Hepatitis E Virus: A review of the current status and perspectives / Virus de la Hepatitis E; revisión del estado actual y perspectivas

Abstract Hepatitis E virus produces approximately 20-million infections per year; symptomatic cases are over 3-million and deaths are approximately 60,000. Generally, it is self-limited; however, it can cause up to 30% mortality in pregnant women and can be chronic in immunosuppressed people. The transmission path of the Hepatitis E virus is principally fecal-oral, especially in developing countries; in industrialized countries, it is transmitted as a zoonosis, through organ transplants or blood transfusions. The vaccine developed is only licensed in China. Currently, no treatment is available for the HEV infection and work is underway in identifying the viral cycle and the immune response. This article sought to offer a review of the theme on the hepatitis E virus, from the last six years, to describe current general aspects of the Hepatitis E virus, genome, ways of transmission and contribute to its visibility for its prevention and control.

Resumen El virus de la hepatitis E produce aproximadamente 20 millones de infecciones por año; los casos sintomáticos superan los 3 millones y las muertes son apro ximadamente 60.000. Generalmente es autolimitada; sin embargo, puede causar hasta un 30% de mortalidad en mujeres embarazadas y puede ser crónica en personas inmunodeprimidas. La vía de transmisión del virus de la hepatitis E, es principalmente fecal-oral; especialmente en los países en desarrollo. En los países industrializados, se transmite como zoonosis, a través de trasplantes de órganos o transfusiones sanguíneas. La vacuna desarrollada solo tiene licencia en China. Actualmente, no hay tratamiento disponible para la infección por HEV y se está trabajando para identificar el ciclo viral y la respuesta inmune. Este artículo buscó ofrecer una revisión del tema sobre el virus de la hepatitis E, de los últimos seis años, para describir aspectos del virus de la Hepatitis E, genoma, vías de transmisión y contribuir a su visibilidad para su prevención y control.

Ulceras post anestésicas en niños: Dos casos clínicos / Post anesthesia ulcers in children: Two clinical cases

RESUMEN El siguiente articulo describe dos casos clínicos de ulceras traumáticas pos-anestesia en niños, luego de un tratamiento odontológico, en el cual se utilizó la infiltración de anestesia local, como parte del tratamiento terapéutico para la perdida de la sensibilidad del sector a tratar. Los efectos del anestésico continuaron al terminar el tratamiento, lo que estimuló por la falta de sensibilidad la curiosidad en los niños que se succionen o se muerdan el tejido blando, esto provocó lesiones graves en la mucosa oral. La importancia de estas lesiones pos-anestésicas radica en la prevención, es decir que el profesional que atienda pacientes pediátricos, debe prevenir y evitar estas lesiones graves autoinflingidas por el niño, dándole las recomendaciones verbalmente y por escrito a los padres.

ABSTRACT The following article describes two clinical cases of post-anesthesia traumatic ulcers in children, after dental treatment, in which infiltration of local anesthesia was used as part of the therapeutic treatment for the loss of sensitivity of the sector to be treated. The effects of the anesthetic continued at the end of the treatment, which stimulated curiosity in children to suck or bite the soft tissue due to lack of sensitivity, this caused serious lesions in the oral mucosa. The importance of these post-anesthetic injuries lies in prevention, that is, the professional who attends pediatric patients, must prevent and avoid these serious injuries self-inflicted by the child, giving the recommendations verbally and in writing to the parents.

Elemental composition, rare earths and minority elements in organic and conventional wines from volcanic areas: The Canary Islands (Spain).

The organic wine market is rapidly growing worldwide, both in terms of production and consumption. However, the scientific literature is not conclusive regarding differences in the elemental composition of wines according to their production method, including both major and trace elements. Minerals can be present in wine as a result of both anthropogenic and environmental factors. To date, this has not been evaluated in volcanic contexts, neither has the emergent issue of rare earths and other minority elements as potential sources of food contamination. This study using inductively coupled plasma mass spectrometry (ICP-MS) analyses organic and conventional wines produced in the Canary Islands (Spain), an archipelago of volcanic origin, to compare their content of 49 elements, including rare earths and minority elements. Our results showed that organic wines presented lower potential toxic element content on average than their conventional counterparts, but differences were not significant. Geographical origin of the wine samples (island) was the only significant variable differentiating wine samples by their composition profiles. By comparing our data with the literature, no agreement was found in terms of differences between organic and conventionally-produced wines. This confirms that other factors prevail over elemental composition when considering differences between wine production methods. Regarding the toxicological profile of the wines, five samples (three organic and two conventional) exceeded the maximum limits established by international legislation. This highlights the need for stricter analytical monitoring in the Canary Islands, with a particular focus on Cu and Ni concentration, and potentially in other volcanic areas.

