The Chikungunya virus: A reemerging cause of acute febrile illness in the high jungle of northern Peru.

BACKGROUND: The Chikungunya virus (CHIKV) is an emerging arthropod-borne virus (arbovirus) that causes undifferentiated acute febrile illness. Cases of CHIKV may be under-reported in Peru, given the various difficulties in diagnosing it, such as lack of diagnostic tests in remote areas, the passive nature of epidemiological surveillance, and co-circulation of other arthropod-borne pathogens. Therefore, a study was conducted in the high jungle of northern Peru to determine the prevalence of CHIKV among febrile patients and describe their clinical characteristics. METHODS: A cross-sectional study was conducted in the province of Jaen, Cajamarca, located in the high jungle of northern Peru. Patients attending primary healthcare centers within Cajamarca's Regional Health Directorate were enrolled. The study took place from June 2020 through June 2021. Patients were eligible if they sought outpatient healthcare for a clinical diagnosis of acute febrile illness (AFI). Serum samples were collected from all patients, and the diagnosis of CHIKV was determined using real-time RT-PCR, as well as the detection of IgM antibodies by ELISA. A logistic regression model was employed to identify the risk factors for CHIKV, and the odds ratios (ORs) were calculated, along with their corresponding 95% confidence intervals (95% CI). RESULTS: A total of 1 047 patients with AFI were included during the study period. CHIKV was identified in 130 patients of 1 047 (12.4%). Among the CHIKV positive cases, 84 of 130 (64.6%) were diagnosed by RT-PCR, 42 of 130 (32.3%) by IgM ELISA detection, and 4 of 130 (3.1%) by both assays. The majority of patients with CHIKV infection fell within the 18-39 years age group (50.0%), followed by the 40-59 years age group (23.9%) and those with 60 years or older (10.8%). The most common clinical symptoms observed in patients with CHIKV infection were headache (85.4%), myalgias (72.3%), and arthralgias (64.6%). The highest number of positive CHIKV cases occurred in May (23.1%), followed by March (20.0%) and February (13.8%) of 2021. CONCLUSION: The study reports a considerable frequency of CHIKV infections among patients with AFI from the high jungle of northern Peru. These findings highlight the importance of recognizing CHIKV as an ongoing pathogen with continuous transmission in various areas of Peru. It is crucial to enhance epidemiological surveillance by implementing reliable diagnostic techniques, as the clinical symptoms of CHIKV infection can be nonspecific.

Prevalence of coinfections in a cross-sectional cohort of women screened for multiple pathogens in Peru.

Objective: To determine the prevalence and risk factors of sexually transmitted infections (STIs) including Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma genitalium among asymptomatic women with human papillomavirus (HPV) infection. Methods: A cross-sectional study was performed in 842 asymptomatic women from Cajamarca, Peru. The pathogens were detected using polymerase chain reaction (PCR) and the results were analyzed according to the HPV status: high-risk HPV, low-risk HPV and negative for HPV. Demographical and gyneco-obstetric data was analyzed to identify risk factors. Results: We found that 23.99% (202/842) women were positive for HPV, of whom 79.21% (160/202) were infected with a high-risk genotype. Co-infections were evaluated and 14.38% (23/160) were positive for Ureaplasma urealyticum, 9.38% (15/160) for Chlamydia trachomatis and 1.25% (2/160) for Mycoplasma genitalium. We found a significant association between HPV genotype and the number of children, partners, and history of sexual abuse. The co-infection between high-risk HPV and Chlamydia trachomatis was associated with number of abortions, number of sexual partners and no use of condom. Finally, co-infection between high-risk HPV and Ureaplasma urealyticum was associated with no use of condom and history of STIs. Conclusion: HPV infection continues to be a highly relevant problem in Peru, particularly due to the high prevalence of high-risk genotypes. In addition, we report high rates of co-infections with other STIs, such as U. urealyticum and C. trachomatis. We highlight the importance of active surveillance to promptly diagnose these infections, since they may lead to persistent HPV infections.

