treatment duration guidelines should be re-evaluated.

CD4+ T cell subsets and Tax expression in HTLV-1 associated diseases.

Human T lymphotropic virus type 1 (HTLV-1) infection displays variable clinical manifestations. These include inflammatory diseases such as HTLV-1 associated myelopathy (HAM) or immunosuppressive conditions such as Strongyloides stercoralis hyperinfection. The viral protein, Tax causes activation and proliferation of T cells. We hypothesize that the expression of Tax in T cell subsets characterizes the clinical manifestations of HTLV-1. To test this hypothesis, we measured T helper 1 effector cells and regulatory T cells (Tregs) among Tax expressing lymphocytes from peripheral blood mononuclear cells (PBMCs) of 32 HTLV-1 infected patients with HAM, with S. stercoralis co-infection or with asymptomatic infection. We observed increased ratios of Th1/Treg among Tax expressing lymphocytes in HAM patients. These data suggest that the expression of Tax among the different target cells may explain the variable presentation of HTLV-1.

[Risk factors associated with virologic failure in HIV- infected patients receiving antiretroviral therapy at a public hospital in Peru]. / Factores asociados a falla virológica en pacientes infectados con VIH que reciben terapia anti-retroviral en un hospital público del Perú

OBJECTIVE: To describe clinical and biological characteristics of subjects with virologic failure who participated in the sexually transmitted diseases HIV/AIDS National Program from a Peruvian public hospital. MATERIALS AND METHODS: An exploratory descriptive study was performed with data from subjects older than 18 who started high activity antiretroviral therapy (HAART) between May 2004 and December 2009 and who had a viral load control after 24 weeks of HAART. Virologic failure was defined as a viral load value above 1000 copies/mL on follow up after 24 weeks on HAART. RESULTS: Of 1478 records of patients on HAART analyzed, the median age was 35 years [IQR, 29-41] and 69.6% were male. Also, virologic failure occurred in 24% and 3.7% died. Of subjects with virologic failure, 9.5% died. On multivariate analysis, age, history of antiretroviral use before starting HAART, change of antiretroviral therapy due to toxicity, opportunistic infections during HAART, level of CD4 + lymphocytes below 100 cells/ml at start of HAART, adherence and clinical stage were independently associated with virologic failure. In the group of patient with no history of antiretroviral use before starting HAART, age, opportunistic infections during HAART were associated with virologic failure. CONCLUSION: This study identified factors associated with virologic failure. Further studies are needed to evaluate whether the use of these factors can help to identify prospectively patients at high risk of failure, and to design interventions aimed to reduce this risk.

Factores asociados a falla virológica en pacientes infectados con VIH que reciben terapia anti-retroviral en un hospital público del Perú / Risk factors associated with virologic failure in HIV- infected patients receiving antiretroviral therapy at a public hospital in Peru

Objective: To describe clinical and biological characteristics of subjects with virologic failure who participated in the sexually transmitted diseases HIV/AIDS National Program from a Peruvian public hospital. Materials and Methods: An exploratory descriptive study was performed with data from subjects older than 18 who started high activity antiretroviral therapy (HAART) between May 2004 and December 2009 and who had a viral load control after 24 weeks of HAART. Virologic failure was defined as a viral load value above 1000 copies/mL on follow up after 24 weeks on HAART. Results: Of 1478 records of patients on HAART analyzed, the median age was 35 years [IQR, 29-41] and 69.6% were male. Also, virologic failure occurred in 24% and 3.7% died. Of subjects with virologic failure, 9.5% died. On multivariate analysis, age, history of antiretroviral use before starting HAART, change of antiretroviral therapy due to toxicity, opportunistic infections during HAART, level of CD4 + lymphocytes below 100 cells/ml at start of HAART, adherence and clinical stage were independently associated with virologic failure. In the group of patient with no history of antiretroviral use before starting HAART, age, opportunistic infections during HAART were associated with virologic failure. Conclusion: This study identified factors associated with virologic failure. Further studies are needed to evaluate whether the use of these factors can help to identify prospectively patients at high risk of failure, and to design interventions aimed to reduce this risk.

