Seroprevalence of hepatitis B, hepatitis C, and human immunodeficiency virus in hemophilia A patients: A descriptive study

Background: Hemophilia A (Factor VIII deficiency) is a X-linked coagulopathy that affects approximately 1/10,000 male live births. In the past, the treatment of hemophilia A consisted of cryoprecipitated plasma and purified factor preparations. As a result, they experienced unusually high incidence of hepatitis and human immunodeficiency virus (HIV) seroconversion. Aims and Objectives: The aims of this study were to find out the seroprevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV infection, among hemophiliacs attending a tertiary care center in Kerala, southern India. Materials and Methods: A cross-sectional study was conducted on hemophilia A patients who attended the departments of medicine and paediatrics. Demographic details and treatment history were obtained by questionnaire. Enzyme-linked immunosorbent assay was used to detect HBV surface antigen, HCV antibodies, and HIV. The statistical data analysis was performed using SPSS software version. Results: Out of 90 hemophilia A patients who underwent testing for the seroprevalence of transfusion-transmitted viral infections, one (1.1%) patient tested positive for HIV, two (2.2%) for HCV, and one (1.1%) for HBV. Among patients with hemophilia A, the prevalence of transfusion-transmitted infection was 4.4%. Patients with HIV- and HCV-positive tests belonged to the severe hemophilia A group. Moreover, the HBV-positive patient belonged to moderate hemophilia A. Conclusion: The present paradigm of management of hemophilia A patients is with plasma-derived or recombinant Factor VIII concentrates, cryoprecipitates, and fresh frozen plasma. Due to the risk, however remote, of transfusion-transmitted viral infections, all hemophiliacs should receive the hepatitis B vaccine and undergo routine testing for HIV, HCV, and HBV viruses.

Effect of viral infection on host cell metabolism: a review / 生物工程学报

As specialized intracellular parasite, viruses have no ability to metabolize independently, so they completely depend on the metabolic mechanism of host cells. Viruses use the energy and precursors provided by the metabolic network of the host cells to drive their replication, assembly and release. Namely, viruses hijack the host cells metabolism to achieve their own replication and proliferation. In addition, viruses can also affect host cell metabolism by the expression of auxiliary metabolic genes (AMGs), affecting carbon, nitrogen, phosphorus, and sulfur cycles, and participate in microbial-driven biogeochemical cycling. This review summarizes the effect of viral infection on the host's core metabolic pathway from four aspects: cellular glucose metabolism, glutamine metabolism, fatty acid metabolism, and viral AMGs on host metabolism. It may facilitate in-depth understanding of virus-host interactions, and provide a theoretical basis for the treatment of viral diseases through metabolic intervention.

Physical exercise in the control of pain or fatigue associated with viral infections: systematic review / Exercícios físicos no controle de dor ou fadiga associadas às infecções virais: revisão sistemática

ABSTRACT BACKGROUND AND OBJECTIVES: Individuals after viral infections remain with persistent symptoms such as pain and fatigue. Physical exercises have been described as a promising alternative for the control of these symptoms, but there are no systematic reviews that verify the effectiveness of this therapy and that assess the quality of these studies. The aim of this study was to investigate the effect of physical exercise on pain or fatigue associated with viral infections. METHODS: Systematic review registered with PROSPERO (CRD42021265174). Data collection was carried out between July 2021 and January 2022. Randomized clinical trials that addressed the practice of exercises, in individuals over 18 years of age, diagnosed with viral infection associated with the presence of pain or fatigue for more than 3 months were included. The search was carried out in the Pubmed, EMBASE, LILACS and Scielo databases, and the paired selection was carried out in the software (rayyan.ai); risk of bias analysis was assessed using the Cochrane risk-of-bias tool for randomized trials 2; certainty of evidence through GRADE; and for the construction of the meta-analysis, the Review Manager software. RESULTS: Eleven clinical trials were selected in populations with acquired immunodeficiency virus (HIV), human T-cell lymphotropic virus (HTLV), chikungunya and poliomyelitis. For both pain and fatigue, the combination of aerobic exercise with resistance training, lasting 40 to 60 minutes, two to three times a week, was effective and safe. The methodological quality of the studies showed a high risk of bias in six studies due to the following domains: bias due to deviations from the intended interventions, bias due to lack of outcome data and bias in the selection of the reported outcome; rated as some concerns in one study due to the domain bias due to deviations from intended interventions; and the others were assessed as low risk of bias. The meta-analysis showed a result in favor of the intervention group on pain intensity in the studies for Chikungunya and in a study for HTLV, which points to a positive effect in favor of the active groups. CONCLUSION: Exercises for the treatment of fatigue have very low evidence, while resistance exercises have moderate evidence for pain outcome. These are low-risk, low-cost resources with promising effects that should be better tested in people after viral infections.

