Association of class II HLA alleles with susceptibility to develop immune-mediated diseases in Paraguayan patients.

Genetic and nongenetic factors are involved in the pathogenesis of immune-mediated inflammatory diseases (IMIDs). The best-known genetic factor for susceptibility to IMIDs is the human leukocyte antigen (HLA). The aim of the present study was to evaluate the association of HLA class II genes with the risk of systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and systemic sclerosis (SSc) in the Paraguayan population. We included 254 patients with IMIDs (101 SLE, 103 RA, and 50 SSc) and 50 healthy controls. The haplotypes of five genes corresponding to HLA class II genes and their relationship to the IMIDs studied were determined. Note that 84.6% were women, with a mean age of 43.4 ± 14 years. Among the associated HLA alleles, we found the previously identified risk factors in other populations like HLA-DRB1*03:01 and HLA-DRB1*14:02 for RA, as well as new ones not previously identified, such as DPA1*02:01 for SLE and, DB1*02:01 for RA and SSc. In the genetic association analysis, already known associations have been replicated, and unpublished associations have been identified in Paraguayan patients with IMIDs. This is the first genetic association study in Paraguayan patients with IMIDs.

Revisiting the dengue epidemic of 2011 in Paraguay: molecular epidemiology of dengue virus in the Asuncion metropolitan area.

BACKGROUND: Dengue is one of the most important re-emerging viral diseases and the most common human arthropod-borne viral infection worldwide. Any of the four Dengue virus serotypes (DENV-1 to 4) can cause asymptomatic infections or clinical manifestations that range in severity from a mild, self-limited illness, to a severe disease characterized by a shock syndrome that can lead to death. Paraguay suffers periodic epidemic outbreaks of dengue since 1988 when the DENV-1 was introduced in the country. Epidemics caused by all four serotypes have been reported and the country. Although dengue is endemic in Paraguay, few studies have described the molecular epidemiology of DENV in the country, which is important to understand the local and global spread, as well as the evolution of this pathogen. METHODS: This was a cross-sectional study of a convenience sample. Suspected dengue patients of any age were recruited from the Emergency Laboratory of the Central Hospital of the Institute of Social Welfare, Asuncion, Paraguay, from February to June of 2011. A DENV antigen test was used to confirm the infection. The protein E gene sequences of isolated viruses were sequenced for phylogenetic analysis. RESULTS: Dengue was confirmed in 55.1% of the participants (n = 98/178). The most frequent clinical findings were fever, headache, and myalgia. Identity analyses of the protein E gene sequence of 56 viruses isolated showed the circulation of DENV-1 (n = 45) and DENV-2 (n = 11) in the Asuncion metropolitan area in 2011. Molecular epidemiology analyses suggest that DENV-1 was introduced into Paraguay from Argentina, while the DENV-2 from Brazil, replacing previous virus lineages. CONCLUSIONS: We have analyzed the molecular epidemiology of DENV-1 and DENV-2 isolated in Paraguay in 2011. We found strong evidence that DENV-1 was introduced into Paraguay from Argentina, while the DENV-2 from Brazil, replacing previous virus lineages. Molecular epidemiology studies are of great interest to analyze the dynamic of DENV spread, which are useful for early implementation of containment measures to reduce the risk of explosive epidemics caused by this virus.

Characterization of Dengue Virus 4 Cases in Paraguay, 2019-2020.

In 2019-2020, dengue virus (DENV) type 4 emerged to cause the largest DENV outbreak in Paraguay's history. This study sought to characterize dengue relative to other acute illness cases and use phylogenetic analysis to understand the outbreak's origin. Individuals with an acute illness (≤7 days) were enrolled and tested for DENV nonstructural protein 1 (NS1) and viral RNA by real-time RT-PCR. Near-complete genome sequences were obtained from 62 DENV-4 positive samples. From January 2019 to March 2020, 799 participants were enrolled: 253 dengue (14 severe dengue, 5.5%) and 546 other acute illness cases. DENV-4 was detected in 238 dengue cases (94.1%). NS1 detection by rapid test was 52.5% sensitive (53/101) and 96.5% specific (387/401) for dengue compared to rRT-PCR. DENV-4 sequences were grouped into two clades within genotype II. No clustering was observed based on dengue severity, location, or date. Sequences obtained here were most closely related to 2018 DENV-4 sequences from Paraguay, followed by a 2013 sequence from southern Brazil. DENV-4 can result in large outbreaks, including severe cases, and is poorly detected with available rapid diagnostics. Outbreak strains seem to have been circulating in Paraguay and Brazil prior to 2018, highlighting the importance of sustained DENV genomic surveillance.

Synthesis and antimalarial activity of urenyl Bis-chalcone in vitro and in vivo.

Some novel derivatives of Bis-chalcone were synthesized and characterized by their physical and spectral data. All the synthesized compounds were subsequently screened for in vitro globin hydrolysis, ß-hematin formation, and murine Plasmodium berghei, using chloroquine as the reference drug. Most of the synthesized compounds exhibited mild to moderate susceptibilities toward the parasite in comparison with the standard. The most active antimalarial compound was 1,1-Bis-[(3',4'-N-(urenylphenyl)-3-(3″,4″,5″-trimethoxyphenyl)]-2-propen-1-one 5, with a percentage of inhibition of heme polymerization of 87.05 ± 0.77, and this compound increased the survival time after infection, reduce the parasitemia and delay the progression of malaria.

[Clinical and epidemiological study of intestinal coccidioses in a rural population of a semiarid region from Falcon state, Venezuela]. / Estudio clcnico-epidemiológico de coccidiosis intestinales en una población rural de región semiárida del estado Falcón, Venezuela.

