Identification of Genetic Variants of Human Papillomavirus in a Group of Mexican HIV/AIDS Patients and Their Possible Association with Cervical Cancer.

Infections caused by the human immunodeficiency virus (HIV) and human papillomavirus (HPV) cause thousands of deaths worldwide each year. So far, there has been no consensus on whether there is a direct relationship between the incidence of neoplasms and the immunosuppression caused by HIV that could help understand if coinfection increases the likelihood of cervical cancer. The objective of the study was to identify the presence of genetic variants of HPV in a group of HIV-positive women and their possible association with cervical cancer. Cervical samples were taken from HIV-positive patients for cytological analysis to identify the HPV genotype by polymerase chain reaction (PCR) and sequencing. The most prevalent L1 capsid protein mutations in the HPV genotype were analyzed in silico. Various types of HPV were identified, both high-risk (HR) and low-risk (LR). The most prevalent genotype was HPV51. Analysis of the L1 gene sequences of HPV51 isolates showed nucleotide variations. Of the samples analyzed in Puebla, Mexico, HPV51 had the highest incidence (17.5%, 7/40). Different mutations, which could be used as population markers, were detected in this area, and they have not been reported in the L1 databases for HPV51 in Mexico. Genotypes 6, 14, 86, 87, 89, and 91, not detected or reported in samples from patients with HPV in Mexico, were also identified. Data from the population analyzed suggest no direct relationship between HIV immunosuppression and cervical cancer, regardless of the high- or low-risk HPV genotype. Furthermore, it is possible to develop regional population markers for the detection of HPV based on the mutations that occur in the sequence of nucleotides analyzed.

Trastornos temporomandibulares en niños y su relación con la lactancia artificial con uso del biberón / Temporomandibular disorders in children and its relation to artificial lactation with bottle-feeding

Objetivo. Establecer la relación de los trastornos temporomandibulares (TTM) de niños de 8 a 10 años, con lactancia artificial exclusiva con uso del biberón. Métodos. Estudio de casos y controles, (pareados por edad y sexo). Se incluyeron 38 niños, sin alteraciones del crecimiento ni parafunciones bucales severas, previo consentimiento (madres) y asentimiento (niños) informado. Los participantes fueron diagnosticados con TTM (19 casos) o sin diagnóstico de TTM (19 controles) utilizando los criterios diagnósticos para los TTM (CD/TTM), previa estandarización de la investigadora; kappa inter 0,98 e intraobservador 0,73. Los antecedentes de lactancia fueron registrados con cuestionario ex profeso: tipo y tiempo de administración y datos generales del niño y la madre. Se calculó estadística descriptiva e inferencial; Ji cuadrada para identificar la asociación entre TTM y lactancia artificial exclusiva con uso del biberón, y razón de posibilidades (OR), con valor significativo ≤0,05. Resultados. Edad 8,95±0,84 años, 57,9% sexo masculino, sin diferencias por grupos en la edad y escolaridad de las madres (p>0,05). El tipo de TTM más común fue dolor muscular (57,9%), seguido de luxación del disco con reducción y su combinación (21,1%). La media de apertura bucal, sitios musculares y articulares doloridos fue estadísticamente diferente entre los casos y controles (p<0,05). El porcentaje de alimentación con lactancia artificial exclusiva con uso del biberón fue igual en ambos grupos (57,9% p=1,00), el OR calculado fue de 1 con IC95% de 0,27-3,60. Conclusión. No se encontró relación entre la lactancia artificial con el uso del biberón y los TTM. El tipo de TTM más frecuente fue dolor muscular. Palabras clave: Niños; Conducta en la lactancia; Asimetría facial; Trastornos de la articulación temporomandibular; Odontología pediátrica (fuente DeCS BIREME).

