Evaluación clínico-terapéutica de pacientes con infección por el virus de inmunodefiencia humana (VIH): consulta de infectología / Clinical and therapeutic evaluation of patients infected with human immunodeficiency virus (HIV): infectious disease consultation

La presente invetsigación tuvo como objetivo principal evaluar, desde el punto de vista clínico-terapéutico al paciente con infección por virus de inmunodeficiencia humana (VIH) en la consulta de infectología. Complejo Hospitalario Universitario "Ruiz y Páez". Marzo-Octubre 2010. Se realizó un estudio prospectivo, descriptivo, longitudinal, de campo, no experimental en el cual se estudiaron 200 pacientes adultos. De estos, 140 (70,00%) tenáin infección por VIH, siendo el grupo etario en edad productiva (31-40 años) con 40% (n=84) lo frecuente. En el espectro clínico, se evidenció fiebre con 25% (n=35) y pérdida de peso en 11,4% (n=16) como síntomas y signos generales más frecuentes; además se encontró pacientes con diarrea en 18,5% (n=26), placas blanquesinas orofaíngea con 10,7% (n=15) y cefalea en 6,4% (n=9). Los hallazgos de laboratorio: anemia con 7,4% (n=10), leucocitosis con 5,7% (n=8), y serología para toxoplasmosis positivos con 7,8% (n=11). Las infecciones asociadas: infecciones respiratorias 25% (n=35), seguido de parasitosis intestinal 12,1% (n=17) y candidiasis orofaríngea 10,7% (n=15). En el seguimiento del contaje linfocitario CD4+, la mayoría de los pacientes que asistían a la consulta de infectología tenían el último contaje de CD4+ dentro del rango de 201-500 células/mm³ con una frecuencia 30% (n=42). Con relación a la carga viral en la última consulta se encontraba dentro del rango de <50 copias de ARN/mL en un 28,5% (n=40). Encuanto al estadio clínico la mayoría de los pacientes se ubicaron en el estudio asintomático (A2) con 25,7% (n=36). Del tratamiento antirretroviral, las que se utilizan con mayor frecuencia son combinaciones de IP reforzadas + análogos nucleótidos con 65,7% (n=92). Se logró evidenciar múltiples dificultades y limitantes que impiden que la consulta de infectología se lleve a cabo con éxito y poder evaluar a los pacientes de manera completa. Entre las dificultades se pueden destacar que 38,5% (n=54) de los pacientes...

This study has as a principal objective to evaluate, patient infected with the Human Immnodeficiency Virus (HIV), from the standpoint of view of the clinical and therapeutic aspects. All patients were treated at the University Hospital "Ruiz y Páez". March to October 2010. We performed a prospective, descriptive, longitudinal, field and non experimental study in which were studied 200 adult patients. 140 of 200 (70.00%) patients had HIV infection, being patients mostly included in teh working age group (31-40 years) with 40% (n=56) and 60% of them being male (n=84). In the clinical spectrum was evidenced fever 25% (n=35) and weight loss 11,4% (n=16) as the general signs and symptoms most frequently seen. We also found patients with diarrhea in 18,5% (n=26), oropharyngeal white plaques 10,7% (n=15), headache 6,4% (n=9). Laboratory findings were: anemia 7,4% (n=10), leukocytosis 5,7% (n=8) and positive serology for toxoplasmosis 7,8% (n=11). Associated ¡nfections were: respiratory infections 25% (n=35), intestinal parasitosis 12,1% (n=17) and 10,7% oropharyngeal candidiasis (n=15). Most of the patients, 30% (n=42), attending infectious Diseases Consulting had the latter CD4 + count in the range of 201-500 cells/mm³. Regarding the viral load in the last vist, it was found to be at <50 copies / mL, in 28.5% (n=40) of the patients. Clinical stage of most of the patients was (A2) (asymptomatic) in 25,7% (n=36). Most often used antiretroviral therapy were combinations of reinforced IP plus nucleotide analogues in 65,7% (n=92). We found a lot of trobubles and limitations for the infectious diseases consultation. Among the difficulties can be noted that 38,5% (n=54) of patients arrives to consultation without history, laboratory test and with/without a scheduled appointment. Regarding the limitations, the most significant one was the excess of patients attending consultation and lack of general and microbiology laboratory at the institution...