Actividades recreativas para motivar el aprendizaje de los niños con síndrome de Down / Atividades recreativas para motivar a aprendizagem em crianças com síndrome de Down / Recreational activities to motivate the learning of children with Down síndrome

RESUMEN Las actividades recreativas pueden potenciar diversas variables para la enseñanza de elementos diversos en niños con síndrome de Down, las cuales pueden mejorar la calidad de vida del sujeto, a través de la aplicación científica de estímulos físicos adecuados y adaptados al contexto. El objetivo de esta investigación consistió en validar teóricamente la importancia que revisten las actividades recreativas para motivar el aprendizaje de los niños con síndrome de Down desde diferentes variables de análisis. La investigación es exploratoria, de orientación descriptiva-explicativa y correlacional, se consultan a 31 especialistas de dos grupos independientes (grupo 1: especialistas nacionales: 16 sujetos; grupo 2: especialistas internacionales: 15 sujetos). Se valida la importancia de las actividades recreativas en las habilidades físicas básicas (HFB) y específicas (HFE), la formación de valores (FV), las habilidades cognitivas (HC) y la cultura lúdica (CL). Los criterios emitidos por los grupos independientes no mostraron diferencias significativas en las variables "HFB" (p=0.626), "FV" (p=0.545) y "CL" (p=0.861), y sí en las variables "HFE" (p=0.000) y "HC" (p=0.000). Se evidencia la necesidad de una actualización de conocimientos en los especialistas nacionales en las dos últimas variables descritas. De las variables analizadas, posee una mayor importancia relativa la "HFB", seguida de "HFE", la "FV", la "HC" y la "CL" respectivamente. La presente investigación sentó las bases teóricas para realizar investigaciones prácticas con una alta originalidad para el entorno ecuatoriano. Se prioriza la superación profesional de los especialistas nacionales y la implementación de acciones prospectivas de consideración.

RESUMO As atividades recreativas podem melhorar várias variáveis para o ensino de diversos elementos em crianças com síndrome de Down, o que pode melhorar a qualidade de vida da disciplina, através da aplicação científica de estímulos físicos adequados adaptados ao contexto. O objectivo desta investigação era validar teoricamente a importância das atividades recreativas para motivar a aprendizagem em crianças com síndrome de Down a partir de diferentes variáveis de análise. A investigação é exploratória, descritiva-explicativa e correlativa. Foram consultados 31 especialistas de dois grupos independentes (Grupo 1: Especialistas Nacionais: 16 temas; Grupo 2: Especialistas Internacionais: 15 temas). A importância das atividades recreativas nas competências físicas básicas (BPS) e competências físicas específicas (BPS), formação de valores (VF), competências cognitivas (CS) e cultura lúdica (LC) é validada. Os critérios emitidos pelos grupos independentes não mostraram diferenças significativas nas variáveis "HFB" (p=0,626), "FV" (p=0,545) e "CL" (p=0,861), mas diferenças significativas nas variáveis "HFE" (p=0,000) e "HC" (p=0,000). A necessidade de atualizar os conhecimentos dos especialistas nacionais nas duas últimas variáveis descritas é evidente. Das variáveis analisadas, "HFB" tem a maior importância relativa, seguido por "HFE", "FV" "HC" e "CL" respectivamente. Esta investigação lançou as bases teóricas para a investigação prática com um elevado grau de originalidade para o ambiente equatoriano. É dada prioridade ao aperfeiçoamento profissional dos especialistas nacionais e à implementação de ações prospectivas de consideração.

ABSTRACT Recreational activities can enhance various variables for the teaching of various elements in children with Down syndrome, which can improve the subject's quality of life, through the scientific application of appropriate physical stimuli and adapted to the context. The objective of this research was to theoretically validate the importance of recreational activities to motivate the learning of children with Down syndrome from different analysis variables. The research is exploratory, with a descriptive-explanatory and correlational orientation, 31 specialists from two independent groups are consulted (Group 1: National Specialists: 16 subjects; group 2: international specialists: 15 subjects). The importance of recreational activities in basic (HFB in Spanish) and specific (HFE in Spanish) physical skills, the formation of values (FV in Spanish), cognitive skills (HC in Spanish) and ludic culture (CL in Spanish) is validated. The criteria issued by the independent groups did not show significant differences in the variables "HFB" (p=0.626), "FV" (p=0.545) and "CL" (p=0.861), but in the variables "HFE" ( p=0.000) and "HC" (p=0.000). The need for an update of knowledge in national specialists in the last two variables described is evident. Of the variables analyzed, "HFB" has a greater relative importance, followed by "HFE", "FV", "HC" and "CL" respectively. The present research laid the theoretical foundations to carry out practical researches with a high originality for the Ecuadorian environment. The professional improvement of national specialists and the implementation of prospective actions of consideration are prioritized.

Comparison of cytokines levels among COVID-19 patients living at sea level and high altitude.