RESUMO JUSTIFICATIVA E OBJETIVOS: Indivíduos após infecções virais permanecem com sintomas persistentes, como a dor e a fadiga. Exercícios físicos têm sido descritos como alternativa promissora para o controle desses sintomas, porém não há revisões sistemáticas que verifquem a eficácia dessa terapêutica e que avaliem a qualidade destes estudos. O objetivo deste estudo foi investigar o efeito de exercícios físicos na dor ou fadiga associados a infecções virais. MÉTODOS: Revisão sistemática registrada na PROSPERO (CRD42021265174). A coleta de dados foi realizada entre julho de 2021 a janeiro de 2022. Foram incluídos ensaios clínicos randomizados que abordaram a prática de exercícios, em indivíduos com idade superior a 18 anos, com diagnóstico de infecção viral associada à presença de dor ou fadiga por mais de três meses. A busca foi realizada nas bases de dados Pubmed, EMBASE, LILACS e Scielo e, a seleção por pares foi realizada no software (rayyan.ai); a análise de risco de viés foi avaliada através da ferramenta Cochrane risk-of-bias tool for randomized trials 2; a certeza da evidência por meio da GRADE; e para a construção da meta-análise, o software Review Manager. RESULTADOS: Foram selecionados 11 ensaios clínicos nas populações com Vírus da Imunodeficiência Adquirida (HIV), Virus Linfotrópico da Célula T Humana (HTLV), Chikungunya e Poliomielite. Tanto para dor quanto para a fadiga, a conjunção de exercícios aeróbicos com treino resistido, com duração de 40 a 60 minutos, de duas a três vezes por semana, foram eficazes e seguros. A qualidade metodológica dos estudos demonstrou em seis estudos alto risco de viés, devido aos domínios: viés devido a desvios das intervenções pretendidas, viés devido à falta de dados de resultado e viés na seleção do resultado relatado; classificado como algumas preocupações em um estudo devido o domínio viés devido a desvios das intervenções pretendidas; e os demais foram avaliados como baixo risco de viés. Na meta-análise foi demonstrado resultado a favor do grupo intervenção sobre a intensidade da dor nos estudos para Chikungunya e em um estudo para HTLV, o que aponta para efeito positivo a favor dos grupos ativos. CONCLUSÃO: Os exercícios físicos no tratamento da fadiga apresentam evidências muito baixas, enquanto para o desfecho dor os exercícios resistidos apresentam moderada evidência. São recursos de baixo risco e custo, com efeitos promissores, que devem ser melhor testados em pessoas após infecções virais. DESTAQUES O treinamento aeróbico combinado com o treinamento de resistência mostra resultados promissores para reduzir a dor e a fadiga nesta população após a infecção viral. O Pilates é um método que reduz significativamente a intensidade da dor após infecções por HTLV-1 e Chikungunya. O exercício pode beneficiar pessoas com sintomas persistentes de dor e fadiga após infecções

Características de la exacerbación del asma bronquial en niños atendidos en el Servicio de Urgencias / Characteristics of the exacerbation of bronchial asthma in children managed in the Emergency Service

Introducción: Actualmente existen aproximadamente 300 millones de personas a nivel mundial con diagnóstico de asma y con una mortalidad de 250 mil cada año. Cuba no está ajena a esta realidad. Objetivo: Describir las características clínicas y epidemiológicas de la exacerbación del asma, y su relación con la edad y la estacionalidad en niños asistidos en el Servicio de Urgencias del Hospital Pediátrico Juan Manuel Márquez, desde enero a diciembre de 2018. Material y Métodos: Se realizó un estudio descriptivo, prospectivo y transversal en pacientes con exacerbación del asma bronquial atendidos en el Servicio de Urgencias del Hospital Pediátrico Juan Manuel Márquez, desde enero a diciembre de 2018. Resultados: El mayor porciento se obtuvo en el sexo masculino con 53 por ciento, el grupo de edad de 5 a 9 años 46,3 por ciento. Dentro de los factores de riesgo que predominaron en el estudio fueron las infecciones virales 51,3 por ciento, los cambios de temperatura 58,2 por ciento y la no adherencia al tratamiento 45,5 por ciento . Las crisis de asma fueron frecuentes en los meses de octubre a diciembre 38,3 por ciento, con frecuencia entre 3 a 6 episodios por año 67,7 por ciento. El grado de severidad fue leve 82,0 por ciento. Conclusiones: Las exacerbaciones de asma bronquial son frecuentes en los servicios de urgencias pediátricos(AU)

Introduction: In these times, there are about 300 million people with the diagnosis of bronchial asthma worldwide and there is a mortality of 250 thousand per year. Cuba is not unaware of this reality. Objective: To describe the clinical and epidemiologic characteristics of the exacerbation of bronchial asthma in children assisted in the emergency service of Juan Manuel Márquez Pediatric University Hospital from January to December 2018. Material and Methods: A descriptive, prospective, cross-sectional study was conducted on 600 children from 1 to 18 years of age that fulfilled the inclusion criteria. These children were assisted in the emergency service of Juan Manuel Márquez Pediatric University Hospital from January to December 2018. Results: The highest percentage of patients were males (53 percent) and from the age group 5 to 9 years (46,3 percent). Among the risk factors that predominated in the study, viral infections (51,3 percent), weather changes (58,2 percent), and non-adherence to treatment (45,5 percent) were observed. The asthma crises were frequent from October to December (38,3 percent), and from 3 to 6 episodes occurred annually (67,7 percent). The degree of severity was mild (82,0 percent). Conclusions: Exacerbations of bronchial asthma are frequent in pediatric emergency services(AU)

Enfermedad de Castleman. Reporte de caso / Castleman Disease. Case report and literature review

Resumen INTRODUCCIÓN: La enfermedad de Castleman, o hiperplasia angiofolicular de los ganglios linfáticos, es todo un reto diagnóstico y terapéutico para la mayoría de los médicos. Puede estar asociada con infecciones virales, como el herpes virus tipo 8 (HHV-8), o ser idiopática. A su vez, puede localizarse en una sola región (unicéntrica) o afectar varias (multicéntrica). Suele diagnosticarse en la cuarta década de la vida y ser un hallazgo cuando se trata de la variante unicéntrica. CASO CLÍNICO: Paciente de 19 años que acudió a consulta debido a la aparición de un nódulo en la mama derecha. En el ultrasonido mamario y axilar se encontraron fibroadenomas bilaterales y adenomegalias en el lado izquierdo, con alta vascularidad. Se catalogó como BIRADS 3. El reporte histopatológico de la biopsia, con aguja de corte, del ganglio axilar izquierdo fue de: proliferación linfoide atípica. La inmunohistoquímica reportó positividad para: CD20, CD3, CD21 en células dendríticas interfoliculares, Ki-67 y negatividad para HHV-8 en centros germinales residuales. CONCLUSIÓN: La extirpación quirúrgica de una masa unicéntrica de tipo hialino-vascular-plasmático es curativa. La evaluación de pacientes con sospecha de esta enfermedad debe incluir, además de la evaluación patológica con inmunotinción, estudios de laboratorio y de imágenes sistémicas con PET-TAC para determinar la extensión de la enfermedad (unicéntrica o multicéntrica) y para los marcadores de seguimiento.