Although intestinal coccidioses caused by Cryptosporidium sp., Cystoisospora belli and Cyclospora cayetanensis are parasitic diseases of major clinical importance in Public Health, several clinical and epidemiological aspects of these diseases still remain unknown in Falcon state, Venezuela. A cross-sectional survey was conducted between June and October 2011, to investigate clinical and epidemiological data in 157 people (X +/- S.D. = 21.28 +/- 17 years-old) from Sabaneta, Falcón state, Venezuela. Symptoms associated with intestinal coccidioses were determined by means of anamnesis and clinical examination. Direct smear and Kinyoun staining were used to perform the parasitological diagnosis. The overall prevalence of intestinal parasites was 61.78% (97/157) and Blastocystis sp. was the most prevalent intestinal parasite (56.68%). Coccidioses prevalence was 26.11% (41/157) and among these, cyclosporiasis was the most prevalent with 24.2%. There were no statistically significant differences in the prevalence between sexes or ages (X2 = 0.20; p = 0.70 and X2 = 10.06; p = 0.44, respectively). Diarrhea and epigastralgia were the most common clinical findings, and the only ones significantly associated with intestinal coccidioses (p < 0.05). In the light of these results, it can be concluded that hand washing (OR = 1.93), bathing (OR = 2.78), keeping domestic animals (OR = 10.1) and their feeding with waste (OR = 6.58), are potential risk factors that appeared to be significantly related to the transmission and endemic maintenance of intestinal coccidioses.

Implementation of a Multiplex rRT-PCR for Zika, Chikungunya, and Dengue Viruses: Improving Arboviral Detection in an Endemic Region.

Arboviral diagnosis has been complicated throughout the tropical and subtropical Americas by the recent co-circulation of Zika virus (ZIKV), chikungunya virus (CHIKV), and dengue virus (DENV). The aim of this study was to implement a multiplex real-time RT-PCR (rRT-PCR) for ZIKV, CHIKV, and DENV in Paraguay to test patients who were clinically suspected of having dengue. We tested 110 sera from patients who presented to the Hospital de Clínicas in 2016 and had testing for DENV nonstructural protein 1 (NS1; 40 positive and 70 negative). Using a composite reference standard, we confirmed 51 dengue cases (46.4%): 38/40 NS1 positive and 13/70 NS1 negative. Chikungunya virus and ZIKV were detected in one sample each, both were DENV NS1 negative. The NS1 test demonstrated good agreement with rRT-PCR for DENV. However, multiplex rRT-PCR identified a subset of dengue cases and additional arboviral infections that would not be detected if NS1 assays are relied upon for diagnosis.

[Scorpionfish (Scorpaena plumieri) envenomation in a fishing and turistic community of Paraguaná peninsula, Falcón state, Venezuela: clinical, epidemiological and treatment aspects]. / Envenenamiento por pez escorpión (Scorpaena plumieri) en una comunidad pesquera y turística de la península de Paraguaná, estado Falcón, Venezuela: aspectos clínicos, epidemiológicos y tratamiento.

Thirty six patients apparently envenomed by the scorpion fish Scorpaena plumieri, consulting to the ambulatory emergency of a fishing and turistic town Adícora, state Falcón, Venezuela, from December 2006 to April 2007, allowed us to carry out a descriptive analysis of the clinical, epidemiology and treatment of this envenoming. Envenomation percentages were not significantly different between sex or age (X2=0.03, p= 0.758; X2=0.06; p=0.81, respectively). Most of the accidents occurred in february and april (> 50%), in the afternoon (83.33%) when individuals were bathing or swimming at the beach (97.22%), suggesting a seasonal pattern. The time between ambulatory medical assistance and the accident varied from 3 to 30 minutes, with a mean time of 5.97 +/- 4.39. The cutting injuries were located at the feet in all patients, with 0.2 to 3 cm (X=1.04 +/- 0.86) of length and between 1 to 2 mm of width. Clinical manifestations observed were: intense and irradiated pain (100%) (VAS=X: 9.39 +/- 0.60), edema (27.78%) and erythema (22.22%). One case had systemic manifestations: hypotension and faintness. Treatment consisted of infiltration with lidocaine (1%), systemic anti-inflmatory-analgesia (100 mg, orally every 8 hours for 5 days) and antibiotic therapy per os (500 mg, 2 daily dose for 10 days). All patients had a satisfactory post-treatment evolution, between 5 to 120 (X=30.11 +/- 33.30) minutes, with a pain VAS mean values significantly lower (0.72 +/- 0.62; t=52.2, p=0.0001).

Características clínico epidemiológicas de pacientes con Lepra en un centro de referencia

Introducción: La lepra o enfermedad de Hansen es una enfermedad infectocontagiosa, crónica, causada por el bacilo Mycobacterium leprae. Es causante de neuropatía periférica, y afecta a la piel, nervios periféricos, vías aéreas superiores y ojos. El objetivo fue evaluar las características clínicas y sociodemográficas a los pacientes con Lepra que acudieron Hospital Menonita Km 81 de Itacurubi de la Cordillera en los años 2018-2022. Material y Método: Estudio observacional descriptivo. retrospectivo, de corte transversal en pacientes con Lepra del Hospital Menonita Km 81 en la ciudad de Itacurubi de la Cordillera del Departamento de Cordillera del año 2018 al 2022. Los datos se obtuvieron de la revisión de las fichas epidemiológicas de pacientes con diagnóstico de lepra en el período abarcado en un periodo de 5 años, 2018 al 2022. Resultados: Fueron reportados 286 casos de lepra en pacientes provenientes de los 18 departamentos del Paraguay. El año con más casos detectados fue el 2019 con 79 casos, siendo el departamento de Alto Paraná con mayor incidencia con 17 casos diagnosticados, seguido del año 2018 con 76 casos. La ocupación más frecuente de los pacientes fue la agricultura. El sexo más frecuente fue el masculino 203 (71%) casos con lepra. El rango de edad de mayor frecuencia fue entre 49- 63 años de edad (29,56%). El motivo de consulta más frecuente fue el de Mácula en 139 (49%). Conclusión: Se requiere aumentar la calidad de la atención primaria y el compromiso del personal de salud para el control y el diagnóstico oportuno de la Lepra en nuestro país.

