Primer Consenso Chileno de Grupo de Estudio de Tuberculosis Ocular

Introducción: El tratamiento de la tuberculosis (TB) ocular es un tema que genera controversia en el mundo. Para el correcto manejo de estos pacientes, es necesario el desarrollo de guías que consideren la epidemiología de la TB ocular en cada nación. El objetivo de este consenso fue discutir de forma interdisciplinaria la epidemiología, fisiopatología, clínica, diagnóstico, estudio y tratamiento de los pacientes con TB ocular, para establecer un algoritmo de tratamiento y proponer qué pacientes deben ser tratados en Chile y con qué tratamiento. Además, se establecieron acuerdos para efectuar quimioprofilaxis de los pacientes con TB latente que tienen indicación de tratamiento inmunosupresor por enfermedades inflamatorias oculares.

The treatment of ocular tuberculosis (TB) remains controversial worldwide. The development of guidelines for ocular TB can facilitate the approach and management of these patients. These guidelines should be developed regionally, considering the local TB epidemiology. The objectives of this consensus are: to initiate an interdisciplinary discussion about the epidemiology, pathophysiology, clinical presentation, diagnosis, workup and treatment of patients with ocular TB, to establish a treatment algorithm and define which patients should be treated in Chile and how and, to analyze and discuss the published data regarding chemoprophylaxis for patients with latent TB who need to start immunosuppressive treatment due to inflammatory ocular conditions.

Recomendaciones para el diagnóstico y manejo de la infección por citomegalovirus en la mujer embarazada y el recién nacido / Recommendations for the diagnosis and management of cytomegalovirus infection in pregnant woman and newborn infant

Resumen La Sociedad Chilena de Infectología, a través de su Comité de Infecciones Neonatales, en conjunto con la Sociedad Chilena de Obstetricia y Ginecología, proponen un documento de diagnóstico y manejo de la Infección por Citomegalovirus en la Mujer Embarazada y el Recién Nacido. Esta guía aborda el manejo de la infección en el binomio, su enfrentamiento diagnóstico y terapéutico, orientado al equipo de salud que atiende a mujeres embarazadas y recién nacidos con infección por citomegalovirus (CMV) en Chile. Considera la situación epidemiológica global y latinoamericana, con recomendaciones para la evaluación clínica y de laboratorio; establece criterios de diagnóstico, propone enfoques terapéuticos de acuerdo a la situación clínica, analiza las medidas de prevención y establece una propuesta nacional para el seguimiento de esta enfermedad. Se ha puesto especial énfasis en entregar, de forma práctica, y con la mayor evidencia posible, las recomendaciones para el manejo del binomio con infección por CMV.

Abstract The Chilean Society of Infectology, through its Neonatal Infections Committee in conjunction with the Chilean Society of Obstetrics and Gynecology, propose a document for the Diagnosis and Management of Cytomegalovirus Infection in Pregnant Woman and Newborn Infant. This guideline suggests the management of mother and child infection, its diagnostic and therapeutic options. Considers the global and Latin American epidemiology, with recommendations for clinical and laboratory evaluation; diagnostic criteria, therapeutic approaches according to the clinical situation, analyzes prevention measures and establishes a national proposal for monitoring this disease.

Recomendaciones para el diagnóstico y el manejo de la infección por citomegalovirus en la mujer embarazada y el recién nacido / Recommendations for the diagnosis and management of cytomegalovirus infection in pregnant women and newborns

Resumen La Sociedad Chilena de Infectología, a través de su Comité de Infecciones Neonatales, en conjunto con la Sociedad Chilena de Obstetricia y Ginecología, proponen un documento de diagnóstico y manejo de la infección por citomegalovirus (CMV) en la mujer embarazada y el recién nacido. Esta guía aborda el manejo de la infección en el binomio, su enfrentamiento diagnóstico y terapéutico, orientado al equipo de salud que atiende a mujeres embarazadas y recién nacidos con infección por CMV en Chile. Considera la situación epidemiológica global y latinoamericana, con recomendaciones para la evaluación clínica y de laboratorio; establece criterios de diagnóstico, propone enfoques terapéuticos de acuerdo a la situación clínica, analiza las medidas de prevención y establece una propuesta nacional para el seguimiento de esta enfermedad. Se ha puesto especial énfasis en entregar, de forma práctica, y con la mayor evidencia posible, las recomendaciones para el manejo del binomio con infección por CMV.