Amígdalas y adenoides: defensa ante agentes patógenos y su implicancia estomatológica / Tonsils and adenoids: defend to pathogenic agents and their stomatological involvement

La función de las amígdalas siempre ha sido discutida, desde afirmar que no tenían funcionalidad, hasta la actualidad que se plantea un papel inmunológico, con actividad linfocitaria de defensa, debido a la localización de linfocitos en el tejido de las amígdalas. Este artículo de actualización pretende describir desde la embriología, histología, fisiología, patología y estomatología, el rol que desempeñan las mismas en su papel inmunológico ante la acción de agentes patógenos. Se destaca la acción conjunta de las amígdalas palatinas, amígdalas faríngeas o adenoides, amígdalas peritubarias, amígdalas linguales y todo el resto de tejido linfático que conforman el anillo linfático faríngeo o anillo de Waldeyer, ya que cumplen un rol determinante en la defensa del organismo (AU)

The function of the tonsils has always been debated, from stating that they had no functionality, to the present day that an immunological role is proposed, with lymphocyte defense activity, due to the location of lymphocytes in the tissue of the tonsils. This update article aims to describe from embryology, histology, physiology, pathology and stomatology, the role they play in their immunological role against the action of pathogens. The joint action of the palatine tonsils, pharyngeal or adenoid tonsils, peritubal tonsils, lingual tonsils and all the rest of the lymphatic tissue that make up the pharyngeal lymphatic ring or Waldeyer's ring is highlighted, since they play a decisive role in the defense of the organism (AU)

Quantification of Cadophora luteo-olivacea From Grapevine Nursery Stock and Vineyard Soil Using Droplet Digital PCR.

Cadophora luteo-olivacea is the most prevalent Cadophora species associated with Petri disease and esca of grapevine. Accurate, early, and specific detection and quantification of C. luteo-olivacea are essential to alert growers and nurseries to the presence of the pathogens in soil and to prevent the spread of this pathogen through grapevine planting material. The aim of this study was to develop molecular tools to detect and quantify C. luteo-olivacea inoculum from environmental samples. Species specific primers based on the ß-tubulin gene and a TaqMan probe for droplet digital PCR (ddPCR) and quantitative PCR (qPCR) were first developed to detect and quantify purified DNA of the target fungus. Specificity tests showed that the primers were able to amplify the C. luteo-olivacea DNA (20 isolates) while none of the 29 nontarget fungal species (58 isolates) tested were amplified. The ddPCR was shown to be more sensitive compared with qPCR in the detection and quantification of C. luteo-olivacea at very low concentrations and was further selected to accurately detect and quantify the fungus from environmental samples. Twenty-five of the 94 grafting plants (26.6%) analyzed by ddPCR tested positive to C. luteo-olivacea DNA (>3 copies/µl). C. luteo-olivacea was barely detected from vineyard soils. The procedure employed in this study revealed the presence of the pathogen in symptomless vines, which makes implementation of this technique suitable for certification schemes of C. luteo-olivacea-free grapevine planting material.

Experiencias del cuidado familiar durante el cáncer de mama: la perspectiva de los cuidadores / Experiências do cuidado familiar durante o câncer de mama: a perspectiva dos cuidadores / Experiences of family care during breast cancer: the perspective of caregivers

RESUMEN Objetivo Describir la experiencia del cuidado familiar a la mujer con cáncer de mama durante el tratamiento, desde la perspectiva de los cuidadores en el contexto mexicano. Método Estudio cualitativo fenomenológico. Fueron realizadas entrevistas en profundidad con cuidadores de mujeres sobrevivientes de cáncer de mama seleccionados mediante muestreo intencional, acumulativo y secuencial. Se llevó a cabo un análisis de contenido convencional. Resultados Participaron siete cuidadores. Los cuidadores refieren sus experiencias positivas y negativas al asumir su rol de cuidadores informales en el contexto familiar. Sobre la fortaleza de la reciprocidad del cuidado y su recompensa, prevalecen los momentos críticos, los sentimientos negativos y la falta de recursos de apoyo durante la experiencia. Ello permite entender el vínculo del cuidado informal para potenciarlo con estrategias de afrontamiento y orientación especifica por parte del personal de enfermería. Conclusión Los participantes experimentaron una transformación en su identidad como cuidadores y al ser conscientes de su experiencia, fueron capaces de describir sus cualidades lo que incrementa sus estrategias de afrontamiento tanto de la enfermedad como de los desafíos del cuidado.

