Passive epidemiological surveillance in wildlife in Costa Rica identifies pathogens of zoonotic and conservation importance.

Epidemiological surveillance systems for pathogens in wild species have been proposed as a preventive measure for epidemic events. These systems can minimize the detrimental effects of an outbreak, but most importantly, passive surveillance systems are the best adapted to countries with limited resources. Therefore, this research aimed to evaluate the technical and infrastructural feasibility of establishing this type of scheme in Costa Rica by implementing a pilot program targeting the detection of pathogens of zoonotic and conservation importance in wildlife. Between 2018 and 2020, 85 carcasses of free-ranging vertebrates were admitted for post-mortem and microbiology analysis. However, we encountered obstacles mainly related to the initial identification of cases and limited local logistics capacity. Nevertheless, this epidemiological surveillance scheme allowed us to estimate the general state of health of the country's wildlife by establishing the causes of death according to pathological findings. For instance, 60% (51/85) of the deaths were not directly associated with an infectious agent. Though in 37.6% (32/85) of these cases an infectious agent associated or not with disease was detected. In 27.1% (23/85) of the cases, death was directly related to infectious agents. Furthermore, 12.9% (11/85), the cause of death was not determined. Likewise, this wildlife health monitoring program allowed the detection of relevant pathogens such as Canine Distemper Virus, Klebsiella pneumoniae, Angiostrongylus spp., Baylisascaris spp., among others. Our research demonstrated that this passive surveillance scheme is cost-effective and feasible in countries with limited resources. This passive surveillance can be adapted to the infrastructure dedicated to monitoring diseases in productive animals according to the scope and objectives of monitoring wildlife specific to each region. The information generated from the experience of the initial establishment of a WHMP is critical to meeting the challenges involved in developing this type of scheme in regions with limited resources and established as hotspots for emerging infectious diseases.

Vesicular Stomatitis Virus Isolated from a Bovine Brain Sample in Costa Rica.

The genome of Vesicular stomatitis (New Jersey) virus was obtained by high-throughput sequencing after the nucleic acid was extracted from the supernatant of Vero E6 cells inoculated with a sample of a bovine brain with nervous signs. The sample was negative for rabies by direct Immunofluorescence and bovine spongiform encephalopathy by histopathology.

Phylogenetic and Mutation Analysis of the Venezuelan Equine Encephalitis Virus Sequence Isolated in Costa Rica from a Mare with Encephalitis.

Venezuelan Equine Encephalitis virus (VEEV) is an arboviral pathogen in tropical America that causes lethal encephalitis in horses and humans. VEEV is classified into six subtypes (I to VI). Subtype I viruses are divided into epizootic (IAB and IC) and endemic strains (ID and IE) that can produce outbreaks or sporadic diseases, respectively. The objective of this study was to reconstruct the phylogeny and the molecular clock of sequences of VEEV subtype I complex and identify mutations within sequences belonging to epizootic or enzootic subtypes focusing on a sequence isolated from a mare in Costa Rica. Bayesian phylogeny of the VEEV subtype I complex tree with 110 VEEV complete genomes was analyzed. Evidence of positive selection was evaluated with Datamonkey server algorithms. The putative effects of mutations on the 3D protein structure in the Costa Rica sequence were evaluated. The phylogenetic analysis showed that Subtype IE-VEEV diverged earlier than other subtypes, Costa Rican VEEV-IE ancestors came from Nicaragua in 1963 and Guatemala in 1907. Among the observed non-synonymous mutations, only 17 amino acids changed lateral chain groups. Fourteen mutations located in the NSP3, E1, and E2 genes are unique in this sequence, highlighting the importance of E1-E2 genes in VEEV evolution.

Molecular characterization of the S1 gene in GI-17 and GI-13 type isolates of avian infectious bronchitis virus (IBV) in Costa Rica, from 2016 to 2019.

