Dispersion patterns of SARS-CoV-2 variants Gamma, Lambda and Mu in Latin America and the Caribbean.

Latin America and Caribbean (LAC) regions were an important epicenter of the COVID-19 pandemic and SARS-CoV-2 evolution. Through the COVID-19 Genomic Surveillance Regional Network (COVIGEN), LAC countries produced an important number of genomic sequencing data that made possible an enhanced SARS-CoV-2 genomic surveillance capacity in the Americas, paving the way for characterization of emerging variants and helping to guide the public health response. In this study we analyzed approximately 300,000 SARS-CoV-2 sequences generated between February 2020 and March 2022 by multiple genomic surveillance efforts in LAC and reconstructed the diffusion patterns of the main variants of concern (VOCs) and of interest (VOIs) possibly originated in the Region. Our phylogenetic analysis revealed that the spread of variants Gamma, Lambda and Mu reflects human mobility patterns due to variations of international air passenger transportation and gradual lifting of social distance measures previously implemented in countries. Our results highlight the potential of genetic data to reconstruct viral spread and unveil preferential routes of viral migrations that are shaped by human mobility patterns.

Renal function and periprocedural complications in patients undergoing left atrial catheter ablation: A comparison between uninterrupted direct oral anticoagulants and phenprocoumon administration.

BACKGROUND: Data regarding uninterrupted oral anticoagulation in patients with chronic kidney disease (CKD) during catheter ablation for left atrial arrhythmias is limited. This study aimed to evaluate the safety and efficacy of periprocedural uninterrupted direct oral anticoagulants (DOAC) compared with uninterrupted phenprocoumon in patients with CKD undergoing left atrial catheter ablation. METHODS AND RESULTS: We conducted a retrospective single-center study of patients who underwent left atrial catheter ablation between 2016 and 2019 with underlying chronic kidney disease (glomerular filtration rate (GFR) between 15 and 45 ml/min). The primary objective of this study was to investigate whether direct oral anticoagulant (DOAC) therapy or warfarin presents a superior safety profile in patients with chronic kidney disease (CKD) undergoing left atrial catheter ablation. We compared periprocedural complications (arteriovenous fistula, aneurysm, significant hematoma (> 5 cm)) and/or bleeding (drop in hemoglobin of >2 g/dl, pericardial effusion, retroperitoneal bleeding, other bleeding, stroke) between patients receiving either uninterrupted DOAC or warfarin therapy. Secondary analysis included patient baseline characteristics as well as procedural data. A total of 188 patients (female n = 108 (57%), mean age 75.3 ± 8.1 years, mean GFR 36.8 ± 6 ml/min) were included in this study. Underlying arrhythmias were atrial fibrillation (n = 104, 55.3%) and atypical atrial flutter (n = 84, 44.7%). Of these, n = 132 patients (70%) were under a DOAC medication, and n = 56 (30%) were under phenprocoumon. Major groin complications including pseudoaneurysm and/or AV fistula occurred in 8.9% of patients in the phenprocoumon group vs. 11.3% of patients in the DOAC group, which was not statistically significant (p = 0.62). Incidence of cardiac tamponade (2.3% vs. 0%; p = 0.55) and stroke (0% vs. 0%) were low in both DOAC and phenprocoumon groups with similar post-procedural drops in hemoglobin levels (1.1±1 g/dl vs 1.1±0.9 g/dl; p = 0.71). CONCLUSION: The type of anticoagulation had no significant influence on bleeding or thromboembolic events as well as groin complications in this retrospective study. Despite observing an increased rate of groin complications, the uninterrupted use of DOAC or phenprocoumon during left atrial catheter ablation in patients with CKD appears to be feasible and effective.

HIV-1 Low-Frequency Variants Identified in Antiretroviral-Naïve Subjects with Virologic Failure after 12 Months of Follow-Up in Panama.

Low-frequency mutations associated with drug resistance have been related to virologic failure in subjects with no history of pre-treatment and recent HIV diagnosis. In total, 78 antiretroviral treatment (ART)-naïve subjects with a recent HIV diagnosis were selected and followed by CD4+ T lymphocytes and viral load tests to detect virologic failure. We sequenced the basal samples retrospectively using next-generation sequencing (NGS), looking for low-frequency mutations that had not been detected before using the Sanger sequencing method (SSM) and describing the response to ART. Twenty-two subjects developed virologic failure (VF), and thirteen of them had at least one drug-resistance mutation associated with Reverse Transcriptase Inhibitors (RTI) and Protease Inhibitors (PIs) at frequency levels ≤ 1%, not detected previously in their basal genotyping test. No resistance mutations were observed to Integrase Strand Transfer Inhibitors (INSTIs). We identified a possible cause of VF in ART-naïve subjects with low-frequency mutations detected. To our knowledge, this is the first evaluation of pre-existing drug resistance for HIV-1 minority variants carried out on ART-naïve people living with HIV/AIDS (PLWHA) by analyzing the HIV-1 pol gene using NGS in the country.