Introduction: Leprosy, or Hansen's disease, is a chronic infectious disease caused by Mycobacterium leprae. It causes peripheral neuropathy and affects the skin, peripheral nerves, upper airways, and eyes. The objective was to evaluate the clinical and sociodemographic characteristics to patients with Leprosy who attended Mennonite Hospital Km 81 of Itacurubí de la Cordillera in the years 2018-2022 Material and Method: descriptive observational study, retrospective of cross-sectional in patients with Leprosy of the Mennonite Hospital Km 81 in the city of Itacurubi de la Cordillera of the Department of Cordillera from the year 2018 to 2022. Data were obtained from the review of epidemiological records of patients with a diagnosis of leprosy in the period covered in a period of 5 years, 2018-2022. Results: Of the 18 departments in Paraguay, 286 cases of leprosy were reported. The year with the most cases detected was 2019, with 79 cases, with the department of Alto Paraná having the highest incidence, with 17 cases diagnosed, followed by 2018 with 76 cases. Agriculture was the most common occupation. The most frequent sex was male (203 [71%] patients) with leprosy. The most frequent age range was 49-63 years (29.56%), and the most frequent reason for consultation was macular in 139 patients (49%). Conclusion: It is necessary to increase the quality of primary care and commitment of health personnel in the control and timely diagnosis of leprosy in our country.

Antimalarial Activity of some Kaurenes.

The antirnalarial activity of sixteen ent-kaurenes was assayed on male albino mice infected with Plasmodium berghei. Ent-kaur-16-en-19-oic acid (kaurenic acid), l5iα-hydroxy- ent-kaur-16-en-19-oic acid, 15α-acetoxy- ent-kaur-16-en-19-oic acid, and ent-kaur-9(11)16-en-19-oic acid, natural kaurenes isolated from two species of Espelletiinae, were modified by semisynthesis to obtain methyl esters, glucopyranosyl esters, epoxides, 17-hydroxy, and isokaurenes (compounds with a 15,16-double bond). The kaurenes were first submitted to an in vitro test to measure their capacity to inhibit the formation of ß-hematin. Compared with chloroquine (95.7%), the best effect was shown by 16,17-epoxy-ent-kauran-19-oic acid α-D- glucopyranosyl ester (2a), which produced 92.6% inhibition. Three other kaurenes showed good inhibition levels: ent-kaur- 16-en-I 9-oic acid (1a, 73.5%), 17-hydroxy- ent-kaur- I5-en-19-oic acid methyl ester (3b, 76.5%), and 15-oxo-16,17-epoxy-ent-kaur-16-en-19-oic acid (X-D-glucopyranosyl ester (4b,76.1%). These four compounds were assayed in a four day suppressive test in vivo (Peters' test) using chloroquine as a positive control. Two hours after infection the mice received the first treatment and then every 24 hours during four consecutive days. Blood smears from the tails were prepared on the fourth day and parasitemia was determined microscopically. Survivals were followed up to the 30th day post-infection, Once again compound 2a performed best, showing 4.5% of parasitemia on the fourth day post-infection (chloroquine 0.2%) and a survival time of 25.5 days (chloroquine 29.5 days; la 18.8 days, 4b 12.7 days and 3b 10.3 days). A comparative examination of the effect of all compounds on the in vitro test permitted the inference that the presence of a C- 19 carboxylic moiety was a requirement for the antimalarial activity and that a 16,17 epoxy group enhanced such activity.

Association between vitamin D deficiency and disease activity in Paraguayan patients with systemic lupus erythematosus / Asociación entre la deficiencia de vitamina D y la actividad de la enfermedad en pacientes paraguayos con lupus eritematoso sistémico

ABSTRACT Objective: To identify the association between vitamin D (VD) concentrations and the activity of systemic lupus erythematosus (SLE) and determine a supplementation dose that allows patients to maintain adequate levels of VD. Methods: Longitudinal, observational study. Serum levels of 25-hydroxy-VD were measured in 100 Paraguayan SLE patients from the Hospital de Clínicas between 2016 and 2018. To analyze the response to different doses of VD supplementation, 50 patients received 1000IU/day and the other 50 patients received 2000IU. SLE disease activity measured by SELENA-SLEDAIwas scored before and after supplementation. Results: The mean age was 27.5 ±9.8 years, 88.9% of patients presented mild disease activ ity and 11.1% presented moderate to severe activity. The mean VD concentration was 30.8 ± 11.8 ng/mL. A total of 34% of patients presented VD insufficiency and 13% VD defi ciency. There was an inverse relationship between VD concentrations and SLE disease activity (p = 0.03). Increasing levels of serum VD are associated with supplementation of 2000 IU/day (p = 0.0224). Conclusion: SLE activity was associated with low levels of VD. In our cohort, SLE patients required a supplementation dose equal to or greater than 2000 IU/day to increase their serum VD.