VPH / HPV

Actualmente la Administración de drogas y Alimentos (FdA) de estados unidos aprobó dos vacunas para prevenir la infección por vPh (virus de Papiloma humano): Gardasil® (vacuna tetravalente) y cervarix ® (vacuna bivalente). Ambas vacunas son muy efectivas en la prevención de infecciones persistentes por los tipos 16 y 18 de vPh, dos de los vPh de “alto riesgo” que causan la mayoría (70%) delos cánceres de cuello uterino y en menor porcentaje de cáncer de ano y pene. Gardasil® impide también la infección por los tipos 6 y 11 de vPh, los cuales causan prácticamente todas (90%) las verrugas genitales. se presenta un resumen de la inmunogenicidad, eficacia, indicaciones, modo de empleo y presentaciones comerciales de estas dos vacunas

the Food and drug Administration (FdA) of usA licensed two vaccines for the prevention of vPh (human Papillomavirus) infection: Gardasil® (quadrivalent vaccine) and cervarix® (bivalent vaccine). Both vaccines are very effective in the prevention of persistent infection by serotypes 16 and 18 of vPh, two of the “high risk” vPh, which cause 70% of cervical cancers and in low percentages anal and penile cancers. Gardasil® prevents infection by serotytpes 6 and 11, which cause almost all (90%) of genital warts.this review presents the immunogenicity, efficacy, recommendations, doses, administration and commercial presentation of bothvaccines

Enteritis virales en adultos inmunocompetentes, agentes clásicos y emergentes / Viral enteritis in immunocompetent adults: classic and emergent agents

Objetivo: Revisar aspectos epidemiológicos y clínicos de las enteritis de etiología viral en pacientes adultos inmunocompetentes. Resumen: La diarrea aguda infecciosa (enteritis) es una patología relevante en todo el mundo y aún es responsable de una alta mortalidad en niños y elevada morbilidad en adultos. En pacientes adultos inmunocompetentes la etiología viral es frecuentemente subestimada aunque la mayoría de las enteritis agudas son causadas por virus. Los agentes virales más frecuentemente identificados son el Norovirus, Rotavirus, Astrovirus, y Adenovirus. Su principal vía de contagio es la ruta fecal-oral y el cuadro clínico suele ser en su gran mayoría leve y autolimitado, con manifestaciones clínicas similares e inespecíficas: diarrea acuosa, náuseas, vómitos y dolor abdominal. Adultos mayores y pacientes inmunosuprimidos pueden presentar cuadros más severos y prolongados. El tratamiento es fundamentalmente sintomático. La prevención se basa en tomar medidas sanitarias y limitar el contagio de persona a persona. Virus respiratorios emergentes como SARS e InfluenzaA-H1N1, con frecuencia comprometen el tracto gastrointestinal y en períodos de epidemia deben ser considerados en el diagnóstico diferencial de enteritis aguda.

Objective: To review epidemiological and clinical aspects of viral enteritis in immunocompetent adult patients. Abstract: Acute infectious diarrhea (enteritis) is a worldwide important disease and it still accounts for high mortality among children and high morbidity among adults. In immunocompetent adult patients the viral etiology is frequently underestimated, although the most common cause of acute enteritis is avirus. The mos frequently identified viral agents are Norovirus, Rotavirus, Astrovirus, and Adenovirus. The main mechanism of spread of the disease is fecal-oral transmission and the clinical setting is commonly mild and self-limited, with clinical manifestations that are similar and unspecific: aqueous diarrhea, nausea, vomiting and abdominal pain. Elderly and immunosupressed patients may show more severe and prolonged episodes. Treatment is mainly symptomatic. Prevention is based on taking sanitary measures and reducing person-to-person transmission. Emerging respiratory viruses as SARS and A-H1N1 influenza frequently compromise the gastrointestinal tract and during epidemic periods these viruses should be considered in differential diagnosis of acute enteritis.

Infecciones virales intestinales en pediatría / Intestinal viral infections in pediatrics

Los virus que causan diarrea en humanos generalmente muestran gran trofismo por las células epiteliales del intestino delgado. El mecanismo tradicionalmente aceptado es que estos agentes causan enfermedad destruyendo gran cantidad de entericitos maduros, (sea por lisis directa o induciendo la apoptosis) los que son reemplazados por células inmaduras provenientes de las criptas. Esto lleva a una absorción inadecuada de agua, electrolitos y nutrientes, con capacidad conservada de secretar cloro y agua. A diferencia de lo que ocurre frente a patógenos bacterianos invasores, la respuesta inflamatoria del huésped es leve y no contribuye significativamente en el mecanismo de la diarrea viral. Estudios posteriores han llevado a postular mecanismos adicionales, que no serían autoexcluyentes. Se ha descrito que algunas proteínas virales no estructurales actuarían como enterotoxina. Además, jugaría un rol la alteración de las uniones estrechas con aumento del flujo paracelular de agua y electrolitos, el aumento de la secreción intestinal mediada por neurotransmisores, y la microisquemia vellositaria. El impacto de la enteritis viral es mayor y la recuperación más lenta en niños previamente desnutridos. Se ha demostrado en animales de experimentación desnutridos un notorio retraso en la recuperación de la capacidad enzimática y absortiva de la mucosa intestinal frente a una enteritis viral, lo que refuerza la necesidad de una temprana y efectiva rehabilitación nutricional durante los episodios agudos de diarrea. Es ampliamente conocido que la lactancia materna, disminuye la incidencia y severidad de las diarreas virales en niños, los primeros meses de vida.

