N-acetylaspartate from fat cells regulates postprandial body temperature.

N-acetylaspartate (NAA), the brain's second most abundant metabolite, provides essential substrates for myelination through its hydrolysis. However, activities and physiological roles of NAA in other tissues remain unknown. Here, we show aspartoacylase (ASPA) expression in white adipose tissue (WAT) governs systemic NAA levels for postprandial body temperature regulation. Proteomics and mass spectrometry revealed NAA accumulation in WAT of Aspa knockout mice stimulated the pentose phosphate pathway and pyrimidine production. Stable isotope tracing confirmed higher incorporation of glucose-derived carbon into pyrimidine metabolites in Aspa knockout cells. Additionally, serum NAA positively correlates with the pyrimidine intermediate orotidine and this relationship predicted lower body mass index in humans. Using whole-body and tissue-specific knockout mouse models, we demonstrate that fat cells provided plasma NAA and suppressed postprandial body temperature elevation. Furthermore, exogenous NAA supplementation reduced body temperature. Our study unveils WAT-derived NAA as an endocrine regulator of postprandial body temperature and physiological homeostasis.

Fuerza prensil y composición corporal en escolares colombianos. Estudio piloto

Introducción: Algunos estudios han encontrado relación entre exceso de peso y baja fuerza de prensión relativa. En países de ingresos socioeconómicos medianos y bajos hay pocas evidencias que evalúen la fuerza prensil y su relación con la composición corporal en población pediátrica. Objetivo: Evaluar la correlación entre la fuerza prensil y la composición corporal de escolares de Bucaramanga, Colombia. Materiales y métodos: Se realizó un estudio piloto de corte transversal, analítico, correlacional. Participaron niños en edad escolar de Bucaramanga, Colombia. Las principales variables dependientes fueron masa muscular, agua corporal total, proteínas (kg) y el porcentaje de grasa corporal. La variable independiente correspondió a la fuerza prensil. Se usó el coeficiente de correlación de Spearman para explorar la relación entre variables. Resultados: El promedio de la fuerza prensil en el total de la muestra fue de 13,8 ± 3,2 Newton. Se encontraron correlaciones positivas y estadísticamente significativas entre la fuerza prensil y la masa musculoesquelética (r = 0,73), agua corporal total (r = 0,73) y proteínas (r = 0,74). Discusión: Nuestros resultados son consistentes con evidencias previas que identifican a la fuerza prensil como un indicador de la composición corporal, específicamente en las variables de masa musculoesquelética y proteínas. Conclusión: Los niños en el tercil más alto de fuerza prensil presentan los terciles más altos de masa musculoesquelética, agua corporal total y proteínas.

Introduction: Some studies have found a relationship between excess weight and low relative grip strength. In countries with medium and low socioeconomic income, there is little evidence evaluating grip strength and its relationship with body composition in the pediatric population. Objective: To evaluate the correlation between grip strength and body composition of schoolchildren from Bucaramanga, Colombia. Materials and Methods: A cross-sectional, analytical, correlational pilot study was conducted. Schoolchildren from Bucaramanga, Colombia participated. The main dependent variables were muscle mass, total body water, protein (kg), and percentage of body fat. The independent variable corresponded to the prehensile force. Spearman's Correlation Coefficient was used to explore the relationship between variables. Results: The average prehensile force in the total sample was 13.8±3.2 Newton. Positive and statistically significant correlations were found between grip strength and musculoskeletal mass (r=0.73), total body water (r=0.73), and protein (r=0.74). Discussion: Our results are consistent with previous evidence that identifies grip strength as an indicator of body composition, specifically in the variables of musculoskeletal mass and protein. Conclusion: Children in the highest tertile of prehensile strength present the highest tertiles of skeletal muscle mass, total body water, and protein.

PCP consensus protein/peptide alphavirus antigens stimulate broad spectrum neutralizing antibodies.