R E S U M E N Objetivo: Identificar la asociación entre las concentraciones de vitamina D (VD) y la actividad del lupus eritematoso sistémico (LES), además de encontrar una dosis de suplementación que les permita a los pacientes mantener niveles adecuados de VD. Métodos: Estudio observacional longitudinal. Se midieron los niveles séricos de 25-hidroxi-VD en 100 pacientes paraguayos con LES, del Hospital de Clínicas, entre los años 2016 y 2018. Para analizar la respuesta a diferentes dosis de suplementación con VD, 50 pacientes recibieron 1.000 UI/día y los otros 50 pacientes recibieron 2.000 UI/día. La actividad de la enfermedad del LES medida por SELENA-SLEDAI se puntuó antes y después de la suplementación. Resultados: La media de edad fue de 27,5 ± 9,8 años, el 88,9% de los pacientes presentó actividad leve de la enfermedad y el 11,1% presentó actividad moderada a severa. La concentración media de VD fue de 30,8 ± 11,8 ng/ml. El 34% de los pacientes presentó insuficiencia de VD y el 13%, deficiencia de VD. Hubo una relación inversa entre las concentraciones de VD y la actividad de la enfermedad del LES (p = 0,03). Los niveles crecientes de VD en suero se asocian con una suplementación de 2.000 UI/día (p = 0,0224). Conclusión: La actividad del LES se asoció con niveles bajos de VD. En nuestra cohorte, los pacientes con LES requirieron una dosis de suplementación igual o superior a 2.000 UI/día para aumentar su VD sérica.

Características clínico-epidemiológicas de los pacientes de la cohorte Lupus Paraguay (2013-2014) / Characteristics clinical-epidemiological of the patients of the Lupus Paraguay cohort (2013-2014)

El lupus eritematoso sistémico (LES) es una enfermedad autoinmune, de etiología desconocida que presenta manifestaciones clínicas de gravedad y curso impredecible. Se ha observado en varias cohortes que esta enfermedad tiene un comportamiento más agresivo en la población no caucásica debido a diferencias socioeconómicas, demográficas y genéticas. El objetivo del estudio es describir las características clínico-epidemiológicas de los pacientes con LES incluidos en la cohorte LUPUS-PY y la situación actual de las muestras custodiadas en el BIOBANCO IMID-PY. Estudio basado en la revisión de historias clínicas y en los cuestionarios clínico-epidemiológicos del día de la inclusión al registro LUPUS-PY. Se calcularon las frecuencias para las variables categóricas y las medias con su desvío estándar para las continuas. Se incluyeron de forma consecutiva, 83 pacientes con diagnóstico de LES (edad media: 34,4±10,0 años), el 86,7% era del sexo femenino, el 55% provenía de Asunción, el 49,1% tenía nivel educativo básico, el 45% percibía un ingreso mensual de un sueldo mínimo (aproximadamente 350 dólares americanos) o menos. El 46,8% no realizaba ningún tipo de actividad física. La media del tiempo trascurrido desde el inicio de los síntomas y el diagnóstico del LES fue de 9,3±13,7 años y el tiempo de evolución de la enfermedad hasta el ingreso al registro fue de 5,9±6,3. El 16% refirió antecedentes familiares de enfermedades autoinmunes. La primera manifestación de la enfermedad más descripta fue la articular (45%). Los pacientes con LES de nuestro centro tienen características tanto clínicas como epidemiológicas similares a las reportadas por otras cohortes(AU)

Perfil antigénico en fase aguda y crónica de toxoplasmosis en embarazadas por la técnica de Western Blot / Antigenic profile in the acute and chronic phase of toxoplasmosis in pregnant women using the Western Blot technique

La toxoplasmosis es una enfermedad endémica con prevalencia mundial variable, cuyo agente causal es el parásito Toxoplasma gondii. Para un diagnóstico certero de la infección por T. gondii son necesarias combinaciones de métodos serológicos. Estudios recientes han reportado que la técnica de Western Blot permite evidenciar proteínas antigénicas como marcadores de la infección, así como ciertos perfiles proteicos como posibles indicadores de las fases de la infección, aguda y crónica. El objetivo del estudio fue identificar el perfil antigénico específico asociado a las diferentes fases de la toxoplasmosis. Fueron incluidos en el estudio 55 sueros de embarazadas con toxoplasmosis, diferenciados en fase aguda y crónica de la enfermedad por medio del método de ELISA de Avidez de IgG. Mediante el método de Western Blot se observó que las proteínas antigénicas p35, p43, p45, p56 y p107 fueron reconocidas por el 20- 60% de los sueros de pacientes en fase aguda, mientras que p65, p95, p98 y p113 fueron reconocidas por el 17-35% de sueros de pacientes en fase crónica. Se observó que seis proteínas antigénicas, p32, p38, p41, p48, p59 y p72, fueron reconocidas por más del 60% de los sueros de pacientes tanto en fase aguda como crónica. Los resultados obtenidos sugieren que estas seis proteínas podrían ser consideradas como marcadores diagnósticos de la enfermedad(AU)

Toxoplasmosis is an endemic disease with variable global prevalence, being the causative agent the parasite Toxoplasma gondii. For an accurate diagnosis of a T. gondii infection, combinations of serological methods are required. Recent studies have reported that the Western Blot technique allows the detection of antigenic proteins as markers of infection, as well as certain protein profiles as possible indicators of acute and chronic phases of infection. The objective of the study was to identify the specific antigenic profile associated with different phases of toxoplasmosis. Fifty five sera from pregnant women with toxoplasmosis were included in the study, differentiated in acute and chronic phase of the disease by an IgG Avidity ELISA. By using the Western Blot method it was observed that antigenic proteins p35, p43, p45, p56 and p107 were recognized by 20-60% of sera from patients in acute phase, while p65, p95, p98 and p113 were recognized by 17-35% of sera from patients in chronic phase. It was observed that six antigenic proteins, p32, p38, p41, p48, p59 and p72, were recognized by more than 60% of sera from patients in both acute and chronic phases. The results obtained in this study suggest that these six proteins could be considered as diagnostic markers of the disease(AU)

Can we predict the severity of pulmonary hypertension in patients with scleroderma?