Three new Glossoscolex (Annelida: Crassiclitellata: Glossoscolecidae) in the truncatus group from the Brazilian Atlantic Forest.

Three new earthworm species of Glossoscolex (Glossoscolex) in the truncatus species group (intra-clitellar male pores on segment 17) are described: Glossoscolex araucariaensis sp. nov., Glossoscolex cardosoi sp. nov., and Glossoscolex santarosaensis sp. nov. from the Brazilian Atlantic Forest. The three earthworm species were distinguished based on the shape and position of the copulatory pouches (all species), the shape of the calciferous glands (G. santarosaensis) and by the presence of tubercula pubertatis and seminal vesicles restricted to segment 12 (G. cardosoi). All are endogeic, unpigmented and were found in low abundances in the topsoil (0-20 cm depth) of Araucaria forest and plantations, a lowland grass pasture and a shrubby grassland, respectively, and are known only from their type-localities. A table containing some of the main internal and external morphological characteristics of the 29 species/subspecies of the Glossoscolex truncatus group is provided in order to assist comparisons within species. Glossoscolex grandis ibirai Righi, 1971 is raised to species rank due to longer extent of clitellum and presence of genital markings, compared to Glossoscolex grandis (Michaelsen, 1892); furthermore, a new subgroup (matogrossensis) of Glossoscolex (Glossoscolex) is proposed to accomodate G. matogrossensis Righi, 1984, with intraclitellar male pores in 15/16. Some considerations on the ecological and taxonomic affinities within the truncatus group are presented, but further studies, particularly genetic are needed in order to better assess phylogenetic relationships within Glossoscolex (Glossoscolex) species groups.

Complete Genome Sequence of Enterobacter Phage vB_EcRAM-01, a New Pseudotevenvirus against the Enterobacter cloacae Complex.

Here, we present the complete genome sequence of Enterobacter phage vB_EcRAM-01, isolated from waters of the Río Abajo river, in Panama City, Panama. This phage has deployed lytic activity against the Enterobacter cloacae complex, a pathogen of clinical importance in intensive care units. It belongs to the Myoviridae family and has a double-stranded DNA genome that is 178,477 bp long and contains 293 open reading frames (ORFs).

Reestenosis de stents liberadores de paclitaxel frente a stents convencionales

RESUMEN Introducción: La reestenosis de los stents liberadores de paclitaxel utilizados en Cuba no ha sido estudiada. Objetivo: Evaluar la reestenosis de los stents liberadores de paclitaxel y los convencionales. Métodos: Se incluyeron 64 pacientes con reestenosis de stent, de un estudio prospectivo previo; en 318 pacientes seguidos por 3 años luego de intervención coronaria percutánea; 25 con stent liberador de paclitaxel y 39 stent metálico convencional. Se consideró reestenosis como nueva lesión ≥ 50 % de la luz del vaso con isquemia demostrada. Se describió el tiempo de aparición, patrón angiográfico y alternativa de revascularización. Resultados: La reestenosis en el grupo de stents liberadores de paclitaxel fue 15,7 % con tiempo medio de supervivencia sin reestenosis de 32,4 meses vs. 24,5 % en stents convencionales, con supervivencia sin reestenosis de 29,8 meses, (p= 0,047). En el grupo de stents liberadores de paclitaxel predominó el patrón IB, (30,3 %) y stent convencional el III (28,3 %). En el 28,0 % del grupo de stents liberadores de paclitaxel, se recurrió a la cirugía de revascularización vs. 5,1 % en el grupo de stent convencional. Conclusiones: El stent liberador de paclitaxel logra una supervivencia libre de reestenosis superior y más perdurable que el stent convencional. La reestenosis en los de stents liberadores de paclitaxel es focal, con mayor frecuencia de nueva revascularización por cirugía y en los stents convencionales es mayormente difusa.

