Outpatient parenteral antimicrobial therapy with continuous infusion of meropenem: A retrospective analysis of three years of clinical experience / Tratamiento antimicrobiano domiciliario endovenoso con infusión continua de meropenem: un análisis restrospectivo de tres años de experiencia clínica

Introduction: Data regarding outpatient parenteral antimicrobial therapy (OPAT) with continuous infusion of meropenem (CIM) remain scarce and controversial. We aimed to analyze its outcomes. Methods: We conducted a retrospective analysis of a cohort of patients who received OPAT with CIM during a three-year period at a single center in northwest Spain. Demographics, clinical data and OPAT outcomes were recorded. Results: Since January 2017–December 2019, 34 patients received 35 OPAT episodes with CIM. The median age was 75 years, and 18 (51.4%) had a Charlson comorbidity index>2. Twelve (34.3%) had respiratory infection, 11 (31.4%) urinary tract infection, and 12 (34.3%) other infections. Twenty-one (60%) received a dose of 6g/day, and 27 (77.1%) received combined antibiotic therapy. The duration of OPAT with CIM was 10 median days. Pseudomonas aeruginosa was the most frequently (34.3%) isolated microorganism and 10 (28.6%) infections were polymicrobial. During OPAT and hospital at home unit admission, 4 (11.4%) patients had any adverse reaction that required CIM withdrawal, 2 (5.7%) were readmitted, and 3 (8.8%) died (2 infection-related deaths). After 30 days from discharge 6 (18.8%) of 32 not-censored patients had unplanned readmissions (2 infection-related), 6 (18.8%) developed recurrence (3 relapses, 3 reinfections) and 1 (3.1%) died (none-infection-related death). Twenty-three (71.9%) of these 32 patients did not experience unplanned readmission, recurrence or death. Conclusion: CIM can be an option to be administrated in OPAT programs in selected patients. Further studies are warranted to increase evidence regarding its use, and to externally validate our findings.(AU)

Introducción: Los datos sobre el tratamiento antimicrobiano domiciliario endovenoso (TADE) con infusión continua de meropenem (ICM) son escasos y controvertidos. Nuestro objetivo fue analizar sus resultados. Métodos: Realizamos un análisis retrospectivo de una cohorte de pacientes que recibieron TADE con ICM durante tres años en un centro del noroeste de España. Se registraron datos demográficos, clínicos y resultados. Resultados: Desde enero de 2017 a diciembre de 2019, 34 pacientes recibieron 35 episodios de TADE con ICM. La mediana de edad fue de 75 años y 18 (51,4%) tenían un índice de comorbilidad de Charlson>2. Doce (34,3%) tenían infección respiratoria, 11 (31,4%) urinaria y 12 (34,3%) otras infecciones. Veintiuno (60%) recibieron una dosis de 6g/día y 27 (77,1%) antibioterapia combinada. La duración mediana del TADE con ICM fue de 10 días. Pseudomonas aeruginosa fue el microorganismo aislado más frecuentemente (34,3%) y 10 (28,6%) infecciones fueron polimicrobianas. Durante el TADE, 4 (11,4%) pacientes presentaron alguna reacción adversa que requirió retirada de ICM, 2 (5,7%) reingresaron y 3 (8,8%) fallecieron (2 muertes relacionadas con infección). Tras 30 días desde el alta, 6 (18,8%) de 32 pacientes tuvieron reingresos no programados (2 relacionados con infección), 6 (18,8%) desarrollaron recurrencia (3 recidivas, 3 reinfecciones) y 1 (3,1%) falleció (sin relación con infección). Veintitrés (71,9%) de 32 pacientes no experimentaron reingreso no programado, recidiva o muerte. Conclusión: La ICM puede ser una opción para ser administrada en programas de TADE en pacientes seleccionados. Se necesitan más estudios para aumentar la evidencia sobre su uso y validar externamente nuestros hallazgos.(AU)

Outpatient parenteral antimicrobial therapy with continuous infusion of meropenem: A retrospective analysis of three years of clinical experience.