Avian infectious bronchitis is one of the most important respiratory diseases affecting poultry production worldwide. The etiological agent of this disease is the avian infectious bronchitis virus (IBV). We analyzed 14 isolates of IBV obtained from poultry farms in Costa Rica, from 2016 through 2019. We sequenced the S1 region of the genome and the sequences obtained were submitted to GenBank. Phylogenetic analyses showed that the isolates obtained during 2016-2017 belong to the GI-17 lineage and are related to the Georgia 13-type Ga-13/14255/14 and CK/CR/1160/16 variants, with a 96.90-100% nucleotide sequence identity and a 92.25-100% amino acid sequence identity. The main differences were detected in the RBD and HVR-3 regions, where a series of mutations eliminate an N-glycosylation site in 10 out of 11 isolates. The isolates obtained during 2018-2019 belong to the GI-13 lineage and are closely related to the 4/91 vaccine variant, with over 98% sequence identity at the nucleotide and amino acids levels. Variations were detected in the RBD and HVR regions, with a possible N-glycosylation site detected in isolate CK/CR/0632/19. These results indicate that a GA13-like pathogenic variant circulated during the 2016-2017 period and that the 4/91 variant was detected after the introduction of the vaccine. The variations shown in both the GA13-like and 4/91 isolates examined, reveal the need for continuous surveillance of IBV in Costa Rica, to detect new variants that may be introduced to the country or develop during outbreaks. This information is highly relevant for vaccination planning and disease management programs. Supplementary Information: The online version contains supplementary material available at 10.1007/s13337-022-00762-2.

Seroprevalence of porcine reproductive and respiratory syndrome virus on swine farms in a tropical country of the Middle Americas: the case of Costa Rica.

Porcine reproductive and respiratory syndrome virus (PRRSV) causes significant economic losses to the swine industry worldwide. Little is known regarding the epidemiology of this infection in tropical countries. To address this problem in Costa Rica, a seroepidemiological study was carried out in two phases. In the first phase, a pilot study was conducted in nine farms with the clinical diagnosis of PRRSV. In total, 265 pig serum samples were collected from animals ranging in age from 1 to 15 weeks of age. This study aimed to establish the duration of maternal immunity in piglets, to identify the period of viremia, and to determine when seroconversion occurs. In the second phase, a cross-sectional serology study was performed on a representative sample of the Costa Rican national herds in the second phase. The twenty-five selected farms represent all provinces and were classified according to herd size (100 to 2000 sows). In each farm, pigs aged 8, 10, and 12 weeks were sampled, as well as gilts based on the pilot study. In total 1281 pigs were sampled across all 25 farms. The aim of the cross-sectional study was to quantify the seroprevalence of PRRSV in Costa Rican pig farms and to describe its geographical distribution in this tropical country. The prevalence of positive farms was 44% (11/25), and these farms were located in six of the seven provinces of Costa Rica. Overall, 58% (344/596) of the pigs were seropositive to PRRSV. The age of the pigs and the ecozone where farms were located were significantly related with PRRSV seroprevalence in animals and herds, respectively.

Linfedema congénito primario bilateral. Reporte de caso / Bilateral primary congenital lymphedema. Case report

RESUMEN Fundamento: El linfedema congénito primario es una condición rara con un componente genético importante que se caracteriza por edema crónico de la zona afectada. Objetivo: Presentar un linfedema congénito primario bilateral y discutir su origen. Presentación de caso: Se presentó un caso de linfedema congénito primario bilateral en un niño de 2 años de edad, sin antecedentes patológicos familiares de la enfermedad. Se discutieron sus posibles causas genéticas ya que existen varias mutaciones que explican su origen. Aunque no se pudieron realizar estudios genéticos para conocer la etiología exacta, existen evidencias clínicas de que no se trata de una enfermedad de Milroy, a menos que se presente como una mutación de novo. Se le realizó al paciente un seguimiento desde su diagnóstico hasta la actualidad. Conclusiones: Existen múltiples mutaciones genéticas que explican el origen de un linfedema congénito primario, por lo que no necesariamente debe tratarse de enfermedad de Milroy cuando este se presente. Se destacó como elemento importante que en este caso no se evidenciaron antecedentes familiares. Se empleó el tratamiento conservador como conducta fundamental a seguir, se evidenció en el paciente una notable mejoría clínica.