BACKGROUND: At the end of 2019, a novel coronavirus denominated SARS-CoV-2 rapidly spread through the world causing the pandemic coronavirus disease known as COVID-19. The difference in the inflammatory response against SARS-CoV-2 infection among people living at different altitudes is a variable not yet studied. METHODS: A descriptive cross-sectional study was performed in two Peruvian cities at different altitudes for comparison: Lima and Huaraz. Five important proinflammatory cytokines were measured including: IL-6, IL-2, IL-10, IFN-γ and TNF-α using ELISA assays. RESULTS: A total of 35 COVID-19 patients and 10 healthy subjects were recruited from each study site. The mean levels of IL-6 (p < 0.03) and TNF-α (p < 0.01) were significantly different among the study groups. In the case of IL-6, patients from Lima had a mean level of 16.2 pg/ml (healthy) and 48.3 pg/ml (COVID-19), meanwhile, patients from Huaraz had levels of 67.3 pg/ml (healthy) and 97.9 pg/ml (COVID-19). Regarding TNF-α, patients from Lima had a mean level of 25.9 pg/ml (healthy) and 61.6 pg/ml (COVID-19), meanwhile, patients from Huaraz had levels of 89.0 pg/ml (healthy) and 120.6 pg/ml (COVID-19). The levels of IL-2, IL-10 and IFN-γ were not significantly different in the study groups. CONCLUSION: Patients with COVID-19 residing at high-altitude tend to have higher levels of inflammatory cytokines compared to patients living at sea level, particularly IL-6 and TNF-α. A better understanding of the inflammatory response in different populations can contribute to the implementation of therapeutic and preventive approaches. Further studies evaluating more patients, a greater variety of cytokines and their clinical impact are required.

Efectividad de la educación sanitaria para la prevención de enfermedades diarreicas agudas / Effectiveness of health education for the prevention of acute diarrheal diseases

En investigaciones similares se ha reportado un grado de desconocimiento respecto a las enfermedades diarreicas agudas en los padres de grupos de riesgo. Varias investigaciones han abordado el tema de la educación sanitaria como factor determinante en la prevención de enfermedades. Las políticas de salud, están obligadas a mantener vigentes las estrategias de prevención efectivas y proponer una búsqueda continua y exhaustiva de nuevas políticas que ayuden a desterrar la EDA de las principales causas de morbilidad en grupos vulnerables. El desafío actual es atenuar los determinantes sociales y atender a la población con factores de riesgo. En esta revisión se evaluó y sistematizó publicaciones en busca de pruebas de la efectividad de la educación sanitaria en la prevención de la enfermedad diarreica aguda(AU)

Similar investigations have reported a degree of ignorance regarding acute diarrheal diseases in parents of risk groups. Several investigations have addressed the issue of health education as a determining factor in disease prevention. Health policies are obliged to keep effective prevention strategies in force and propose a continuous and exhaustive search for new policies that help banish ADD from the main causes of morbidity in vulnerable groups. The current challenge is to mitigate the social determinants and care for the population with risk factors. In this review, we evaluated and systematized publications looking for evidence of the effectiveness of health education in the prevention of acute diarrheal disease(AU)

Bacteremia due to Ralstonia mannitolilytica: A report of the first case in Peru. / Bacteremia por Ralstonia mannitolilytica: primer reporte de caso en Perú.

The first report of Ralstonia mannitolilytica bacteremia in Peru is presented. The patient was a pediatric cancer patient with a long-term central venous access device. For the diagnosis, the MicroScan Walk Away 96 automated system was used. 16S rDNA was amplified by conventional PCR, and the bacterial genus and species were identified by genetic sequencing. In addition, the bacterial resistance profile to major antimicrobials was determined. The article discusses the need to actively monitor Ralstonia mannitolilytica, especially in hospital areas of immunocompromised patients.

Se presenta el primer reporte de una bacteriemia por Ralstonia mannitolilytica en Perú. Se trata de un paciente pediátrico con cáncer que porta un dispositivo de acceso venoso central de larga duración. Para establecer el diagnóstico, se utilizó el sistema automático MicroScan Walk Away 96. Se amplificó el rADN 16S mediante PCR convencional y se identificó el género y la especie bacteriana mediante secuenciación genética. Además, se determinó el perfil de resistencia bacteriana a los principales antimicrobianos. El artículo discute la necesidad de monitorizar activamente la presencia de Ralstonia mannitolilytica, especialmente en áreas hospitalarias de pacientes inmunodeprimidos.