INTRODUCTION: Data regarding outpatient parenteral antimicrobial therapy (OPAT) with continuous infusion of meropenem (CIM) remain scarce and controversial. We aimed to analyze its outcomes. METHODS: We conducted a retrospective analysis of a cohort of patients who received OPAT with CIM during a three-year period at a single center in northwest Spain. Demographics, clinical data and OPAT outcomes were recorded. RESULTS: Since January 2017-December 2019, 34 patients received 35 OPAT episodes with CIM. The median age was 75 years, and 18 (51.4%) had a Charlson comorbidity index>2. Twelve (34.3%) had respiratory infection, 11 (31.4%) urinary tract infection, and 12 (34.3%) other infections. Twenty-one (60%) received a dose of 6g/day, and 27 (77.1%) received combined antibiotic therapy. The duration of OPAT with CIM was 10 median days. Pseudomonas aeruginosa was the most frequently (34.3%) isolated microorganism and 10 (28.6%) infections were polymicrobial. During OPAT and hospital at home unit admission, 4 (11.4%) patients had any adverse reaction that required CIM withdrawal, 2 (5.7%) were readmitted, and 3 (8.8%) died (2 infection-related deaths). After 30 days from discharge 6 (18.8%) of 32 not-censored patients had unplanned readmissions (2 infection-related), 6 (18.8%) developed recurrence (3 relapses, 3 reinfections) and 1 (3.1%) died (none-infection-related death). Twenty-three (71.9%) of these 32 patients did not experience unplanned readmission, recurrence or death. CONCLUSION: CIM can be an option to be administrated in OPAT programs in selected patients. Further studies are warranted to increase evidence regarding its use, and to externally validate our findings.

Home-based blood transfusion therapy: A systematic review.

Home care is a healthcare alternative to hospitalisation. Different types of procedures are performed at home care services, such as home transfusion of blood products. However, home blood transfusion is not fully implemented and there is a great lack of knowledge about it. The aims of this study were thus to assess the safety and effectiveness of home blood transfusions and patient acceptance and satisfaction. A systematic literature review was conducted in the main biomedical databases. We included all studies that covered patients who had received a home blood transfusion, regardless of their baseline diagnosis. The literature search yielded 290 studies, 14 of which were included in this study as they met the predefined criteria. The main patient profile of a home-transfusion recipient was a person with anaemia associated with other diseases. Overall incidence of severe adverse events was 0.05%. No studies evaluated the effectiveness of home versus hospital transfusions. One study showed that 51% of patients would be willing to receive home transfusions. Home blood transfusion appears to be a feasible, safe, and well-accepted procedure. Existing studies are of low quality, however, and this is an important limitation when it comes to drawing definitive benefit-risk conclusions.

Prevalência de parasitoses em trabalhadores de restaurantes de Caxias do Sul ­ RS / Prevalence of parasitic infections in restaurant employees in Caxias do Sul, RS, Brazil

A qualidade higiênico-sanitária como fator de segurança alimentar tem sido amplamente estudada e discutida mundialmente. No Brasil, apesar da relevância e da atualidade do problema das contaminações dos alimentos e dos manipuladores por microorganismos, são poucas as pesquisas que avaliam a ocorrência de enteroparasitoses nesses trabalhadores. Alimentos consumidos que estejam contaminados por estruturas parasitárias do meio ambiente ou por manipuladores infectados formam a cadeia de transmissão dessas parasitoses, sendo este um dos mais importantes meios de disseminação. O objetivo deste estudo foi investigar a prevalência de parasitoses em trabalhadores de restaurantes de Caxias do Sul. Foram analisados laudos de exames parasitológicos de fezes (EPF) realizados entre 2011 e 2014 em um laboratório da cidade de Caxias do Sul. Dos 331 resultados de EPF avaliados, observou-se a presença de parasitos em 10,3%, sendo 44,1% de Endolimax nana, 32,4% de Entamoeba coli, 14,7% de Giardia duodenalis, 5,9% de Trichuris trichiura e 2,9% de Enterobius vermicularis. Ficou evidenciada, entre os manipuladores de alimentos, a existência de portadores e transmissores de parasitos, o que reforça a necessidade de medidas efetivas de saúde pública que controlem ou, ao menos, minimizem os riscos de infecção e contaminação, além de destacar a importância da realização de exames periódicos de fezes em trabalhadores envolvidos no manuseio de alimentos

HIV-1 and GBV-C co-infection in Venezuela.