Abstract BACKGROUND: Castleman's disease, or angiofollicular lymph node hyperplasia, is a diagnostic and therapeutic challenge for most physicians. It may be associated with viral infections, such as herpes virus type 8, or be idiopathic. In turn, it can be localized in a single region (unicentric) or affect several (multicentric). It is usually diagnosed in the fourth decade of life and is a finding when it is the unicentric variant. CLINICAL CASE: 19 year old patient who came to consult due to the appearance of a nodule in the right breast. Breast and axillary ultrasound showed bilateral fibroadenomas and adenomegaly on the left side, with high vascularity. It was classified as BIRADS 3. The histopathological report of the biopsy, with cutting needle, of the left axillary node was: atypical lymphoid proliferation. Immunohistochemistry reported positivity for: CD20, CD3, CD21 on interfollicular dendritic cells, Ki-67 and negativity for HHV-8 in residual germinal centers. CONCLUSION: Surgical removal of a unicentric hyaline-vascular-plasmic type mass is curative. Evaluation of patients with suspected disease should include, in addition to pathologic evaluation with immunostaining, laboratory and systemic imaging studies with PET-CT to determine the extent of disease (unicentric or multicentric) and for follow-up markers.

Infecções virais na prática odontológica: riscos e prevenção / Viral infections in dental practice: risks and prevention

Objetivo: revisar a literatura sobre as principais patologias virais associadas à área odontológica, tais como varicela, herpes zoster, sarampo, mononucleose infecciosa, síndrome da imunodeficiência adquirida (Aids), hepatites virais e infecções associadas ao herpes-vírus simples (HSV) e ao papilomavírus humano (HPV), com o intuito de descrever as manifestações orais relacionadas a essas patologias e informar e esclarecer aos profissionais da área odontológica os riscos e os cuidados durante a prática clínica. Métodos: foi realizada uma busca nas bases de dados Google Acadêmico, SciELO, LILACS e PubMed sobre o tema infecções virais na prática odontológica. Foram incluídos nesta revisão 31 artigos, publicados no período de 2000 a 2020. Também foram utilizados como fonte bibliográfica 4 livros que abordavam o assunto em questão. Revisão de literatura: o consultório odontológico é um local propício à propagação de agentes biológicos patógenos causadores de infecção, nos quais se incluem os vírus. O profissional da área deve adotar medidas de biossegurança para evitar possíveis infecções. As precauções universais eficazes na redução do risco ocupacional baseiam-se no uso de equipamentos de proteção individual (EPIs), na prevenção da exposição a sangue e fluidos corpóreos, na prevenção de acidentes com instrumentos perfurocortantes e no descarte adequado dos resíduos contaminados. Considerações finais: as infecções virais representam um assunto relevante para o odontólogo, pois, além de serem transmissíveis por vários meios, também apresentam manifestações orais. Dessa forma, o cirurgião-dentista deve ter conhecimento suficiente sobre o tema para nortear a sua conduta clínica.(AU)

Objective: the present study aims to review the literature regarding the main viral pathologies associated with the dental field, such as chickenpox, herpes zoster, measles, infectious mononucleosis, acquired immunodeficiency syndrome (AIDS), viral hepatitis, and infections associated with herpes simplex virus (HSV) and human papillomavirus (HPV), in order to describe the oral manifestations related to these pathologies, and inform and clarify to the dental professionals the risks and care during clinical practice. Methods: a search was performed using Google Scholar, SciELO, LILACS and PubMed databases on the topic of viral infections in dental practice. This review included 31 articles, published from 2000 to 2020. Four books on the subject were also used as a bibliographic source. Literature review: the dental office is a place susceptible to the spread of pathogenic biological agents that cause infection, including viruses. The professional must adopt biosafety measures to avoid possible infections. Universal precautions that are effective in reducing occupational risk are based on the use of personal protective equipment (PPE), the prevention of exposure to blood and bodily fluids, the prevention of accidents with sharps, and the proper disposal of contaminated waste. Final considerations: viral infections represent a relevant issue for the dentist, because in addition to being transmissible through various means, they also present oral manifestations. Thus, the dentist must have sufficient knowledge on the subject to guide his clinical conduct.(AU)

Placental Sampling for Understanding Viral Infections - A Simplified Protocol for the COVID-19 Pandemic / Coleta placentária para entender infecções virais - Um protocolo simplificado para a pandemia de COVID-19

Abstract Objective The coronavirus disease 2019 (COVID-19) is a pandemic viral disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The impact of the disease among the obstetric population remains unclear, and the study of the placenta can provide valuable information. Adequate sampling of the placental tissue can help characterize the pathways of viral infections. Methods A protocol of placental sampling is proposed, aiming at guaranteeing representativity of the placenta and describing the adequate conservation of samples and their integrity for future analysis. The protocol is presented in its complete and simplified versions, allowing its implementation in different complexity settings. Results Sampling with the minimum possible interval from childbirth is the key for adequate sampling and storage. This protocol has already been implemented during the Zika virus outbreak. Conclusion A protocol for adequate sampling and storage of placental tissue is fundamental for adequate evaluation of viral infections on the placenta. During the COVID-19 pandemic, implementation of this protocol may help to elucidate critical aspects of the SARS-CoV-2 infection.