Abstract The Chilean Society of Infectology, through its Neonatal Infections Committee in conjunction with the Chilean Society of Obstetrics and Gynecology, propose a document for the Diagnosis and Management of Cytomegalovirus Infection in Pregnancy and Newborn. This guideline suggests the management of mother and child infection, its diagnostic and therapeutic options. Considers the global and Latin American epidemiology, with recommendations for clinical and laboratory evaluation, diagnostic criteria, therapeutic approaches according to the clinical situation, analyzes prevention measures and establishes a national proposal for monitoring this disease.

[Recommendations for the diagnosis and management of cytomegalovirus infection in pregnant woman and newborn infant]. / Recomendaciones para el diagnóstico y manejo de la infección por citomegalovirus en la mujer embarazada y el recién nacido.

The Chilean Society of Infectology, through its Neonatal Infections Committee in conjunction with the Chilean Society of Obstetrics and Gynecology, propose a document for the Diagnosis and Management of Cytomegalovirus Infection in Pregnant Woman and Newborn Infant. This guideline suggests the management of mother and child infection, its diagnostic and therapeutic options. Considers the global and Latin American epidemiology, with recommendations for clinical and laboratory evaluation; diagnostic criteria, therapeutic approaches according to the clinical situation, analyzes prevention measures and establishes a national proposal for monitoring this disease.

[Tuberculosis: a challenge in newborn care and how to deal with it. Update document]. / Tuberculosis: un reto en la atención del recién nacido y cómo enfrentarlo. Documento de Actualización.

Tuberculosis in the neonatal stage has a high morbidity and mortality, is difficult to diagnose and involves the mother-child binomial and their environment. The particular characteristics of the immune system in pregnant women and the newborn, impact the clinical presentation of this disease. Its diagnosis is complex and the establishment of treatment must be timely and cannot be postponed. Relevant aspects for the diagnosis and management of the newborn exposes to the tuberculosis are covered.

Tuberculosis: un reto en la atención del recién nacido y cómo enfrentarlo: documento de Actualización / Tuberculosis: a challenge in newborn care and how to deal with it: update document

Resumen La tuberculosis en etapa neonatal tiene una alta morbimortalidad, es de difícil diagnóstico e involucra al binomio madre-hijo y su entorno. Las características particulares del sistema inmune en la mujer gestante y el recién nacido, impactan en la presentación clínica de esta enfermedad. Su diagnóstico es complejo y la instauración del tratamiento debe ser oportuna e impostergable. Se abarcan aspectos relevantes para el diagnóstico y manejo del recién nacido expuesto a la tuberculosis

Abstract Tuberculosis in the neonatal stage has a high morbidity and mortality, is difficult to diagnose and involves the mother-child binomial and their environment. The particular characteristics of the immune system in pregnant women and the newborn, impact the clinical presentation of this disease. Its diagnosis is complex and the establishment of treatment must be timely and cannot be postponed. Relevant aspects for the diagnosis and management of the newborn exposes to the tuberculosis are covered.

[Blood cultures in newborns: optimizing sample collection and performance]. / Hemocultivos en recién nacidos: optimizando la toma de muestra y su rendimiento.

The request of blood cultures in medical care is frequent, especially in Neonatal Units, where it is performed routinely in case of suspected early or late sepsis. The purpose of this document is to standardize the sampling technique in order to increase its performance and establish criteria to interpret a positive blood culture.

Impact of operational factors on HPV positivity rates in an HPV-based screening study in Colombia.