INTRODUCTION: Co-infection with GB virus C (GBV-C) in patients infected with human immunodeficiency virus 1 (HIV-1) has been associated with prolonged survival. The aim of this study was to evaluate the prevalence of GBV-C infection among HIV-1-infected patients in Venezuela, and to determine the effects of the co-infection on the levels of relevant cytokines. METHODOLOGY: Plasma samples were collected from 270 HIV-1-seronegative and 255 HIV-1-seropositive individuals. GBV-C infection was determined by RT-PCR of the NS5 region and genotyped by sequence analysis of the 5´UTR region. HIV-1 strains were characterized by sequence analysis of pol, vif, env, and nef genes. Selected cytokines were evaluated by ELISA. RESULTS: Ninety-seven of 525 (18.5%) plasma samples tested positive for GBV-C RNA. A significantly higher prevalence of GBV-C was found among HIV-1 patients compared to HIV-1-seronegative individuals (67/255, 26% versus 30/270, 11%; p < 0.001). Statistical difference was observed in the viral load between HIV-1+GBV-C+ and HIV-1+GBV-C- (p = 0.014), although no differences in CD4+ cell counts were found between both groups. TNFα concentration was higher in HIV-1+GBV-C- than in HIV-1+GBV-C+ patients (25.9 pg/mL versus 17.3 pg/mL; p = 0.02); RANTES expression levels were more variable in GBV-C co-infected patients and more frequently elevated in HIV-1 mono-infected patients compared to patients co-infected with GBV-C. CONCLUSIONS: The previously observed beneficial effect of co-infection with HIV-1 and GBV-C on disease progression is complex and might be due in part to a change in the cytokine environment. More studies are required to understand the interaction between both viruses.

Determinación del virus papiloma humano y virus herpes simple y su posible relación con la presencia y tipo de lesiones preinvasivas del cuello uterino / Determination of Human Papiloma and Herpes Simplex Viruses and Their Possible Relation to the Presence and Type of Preinvasive Lesions on the Uterine Cervix

El Cáncer (Ca) de Cuello Uterino (Cu) persiste como un problema de salud pública a nivel mundial. Entre los agentes infecciosos más estudiados que se han relacionado con los procesos neoplásicos, están los virus, y entre ellos el herpes y el papiloma. Esta investigación se realizó para determinar el Virus Papiloma Humano (VPH) y el Virus Herpes Simple (VHS) y su posible relación con la presencia y tipo de lesiones preinvasivas de Cu. Se seleccionaron 65 muestras de tejido de Cu con lesiones de pacientes de sexo femenino y 10 controles aparentemente sanas, para la detección del VPH y VSH. Se utilizó el método de PCR e Hibridación para la genotipificación del VPH. Se observó un 15,38% de positividad para VPH y un 20% para VSH, un caso de coinfección en una paciente con lesión intraepitelial de alto grado (LIEag), demostrándose una diferencia significativa entre las pacientes VPH positivo con LIEag respecto a aquellas con lesiones intraepiteliales de bajo grado (LIEbg). La mayoría de los casos positivos para VHS se detectaron en pacientes con LIEbg. Se demostró una correlación significativa entre el tipo de lesión y la presencia de genotipos de alto y bajo riesgo del VPH.

Cervical cancer persists as a public health problem worldwide. Among the most studied infectious agents that have been associated with neoplasic processes are viruses, including herpes and papilloma. This research was carried out in order to determine the possible relation between infection with herpes simplex virus (HSV) and human papilloma virus (HPV) and the presence and type of pre-invasive cervical lesions. Sixty-five samples of cervical tissue with lesions and ten apparently healthy controls were selected from female patients for the detection of HSV and HPV. PCR and hybridization (HC2) methods were implemented for genotyping HPV. For HPV, 15.38% were positive while for HSV, 20.0%. There was one case of co-infection in a patient with a high grade intraepithelial lesion (HSIL), showing a significant difference between HPV-positive patients with HSIL compared to women with LSIL, low grade intraepithelial lesions. Most of the HSV positive cases were detected in patients with LSIL. A significant correlation was proved between the type of lesion and the presence of high and low risk HPV genotypes.