Resumo Objetivo A doença do novo coronavírus (COVID-19) é uma doença viral pandêmica causada pelo coronavírus da síndrome respiratória aguda 2 (SARS-CoV-2). O impacto da doença entre a população obstétrica ainda é incerto, e o estudo da placenta pode fornecer informações valiosas. Assim, a coleta adequada do tecido placentário pode ajudar a caracterizar algumas propriedades das infecções virais. Métodos Um protocolo de coleta placentária é proposto, objetivando a garantia de representatividade da placenta, descrevendo a maneira de conservação adequada das amostras, e visando garantir sua integridade para análises futuras. O protocolo é apresentado em suas versões completa e simplificada, permitindo sua implementação em diferentes configurações de infraestrutura. Resultados A amostragem com o intervalo mínimo possível do parto é essencial para coleta e armazenamento adequados. Esse protocolo já foi implementado durante a epidemia de vírus Zika. Conclusão Um protocolo para coleta e armazenamento adequados de tecido placentário é fundamental para a avaliação adequada de infecções virais na placenta. Durante a pandemia de COVID-19, a implementação deste protocolo pode ajudar a elucidar aspectos críticos da infecção por SARS-CoV-2.

Effects of viral infection and microbial diversity on patients with sepsis: A retrospective study based on metagenomic next-generation sequencing / 世界急诊医学杂志（英文）

@#BACKGROUND: The study aims to investigate the performance of a metagenomic next-generation sequencing (NGS)-based diagnostic technique for the identification of potential bacterial and viral infections and effects of concomitant viral infection on the survival rate of intensive care unit (ICU) sepsis patients. METHODS: A total of 74 ICU patients with sepsis who were admitted to our institution from February 1, 2018 to June 30, 2019 were enrolled. Separate blood samples were collected from patients for blood cultures and metagenomic NGS when the patients’ body temperature was higher than 38 °C. Patients’ demographic data, including gender, age, ICU duration, ICU scores, and laboratory results, were recorded. The correlations between pathogen types and sepsis severity and survival rate were evaluated. RESULTS: NGS produced higher positive results (105 of 118; 88.98%) than blood cultures (18 of 118; 15.25%) over the whole study period. Concomitant viral infection correlated closely with sepsis severity and had the negative effect on the survival of patients with sepsis. However, correlation analysis indicated that the bacterial variety did not correlate with the severity of sepsis. CONCLUSIONS: Concurrent viral load correlates closely with the severity of sepsis and the survival rate of the ICU sepsis patients. This suggests that prophylactic administration of antiviral drugs combined with antibiotics may be beneficial to ICU sepsis patients.

COVID 19 y embarazo en Chile: Informe preliminar del estudio multicéntrico GESTACOVID / COVID-19 and pregnancy in Chile: preliminary report of the GESTACOVID multicenter study

INTRODUCCIÓN: En Chile, los efectos maternos y perinatales de la pandemia por SARS-CoV-2 son aún desconocidos. GESTACOVID es un estudio multicéntrico que incluye embarazadas y puérperas hasta el día 42 con COVID-19. El objetivo de este estudio es presentar un informe preliminar, describiendo el impacto de la enfermedad en las embarazadas, factores de riesgo asociados y resultados perinatales. MÉTODOS: Estudio de cohorte descriptivo que incluye 661 pacientes enroladas entre el 7 de marzo y el 6 de julio de 2020, en 23 centros hospitalarios del país. Se analizaron variables demográficas, comorbilidades, características clínicas y del diagnóstico de COVID-19 y resultado materno y perinatal. RESULTADOS: Las pacientes hospitalizadas por COVID-19 tuvieron mayor prevalencia de hipertensión arterial crónica [10% vs 3%; OR=3,1 (1,5-6,79); p=0,003] y de diabetes tipo 1 y 2 [7% vs 2%; OR=3,2 (1,3-7,7); p=0,009] que las pacientes manejadas ambulatoriamente. Un IMC >40 kg/mt2 se asoció con un riesgo dos veces mayor de requerir manejo hospitalizado [OR=2,4 (1,2 - 4,6); p=0,009]. Aproximadamente la mitad de las pacientes (54%) tuvo un parto por cesárea, y un 8% de las interrupciones del embarazo fueron por COVID-19. Hasta la fecha de esta publicación, 38% de las pacientes continuaban embarazadas. Hubo 21 PCR positivas en 316 neonatos (6,6%), la mayoría (17/21) en pacientes diagnosticadas por cribado universal. CONCLUSIONES: Las embarazadas con COVID-19 y comorbilidades como diabetes, hipertensión crónica y obesidad mórbida deben ser manejadas atentamente y deberán ser objeto de mayor investigación. La tasa de transmisión vertical requiere una mayor evaluación para diferenciar el mecanismo y tipo de infección involucrada.