Objetivo: Describir las características clínicas y biológicas de sujetos con falla virológica participantes de la Estrategia Sanitaria de Prevención y Control de Infecciones de Transmisión Sexual (ITS) VIH/SIDA de un hospital público del Perú. Materiales y Métodos: Se realizó un estudio descriptivo exploratorio con datos de sujetos mayores de 18 años que iniciaron terapia anti-retroviral de gran actividad (TAlRGA) entre mayo de 2004 y diciembre de 2009 con al menos un control de carga viral luego de 24 semanas de TARGA. Falla virológica fue definida como un valor de carga viral superior a 1.000 copias/mL luego de 24 semanas de TARGA. Resultados: Se analizaron 1.478 registros de sujetos en TAlRGA: la mediana de edad fue 35 años (rango intercuartíl [RIQ] 2941) y 69,6% fueron varones. Se encontró falla virológica en 24%. La proporción de fallecidos fue superior en el grupo con falla virológica (9,5%) respecto al grupo sin falla virológica (1,8%). En el análisis multivariado, la edad, antecedentes de uso de anti-retrovirales antes de iniciar TARGA, cambio de anti-retrovirales por toxicidad, infecciones oportunistas durante TARGA, nivel de linfocitos CD4+ inferior a 100 céls/mL al año de inicio de TARGA, adherencia y estadio clínico se asociaron independientemente a falla virológica. En un sub-análisis limitado al grupo de pacientes sin antecedente de uso de anti-retrovirales antes del inicio de la TARGA, se encontró que adherencia, edad y aparición de infecciones oportunistas tuvieron asociación con falla virológica. Conclusión: Este estudio identificó factores asociados a falla virológica. Se necesitan estudios adicionales para evaluar si el uso de estos factores ayudaría a identificar prospectivamente pacientes en riesgo de fallar y al diseño de intervenciones para disminuir este riesgo.

Association between onychodystrophy and human T-lymphotropic virus type 1 infection.

OBJECTIVE: To assess the association between human T-lymphotropic virus type 1 (HTLV-1) infection and onychodystrophy. METHODS: This was a cross-sectional study. At our institute, we provide HTLV-1 testing to relatives of HTLV-1-infected people and patients with suspected HTLV-1-associated diseases. The diagnosis of onychodystrophy was made clinically before testing for HTLV-1; the number and distribution of affected nails was registered. We assessed the association between onychodystrophy and HTLV-1 through bi- and multivariable analyses. Logistic regression was used to adjust for age, sex, and indication for HTLV-1 testing, using six affected nails (90(th) percentile) as the cut-off point. RESULTS: Between April 2006 and March 2008, we included 893 subjects; their mean age was 38 years (standard deviation 19 years), and 527 (59%) were women. Onychodystrophy of one or more nails was observed in 323 participants (36%), and 236 subjects (26%) were HTLV-1-positive. The median number of affected nails was higher in HTLV-1-positive than in HTLV-1-negative subjects (Mann-Whitney test, p < 0.001). Thirty-eight of 97 subjects with six or more affected nails (39%) were HTLV-1-infected, compared to 198 of 796 subjects with fewer than six affected nails (25%) (crude OR 1.9, 95% confidence interval (CI) 1.2-3.1; p = 0.003). This association remained significant in the multiple logistic regression model (adjusted OR 2.0, 95% CI 1.2-3.3; p = 0.005). CONCLUSIONS: There is an independent association between HTLV-1 infection and onychodystrophy. Patients with an HTLV-1 infection might have a higher risk for onychomycosis given the abnormal nail plate and a decreased T-cell-mediated immunologic response.

Possible implication of NFKB1A and NKG2D genes in susceptibility to HTLV-1-associated myelopathy/tropical spastic paraparesis in Peruvian patients infected with HTLV-1.

The human T-cell lymphotropic virus type 1 (HTLV-1) is the etiological agent of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), a progressive disease causing paraparesis of the lower limbs. Only a minority of persons infected with HTLV-1 develop HAM/TSP. Universal susceptibility factors for HAM/TSP are not known. The viral genotype is similar in asymptomatic carriers and HAM/TSP patients. High proviral load has been associated consistently with HAM/TSP, but this factor does not explain fully the presence of disease in HTLV-1-infected subjects. Most likely, host genetic factors will play an important role in HAM/TSP development. A two-stage case-control study was carried out to evaluate the association between HAM/TSP and candidate single nucleotide polymorphisms (SNPs) from 45 genes in addition to six human leukocyte antigen (HLA) alleles. Ancestry-informative markers were used to correct for population stratification. Several SNPs belonging to NFKB1A and NKG2D showed a trend of association in both stages. The fact that the direction of the association observed in the first stage was the same in the second stage suggests that NFKB1A and NKG2D may be implicated in the development of HAM/TSP. Further replication studies in independent HTLV-1 patient groups should validate further these associations.

[Distribution of extended spectrum ß-lactamases-codifying genes in Klebsiella pneumoniae isolates from hospitals of Bogota, D.C., Colombia]. / Distribución de genes codificadores de ß-lactamasas de espectro extendido en aislamientos de Klebsiella pneumoniae de hospitales de Bogotá, D.C., Colombia.