ABSTRACT Background: Primary congenital lymphedema is a rare condition with an important genetic component characterized by chronic edema of the affected area. Objective: To present a bilateral primary congenital lymphedema and discuss its origin. Case report: A case of bilateral primary congenital lymphedema was presented in a 2-year-old boy with no any family background of the disease. Its possible genetic causes were discussed since there are several mutations that explain its origin. Although genetic studies could not be performed to know the exact etiology, there is clinical evidence that it is not a Milroy's disease, unless it presents as a de novo mutation. The patient was followed up from diagnosis to the present. Conclusions: There are multiple genetic mutations that explain the origin of a primary congenital lymphedema, so it should not necessarily be Milroy's disease when present. A highlighted and important element was that in this case no any family background was evidenced. Conservative treatment was used as the essential conduct to follow up, a remarkable clinical progress was evidenced in the patient.

Rabies in Costa Rica - Next Steps Towards Controlling Bat-Borne Rabies After its Elimination in Dogs.

Rabies is an acute, progressive encephalitis caused by a lyssavirus, with the highest case fatality of any conventional infectious disease. More than 17 different lyssaviruses have been described, but rabies virus is the most widely distributed and important member of the genus. Globally, tens of thousands of human fatalities still occur each year. Although all mammals are susceptible, most human fatalities are caused by the bites of rabid dogs, within lesser developed countries. A global plan envisions the elimination of human rabies cases caused via dogs by the year 2030. The combination of prophylaxis of exposed humans and mass vaccination of dogs is an essential strategy for such success. Regionally, the Americas are well on the way to meet this goal. As one example of achievement, Costa Rica, a small country within Central America, reported the last autochthonous case of human rabies transmitted by a dog at the end of the 1970s. Today, rabies virus transmitted by the common vampire bat, Desmodus rotundus, as well as other wildlife, remains a major concern for humans, livestock, and other animals throughout the region. This review summarizes the historical occurrence of dog rabies and its elimination in Costa Rica, describes the current occurrence of the disease with a particular focus upon affected livestock, discusses the ecology of the vampire bat as the primary reservoir relevant to management, details the clinical characteristics of recent human rabies cases, and provides suggestions for resolution of global challenges posed by this zoonosis within a One Health context.

Analysis of ORF5 sequences of Porcine Reproductive and Respiratory Syndrome virus (PRRSV) circulating within swine farms in Costa Rica.

BACKGROUND: Worldwide, Porcine Reproductive and Respiratory Syndrome (PRRS) is among the diseases that cause the highest economic impact in modern pig production. PRRS was first detected in Costa Rica in 1996 and has since then severely affected the local swine industry. Studies of the molecular characterization of circulating strains, correlation with clinical records, and associations with pathogens associated with Porcine Respiratory Disease Complex (PRDC) have not been done in Costa Rica. RESULTS: Sequencing and phylogenetic analysis of ORF5 proved that PRRSV-2 was the only species detected in all locations analyzed. These sequences were grouped into three clusters. When comparing samples from San Jose, Alejuela, and Puntarenas to historical isolates of the previously described lineages (1 to 9), it has been shown that these were closely related to each other and belonged to Lineage 5, along with the samples from Heredia. Intriguingly, samples from Cartago clustered in a separate clade, phylogenetically related to Lineage 1. Epitope analysis conducted on the GP5 sequence of field isolates from Costa Rica revealed seven peptides with at least 80% amino acid sequence identity with previously described and experimentally validated immunogenic regions. Previously described epitopes A, B, and C, were detected in the Santa Barbara-Heredia isolate. CONCLUSIONS: Our data suggest that the virus has three distinct origins or introductions to the country. Future studies will elucidate how recently introduced vaccines will shape the evolutionary change of circulating field strains.

Molecular characterization of an avian GA13-like infectious bronchitis virus full-length genome from Costa Rica.

We describe the first whole-genome sequence of a GA13-like isolate of avian infectious bronchitis virus CK/CR/1160/16 (MN757859), obtained in 2016 in the province of Alajuela, Costa Rica. This virus caused an outbreak with great economic impact to the local poultry industry. The genome sequence is 27 696 bp in length, with the following genome organization 5'-UTR-Pol-S-3a-3b-E-4b-4c-M-5a-5b-N-6b-3'-UTR. The complete genome sequence has the highest sequence identity (94.03%) with DMV/1639/GA9977/2019 (MK878536) from Georgia, USA, and the lowest identity (86.03%) with ck/CH/LHLJ/08-6 (KX252788), from China. Analysis of the S1 subunit indicates that the Costa Rican isolate belongs to genotype I, lineage 17 (GI-17) and displays 96.89% identity with the S1 subunit of Ga-13/14255/14 (KM087780) (USA). Possible recombination events in genes S, E, M, 4b y 4c were detected, with Massachusetts, Connecticut, Arkansas and MA5 as potential parental types. This study highlights the importance of the epidemiological and molecular surveillance of avian infectious bronchitis.