INTRODUCTION: In Chile, effects of the SARS-CoV-2 infection in pregnant women are unknown. GESTACOVID is a multicenter collaborative study including pregnant women and those in the postpartum period (until 42 days) who have had COVID-19. The purpose of this study is to report our preliminary results describing the clinical impact of COVID-19 in pregnant women, the associated risk factors and perinatal results. METHODS: Descriptive cohort study including 661 patients between April 7th and July 6th, 2020, in 23 hospitals. Demographical, comorbidities, clinical and diagnostic characteristics of COVID-19 disease and maternal and perinatal outcomes were analyzed. RESULTS: Pregnant women with COVID-19 admitted to the hospital were more likely to have chronic hypertension [10% vs 3%; OR=3.1 (1.5-6.79); p=0,003] and diabetes type 1 and 2 [7% vs 2%; OR=3.2 (1.3-7.7); p=0.009] than those with outpatient management. A body mass index of >40 kg/mt2 was associated with two-fold higher risk of hospitalization [OR=2.4 (1.2-4.6); p=0.009]. Almost half of patients (54%) were delivered by cesarean section, and 8% of the medically indicated deliveries were due to COVID-19. So far, 38% of the patients are still pregnant. Among 316 newborns, there were 21 positive PCR tests (6.6%), mostly from asymptomatic mothers undergoing universal screening. CONCLUSIONS: Pregnant women with COVID-19 and comorbidities such as diabetes, chronic hypertension and morbid obesity need a close follow up and should be a matter for further research. Vertical transmission of COVID-19 should be thoroughly studied to define the mechanisms and type of infection involved.

Miositis viral, reporte de un caso pediátrico / Viral myositis, a pediatric case report

La miositis viral aguda es una complicación posterior a una infección viral causada, principalmente, por virus influenza A y B. Se caracteriza por ser un proceso inflamatorio transitorio, súbito, autolimitado y benigno. Generalmente, afecta a niños preescolares y escolares, que presentan dolor bilateral y sensibilidad en los grupos musculares de los miembros inferiores sin alteración en el examen neurológico. Puede generar alteración de la marcha o de la bipedestación. Su principal complicación es la rabdomiólisis, por lo que se debe hacer un seguimiento clínico y de los valores de la creatinfosfoquinasa. Se presenta el caso de un niño en edad escolar con diagnóstico de miositis viral aguda. Debido a que es poco frecuente y su incidencia en Latinoamérica es desconocida, se considera importante el reporte del caso y la revisión del tema, ya que su curso es benigno, de fácil manejo, y su conocimiento evita estudios y hospitalizaciones innecesarias.

Acute viral myositis is a complication after a viral infection mainly caused by Influenza A and B viruses. It is characterized as a transitory, sudden, self-limiting and benign inflammatory process. It usually affects preschool and school children presenting bilateral pain and sensitivity in the muscle groups of the lower limbs without alteration in the neurological examination. It can affect the gait or standing. The main complication is rhabdomyolysis, which is why clinical followup and values of creatine phosphokinase must be done. We present the case of a school-age child diagnosed with acute viral myositis. Because it is not a frequent entity and its incidence in Latin America is unknown, we consider important to report the case and review the topic, as its clinical course is benign, easily treated, and its knowledge can avoid unnecessary studies and hospitalizations.

Emerging/re-emerging viral diseases & new viruses on the Indian horizon

Infectious diseases remain as the major causes of human and animal morbidity and mortality leading to significant healthcare expenditure in India. The country has experienced the outbreaks and epidemics of many infectious diseases. However, enormous successes have been obtained against the control of major epidemic diseases, such as malaria, plague, leprosy and cholera, in the past. The country's vast terrains of extreme geo-climatic differences and uneven population distribution present unique patterns of distribution of viral diseases. Dynamic interplays of biological, socio-cultural and ecological factors, together with novel aspects of human-animal interphase, pose additional challenges with respect to the emergence of infectious diseases. The important challenges faced in the control and prevention of emerging and re-emerging infectious diseases range from understanding the impact of factors that are necessary for the emergence, to development of strengthened surveillance systems that can mitigate human suffering and death. In this article, the major emerging and re-emerging viral infections of public health importance have been reviewed that have already been included in the Integrated Disease Surveillance Programme.

Practice pattern of cataract surgeons when operating on seropositive patients

Purpose: The aim of this study is to know practice pattern of cataract surgeons when operating on patients, positive for blood-borne viral infections (BBVIs), namely, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus. We also studied their awareness, knowledge, and attitude toward universal precautions and guidelines. Methods: The telephonic survey enrolled practicing cataract surgeons, who were interviewed to record responses pertaining to their practice using an open-ended questionnaire. We studied statistical significance of difference of frequency of prick injuries in topical versus peribulbar anesthesia, and phacoemulsification versus manual small incision cataract surgery by employing Chi-square test. Significance of proportion was calculated using z-test. For all statistical calculations, significance level was set at 0.05%. Results: Of 623 ophthalmologists contacted, responses of 479 (79%) ophthalmologists were analyzed. Maximum participants were in private practice (48%). During whole practicing carrier, 313 (65%; 95% confidence interval [CI]: 61–70) participants admitted having suffered injury with needle or sharp instruments; of these, 204 (65%; 95% CI: 60–70) participants did not report their injury. Wearing “double gloves” during cataract surgery was the most common barrier adopted by participants. Conclusion: We found high prevalence of occupational-related sharp injuries among ophthalmologists in this survey. Majority of them were aware of universal precautions, but adherence to postexposure prophylaxis was lacking.