OBJECTIVES: To describe the clinical-biological characteristics of patients with scleroderma (SSc) and pulmonary artery hypertension (PAH). To establish the relationship between pulmonary functional tests (PFT), Doppler echocardiography (ECHO) and the severity of the PAH. MATERIAL AND METHODS: Retrospective study of patients with scleroderma treated at a tertiary center. All participants received a protocol study, which included a complete analysis and additional tests: Doppler Echocardiography and pulmonary functional tests (PFT) with carbon monoxide diffusing capacity (DLCO). RESULTS: Overall, 331 patients were treated, including 68 (20.5%) with PAH. The limited subtype of Scleroderma was the most prevalent. The Person's correlation coefficient was used for the following variables: FVC-sPAP, FVC/DLCO-sPAP, DLCO-sPAP and TRV-sPAP, showed a significant moderate linear association in the relationship DLCO-sPAP and TRV-sPAP. 29 deaths occurred, with 12 of them related to PAH. The median time between the PAH diagnosis and death was 1.8 years. CONCLUSIONS: The decrease in DLCO and the increase in TRV are negative predictor factor of PAH which, at the same time, means a worsening prognosis for patients with Scleroderma.

Seroprevalencia y factores de riesgo asociados a la toxoplasmosis en mujeres en edad reproductiva que acudieron al Hospital Distrital de Lambaré, Paraguay / Seroprevalence and associated risk factors of toxoplasmosis among women in reproductive age who attended district Hospital of Lambaré, Paraguay

La toxoplasmosis es una enfermedad zoonótica de prevalencia mundial, causada por un parásito intracelular Toxoplasma gondii que infecta a los seres vivos y tiene como hospedador definitivo a los felinos. El presente estudio tuvo como objetivo determinar la seroprevalencia de toxoplasmosis y factores de riesgo asociados en mujeres en edad reproductiva no embarazadas que asistieron al Hospital Distrital de Lambaré, Paraguay. Se obtuvieron muestras de suero de 185 mujeres y se analizaron mediante ELISA Chagas IICS-UNA para la detección de anticuerpos IgG específicos contra T. gondii. Se utilizaron encuestas diseñadas para recoger datos demográficos y factores de riesgo. Se aplicó estadística descriptiva y la prueba de chi-cuadrado y OR (odds ratio) para establecer asociación entre las variables higiénicas, alimenticias y de conocimiento con la toxoplasmosis. De las 185 participantes, 117 presentaron IgG anti-T gondii, que representa una prevalencia de 63% IC95 (56,2-69,7%). El nivel de conocimiento fue el único factor de riesgo que se asoció en forma significativa con la serología positiva para toxoplasmosis. Aunque los demás factores de riesgo no alcanzaron significancia estadística, probablemente debido a la alta seroprevalencia en esta población, sin lugar a duda los mismos contribuyen en gran medida a la propagación de la infección.

Toxoplasmosis is a zoonotic disease of worldwide prevalence, caused by an intracellular parasite Toxoplasma gondii that infects living beings and has as its final host the felines. The present study aimed to determine the seroprevalence of toxoplasmosis and associated risk factors in non-pregnant reproductive age women attending the Hospital District of Lambaré, Paraguay. Serum samples were obtained from 185 women and analyzed by ELISA for the detection of IgG antibodies specific for T. gondii. Surveys designed to collect demographic data and risk factors were used. Descriptive statistics were applied and chi2 and OR (odds ratio) were calculated for the analysis of hygienic, nutritional and knowledge variables. Of the 185 participants, 117 presented positive serology for anti-T. gondii IgG, yielding a prevalence of 63% IC95 (56,2-69,7). The level of knowledge was The only risk factor significantly related to to positive serology for toxoplasmosis. Although the other risk factors were not statistically significant, probably due to the high seroprevalence in this population, there is no doubt that they contributgreatly to the spread of the disease.

Concordancia entre tablas de referencia utilizadas para diagnóstico del estado nutricional de escolares de comunidades rurales

Introducción: La forma más fácil y económica para observar el crecimiento es la antropometría, Para medir el crecimiento se utilizan estándares de referencia que evalúan a la normalidad del crecimiento. Las curvas de crecimiento recomendadas por la OMS hasta antes del 2006 eran las del NCHS y CDC, a partir de abril del 2006 la OMS propuso el uso del nuevo patrón de crecimiento. Objetivo: Medir la concordancia entre las tablas de referencias de crecimiento de la OMS 2007 y del NCHS/CDC 2000 utilizando los indicadores talla para la edad (T/E) e índice de masa corporal para la edad (IMC/E). Materiales y Métodos: Estudio analítico de corte trasverso. Se estudiaron 148 niños de entre 5 y 16 años que asistieron a escuelas de tres comunidades rurales. Las variables analizadas fueron T/E e IMC/E diferenciada por sexo. Se estimó el coeficiente kappa para evaluar la concordancia entre las referencias. Se utilizó programas estadísticos WHO Antro Plus V.1.0.4, y con EpiInfo v3.5.1 2008. Resultados: La concordancia más alta se encontró entre las referencias de la OMS 2007 y el CDC 2000 con el indicador T/E en la niñas con κ=0,882 y en los niños κ=0,760; con el indicador IMC/E el coeficiente Kappa más alto se encontró en la población de niños (κ=0,733) y en las niñas (κ=0,452). Conclusiones: Se obtuvo una concordancia buena entre ambas tablas de referencias para el indicador T/E. Existen concordancia moderada con el indicador IMC/E entre las referencias de la OMS 2007 y CDC 2000 para el diagnóstico nutricional.