Vaccines based on proteins and peptides may be safer and if calculated based on many sequences, more broad-spectrum than those designed based on single strains. Physicochemical Property Consensus (PCPcon) alphavirus (AV) antigens from the B-domain of the E2 envelope protein were designed, synthesized recombinantly and shown to be immunogenic (i.e. sera after inoculation detected the antigen in dotspots and ELISA). Antibodies in sera after inoculation with B-region antigens based on individual AV species (eastern or Venezuelan equine encephalitis (EEEVcon, VEEVcon), or chikungunya (CHIKVcon) bound only their cognate protein, while those designed against multiple species (Mosaikcon and EVCcon) recognized all three serotype specific antigens. The VEEVcon and EEEVcon sera only showed antiviral activity against their related strains (in plaque reduction neutralization assays (PRNT50/80). Peptides designed to surface exposed areas of the E2-A-domain of CHIKVcon were added to CHIKVcon inocula to provide anti-CHIKV antibodies. EVCcon, based on three different alphavirus species, combined with E2-A-domain peptides from AllAVcon, a PCPcon of 24 diverse AV, generated broad spectrum, antiviral antibodies against VEEV, EEEV and CHIKV, AV with less than 35% amino acid identity to each other (>65% diversity). This is a promising start to a molecularly defined vaccine against all AV. Further study with these antigens can illuminate what areas are most important for a robust immune response, resistant to mutations in rapidly evolving viruses. The validated computational methods can also be used to design broad spectrum antigens against many other pathogen families.

Consumo de suplementos dietarios en niños escolares de Bucaramanga, Colombia. Un estudio piloto / Dietary supplements consumption in school children from Bucaramanga, Colombia. A pilot study

Resumen Introducción: La obesidad infantil es un problema global de salud pública. Una de las causas subyacentes de este evento complejo y multicausal se relaciona con la alta ingesta de energía. El uso inadecuado de suplementos dietarios podría superar los requerimientos de energía y nutrientes y generar una ganancia excesiva de peso corporal en los niños. Objetivo: Describir el tipo, cantidad y frecuencia de consumo de suplementos dietarios ingeridos por niños y niñas durante la edad preescolar, y evaluar la correlación entre este consumo y la composición corporal de los mismos en la edad escolar. Metodología: Estudio de corte transversal analítico. Estudio piloto realizado en niños en edad escolar de Bucaramanga, Colombia. Variables dependientes: porcentaje de grasa corporal y masa músculo esquelética. Principal variable independiente: consumo de suplementos dietarios. La correlación entre variables fue evaluada usando el coeficiente de correlación de Spearman (rho). Resultados: La prevalencia del consumo de suplementos dietarios en algún momento, antes de los cinco años, fue de 51,11% (IC 95%, 0,35 a 0,66). Las formas de presentación usadas con mayor frecuencia fueron en polvo, granulado y líquido. Los tipos de suplementos utilizados correspondieron a fórmulas poliméricas (40,91%), seguidos por aceite de hígado de bacalao (36,36%). A mayor consumo de suplementos dietarios, se observó mayor porcentaje de grasa corporal (rho = 0,346) y menores valores de masa muscular esquelética (rho = -0,286). Sin embargo, estas correlaciones no fueron estadísticamente significativas (p = 0,114 y p = 0,286, respectivamente). Conclusión: Este estudio encontró una correlación débil y positiva entre el consumo de suplementos dietarios en la primera infancia y el porcentaje de grasa corporal y una correlación débil y negativa con la masa músculo esquelética; sin embargo, no hubo significancia estadística. Es necesario continuar investigando acerca de potenciales efectos no deseados del consumo inadecuado de suplementos durante la primera infancia.

Abstract Introduction: Childhood obesity is a global public health problem. One of the underlying causes of this complex and multicausal event is related to high energy intake. Inappropriate use of dietary supplements could exceed energy and nutrient requirements resulting in excessive body weight gain in children. Objective: To describe the type, quantity and frequency of consumption of dietary supplements ingested by boys and girls during preschool age and to evaluate the correlation between this consumption and their body composition at school age. Methods: Analytical cross-sectional study. Pilot study, carried out in school children from Bucaramanga, Colombia. Dependent variables: body fat percentage and skeletal muscle mass. Main independent variable: consumption of dietary supplements. The correlation between variables was evaluated using Spearman's correlation coefficient (rho). Results: The prevalence of consumption of dietary supplements at some point before the age of five was 51.11% (95% CI, 0.35 to 0.66). The most frequently used forms of presentation were powder, granules and liquid. The types of supplements used corresponded to polymeric formulas (40.91%), followed by cod liver oil (36.36%). A higher consumption of dietary supplements showed a higher percentage of body fat (rho=0.346) and lower values of skeletal muscle mass (rho= -0.286). However, these correlations were not statistically significant (p=0.114 and p=0.286, respectively). Conclusion: This study found a weak positive correlation between dietary supplement use in early childhood and body fat percentage and a weak negative correlation with skeletal muscle mass; however, there was no statistical significance. Further research is needed on the potential undesirable effects of inappropriate supplement use in early childhood.