ABSTRACT Introduction: The restenosis of the paclitaxel-eluting stents used in Cuba has not been studied. Objective: To evaluate the restenosis of paclitaxel-eluting stents and conventional stents. Methods: 64 patients with stent restenosis were included, from a previous prospective study; in 318 patients followed up for 3 years after percutaneous coronary intervention; 25 with a paclitaxel-eluting stent and 39 conventional metal stent. Restenosis was considered as a new lesion ≥ 50 % of the vessel lumen with proven ischemia. The time to onset, angiographic pattern and alternative revascularization were described. Results: Restenosis in the group with paclitaxel-eluting stents was 15.7 % with a mean survival time without restenosis of 32.4 months vs. 24.5 % in conventional stents, with restenosis-free survival of 29.8 months, (p = 0.047). In the group with paclitaxel-eluting stents, the IB pattern predominated (30.3 %) and the conventional stent III (28.3 %). In 28.0 % of the paclitaxel-eluting stent group, revascularization surgery was used vs. 5.1 % in the conventional stent group. Conclusions: The paclitaxel-eluting stent achieves a superior and more durable restenosis-free survival than the conventional stent. Restenosis in paclitaxel-eluting stents is focal, with a higher frequency of revascularization by surgery, and in conventional stents it is mostly diffuse.

Incidence and risk factors for acute kidney injury associated to surgery for congenital heart disease / Incidencia y factores de riesgo de falla renal aguda asociados a la corrección quirúrgica de cardiopatías congénitas

Abstract Background: Acute kidney injury (AKI) occurs frequently after cardiac surgery for congenital heart disease and it has a great impact on patient´s prognosis. Objective: The aims of this study were to determine the incidence and risk factors for AKI in children undergoing cardiac surgery and its impact on mortality, duration of mechanical ventilation, ICU and total hospital length of stay. Methods: This was a historical cohort study of children 0 - 18 years of age who underwent cardiac surgery between 2012 and 2014. We used the Risk Adjustment for Congenital Heart Surgery-1 (RACHS) scale to evaluate risk of the surgery. AKI was defined in accordance to the Acute Kidney Injury Network (AKIN) criteria. Results: A total of 485 patients were included. AKI occurred in 89 (18.3%) patients during the study period. Risk factors for AKI were age < 2 years, cardiopulmonary bypass (CPB) time > 120 min and RACHS score > 3. AKI increased the mortality risk (OR: 5.82, 95% CI: 2.24-15.10) and the time in mechanical ventilation and ICU stay from 1 to 5 days and 6 to 12 days, respectively. Conclusions: Risk factors for AKI are younger age, higher RACHS score, and time of CPB greater than 120 minutes. AKI increases mortality, days on MV and ICU stay. In the present study AKIN scale allowed us to classify the severity of AKI and it correlated with prognosis after cardiac surgery.

Resumen Introducción: La insuficiencia renal aguda (IRA) ocurre frecuentemente después de las cirugías de cardiopatías congénitas e impacta el pronóstico del paciente. Objetivo: Determinar incidencia y factores de riesgo para IRA en niños sometidos a cirugía de cardiopatía congénita y su impacto en mortalidad, duración de ventilación mecánica, tiempo de hospitalización total y en Cuidados Intensivos (UCI). Métodos: Cohorte histórica de niños entre cero y 18 años sometidos a cirugía cardiaca entre 2012 y 2014. El riesgo de la cirugía fue calculado mediante la escala Risk Adjustment for Congenital Heart Surgery-1 (RACHS). La falla renal fue establecida de acuerdo a la escala de Acute Kidney Injury Network (AKIN). Resultados: Se incluyeron 485 pacientes. 89 pacientes (18.3%) desarrollaron IRA durante el postquirúrgico. Los factores de riesgo para IRA fueron edad < 2 años, tiempo de bypass cardiopulmonar > 120 minutos y escala de RACHS > 3. La ocurrencia de IRA aumento el tiempo de ventilación mecánica de 1 a 5 días, la estancia en UCI de 6 a 12 días y el riesgo de mortalidad (OR: 5.82, 95% IC: 2.24-15.10). Conclusiones: Los factores de riesgo para IRA fueron menor edad, mayor escala de RACHS y de tiempo de bypass. La ocurrencia de IRA aumentó la mortalidad, días en ventilación mecánica y estancia en UCI. En el presente estudio la escala de AKIN permitió clasificar la severidad de AKI y se correlaciono con el pronóstico después de cirugía de cardiopatía congénita.