Introduction: The easiest and most economical way to observe growth is anthropometry. To measure growth, reference standards are used that evaluate the normality of growth. The growth curves recommended by the WHO until before 2006 were those of the NCHS and the CDC. As of April 2006, the WHO proposed the use of new growth pattern charts. Objective: To measure the concordance between the 2007 WHO growth reference tables and those of the 2000 NCHS / CDC using the height-for-age (T / E) and body-mass-index-for-age (BMI / E) indicators. Materials and Methods: This was a cross-sectional analytical study. We studied 148 children between 5 and 16 years of age who attended schools in three rural communities. The variables analyzed were T / E and BMI / E, differentiated by sex. The kappa coefficient was estimated in order to evaluate the concordance between the references. The WHO Antro Plus V.1.0.4 and Epi Info v3.5.1 2008 were used for statistical analysis. Results: The highest concordance was found between the 2007 WHO growth reference tables and the 2000 CDC tables with the T / E indicator in girls with κ = 0.882 and in boys with κ = 0.760; with the IMC / E indicator, the highest Kappa coefficient was found in the population of boys (κ = 0.733) and in girls (κ = 0.452). Conclusions: There is good concordance between both reference tables for the T / E indicator. There is moderate agreement with the IMC / E indicator between the 2007 WHO and 2000 CDC growth references tables for the diagnosis of nutritional status..

Eventos cardiovasculares en pacientes con lupus eritematoso sistémico y su asociación con factores de riesgo cardiovascular / Cardiovascular events in patients with systemic lupus erythematosus and their association with cardiovascular risk factors

Los pacientes con lupus eritematoso sistémico (LES) presentan un elevado riesgo cardiovascular, cuya etiología aún no se conoce con exactitud. Se ha postulado que podrían estar implicados tanto los factores de riesgo cardiovascular tradicionales como determinados factores relacionados a la propia enfermedad. En el presente estudio, se ha analizado a un grupo de pacientes con LES y se ha determinado la presencia de eventos cardiovasculares (EC), así como también a los factores de riesgo cardiovascular (FRCV) tradicionales y los relacionados a la enfermedad. Además, se ha estudiado la asociación de estos últimos con el desarrollo de un EC (i.e. infarto de miocardio agudo, hipertensión arterial, accidente cerebrovascular). En el total de 83 pacientes analizados, el EC más frecuente fue la hipertensión arterial (HTA) en un 41%. En relación a los FRCV tradicionales, el sedentarismo fue el hallado con más frecuencia, seguido por la obesidad. Al analizar cada EC y su asociación con los FRCV, se observó una asociación significativa entre la HTA y la dislipidemia (p = 0,001). En relación a los accidentes cerebrovasculares, se observó una asociación con la edad avanzada (p = 0,037) y la presencia de síndrome antifosfolípido (p = 0,001). La elevada frecuencia de EC en los pacientes con diagnóstico de LES pone de manifiesto la necesidad de una evaluación inicial detallada para estratificar tanto FRCV tradicionales como los no tradicionales de los pacientes con LES para permitir una mejor supervisión y así mejorar el pronóstico cardiovascular de estos pacientes

Patients with systemic lupus erythematosus (SLE) have a high cardiovascular risk, whose etiology is not yet known accurately. It has been postulated that both traditional cardiovascular risk factors and certain factors related to the disease itself could be involved. In this study, we analyzed a group of patients with SLE and determined the presence of cardiovascular events (CE), and cardiovascular risk factors (CVRF), both traditional ones and those inherent to the disease. Besides, the association of the risk factors with the development of a CE (i.e. acute myocardial infarction, arterial hypertension (AHT), cerebrovascular accident) was studied. In a total of 83 patients, the most frequent CE was AHT in 41% of the patients. In relation to traditional CVRF, sedentary lifestyle was the most frequent (72%) followed by obesity. When we analyzed each CE and their association with the CVRF, we found a significant association between AHT and dyslipidemia (p = 0.001). In relation to cerebrovascular accidents, we observed an association with advanced age (p = 0.037) and presence of antiphospholipid syndrome (p = 0.001). The high frequency of CE in patients with diagnosis of SLE showed the need of a detailed initial assessment to stratify both traditional and non-traditional CVRF of a patient with SLE to allow a better monitoring and thus improve cardiovascular prognosis of these patients.

