Molecular Characterization of Leptospira Species among Patients with Acute Undifferentiated Febrile Illness from the Municipality of Villeta, Colombia.

Leptospira is a bacterial genus that includes several pathogenic species related to leptospirosis. In Colombia, leptospirosis is a mandatorily reported disease, widely distributed across the country. In the Villeta municipality, leptospirosis has been identified as an important cause of febrile illness; however, to date, no studies have been performed to identify the circulating species. A genus-specific qualitative qPCR was performed on DNA extracted from febrile patients' acute-phase whole-blood samples targeting a fragment of the rrs gene. Positive qPCR samples were further amplified for the adk, icdA, LipL32, LipL41, rrs, and secY genes through conventional PCR for sequencing. All high-quality obtained sequences were further assessed through concatenated phylogenetic analysis. A total of 25% (14/56) of febrile patients' acute blood samples were positive for Leptospira spp. High-quality sequences were obtained for only five genes, and analysis through concatenated phylogeny identified that all sequences clustered within the P1/pathogenic clade; some of them formed a robustly supported clade with Leptospira santarosai, and others were closely related with other Leptospira species but exhibited considerable genetic divergence. We describe the presence of pathogenic Leptospira species among febrile patients from the Villeta municipality and identify L. santarosai and other Leptospira species as causative agents of leptospirosis in the region.

Virome analyses of Amblyomma cajennense and Rhipicephalus microplus ticks collected in Colombia.

Tick-borne viruses (TBV) have gained public health relevance in recent years due to the recognition of human-associated fatal cases and the increase in tick-borne disease and transmission. However, many tick species have not been studied for their potential to transmit pathogenic viruses, especially those found in Latin America. To gain better understanding of the tick virome, we conducted targeted amplification using broadly-reactive consensus-degenerate pan-viral targeting viruses from the genera Flavivirus, Bandavirus, Uukuvirus, and Orthonairovirus genus. Additionally, we conducted unbiased metagenomic analyses to investigate the presence of viral RNA sequences in Amblyomma cajennense, A. patinoi and Rhipicephalus microplus ticks collected from a horse slaughter plant in Medellín, Colombia. While no viral products were detected by PCR, results of the metagenomic analyses revealed the presence of viral genomes belonging to the genera Phlebovirus, Bandavirus, and Uukuvirus, including Lihan Tick Virus (LTV), which was previously reported in Rhipicephalus microplus from Colombia. Overall, the results emphasized the enormous utility of the next-generation sequencing in identifying virus genetic diversity presents in ticks and other species of vectors and reservoirs.

Clinical and epidemiological characteristics of Madariaga and Venezuelan equine encephalitis virus infections.

Madariaga virus (MADV) and Venezuelan equine encephalitis virus (VEEV) are emerging arboviruses affecting rural and remote areas of Latin America. However, there are limited clinical and epidemiological reports available, and outbreaks are occurring at an increasing frequency. We addressed this gap by analyzing all the available clinical and epidemiological data of MADV and VEEV infections recorded since 1961 in Panama. A total of 168 of human alphavirus encephalitis cases were detected in Panama from 1961 to 2023. Here we describe the clinical signs and symptoms and epidemiological characteristics of these cases, and also explored signs and symptoms as potential predictors of encephalitic alphavirus infection when compared to those of other arbovirus infections occurring in the region. Our results highlight the challenges clinical diagnosis of alphavirus disease in endemic regions with overlapping circulation of multiple arboviruses.

Etiological characterization of acute undifferentiated febrile illness in Apartadó and Villeta municipalities, Colombia, during COVID-19 pandemic.