Characterization of the gut microbiota in diabetes mellitus II patients with adequate and inadequate metabolic control.

OBJECTIVE: The objective of this study was to characterize the composition of the gut microbiota in type 2 Diabetes Mellitus (T2DM) patients with adequate and inadequate metabolic control, and its relationship with fiber consumption. RESULTS: A total of 26 patients with type 2 diabetes mellitus (T2DM) were enrolled, of which 7 (26.9%) cases had adequate metabolic control (HbA1c < 7%) and 19 (73.1%) inadequate metabolic control (HbA1c ≥ 7%). It was observed that among patients with controlled T2DM, 2 (28.6%) cases presented good intake of fiber and 5 (71.4%) cases a regular intake. In contrast, in patients with uncontrolled T2DM, 13 (68.4%) patients reported a regular intake and 6 (31.6%) a poor intake. In relation to the identification of the gut microbiota, both groups presented a similar characterization. There were differences in the population of bacteria identified in both groups, however, the results were not statistically significant. The most frequently identified bacteria in controlled and uncontrolled T2DM patients were Prevotella (71.4% vs 52.6%), followed by Firmicutes (71.4% vs 42.1%), Proteobacteria (71.4% vs 36.8%) and Bacteroidetes (57.1% vs 37.8%). On the other hand, Fusobacterium, Actinobacteria were not identified in either of the two groups of study.

Leptospirosis in febrile patients with suspected diagnosis of dengue fever.

OBJECTIVE: This study was carried out to determine the prevalence of leptospirosis among febrile patients with a suspicious clinical diagnosis of dengue fever in northern Peru. RESULTS: A total of 276 serum samples from patients with acute febrile illness (AFI) and suspected diagnosis for dengue virus (DENV) were analyzed. We identified an etiological agent in 121 (47.5%) patients, DENV was detected in 30.4% of the cases, leptospirosis in 11.2% and co-infection by both pathogens was observed in 5.9% of the patients. In this study the most common clinical symptoms reported by the patients were: headache 89.1%, myalgias 86.9% and arthralgias 82.9%. No differences in symptomatology was observed among the different study groups.

Genotype-specific prevalence of human papillomavirus infection in asymptomatic Peruvian women: a community-based study.

OBJECTIVE: To determine the general and genotype-specific prevalence of HPV and to identify potential risk factors for the infection in a population-based screening of Peruvian women. RESULTS: A total of 524 samples were analyzed by PCR and a total of 100 HPV positive samples were found, of which 89 were high-risk, 19 were probably oncogenic, 9 were low-risk and 27 other HPV types. The 26-35 and 36-45 age groups showed the highest proportion of HPV positive samples with a total of 37% (37/100) and 30% (30/100), respectively. Moreover, high-risk HPV was found in 33.7% of both groups and probably oncogenic HPV in 52.6% and 31.6%, respectively. High-risk HPV were the most frequent types identified in the population studied, being HPV-52, HPV-31 and HPV-16 the most commonly detected with 17.6%, 15.7% y 12.9%, respectively. Demographic characteristics and habits were assessed in the studied population. A total of 62% high-risk HPV were detected in married/cohabiting women. Women with two children showed the highest proportion (33.8%) of high-risk HPV, followed by women with only one child (26.9%). Those women without history of abortion had a higher frequency of high-risk HPV (71.9%), followed by those with one abortion (25.8%).

Clinical characteristics and molecular detection of Bordetella pertussis in hospitalized children with a clinical diagnosis of whooping cough in Peru.

BACKGROUND AND OBJECTIVES: Pertussis is an infectious disease caused by the Gram-negative bacterium Bordetella pertussis. In Peru, actual public health programs indicate that vaccination against B. pertussis must be mandatory and generalized, besides all detected cases must be reported. The objective of this study was to determine the prevalence of B. pertussis among children under five years of age with a presumptive diagnosis of whopping cough in Cajamarca, a region located in northern Peru. MATERIALS AND METHODS: The population of this cross-sectional study were children under 5 years old hospitalized as presumptive cases of pertussis during December 2017 to December 2018. The nasopharyngeal samples were analyzed by real-time PCR for the detection of B. pertussis. RESULTS: B. pertussis was identified as PCR + in 42.3% of our sample (33/78). The clinical presentation that was observed most frequently includes paroxysmal coughing (97%), difficulty breathing (69.7%), cyanosis (72.7%) and post-tussive emesis (60.6%). Additionally, pneumonia was the most observed complication (33.3%). Four of the patients with PCR+ for B. pertussis presented only lymphocytosis, five only leukocytosis, two patients with decreased leukocytosis and lymphocytes and only one patient with leukopenia and relative lymphocytosis. There was a percentage of 84.8% of unvaccinated children in the PCR+ group. Finally, the mother was the most frequent symptom carrier (18.2%). CONCLUSION: In conclusion, in the studied population there is a high rate of PCR+ cases for B. pertussis. Laboratory values may show leukopenia or lymphopenia in patients with pertussis. It is necessary to use appropriate laboratory diagnostic tests in all infants with respiratory symptoms for B. pertussis. Since, the clinical diagnosis overestimates the diagnosis of pertussis.