Facial and Vocal Expressions During Clinical Interviews Suggest an Emotional Modulation Paradox in Borderline Personality Disorder: An Explorative Study.

Videotape recordings obtained during an initial and conventional psychiatric interview were used to assess possible emotional differences in facial expressions and acoustic parameters of the voice between Borderline Personality Disorder (BPD) female patients and matched controls. The incidence of seven basic emotion expressions, emotional valence, heart rate, and vocal frequency (f0), and intensity (dB) of the discourse adjectives and interjections were determined through the application of computational software to the visual (FaceReader) and sound (PRAAT) tracks of the videotape recordings. The extensive data obtained were analyzed by three statistical strategies: linear multilevel modeling, correlation matrices, and exploratory network analysis. In comparison with healthy controls, BPD patients express a third less sadness and show a higher number of positive correlations (14 vs. 8) and a cluster of related nodes among the prosodic parameters and the facial expressions of anger, disgust, and contempt. In contrast, control subjects showed negative or null correlations between such facial expressions and prosodic parameters. It seems feasible that BPD patients restrain the facial expression of specific emotions in an attempt to achieve social acceptance. Moreover, the confluence of prosodic and facial expressions of negative emotions reflects a sympathetic activation which is opposed to the social engagement system. Such BPD imbalance reflects an emotional alteration and a dysfunctional behavioral strategy that may constitute a useful biobehavioral indicator of the severity and clinical course of the disorder. This face/voice/heart rate emotional expression assessment (EMEX) may be used in the search for reliable biobehavioral correlates of other psychopathological conditions.

National Seroprevalence and Risk Factors for Eastern Equine Encephalitis and Venezuelan Equine Encephalitis in Costa Rica.

Eastern equine encephalitis and Venezuelan equine encephalitis are endemic neglected tropical diseases in the Americas, causing encephalitis in both horses and humans. In 2013, a cross-sectional study was performed in 243 horses located in the highlands and lowlands throughout Costa Rica. Serum samples were analyzed with an IgG ELISA and confirmed by the plaque-reduction neutralization test (PRNT80). Venezuelan equine encephalitis virus (VEEV) and Eastern equine encephalitis virus (EEEV) overall seroprevalences by the PRNT80 were 36% (95% confidence interval [CI]: 29.9-42.5; 78/217 horses) and 3% (95% CI: 1.3-5.9; 6/217 horses), respectively. Both the viruses occurred in the lowlands and highlands. Rainfall and altitude were associated with VEEV seropositivity in the univariate analysis, but only altitude <100 meters above sea level was considered a risk factor in the multivariate analysis. No risk factors could be identified for the EEEV in the multivariate analysis. This is the first study that estimates the seroprevalence of the EEEV and VEEV in Costa Rican horses. The VEEV is widely distributed, whereas the EEEV occurs at a much lower frequency and only in specific areas. Clinical cases and occasional outbreaks of both viruses are to be expected.

Caracterización clínico-epidemiológica en pacientes discapacitados visuales por retinosis pigmentaria. Sancti Spíritus. 2009-2019 / Clinical and epidemiological characterization in visual impaired patients due to retinitis pigmentosa. Sancti Spíritus. 2009-2019