Desempeño del kit ELISA chagas IICS V.1 para el diagnóstico de la enfermedad de chagas / ELISA chagas test IICS V.1 evaluation for the diagnosis of chagas disease

En Paraguay, el tamizaje serológico para la enfermedad de Chagas en bancos de sangre es necesario, por lo cual es importante un método diagnóstico con alta sensibilidad. El ELISA Chagas test IICS V.1 es un ELISA indirecto sensibilizados con antígeno soluble de epimastigote de T.cruzide la cepa Ypsilon. El objetivo del presente trabajo fue evaluar el desempeño del ELISA Chagas test IICS V.1 en comparación con kits comerciales, ademásanalizar los resultados de la evaluación externa e interna de calidad del kit. En este estudio observacional de prueba diagnóstica se analizaron 56 muestras de suerospositivos y negativos para antígenos de Trypanosoma cruzi, testados por el ELISA BiosChile, obteniéndose una concordancia excelente entre el ELISA Chagas test IICS V.1y los kits comerciales: Chagatest ELISA-Wiener, con Índice kappa: 0,89 IC de 95% (0,76-1) y Test ELISA para Chagas III-Grupo BiosChile con Índice kappa: 0,92 IC 95% (0,82-1).En la evaluación externa de calidad realizada por la Fundação Pró-Sangue/Hemocentro de São Paulo, Brasil en el periodo 2001 al 2012 se analizaron 450 muestras: 372 negativas y 78 positivas para T. cruzi, obteniéndose en dicha evaluación la calificación "A" que indica ausencia de falsos positivos y negativos. Además, en el mismo periodo los valores del control interno se encontraron dentro del rango permitido de ±2DS. Los resultados obtenidos en el estudio demuestran la alta calidad de este test de producción nacional, que sumado al bajo costo del mismo, pueden ser utilizados en trabajos de campo, donde no necesita de instrumentación y las lecturas pueden realizarse a simple vista, constituyendo una herramienta válida y útil para el apoyo al diagnóstico de la enfermedad de Chagas.

In Paraguay, the serological screening for Chagas disease is mandatory in pregnant women and blood banks, therefore a high sensitivity diagnostic method is required. The aimof this study was to evaluate the ELISA Chagas test IICS V.1 by comparison with commercial kits and to analyze the external and internal quality evaluation results. In this descriptive observational study, 56 seropositive and seronegative to Trypanosoma cruzisamples were analyzed, obtaining an excellent concordance between the ELISA Chagas test IICS V.1 and these commercial kits: Chagatest ELISA-Wiener, Argentina (kappa index:0.89) and Test ELISA Chagas III-Grupo Bios, Chile (kappa index: 0.92).In the externalquality assessment carried out by the Fundação Pró-Sangue /Blood Center of São Paulo,Brazil in the period 2001 to 2012, 450 samples were analyzed: 372 seronegative and 78seropositive for T. cruzi. In this evaluation, an “A” score was obtained indicating theabsence of false positives and negatives. Additionally, in the same period of time theinternal control values were within the accepted range of ± 2SD, with a confidence intervalof 95%. The results obtained in the present study demonstrate the high quality of this locally produced test which added to its low cost, making it a valid and useful tool tosupport the diagnosis of Chagas disease.

Manifestaciones clínicas y laboratoriales en el lupus eritematoso sistémico - LES / Clinical and laboratory manifstations in systemic Lupus erythematosus

El Lupus eritematoso sistémico (LES) es una enfermedad autoinmune compleja que se caracteriza por su capacidad de afectar a diversos órganos, lo que determina las diferentes manifestaciones clínicas objetivadas durante la evolución de la enfermedad. De forma asociada se ha descrito que estas manifestaciones presentan una variación geográfica o étnica, siendo por lo general menos grave en pacientes con ascendencia europea que en aquellos que presentan ascendencia africana, asiática o hispana. Alteraciones, tanto del sistema inmune adaptativo (células T y B) como del innato (Toll like receptorx-TLR), contribuyen al desarrollo del LES. Las células B tienen su papel en la producción de los autoanticuerpos (i.e. anticuerpos anti-ADN y anticuerpos anti-nucleosoma) y de determiandas citocinas. Las pruebas de laboratorio son de gran valor cuando se evalúa a un paciente con sospecha de enfermedad autoinmune. Los resultados pueden confirmar el diagnóstico, estimar la severidad de la enfermedad, evaluar el pronóstico y son de suma utilidad para el seguimiento de la actividad del LES.

Systemic Lupus Erythematosus (SLE) is a complex autoimmnune disease characterizedby its ability to affect different organs, which determines different clinical manifestationsobserved during the course of the disease. It has been described that thesemanifestations have geographic or ethnic varations being generally less serious in patientsof European descent than in those with African, Asian or Hispanic descents. Alterations ofboth the adaptative (T and B cells) and innate (Toll like receptorx-TLR) immnune systemscontribute to the development of SLE. B cells have a role in the production of autoantibodies(i.e. anti-DNA and anti-nucleosome antibodies) and some cytokines. Laboratorytests are invaluable when evaluating a patient with suspected autoimmune disease. Theresults can confirm the diagnosis, estimate the severity of the disease, assess prognosisand are extremely useful for monitoring the activity of SLE.

Contaminación de billetes con enteroparásitos en Coro, estado Falcón, Venezuela / Contamination of banknotes with enteric parasites in Coro, Falcon state, Venezuela

El papel moneda es uno de los objetos que mayormente manipulan e intercambian los humanos, pudiendo representar un vehículo potencial en la transmisión de los parásitos intestinales. Entre mayo y julio de 2013, se evaluaron 185 muestras de billetes (Bs.F) de todas las denominaciones, los cuales se obtuvieron al azar en bancos y comercios de Coro, estado Falcón, Venezuela. Todas las muestras se lavaron con agua destilada estéril + Tween® 20 al 20%, y se sometieron a sedimentación espontánea por 2-3 horas, centrifugación y observación microscópica por métodos parasitológicos directo y tinción de Kinyoun. Se detectó que el 42,16% (78/185) de los billetes presentaron contaminación por uno o más taxones parasitarios/comensales, siendo los más frecuentemente observados: Blastocystis sp. (30,27%), Endolimax sp. (8,65%), Cyclospora sp. (8,11%) y Giardia sp. (7,57%). Los billetes sucios/mutilados (50,75%) presentaron porcentajes de contaminación parasitaria significativamente mayores que los nuevos (0%) y limpios (50%) (χ²= 26,11; P= 0,00001). No se encontró una relación estadísticamente significativa entre la denominación, la fecha de emisión de los billetes y los porcentajes de contaminación (P > 0,05). Se concluye que los billetes circulantes en la ciudad de Coro pueden potencialmente jugar un papel significativo en la diseminación de enfermedades parasitarias vía fómite. Por lo tanto, se recomienda programas de educación para la salud para el manejo y uso del papel moneda.