Case Report: First Confirmed Case of Coinfection of SARS-CoV-2 With Choclo orthohantavirus.

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a major international public health concern. The World Health Organization (WHO) declared the pandemic of coronavirus disease 2019 (COVID-19) on March 11, 2020. In Panama, the first SARS-CoV-2 infection was confirmed on March 9, 2020, and the first fatal case associated to COVID-19 was reported on March 10. This report presents the case of a 44-year-old female who arrived at the hospital with a respiratory failure, five days after the first fatal COVID-19 case, and who was living in a region where hantavirus pulmonary syndrome cases caused by Choclo orthohantavirus (CHOV), are prevalent. Thus, the clinical personnel set a differential diagnosis to determine a respiratory disease caused by the endemic CHOV or the new pandemic SARS-CoV-2. This case investigation describes the first coinfection by SARS-CoV-2 and CHOV worldwide. PCR detected both viruses during early stages of the disease and the genomic sequences were obtained. The presence of antibodies was determined during the patient's hospitalization. After 23 days at the intensive care unit, the patient survived with no sequelae, and antibodies against CHOV and SARS-CoV-2 were still detectable 12 months after the disease. The detection of the coinfection in this patient highlights the importance, during a pandemic, of complementing the testing and diagnosis of the emergent agent, SARS-CoV-2, with other common endemic respiratory pathogens and other zoonotic pathogens, like CHOV, in regions where they are of public health concern.

SARS-CoV-2 reinfection with a virus harboring mutation in the Spike and the Nucleocapsid proteins in Panama.

We report a case of reinfection by SARS-CoV-2 with the second virus harboring amino acid changes in the Spike protein (141-143del, D215A, ins215AGY, L452R, D614G), orf1a, helicase, orf3a, and Nucleocapside. The virus associated with the reinfection, from an endemic lineage containing the S:L452R immune escape mutation, was circulating in Panama at the time.

Severe acute respiratory syndrome coronavirus 2 detected in placentas of 2 coronavirus disease 2019-positive asymptomatic pregnant women-case report.

There is limited evidence regarding severe acute respiratory syndrome coronavirus 2 infection in the placenta of pregnant women who tested positive, and if this could be a route for vertical transmission of the virus in utero. We present the cases of 2 pregnant women in their third trimester who were admitted for delivery by cesarean delivery and who, through universal screening, tested positive for coronavirus disease 2019. The maternal and fetal sides of the placenta were sectioned from both patients for viral analysis. Real-time polymerase chain reaction analysis of the placental-extracted RNA revealed a severe acute respiratory syndrome coronavirus 2 infection on the fetal side of the placenta in both patients. The virus was isolated from the patient with the lowest cycle threshold value on the fetal side of the placenta. Whole genome sequencing showed that the virus detected in this placenta was from the B1 lineage. Immunohistochemical analysis of the placental tissue detected severe acute respiratory syndrome coronavirus 2 in the endothelial cells of chorionic villi vessels proximal to both the maternal and fetal sides, with a granular cytoplasmic pattern and perinuclear reinforcement. Histologic examination of the placenta also detected a dense infiltrate of lymphoid cells around decidual vessels and endothelial cells with cytopathic changes, especially on the maternal side. Nasopharyngeal swabs from the infants that were subjected to reverse transcription quantitative polymerase chain reaction testing were negative for severe acute respiratory syndrome coronavirus 2 at 24 hours after birth. A follow-up analysis of the infants for immunoglobin G and immunoglobin M expression, clinical manifestations, and long-term developmental abnormalities is recommended.

Rapid genetic adaptation to recently colonized environments is driven by genes underlying life history traits.

