ABSTRACT
[This corrects the article DOI: 10.1371/journal.pntd.0010613.].
ABSTRACT
Chagas disease is a significant public health risk in rural and semi-rural areas of Venezuela. Triatomine infection by the aetiological agent Trypanosoma cruzi is also observed in the Metropolitan District of Caracas (MDC), where foodborne T. cruzi outbreaks occasionally occur but active vector-to-human transmission (infection during triatomine bloodmeal) is considered absent. Citizen science-based domiciliary triatomine collection carried out between 2007 and 2013 in the MDC has advanced understanding of urban T. cruzi prevalence patterns and represents an important public awareness-building tool. The present study reports on the extension of this triatomine collection program from 2014 to 2019 and uses mitochondrial metabarcoding to assess feeding behavior in a subset of specimens. The combined, thirteen-year dataset (n = 4872) shows a high rate of T. cruzi infection (75.2%) and a predominance of Panstrongylus geniculatus (99.01%) among triatomines collected in domiciliary areas by MDC inhabitants. Collection also involved nymphal stages of P. geniculatus in 18 of 32 MDC parishes. Other collected species included Triatoma nigromaculata, Triatoma maculata, Rhodnius prolixus, and Panstrongylus rufotuberculatus. Liquid intestinal content indicative of bloodmeal was observed in 53.4% of analyzed specimens. Dissection pools representing 108 such visually blooded P. geniculatus specimens predominantly tested positive for human cytochrome b DNA (22 of 24 pools). Additional bloodmeal sources detected via metabarcoding analysis included key sylvatic T. cruzi reservoirs (opossum and armadillo), rodents, and various other synanthropic and domesticated animals. Results suggest a porous sylvatic-domiciliary transmission interface and ongoing adaptation of P. geniculatus to the urban ecotope. Although P. geniculatus defecation traits greatly limit the possibility of active T. cruzi transmission for any individual biting event, the cumulation of this low risk across a vast metropolitan population warrants further investigation. Efforts to prevent triatomine contact with human food sources also clearly require greater attention to protect Venezuela's capital from Chagas disease.
Subject(s)
Chagas Disease , Panstrongylus , Triatoma , Trypanosoma cruzi , Animals , Humans , Venezuela/epidemiology , Chagas Disease/epidemiology , Trypanosoma cruzi/geneticsABSTRACT
Panstrongylus geniculatus has become the most frequently registered vector of Chagas disease in the metropolitan area of Caracas, Venezuela. This triatomine species has invaded urban areas in recent years and has been implicated in multiple oral outbreaks of Chagas disease in the region. The study of genetic variability and spatial structure in P. geniculatus populations can provide information about possible events of domiciliation and aid intervention programs against triatomine species rapidly adapting to urban ecotopes. We sequenced a region of the cytochrome-b gene in 114 specimens of P. geniculatus from the Metropolitan District of Caracas and assessed patterns of gene flow and phylogenetic relationships among these individuals. A total of 29 haplotypes were detected in the two sampled municipalities, Sucre and Libertador. Though high genetic connectivity was observed between the municipalities (FSTâ¯=â¯0.10796; Nmâ¯=â¯11.20), subtle genetic structuring was also observed in particular geographic sub regions. Based on neutrality tests and the observed allele-frequency distribution, the Panstrongylus geniculatus population appears to be expanding and adapting to different microhabitats present in the study area. Our findings affirm the capacity of this insect to adapt to different environments and emphasize its principal role in the epidemiology of Chagas disease in northern Venezuela.
Subject(s)
Genetic Variation , Insect Vectors/genetics , Panstrongylus/classification , Panstrongylus/genetics , Animals , Chagas Disease/transmission , Genes, Insect , Genes, Mitochondrial , Genetics, Population , Geography, Medical , Haplotypes , Humans , Neutralization Tests , Phylogeny , Venezuela/epidemiologyABSTRACT
Percutaneous intervention of chronic limb ischemia is often limited by vascular access especially in patients with previous surgical interventions. This warrants development of alternative endovascular techniques, particularly for patients in whom traditional ipsilateral antegrade or contralateral retrograde access has failed or is not possible. We describe a novel approach to the posterior tibial artery using retrograde access with transradial techniques including closure devices in two patients with inaccessible antegrade access.
Subject(s)
Angioplasty, Balloon , Catheterization, Peripheral/methods , Ischemia/therapy , Lower Extremity/blood supply , Radial Artery , Tibial Arteries , Aged , Angioplasty, Balloon/adverse effects , Angioplasty, Balloon/instrumentation , Catheterization, Peripheral/adverse effects , Catheters , Chronic Disease , Hemorrhage/etiology , Hemorrhage/prevention & control , Hemostatic Techniques/instrumentation , Humans , Ischemia/diagnostic imaging , Male , Middle Aged , Radial Artery/diagnostic imaging , Radiography , Stents , Tibial Arteries/diagnostic imaging , Treatment OutcomeABSTRACT
El desarrollo de las ciencias básicas como la inmunología, la genética y la biología molecular ha permitido implementar nuevas alternativas de tratamiento en enfermedades que tradicionalmente contaban con pocas opciones terapéuticas. La reumatología en los últimos años ha adoptado y extendido el uso de agentes biológicos y la quimioterapia en la mayoría de las enfermedades reumáticas. Para ello es necesario establecer guías para la utilización de estos agentes. El uso inapropiado de estos agentes puede llevar a consecuencias catastróficas. Los nuevos medicamentos deben ser usados sólo por personas expertas en el tratamiento de las enfermedades reumáticas y su administración debería realizarse en condiciones ideales para minimizar el riesgo. La Asociación Colombiana de Reumatología pretende con este documento establecer las guías locales para utilizar estos agentes
Subject(s)
Drug Therapy , RheumatologyABSTRACT
El pinzamiento del cordón umbilical la mayoría de las veces se realiza en forma mecánica y casi inmediata al nacimiento, sin detenerse a pensar en las posibles implicaciones que esta conducta puede tener en el recién nacido o en la madre. En el presente artículo se revisa la evidencia disponible con respecto a los conceptos fisiológicos inherentes al pinzamiento del cordón, las razones por las que se ha recomendado el pinzamiento temprano, los posibles efectos benéficos o perjudiciales al momento del pinzamiento y las recomendaciones del Ministerio de la Protección Social.
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Umbilical Cord , ColombiaABSTRACT
Se realiza en este artículo una revisión sobre la patogénesis de las espondiloartropatías seronegativas, analizando las posibles causas que puedan dar origen a la enfermedad, sobre todo el papel del HLA B27 y sus diferentes subtipos
Subject(s)
Spondylitis, AnkylosingABSTRACT
Estudiamos 102 pacientes con diagnóstico de Esclerosis Sistémica Progresiva vistos de manera retrospectiva y prospectiva durante un periódo de 9 meses (marzo a diciembre de 1993) y analizamos sus manifestaciones clínicas, su forma de presentación, las diferencias existentes entre la variedad limitada y la difusa. Los patrones de anticuerpos antinucleares presentes en cada una de ellas y la asociación con diferentes enfermedades, en especial osteoartritis, hipertensión arterial sistémica, síndrome de Sjörgren, fibrosis pulmonar, necrosis digital, acroosteolisis, entre otras. En general las manifestaciones clínicas de esta enfermedad en nuestro medio son similares a las descritas en otras series. Resaltamos la alta asociación con hipotiroidismo, síndrome de sjörgren, fibrosis pulmonar y 8 casos con necrosis digital, en especial 3 de estos que se presentaron dentro del primer año de evolución de la enfermedad. Es el primer estudio epidemiológico en Colombia respecto a esta patología