[Prevalence of cytomegalovirus infection in pediatric patients with neurological disorders in Zulia state, Venezuela (2007-2008)]. / Prevalencia de infección por citomegalovirus en pacientes pediátricos con afecciones neurológicas en el estado Zulia, Venezuela (2007-2008).

The aim of this study was to determine the prevalence of cytomegalovirus (CMV) in pediatric patients with neurological disorders from Zulia State, Venezuela, during the period 2007-2008. Samples of cerebrospinal fluid (CSF) and serum were obtained from 186 patients with neurological symptoms and bacteriological negative CSF. The albumin CSF/serum content was determined to rule out contamination of CSF and optimal pairs were determined by ELISA of IgM and IgG anti-CMV antibodies in serum and IgG in CSF. Only 40.86% (76/186) of patients were optimal for this study. Serum samples positive for IgM antibodies (2/76; 2.6%) and IgG antibodies (71/76; 93.4%) were obtained. CSF IgG antibodies were observed in 24/76 patients (31.6%). Increased values of glucose in CSF (p < 0.05) were observed in 58.3% of CMV patients with meningoencephalitis. In addition, increased CSF protein concentration (p < 0.01) was observed in CSF anti-CMV antibodies positive patients with meningitis. This study shows high prevalence of acute CMV infection in pediatric patients with neurological affections suggesting an important role of this virus in this pathology during the studied period.

Prevalencia de infección por citomegalovirus en pacientes pediátricos con afecciones neurológicas en el estado Zulia, Venezuela (2007-2008) / Prevalence of cytomegalovirus infection in pediatric patients with neurological disorders in Zulia state, Venezuela (2007-2008)

El objetivo de este estudio fue determinar la prevalencia de citomegalovirus en pacientes pediátricos con afecciones neurológicas, provenientes del Estado Zulia, Venezuela durante el período 2007-2008. Se recolectaron 186 muestras pareadas de líquido cefalorraquídeo (LCR) y suero, de pacientes entre 1 mes y 14 años de edad, que presentaron sintomatología clínica sugestiva de afectación del SNC y cuyo estudio bacteriológico convencional de LCR resultó negativo. Se determinó la relación albúmina LCR/suero a fin de descartar contaminación y a los pares óptimos se les determinó por la técnica de ELISA anticuerpos IgM e IgG en suero e IgG en LCR anti-CMV. Del total de muestras recolectadas 40,86% (76/186) resultaron óptimas para el análisis. De los 76 casos analizados, el 2,6% (2/76) de las muestras de suero resultaron positivas para IgM; 93,4% (71/76) fueron seropositivas a IgG mientras que el 31,6% (24/76) de las muestras de LCR presentaron anticuerpos IgG. En cuanto a los parámetros citoquímicos del LCR, se observaron valores de glucosa aumentados en el 58,3% (p<0,05) de los pacientes con CMV que presentaron meningoencefalitis. En los pacientes con meningitis que presentaron positividad de anticuerpos IgG anti-CMV en el LCR se observó un aumento significativo (p<0,01) en las proteínas del LCR. Se evidencia que una proporción de los pacientes pediátricos con afecciones neurológicas presentaron infección aguda por CMV, lo que demuestra una participación importante de este agente en pacientes del estado Zulia, Venezuela para el período en estudio.

The aim of this study was to determine the prevalence of cytomegalovirus (CMV) in pediatric patients with neurological disorders from Zulia State, Venezuela, during the period 2007-2008. Samples of cerebrospinal fluid (CSF) and serum were obtained from 186 patients with neurological symptoms and bacteriological negative CSF. The albumin CSF/serum content was determined to rule out contamination of CSF and optimal pairs were determined by ELISA of IgM and IgG anti-CMV antibodies in serum and IgG in CSF. Only 40.86% (76/186) of patients were optimal for this study. Serum samples positive for IgM antibodies (2/76; 2.6%) and IgG antibodies (71/76; 93.4%) were obtained. CSF IgG antibodies were observed in 24/76 patients (31.6%). Increased values of glucose in CSF (p<0.05) were observed in 58.3% of CMV patients with meningoencephalitis. In addition, increased CSF protein concentration (p<0.01) was observed in CSF anti-CMV antibodies positive patients with meningitis. This study shows high prevalence of acute CMV infection in pediatric patients with neurological affections suggesting an important role of this virus in this pathology during the studied period.