Viruses that cause diarrhea in humans generally show great tropism due to epithelial cells of the small intestine. The traditionally accepted mechanism is that these agents cause illness by destroying large number of mature enterocytes (via direct lysis or by inducing apoptosis), which are replaced by immature cells coming from the crypts. This leads to an inadequate absorption of water, electrolytes and nutritients with conserved chloride and water secretion. In contrast to invasive bacterial pathogens, the host infl amatory response is mild and it does not contribute significantly to the mechanism of viral diarrhea. Subsequent studies have leaded to postulate additional mechanisms that would not exclude each other. It has been described that some non-structural viral proteins may act as enterotoxin. In addition, the alteration of the tight junctions with an enhanced paracellular flow of water and electrolytes, the increase of neurotransmitter mediated intestinal secretion, and the micro-ischemia of villi would also play a role. The impact of viral enteritis is larger and the recovery slower in previously undernourished children. Studies carried out on undernourished experimentation animals have demonstrated a notorious delay in the recovery of the enzymaticand absorptive capacity of intestinal mucosa after viral enteritis, which reinforces the need for early and effective nutritional rehabilitation during episodes of acute diarrhea. It is well-known that the breastfeeding reduces the incidence and severity of viral diarrheas in children during the first months of life.

Phytoplasma and virus detection in commercial plantings of Vitis vinifera cv. Merlot exhibiting premature berry dehydration

A new and devastating physiological disorder of Vitis vinifera cv. Merlot was recently reported, known as premature berry dehydration (PBD), which is characterized by plant growth reduction, induction of general senescence and pedicel necrosis in the fruit, causing significant reductions in vineyard production. The causes of this disease remain unclear and previous reports suggest that it may be associated with phloem disruption and water provision. For this reason, any factor causing phloem disturbances could cause an important change in the berry water status. As some micro-organisms have been reported to disrupt phloem flow, we analyzed the occurrence of phytoplasma and viruses in commercial vineyards presenting PBD. In this study, a phytoplasma was detected by electron microscopy and nested PCR while virus infections were diagnosed by RT-PCR in samples collected during two growing seasons. The presence of phytoplasma only in samples from grape plants with PBD suggests that this pathogen may be one of the causal agents of this disorder. We suggest that the influence of other factors, such as virus infections, agronomic handling and environmental conditions also modulate berry dehydration. This is the first study at the microscopic and molecular levels that correlates phytoplasma presence with PBD.

Uso de antiinflamatorios nao-hormonais em crianças com doenças virais versus risco potencial para sindrome de Reye e doencas invasivas graves por estreptococos do grupo A / Nonsteroidal anti-inflammatory drugs use in children with viral diseases versus potential risks for Reyes's syndrome and invasive group A streptococal infections

Desde o inicio da decada de 1980, o uso de aspirina tem sido relacionado a sindrome de Reye e, na ultima decada, apos ter sido detectado um aumento na frequencia das doencas invasivas graves causadas por estreptococo beta-hemolitico do grupo A, tem sido publicados diversos artigos sobre a possivel relacao entre o uso de antiinflamatorios nao-hormonais em criancas com varicela e a ocorrencia de fasciite necrosante e sindrome do choque toxico. Neste artigo, a autora relata os...

Recovery from rabies in man: a case report

A human survival from clinical rabies was presented, the diagnosis was supported by an epidemiological, clinical and laboratory evidences. Perhaps this case is the fourth reported recovery from clinical rabies in the world

A testable theoretical model for magnetotherapy potentially applicative to such diverse concerns as oncogenic, CNS trophic factor and viral disorders.

Physiologic magnetic fields of the order 10(-8) gauss have been unified with their propitiators: quantum genetic particles, the gravitational potential of which is about an erg. As these fields are applied to the equation for solenoidal models, B = micro NI/L, currents of about a microampere are derived; in perfect accord with recent clinical data indicating the therapeutic efficacy of weak currents in repair and growth of soft tissue, bone and nerve. The mechanism of reorientation of spin angular momentum of leptons and baryons influencing molecular magnetic domains to bring about 'particle jumps' is presented so that a clinical picture results. The clinical picture is that of an organism placed at right angles to flux lines in the midst of a solenoid immersed in water exposed then to exogenously applied resonant physiologic magnetic fields which convert malalligned atomic lattices of oncogenes and associated particles to homologous normal structures.

Lucha contra la virosis mediante agentes antiviricos. / Antiviral agents for the control of viral diseases

Las enfermedades infecciosas viricas constituyen un serio problema mundial; periodicamente se identifican "nuevas" enfermedades como resultado de estudios epidemiologicos mas eficaces y de mejores tecnicas para el diagnostico de virus. Todavia mas importante, a medida que aprendemos a combatir el cancer y a llevar a cabo trasplantes de organos y tejidos, el paciente inmunosuprimido es mas sensible a las infecciones viricas. En la actualidad existen muy pocos agentes antiviricos de aceptacion generalizada aunque las investigaciones recientes son alentadoras. En este articulo se analiza la situacion de los agentes aprobados asi como la de aquellos que se consideran mas prometedores