Objective. To establish the relationship of temporomandibular disorders (TMD) in children aged 8 to 10 years, with exclusive artificial feeding. Methods. Case-control study (matched by age and sex). 38 children were included, without growth disturbances or severe oral parafunctions, with prior informed consent (mothers) and assent (children). Participants were diagnosed with TMD (19 cases) or without TMD diagnosis (19 controls) using the Diagnostic Criteria for TMD (CD / TMD), after standardization by the researcher; kappa inter 0.98 and intraobserver 0.73. The history of breastfeeding was recorded with an express questionnaire: type and time of administration, and general data of the child and the mother. Descriptive and inferential statistics were calculated; Chi square analysis was performed to identify the association between TMD and exclusive artificial feeding, and odds ratio (OR), with a significant value of ≤0.05. Results. Age 8.95 ± 0.84 years, 57.9% male, with no differences in age or education of the mother between groups (p> 0,05). The most common type of TMD was muscle pain (57.9%), followed by disc luxation with reduction and combination (21.1%). The mean mouth opening, muscle and joint pain sites were statistically different between cases and controls (p <0.05). The percentage of exclusive artificial feeding was the same in both groups (57.9% p = 1.00), the calculated OR was 1 with a 95% CI of 0.27-3.60. Conclusions. Artificial feeding with the use of a bottle was not related to TMD. The most common type of TMD was muscle pain.

Evaluación de la susceptibilidad y autoeficacia ante VIH/sida en profesionales de Estomatología / Avaliação da suscetibilidade e autoeficácia contra o HIV/AIDS em profissionais de Estomatología / Evaluation of susceptibility and self-efficacy against HIV/AIDS in stomatology professionals

Introducción: el VIH/sida es una de las enfermedades que mayor repercusión social ha tenido y afecta a millones de personas. Objetivo: identificar la susceptibilidad y la autoeficacia de los profesionales de la salud de la Facultad de Estomatología de la Benemérita Universidad Autónoma de Puebla (FEBUAP) frente al virus VIH/sida. Método: se trató de un estudio observacional descriptivo. Se incluyeron 250 alumnos y 50 docentes de la FEBUAP, con previa aceptación voluntaria y firma de consentimiento informado, seleccionados mediante una muestra por conveniencia. Se aplicó la Escala VIH/SIDA-65, instrumento con validez y confiabilidad demostrada para la evaluación de las subescalas del instrumento (alfa de Cronbach 0,79), propuesta por Paniagua en 1998 y adaptada al español por Bermúdez, Buela-Casal &Uribe en 2005. Resultados: con respecto a la autoeficacia, los alumnos demostraron superioridad. En la susceptibilidad, la creencia de la posibilidad de contraer el virus fue mayor en docentes (64 por ciento vs. 48 por ciento). La creencia de que solo homosexuales debieran preocuparse por el contagio fue mayor en docentes (92 por ciento). Se encontró una autoeficacia mayor en alumnos y una mejor susceptibilidad en docentes. Conclusiones: es necesario fortalecer estrategias que refuercen conceptos y comportamientos frente al VIH/sida(AU)

Introduction: HIV/AIDS is one of the diseases that has had the greatest social impact and affects millions of people. Objective: to identify the susceptibility and self-efficacy of the health professionals of the Faculty of Stomatology of the Benemérita Autonomous University of Puebla (FEBUAP) against the HIV / AIDS virus. Method: it was a descriptive observational study. 250 students and 50 FEBUAP teachers were included, with prior voluntary acceptance and signed informed consent, selected by means of a convenience sample. The HIV/AIDS-65 scale was applied, an instrument with proven validity and reliability for the evaluation of the subscales of the instrument (Cronbach alpha 0.79), proposed by Paniagua in 1998 and adapted to Spanish by Bermúdez, Buela-Casal & Uribe in 2005. Results: with respect to self-efficacy, the students demonstrated superiority. In the susceptibility, the belief of the possibility of contracting the virus was higher in teachers (64 percent vs. 48 percent). The belief that only homosexuals should worry about contagion was higher in teachers (92percent). We found a higher self-efficacy in students and a better susceptibility in teachers. Conclusions: it is necessary to strengthen strategies that reinforce concepts and behaviors against HIV / AIDS(AU)