Baja prevalencia de la infección por el virus de la hepatitis C en una población de reclusos, Maracaibo, Venezuela / Low prevalence of hepatitis C virus infection in a prisoner population from Maracaibo, Venezuela

Introducción. Las conductas de alto riesgo presentes en los centros de reclusión incrementan la probabilidad de transmisión de la infección por el virus de la hepatitis C. En Venezuela no se han realizado estudios del virus en estos centros, por lo que se desconoce la relevancia de la infección en ellos. Objetivo. Estimar la prevalencia del virus de la hepatitis C y los posibles factores de riesgos involucrados en la transmisión del virus en reclusos de la cárcel de Sabaneta, Maracaibo, Venezuela. Material y métodos. Se seleccionó una población de 200 reclusos de un total de 1.000. Las edades estaban comprendidas entre 18 y 69 años (media ± DE: 31,629,93 a˜os). La detección de anticuerpos contra el virus de la hepatitis C se realizó por duplicado mediante el método inmunoenzimático ELISA de IV generación y por el método de inmunoblot INNO-LIA HCV®, ambos de Innogenetic Lab (Bélgica). El ARN viral se detectó por la técnica de reacción en cadena de la polimerasa, previa transcripción inversa, RT-PCR. Resultados. La frecuencia obtenida con el método ELISA fue de 5% (10/20) y 3/200 (1,5%) individuos fueron positivos, a la vez, con los métodos de INNO-LIA y RT-PCR. Conclusiones. La prevalencia de la infección por el virus de la hepatitis C en esta población fue baja, lo que evidencia la baja circulación del virus en el reclusorio. El principal factor de riesgo para la adquisición de la infección, al parecer, es el uso de drogas intravenosas.

Introduction. The high risk behaviors observed in prison centers have favored the transmission of hepatitis C virus infection. The main risk factor to acquire hepatitis C virus infection seems to be the use of intravenous drugs. In Venezuela, the prevalence of the infection in these centers is unknown since studies of the hepatitis C virus there are lacking. Objective. The aim of this study was to determine the prevalence of hepatitis C virus and the risk factors involved in the transmission in prisoner populations. Material and methods. A sample of 200 prisoners was studied from Sabaneta Jail, Maracaibo, Venezuela. The ages were between 18-69 years (average ± DS: 31.6±9.9 years). Serum samples were tested by a fourth generation enzyme-linked immunosorbent assay ELISA and a confirmatory assay INNO-LIA. Both kits were from Innogenetic Laboratories N.V. (Belgium). Viral RNA was tested by the reverse transcription polymerase chain reaction technique (RT-PCR). Results. The ELISA assay determined a hepatitis C virus prevalence of 5.0% (10/200); 3/200 (1.5%) individuals were positive by both INNO-LIA and RT-PCR tests. Conclusions. The observed prevalence of hepatitis C virus antibodies in this population was very low, suggesting a low circulation of the virus in this environment and a low level of associated risk behaviors.

[Low prevalence of hepatitis C virus infection in a prisoner population from Maracaibo, Venezuela]. / Baja prevalencia de la infección por el virus de la hepatitis C en una población de reclusos, Maracaibo, Venezuela.

INTRODUCTION: The high risk behaviors observed in prison centers have favored the transmission of hepatitis C virus infection. The main risk factor to acquire hepatitis C virus infection seems to be the use of intravenous drugs. In Venezuela, the prevalence of the infection in these centers is unknown since studies of the hepatitis C virus there are lacking. OBJECTIVE: The aim of this study was to determine the prevalence of hepatitis C virus and the risk factors involved in the transmission in prisoner populations. MATERIAL AND METHODS: A sample of 200 prisoners was studied from Sabaneta Jail, Maracaibo, Venezuela. The ages were between 18-69 years (average +/- DS: 31.6+/-9.9 years). Serum samples were tested by a fourth generation enzyme-linked immunosorbent assay ELISA and a confirmatory assay INNO-LIA. Both kits were from Innogenetic Laboratories N.V. (Belgium). Viral RNA was tested by the reverse transcription polymerase chain reaction technique (RT-PCR). RESULTS: The ELISA assay determined a hepatitis C virus prevalence of 5.0% (10/200); 3/200 (1.5%) individuals were positive by both INNO-LIA and RT-PCR tests. CONCLUSIONS: The observed prevalence of hepatitis C virus antibodies in this population was very low, suggesting a low circulation of the virus in this environment and a low level of associated risk behaviors.