BACKGROUND: Uncovering the mechanisms underlying rapid genetic adaptation can provide insight into adaptive evolution and shed light on conservation, invasive species control, and natural resource management. However, it can be difficult to experimentally explore rapid adaptation due to the challenges associated with propagating and maintaining species in captive environments for long periods of time. By contrast, many introduced species have experienced strong selection when colonizing environments that differ substantially from their native range and thus provide a "natural experiment" for studying rapid genetic adaptation. One such example occurred when sea lamprey (Petromyzon marinus), native to the northern Atlantic, naturally migrated into Lake Champlain and expanded their range into the Great Lakes via man-made shipping canals. RESULTS: Utilizing 368,886 genome-wide single nucleotide polymorphisms (SNPs), we calculated genome-wide levels of genetic diversity (i.e., heterozygosity and π) for sea lamprey collected from native (Connecticut River), native but recently colonized (Lake Champlain), and invasive (Lake Michigan) populations, assessed genetic differentiation between all populations, and identified candidate genes that responded to selection imposed by the novel environments. We observed a 14 and 24% reduction in genetic diversity in Lake Michigan and Lake Champlain populations, respectively, compared to individuals from the Connecticut River, suggesting that sea lamprey populations underwent a genetic bottleneck during colonization. Additionally, we identified 121 and 43 outlier genes in comparisons between Lake Michigan and Connecticut River and between Lake Champlain and Connecticut River, respectively. Six outlier genes that contained synonymous SNPs in their coding regions and two genes that contained nonsynonymous SNPs may underlie the rapid evolution of growth (i.e., GHR), reproduction (i.e., PGR, TTC25, STARD10), and bioenergetics (i.e., OXCT1, PYGL, DIN4, SLC25A15). CONCLUSIONS: By identifying the genomic basis of rapid adaptation to novel environments, we demonstrate that populations of invasive species can be a useful study system for understanding adaptive evolution. Furthermore, the reduction in genome-wide levels of genetic diversity associated with colonization coupled with the identification of outlier genes underlying key life history traits known to have changed in invasive sea lamprey populations (e.g., growth, reproduction) illustrate the utility in applying genomic approaches for the successful management of introduced species.

Diversity of Rickettsia in ticks collected from wild animals in Panama.

This paper presents new data about Rickettsia species detected in ticks collected from wild animals, using 16S rRNA, gltA and ompA. Rickettsia DNA was found in 66 of 101 ticks. Using EZ BioCloud libraries were produced reads that identified Rickettsia aeschlimannii, and Illumina BaseSpace produced reads of Rickettsia rickettsii group, Rickettsia bellii group, and unclassified Rickettsia. Using gltA and ompA gene-specific primers, R. aeschlimannii could not be confirmed, but detection of Rickettsia amblyommatis was achieved in Amblyomma auricularium, Amblyomma geayi, Amblyomma mixtum, and Amblyomma pacae; R. bellii from Amblyomma dissimile, "Candidatus Rickettsia colombianensi" from A. dissimile, Rickettsia spp. closely related to R. raoultii from A. geayi, Rickettsia tamurae from A. dissimile, and Rickettsia endosymbionts of Ixodes from Ixodes affinis. There were no databases available specifically for 16S rRNA of Neotropical Rickettsia, highlighting the need to use species primers over only 16S rRNA primers to achieve more accurate interpretations and identifications. These findings increase the number of Rickettsia species detected in Panama and highlight the need to establish isolates to further characterize the nature of Rickettsia in the area.

Field and classroom initiatives for portable sequence-based monitoring of dengue virus in Brazil.

Brazil experienced a large dengue virus (DENV) epidemic in 2019, highlighting a continuous struggle with effective control and public health preparedness. Using Oxford Nanopore sequencing, we led field and classroom initiatives for the monitoring of DENV in Brazil, generating 227 novel genome sequences of DENV1-2 from 85 municipalities (2015-2019). This equated to an over 50% increase in the number of DENV genomes from Brazil available in public databases. Using both phylogenetic and epidemiological models we retrospectively reconstructed the recent transmission history of DENV1-2. Phylogenetic analysis revealed complex patterns of transmission, with both lineage co-circulation and replacement. We identified two lineages within the DENV2 BR-4 clade, for which we estimated the effective reproduction number and pattern of seasonality. Overall, the surveillance outputs and training initiative described here serve as a proof-of-concept for the utility of real-time portable sequencing for research and local capacity building in the genomic surveillance of emerging viruses.

Incipient resistance to an effective pesticide results from genetic adaptation and the canalization of gene expression.