Aging and the Immune System: the Impact of Immunosenescence on Viral Infection, Immunity and Vaccine Immunogenicity

Immunosenescence is characterized by a progressive deterioration of the immune system associated with aging. Multiple components of both innate and adaptive immune systems experience aging-related changes, such as alterations in the number of circulating monocytic and dendritic cells, reduced phagocytic activities of neutrophils, limited diversity in B/T cell repertoire, T cell exhaustion or inflation, and chronic production of inflammatory cytokines known as inflammaging. The elderly are less likely to benefit from vaccinations as preventative measures against infectious diseases due to the inability of the immune system to mount a successful defense. Therefore, aging is thought to decrease the efficacy and effectiveness of vaccines, suggesting aging-associated decline in the immunogenicity induced by vaccination. In this review, we discuss aging-associated changes in the innate and adaptive immunity and the impact of immunosenescence on viral infection and immunity. We further explore recent advances in strategies to enhance the immunogenicity of vaccines in the elderly. Better understanding of the molecular mechanisms underlying immunosenescence-related immune dysfunction will provide a crucial insight into the development of effective elderly-targeted vaccines and immunotherapies.

Clinical study of sexually transmitted viral infections in HIV seropositive patients

Human immunodeficiency virus disease (HIV) and sexually transmitted viral infections (STIs) are important cause of increasing morbidity and mortality in sexually active individuals, In our study we the incidence, age, sex distribution, risk factors and prevalence of viral STIs among HIV positive and negative patients who attended the tertiary care hospital and study we found that Herpes Genitalis to be the most common viral infection in HIV seropositive patients. Condylomaaccuminata are second most common viral infection in seropositive HIV patients. Social factors, lack of awareness, multiple sexual partners, poverty also contributed to the spread of HIV. HPV vaccine-based prevention and education programs need to be implemented in this high-risk community and centres providing voluntary counselling and testing (VCT) services for HIV. Introduction Human immunodeficiency virus (HIV) disease and sexually transmitted viral infections (STIs) are important cause of increasing morbidity and mortality in sexually active individuals. Patients suffering with viral STI are more vulnerable to acquire HIV infection in comparison with individuals without STI. HIV-seropositive patients are more vulnerable to acquire viral STI in comparison with HIVseronegative patients. Objectives of the Study To study the incidence, age, sex distribution, risk factors and prevalence of viral STI among HIV-positive and negative patients who attended the tertiary-care hospital. Materials and Methods This is a prospective and descriptive study conducted in STI clinic, Andhra Medical College, Department of Dermatology Venereology and Leprosy, King George Hospital, Visakhapatnam, Andhra Pradesh, for a period of 1 year from February 2017 to January 2018. The study includes 150 HIV-seropositive patients suffering with viral STI like genital herpes, molluscum contagiosum, genital warts, viral hepatitis and 150 HIV-seronegative patients. Results In our observation of 150 HIV-seropositive patients, herpes genitalis 57 cases (38%) was found to be the most common viral STI followed by condyloma accuminata 34 cases (22.7%). The most common age group involved was 20–29 years 68 cases (45.4%) with males most commonly effected 108 (72%) than females 42 (28%). Social factors like illiteracy, multiple sex partners and unprotected sex contributed to the risk of viral STI and HIV. Conclusion In our study, we found that herpes genitalis to be the most common viral infection in HIV-seropositive patients. Warts are second most common viral infection in seropositive HIV patients. Social factors, lack of awareness, multiple sexual practises, poverty also contribute to the spread of HIV.

Infecciones virales en receptores de trasplante alogénico de células progenitoras hematopoyéticas / Viral infections in allogeneic hematopoietic stem cell transplantation recipients

Introducción: El Trasplante alogénico de células progenitoras hematopoyéticas (TCPH) se asocia a una lenta recuperación de sistema inmune, lo que predispone a sus receptores a presentar múltiples complicaciones infecciosas. En este trabajo se analizan las infecciones virales de una cohorte retrospectiva. Material y métodos: se revisó la base de datos del servicio y se registraron las infecciones virales del periodo 2012-2016. Resultados: n 215. El 91% de los receptores y el 70% de los donantes eran CMV positivos antes del trasplante, el 47% de os receptores presentó reactivación de CMV y el 10% enfermedad, con una mortalidad directa del 3,1%. El 87% de los receptores y el 70% de los donantes tenían serología para EBV y el 13% tuvieron una reactivación con una carga viral > 20.000 copias/ml. El 11% de los pac tuvieron enfermedad por Herpes zoster, el 6% por Herpes 6 y el 5% por Herpes simple. Se detectó infección por adenovirus en el 25% de los pacientes, siendo el compromiso más frecuente el digestivo, seguido de la infección respiratoria baja. La mortalidad directa por adenovirus fue 5,1%. Se registraron 41 episodios de infección respiratoria aguda baja por virus respiratorios, con una mortalidad directa del 4%. El 18% de los pac tuvo cistitis hemorrágica por virus BK, con viremia asociada en el 41% de los casos. El 6% de los pacientes presentó falla hematológica asociada a Parvovirus, que un caso fue causa de la pérdida del injerto. Conclusión: las enfermedades virales son una complicación muy frecuente del TCPH y con gran peso en la mortalidad relacionada al trasplante. Los avances terapéuticos han sido menores que los alcanzados en los métodos diagnósticos (AU)

Introduction: Allogeneic hematopietic stem cell transplantation (HSCT) is associated with a slow recovery of the immune system leading to multiple infectious complications. In this study viral infections are evaluated in a retrospective cohort. Material and methods: The data base of the department was reviewed recording viral infections that occurred between 2012-2016. Results: n 215; 91% of the recipients and 70% of the donors were CMV prior to the transplant; 47% of the recipients had a CMV reactivation and 10% developed the disease with a related mortality of 3.1%. Overall, 87% of the recipients and 70% of the donor had a positive serology for EBV and 13% had a reactivation with a viral load of > 20,000 copies/ml. Of the patients, 11% had Herpes zoster, 6% Herpes 6, and 5% Herpes simplex. Adenovirus infection was detected in 25% of the patients, most commonly involving the digestive tract followed by lower respiratory tract infection. Adenovirusrelated mortality was 5.1%. Forty-one acute lower respiratory tract infections due to respiratory viruses were recorded leading to a mortality of 4%. Of all the patients, 18% had BK virus-related hemorrhagic cystitis with associated viremia in 41% of the cases. Six percent of the patients had parvovirusassociated hemotologic failure leading to graft loss in one case. Conclusion: Viral diseases are a very frequent complication in HSCT with a high transplant-related mortality. Advances in therapy have lagged behind advances in diagnostic methods (AU)