Banknotes are some of the objects most handled and exchanged by people, thus representing a potential vehicle for the transmission of intestinal parasites. Between May and July 2013, a total of 185 banknotes (Bs.F) from all denominations were randomly selected from trade centers and banks in Coro, Falcon state, Venezuela. The notes were washed with sterile distilled water + Tween® 20 (20 %) and then left at room temperature for 2-3 h for sedimentation to occur. Five mL of sediment were then centrifuged for 3-5min and the sediment was then examined with the aid of a light microscopy using direct parasitological methods and Kinyoun stained slides. A total of 42.16% (78/185) of the examined notes were contaminated by one or more parasitic/commensal taxa, with Blastocystis sp. (30.27%), Endolimax sp. (8.65%), Cyclospora sp. (8.11%) and Giardia sp. (7.57%) the most commonly isolated species. Dirty and damaged notes (50.75%) showed significantly higher percentages of contamination compared to mint (0%) and apparently clean (50%) ones (χ2= 26.11; P=0.0000). No statistically significant associations between the value of the notes, their date of emission and contamination frequencies were found (P > 0.05). We conclude that banknotes (Bs.F) circulating in Coro, Falcon state, Venezuela, could serve as a potential fomite for the spread of intestinal parasites. Sanitation awareness campaigns for the proper use and management of banknotes are therefore recommended.

Estudio clínico-epidemiológico de coccidiosis intestinales en una población rural de región semiárida del estado Falcón, Venezuela / Clinical and epidemiological study of intestinal coccidioses in a rural population of a semiarid region from Falcon state, Venezuela

A pesar de que las coccidiosis intestinales ocasionadas por Cryptosporidium, Cystoisospora belli y Cyclospora cayetanensis constituyen patologías parasitarias de alta relevancia en la Salud Pública, en el estado Falcón, Venezuela, se desconocen muchos aspectos de sus características clínicas y epidemiológicas. Durante junio-octubre de 2011, se realizó un estudio para determinar los aspectos clínicos y epidemiológicos en 157 habitantes (X ± D.S= 21,28 ± 17 años), de Sabaneta, estado Falcón, Venezuela. Se hizo evaluación clínica y anamnesis para la búsqueda de signos y síntomas que usualmente se encuentran asociados a las coccidiosis intestinales. La detección de la infección parasitaria se realizó por análisis microscópico al fresco y ooquistes en extendidos teñidos con Kinyoun. El análisis de los resultados reveló una prevalencia global de parasitosis intestinales de 61,78% (97/157), siendo Blastocystis sp. el taxón más frecuentemente observado (56,68%). La prevalencia de coccidiosis intestinal fue de 26,11% (41/157), siendo la ciclosporiosis la más prevalente con 24,2%, no detectándose diferencias estadísticamente significativas entre sexos ni edades (X2= 0,20; p=0,70 y x2=10,06; p= 0,44, respectivamente). La diarrea y la epigastralgia fueron las manifestaciones características más frecuentemente observadas, y las únicas significativamente asociadas con las coccidiosis (p < 0,05). A la luz de los resultados obtenidos, se concluye que el lavado de manos (OR= 1.93), la tenencia de animales domésticos (OR= 10.1), su alimentación con desperdicios (OR= 6.58), y su aseo (OR= 2.78), son potenciales factores de riesgo que aparecen de forma significativa en la dinámica de transmisión y mantenimiento endémico de las coccidiosis intestinales.

Although intestinal coccidioses caused by Cryptosporidium sp., Cystoisospora belli and Cyclospora cayetanensis are parasitic diseases of major clinical importance in Public Health, several clinical and epidemiological aspects of these diseases still remain unknown in Falcon state, Venezuela. A cross-sectional survey was conducted between June and October 2011, to investigate clinical and epidemiological data in 157 people (X ± S.D. = 21.28 ± 17 years-old) from Sabaneta, Falcón state, Venezuela. Symptoms associated with intestinal coccidioses were determined by means of anamnesis and clinical examination. Direct smear and Kinyoun staining were used to perform the parasitological diagnosis. The overall prevalence of intestinal parasites was 61.78% (97/157) and Blastocystis sp. was the most prevalent intestinal parasite (56.68%). Coccidioses prevalence was 26.11% (41/157) and among these, cyclosporiasis was the most prevalent with 24.2%. There were no statistically significant differences in the prevalence between sexes or ages (X2= 0.20; p=0.70 and x2=10.06; p= 0.44, respectively). Diarrhea and epigastralgia were the most common clinical findings, and the only ones significantly associated with intestinal coccidioses (p< 0.05). In the light of these results, it can be concluded that hand washing (OR= 1.93), bathing (OR= 2.78), keeping domestic animals (OR= 10.1) and their feeding with waste (OR= 6.58), are potential risk factors that appeared to be significantly related to the transmission and endemic maintenance of intestinal coccidioses.