Synthetic proteins for COVID-19 diagnostics.

There is an urgent need for inexpensive, rapid and specific antigen-based assays to test for vaccine efficacy and detect infection with SARS-CoV-2 and its variants. We have identified a small, synthetic protein (JS7), representing a region of maximum variability within the receptor binding domain (RBD), which binds antibodies in sera from nine patients with PCR-verified COVID-19 of varying severity. Antibodies binding to either JS7 or the SARS-CoV-2 recombinant RBD, as well as those that disrupt binding between a fragment of the ACE2 receptor and the RBD, are proportional to disease severity and clinical outcome. Binding to JS7 was inhibited by linear peptides from the RBD interface with ACE2. Variants of JS7, such as E484K or N501Y, can be quickly synthesized in pure form in large quantities by automated methods. JS7 and related synthetic antigens can provide a basis for specific diagnostics for SARS-CoV-2 infections.

Stent diversor de flujo paratratamiento de aneurisma intracraneal / Flow diversifier stent for treatment of intracranial aneurysm

INTRODUCCIÓN: Cuadro clínico: El aneurisma intracraneal (AI) es una dilatación anormal de la arteria localizada en el cerebro, que conllevan al riesgo de ruptura y que puede conllevar una apoplejía, coma y / o muerte. La prevalencia de AI no rotos estimada en la población general es de 2-3%. En promedio uno en cada 25 personas pueden sufrir un AI, siendo esta una condición común y asintomática hasta el momento de la ruptura. Los procedimientos para prevenir la ruptura de AI son mediante medios endovasculares o microquirúrgicos, siendo invasivos y con una elevada tasa de complicaciones que pueden incluso llevar a la muerte. El tratamiento endovascular incluye la embolización del aneurisma con o sin stent, o en los casos que esto no es posible (como aneurismas de gran tamaño o cuello ancho) se recomienda el uso de dispositivos diversores de flujo (DDF). Descripción de la tecnología: Los DDF son una técnica endovascular para el tratamiento de AI con anatomía compleja, tiene una alta eficacia y cuenta con aceptables tasas de morbilidad y mortalidad. Los dispositivos de dispersor de flujo que han sido aprobados para el tratamiento del AI son de 5 tipos: Embolization Device (PED), Silk, Flow Re-direction Endoluminal Device (FRED), p64 Flow-Modulation Device, y Surpass Flow-Diverter. OBJETIVO: Evaluar la eficacia y seguridad, así como documentos relacionados a la decisión de cobertura del stent diversor de flujo para el tratamiento del aneurisma intracraneal. METODOLOGÍA: Se realizó una búsqueda sin restricciones de idioma ni fecha en las principales bases de datos bibliográficas: MEDLINE, LILACS, y COCHRANE. Adicionalmente, se hizo una búsqueda en los repositorios de agencias de evaluaciones de tecnologías sanitarias (ETS) y de guías de práctica clínica (GPC). Se dio preferencia a revisiones sistemáticas (RS). Se excluyeron reportes de casos. RESULTADOS: La estrategia de búsqueda en los repositorios arrojó 144 reportes de los cuales se seleccionó una 10 RS que valoraban la eficacia y seguridad de DDF. No se identificaron GPC ni ETS que mencionaran la tecnología sanitaria en evaluación, ni EE de la región. Todas las RS reportaron tasas elevadas de curación de AI, con bajas tasas de complicaciones. Sólo encontramos una revisión que comparó DDF con otras metodologías, reportando que la oclusión fue significativamente mayor que con embolización sola (OR = 3,13; IC95% = 2,11 a 4,65) o frente a embolización con stent (OR = 2,08; IC95% = 1,34 a 3,24); sin diferencias significativas en las tasas de complicaciones (OR = 0,87; IC95% = 0,45 a 1,69; y OR = 0,86; IC95% = 0,33 a 2,26, respectivamente). Las RS recibieron una calificación de críticamente baja calidad debido a que no cumplían con uno o más criterios críticos. CONCLUSIONES: En base a la evidencia de estudios sin comparador el uso de dispositivos dispersores de flujo en el tratamiento de aneurismas intracraniales es eficaz y seguro. Sólo una revisión sistemática compara este tratamiento con embolización sola o asistida encontrando que fue significativamente mejor.