Introdução: O HIV/AIDS é uma das doenças que mais impactou socialmente e afeta milhões de pessoas. Objetivo: identificar a suscetibilidade e autoeficácia dos profissionais de saúde da Faculdade de Estomatologia da Universidade Autônoma de Benemérita de Puebla (FEBUAP) contra o vírus HIV/AIDS. Método: foi um estudo observacional descritivo. Foram incluídos 250 alunos e 50 professores da FEBUAP, com prévia aceitação voluntária e termo de consentimento livre e esclarecido, selecionados por meio de amostra de conveniência. escala VIH/SIDA-65 foi aplicado, e instrumento válido para avaliar a fiabilidade comprovada das subescalas do instrumento (alfa Cronbach 0,79), proposto pela Paniagua em 1998 e adaptadas para o español por Bermudez, Buela-Casal & Uribe em 2005. Resultados: com relação à autoeficácia, os estudantes demonstraram superioridade. Na suscetibilidade, a crença na possibilidade de contrair o vírus foi maior nos professores (64 por cento vs. 48 por cento). A crença de que apenas os homossexuais deveriam se preocupar com o contágio era maior nos professores (92%). Encontramos uma maior autoeficácia nos alunos e uma melhor susceptibilidade nos professores. Conclusões: é necessário fortalecer estratégias que reforcem conceitos e comportamentos contra o HIV/AIDS(AU)

Safety and Efficacy of Atazanavir Powder and Ritonavir in HIV-1-Infected Infants and Children From 3 Months to <11 Years of Age: The PRINCE-2 Study.

BACKGROUND: Novel antiretroviral formulations that are palatable, safe, and effective are needed for infants and children. METHODS: PRINCE-2 is an ongoing clinical trial assessing safety, efficacy, and palatability of once-daily atazanavir powder formulation boosted with ritonavir (ATV + RTV) plus optimized dual nucleos(t)ide reverse transcriptase inhibitors therapy in antiretroviral-naïve/experienced children with screening HIV-1 RNA ≥1000 copies/mL. Children 3 months to <11 years received ATV + RTV by 5 baseline weight bands: 5 to <10 kg = 150/80 mg; 5 to <10 kg = 200/80 mg; 10 to <15 kg = 200/80 mg; 15 to <25 kg = 250/80 mg; and 25 to <35 kg = 300/100 mg. RESULTS: Of 99 treated children, 83.8% and 59.6% remained on ATV powder until 24 and 48 weeks, respectively. Through 48 weeks, the most common adverse events were upper respiratory tract infections (33.3%), gastroenteritis (28.3%), vomiting (21.2%) and hyperbilirubinemia (18.2%; none leading to treatment discontinuation). Serious adverse events occurred in 20.2% of patients. Laboratory grade 3-4 hyperbilirubinemia occurred in 9.2% and elevated total/pancreatic amylase in 33.7%/3.1%. At week 24, proportions with virologic suppression (HIV-1 RNA <50 copies/mL; intention-to-treat analysis) across weight bands were 10/23 (43.5%), 2/12 (16.5%), 10/21 (47.6%), 19/35 (54.3%) and 5/8 (62.5%), respectively. Virologic suppression was similar in antiretroviral-naïve/experienced patients and lowest in the 5 to <10 kg = 200/80 mg group, likely because of higher baseline HIV-1 RNA and discontinuation (66.7%). Overall, virologic suppression at weeks 24 (46.5%) and 48 (43.0%) was comparable. At week 48, 83.3% and 74.1% of caregivers reported no trouble giving ATV powder and RTV, respectively. CONCLUSIONS: ATV powder palatability, efficacy and lack of unexpected safety findings support its use for HIV-1-infected children ≥3 months to <11 years.

Late Diagnosis Due to Missed Opportunities and Inadequate Screening Strategies in HIV Infected Mexican Women.