RESUMEN Fundamento: La retinosis pigmentaria constituye una causa de discapacidad visual que provoca alteraciones psicológicas y sociales al paciente. Objetivo: Describir las características clínicas y epidemiológicas en pacientes discapacitados visuales por retinosis pigmentaria de la provincia Sancti Spíritus. Metodología: Se realizó un estudio descriptivo, que incluyó 140 pacientes discapacitados visuales afectados por retinosis pigmentaria. Resultados: El grupo etario entre los 29 y 56 años fue el más afectado (78.1 %), el 65 % era del sexo masculino, predominó el color blanco de la piel (87.1 %), sobresalió la catarata como la afección ocular (13.6 %), el 16.4 % presentó hipertensión arterial; la mayoría de los discapacitados no presentó hábitos tóxicos (55 %), prevaleció el debut precoz en el 70 % de los casos. La forma típica de la enfermedad se observó en el 98.5 % de los enfermos, el 67 % manifestó un estadio clínico de la enfermedad grado IV, así como la herencia autosómica recesiva en el 36.4 %. Conclusiones: Predominio de los enfermos en los grupos etario entre 29 y 56 años, masculino, color blanco de la piel; la catarata como patología ocular más frecuente junto a la hipertensión arterial dentro las enfermedades sistémicas; la mayoría de los discapacitados no presentó hábitos tóxicos. El debut precoz, la forma típica, el estadio IV de la enfermedad, así como la herencia autosómica dominante prevalecieron en el estudio.

ABSTRACT Background: Retinitis pigmentosa is a cause of visual impairment that causes psychological and social alterations to the patient. Objective: To describe the clinical and epidemiological characteristics in visual impaired patients due to retinitis pigmentosa in Sancti Spíritus province. Methodology: A descriptive study was carried out, which included 140 visual impaired patients affected by retinitis pigmentosa. Results: The age group between 29 and 56 years old was the most affected (78.1 %), 65 % were male, white skin predominated (87.1 %), cataract stood out as an eye condition (13.6 %), 16.4 % presented arterial hypertension; most of the disabled did not present toxic habits (55 %), early debut prevailed in 70 % of cases. The typical form of the disease was observed in 98.5 % of patients, 67 % showed a clinical stage of grade IV disease, as well as autosomal recessive inheritance in 36.4 %. Conclusions: Prevalence of patients in the age groups between 29 and 56 years, male, white skin color; cataract as the most frequent ocular pathology together with arterial hypertension within systemic diseases; the majority of the disabled patients did not show toxic habits. Early debut, typical form, stage IV disease, and autosomal dominant inheritance prevailed in the study.

Caracterización clínico-epidemiológica en pacientes discapacitados visuales por retinosis pigmentaria. Sancti Spíritus. 2009-2019 / Clinical and epidemiological characterization in visual impaired patients due to retinitis pigmentosa. Sancti Spíritus. 2009-2019

RESUMEN Fundamento: La retinosis pigmentaria constituye una causa de discapacidad visual que provoca alteraciones psicológicas y sociales al paciente. Objetivo: Describir las características clínicas y epidemiológicas en pacientes discapacitados visuales por retinosis pigmentaria de la provincia Sancti Spíritus. Metodología: Se realizó un estudio descriptivo, que incluyó 140 pacientes discapacitados visuales afectados por retinosis pigmentaria. Resultados: El grupo etario entre los 29 y 56 años fue el más afectado (78.1 %), el 65 % era del sexo masculino, predominó el color blanco de la piel (87.1 %), sobresalió la catarata como la afección ocular (13.6 %), el 16.4 % presentó hipertensión arterial; la mayoría de los discapacitados no presentó hábitos tóxicos (55 %), prevaleció el debut precoz en el 70 % de los casos. La forma típica de la enfermedad se observó en el 98.5 % de los enfermos, el 67 % manifestó un estadio clínico de la enfermedad grado IV, así como la herencia autosómica recesiva en el 36.4 %. Conclusiones: Predominio de los enfermos en los grupos etario entre 29 y 56 años, masculino, color blanco de la piel; la catarata como patología ocular más frecuente junto a la hipertensión arterial dentro las enfermedades sistémicas; la mayoría de los discapacitados no presentó hábitos tóxicos. El debut precoz, la forma típica, el estadio IV de la enfermedad, así como la herencia autosómica dominante prevalecieron en el estudio.