Background: Acute undifferentiated febrile illness (AUFI) is one of the leading causes of illness in tropical regions. Although malaria is the most important cause, other pathogens such as Dengue (DENV), Leptospira and recently, Coronavirus Disease 2019 (COVID-19) have gained importance. In Colombia, few studies aimed to identify the etiology of AUFI. Most of them performed in Apartadó and Villeta municipalities, identifying the active circulation of several pathogens. Thus, we conducted a cross-sectional study in these municipalities to characterize the etiologies of AUFI during COVID-19 pandemic. Methods: An active surveillance was conducted between September and December 2021 in local hospitals of Apartadó and Villeta municipalities. Febrile patients were enrolled after voluntarily agreeing to participate in the study. Ten different etiologies were evaluated through direct, serological, molecular and rapid diagnostic methods. Results: In Apartadó a confirmed etiology was found in 60% of subjects, DENV (25%) being the most frequent, followed by leptospirosis (16.7%), malaria (10%), COVID-19 (8.3%), spotted fever group (SFG) rickettsiosis (6.7%) and Chikungunya (1.7%). In Villeta, a specific etiology was confirmed in 55.4% of patients, of which SFG rickettsiosis (39.3%) was the most frequent, followed by leptospirosis (21.4%), DENV (3.6%) and malaria (1.8%). No cases due to Mayaro, Yellow Fever, Oropouche and Venezuelan Equine Encephalitis viruses were detected. Conclusion: We confirm the relevance of dengue fever, leptospirosis, SFG rickettsiosis, COVID-19 and malaria as causes of AUFI in the municipality of Apartadó, and highlight the great importance of SFG rickettsiosis as the main cause of AUFI in the municipality of Villeta.

A multi-centre randomized controlled trial investigating Consolidation Chemotherapy with and without oxaliplatin in distal rectal cancer and Watch & Wait.

BACKGROUND: Neoadjuvant chemoradiation(nCRT) has been considered the preferred initial treatment strategy for distal rectal cancer. Advantages of this approach include improved local control after radical surgery but also the opportunity for organ preserving strategies (Watch and Wait-WW). Consolidation chemotherapy(cCT) regimens using fluoropyrimidine-based with or without oxalipatin following nCRT have demonstrated to increase complete response and organ preservation rates among these patients. However, the benefit of adding oxaliplatin to cCT compared to fluoropirimidine alone regimens in terms of primary tumor response remains unclear. Since oxalipatin-treatment may be associated with considerable toxicity, it becomes imperative to understand the benefit of its incorporation into standard cCT regimens in terms of primary tumor response. The aim of the present trial is to compare the outcomes of 2 different cCT regimens following nCRT (fluoropyrimidine-alone versus fluoropyrimidine + oxaliplatin) for patients with distal rectal cancer. METHODS: In this multi-centre study, patients with magnetic resonance-defined distal rectal tumors will be randomized on a 1:1 ratio to receive long-course chemoradiation (54 Gy) followed by cCT with fluoropyrimidine alone versus fluoropyrimidine + oxaliplatin. Magnetic resonance(MR) will be analyzed centrally prior to patient inclusion and randomization. mrT2-3N0-1 tumor located no more than 1 cm above the anorectal ring determined by sagittal views on MR will be eligible for the study. Tumor response will be assessed after 12 weeks from radiotherapy(RT) completion. Patients with clinical complete response (clinical, endoscopic and radiological) may be enrolled in an organ-preservation program(WW). The primary endpoint of this trial is decision to organ-preservation surveillance (WW) at 18 weeks from RT completion. Secondary endpoints are 3-year surgery-free survival, TME-free survival, distant metastases-free survival, local regrowth-free survival and colostomy-free survival. DISCUSSION: Long-course nCRT with cCT is associated with improved complete response rates and may be a very attractive alternative to increase the chances for organ-preservation strategies. Fluoropyrimidine-based cCT with or without oxaliplatin has never been investigated in the setting of a randomized trial to compare clinical response rates and the possibility of organ-preservation. The outcomes of this study may significantly impact clinical practice of patients with distal rectal cancer interested in organ-preservation. TRIAL REGISTRATION: www. CLINICALTRIALS: gov NCT05000697; registered on August 11th, 2021.

Arbovirus Antibody Seroprevalence in the Human Population from Cauca, Colombia.