Late diagnosis of HIV remains a public health issue in Mexico. Most national programs target high-risk groups, not including women. More data on factors associated with late diagnosis and access to care in women are needed. In 2012-2013, Mexican women recently diagnosed with HIV were interviewed. Socio-cultural background, household-dynamics and clinical data were collected. Of 301 women, 49 % had <200 CD4 cells/mm3, 8 % were illiterate, 31 % had only primary school. Physical/sexual violence was reported by 47/30 %; 75 % acquired HIV from their stable partners. Prenatal HIV screening was not offered in 61 %; 40 % attended consultation for HIV-related symptoms without being tested for HIV. Seeking medical care ≥3 times before diagnosis was associated with baseline CD4 <200 cells/mm3 (adjusted OR 3.74, 95 % CI 1.88-7.45, p < 0.001). There were missed opportunities during prenatal screening and when symptomatic women seeked medical care. Primary care needs to be improved and new strategies implemented for early diagnosis in women.

National prevalence and trends of HIV transmitted drug resistance in Mexico.

BACKGROUND: Transmitted drug resistance (TDR) remains an important concern for the management of HIV infection, especially in countries that have recently scaled-up antiretroviral treatment (ART) access. METHODOLOGY/PRINCIPAL FINDINGS: We designed a study to assess HIV diversity and transmitted drug resistance (TDR) prevalence and trends in Mexico. 1655 ART-naïve patients from 12 Mexican states were enrolled from 2005 to 2010. TDR was assessed from plasma HIV pol sequences using Stanford scores and the WHO TDR surveillance mutation list. TDR prevalence fluctuations over back-projected dates of infection were tested. HIV subtype B was highly prevalent in Mexico (99.9%). TDR prevalence (Stanford score>15) in the country for the study period was 7.4% (95% CI, 6.2∶8.8) and 6.8% (95% CI, 5.7∶8.2) based on the WHO TDR surveillance mutation list. NRTI TDR was the highest (4.2%), followed by NNRTI (2.5%) and PI (1.7%) TDR. Increasing trends for NNRTI (p = 0.0456) and PI (p = 0.0061) major TDR mutations were observed at the national level. Clustering of viruses containing minor TDR mutations was observed with some apparent transmission pairs and geographical effects. CONCLUSIONS: TDR prevalence in Mexico remains at the intermediate level and is slightly lower than that observed in industrialized countries. Whether regional variations in TDR trends are associated with differences in antiretroviral drug usage/ART efficacy or with local features of viral evolution remains to be further addressed.

Prospective, randomized, open label trial of Efavirenz vs Lopinavir/Ritonavir in HIV+ treatment-naive subjects with CD4+<200 cell/mm3 in Mexico.

OBJECTIVE: To compare the efficacy of efavirenz (EFV) vs lopinavir/ritonavir (LPV/r) in combination with azidothymidine/lamivudine in antiretroviral therapy naive, HIV+ individuals presenting for care with CD4 counts <200/mm. METHODS: Prospective, randomized, open label, multicenter trial in Mexico. HIV-infected subjects with CD4 <200/mm were randomized to receive open label EFV or LPV/r plus azidothymidine/lamivudine (fixed-dose combination) for 48 weeks. Randomization was stratified by baseline CD4 cell count (< or =100 or >100/mm). The primary endpoint was the percentage of patients with plasma HIV-1 RNA <50 copies/mL at 48 weeks by intention-to-treat analysis. RESULTS: A total of 189 patients (85% men) were randomized to receive EFV (95) or LPV/r (94). Median baseline CD4 were 64 and 52/mm, respectively (P = not significant). At week 48, by intention-to-treat analysis, 70% of EFV and 53% of LPV/r patients achieved HIV-1 RNA <50 copies/mL [estimated difference 17% (95% confidence interval 3.5 to 31), P = 0.013]. The proportion with HIV-1 RNA <400 copies/mL was 73% with EFV and 65% with LPV/r (P = 0.25). Virologic failure occurred in 7 patients on EFV and 17 on LPV/r. Mean CD4 count increases (cells/mm) were 234 for EFV and 239 for LPV/r. Mean change in total cholesterol and triglyceride levels were 50 and 48 mg/dL in EFV and 63 and 116 mg/dL in LPV/r (P = 0.24 and P < 0.01). CONCLUSIONS: In these very advanced HIV-infected ARV-naive subjects, EFV-based highly active antiretroviral therapy had superior virologic efficacy than LPV/r-based highly active antiretroviral therapy, with a more favorable lipid profile.