A silent public health threat: emergence of Mayaro virus and co-infection with Dengue in Peru.

OBJECTIVE: To describe frequency and clinical characteristics of MAYV infection in Piura, as well as the association of this pathogen with DENV. RESULTS: A total of 86/496 (17.3%) cases of MAYV were detected, of which 54 were MAYV mono-infection and 32 were co-infection with DENV, accounting for 10.9% and 6.4%, respectively. When evaluating monoinfection by MAYV the main groups were 18-39 and 40-59 years old, with 25.9% and 20.4% respectively. Co-infections were more common in the age group 18-39 and those > 60 years old, with 34.4% and 21.9%, respectively. The most frequent clinical presentation were headaches (94.4%, 51/54) followed by arthralgias (77.8%, 42/54). During the 8-month study period the most cases were identified in the months of May (29.1%) and June (50.0%).

Variations in cervico-vaginal microbiota among HPV-positive and HPV-negative asymptomatic women in Peru.

OBJECTIVE: To characterize the cervicovaginal microbiota of HPV-positive and HPV-negative asymptomatic Peruvian women, by identifying the presence of 13 representative bacteria genus. RESULTS: A total of 100 HPV-positive and 100 HPV-negative women were matched by age for comparison of microbiota. The following bacteria were more frequently identified in HPV-positive patients compared to HPV-negative: Eubacterium (68 vs 32%), Actinobacteria (46 vs 33%), Fusobacterium (11 vs 6%) and Bacteroides (20 vs 13%). A comparison between high-risk and low-risk genotypes was performed and differences were found in the detection of Actinobacteria (50 vs 33.33%), Bifidobacterium (50 vs 20.83%) and Enterococcus (50 vs 29.17%).

Unidentified dengue serotypes in DENV positive samples and detection of other pathogens responsible for an acute febrile illness outbreak 2016 in Cajamarca, Peru.

OBJECTIVE: To describe the prevalence of dengue virus serotypes, as well as other viral and bacterial pathogens that cause acute febrile illness during an outbreak in Cajamarca in 2016. RESULTS: Dengue virus (DENV) was the most frequent etiologic agent detected in 25.8% of samples (32/124), followed by Rickettsia spp. in 8.1% (10/124), Zika virus in 4.8% (6/124), Chikungunya virus 2.4% (3/124) and Bartonella bacilliformis 1.6% (2/124) cases. No positive cases were detected of Oropouche virus and Leptospira spp. DENV serotypes identification was only achieved in 23% of the total positive for DENV, two samples for DENV-2 and four samples for DENV-4. During the 2016 outbreak in Cajamarca-Peru, it was observed that in a large percentage of positive samples for DENV, the infecting serotype could not be determined by conventional detection assays. This represents a problem for the national surveillance system and for public health due to its epidemiological and clinical implications. Other viral and bacterial pathogens responsible for acute febrile syndrome were less frequently identified.

Dengue diagnosis in an endemic area of Peru: Clinical characteristics and positive frequencies by RT-PCR and serology for NS1, IgM, and IgG.

BACKGROUND: Huánuco is a central eastern region of Peru whose geography includes high forest and low jungle, as well as a mountain range that constitutes the inter-Andean valleys. It is considered a region endemic for dengue due to the many favorable conditions that facilitate transmission of the virus. METHODS: A total of 268 serum samples from patients in Huánuco, Peru with an acute febrile illness were assessed for the presence of dengue virus (DENV) via RT-PCR and NS1, IgM, and IgG ELISA during December 2015 and March 2016. RESULTS: DENV was detected in 25% of samples via RT-PCR, 19% of samples by NS1 antigen ELISA, and 10.5% of samples by IgM ELISA. DENV IgG was detected in 15.7% of samples by ELISA. The most frequent symptoms associated with fever across all groups were headache, myalgia, and arthralgia, with no significant difference between the four test methods CONCLUSIONS: In this study, DENV was identified in up to 25% of the samples using the standard laboratory method. In addition, a correlation was established between the frequency of positive results and the serological tests that determine NS1, IgM, and IgG. There is an increasing need for point-of-care tests to strengthen epidemiological surveillance in Peru.