OBJECTIVE: To assess the effect of operational factors on the positivity rates of three HPV assays. METHODS: Within the cross-sectional ESTAMPA study, women aged 30-64 years were recruited at healthcare centers from Soacha, Colombia, during 2012-2015. Cervical samples were collected for cotesting with Hybrid Capture 2 (HC2; Qiagen, Gaithersburg, MD, USA), and either Aptima (Hologic, Marlborough, MA, USA) or Cobas 4800 (Roche Diagnostics, Indianapolis, IN, USA). The effect of operational factors on assay performance was assessed using adjusted positivity rates obtained from logistic regression models. RESULTS: There were 4168 women included. For samples collected in assay-specific medium, positivity rate differences were associated with the expertise of the nurse collecting the sample (P=0.014 HC2; P=0.091 Aptima) and if sample collection occurred after an initial cytology (P=0.025 HC2; P=0.033 Aptima). If PreservCyt medium (Hologic) was used, HC2 positivity differences were observed depending on the time between sample collection and processing (P=0.026) and on the laboratory technician processing the samples (P=0.003). No differences were observed for PreservCyt samples processed with Aptima or Cobas. CONCLUSION: Nurse expertise, collection of previous cytology, processing time, and laboratory technician could influence HPV assay performance. Suitable quality assurance protocols for HPV-based screening programs are required. ClinicalTrials.gov: NCT01881659.

Hemocultivos en recién nacidos: optimizando la toma de muestra y su rendimiento / Blood cultures in newborns: optimizing sample collection and performance

Resumen La solicitud de hemocultivos en la atención médica es frecuente, especialmente en las Unidades de Neonatologia, donde se realiza en forma rutinaria frente a la sospecha de sepsis precoz o tardia. Este documento tiene como objetivo estandarizar la técnica de obtención de muestra con la finalidad de aumentar su rendimiento y establecer criterios de cómo interpretar un hemocultivo positivo.

The request of blood cultures in medical care is frequent, especially in Neonatal Units, where it is performed routinely in case of suspected early or late sepsis. The purpose of this document is to standardize the sampling technique in order to increase its performance and establish criteria to interpret a positive blood culture.

[Immigration and impact on infectious diseases of the newborn]. / Inmigración e impacto en la infectología de recién nacidos.

Over the past few years immigration has become an important issue in Chile. Particular attention should be paid in foreign pregnant mothers. Infectious diseases screening in this group greatly reduce the risk of transmission to the fetus with appropriate therapy.

Inmigración e impacto en la infectología de recién nacidos / Immigration and impact on infectious diseases of the newborn

Resumen El fenómeno migratorio en Chile ha aumentado en forma exponencial en los últimos años y con ello las mujeres embarazadas extranjeras en las maternidades de nuestro país. El conocer el estado de salud y el tamizaje de enfermedades infecciosas en la madre, permitiría tomar conductas preventivas de gran impacto en el recién nacido.

Over the past few years immigration has become an important issue in Chile. Particular attention should be paid in foreign pregnant mothers. Infectious diseases screening in this group greatly reduce the risk of transmission to the fetus with appropriate therapy.

Modeling Neurodegenerative Disorders for Developing Cannabinoid-Based Neuroprotective Therapies.

The increase in lifespan during the last 50 years, mainly in developed countries, has originated a progressive elevation in the incidence of chronic neurodegenerative disorders, for which aging is the key risk factor. This fact will definitively become the major biomedical challenge during the present century, in part because the expectation of a persisting elevation in the population older than 65 years over the whole population and, on the other hand, because the current lack of efficacious therapies to control these disorders despite years of intense research. This chapter will address this question and will stress the urgency of developing better neuroprotective and neurorepair strategies that may delay/arrest the progression of these disorders, reviewing the major needs to solve the causes proposed for the permanent failures experienced in recent years, e.g., to develop multitarget strategies, to use more predictive experimental models, and to identify early disease biomarkers. This chapter will propose the cannabinoids and their classic (e.g., endocannabinoid receptors and enzymes) and nonclassic (e.g., peroxisome proliferator-activated receptors, transcription factors) targets as a useful strategy for developing novel therapies for these disorders, based on their broad-spectrum neuroprotective profile, their activity as an endogenous protective system, the location of the endocannabinoid targets in cell substrates critical for neuronal survival, and their ability to serve for preservation and rescue, but also for repair and/or replacement, of neurons and glial cells against cytotoxic insults.

Association of vitamin D deficiency, season of the year, and latent tuberculosis infection among household contacts.