Several arboviruses have emerged or reemerged into the New World during the past several decades, causing outbreaks of significant proportion. In particular, the outbreaks of Dengue virus (DENV), Zika virus, and Chikungunya virus (CHIKV) have been explosive and unpredictable, and have led to significant adverse health effects. These viruses are considered the leading cause of acute undifferentiated febrile illnesses in Colombia. However, Venezuelan equine encephalitis virus (VEEV) is endemic in Colombia, and arboviruses such as the Mayaro virus (MAYV) and the Oropouche virus (OROV) cause febrile illnesses in neighboring countries. Yet, evidence of human exposure to MAYV and OROV in Colombia is scarce. In this study, we conducted a serosurvey study in healthy individuals from the Cauca Department in Colombia. We assessed the seroprevalence of antibodies against multiple arboviruses, including DENV serotype 2, CHIKV, VEEV, MAYV, and OROV. Based on serological analyses, we found that the overall seroprevalence for DENV serotype 2 was 30%, 1% for MAYV, 2.6% for CHIKV, 4.4% for VEEV, and 2% for OROV. This study provides evidence about the circulation of MAYV and OROV in Colombia, and suggests that they-along with VEEV and CHIKV-might be responsible for cases of acute undifferentiated febrile illnesses that remain undiagnosed in the region. The study results also highlight the need to strengthen surveillance programs to identify outbreaks caused by these and other vector-borne pathogens.

Etiologies of Acute Undifferentiated Febrile Illnesses in and near Iquitos from 1993 to 1999 in the Amazon River Basin of Peru.

The objective of this study was to determine the etiology of febrile illnesses among patients from October 1, 1993 through September 30, 1999, in the urban community of Iquitos in the Amazon River Basin of Peru. Epidemiological and clinical data as well as blood samples were obtained from consenting patients at hospitals, health clinics and private residences. Samples were tested for arboviruses in cell cultures and for IgM and IgG antibodies by ELISA. Blood smears were examined for malaria, and sera were tested for antibodies to Leptospira spp. by ELISA and microscopic agglutination. Among 6,607 febrile patients studied, dengue viruses caused 14.6% of the cases, and Venezuelan equine encephalitis virus caused 2.5%, Oropouche virus 1.0%, Mayaro virus 0.4%, and other arboviruses caused 0.2% of the cases. Also, 22.9% of 4,844 patients tested were positive for malaria, and of 400 samples tested, 9% had evidence of acute leptospirosis. Although the study was not designed to assess the importance of these pathogens as a cause of human morbidity in the total population, these results indicate that arboviruses, leptospirosis, and malaria were the cause of approximately 50% of the febrile cases. Although the arboviruses that were diagnosed can produce asymptomatic infections, our findings increased the overall understanding of the relative health burden of these infections, as well as baseline knowledge needed for designing and implementing further studies to better assess the health impact and threat of these pathogens in the Amazon Basin of Peru.

Impact of cranial stereotactic radiotherapy associated with immunotherapy with nivolumab and ipilimumab on overall survival in patients with melanoma brain metastases: a real-world evidence.

PURPOSE: To evaluate the impact of cranial stereotactic radiotherapy (SRT) on overall survival (OS) of melanoma brain metastases (MBM) patients treated with combined nivolumab and ipilimumab (CNI) in a contemporary and real-world setting. METHODS/PATIENTS: The study was performed by using TriNetX, a global health network dataset of electronic medical records from patients in 49 healthcare organizations. We queried for patients with specific terms between January 2016 and December 2020 and run a propensity score matching (PSM) analysis. OS was estimated by Kaplan-Meier and log-rank test was applied. RESULTS: After initial query and PSM, 114 patients were selected in each cohort. Median OS was 327 days in CNI and not reached in the CNI + SRT cohort, with OS probability of 54.4 and 40.9%, respectively (log-rank P = .0057). CNI + SRT was associated with significantly decreased mortality (HR, 0.57; 95% CI 0.377-0.853; proportionality P = .0034). CONCLUSIONS: This real-world analysis showed that CNI + SRT led to an improvement in OS compared to CNI.