Bordetella pertussis in children hospitalized with a respiratory infection: clinical characteristics and pathogen detection in household contacts.

OBJECTIVE: Describe the prevalence of Bordetella pertussis via PCR in children under 5 years old hospitalized as probable cases of pertussis and report the most common clinical features among them. RESULTS: A positive PCR result for B. pertussis was observed in 20.5% of our samples (18/88), one-third of them were from infants between 2 and 3 months old. The most common symptoms were paroxysms of coughing (88.9%), difficulty breathing (72.2%), cyanosis (77.8%) and fever (50%). The mother was the most common symptomatic carrier (27.8%), followed by uncles/aunts (22.2%) among children with pertussis.

Embarazo ectópico abdominal: caso reportado en Ambato (Ecuador) / Ectopic abdominal pregnancy: case reported in Ambato (Ecuador)

El embarazo ectópico (EE) es la implantación del óvulo fecundado fuera de la cavidad uterina, su incidencia ha aumentado en las últimas décadas. El EE abdominal es una forma rara, localizado a nivel de la cavidad peritoneal fuera de la cavidad uterina. Para su diagnóstico se usan los criterios de Studdiford. Tiene una alta morbilidad y mortalidad materna asociada. Presentamos el caso de una segundigesta de 33 años, casada. Con parto vaginal previo y FUM incierta, con ciclos menstruales irregulares, en tratamiento con progestágenos durante dos meses, y sangrado menstrual por 8 días durante el último mes. Ingresa por emergencia con signos de shock hipovolémico. Se realizó laparotomía y se confirmó diagnóstico. Se extrajo feto y anexos con evolución favorable...

Ectopic pregnancy (EP) is the implantation of the fertilized egg outside the uterine cavity, its incidence has increased in recent decades. The abdominal EP is a rare form, located at the level of the peritoneal cavity outside the uterine cavity. For diagnostic criteria used Studdiford. lt has a high maternal morbidity and mortality associated. We report the case of a patient 33 years old, married. Prior vaginal delivery and LMP uncertain, with irregular menstrual cycles, progestogen therapy for two months, and menstrual bleeding for 8 days during the last month. Enteres by emergency with signs of hypovolemic shock. Laparatomy was performed and confirmed diagnosis. Fetus and Annexes fetus and extracted with favorable evolution...

GENERACIÓN DE SEÑALES SIMULADAS DE ECG ABDOMINAL A PARTIR DE UN MODELO ABDOMINAL 3D / GENERATION OF SYNTHETIC ABDOMINAL ECG SIGNALS FROM AN ABDOMINAL 3D MODEL

El electrocardiograma abdominal es una técnica de monitoreo promisoria para la vigilancia en el periodo prenatal, ya que presenta facilidad de adquisición y permite la supervisión materna y fetal simultáneamente. La separación de estas señales es complicada y no existe una forma estandarizada de evaluar la efectividad de algoritmos reportados en la literatura. Basados en un modelo de dipolo propagado en el abdomen materno tridimensional, el presente trabajo propone la implementación de un sistema de generación de señales de ECG abdominal, con características controlables de simulación de condiciones reales: interferencias, variabilidad de periodos cardiacos, número de canales, ubicación de electrodos y posición fetal. Con el sistema desarrollado se generaron 50 señales sintéticas de prueba que mostraron una correlación de 0,99 con respecto a valores esperados en la relación señal-interferencia, sin diferencias significativas en la regresión (p>0.05); mientras que el coeficiente de correlación para la relación señal a ruido fue de 0.87 con diferencias significativas en la regresión por debajo de los -20 dB (p<0.05). En conclusión, el sistema propuesto proporciona señales de ECG abdominal con condiciones similares a las de señales reales, lo cual facilita la adecuada evaluación de algoritmos de separación de ECG materno y fetal a partir del ECG abdominal.