Intervenciones efectivas para la reducción de mortalidad y lesiones por accidentes de tránsito: policy brief y diálogo deliberativo / Effective interventions for the reduction of mortality and injuries due to traffic accidents: policy brief and deliberative dialogue

Las lesiones y muertes por accidentes de tránsito representan un problema global de salud pública. En Perú preenta una alta tasa de lesiones y muertes por accidentes de tránsito. Por ello, resulta necesario contar con evidencia acerca de intervenciones efectivas para prevenirlas. Este policy brief y dialogo deliberativo presento las seguientes opciones para enfrentar en problema: 1- Educación por etapas de vida sobre seguridad vial y consumo de alcohol; 2- Reforzamiento de leyes de tránsito y educacioón masiva vía radio y televisión; 3- Optimización de la infraestructura integral de transito; 4- asistencia pre-hospitalaria.

Association between gross motor function and nutritional status in children with cerebral palsy: a cross-sectional study from Colombia.

AIM: To determine the association between gross motor function and nutritional status in children with cerebral palsy (CP) residing in an urban area in a developing country. METHOD: We conducted a cross-sectional study in 177 children (ages 2-12y, 59.3% male) with a diagnosis of CP who were attending rehabilitation centres in Bucaramanga, Colombia (2012-2013). A physiotherapist evaluated patients using the Gross Motor Function Classification System (GMFCS, levels I to V). Nutritional status was evaluated by nutritionists and classified according to the World Health Organization growth charts. We used linear and multinomial logistic regression methods to determine the associations. RESULTS: There were 39.5%, 6.8%, 5.6%, 16.4%, and 31.6% patients classified in levels I to V respectively. The mean adjusted differences for weight-for-age, height-for-age, BMI-for-age, and height-for-weight z-scores were significantly larger for children classified in levels II to V compared with those in level I. The children classified in levels IV and V were more likely to have malnutrition (adjusted odds ratio [OR] 5.64; 95% confidence interval [CI] 2.27-14.0) and stunting (OR 8.42; 95% CI 2.90-24.4) than those classified in GMFCS levels I to III. INTERPRETATION: Stunting and malnutrition are prevalent conditions among paediatric patients with CP, and both are directly associated with higher levels of gross motor dysfunction.

Estrategia para fortalecer las capacidades de investigación en salud en universidades públicas regionales: rol del canon y del Instituto Nacional de Salud / Strategy to strengthen health research capabilities in regional public universities: the role of the mining canon and the Instituto Nacional de Salud

El desarrollo de investigación científica en salud requiere de un sistema de investigación sostenido, articulado y coherente con las prioridades de investigación; este sistema de investigación implica la existencia de financiamiento tanto interno como externo, y de disponer recursos humanos competentes. El canon minero es un derecho constitucional, parte de él ha sido destinado para el desarrollo de investigación científica y aplicada por las universidades públicas (UP). El Instituto Nacional de Salud (INS) tiene entre sus funciones promover, gestionar y difundir el desarrollo de investigación en salud a nivel nacional. Como parte de estas funciones se conformó un equipo técnico para brindar asesoría técnica a las UP para el desarrollo de investigación con fondos del canon minero, mediante la adecuación local de protocolos de investigación promovidos por el INS y asumidos por los docentes-investigadores de la universidad. El presente artículo tiene como objetivo describir la realidad de investigación de las UP peruanas que cuentan con fondos del canon minero, y presentar la intervención que el INS viene realizando para fortalecer las capacidades de investigación, iniciando con desarrollar propuestas de investigación que potencialmente puedan obtener financiamiento de parte del canon.

The development of scientific health research requires a sustained and articulated research system that is consistent with the research priorities, as well as both internal and external funding, and availability of competent human resources. The Mining Canon, a constitutional right, has been partly used to foster applied scientific research in public universities (PU). In addition, the National Health Institute (INSTITUTO NACIONAL DE SALUD - INS) is devoted, among others, to promoting, managing and disseminating health research development at a national level. As part of these activities, a technical team was created to provide technical assistance to PU for research development using Mining Canon funds by making local adjustments to research protocols promoted by the INS and assumed by the professors-researchers at the Universities. This article aims at describing the reality of research at Peruvian public universities that have access to Mining Canon funds, as well as to elaborate on the work the INS is carrying out in order to strengthen research capabilities, starting with the development of research proposals that could potentially be funded by the Mining Canon.