The resistance of pest species to chemical controls has vast ecological, economic, and societal costs. In most cases, resistance is only detected after spreading throughout an entire population. Detecting resistance in its incipient stages, by comparison, provides time to implement preventative strategies. Incipient resistance can be detected by coupling standard toxicology assays with large-scale gene expression experiments. We apply this approach to a system where an invasive parasite, sea lamprey (Petromyzon marinus), has been treated with the highly effective pesticide 3-trifluoromethyl-4-nitrophenol (TFM) for 60 years. Toxicological experiments revealed that lamprey from treated populations did not have higher survival to TFM exposure than lamprey from untreated populations, demonstrating that full-fledged resistance has not yet evolved. In contrast, we find hundreds of genes differentially expressed in response to TFM in the population with the longest history of exposure, many of which relate to TFM's primary mode of action, the uncoupling of oxidative phosphorylation, and subsequent depletion of ATP. Three genes critical to oxidative phosphorylation, ATP5PB, PLCB1, and NDUFA9, were nearly fixed for alternative alleles in comparisons of SNPs between treated and untreated populations (FST  > 5 SD from the mean). ATP5PB encodes subunit b of ATP synthase and an additional subunit, ATP5F1B, was canalized for high expression in treated populations, but remained plastic in response to TFM treatment in individuals from the untreated population. These combined genomic and transcriptomic results demonstrate that an adaptive, genetic response to TFM is likely driving incipient resistance in a damaging pest species.

Early Transmission Dynamics, Spread, and Genomic Characterization of SARS-CoV-2 in Panama.

We report an epidemiologic analysis of 4,210 cases of infection with severe acute respiratory syndrome coronavirus 2 and genetic analysis of 313 new near-complete virus genomes in Panama during March 9-April 16, 2020. Although containment measures reduced R0 and Rt, they did not interrupt virus spread in the country.

Prevalence and determinants of genital Chlamydia trachomatis among school-going, sexually experienced adolescents in urban and rural Indigenous regions of Panama.

OBJECTIVES: To determine the prevalence and risk factors of genital Chlamydia trachomatis (CT) among school-going sexually experienced male and female adolescents in Panama. METHODS: We conducted two multisite cross-sectional studies using two-stage cluster sampling to select adolescents aged 14-19 years attending urban public high schools (URB) in Panama City, San Miguelito, Colón and Panama Oeste from 2015 to 2018, and in the rural Indigenous Comarca Ngäbe-Buglé (CNB) from July-November 2018. CT testing was performed by real-time PCR on urine samples. Random-effects logistic regression accounting for sample clustering was used to identify risk factors. RESULTS: We enrolled 3166 participants (54.3% females), median age 17 years (IQR: 15.9-18.1), with no difference by sex. Sexual experience was reported by 1954 (61.7%) participants. Combined CT prevalence was 15.8% (95% CI: 14.2 to 17.4), with no significant differences by region (URB=16.5%, 95% CI: 14.7% to 18.6%; CNB=13.6%, 95% CI: 10.9% to 16.8%; p=0.12). In an age-and-region-adjusted analysis, CT prevalence was higher among female participants compared with males (21.6% vs 9.1%, adjusted OR (AOR)=2.87, 95% CI: 1.62 to 5.10). Among sexually experienced females, CT prevalence was higher among those who reported ≥3 lifetime sex partners compared with one partner (33.5% vs 15.3%, AOR=2.20, 95% CI: 1.09 to 4.07); and among those reporting at least one pregnancy compared with nulligravidae participants (30.9% vs 13.8%, AOR=1.89, 95% CI: 1.05 to 3.43). In unadjusted analyses among males, CT was associated with older age (11.5% among those aged 18-19 years vs 3.4% among those aged 14-15 years, OR=3.69, 95% CI: 1.10 to 12.33). CONCLUSIONS: We report high CT prevalence among sexually experienced, school-going adolescents in Panama. Female adolescents, particularly those with multiple sex partners and a history of pregnancy, were at highest risk. Adolescent-targeted CT screening should be implemented in Panama. Additionally, evidence-based comprehensive sexuality education will be imperative.

Evaluación del método clínico en el diagnóstico de la cefalea oftalmológica en niños / Evaluation of the clinical method in the diagnosis of ophthalmic headache in children

Introducción: la cefalea constituye uno de los motivos de consulta más comunes por el cual las personas acuden a los servicios médicos, es una causa importante de discapacidad, que trae consigo consecuencias a nivel personal. Objetivo: evaluar la utilización del método clínico, en el diagnóstico de la cefalea de causa oftalmológica en la edad pediátrica. Método: se realizó un estudio observacional, descriptivo de corte transversal, a 192 pacientes que asistieron a los servicios de Urgencias de Oftalmología, en el Hospital Pediátrico Hermanos Cordové, en el período comprendido entre enero y diciembre del 2019. Se estudiaron las variables: edad y sexo, enseñanza escolar, antecedentes patológicos personales, características de la cefalea y diagnóstico presuntivo. Resultados: predominó los pacientes entre 6 y 7 años de edad del sexo femenino, cursando la enseñanza primaria, sin antecedentes patológicos personales, con una cefalea de inicio subagudo, episódica, que afecta las actividades cotidianas, que aparece en cualquier momento del día, acompañada principalmente de alteraciones visuales y náuseas y vómitos, predominando como diagnóstico presuntivo la cefalea migrañosa. Conclusiones: se demostró que el mayor por ciento de los pacientes que acudieron por cefalea a los servicios de urgencias de oftalmología, esta, no estaba relacionada a trastornos oftalmológicos(AU)