Nefropatía inducida por constraste en pacientes oncológicos: Un estudio de casos y controles / Contrast induced nephropathy in cancer patients: A case-control study

Introducción: La Nefropatía Inducida por Contraste (NIC) es una complicación causada por la ad-ministración intravenosa de medios de contrastes para estudios imagenológicos, lo cual incrementa la morbi-mortalidad y costos hospitalarios. La incidencia oscila el 2% en personas sin factores de riesgo, pudiendo llegar hasta el 25 a 50% cuando se asocian factores predisponentes. El objetivo de este estudio fue evaluar el desarrollo de NIC en pacientes oncológicos y no oncológicos hospitaliza-dos, sus características clínicas, prevalencia, factores asociados y aplicación de una escala de riesgo pre exposición. Metodología: Se realizó un estudio de casos y controles en los Hospitales "Abel Gilbert Pontón" y el Instituto Oncológico Nacional "Dr. Juan Tanca Marengo" - Guayaquil en el período Abril a Septiembre del 2020. La muestra fue no probabilística, de pacientes con y sin diagnóstico oncológico. En ambos grupos se requirió una tomografía contrastada. Se registró edad, sexo, tipo de cáncer, presencia de Diabetes Tipo 2 (DMT2), Hipertensión arterial, creatinina basal y a las 48 horas. Se usó una escala de preexposición para NIC. Se compara las prevalencias con Chi2, y las asociaciones con Odds Ratio. Resultados: Fueron 100 casos y 100 controles. La prevalencia de NIC fue 28% en no oncológicos y 22% en oncológicos (P=0.33), el factor de riesgo asociado fue la Diabetes Mellitus tipo 2 (OR 2.19 [IC95% 1.0007 ­ 4.808; P=0.0498). El valor de creatinina previa no tuvo efecto sobre el desenlace de nefropatía. La distribución de categorías pre exposición no mostró diferencias significativas entre los pacientes que desarrollaron NIC en relación con los que no desarrollaron (P=0.063). Conclusión: El desarrollo de NIC no se ve influenciado por edad, sexo, paciente e HTA, pero si se ve asociado a la presencia de DM2. La estratificación de riesgo pre exposición no fue de utilidad en este caso, su distribución fue similar en pacientes con o sin NIC

Introduction: Contrast Induced Nephropathy (CIN) is a complication caused by intravenous administration of contrast media for imaging studies, which increases morbidity and mortality and hospital costs. The incidence ranges from 2% in people without risk factors, and can reach up to 25 to 50% when predisposing factors are associated. The objective of this study was to evaluate the develop-ment of CIN in hospitalized cancer and non-cancer patients, their clinical characteristics, prevalence, associated factors, and the application of a pre-exposure risk scale. Methodology: A case-control study was carried out at the "Abel Gilbert Pontón" Hospitals and the "Dr. Juan Tanca Marengo "- Guayaquil in the period April to September 2020. The sample was non-probabilistic, of patients with and without oncological diagnosis. Contrast tomography was required in both groups. Age, sex, type of cancer, presence of Type 2 Diabetes (T2DM), arterial hypertension, creatinine at baseline and at 48 hours were recorded. A pre-exposure scale for CIN was used. The prevalences are compared with Chi2, and the associations with Odds Ratio. Results: There were 100 cases and 100 controls. The prevalence of CIN was 28% in non-cancer patients and 22% in oncological patients (P = 0.33). The associated risk factor was Type 2 Diabetes Mellitus (OR 2.19 [95% CI 1.0007 - 4.808; P = 0.0498). The previous creatinine value had no effect on the outcome of nephropathy. The distribution of pre-exposure categories did not show significant differences between the patients who developed CIN in relation to those who did not develop (P = 0.063). Conclusion: The development of CIN is not influenced by age, sex, patient and hypertension, but is associated with the presence of DM2. Pre-exposure risk stratification was not useful in this case, its distribution was similar in patients with or without CIN

Serological Responses in Patients Infected with Mayaro Virus and Evaluation of Cross-Protective Responses against Chikungunya Virus.