ABSTRACT Background: Retinitis pigmentosa is a cause of visual impairment that causes psychological and social alterations to the patient. Objective: To describe the clinical and epidemiological characteristics in visual impaired patients due to retinitis pigmentosa in Sancti Spíritus province. Methodology: A descriptive study was carried out, which included 140 visual impaired patients affected by retinitis pigmentosa. Results: The age group between 29 and 56 years old was the most affected (78.1 %), 65 % were male, white skin predominated (87.1 %), cataract stood out as an eye condition (13.6 %), 16.4 % presented arterial hypertension; most of the disabled did not present toxic habits (55 %), early debut prevailed in 70 % of cases. The typical form of the disease was observed in 98.5 % of patients, 67 % showed a clinical stage of grade IV disease, as well as autosomal recessive inheritance in 36.4 %. Conclusions: Prevalence of patients in the age groups between 29 and 56 years, male, white skin color; cataract as the most frequent ocular pathology together with arterial hypertension within systemic diseases; the majority of the disabled patients did not show toxic habits. Early debut, typical form, stage IV disease, and autosomal dominant inheritance prevailed in the study.

An Environmental Niche Model to Estimate the Potential Presence of Venezuelan Equine Encephalitis Virus in Costa Rica.

Venezuelan equine encephalitis virus (VEEV) is an arbovirus transmitted by arthropods, widely distributed in the Americas that, depending on the subtype, can produce outbreaks or yearly cases of encephalitis in horses and humans. The symptoms are similar to those caused by dengue virus and in the worst-case scenario, involve encephalitis, and death. MaxEnt is software that uses climatological, geographical, and occurrence data of a particular species to create a model to estimate possible niches that could have these favorable conditions. We used MaxEnt with a total of 188 registers of VEEV presence, and 20 variables, (19 bioclimatological plus altitude) to determine the niches promising for the presence of VEEV. The area under the ROC curve (AUC) value for the model with all variables was 0.80 for the training data and 0.72 for the test. The variables with the highest contribution to the model were Bio11 (mean temperature of the coldest quarter) 32.5%, Bio17 (precipitation of the driest quarter) 16.9%, Bio2 (annual mean temperature) 15.1%, altitude (m.a.s.l) 6.6%, and Bio18 (precipitation of the warmest quarter) 6.2%. The product of this research will be useful under the one health scheme to animal and human health authorities to forecast areas with high propensity for VEEV cases in the future.

Profilaxis de la endoftalmitis posquirúrgica con cefuroxima intracamerular / Prophylaxis of postoperative endophthalmitis with intracamerular cefuroxime

RESUMEN Fundamento: La cirugía de catarata es la intervención oftalmológica más realizada en el mundo con exitosos resultados visuales posoperatorio, por lo cual una endoftalmitis posquirúrgica es una de las complicaciones más temidas y devastadoras. Objetivo: Caracterizar los pacientes operados de catarata a los cuales se les administró cefuroxima intracameral como método profiláctico para la endoftalmitis posquirúrgica durante los primeros 6 meses de su aplicación. Metodología: Se realizó un estudio retrospectivo en el Hospital Provincial General Camilo Cienfuegos de Sancti Spíritus del 15 de octubre de 2015 al 15 de abril de 2016. El universo estuvo constituido por 575 pacientes operados de cirugía de cataratas y la muestra por 538 pacientes a los cuales se les aplicó cefuroxima intracamerular como método profiláctico. Resultados: Se incluyeron 538 pacientes de ellos 279 mujeres y 259 hombres con edad promedio de 46 a 60 años. Se presentaron complicaciones en 21 ojos. En ningún paciente se diagnosticó síndrome inflamatorio tóxico asociado al uso de medicamentos intraoculares. Se reportó un solo caso de endoftalmitis al cual se le realizó extracción extracapsular. Conclusiones: La inyección de cefuroxima intracameral es una maniobra sencilla, eficaz y segura para la profilaxis de la endoftalmitis posquirúrgica.

ABSTRACT Background: Cataract surgery is the most performed ophthalmologic intervention in the world with successful postoperative visual results, so a postoperative endophthalmitis is one of the most feared and devastating complications. Objective: To characterize cataract surgery patients who were given intracameral cefuroxime as a prophylactic method of postoperative endophthalmitis during the first 6 months of its application. Methodology: A retrospective study was carried out at Camilo Cienfuegos General Provincial Hospital in Sancti Spíritus from October 15, 2015 to April 15, 2016. The universe consisted of 575 patients operated on from cataract surgery with a sample of 538 patients which were applied intracamerular cefuroxime as a prophylactic method. Results: 538 patients were included, 279 women and 259 men with an average age of 46 to 60 years. There were complications in 21 eyes. In no patient was toxic inflammatory syndrome associated with the use of intraocular medications. A single case of endophthalmitis was reported and extracapsular extraction was performed. Conclusions: The injection of intracameral cefuroxime is a simple, effective and safe maneuver for the prophylaxis of postoperative endophthalmitis.