Estrategia para fortalecer las capacidades de investigación en salud en universidades públicas regionales: rol del canon y del Instituto Nacional de Salud / Strategy to strengthen health research capabilities in regional public universities: the role of the mining canon and the Instituto Nacional de Salud

El desarrollo de investigación científica en salud requiere de un sistema de investigación sostenido, articulado y coherente con las prioridades de investigación; este sistema de investigación implica la existencia de financiamiento tanto interno como externo, y de disponer recursos humanos competentes. El canon minero es un derecho constitucional, parte de él ha sido destinado para el desarrollo de investigación científica y aplicada por las universidades públicas (UP). El Instituto Nacional de Salud (INS) tiene entre sus funciones promover, gestionar y difundir el desarrollo de investigación en salud a nivel nacional. Como parte de estas funciones se conformó un equipo técnico para brindar asesoría técnica a las UP para el desarrollo de investigación con fondos del canon minero, mediante la adecuación local de protocolos de investigación promovidos por el INS y asumidos por los docentes-investigadores de la universidad. El presente artículo tiene como objetivo describir la realidad de investigación de las UP peruanas que cuentan con fondos del canon minero, y presentar la intervención que el INS viene realizando para fortalecer las capacidades de investigación, iniciando con desarrollar propuestas de investigación que potencialmente puedan obtener financiamiento de parte del canon. (AU)

The development of scientific health research requires a sustained and articulated research system that is consistent with the research priorities, as well as both internal and external funding, and availability of competent human resources. The Mining Canon, a constitutional right, has been partly used to foster applied scientific research in public universities (PU). In addition, the National Health Institute (INSTITUTO NACIONAL DE SALUD - INS) is devoted, among others, to promoting, managing and disseminating health research development at a national level. As part of these activities, a technical team was created to provide technical assistance to PU for research development using Mining Canon funds by making local adjustments to research protocols promoted by the INS and assumed by the professors-researchers at the Universities. This article aims at describing the reality of research at Peruvian public universities that have access to Mining Canon funds, as well as to elaborate on the work the INS is carrying out in order to strengthen research capabilities, starting with the development of research proposals that could potentially be funded by the Mining Canon. (AU)

[Strategy to strengthen health research capabilities in regional public universities: the role of the Mining Canon and the Instituto Nacional de Salud]. / Estrategia para fortalecer las capacidades de investigación en salud en universidades públicas regionales: rol del canon y del Instituto Nacional de Salud.

The development of scientific health research requires a sustained and articulated research system that is consistent with the research priorities, as well as both internal and external funding, and availability of competent human resources. The Mining Canon, a constitutional right, has been partly used to foster applied scientific research in public universities (PU). In addition, the National Health Institute (INSTITUTO NACIONAL DE SALUD - INS) is devoted, among others, to promoting, managing and disseminating health research development at a national level. As part of these activities, a technical team was created to provide technical assistance to PU for research development using Mining Canon funds by making local adjustments to research protocols promoted by the INS and assumed by the professors-researchers at the Universities. This article aims at describing the reality of research at Peruvian public universities that have access to Mining Canon funds, as well as to elaborate on the work the INS is carrying out in order to strengthen research capabilities, starting with the development of research proposals that could potentially be funded by the Mining Canon.

Evidencia serológica de ehrlichiosis humana en Ancash, Perú / Serological evidence of human ehrlichiosis in Ancash, Perú

Se desarrolló y estandarizó una prueba de inmunofluorescencia indirecta para detección de IgG e IgTotal para el diagnóstico de Ehrlichiosis humana. Se utilizó como antígeno, a células DH82 infectadas con Ehrlichia chaffeensis cepa Sapulpa, se consideró una dilución de 1/64 como positivo. Se evaluó 130 sueros de pacientes febriles negativos para Rickettsiosis y enfermedad de Carrión procedentes de Ancash, que ingresaron al Instituto Nacional de Salud entre los años 2004 a 2006. Se encontró que 12 (9,2%) sueros fueron positivos a Ehrlichiosis. Teniendo en cuenta que es una enfermedad emergente y con el desarrollo de esta prueba, es recomendable iniciar estudios epidemiológicos y de vigilancia de la Ehrlichiosis en el Perú.