RESUMO Objetivo Descrever a experiência do cuidado familiar com a mulher com câncer de mama durante o tratamento, do ponto de vista dos cuidadores no contexto mexicano. Método Estudo qualitativo fenomenológico. Foram realizadas entrevistas em profundidade com cuidadores de mulheres sobreviventes ao câncer de mama selecionados por meio de amostragem intencional, acumulativa e sequencial. Foi realizada uma análise de conteúdo convencional. Resultados Participaram sete cuidadores. Os cuidadores relatam suas experiências positivas e negativas ao assumir seu papel de cuidadores informais no contexto familiar. Sobre a força da reciprocidade do cuidado e sua recompensa, prevalecem os momentos críticos, os sentimentos negativos e a falta de recursos de apoio durante a experiência. Isso permite entender o vínculo do cuidado informal para potencializá-lo com estratégias de enfrentamento e orientação específica por parte do pessoal de enfermagem. Conclusão Os participantes experimentaram uma transformação na sua identidade como cuidadores e, ao ser conscientes da sua experiência, foram capazes de descrever suas qualidades, o que aumenta suas estratégias de enfrentamento tanto da doença quanto dos desafios do cuidado.

ABSTRACT Objective To describe the experience of family care to women with breast cancer during treatment from the perspective of caregivers in the Mexican context. Method Qualitative phenomenological study. In-depth interviews were conducted with caregivers of women who survived breast cancer. Participants were selected by intentional, cumulative and sequential sampling. A conventional content analysis was performed. Results Participation of seven caregivers, who reported their positive and negative experiences when assuming their role as informal caregivers in the family context. On the strength of the reciprocity of care and its reward, prevailed critical moments, negative feelings, and lack of support resources during the experience. This enables the understanding of the informal care bond in order to enhance it with coping strategies and specific guidance from the nursing staff. Conclusion Participants experienced a transformation in their identity as caregivers and by being aware of their experience, they could describe their qualities, which increased their coping strategies with the disease and the care challenges.

Lengua Geográfica en Niños: Dos Casos Clínicos / Geographic tongue in children: two clinical cases

El Odontopediatra juega un rol importante en la detección precoz de patologías orales en edades tempranas, debido que casi siempre es el primero que tiene contacto con el niño y cabe la posibilidad de ser el detector de lesiones en boca, como la lengua geográfica. Pero también es motivo de consulta de los padres, una lesión de color rojizo que aparece y desaparece, que los alarma. Es de suma importancia transmitir y tranquilizar a los padres de que se trata de una lesión benigna, que generalmente no requiere tratamiento 1. Este artículo tiene como objetivo la presentación de dos casos clínicos, con signos y síntomas diferentes para lo cual es de importancia conocer las características clínicas específicas de la lengua geográfica y el manejo clínico.

O Odontopediatra desempenha um papel importante na detecção precoce de patologias bucais em uma idade precoce, pois é quase sempre o primeiro a ter contato com a criança e é possível detectar lesões na boca, como a linguagem geográfica. Mas também é um motivo de consulta dos pais, uma lesão avermelhada que aparece e desaparece, o que os alarma. É muito importante transmitir e tranquilizar os pais de que é uma lesão benigna, que geralmente não requer tratamento (1). Este artigo tem como objetivo apresentar dois casos clínicos, com diferentes sinais e sintomas, para os quais é importante conhecer as características clínicas específicas da linguagem geográfica e do manejo clínico.

Pediatric dentists play a significant role in the early detection of oral pathologies at a young age because they are usually the first to have contact with the child. This enables them to detect mouth lesions, such as geographic tongue, which is a reddish lesion that appears and disappears and leads parents to seek professional help as they are alarmed. It is essential to reassure parents that it is a benign lesion, which generally does not require treatment 1. This article aims to present two clinical cases, with different signs and symptoms, for which it is important to know the specific clinical characteristics of the geographic tongue and clinical management.

Effects and Mechanisms of Cognitive, Aerobic Exercise, and Combined Training on Cognition, Health, and Brain Outcomes in Physically Inactive Older Adults: The Projecte Moviment Protocol.

INTRODUCTION: Age-related health, brain, and cognitive impairment is a great challenge in current society. Cognitive training, aerobic exercise and their combination have been shown to benefit health, brain, cognition and psychological status in healthy older adults. Inconsistent results across studies may be related to several variables. We need to better identify cognitive changes, individual variables that may predict the effect of these interventions, and changes in structural and functional brain outcomes as well as physiological molecular correlates that may be mediating these effects. Projecte Moviment is a multi-domain randomized trial examining the effect of these interventions applied 5 days per week for 3 months compared to a passive control group. The aim of this paper is to describe the sample, procedures and planned analyses. METHODS: One hundred and forty healthy physically inactive older adults will be randomly assigned to computerized cognitive training (CCT), aerobic exercise (AE), combined training (COMB), or a control group. The intervention consists of a 3 month home-based program 5 days per week in sessions of 45 min. Data from cognitive, physical, and psychological tests, cardiovascular risk factors, structural and functional brain scans, and blood samples will be obtained before and after the intervention. RESULTS: Effects of the interventions on cognitive outcomes will be described in intention-to-treat and per protocol analyses. We will also analyze potential genetic, demographic, brain, and physiological molecular correlates that may predict the effects of intervention, as well as the association between cognitive effects and changes in these variables using the per protocol sample. DISCUSSION: Projecte Moviment is a multi-domain intervention trial based on prior evidence that aims to understand the effects of CCT, AE, and COMB on cognitive and psychological outcomes compared to a passive control group, and to determine related biological correlates and predictors of the intervention effects.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03123900.