Mayaro virus (MAYV) is an alphavirus endemic to both Latin America and the Caribbean. Recent reports have questioned the ability of MAYV and its close relative, Chikungunya virus (CHIKV), to generate cross-reactive, neutralizing antibodies to one another. Since CHIKV was introduced to South America in 2013, discerning whether individuals have cross-reactive antibodies or whether they have had exposures to both viruses previously has been difficult. Using samples obtained from people infected with MAYV prior to the introduction of CHIKV in the Americas, we performed neutralizing assays and observed no discernable neutralization of CHIKV by sera from patients previously infected with MAYV. These data suggest that a positive CHIKV neutralization test cannot be attributed to prior exposure to MAYV and that previous exposure to MAYV may not be protective against a subsequent CHIKV infection.

Análisis confirmatorio de la Escala de Autoevaluación Breve de Bienestar y Autonomía en Adultos Mayores de Coahuila y Yucatán, México / Confirmatory Analysis of the Short Self-Assessment of Wellbeing and Autonomy Scale in Older Adults in Coahuila and Yucatán, Mexico

Resumen El objetivo de este trabajo fue realizar un Análisis Factorial Confirmatorio de la Escala de Bienestar y Autonomía específica para adultos mayores en dos muestras mexicanas, lo que permitió determinar la validez del constructo medido. Se utilizó un diseño cuantitativo, transversal con alcances explicativos. Se analizó una muestra incidental de 895 adultos mayores, de los cuales 59.8 % eran habitantes de la ciudad de Saltillo, Coahuila, México y 40.2 % de Tizimín, Yucatán, México. Se utilizó la Escala de Autoevaluación Breve de Bienestar y Autonomía para Adultos Mayores. Se procesó el Análisis Factorial Exploratorio, Paralelo y Confirmatorio con el método de Mínimos Cuadrados Generalizados, además de obtener la confiabilidad y los estadísticos descriptivos de las dimensiones. La estructura que se identificó presentó indicadores de ajuste estadístico adecuado. Originalmente, la estructura consideraba dos dimensiones: la autonomía y el bienestar, sin embargo, los resultados mostraron la separación en tres dimensiones de la medición de bienestar.

Abstract The objective of this work was to carry out a Confirmatory Factorial Analysis of the Scale of Wellbeing and Specific Autonomy for Older Adults in two Mexican samples, which allowed to establish the validity of the measured construct. A quantitative, transversal design with explanatory scopes was used. An incidental sample of 895 aging adults was obtained, from which 59.8% were inhabitants of the Saltillo city, Coahuila, Mexico, and 40.2%, of Tizimín city, Yucatán, Mexico. We used the Short SelfAssessment of Wellbeing and Autonomy for Older Adults. The Exploratory, Parallel and Confirmatory Factor Analysis was processed with the Generalized Least Squares Method, in addition to obtaining the reliability and descriptive statistics of dimensions. The identified structure showed adequate statistical adjustment indicators. Initially, the structure considered two dimensions: autonomy and wellbeing; however, the results showed the separation in three dimensions of the wellbeing measurement.

Estudios de laboratorio como herramienta en la identificación de apendicitis aguda y su diferenciación con hiperplasia linfoide / Laboratory studies as a tool for the differential diagnosis between acute appendicitis and lymphoid hyperplasia

RESUMEN Antecedentes: La apendicitis aguda (AA) es una de las principales patologías quirúrgicas en México y el mundo. A pesar de ser una patología frecuente, el manejo quirúrgico presenta una tasa del 10-20% de apendicitis blancas (AB) o hiperplasia folicular linfoide (HPL) por histopatología. Objetivo: Comparar los hallazgos clínicos, de laboratorio y radiológicos de pacientes con sospecha de AA con su diagnóstico por histopatología. Material y métodos: El estudio es retrospectivo, observacional y transversal. Se analizaron los datos de los pacientes con diagnóstico clínico de apendicitis aguda, desde febrero de 2013 hasta diciembre de 2017, atendidos en un hospital de tercer nivel en Monterrey, México. Se compararon los hallazgos de los pacientes con diagnóstico de AA vs. HPL, AA no complicadas vs. AA complicadas y pacientes pediátricos vs. adultos. Se realizó un análisis descriptivo por medio de frecuencias y porcentajes, y mediana y rango intercuartil (RIC), dada la distribución no paramétrica de estas variables. Se compararon los hallazgos por laboratorio mediante la prueba de Mann-Whitney. Se consideró una p< 0,05 como estadísticamente significativa. Resultados: En nuestro medio, ambos sexos tienen la misma frecuencia de presentación de AA. El tiempo de evolución es significativo en la presentación frecuente de AA complicada. Existe asociación entre leucocitosis, neutrofilia total y porcentual y recuento plaquetario mayor en presencia de AA vs. HPL. Conclusión: Los estudios de laboratorio no muestran cambios significativos en pacientes pediátricos con AA. En adultos con AA no complicada vs. apendicitis complicada, el aumento en WBC, NEU y NEU% son estadísticamente significativos.