Determinantes de la morbi-mortalidad por enfermedad diarréica de los menores de cinco años que acuden a los hospitales infantiles de Managua

Expone los factores socioeconómicos y de atención médica que influyen en la morbi-mortalidad por diarrea en los menores de cinco años que asistieron a los hospitales infantiles "Fernando Vélez Paíz" y "Manuel de Jesús Rivera" de Managua, fallecidos durante 1985 y los ingresados en abril de 1986. De los pacientes fallecidos se revisaron 232 expedientes clínicos, con una muestra de 170, de los cuales, 120 eran del Hospital Vélez Paíz, y 50 del Hospital Manuel de Jesús Rivera, implicando una letalidad hospitalaria de 9.5 por ciento y 3.5 por ciento respectivamente. El 84 por ciento eran menores de un año, teniendo el 78 por ciento atención previa y el 34 por ciento era reingreso. Sólo el 15 por ciento recibió lactancia materna durante los tres primeros meses de vida y al morir el 60 por ciento tenían las inmunizaciones incompletas, menos del 20 por ciento contaba con vivienda, agua e instalaciones sanitarias aceptables. De los ingresados durante abril de 1986 se estudiaron 410 pacientes captados de las distintas salas donde fueron atendidos, siendo el 80 por ciento menores de 5 meses, el 37 por ciento no reunía condiciones higiénico-sanitaria proviniendo el 22 por ciento de asentamientos. Se detecta la educación popular para la prevención y tratamiento de la diarrea; revisión de los servicios y del sistema de referencia y contrarreferencia, como la difusión, implementación y control de normas de tratamiento y de vigilancia

Determinantes de la Morbi-mortalidad por enfermedad diarreica de los menores de cinco años que acuden a los hospitales de Managua / Decisive of the morbi-mortality for diseases diarrhea of the minor of five years that goes to the infantile Hospitals of Managua

El presente trabajo es un estudio descriptivo y analítico, en su primera fase retrospectivo y en la segunda prospectivo: En la primera fase se revisaron los expedientes de los muertos durante 1985 que fueron reportada como causa de muerte la enfermedad diarreica(ED), DHE, shock, sepsis e insuficiencia renal aguda y en la segunda que hubieran sido hospitalizados con ED como causa principal o secundaria. En la segunda fase se captaron los niños que hubieran consultado por ED, entrevistando a las madres, valorando a los niños desde su ingreso evolucionándolos diariamente hasta su egreso vivos o muertos y consignando todos los días la atención recibida. Para el análisis de esta fase se dividieron los pacientes en dos grupos, según tuvieran deshidratación mayor o menor del 5 porciento y alguna complicación. En la primera fase se estudiaron 120 fallecidos del Hospital Manuel de Jesús Rivera (HMJR) y 50 del Hospital Fernando Velez Paiz (HFVP) que representan una letalidad hospitalaria de 9.5 y 3.5 porciento respectivamente. El 84 porciento eran menores de 1 año, que en su mayoría murieron durante los meses de lluvia. En ambos centros una cuarta parte habita el otro hospital. El 78 porciento de los niños había tenido atención previa y el 34 porciento fueron reingresos. Menos del 20 porciento de los niños contaban con habitaciones aceptables, agua e instalaciones sanitarias aceptables. Sólo el 15 porciento tuvo lactancia los tres primeros meses de vida y al morir el 60 porciento tenían las inmunizaciones incompletas para su edad...