Introduction: headache is one of the most common reasons for consultation for which people go to medical services, it is an important cause of disability, which brings with it consequences on a personal level. Objective: to evaluate the use of the clinical method in the diagnosis of headache of ophthalmic cause in pediatric age. Method: an observational, descriptive, cross-sectional study was carried out of 192 patients who attended the Ophthalmology Emergency Services at the Hermanos Cordové Pediatric Hospital, in the period between January and December 2019. The variables were studied: age and sex, school education, personal pathological history, headache characteristics and presumptive diagnosis. Results: there was a predominance of female patients between 6 and 7 years of age, attending primary school, without personal pathological history, with a headache of subacute onset, episodic, which affects daily activities, which appears at any time of the day, accompanied mainly of visual disturbances and nausea and vomiting, prevailing as a presumptive diagnosis migraine headache. Conclusions: It was shown that the highest percentage of patients who attended the ophthalmology emergency department for headache, this was not related to ophthalmological disorders(EU)

Evaluación del método clínico en el diagnóstico de la cefalea oftalmológica en niños / Evaluation of the clinical method in the diagnosis of ophthalmic headache in children / Avaliação do método clínico no diagnóstico de cefaléia oftálmica em crianças

RESUMEN Introducción: la cefalea constituye uno de los motivos de consulta más comunes por el cual las personas acuden a los servicios médicos, es una causa importante de discapacidad, que trae consigo consecuencias a nivel personal. Objetivo: evaluar la utilización del método clínico, en el diagnóstico de la cefalea de causa oftalmológica en la edad pediátrica. Método: se realizó un estudio observacional, descriptivo de corte transversal, a 192 pacientes que asistieron a los servicios de Urgencias de Oftalmología, en el Hospital Pediátrico Hermanos Cordové, en el período comprendido entre enero y diciembre del 2019. Se estudiaron las variables: edad y sexo, enseñanza escolar, antecedentes patológicos personales, características de la cefalea y diagnóstico presuntivo. Resultados: predominó los pacientes entre 6 y 7 años de edad del sexo femenino, cursando la enseñanza primaria, sin antecedentes patológicos personales, con una cefalea de inicio subagudo, episódica, que afecta las actividades cotidianas, que aparece en cualquier momento del día, acompañada principalmente de alteraciones visuales y náuseas y vómitos, predominando como diagnóstico presuntivo la cefalea migrañosa. Conclusiones: se demostró que el mayor por ciento de los pacientes que acudieron por cefalea a los servicios de urgencias de oftalmología, esta, no estaba relacionada a trastornos oftalmológicos.

ABSTRACT Introduction: headache is one of the most common reasons for consultation for which people go to medical services, it is an important cause of disability, which brings with it consequences on a personal level. Objective: to evaluate the use of the clinical method in the diagnosis of headache of ophthalmic cause in pediatric age. Method: an observational, descriptive, cross-sectional study was carried out of 192 patients who attended the Ophthalmology Emergency Services at the Hermanos Cordové Pediatric Hospital, in the period between January and December 2019. The variables were studied: age and sex, school education, personal pathological history, headache characteristics and presumptive diagnosis. Results: there was a predominance of female patients between 6 and 7 years of age, attending primary school, without personal pathological history, with a headache of subacute onset, episodic, which affects daily activities, which appears at any time of the day, accompanied mainly of visual disturbances and nausea and vomiting, prevailing as a presumptive diagnosis migraine headache. Conclusions: It was shown that the highest percentage of patients who attended the ophthalmology emergency department for headache, this was not related to ophthalmological disorders.