INTRODUCTION: Extended spectrum ß-lactamases (ESBL) are the most widely distributed enzymes in Enterobacteriaceae of Latin America and are key enzymes in resistance to antibiotics in common use. However, in Colombia, little information is available concerning the identity of genes coding for these enzymes in Klebsiella pneumoniae. OBJECTIVE: The bla genes were identified in K. pneumoniae isolated from hospitals in Bogotá D.C., Colombia. Materials and methods. One hundred seventy-seven isolates of ESBL producers were collected from 10 hospitals in Bogota between 2003 and 2005. Antibiotic susceptibility was determined by disk diffusion, and the number of ß-lactamases in each isolate was assessed by isoelectric focusing. blaCTX-M, blaSHV and blaTEM were identified by PCR and subsequent sequencing. RESULTS: Besides, the resitenance to third generation cephalosporins, 44.7 % and 49.7 % were resistant to amikacyn and thrimetoprim-sulaphametoxazole respectively. Lower resistance rates to other antibiotics were observed as well. An average of three ß-lactamases were detected by isoelectric focusing, and the genes blaCTX-M-12 (56.0%) and blaSHV-12 (33.3%) were the most prevalent. blaSHV-5 (11.8%), blaCTX-M-1-1 (4.0%), blaSHV-27 (2.8%), blaSHV-2 (2.8%), blaCTX-M-1-2 (1.7%) and blaCTX-M-1-15 (0.6%) were present in smaller percentages. In addition, three genes were identified that coded for narrow spectrum ß-lactamases. CONCLUSION: Eleven bla genes were identified, eight of which were ESBL-coding. The diversity of the bla genes suggested a continuing exposure of K. pneumoniae to strong antibiotic pressures in Bogota hospitals.

Infección por HTLV-1 y HIV en pacientes con herpes zoster en Perú / HTLV-1 and HIV infection among patients with herpes zoster in Perú

Objetivos: Determinar la frecuencia de infección por el virus linfotrópico humano tipo 1 (HTLV-1) y VIH en pacientes con herpes zoster. Material y métodos: Estudio prospectivo observacional realizado entre agosto de 2005 y agosto de 2006. Se incluyeron pacientes adultos con diagnóstico de herpes zoster atendidos en los diferentes servicios del Hospital Nacional Cayetano Heredia. Un cuestionario de características clínicas y factores de riesgo asociados con infección por HTLV-1 y VIH fue completado previo a la toma de muestra. Se excluyeron los pacientes con resultados positivos previos para HTLV-1 y HIV. Resultados: Se incluyeron 44 pacientes, la edad promedio fue 48,1 ± 19,5; 24/44 (55%) fueron mujeres. Infección solo por VIH se encontró en 4/44 (9%) pacientes, todos menores de 35 años, mientras que infección solo por HTLV-1 se encontró en 2/44 (5%) pacientes, todas mujeres mayores de 50 años. Un caso de infección dual fue encontrado en una mujer de 56 años. La tasa de infección por HTLV-1 fue 25% (3/12) en mujeres mayores de 50 años con compromiso de múltiples dermatomas. Conclusiones: En nuestro escenario, la infección por HTLV-1 es ligeramente mas frecuente en mujeres mayores de 50 años con herpes zoster. Por ello, el despistaje de HTLV-1 debe ser recomendado en este grupo etario, mientras que el despistaje de VIH es aún particularmente importante en pacientes jóvenes.(AU).

Objectives: To determine the frequency of infection with human T-cell lymphotropic virus type 1 (HTLV-1) and VIH among patients with herpes zoster. Material and methods: Observational prospective study between august 2005 and august 2006. We included adult patients with diagnosis of herpes zoster attending different services at the HNCH. A questionnaire of clinical characteristics and risk factors associated with HTLV-1 and VIH infection was filled prior to blood testing. Patients with previous positive results of HTLV-1 or VIH were not included. Results: 44 patients were included. Age was 48,1 ± 19,5 years, and 24/44 (55%) were women. Isolated VIH infection was diagnosed in 4/44 (9%) patients, all of them under 35 years, whereas isolated HTLV-1 infection was diagnosed in 2/44 (5%) patients, all women over 50 years. A case of dual infection was found in a 56 year old woman. Rate of HTLV-1 infection was 25% (3/12) among women over 50 years with multi-dermatomic involvement. Conclusions: In our setting, HTLV-1 infection is rather frequent among women over the age of 50 presenting with herpes zoster. Thus, HTLV-1 screening should be recommended in this age group, whereas VIH testing is still particularly important among younger patients.(AU).