Abdominal ECG is one of the most promising monitoring techniques for fetal surveillance in the antenatal period, as it presents easy availability and allows the maternal and fetal monitoring simultaneously. However, separation of these signals is complicated and there is no standardized way to evaluate the effectiveness of separation algorithms reported in the literature. Based on the dipole model spread through the three-dimensional maternal abdomen, this paper proposes the implementation of a system for the generation of abdominal ECG signals with controllable characteristics simulating real conditions by interference, heart period variability, number of channels , electrodes location and fetal position. Using the developed system, 50 synthetic test signals were generated and compared with desired values. Results showed a correlation of 0.99 with respect to expected values in the signal interference ratio, with no significant differences in the regression (p>0.05); while the correlation coefficient was 0.87 for the signal to noise ratio, with significant differences below -20 dB (p<0.05) in the regression. In conclusion, the proposed system provides abdominal ECG signals showing similar conditions to those of real signals, and comprises a tool that ensures proper evaluation of separation algorithms of maternal and fetal ECG from abdominal ECG.

Transplante hepático pediátrico en Venezuela experiencia preliminar

Introducción y objetivos: el transplante hepático es uno de los tratamientos adecuados en pacientes pediátricos con enfermedades hepáticas en fase terminal. El objetivo del presente trabajo es presentar la experiencia preliminar del programa de transplante hepático pediátrico llevada a cabo en nuestro país. Pacientes y métodos: se incluyeron niños que fueron evaluados en la consulta de pretransplante pediátrico del programa metropolitano de transplante por presentar enfermedades hepáticas en fase terminal Resultados: se incluyeron pacientes a los que se les realizó transplante hepático entre abril de 2005 y marzo de 2007; 9 pacientes en edades comprendidas entre 5 años y 15 años, 3 del sexo masculino y 6 del sexo femenino. Todos los pacientes presentaban serología para CMV positiva previo al transplante y 5 presentaban serología positiva para EBV previa al transplante. Todos los individuos tenían una calificación PELD entre 9 y 17. La enfermedad hepática crónica que los llevó a la necesidad de realizarles transplante hepático incluyó los siguientes diagnósticos: atresia de vías biliares extrahepáticas4, colestasis intrahepática familiar progresiva² y hepatitis autoinmune¹, hepatocarcinoma¹ y fibrosis hepática congénita¹. A 7 de los pacientes se les realizó transplante hepático de donante vivo, 1 de donante cadavérico y 1 autotransplante. El tiempo de estadía en terapia intensiva fue de 11 a 30 días, y el tiempo posterior en hospitalización fue de 3 a 15 días. El esquema de inmunosupresión inicial fue ciclosporina, prednisona, micofenolato a 4 pacientes y 5 tacrolimus y prednisona. Dos pacientes presentaron rechazo agudo el cual fue tratado con bolus de esteroides por 3 días con resolución completa de la disfunción del injerto. Todos los pacientes presentaron complicaciones infecciosas en los primeros 6 meses del postransplante, entre ellas: 4 pacientes infecciones urinarias documentadas por urocultivo por Proteus Mirabilis 2 y E. Coli 2, 5 pacientes presentaron infecciones por CMV a los cuales se les administró valganciclovir por vía oral obteniendo una respuesta adecuada. Dos de los pacientes presentaron complicaciones neurológicas, 1 presentó convulsiones tónico clónicas generalizadas sin déficit neurológico, se le realizó TAC y EEG los cuales resultaron normales con niveles elevados de ciclosporina y niveles bajos de magnesio que fueron corregidos. Un paciente presentó alucinaciones, se le realizó TAC cerebral y EEG normal, recibió haloperidol durante un período de 3 meses, con evolución satisfactoria. Uno de los pacientes presentó complicación biliar a los 9 meses postransplante, demostrada por ecografía abdominal y colangioresonancia (estenosis de la vía biliar), se colocó prótesis biliar con mejoría completa del funcionalismo hepático. Un paciente con síndrome hepatopulmonar previo al transplante, amerito para su corrección final, después del trasplante de tratamiento endovascular del shunt AV, arteria pulmonar lóbulo inferior izquierdo con colocación de espirales de titanium con resolución de la hipoxemia persistente. Posteriormente, ese mismo paciente presentó vasoespasmo de la arteria hepática documentado por perdida del registro arterial durante evaluación doppler y acompañado de elevación de las aminotranferasas recibiendo tratamiento con nitroglicerina intrarterial y colocación de stent con mejoría completa del funcionalismo hepático. La sobrevida del injerto y de los pacientes es en la actualidad de un 100%. Conclusión: el transplante hepático constituye hoy en día en Venezuela una posibilidad terapéutica para los pacientes pediátricos con enfermedad hepática terminal, progresiva e irreversible, que no está exento de complicaciones pero que al ser diagnosticadas y tratadas a tiempo, alcanza un 100% de sobrevida tanto del injerto como de los pacientes.