Prevalence of nonsyndromic oral clefts in a reference hospital in the state of Minas Gerais, Brazil, between 2000-2005.

The aim of the present study was to analyze the prevalence of nonsyndromic oral clefts in children receiving treatment at the Center for the Rehabilitation of Craniofacial Anomalies, José do Rosário Vellano University, Alfenas, MG, Brazil. All the data for the epidemiological study was retrieved from the files of 126 pediatric patients with oral clefts without any additional malformation, who came to the center for treatment between 2000 and 2005. A predominance of clefts was observed in Caucasians, and the ratio of male to female was 1.3. Males were 2.57 times more affected by cleft lip and palate (CLP) than females. CLP with a prevalence of 39.68% and isolated cleft lip (CL) with a prevalence of 38.09% were the most common anomalies, followed by isolated cleft palate (CP; 22.23%). Complete and unilateral CLP (26.19%) presented the highest prevalence, followed by incomplete and unilateral CL (23.81%). The present study presents the experience of a reference hospital in the state of Minas Gerais; however, the real prevalence of oral clefts in Brazil is still unknown. Our findings differ from those of a few previous Brazilian reports because they suggest similar prevalences of CLP and CL, and a higher prevalence of CLP in Caucasian males.

Prevalence of nonsyndromic oral clefts in a reference hospital in the state of Minas Gerais, Brazil, between 2000-2005

The aim of the present study was to analyze the prevalence of nonsyndromic oral clefts in children receiving treatment at the Center for the Rehabilitation of Craniofacial Anomalies, José do Rosário Vellano University, Alfenas, MG, Brazil. All the data for the epidemiological study was retrieved from the files of 126 pediatric patients with oral clefts without any additional malformation, who came to the center for treatment between 2000 and 2005. A predominance of clefts was observed in Caucasians, and the ratio of male to female was 1.3. Males were 2.57 times more affected by cleft lip and palate (CLP) than females. CLP with a prevalence of 39.68 percent and isolated cleft lip (CL) with a prevalence of 38.09 percent were the most common anomalies, followed by isolated cleft palate (CP; 22.23 percent). Complete and unilateral CLP (26.19 percent) presented the highest prevalence, followed by incomplete and unilateral CL (23.81 percent). The present study presents the experience of a reference hospital in the state of Minas Gerais; however, the real prevalence of oral clefts in Brazil is still unknown. Our findings differ from those of a few previous Brazilian reports because they suggest similar prevalences of CLP and CL, and a higher prevalence of CLP in Caucasian males.

O objetivo do presente estudo foi analisar a prevalência de fissuras orais não-sindrômicas em crianças que receberam tratamento no Centro de Reabilitação de Anomalias Craniofaciais da Universidade José do Rosário Vellano, Alfenas, MG, Brasil. Todos os dados epidemiológicos deste estudo foram obtidos dos arquivos de 126 pacientes pediátricos com fissuras orais sem outra malformação adicional que compareceram ao Centro para tratamento entre 2000 e 2005. O predomínio das fissuras foi observado em caucasianos e a relação entre homens e mulheres foi de 1,3. Os homens foram 2,57 vezes mais atingidos por fissuras lábio-palatais (FLP) do que as mulheres. FLP com prevalência de 39,68 por cento e fissuras labial isolada (FL) com prevalência de 38,09 por cento foram as anomalias mais comuns, seguidas por fissuras palatinas isoladas (FP, 22,23 por cento). As FLP completas e unilaterais (26,19 por cento) foram as de maior prevalência, seguidas por FL incompletas e unilaterais (23,81 por cento). O presente estudo mostrou a experiência de um Hospital de Referência em Minas Gerais; contudo, a verdadeira prevalência de fendas orais ainda é desconhecida. Nossos achados divergem dos de alguns poucos estudos anteriores por demonstrar prevalências similares de FLP e FL, e um acometimento maior de FLP em caucasianos do sexo masculino.