OBJECTIVES: Vitamin D (VD) enhances the immune response against Mycobacterium tuberculosis in vitro, and VD deficiency has been described in patients with active tuberculosis (TB). However, the role of hypovitaminosis D in the pathogenesis of early TB infection acquisition is unclear. We aimed to evaluate the association of VD deficiency, season of the year, and latent TB infection in household contacts (HHC), given that this is a potentially modifiable condition often related to nutritional deficiencies and lack of sun exposure. METHODS: We prospectively enrolled new pulmonary TB cases (n = 107) and their HHC (n = 144) over a 2-year period in Santiago, Chile. We compared plasma 25-hydroxycholecalciferol (25OHD) levels and examined the influence of season, ethnic background, living conditions, and country of origin. RESULTS: Over 77% of TB cases and 62.6% of HHC had VD deficiency (<20 ng/ml). Median 25OHD concentration was significantly lower in TB cases than in HHC (11.7 vs. 18.2 ng/ml, p<0.0001). Migrants HHC had lower 25OHD levels than non-migrants (14.6 vs. 19.0 ng/ml, p = 0.026), and a trend towards a higher burden of latent TB infection (52.9% vs. 35.2%, p = 0.066). Multivariate analysis found VD deficiency in HHC was strongly associated with being sampled in winter/spring (adOR 25.68, 95%CI 7.35-89.7), corresponding to the seasons with lowest solar radiation exposure. Spring enrollment-compared with other seasons-was the chief risk factor for latent TB infection in HHC (adOR 3.14, 95%CI 1.28-7.69). CONCLUSIONS: Hypovitaminosis D was highly prevalent in TB cases and also in HHC. A marked seasonality was found for both VD levels and latent TB in HHC, with winter being the season with lowest VD levels and spring the season with the highest risk of latent TB infection.

[Latent tuberculosis infection screening in healthcare workers in four large hospitals in Santiago, Chile]. / Pesquisa de infección tuberculosa latente en personal de la salud en cuatro instituciones de salud en Santiago de Chile.

BACKGROUND: It is currently unknown which is the prevalence of latent tuberculosis infection in healthcare workers in Chile, but this group has been described as at higher risk of developing active tuberculosis than general population. OBJECTIVES: To determine the prevalence of latent tuberculosis infection in a sample of healthcare workers from at risk areas. METHODOLOGY: A cross-sectional, descriptive study, conducted in health care workers from clinical laboratories or respiratory care areas in four hospitals in Santiago. Latent tuberculosis infection detection was determined by Quantiferon® TB Gold In Tube testing (QFT). RESULTS: QFT resulted positive in 20 of 76 (26.3%) of the individuals tested. Test positivity reached 62.5% among the personnel that reported history of past TB contact in the community, 50% among the personnel who belonged to the national tuberculosis control program and 38% among those doing induced sputum, acid fast smear or mycobacterial cultures. The proportion of individuals with positive QFT was significantly lower in those personnel who had no such risk factors (15.7%, p = 0.03). The proportion of latent tuberculosis infection also increased in direct relation to the age of the subject. CONCLUSION: Latent tuberculosis infection as detected by QFT testing was highly prevalent in healthcare workers included in the present study. Further exploring the limitations and possible scenarios for this new diagnostic tool is needed, with emphasis on health personnel at higher-risk and younger individuals.

Pesquisa de infección tuberculosa latente en personal de la salud en cuatro instituciones de salud en Santiago de Chile / Latent tuberculosis infection screening in healthcare workers in four large hospitals in Santiago, Chile

Background: It is currently unknown which is the prevalence of latent tuberculosis infection in healthcare workers in Chile, but this group has been described as at higher risk of developing active tuberculosis than general population. Objectives: To determine the prevalence of latent tuberculosis infection in a sample of healthcare workers from at risk areas. Methodology: A cross-sectional, descriptive study, conducted in health care workers from clinical laboratories or respiratory care areas in four hospitals in Santiago. Latent tuberculosis infection detection was determined by Quantiferon® TB Gold In Tube testing (QFT). Results: QFT resulted positive in 20 of 76 (26.3%) of the individuals tested. Test positivity reached 62.5% among the personnel that reported history of past TB contact in the community, 50% among the personnel who belonged to the national tuberculosis control program and 38% among those doing induced sputum, acid fast smear or mycobacterial cultures. The proportion of individuals with positive QFT was significantly lower in those personnel who had no such risk factors (15.7%, p = 0.03). The proportion of latent tuberculosis infection also increased in direct relation to the age of the subject. Conclusion: Latent tuberculosis infection as detected by QFT testing was highly prevalent in healthcare workers included in the present study. Further exploring the limitations and possible scenarios for this new diagnostic tool is needed, with emphasis on health personnel at higher-risk and younger individuals.