We developed and standardized an indirect immunofluorescence test for detection of IgG and IgTotal for diagnosing human Ehrlichiosis. It was used as antigen to DH82 infected cells with Ehrlichia chaffeensis Sapulpa strain; it was considered a dilution of 1/64 as positive. We evaluated sera from 130 febrile patients negative for Rickettsiosis and Carrion disease from Ancash, who entered at Instituto Nacional de Salud (Lima, Peru) between 2004 and 2006. We found that 12 (9.2%) sera were positive for Ehrlichiosis. Given that Ehrlichiosis is an emerging disease and with the development of this test, it should start monitoring and epidemiological studies of Ehrlichiosis in Peru.

Evaluación de pruebas de Elisa e inmunofluorescencia indirecta para la detección de anticuerpos IgM contra Rickettsiosis / Elisa and indirect immunofluorescent assays evaluation for IgM antibodies detection against Rickettsiosis

Se evaluó dos pruebas modificadas de ELISA e inmunofluorescencia indirecta (IFI) para la detección de IgM basadas en el lisado total de Rickettsia akari para el diagnóstico de Rickettsiosis. Se usaron 55 sueros negativos, 100 sueros positivos confirmados por IFI IgG Total y15 sueros con diagnóstico confirmado para otras enfermedades bacterianas procedentes de la seroteca del Instituto Nacional de Salud. La prueba de ELISA IgM tuvo una sensibilidad de 78,0 por ciento, especificidad de 80,0 por ciento, valor predictivo positivo de 87,6 por ciento y el valor predictivo negativo de 66,7 por ciento, con una reacción cruzada con otras etiologías bacterianas de 20 por ciento (3/15). La prueba de IFI IgM tuvo una sensibilidad de 82,0 por ciento, especificidad de 91,7 por ciento, valor predictivo positivo de 94,3 por ciento y valor predictivo negativo de 75,3 por ciento, con una reacción cruzada de 13 por ciento (2/15). El método ELISA IgM no es una prueba útil, a diferencia de la prueba IFI IgM que podría ser aplicada en el diagnóstico de Rickettsiosis para estudios epidemiológicos y de vigilancia en el Perú.

We evaluated two modified tests of ELISA and indirect immunofluorescence (IFI) for detecting IgM based on the total lysate of Rickettsia Akari for Rickettsiosis diagnosing. 55 negative sera were used, 100 positive sera confirmed by IFI IgGTotal and 15 sera with a confirmed diagnosis for other bacterial diseases from the serum of the Instituto Nacional de Salud (Lima, Perú). IgM ELISA test had a sensitivity of78.0 per cent, 80.0 per cent specificity, positive predictive value of 87.6 per cent and negative predictive value of 66.7 per cent, and have a 20 per cent (3/15) cross-reaction with other bacterial aetiologies. The IFI IgM test had a sensitivity of 82.0 per cent, specificity of 91.7 per cent, positive predictive value of 94.3 per cent and negative predictive value of 75.3 per cent, with a 13 per cent (2/15) cross-reaction. The IgM ELISA test is not useful, unlike the IFI IgM test that could be applied in diagnosing Rickettsiosis for surveillance and epidemiological studies in Peru.

Prueba de Elisa indirecta del lisado total de bartonella bacilliformis para el diagnóstico rápido de la enfermedad de Carrión / Indirect Elisa of Bartonella bacilliformis total lysate for quick diagnosis of Carrion disease

Se elaboró y estandarizó una prueba de ELISA indirecta con el lisado total de Bartonella bacilliformis procedentes de una cepa ATCC y de un aislamiento clínico. Se seleccionaron 86 sueros de pacientes con diagnóstico confirmado de enfermedad de Carrión por frotis ycultivo, 51 sueros negativos de pacientes de zonas no endémicas y 32 sueros de pacientes con diagnóstico serológico confirmado para otras enfermedades bacterianas como brucelosis, leptospirosis, sífilis y Rickettsiosis. Se encontró una sensibilidad de 68,6 por ciento (IC95 por ciento: 58,2-79,0 por ciento), especificidad de 94,1 por ciento (86,7-100 por ciento), valor predictivo positivo de 95,2 por ciento (89,0-100 por ciento) y valor predictivo negativo de 64,0 por ciento (54,3-71,2 por ciento), con una reacción cruzada con otras etiologías bacterianas de 78,1 por ciento (25/32). Esta no es una prueba idónea para ser usada como herramienta diagnóstica para la Enfermedad de Carrión, se debe continuar los estudios hacia la búsqueda de una prueba rápida con mayor sensibilidad.