ABSTRACT Background: Acute appendicitis (AA) is one of the main surgical pathologies in our country and worldwide. Despite being a surgery that is frequently done, it is still reported a 10-20% of negative appendectomies (NA). Objective: The objective of the study is to compare clinical, laboratory and radiology results with the histopathology diagnosis. Material and methods: A retrospective study was done analyzing the data of patients with clinical diagnosis of AA from February 2013 to December 2017, in a tertiary hospital in Monterrey, Mexico. They were classified by their histopathological results into different groups: AA or NA; and the AA was subdivided into complicated AA and uncomplicated AA. Finally, these groups were also subdivided by ages, into pediatric and adult groups of each category. A descriptive analysis was made using frequencies, percentages, median and the interquartile range. Laboratory results were compared with the Mann-Whitney test. Considering a p-value of p < 0.05 as statistically significant. Results: In our group of patients both genders had AA in a similar frequency, the time between the appearance of symptoms and reaching for medical advice was an important factor for having complicated AA. There is a correlation between leukocytosis, neutrophil count and platelet count elevated in presence of AA against NA. Conclusion: Laboratory studies did not report significant changes in pediatric patients with AA. In adults with uncomplicated AA vs. complicated AA, white blood cell count, and neutrophil count are statistically significant.

Gastrointestinal helminths of waterfowl (Anatidae: Anatinae) in the Lerma marshes of central Mexico: Some pathological aspects.

Gastrointestinal helminths of migratory waterfowl can cause several lesions that may affect the health and even the survival of their hosts. As part of an ongoing project that aims to inventory the helminth species that infect this group of birds, as well as the histopathologic lesion they cause, a total of 200 digestive tracts of nine species of anatid birds (Spatula discors, S. cyanoptera, S. clypeata, Mareca strepera, M. americana, Anas crecca, A. acuta, A. platyrhynchos diazi, and Oxyura jamaicensis) were collected in the Atarasquillo marsh of Lerma, in the State of Mexico. The present work had a twofold goal: to determine the taxonomic identity of the helminth species present in waterfowl as well as their infection levels and to describe the lesions caused by gastrointestinal parasites in migratory and resident anatids in Atarasquillo marsh, State of Mexico. The specimens were examined using routine helminthological and histopathological techniques. A total of 23 helminths were identified: six trematodes (Zygocotyle lunata, Notocotylus triserialis, Notocotylus seineti, Psilochasmus oxyurus, Australapatemon burti and Cotylurus magniacetabulus), four cestodes (Cloacotaenia megalops, Fimbriaria fasciolaris, Gatrotaenia cygni and Diorchis sp.), eleven nematodes (Echinuria uncinata, Tetrameres sp., Tetrameres fissispina, Hystrichis sp., Streptocara sp., Amidostomum sp., Epomidiostomum uncinatum, Capillaria sp., Capillaria contorta, Ascaridia sp. and Heterakis sp.) and two acanthocephalans (Pseudocorynosoma constrictum and Filicollis sp.). At the proventriculus level, Echinuria uncinata caused the most severe lesions; in the gizzard, Amidostomum sp. and E. uncinatum produced hemorrhages and necrosis. Finally, the main lesions found in the intestine (necrosis, heterophilic granulomas and the formation of lumps on the serosa) were caused by the implantation of the acanthocephalans' proboscis. Eleven species of gastrointestinal helminths found are new records for the Lerma marshes, as well as the first record in Mexico of the nematode Capillaria contorta and the acanthocephalan Filicollis sp.