Profilaxis de la endoftalmitis posquirúrgica con cefuroxima intracamerular / Prophylaxis of postoperative endophthalmitis with intracamerular cefuroxime

RESUMEN Fundamento: La cirugía de catarata es la intervención oftalmológica más realizada en el mundo con exitosos resultados visuales posoperatorio, por lo cual una endoftalmitis posquirúrgica es una de las complicaciones más temidas y devastadoras. Objetivo: Caracterizar los pacientes operados de catarata a los cuales se les administró cefuroxima intracameral como método profiláctico para la endoftalmitis posquirúrgica durante los primeros 6 meses de su aplicación. Metodología: Se realizó un estudio retrospectivo en el Hospital Provincial General Camilo Cienfuegos de Sancti Spíritus del 15 de octubre de 2015 al 15 de abril de 2016. El universo estuvo constituido por 575 pacientes operados de cirugía de cataratas y la muestra por 538 pacientes a los cuales se les aplicó cefuroxima intracamerular como método profiláctico. Resultados: Se incluyeron 538 pacientes de ellos 279 mujeres y 259 hombres con edad promedio de 46 a 60 años. Se presentaron complicaciones en 21 ojos. En ningún paciente se diagnosticó síndrome inflamatorio tóxico asociado al uso de medicamentos intraoculares. Se reportó un solo caso de endoftalmitis al cual se le realizó extracción extracapsular. Conclusiones: La inyección de cefuroxima intracameral es una maniobra sencilla, eficaz y segura para la profilaxis de la endoftalmitis posquirúrgica.

ABSTRACT Background: Cataract surgery is the most performed ophthalmologic intervention in the world with successful postoperative visual results, so a postoperative endophthalmitis is one of the most feared and devastating complications. Objective: To characterize cataract surgery patients who were given intracameral cefuroxime as a prophylactic method of postoperative endophthalmitis during the first 6 months of its application. Methodology: A retrospective study was carried out at Camilo Cienfuegos General Provincial Hospital in Sancti Spíritus from October 15, 2015 to April 15, 2016. The universe consisted of 575 patients operated on from cataract surgery with a sample of 538 patients which were applied intracamerular cefuroxime as a prophylactic method. Results: 538 patients were included, 279 women and 259 men with an average age of 46 to 60 years. There were complications in 21 eyes. In no patient was toxic inflammatory syndrome associated with the use of intraocular medications. A single case of endophthalmitis was reported and extracapsular extraction was performed. Conclusions: The injection of intracameral cefuroxime is a simple, effective and safe maneuver for the prophylaxis of postoperative endophthalmitis.

Phylodynamics reveals extinction-recolonization dynamics underpin apparently endemic vampire bat rabies in Costa Rica.

Variation in disease incidence in wildlife is often assumed to reflect environmental or demographic changes acting on an endemic pathogen. However, apparent endemicity might instead arise from spatial processes that are challenging to identify from traditional data sources including time series and field studies. Here, we analysed longitudinal sequence data collected from rabies virus outbreaks over 14 years in Costa Rica, a Central American country that has recorded continuous vampire bat-transmitted rabies outbreaks in humans and livestock since 1985. We identified five phylogenetically distinct lineages which shared most recent common ancestors with viruses from North and South America. Bayesian phylogeographic reconstructions supported bidirectional viral dispersals involving countries to the north and south of Costa Rica at different time points. Within Costa Rica, viruses showed little contemporaneous spatial overlap and no lineage was detected across all years of surveillance. Statistical models suggested that lineage disappearances were more likely to be explained by viral extinctions than undetected viral circulation. Our results highlight the importance of international viral dispersal for shaping the burden of rabies in Costa Rica, suggest a Central American corridor of rabies virus invasions between continents, and show that apparent disease endemicity may arise through recurrent pathogen extinctions and reinvasions which can be readily detected in relatively small datasets by joining phylodynamic and modelling approaches.