Experiences of family care during breast cancer: the perspective of caregivers. / Experiencias del cuidado familiar durante el cáncer de mama: la perspectiva de los cuidadores.

OBJECTIVE: To describe the experience of family care to women with breast cancer during treatment from the perspective of caregivers in the Mexican context. METHOD: Qualitative phenomenological study. In-depth interviews were conducted with caregivers of women who survived breast cancer. Participants were selected by intentional, cumulative and sequential sampling. A conventional content analysis was performed. RESULTS: Participation of seven caregivers, who reported their positive and negative experiences when assuming their role as informal caregivers in the family context. On the strength of the reciprocity of care and its reward, prevailed critical moments, negative feelings, and lack of support resources during the experience. This enables the understanding of the informal care bond in order to enhance it with coping strategies and specific guidance from the nursing staff. CONCLUSION: Participants experienced a transformation in their identity as caregivers and by being aware of their experience, they could describe their qualities, which increased their coping strategies with the disease and the care challenges.

Environmental Surveillance of Polioviruses in Armenia, Colombia before Trivalent Oral Polio Vaccine Cessation.

Although acute flaccid paralysis (AFP) surveillance is the "gold standard" for detecting cases of polio, environmental surveillance can provide supplementary information in the absence of paralytic poliomyelitis cases. This study aimed to detect the introduction and/or circulation of wild poliovirus or vaccine-derived polioviruses (VDPV) in wastewater, covering a significant population of Armenia, Colombia, before trivalent oral polio vaccine (OPV) cessation. Between March and September 2015, 24 wastewater samples were collected from eight study sites in eight communes of Armenia, Colombia. Virus detection and characterization were performed using both cell culture (i.e., RD or L20B cells) and RT-PCR. Polioviruses were isolated in 11 (45.8%) of 24 wastewater samples. All isolates were identified as Sabin strains (type 1 = 9, type 3 = 2) by intratypic differentiation. Type 2 poliovirus was not detected in any of the samples. No wild poliovirus or VDPV was detected among the isolates. Non-polio enterovirus was identified in 8.3% (2/24) of the samples. This study revealed the excretion of Sabin poliovirus from OPV-immunized individuals, as well as the absence of VDPV and wild poliovirus in wastewaters of Armenia, Colombia. This confirms that environmental surveillance is an effective method, as an additional support to AFP surveillance, to monitor poliovirus during the OPV-to-IPV (inactivated polio vaccine) transition period.

Effect of white mustard cover crop residue, soil chemical fumigation and Trichoderma spp. root treatment on black-foot disease control in grapevine.

BACKGROUND: Black-foot disease is one of the main soilborne fungal diseases affecting grapevine production worldwide. Two field experiments were established to evaluate the effect of white mustard cover crop residue amendment and chemical fumigation with propamocarb + fosetyl-Al combined with Trichoderma spp. root treatment on the viability of black-foot inoculum in soil and fungal infection in grafted plants and grapevine seedlings used as bait plants. RESULTS: A total of 876 black-foot pathogen isolates were collected from grafted plants and grapevine seedlings used as bait plants in both fields. White mustard biofumigation reduced inoculum of Dactylonectria torresensis and the incidence and severity of black-foot of grapevine, but no added benefit was obtained when biofumigation was used with Trichoderma spp. root treatments. The effect of white mustard residues and chemical fumigation on populations of D. torresensis propagules in soil was inconsistent, possibly because of varying pretreatment inoculum levels. CONCLUSION: Biofumigation with white mustard plants has potential for improving control of black-foot disease in grapevines. This control strategy can reduce soil inoculum levels and protect young plants from infection, providing grape growers and nursery propagators with more tools for developing integrated and sustainable control systems. © 2018 Society of Chemical Industry.

Experiencia de cuidadores familiares de mujeres con cáncer de mama: una revisión integradora / Experience of Family Caregivers of Women with Breast Cancer: An Integrative Review / Experiência de cuidadores familiares de mulheres com câncer de mama: uma revisão integradora