Riesgo de diabetes de una comunidad rural en México: un estudio observacional / Diabetes Risk in a Rural Community in Mexico: an Observational Study

Introducción. La rápida transición del medio rural a la adopción de hábitos alimenticios de zonas urbanas, el sedentarismo, las dificultades de acceso a la salud, ponen a la población en mayor riesgo de desarrollo de diabetes, sin embargo, son pocos los estudios que se enfocan en este fenómeno a nivel rural. Conocer el riesgo permite identificar las áreas problemáticas y revertir la situación a través de modelos de atención para esta población. El objetivo de este estudio fue describir los factores de riesgo presentes en una comunidad rural de Guanajuato. Material y Métodos: Estudio descriptivo, observacional, transversal; muestra no probabilística de 164 personas sin diabetes, se calculó con Epidat 3.1, intervalo de confianza al 95%, precisión del 3%; se aplicó el Cuestionario de Factores de Riesgo para la Diabetes Mellitus. Para la colecta se hizo un recorrido de casa por casa hasta completar la muestra, para el análisis estadístico se utilizó la chi cuadrada y cálculo de odds ratio. Resultados: El 71%(117) de la población fueron mujeres; el promedio para la edad fue de 43 años; el 85% de los sujetos presentaron un alto riesgo de padecer diabetes; los tres principales factores de riesgo fueron: 57.9% (95) con sobrepeso y obesidad, el 77.4%(127) de la muestra con cintura superior al parámetro recomendado, 75.6% (124) de la muestra presentó antecedentes heredofamiliares; en cuestión de género las mujeres presentaron 3 veces más riesgo de diabetes (p=<.05). Conclusión: Los entornos rurales muy contrario a lo que se observaba, tienen alto riesgo de desarrollo de diabetes, probablemente va de la mano con los cambios de hábitos de las comunidades, pues la industrialización las ha invadido, con todo lo que conlleva, como lo señala Moreno L

Hernia diafragmática congénita recurrente asociada a malrotación intestinal / Recurrent congenital diaphragmatic hernia associated with intestinal malrotation

RESUMEN La recurrencia de las hernias diafragmáticas congénitas, luego de reparadas quirúrgicamente, es de baja frecuencia. Se presenta el caso de un paciente masculino de 22 años con hernia diafragmática congénita reparada inicialmente al segundo día de vida, el cual presenta disnea grado 1 y enfermedad por reflujo gastroesofágico. Se evidencia por medio de imagen una hernia diafragmática izquierda, el saco herniario con contenido de bazo, colon, cola de páncreas y glándula suprarrenal izquierda. Se aborda de manera abdominal mediante incisión subcostal izquierda, se reduce el saco herniario, se coloca malla tipo en el defecto diafragmático y se realiza procedimiento de Ladd por la presencia de malrotación intestinal.

ABSTRACT Recurrence of congenital diaphragmatic hernia, after surgical repair, is infrequent. Here, we report the case of a 22-year-old male patient with a history of congenital diaphragmatic disease initally treated with surgery on the second day of life who presented class I dyspnea and gastroesophageal reflux. A left diaphragmatic hernia with a hernia sac containing the spleen, colon, tail of pancreas and left adrenal gland. The patient underwent surgical repair via a left subcostal incision; the hernia sac was reduced, the diaphragmatic defect was repaired with a mesh and the Ladd procedure was performed due to the diagnosis of intestinal malrotation.

Barrita Virus, a Novel Virus of the Patois Serogroup (Genus Orthobunyavirus; Family Peribunyaviridae).

During ecological investigations for arboviruses conducted in coastal Chiapas, Mexico, in 2007, isolate MP1078 was obtained from a pool of Psorophora varipes mosquitoes. Based on antigenic characterization, this isolate was classified as a strain of Patois virus (PATV) (Orthobunyavirus genus, Peribunyaviridae family). Recently, we conducted nearly complete genome sequencing of this isolate to gain further insight into its genetic relationship with other members of the Patois serogroup. Based on the genetic characterization, we determined that MP1078 contains S, M, and L genome segments that are genetically distinct from other viruses within the Patois serogroup. Serological analyses confirmed the taxonomic classification of MP1078 as a new virus and species within the Patois serogroup, and we propose the name Barrita virus (BITV).