Agentes antivirales

Para evaluar y analizar los avances terapéuticos de los antivirales, se consideró necesario describir y actualizar aspectos relevantes de estos agentes infecciosos, destacándose fundamentalmente su estructura (núcleo y cápside), las fases de la replicación viral, los dos grandes grupos y como se integran de acuerdo al ácido nucleico que contienen, ADN y los que incluyen al ARN en su estructura. Entre los primeros, se incluye el virus de la hepatitis B y el del Herpes simple. Para los que contienen ARN se incluye entre otros, los virus de las hepatitis A, C, delta y G. Se describen y evalúan los diferentes fármacos antivirales, resaltando su composición química, mecanismo de acción, usos terapéuticos, absorción, distribución, eliminación corporal y sus efectos adversos. Se efectúan comentarios finales sobre los avances científicos que están ocurriendo en el desarrollo de estos antivirales tan necesarios para el tratamiento de enfermedades de etiología viral, agentes que continúan ejerciendo sus efectos letales sobre la humanidad.

To evaluate and analyze the therapeutic advances on antiviral agents, it was considered necessary to describe and actualize the most relevant aspects of these infectious agents, emphasizing the viral structure (core and capsid), the different phases of viral replication, the classification of the two different viral groups according the nucleic acid in their structure, DNA and those including RNA. Among the first group there are included the hepatitis B virus (HBV) and the Herpes simplex virus. For the RNA viruses we have considered, among others, hepatitis viruses A, C, delta and G. It is described and evaluated the different antiviral agents, emphasizing their chemical composition, mechanism of action, therapeutic uses, absorption, body distribution and elimination and their adverse effects. Finally, comments are made as to the scientific advances that are taking place related to the development of these antiviral agents so important for the treatment of viral infectious diseases that are being so deleterious to mankind.

Manejo de las infecciones por citomegalovirus y virus herpes simple en gestantes y recién nacidos / Management of Cytomegalovirus Infections and Herpes Simplex Virus in Pregnant Women and Newborns

Existe un grupo de infecciones que pueden producir defectos congénitos graves cuando se adquieren durante la gestación. Estas inciden en la morbilidad y mortalidad infantil, especialmente si la infección ocurre antes de las 20 semanas de embarazo. Entre ellas se encuentran las producidas por el citomegalovirus y el virus del herpes simple que con frecuencia se asocian con infección congénita y daño al recién nacido. El citomegalovirus humano está mundialmente distribuido entre las poblaciones humanas, desde los países desarrollados hasta las comunidades aborígenes. En países en vías de desarrollo y en los estratos socioeconómicos bajos de los países desarrollados, la prevalencia es mayor (más de 90 por ciento) y el virus se adquiere en edades más tempranas de la vida. Es la infección viral congénita más frecuente, ocurre de 0,3 a 2 por ciento de los nacimientos y en el 40 por ciento la transmisión es vertical. La distribución del virus del herpes simple es amplia y la seroprevalencia en el adulto es entre 60 y 75 por ciento para virus del herpes simple -1 y de 11-30 por ciento para virus del herpes simple -2. El objetivo de la presente revisión es describir estas dos entidades al abordar las características más comunes de estas afecciones, la epidemiología, el diagnóstico, la clínica y la terapéutica. Es necesario que el médico de asistencia las conozca a profundidad para realizar un correcto manejo de estas(AU)

There is a group of infections, which can cause serious birth defects when acquired during pregnancy. They affect infant morbidity and mortality, especially if the infection occurs before 20 weekspregnant. These include those caused by cytomegalovirus and herpes simplex virus that are often associated with congenital infection and damage to the newborn.Human cytomegalovirus (HCMV)is globally distributed among human populations from developed countries to Aboriginal communities. In developing and low socioeconomic strata of the developed countries, the prevalence is higher (over 90 percent) and the virus is acquired in earlier stages of life. It is the most common congenital viral infection. It occurs 0.3 to 2 percent of births and 40 percent transmission is vertical. The distribution of herpes simplex virus is broad and seroprevalence in adults is between 60 and 75 percent for herpes simplex 1 virus and 11-30 percent for herpes simplex virus -2. The aim of this review is to describe these two entities in addressing the most common features of these conditions as epidemiology, diagnosis, clinical and therapeutic. A profound knowledge is necessary for the attending physician to the proper handling of them(AU)

Nuevos virus respiratorios emergentes diagnosticados por exudado nasofaríngeo / New Emerging Respiratory Virus Diagnosed by Nasopharyngeal Swab

Introducción: las infecciones respiratorias agudas constituyen una de las principales causas de consulta en los servicios de salud. Objetivo: identificar las características epidemiológicas y clínicas de las infecciones producidas por los nuevos virus respiratorios emergentes. Método: se realizó un estudio epidemiológico descriptivo de serie de casos, en niños menores de 15 años ingresados en el Hospital Pediátrico Docente Luis Ángel Milanés Tamayo de Bayamo, Granma, desde el primero de diciembre de 2010 al 31 de diciembre de 2011. El universo estuvo constituido por 144 pacientes con el diagnóstico de infección respiratoria aguda, a los cuales se les realizó exudado nasofaríngeo. La muestra fue de 119 casos con aislamientos virales positivos. Resultados: predominó el grupo de edad uno a cuatro años (47,08 %) y el sexo masculino con 55,46 %. La desnutrición se presentó en 48 niños (40,33 %) y la exposición pasiva al cigarro en 59 pacientes (49,57 %). Los virus respiratorios emergentes encontrados fueron los metapneumovirus y el bocavirus con 12 casos respectivamente. Conclusiones: los niños menores de cinco años, con factores de riesgo como la desnutrición y exposición pasiva al humo del cigarro fueron los más afectados por estos agentes virales. Los rinovirus, el rincitial respiratorio y el virus de la influenza A H1N1 presentaron una circulación estacional.