RESUMEN Objetivo: identificar la evidencia científica de enfermería relacionada con la experiencia de los cuidadores familiares de mujeres con cáncer de mama. Metodología: revisión integradora siguiendo los lineamientos de Ganong; búsqueda en bases de datos: EMBASE, OVID, PUBMED, SAGE journals, SCIELO, Google Academic, ISI Web of Science y SCOPUS, artículos publicados entre los años 2000 y 2016. Resultados: se incluyeron 18 artículos producto de investigaciones primarias de tipo cualitativo, cuyos referentes teórico-metodológicos fueron fenomenología y teoría fundamentada, las técnicas de recolección de datos fueron la entrevista semiestructurada y en profundidad. Se presentan y discuten como hallazgos las siguientes categorías: impacto del diagnóstico; lo que implica ser cuidador; efectos en el cuidador; estrategias de afrontamiento; cambios en los roles y las relaciones; apoyo social. Conclusiones: las características de los cuidadores son variables, es necesario conocer sobre la cultura y recursos propios de cada contexto. Los cuidadores requieren información clara y oportuna en relación su función y las habilidades a desarrollar, especialmente para otorgar apoyo emocional. Es necesaria la indagación de dichas experiencias en el contexto mexicano. Las relaciones padres e hijos en las familias de mujeres con cáncer de mama es un asunto poco estudiado, se requieren futuros estudios en este tema.

ABSTRACT Objective: identify scientific nursing evidence related to the experience of family caregivers of women who have breast cancer. Methodology: An integrative review was conducted following Ganong's guidelines. It included a database search of EMBASE, OVID, PUBMED, SAGE journals, SCIELO, Google Academic, ISI Web of Science and SCOPUS. The focus was on articles published between 2000 and 2016. Results: The review included 18 articles that are the result of qualitative primary studies; their theoretical-methodological references were phenomenology and the grounded theory. Semi-structured and in-depth interview were the data collection techniques used. The following categories are presented and discussed as findings: impact of the diagnosis; what it means to be a caregiver; effects on the caregiver; coping strategies; changes in roles and relationships; and social support. Conclusions: The characteristics of the caregivers vary and it is necessary to know about the culture and resources in each context. Caregivers require clear and timely information about their role and the skills they must develop, especially if they are to provide emotional support. It is necessary to research these experiences in the Mexican context. The relationship between parents and children in the families of women with breast cancer is a topic that has received little study, and future research on this subject is required.

RESUMO Objetivo: identificar a evidência científica de enfermagem relacionada com a experiência dos cuidadores familiares de mulheres com câncer de mama. Metodologia: revisão integradora que segue os lineamentos de Ganong; busca em bases de dados: Embase, OVID, PubMed, Sage journals, SciELO, Google Academic, ISI Web of Science e Scopus, artigos publicados entre 2000 e 2016. Resultados: foram incluídos 18 artigos produto de pesquisas primárias de tipo qualitativo, cujos referenciais teórico-metodológicos foram fenomenologia e teoria fundamentada, técnicas de coleta de dados foram a entrevista semiestruturada e em profundidade. São apresentados e discutidos como achados as seguintes categorias: impacto do diagnóstico; o que implica ser cuidador; efeitos no cuidador; estratégias de enfretamento; mudanças nos papéis e nas relações; apoio social. Conclusões: as características dos cuidadores são variáveis; é necessário conhecer sobre a cultura e recursos próprios de cada contexto. Os cuidadores requerem informação clara e oportuna sobre sua função e habilidades a desenvolver, em especial para oferecer apoio emocional. Requer-se o questionamento dessas experiências no contexto mexicano. As relações pais-filhos nas famílias de mulheres com câncer de mama é assunto pouco estudado e, portanto, exige estudos.

Determinación del riesgo cardiovascular en una población / Determining cardiovascular risk in a population group

Resumen Objetivo: Determinar el riesgo cardiovascular con las escalas Framingham, Framingham Colombia, Procam y Procam Colombia en la población del programa de riesgo cardiovascular de una institución de salud de primer nivel en la ciudad de Armenia, Quindío. Métodos: Se realizó un estudio descriptivo de corte transversal, que tomó como población las personas del programa de riesgo cardiovascular de una institución de salud de primer nivel en la ciudad de Armenia, Quindío, entre el 1 de enero y 31 de diciembre de 2015. Se describieron las variables en promedio, desviación estándar e intervalos de confianza, con un análisis comparativo por sexo para los factores de riesgo en cada escala. Resultados: En la población del programa de riesgo cardiovascular se encontró, un promedio de edad de 64,54 años e índice de masa corporal de 27,71 m2/kg. El 76,48% presenta hipertensión arterial, el 20,86% presenta diabetes mellitus y el 9,36% fuma. El riesgo cardiovascular calculado con la escala de Framingham es el 11,36% y con Framingham Colombia es el 8,52%. Con la escala Procam es el 9,44% y con Procam Colombia es el 8,81%. El índice de masa corporal, la edad y el colesterol LDL, no son estadísticamente significativos para la valoración del riesgo con las escalas Framingham y Framingham Colombia. Conclusiones: Se propone que la escala adecuada para la medición del riesgo cardiovascular en esta población es la escala de Procam o Procam Colombia, porque identifica casi todas las variables de manera significativa. Las escalas de Framingham y Framingham Colombia deben ser utilizadas con precaución en esta población.