First Complete Coding Sequence of a Venezuelan Equine Encephalitis Virus Strain Isolated from an Equine Encephalitis Case in Costa Rica.

The first complete coding sequence of the Venezuelan equine encephalitis virus IE, isolated from a Costa Rican mare with severe encephalitis, was confirmed by histological and viral whole-genome analyses. The isolated virus grouped in the Pacific cluster.

Assessing changing weather and the El Niño Southern Oscillation impacts on cattle rabies outbreaks and mortality in Costa Rica (1985-2016).

BACKGROUND: Rabies is a major zoonotic disease affecting humans, domestic and wildlife mammals. Cattle are the most important domestic animals impacted by rabies virus in the New World, leading to thousands of cattle deaths per year and eliciting large economic losses. In the New World, virus transmission in cattle is primarily associated with Desmodus rotundus, the common vampire bat. This study analyses the association of weather fluctuations and the El Niño Southern Oscillation (ENSO), with the occurrence and magnitude, in terms of associated mortality, of cattle rabies outbreaks. Data from the 100 cattle rabies outbreaks recorded between 1985 and 2016 in Costa Rica were analyzed. Periodograms for time series of rabies outbreaks and the El Niño 4 index were estimated. Seasonality was studied using a seasonal boxplot. The association between epidemiological and climatic time series was studied via cross wavelet coherence analysis. Retrospective space-time scan cluster analyses were also performed. Finally, seasonal autoregressive time series models were fitted to study linear associations between monthly number of outbreaks, monthly mortality rates and the El Niño 4 index, temperature, and rainfall. RESULTS: Large rabies mortality occurred towards the Atlantic basin of the country. Outbreak occurrence and size were not directly associated with ENSO, but were sensitive to weather variables impacted by ENSO. Both, ENSO phases and rabies outbreaks, showed a similar 5 year period in their oscillations. Cattle rabies mortality and outbreak occurrence increased with temperature, whereas outbreak occurrence decreased with rainfall. These results suggest that special weather conditions might favor the occurrence of cattle rabies outbreaks. CONCLUSIONS: Further efforts are necessary to articulate the mechanisms underpinning the association between weather changes and cattle rabies outbreaks. One hypothesis is that exacerbation of cattle rabies outbreaks might be mediated by impacts of weather conditions on common vampire bat movement and access to food resources on its natural habitats. Further eco-epidemiological field studies could help to understand rabies virus transmission ecology, and to propose sound interventions to control this major veterinary public health problem.

Extracción de catarata mediante la técnica de facoemulsificación con implante de lente intraocular / Cataract´s extraction by phacoemulsification´s technique with intraocular lens

Fundamento: La facoemulsificación es la técnica quirúrgica más aceptada en la actualidad para la cirugía de catarata Objetivo: Describir los resultados de la cirugía de catarata mediante la técnica de facoemulsificación. Metodología: Se realizó un estudio descriptivo, longitudinal y prospectivo en 115 ojos de pacientes con diagnóstico de catarata operados en el Hospital General Provincial Camilo Cienfuegos, entre julio 2009 y agosto 2015. Se analizaron las variables: edad, sexo, tipo de catarata, agudeza visual sin corrección y mejor corregida, tipo de lente intraocular empleado y posición del mismo, complicaciones transoperatorias y posoperatorias. Resultados: El grupo etario que prevaleció fue el de 60 años y más con 47 %, hubo un predominio de féminas sobre masculinos para un 55,7 %; se halló un 53 % de catarata relacionada con la edad, se encontró un 45,2 % de pacientes con agudeza visual preoperatoria de 0.1 a 0.3 de visión; en cuanto a la agudeza visual posoperatoria, a los siete días ya un 13 % alcanzó la unidad de visión, situación que cambió al mes con un 27 %; ya con la agudeza visual mejor corregida se observó un 86,1 % de pacientes con una visión de 1.0 y con visión de 0.8 a 0.9 para un 6,8 %, lo que evidenció la mejoría en la misma. La complicación transoperatoria más frecuente fue el surge y la posquirúrgica, la opacidad de cápsula posterior, aunque en ambos casos el mayor por ciento de pacientes no las presentó. Conclusiones: Se constató una mejoría importante de la agudeza visual sin corregir y con corrección después de la cirugía con un menor número de complicaciones