Was developed and standardized an indirect ELISA test with the total lysate of Bartonella bacilliformis from an ATCC strain and a clinical isolation. We selected 86 sera from patients with confirmed diagnosis of Carrion disease by smear and culture, 51 sera of negative patients for non-endemic areas and 32 sera from patients with confirmed serological diagnosis for other bacterial diseases such as brucellosis, leptospirosis, syphilis and Rickettsiosis. We found a sensitivity of 68.6 per cent (95 per cent CI: 58.2-79.0 per cent), specificity of 94.1 per cent (86.7-100 per cent), positive predictive value of 95.2 per cent (89.0 -100 per cent) and negative predictive value of 64.0 per cent (54.3-71.2 per cent), with a cross-reaction with other bacterial aetiologies of 78.1 per cent (25/32). This is not a recommended test to be used as a diagnostic tool for Carrion disease, is continuing studies toward finding a quick test with greater sensitivity.

Phylogenetic analysis of a novel molecular isolate of spotted fever group Rickettsiae from northern Peru: Candidatus Rickettsia andeanae.

Phylogenetic analysis of five rickettsial genes (17-kDa gene, gltA, ompB, ompA, and sca4) from two molecular isolates of Candidatus Rickettsia andeanae from two ticks (Amblyomma maculatum and Ixodes boliviensis) collected from two domestic horses living in two separate locations in northern Peru (Coletas and Naranjo) was conducted to more clearly characterize this recently reported novel spotted fever group (SFG) rickettsia. Following nested polymerase chain reaction (PCR) amplification of the 17-kDa gene, gltA, ompB, ompA, and sca4, amplicons were purified, sequenced, and compared to those downloaded from GenBank. Phylogenetic analyses of the Candidatus Rickettsia andeanae sequences generated from 17-kDa gene (483 bp), gltA (1185 bp), ompA (1598 bp), ompB (4839 bp), and sca4 (2634 bp) demonstrated that they aligned strongly with those of SFG rickettsiae. Moreover, the sequences of these five genes most closely aligned with the following rickettsiae: ompA: Rickettsia sp RpA4 (98.03%), R. sp DnS28 (97.90%), and R. rhipicephali and R. massiliae (97.11%); ompB: R. aeschlimannii (97.22%), R. rhipicephali (97.20%), and R. sp Bar 29 (97.10%); and sca4: R. massiliae (97.8%), R. rhipicephali, and R. slovaca (97.7%). These results from the additional phylogenetic analyses of Candidatus Rickettsia andeanae confirm its inclusion within, and distance and uniqueness from, other known SFG rickettsiae.

Characterization of spotted fever group rickettsiae in flea and tick specimens from northern Peru.

Evidence of spotted fever group (SFG) rickettsiae was obtained from flea pools and individual ticks collected at three sites in northwestern Peru within the focus of an outbreak of febrile disease in humans attributed, in part, to SFG rickettsia infections. Molecular identification of the etiologic agents from these samples was determined after partial sequencing of the 17-kDa common antigen gene (htrA) as well as pairwise nucleotide sequence homology with one or more of the following genes: gltA, ompA, and ompB. Amplification and sequencing of portions of the htrA and ompA genes in pooled samples (2 of 59) taken from fleas identified the pathogen Rickettsia felis. Four tick samples yielded molecular evidence of SFG rickettsiae. Fragments of the ompA (540-bp) and ompB (2,484-bp) genes were amplified from a single Amblyomma maculatum tick (tick 124) and an Ixodes boliviensis tick (tick 163). The phylogenetic relationships between the rickettsiae in these samples and other rickettsiae were determined after comparison of their ompB sequences by the neighbor-joining method. The dendrograms generated showed that the isolates exhibited close homology (97%) to R. aeschlimannii and R. rhipicephali. Significant bootstrap values supported clustering adjacent to this nodule of the SFG rickettsiae. While the agents identified in the flea and tick samples have not been linked to human cases in the area, these results demonstrate for the first time that at least two SFG rickettsia agents were circulating in northern Peru at the time of the outbreak. Furthermore, molecular analysis of sequences derived from the two separate species of hard ticks identified a possibly novel member of the SFG rickettsiae.

Evidence of rickettsial and leptospira infections in Andean northern Peru.