Abstract Motivation: To determine cardiovascular risk with Framingham, Framingham Colombia, Procam, and Procam Colombia in the population of the cardiovascular risk program of a first level institution in the city of Armenia, Quindío. Methods: A cross-sectional, descriptive study was conducted that selected as population the participants of the cardiovascular risk program of a first level health institution in the city of Armenia, Quindío, between 1st of January and 31st of December 2015. Average variables, standard deviation and confidence intervals were described with a comparative gender-sensitive analysis of risk factors for each scale. Results: The average age in the cardiovascular risk program was 64.54 years, and a body mass index of 27.71 m2/kg. 76.48% presents arterial hypertension, 20.86% diabetes mellitus and 9.36% smoke. Cardiovascular risk according to the Framingham scale is 11.36%, and with Framingham Colombia it is 8.52%. According to Procam scale it is 9.44%, and with Procam Colombia it is 8.81%. Body mass index, age and LDL cholesterol are not statistically significant for risk assessment with Framingham and Framingham Colombia scales. Conclusion: The proposed appropriate scale for measuring cardiovascular risk in this population group is the Procam or Procam Colombia scale, because it identifies almost all variables in a significant way. Framingham and Framingham Colombia scales must be used with caution for this population group

Sensitivity and specificity of dried blood spots for HIV-1 viral load quantification: A laboratory assessment of 3 commercial assays.

The use of dried blood spots (DBS) instead of plasma as a specimen type for HIV-1 viral load (VL) testing facilitates the decentralization of specimen collection and can increase access to VL testing in resource-limited settings. The performance of DBS for VL testing is lower, however, when compared to the gold standard sample type plasma. In this diagnostic accuracy study, we evaluated 3 VL assays with DBS.Participants were recruited between August 2012 and April 2015. Both plasma and DBS specimens were prepared and tested for HIV-1 VL with the Roche CAP/CTM HIV-1 test v2.0, the Abbott RealTime HIV-1, and the bioMérieux NucliSENS EasyQ HIV-1 v2.0. Sensitivity and specificity to detect treatment failure at a threshold of 1000 cps/mL with DBS were determined.A total of 272 HIV-positive patients and 51 HIV-negative people were recruited in the study. The mean difference or bias between plasma and DBS VL was <0.5 log cps/mL with all 3 assays but >25% of the specimens differed by >0.5 log cps/mL.All 3 assays had comparable sensitivities around 80% and specificities around 90%. Upward misclassification rates were around 10%, but downward misclassification rates ranged from 20.3% to 23.6%. Differences in between assays were not statistically significant (P > 0.1).The 3 VL assays evaluated had suboptimal performance with DBS but still performed better than immunological or clinical monitoring. Even after the introduction of the much-anticipated point-of-care VL devices, it is expected that DBS will remain important as a complementary option for supporting access to VL monitoring, particularly in rural, resource-limited settings. Manufacturers should accelerate efforts to develop more reliable, sensitive and specific methods to test VL on DBS specimens.

Evidence of the circulation of hepatitis A virus, subgenotype IA, in environmental samples from Antioquia, Colombia.

INTRODUCTION: Hepatitis A virus (HAV) is an important pathogen, typically transmitted via the faecal-oral route. The epidemiology of the infection is directly related to drinking water access and adequate disposal of sewage water.  OBJECTIVE: To determine the presence and identify the genotype of HAV in environmental samples from eight municipalities and two villages in Antioquia, northwestern Colombia.  MATERIALS AND METHODS: Three serial samplings were done between December, 2012, and April, 2014. Water samples were obtained from drinking water plants prior to treatment, as well as from the main reserve of wastewater in each municipality included in the study. Viral concentrations for the two types of sample sources were determined by filtration/tangential ultrafiltration and polyethyleneglycol plus flocculation with skimmed milk, respectively. Total ARN was subsequently obtained from each sample and the VP3-VP1 region amplified for detection of the viral genome. The genotype was determined by amplification of the VP1-2B region.  RESULTS: The HAV genome was detected in samples from drinking water plants at Puerto Berrío, Frontino and Nutibara, and in wastewater samples from the municipalities of Arboletes, Zaragoza and Venecia. HAV subgenotype IA was identified using phylogenetic analysis.  CONCLUSION: In this study, HAV was identified in 6.6% of the samples from drinking water plants and 13.3% of wastewater samples. This is the first report of HAV subgenotype IA circulating in environmental samples from Antioquia.