Relación entre el herpes simple tipo 2 y las lesiones preinvasivas de cuello uterino / Relationship between type 2 herpes simples and uterine cervix pre-invasive lesions

Objetivos: Determinar la presencia y relación del virus herpes simple tipo 2 (VHS-2) en mujeres con diferentes gradosde lesiones preinvasivas de cuello uterino. Materiales y métodos: Se estudiaron 176 mujeres con lesiones pre invasivas de cuello uterino y 40 mujeres como grupo control con cuello uterino sano, que asistieron a la consulta ginecológica en diferentes centros de salud, durante los años 2002-2005 en Maracaibo-Venezuela. A las pacientes se les tomó un hisopado del exocervix y una biopsia dirigida del sitio de la lesión por colposcopía. La determinación deVHS-2 se realizó a través de inmunofluorescencia directa. Resultados: La presencia de infección por VHS-2 fue 44/176 (25). El mayor número de VHS-2 se obtuvo en las pacientes con grado de lesión tipo NIC II (66,7). El mayor porcentaje de infección por VHS-2 se determinó en las pacientes que iniciaron sus relaciones sexuales entre los 15 y20 años (34,5), las relaciones sexuales diarias (50), así como relaciones de tipo orogenital fueron consideradas las conductas de mayor riesgo para adquirir la infección. Conclusiones: No se evidenció una relación directa entre VHS-2y la presencia de cáncer. Los factores de riesgo asociados con la infección son similares a otras ITS, y están ligados con la conducta sexual y hábitos propios del individuo.

Objectives: To determine the presence and relationship of type 2 herpes simplex virus (HSV-2) in women with different degrees of pre-invasive cervical lesions. Materials and methods: 176 women with pre-invasive cervical lesions and 40 healthy controls were studied. These women were regular clients of gynecology outpatient clinics in different health centers during the 2002-2005 period in Maracaibo, Venezuela. Subjects underwent an exo-cervical smear and a colposcopy-oriented biopsy of the lesion site. HSV-2 determination was performed using direct immunofluorescence. Results: HSV-2 infection was detected in 44/176 women (25%). The highest figures for HSV-2 were obtained in women with ICN II lesions (66,7%). The highest frequencies of HSV-2 infections were found in women starting sexual life between 15 and 20 years of age (34,5%). Daily intercourse (50%), as well as oral sex, was considered as the most risky behavior for acquiring the infection. Conclusions: No direct relationship between HSV-2 and cancer was evidenced. Risk factors associated with this infection are similar to those for other sexually transmitted diseases, and they are linked with sexual behavior and individual habits.

[Hepatitis B in children with cancer]. / Hepatitis B en niños con cáncer.

INTRODUCTION: Cancer patients can be asymptomatic carriers of the hepatitis B virus (HBV), which can be reactivated by chemotherapy. Our aim was to identify the serological markers of HBV in children with cancer who were asymptomatic carriers of the virus. Fifty two (52) children with cancer treated at the Maracaibo University Hospital in Venezuela were studied, 28 of these children (53.8%) were HBV positive, despite no clinical or biochemical signs or symptoms of hepatitis. The type of serological markers present in each of these children.were investigated. We found 7 cases (25%) with hepatitis B surface antigen (HBsAg) and 2 (7.1%) with anticore as the only markers. Multiple markers were found in the other children: 9 (32.1%) HBsAg and anticore; 7 (25%) HBsAg, e-antigen (HBeAg) and anticore; 3 (10.7%) HBsAg, HBeAg antibody and anticore. In total, of the 28 positive children 20 (71.4%) showed positive anticore and of these 4 (20%) were of the IgM type. Our results show a high level of positivity for HBV in the children with cancer studied. In spite of being asymptomatic carriers of the HBV, it is noticeable the presence of serological markers for acute disease. We recommend testing for HBV serological markers before starting chemotherapy. Should the test results be negative, vaccination is indicated and should they be positive, specialized care is indicated.

Concentrations of cytokines, soluble interleukin-2 receptor, and soluble CD30 in sera of patients with hepatitis B virus infection during acute and convalescent phases.