Introduction: acute respiratory infections are a leading cause of consultation in health services. Objective: to identify the epidemiological characteristics and clinical infections caused by newly emerging respiratory virus. Method: a descriptive epidemiological study of case series was performed in children under 15 years admitted to the Luis Angel Milanés Tamayo Pediatric Teaching Hospital of Bayamo, Granma, from December 1st, 2010 to December 31st, 2011. The universe comprised 144 patients with the diagnosis of acute respiratory infection, with and nasopharyngeal sampling. The sample was composed of 119 cases with isolate positive virus. Results: the age group between 1-4 years (47.08 %) predominated as well as male sex (55.46 %). Malnutrition occurred in 48 children (40.33 %) and exposure to smoking in 59 patients (49.57 %). The emerging respiratory viruses found were metapneumovirus and bocavirus 12 cases respectively. Conclusions: children under 5 years with risk factors such as malnutrition and passive exposure to cigarette smoke were the most affected by these viral agents. Rhinovirus, respiratory and rincitial virus A H1N1 influenza showed a seasonal circulation.

Papel de los receptores tipo toll (TLRs) y receptores para dominios de oligomerización para la unión a nucleótidos (NLRs) en las infecciones virales / Role of toll-like receptors (TLRs) and nucleotide-binding oligomerization domain receptors (NLRs) in viral infections

Las células del sistema inmunitario (SI) son capaces de reconocer una gran variedad de microorganismos, a través de los receptores que se encuentran expresados y distribuidos a lo largo de su arquitectura celular. La interacción entre los patrones moleculares asociados a microorganismos o a daño (PMAM o PMAD) y los receptores reconocedores de patrones (RRP) presentes en las células del hospedero es un evento crítico que implica procesos intracelulares de señalización que finalizan en la expresión de mediadores tanto proinflamatorios como antivirales. Por consiguiente, de la integridad de estos receptores dependerá el buen funcionamiento de los distintos mecanismos de transducción de señal desde las membranas celulares al citoplasma y por ende, de la respuesta que el SI desencadene contra los patógenos entre ellos los agentes virales. De allí que, en esta revisión se discutirá el papel de los receptores tipo toll (TLRs) y receptores para dominios de oligomerización para la unión a nucleótidos (NLRs) en las infecciones virales, tomando como evidencia los estudios en humanos y ratones que a la fecha se conocen.

The immune system (IS) cells are capable of recognizing a wide variety of microorganisms, through receptors that are expressed and distributed throughout the cell architecture. The interaction between the pathogen-associated molecular patterns or damage-associated molecular patterns (PAMPs or DAMPs) and pattern recognition receptors (PRR), present in host cells, is a critical event that involves intracellular signaling processes that end up in the expression of both, proinflammatory and antiviral mediators. Accordingly, the proper functioning of the different mechanisms of signal transduction from the cell membrane to the cytoplasm will depend on the integrity of these receptors (PRR); and therefore, the IS response triggered against pathogens including viral agents. Hence, in this review we discuss the role of toll-like receptors (TLRs) and nucleotide-binding oligomerization domain receptors (NLRs) in viral infections, using as evidence the studies in humans and mice known to date.

Immunohistochemical detection of virus through its nuclear cytopathic effect in idiopathic interstitial pneumonia other than acute exacerbation

Idiopathic interstitial pneumonias include complex diseases that have a strong interaction between genetic makeup and environmental factors. However, in many cases, no infectious agent can be demonstrated, and these clinical diseases rapidly progress to death. Theoretically, idiopathic interstitial pneumonias could be caused by the Epstein-Barr virus, cytomegalovirus, adenovirus, hepatitis C virus, respiratory syncytial virus, and herpesvirus, which may be present in such small amounts or such configuration that routine histopathological analysis or viral culture techniques cannot detect them. To test the hypothesis that immunohistochemistry provides more accurate results than the mere histological demonstration of viral inclusions, this method was applied to 37 open lung biopsies obtained from patients with idiopathic interstitial pneumonias. As a result, immunohistochemistry detected measles virus and cytomegalovirus in diffuse alveolar damage-related histological patterns of acute exacerbation of idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia in 38 and 10% of the cases, respectively. Alveolar epithelium infection by cytomegalovirus was observed in 25% of organizing pneumonia patterns. These findings were coincident with nuclear cytopathic effects but without demonstration of cytomegalovirus inclusions. These data indicate that diffuse alveolar damage-related cytomegalovirus or measles virus infections enhance lung injury, and a direct involvement of these viruses in diffuse alveolar damage-related histological patterns is likely. Immunohistochemistry was more sensitive than the histological demonstration of cytomegalovirus or measles virus inclusions. We concluded that all patients with diffuse alveolar damage-related histological patterns should be investigated for cytomegalovirus and measles virus using sensitive immunohistochemistry in conjunction with routine procedures.