Evidencia de circulación del virus de la hepatitis A, subgenotipo IA, en muestras ambientales en Antioquia, Colombia / Evidence of the circulation of hepatitis A virus, subgenotype IA, in environmental samples from Antioquia, Colombia

Introducción. El virus de la hepatitis A (HAV) es un importante patógeno que se transmite por vía fecal-oral. La epidemiología de la infección está directamente relacionada con el acceso de la población al agua potable y con la infraestructura de alcantarillado. Objetivo. Determinar la presencia del HAV e identificar el genotipo en muestras de agua de abastecimiento y agua residual en ocho municipios, un corregimiento y una vereda del departamento de Antioquia, noroccidente de Colombia. Materiales y métodos. Se hicieron tres muestreos seriados de diciembre de 2012 a abril de 2014 en la fuente principal de abastecimiento de los acueductos y en el principal vertimiento de aguas residuales de cada municipio. Las muestras se concentraron por filtración y ultrafiltración tangencial, y por las técnicas de polietilenglicol y floculación con leche descremada, respectivamente. A partir del ARN total de cada muestra, se amplificaron la región VP3-VP1 para la detección del genoma viral y la región VP1-2B para la genotipificación. Resultados. El genoma del HAV se detectó en las fuentes de agua de abastecimiento de Puerto Berrío, Frontino y Nutibara, y en las muestras de aguas residuales provenientes de los municipios de Arboletes, Zaragoza y Venecia. Mediante el análisis de las secuencias se identificó el subgenotipo IA del virus. Conclusión. Este estudio permitió detectar la presencia del HAV en 6,6 % de las muestras de agua de abastecimiento y en 13,3 % de las muestras de agua residual de los municipios en estudio. Se reporta por primera vez la circulación del subgenotipo IA en muestras ambientales en Antioquia.

Introduction: Hepatitis A virus (HAV) is an important pathogen, typically transmitted via the faecal-oral route. The epidemiology of the infection is directly related to drinking water access and adequate disposal of sewage water. Objective: To determine the presence and identify the genotype of HAV in environmental samples from eight municipalities and two villages in Antioquia, northwestern Colombia. Materials and methods: Three serial samplings were done between December, 2012, and April, 2014. Water samples were obtained from drinking water plants prior to treatment, as well as from the main reserve of wastewater in each municipality included in the study. Viral concentrations for the two types of sample sources were determined by filtration/tangential ultrafiltration and polyethyleneglycol plus flocculation with skimmed milk, respectively. Total ARN was subsequently obtained from each sample and the VP3-VP1 region amplified for detection of the viral genome. The genotype was determined by amplification of the VP1-2B region. Results: The HAV genome was detected in samples from drinking water plants at Puerto Berrío, Frontino and Nutibara, and in wastewater samples from the municipalities of Arboletes, Zaragoza and Venecia. HAV subgenotype IA was identified using phylogenetic analysis. Conclusion: In this study, HAV was identified in 6.6% of the samples from drinking water plants and 13.3% of wastewater samples. This is the first report of HAV subgenotype IA circulating in environmental samples from Antioquia.

Manifestaciones clínicas y hallazgos de laboratorio de una serie de casos febriles agudos con diagnóstico presuntivo de infección por el virus dengue. Quindío (Colombia) / Clinical manifestations and laboratory findings on a case series of acute febrile syndrome with a presumptive diagnosis of dengue virus infection. Quindio, Colombia

Objetivo: Describir las manifestaciones clínicas y hallazgos de laboratorio de una serie de casos febriles agudos con diagnóstico presuntivo de infección por el virus dengue. en Quindío (Colombia). Materiales y métodos: Se realizó un estudio de corte transversal, en pacientes con sospecha clínica de dengue en el periodo comprendido entre enero y agosto de 2013, en algunos centros hospitalarios del departamento del Quindío. Se tomaron muestras de sangre para diagnóstico de dengue, leptospira, malaria, hepatitis B, y rickettsiosis. Como pruebas confirmatorias para dengue se realizó aislamiento viral en células C6/36HT y serotipificación para dengue por RTPCR; pruebas de función hepática, cuadro hemático y niveles de citocinas. Resultados: Se caracterizaron 149 casos, de los cuales el 43% presentaron infección por dengue, 4% leptospira, 6,8% rickettsias, un caso de malaria y uno de hepatitis B. En 5 casos se logró el aislamiento del DENV2 y DENV3. Mediante la RT-PCR, se evidenció cocirculación de serotipos 2, 3, 4. Se encontró que las enzimas AST/ALT, el conteo de plaquetas, la erupción y el dolor abdominal fueron marcadores característicos de la infección por dengue, mientras la ictericia y el dolor lumbar se correlacionaron con la leptospirosis. Los valores de citocinas mostraron que la IL-10, TNF α variaron significativamente en casos con dengue frente a otros diagnósticos, y la IL-17 a presentó diferencias significativas en individuos con dengue grave. Conclusiones: El dengue se confirmó como causa etiológica importante de síndrome febril icterohemorrágico en el departamento del Quindío, pero la leptospirosis y la rickettsiosis tienen también una participación importante. Sin embargo, en el 44% de los casos fueron catalogados como síndrome febril indeterminado.