RESUMO Introdução: a dor de cabeça é um dos motivos mais comuns de consulta para as quais as pessoas vão aos serviços médicos; é uma importante causa de incapacidade, o que traz conseqüências em nível pessoal. Objetivo: avaliar o uso do método clínico no diagnóstico de cefaleia de causa oftalmológica em idade pediátrica. Método: estudo observacional, descritivo, transversal, com 192 pacientes atendidos no Serviço de Emergência em Oftalmologia do Hospital Pediátrico Hermanos Cordové, no período de janeiro a dezembro de 2019. As variáveis ​​estudadas foram: idade e sexo, educação escolar, história patológica pessoal, características da dor de cabeça e diagnóstico presuntivo. Resultados: houve predomínio de pacientes do sexo feminino entre 6 e 7 anos de idade, frequentadoras do ensino fundamental, sem histórico patológico pessoal, com cefaléia de início subagudo, episódica, que afeta as atividades diárias, que aparecem a qualquer hora do dia, acompanhadas principalmente de distúrbios visuais e náuseas e vômitos, prevalecendo como diagnóstico presuntivo de enxaqueca. Conclusões: Foi demonstrado que o maior percentual de pacientes que compareceu ao pronto-socorro oftalmológico por cefaleia não estava relacionado a distúrbios oftalmológicos.

Evolution of late presentation to care and advanced HIV in newly HIV diagnosed subjects in the Republic of Panama: 2012-2017.

Most of the information on clinical factors related to HIV infection is focused on key populations and young people. Therefore, there is little information on clinical factors related to HIV infection in older persons (>45 years old). In this study, data on CD4 lymphocyte counts were analyzed on adults who are linked to care and have their first CD4 cell count done from different regions of the Republic of Panama from 2012 to 2017. Samples were grouped according to late presentation status, region of origin in the country, year, gender, and age groups. Factors associated with late presentation to care and advanced HIV were assessed on each group by multivariable logistic regression. Late presentation to care was observed in 71.6% of the evaluated subjects, and advanced HIV in 54.5%. Late presentation was associated with males (adjusted odds ratio [AOR] = 1.3, 95% confidence interval [CI]=1.1-1.6, p = 0.03), age greater than 45 years old (AOR = 2.3 CI= 1.8-2.9, p < 0.001), and being from regions where antiretroviral clinics are not well instituted (AOR = 2.1, CI = 1.6-2.7, p < 0.001). Despite an increase in subjects linked to care with a CD4 test performed over the years, late presentation remained constant. Therefore, prevention policies must be reformulated. Promotion of routine HIV testing, accessibility among all population groups, installation of antiretroviral clinics, and implementation of programs as rapid initiation of antiretroviral therapy should be rolled out nationally.

The skin microbiome of elasmobranchs follows phylosymbiosis, but in teleost fishes, the microbiomes converge.

BACKGROUND: The vertebrate clade diverged into Chondrichthyes (sharks, rays, and chimeras) and Osteichthyes fishes (bony fishes) approximately 420 mya, with each group accumulating vast anatomical and physiological differences, including skin properties. The skin of Chondrichthyes fishes is covered in dermal denticles, whereas Osteichthyes fishes are covered in scales and are mucous rich. The divergence time among these two fish groups is hypothesized to result in predictable variation among symbionts. Here, using shotgun metagenomics, we test if patterns of diversity in the skin surface microbiome across the two fish clades match predictions made by phylosymbiosis theory. We hypothesize (1) the skin microbiome will be host and clade-specific, (2) evolutionary difference in elasmobranch and teleost will correspond with a concomitant increase in host-microbiome dissimilarity, and (3) the skin structure of the two groups will affect the taxonomic and functional composition of the microbiomes. RESULTS: We show that the taxonomic and functional composition of the microbiomes is host-specific. Teleost fish had lower average microbiome within clade similarity compared to among clade comparison, but their composition is not different among clade in a null based model. Elasmobranch's average similarity within clade was not different than across clade and not different in a null based model of comparison. In the comparison of host distance with microbiome distance, we found that the taxonomic composition of the microbiome was related to host distance for the elasmobranchs, but not the teleost fishes. In comparison, the gene function composition was not related to the host-organism distance for elasmobranchs but was negatively correlated with host distance for teleost fishes. CONCLUSION: Our results show the patterns of phylosymbiosis are not consistent across both fish clades, with the elasmobranchs showing phylosymbiosis, while the teleost fish are not. The discrepancy may be linked to alternative processes underpinning microbiome assemblage, including possible historical host-microbiome evolution of the elasmobranchs and convergent evolution in the teleost which filter specific microbial groups. Our comparison of the microbiomes among fishes represents an investigation into the microbial relationships of the oldest divergence of extant vertebrate hosts and reveals that microbial relationships are not consistent across evolutionary timescales. Video abstract.