Introducción: Se desconoce en la actualidad cuál es la real prevalencia de infección tuberculosa latente en el personal de salud en Chile; sin embargo, este grupo ha sido descrito como con mayor riesgo de desarrollar tuberculosis activa que la población general. Objetivo: Determinar la prevalencia de infección tuberculosa latente en funcionarios de la salud en diferentes áreas laborales de riesgo. Metodología: Estudio de corte transversal, descriptivo, realizado en funcionarios pertenecientes a laboratorios clínicos o áreas de atención broncopulmonar de cuatro hospitales de la Región Metropolitana en quienes se hizo test de Quantiferon TB Gold®In tube(QFT). Resultados: Se evidenció infección tuberculosa latente en 20 de las 76 (26,3%) personas estudiadas. En aquellos funcionarios que referían antecedente de contacto en el pasado en la comunidad con enfermos de tuberculosis, la positividad del test llegó a 62,5%; en aquellos que pertenecían al Programa Nacional de Control de la Tuberculosis, a 50% y en los que realizaban toma de esputo inducido, baciloscopias o cultivo de micobacterias, a 38%. La proporción de individuos con QFT positivo fue significativamente menor en aquellos funcionarios que no tenían estos antecedentes (15,7%, p = 0,03). Se encontró además una mayor proporción de infección tuberculosa latente a mayor edad del individuo estudiado. Conclusión: La infección tuberculosa latente medida por QFT resultó altamente prevalente en el personal de la salud incluido en el presente estudio. Es necesario seguir profundizando en los posibles escenarios de implementación y limitaciones del uso de esta nueva herramienta diagnóstica, haciendo énfasis en el personal de la salud de mayor riesgo y menor edad.

Plaguicidas organoclorados en leche de bovinos suplementados con residuos de algodón en San Pedro, Colombia / Organochlorine pesticides in cows'milk supplemented with cotton waste in San Pedro, Colombia

Objetivo Evaluar la presencia de pesticidas organoclorados (OCPs) en leche cruda bovina procedente de fincas de tradición algodonera del municipio de San Pedro, Sucre. Materiales y métodos Se tomaron 48 muestras de leche procedente de tres fincas ganaderas, dos de ellas con tradición en la suplementación alimenticia con semillas y soca de algodón, y se les determinó la concentración de OCPs por cromatografía gaseosa empleando un detector de microcaptura de electrones (µECD). Resultados El 100 por ciento de las muestras presentaron algún tipo de OCPs, y las concentraciones más altas correspondieron a los pesticidas Endrin, DDT y Aldrin, con 0,62, 0,59 y 0,52 µg/mL, respectivamente. Las fincas que suplementaron con soca de algodón tuvieron una mayor presencia y concentración de OCPs en leche que las muestras provenientes de la finca que no realizaba esta práctica. Conclusión A pesar que la mayoría de los plaguicidas organoclorados están prohibidos en el país desde 1986, aún se presentan residuos en las muestras de leche cruda analizadas provenientes de fincas con tradición en el cultivo de algodón, generando un riesgo de salud pública a los consumidores.

Objective Ascertaining the presence of organochlorine pesticides (OCPs) in raw milk from cows grazing on traditional cotton farms in San Pedro, Sucre, Colombia. Materials and methods 48 samples were taken from three cattle farms; two of them used cotton seed and soca dietary supplement.OCP concentration was determined by gas chromatography (GC) using an electron capturedetector (µ-ECD). Results 100 percent of the samples had some type of OCPs and Endrin, DDT and Aldrin pesticides hadthe highest concentrations (0.62, 0.59 and 0.52 µg/mL, respectively). Farms supplementing feed with soca cotton had the greatest OCP presence and concentration in milk samples compared to samples from farms which did not engage in this practice. Conclusion Although most OCPs have been banned in Colombia since 1986, residues are still being presented in raw milk samples tested from cottongrowing farms, thereby creating a public health risk for consumers.