Between May and October 2002, a cluster of acute febrile illnesses occurred in the subtropical Andean foothills of Peru. Serologic evidence in villages where disease had been documented showed that the prevalence of IgM antibody to Leptospira ranged from 6% to 52%, that of IgM antibody to spotted fever group (SFG) rickettsia ranged from 10% to 19%, and that of IgM antibody to Coxiella burnetii from 1% to 15%. Measurement of IgG antibodies for SFG rickettsiae suggested that this disease was endemic. In contrast, IgG antibodies against C. burnetii were largely absent. In humans, microagglutination tests identified pathogenic variants of Leptospira. The presence of an SFG rickettsial infection was confirmed in four febrile patients following polymerase chain reaction and sequencing of the conserved 17-kD common antigen gene (htrA). Collectively, these analyses indicated that Rickettsia sp., C. burnetii, and Leptospira sp. were circulating in the region during the time of disease outbreak and implicate the involvement of an as yet undetermined SFG rickettsia in northwestern Peru.

Rickettsiosis of the genus Rickettsia in South America.

In South America, human cases of infection by the genus Rickettsia have been described in several countries in the last twenty years. The role of international organizations, such as the Centers for Disease Control and Prevention in Atlanta, Georgia, USA and the World Health Organization Collaborating Center for Tropical Diseases at the University of Texas Medical Branch at Galveston, Texas, USA, was very important in the last twenty years for the development of surveillance systems and for the increase in notification of rickettsial diseases by the countries of South America. We hope that the next goal will be prevention and control of rickettsial diseases in the countries of South America, as well as maintaining the programs developed during the last twenty years, so that a good health system and improved social conditions will be possible.

Transmisión horizontal de hapatitis viral B en población desplazada de un área hiperendémica a sus contactos en un área de baja endemicidad del Perú / Horizontal transmission of HBV infection in migrants from a hyperendemic area to their contacts in alow endemicity area in Peru

La migración de habitantes de áreas hiperendémicas de HVB a áreas de bajaendemicidad, donde la mayoría de la población es susceptible, implica un riesgo de transmisión, por lo que en este estudio se evalúa el estado de infección en ambos grupos de población que cohabitan en Lima. Materiales y métodos: Cuarenta familias de un Asentamiento Humano del distrito SanJuan de Lurigancho en Lima fueron elegidos aleatoriamente, incluyéndose entre ellos a población migrante y nacida en Lima. Se obtuvo información demográfica y de factores de riesgo para infección por HVB,y una muestra de sangre venosa para la determinación de marcadores serológicos de HVB por la técnica de ELlSA. Resultados: Se evaluaron 215 personas, 130 (60.5 por ciento) mujeres y 85(39.5 por ciento) varones. Se encontraron 9 (4.2 por ciento) portadores crónicos de HBsAg; 4 de ellos (1.9 por ciento) habían nacidoen Huanta, los otros 5(2.3 por ciento)nacieron en Lima y nunca viajaron a zonas endémicas. No se encontró asociación significativa entre la presencia de HBsAg y el uso de inyectables, transfusiones de sangre, cirugía previa, tatuajes, extracciones dentales o relaciones sexuales.Conclusión: La infección por HVB en personas nacidas en Lima, y sin factores de riesgo ®clásicos¼ para esta infección, puede estar asociado a su contacto con migrantes portadores crónicos de HVB, sugiriendo un mecanismo de transmisión horizontal.

Migration of inhabitants from high endemicity to low endemicity areas, where the majority of population is susceptible, implies a risk of transmission. This factor suggested the study of the presence of HBVinfection on migrants from Huanta and in their host communities in Lima. Material and methods: Forty families from ahuman settlement in the District of SanJuan de Lurigancho, Lima, were chosen at random. This sample included migrantfamilies and people who had born in Lima. The members of these families were subjected to a survey to obtain demographic data and possible risk factor for HBVinfection, and venous blood sample was obtained to determine HBVserological markers by ELlZA techniques. Results: A total of 215 people were evaluated, 130 (60.5 per cent)were female, and 85 (39.5 per cent) were male. There were 9 (4.2per cent)HbsAg carriers; 4 (1.9 per cent) of them were born in Huanta; the other 5 (2.3 per cent)were born in Lima, and had never been to Huanta. They were under 20 years of age. No signifcant association was found between the presence of HbsAg and the use of injectables, blood transfusions, tatoos, previous surgery, dental extractions or sexual relations. Conclusion: The presence of HbsAg carrier on people born in Lima, with no "classical" risk factor for HBV infection, could be associated with carriers migrating from ahyperendemic HBVarea, suggesting a mechanism of horizontal transmission.