Objective: To characterise the clinical and laboratory findings on a series of febrile cases with a presumptive diagnosis of dengue virus infection in Quindío, Colombia. Materials and methods: This study was conducted from January to July 2013. Blood samples were obtained from patients suspected of dengue virus infection from Quindío department hospitals. These samples were tested for dengue, leptospira, malaria, hepatitis B and rickettsiosis. To confirm dengue infection, we performed viral isolation in C6/36HT cells and dengue serotyping by RT-PCR; liver function tests, complete blood counts and cytokine levels. Results: Of 149 cases, 43% were infected by dengue, 4% leptospira, 6.8% rickettsia, one case of malaria and one case of hepatitis b. We obtained 5 clinical isolates of DENV2 and DENV3 that evidenced co-circulation of serotypes 2, 3, and 4. We found that AST/ALT levels, platelet count, rash and abdominal pain were good markers of infection by dengue, while jaundice and lumbar pain suggested leptospirosis. Cytokine levels revealed that IL-10, TNF a varied significantly in dengue compared with other diagnostics and that IL-17 α showed significant differences in individuals with severe dengue. Conclusions: Dengue was confirmed as an important aetiology of acute febrile icterohaemorrhagic syndrome in Quindío, but leptospirosis and rickettsia also play an important role. However, 44% of the cases were classified as undetermined febrile syndrome.

Manifestaciones bucales y cutáneas del pénfigo vulgar: caso clínico / Oral and cutaneous manifestations of pemphigus vulgaris: a clinical case

El pénfigo vulgar es una enfermedad ampollar autoinmune que se caracteriza por presentarse en mucosas y en la piel en zonas de roce o traumatismo. Es una variedad muy poco frecuente de la enfermedad, pero es mortal para el individuo si no se trata a tiempo. Se presenta con mayor frecuencia en mujeres entre la cuarta y sexta década de la vida. Se presentó a la consulta un paciente de sexo masculino de 35 años de edad con lesiones ampollares en la boca que le difi cultaban llevar a cabosus actividades cotidianas; las lesiones se extendieron hacia el tórax, por lo que acudió al hospital. El diagnóstico se estableció mediante una biopsia, que fue enviada al Laboratorio de Anatomía Patológica de la Facultad de Odontología de la Universidad Nacional del Nordeste, en Argentina. Para su tratamiento se prescribieron corticosteroides tópicosy sistémicos, iniciando con altas dosis y posteriormente se disminuyeron en la etapa de mantenimiento. El pronóstico fue bueno y el paciente en dos semanas fue recuperando su salud bucal...

La saliva: una mirada hacia el diagnóstico / Saliva: a look on diagnosis

La saliva juega un importante rol en la prevención y mantenimiento de la salud oral. La alteración del flujo salival es un factor clave en el desarrollo de diversas patologías e infecciones oportunistas en lacavidad bucal. Existen diversos caminos por los que algunos elementosque no son constituyentes y habituales de la saliva pueden llegar a ella, a través de rutas intracelulares y extracelulares; gracias a esta posibilidad, se abre una perspectiva para su aplicación en el diagnósticode determinadas patologías. El conocimiento de su composición y funciones ayudará a promoveren los profesionales una mayor conciencia del papel de la saliva en la prevención de patologías y mantenimiento de la salud oral.

Saliva plays an important role in the preventionand maintenance of oral health. Alterationof salivary flow is a key factor in the developmentof various diseases and opportunistic infectionsin the oral cavity.There are various way by which some elementsthat are not common constituents of saliva canreach it through intracellular and extracellularroutes; thanks to this possibility, a prospectfor application in the diagnosis of certainpathologies opens. The knowledge of itscomposition and functions, help promoteprofessionals, greater awareness of the roleof saliva in the prevention of diseasesand maintenance of oral health.

The impact of Advanced Life Support in Obstetrics (ALSO) training in low-resource countries.

OBJECTIVE: To examine the effects of the Advanced Life Support in Obstetrics (ALSO) program on maternal outcomes in four low-income countries. METHODS: Data were obtained from single-center, longitudinal cohort studies in Colombia, Guatemala, and Honduras, and from an uncontrolled prospective trial in Tanzania. RESULTS: In Colombia, maternal morbidity and the number of near misses increased after ALSO training, but maternal mortality decreased. In Guatemala, sustained reductions in overall maternal mortality and mortality from postpartum hemorrhage (PPH) were recorded after ALSO implementation. In Honduras, there was a significant decrease in episiotomy rates, and increases in active management of the third stage of labor (AMTSL), vacuum-assisted delivery, and reported comfort managing obstetric emergencies. In Tanzania, the frequency of PPH and severe PPH decreased after training, while management improved. CONCLUSION: In low-income countries, ALSO training was associated with decreased in-hospital maternal mortality, episiotomy use, and PPH. AMTSL and vacuum-assisted vaginal delivery increased in frequency after ALSO training.