The immunoregulatory roles of interleukin-2 (IL-2), IL-4, IL-10, gamma interferon (IFN-gamma), tumor necrosis factor alpha (TNF-alpha), the soluble form of the IL-2 receptor (sIL-2R), and the soluble form of CD30 (sCD30) were evaluated in patients with hepatitis B virus (HBV) infection. Two groups of subjects were studied: 15 healthy individuals without hepatitis antecedents and 15 patients with HBV infection. Blood samples were taken during the acute and convalescent phases. The analysis of the samples was done by the enzyme-linked immunosorbent assay technique. IFN-gamma and TNF-alpha levels decreased in the convalescent phase. IL-10, IL-2, and sIL-2R levels increased in the acute and convalescent phases, while sCD30 levels increased during the acute phase. The IL-4 concentrations decreased in both phases. During the acute phase, IFN-gamma and TNF-alpha induced increases in IL-2, sIL-2R, IL-10, and sCD30 levels in serum, which allowed the development of immunity characterized by the nonreactivity of the HBV surface antigen, the onset of antibodies to the HBV surface antigen (anti-HBs), and normal alanine aminotransferase levels during the convalescent phase. Increased IL-2 levels during the acute phase would stimulate the activities of NK cells and CD8(+) lymphocytes, which are responsible for viral clearing. The raised sIL-2R levels reveal activation of T lymphocytes and control of the IL-2-dependent immune response. The sCD30 increment during the acute phase reflects the greater activation of the Th2 cellular phenotype. Its decrease in the convalescent phase points out the decrease in the level of HBV replication. The increase in IL-10 levels could result in a decrease in IL-4 levels and modulate IFN-gamma and TNF-alpha levels during both phases of disease, allowing the maintenance of anti-HBs concentrations.

Seroprevalencia de anticuerpos para citomegalovirus, toxoplasma gondii y virus de hepatitis A y B en el niño desnutrido grave / Citomegalovirus, Toxoplasma Gondii and hepatitis virus types A and B antibody seroprevalence in the gravidly malnourished child

La desnutrición infantil ha sido motivo de numerosas investigaciones desde hace más de dos décadas tratando de entender y explicar todos los cambios que se suceden como consecuencia de la disminución de la ingesta proteico-calórica. Hoy se conocen los cambios que ocurren en el sistema inmunitario y día a día se investiga más sobre nuevos aspectos en este campo. Sin embargo poco se conoce sobre la respuesta del desnutrido frente a algunas enfermedades infecciosas como las producidas por el Citomegalovirus (CMV), la Hepatitis por Virus A y B y la toxoplasmosis. Con la finalidad de conocer este aspecto se realizó un estudio serológico para investigar los anticuerpos dirigidos contra el virus de Hepatitis A y B, el CMV y Toxoplasma gondii en una población de 64 desnutridos graves entre 6 y 24 meses y compararlos con un grupo etáreo similar de 35 niños controles (eutróficos). Se encontró que para CMV la seroprevalencia en el niño desnutrido fue del 48,4 por ciento en comparación con el 34,22 por ciento del grupo de niños controles. Igualmente para Toxoplasma gondii el porcentaje de seroprevalencia para el desnutrido (10.9 por ciento) fue superior al del grupo control (2.8 por ciento). No se encontró diferencias en la seroprevalencia para el virus de Hepatitis A en el grupo de desnutridos y control, mientras que para el virus de Hepatitis B tan sólo un desnutrido presentó anticore IgM positivo (indicativo de infección reciente) y niguno del grupo control. Al estudiar la infección reciente para CMV mediante la investigación de anticuerpos IgM específicos se encontró que el 22 por ciento de los pacientes desnutridos fueron recién infectados contrastando con el 8,3 por ciento del grupo control. Para Toxoplasmosis se demostró infección reciente en el 57.1 de los casos y no hubo ningún caso en el grupo control. No se demostró infección reciente en ninguno de los dos grupos para el Virus de Hepatitis A. El mayor porcentaje de todos los pacientes recién infectados tanto para Toxoplasma gondii como para CMV correspondió al grupo etáreo de 12 a 24 meses. Estos resultados nos permiten concluir que la desnutrición es un factor predisponente para la infección temprana por CMV y Toxoplasma gondii, que ésta se adquiere predominantemente después del año de vida y que dadas las condiciones de inmunodeficiencia transitoria que presenta el desnutrido, deben considerarse estas infecciones cuando existan cuadros clínicos como neumonía