Introduction and Objectives: Liver transplantation is the treatment of choice for pediatrics patients that suffer end stage liver disease (ESLD). The goal of this essay is to introduce the first national experience with the modality of liver pediatric transplantation programs in the treatment of ESLD in pediatrics patients. Patients and Methods: 9 children suffering ESLD and their respective donors were seen between April 2005 and May 2007, each patient and its donor underwent a complete transplant evaluation (cardiac, respiratory, renal evaluation, imaging studies, and blood work up) to determine their candidate for either liver transplant recipient, or liver donor. RESULTS: 9 patients in ages between 5 years and 15 years, 3 male and 6 were included. All the patients had positive serology for CMV before transplant and 5 had positive serology for EBV before transplant. All the patients had score PELD 9 and 17. Diagnoses of the recipients were as follow: 4 Atresias of extrahepatic biliary tract, 2 progressive familiar intrahepatic cholestasis, 1 autoimmune hepatitis, 1 congenital fibrosis and 1 hepatocarcinoma. 7 live donor liver transplants, 1 deceased donor and 1 autologous liver transplant were performed. Operative mortality was 0%. Patient and graft survival were 100% at 1 and 2 years follow up. Patients presented various complications that included: acute rejection, CMV infection, acute urinary tract infections, hepatic artery spasm, and seizures among others. All the previous mentioned complications were successfully treated. Conclusion: Liver transplant constitutes the best option for the patient with ESLD, early referral is critical in the outcome of pediatric patients that need liver transplant.

Ecocardiografía fetal: cardiopatías congénitas y otras alteraciones circulatorias en fetos de alto riesgo 1986-1997 / Fetal echocardiography: congenital cardiopathies and other circulatory alterations in high risk fetuses

Evaluar los diagnósticos ecocardiográficos fetales anatómicos, funcionales, y circulatorios, realizados desde 1986 a 1997. Revisión de 418 informes ecocardiográficos del servicio y videos. Fundación de Perinatología. Hospital Universitario de Caracas. Ministerio de Sanidad. Servicio de Ecocardiografía, Policlínica Metropolitana, Caracas, Venezuela. Hubo 156 anormalidades en placenta y cordón, 69 arritmias, 61 alteraciones funcionales, 133 cardiopatías (32 por ciento). Destacaron comunicaciones interventriculares (17 por ciento); canales aurículo ventriculares (12 por ciento): miocardiopatías (11 por ciento); aneurisma del foramen oval (8 por ciento). Comparación (chicuadrado) con otras series resultaron no significativos (p> 0,001). En arritmias: extrasístoles, bradicardias, taquicardias supraventriculares. De alteraciones funcionales: el espasmo del conducto arterioso. De las alteraciones estructurales circulatorias: placentas envejecidas, circulares de cordón, quistes de cordón y arterias únicas. No incluimos elevaciones de resistencias. El conocimiento de los datos estadísticos de cardiopatías prenatales y otras alteraciones cardiológicas in útero, permiten establecer estrategias de atención ajustadas a la realidad local. Es posible establecer antenal, el pronóstico evolutivo y planear conductas quirúrgicas objetivas

Modificaciones en funciones sistodiastólicas por poscarga alta: estudio ecocardiográfico fetal / Modifications in systolic functions for high postload: fetal echocardiography study

Observar el efecto de incremento de las poscargas sobre las variables fisiológicas de vaciamiento aurículo ventricular ondas E,A, relación E/A para tricúspide y mitral y eyección, relación aceleración/eyección en aorta y pulmonar. Revisamos los ecocardiogramas fetales consecutivos de 76 fetos en alto riesgo con aumento de poscarga de diferentes etiologías. Se calculó media, desviación estándar y aplicamos comparaciones múltiples de Newman Keuls. Fundación de Perinatología del Hospital Universitario de Caracas y Servicio de Ecocardiografía, Policlínica Metropolitana. Se observaron cambios significativos en la onda A y relación E/A tricuspidea (p>0,001); ondas E y A mitral (p<0,001) pero no en la relación E/A. Los tiempos de eyección, aceleración/eyección aórtico y pulmonar no mostraron cambios significativos. Las variaciones detectadas no siempre se acompañan de modificaciones en el modo M o B. Son patrones sutiles precursores de deterioro, conforme aumentan las poscargas hasta niveles críticos y a veces son insospechados