Real-time RT-PCR for the detection and quantitation of Oropouche virus.

Oropouche virus (OROV) causes an acute, systemic febrile illness, and in certain regions of South America, this represents the second most common human arboviral infection after dengue virus. A new real-time RT-PCR was developed for OROV and reassortant species. The new OROV rRT-PCR proved linear across 6-7 orders of magnitude with a lower limit of 95% detection of 5.6-10.8 copies/µL. Upon testing dilutions of OROV and Iquitos virus reference genomic RNA, all dilutions with >10 copies/µL were detected in both the OROV rRT-PCR and a comparator molecular assay, but the OROV rRT-PCR detected more samples with ≤10 copies/µL (8/14 vs 0/13, respectively, P = 0.002). In a set of 100 acute-phase clinical samples from Paraguay patients with a suspected arboviral illness, no patients tested positive for OROV RNA using either assay. The OROV rRT-PCR provides a sensitive molecular assay for the study of this important yet neglected tropical arboviral infection.

Organ Preservation in cT2N0 Rectal Cancer After Neoadjuvant Chemoradiation Therapy: The Impact of Radiation Therapy Dose-escalation and Consolidation Chemotherapy.

OBJECTIVE: To demonstrate the difference in organ-preservation rates and avoidance of definitive surgery among cT2N0 rectal cancer patients undergoing 2 different chemoradiation (CRT) regimens. BACKGROUND: Patients with cT2N0 rectal cancer are more likely to develop complete response to neoadjuvant CRT. Organ preservation has been considered an alternative treatment strategy for selected patients. Radiation dose-escalation and consolidation chemotherapy have been associated with increased rates of response and may improve chances of organ preservation among these patients. METHODS: Patients with distal and nonmetastatic cT2N0 rectal cancer managed by neoadjuvant CRT were retrospectively reviewed. Patients undergoing standard CRT (50.4 Gy and 2 cycles of 5-FU-based chemotherapy) were compared with those undergoing extended CRT (54 Gy and 6 cycles of 5-FU-based chemotherapy). Patients were assessed for tumor response at 8 to 10 weeks. Patients with complete clinical response (cCR) underwent organ-preservation strategy ("Watch and Wait"). Patients were referred to salvage surgery in the event of local recurrence during follow-up. RESULTS: Thirty-five patients underwent standard and 46 patients extended CRT. Patients undergoing extended CRT were more likely to undergo organ preservation and avoid definitive surgical resection at 5years (67% vs 30%; P = 0.001). After development of a cCR, surgery-free survival is similar between extended and standard CRT groups at 5 years (78% vs 56%; P = 0.12). CONCLUSIONS: Dose-escalation and consolidation chemotherapy leads to increased long-term organ-preservation rates among cT2N0 rectal cancer. After achievement of a cCR, the risk for local recurrence and need for salvage surgery is similar, irrespective of the CRT regimen.

Living With Type 2 Diabetes in San Jose Tecoh, Yucatan, Mexico: A Phenomenological Study.

INTRODUCTION: Understanding the psychosocial aspects that accompany and influence type 2 diabetes mellitus (T2DM) has become increasingly important for culturally appropriate health care in Mexico. The purpose of this study was to understand the lived experience of individuals' with T2DM in Merida, Yucatan. METHOD: A phenomenological method guided data collection and analysis. Patients in San Jose Tecoh, diagnosed with T2DM for at least 5 years, were interviewed. RESULTS: Eight (six female, two male) patients described their lived experience. Individuals discussed knowledge of the disease (e.g., care, beliefs about origin, consequences, type, symptoms) and changes arising from diagnosis (e.g., emotional, dietary, physiological, lifestyle and self-care, economic). DISCUSSION: The Mayan-Yucatecan cultural perceptions of factors that influence physical health are unique to this region. Nurses can facilitate improvement in T2DM health outcomes through providing information and encouraging self-care. Our results emphasize the importance of considering T2DM in terms of differences between and within culture.