Detection of dengue virus serotype 4 in Panama after 23 years without circulation.

Panama is a country with endemic Dengue virus (DENV) transmission since its reintroduction in 1993. The four serotypes have circulated in the country and the region of the Americas, however, DENV-4 confirmed autochthonous cases have not been identified since 2000, despite its circulation in neighboring countries. Here, we report DENV-4 detection in Panama in the last four-month period of 2023 with co-circulation of the other serotypes, this was associated with a peak of dengue cases during the dry season even though most dengue outbreaks are described in the rainy season. Complete genomes of DENV-4 allowed us to determine that cases were caused by DENV-4 genotype IIb, the same genotype as 23 years ago, with high similarity to DENV-4 sequences circulating in Nicaragua and El Salvador during 2023. This report shows the importance of maintaining serotype and genotype surveillance for early detection of new variants circulating in the country.

Evaluation of rapid antiretroviral initiation strategy in a cohort of newly diagnosed people living with HIV in Panama, 2018-2019.

Antiretroviral therapy (ART) has been adopted as a form of HIV treatment and prevention. This study assesses rapid ART initiation using clinical outcomes such as viral load (VL) and CD4+ T lymphocytes count. Over the course of one year, the progress of newly diagnosed people living with HIV who started ART early in a hospital in Panama City was followed. The evaluation of early initiation of ART in achieving viral suppression (VL <200 copies/ml) was analyzed using descriptive statistics. Additionally, the cost difference between early (first 7 days) and late initiation of ART was evaluated from the perspective of the service provider. In total, 209 people were followed up during the study; 85% were male, 70% started ART on same day from hospital arrival, 80% had suppressed viral load at 6 months, and the median count of CD4 increased from 285 (IQR: 166-429) to 509 (IQR: 373-696) over 12 months. Starting ART early led to a 42% increase for the provider in terms of staffing costs; however, the clients had the opportunity to decrease absenteeism in daily activities. The results reveal that early initiation of ART generates clinical and economic benefits for the person in treatment.

Dispersion patterns of SARS-CoV-2 variants Gamma, Lambda and Mu in Latin America and the Caribbean.

Latin America and Caribbean (LAC) regions were an important epicenter of the COVID-19 pandemic and SARS-CoV-2 evolution. Through the COVID-19 Genomic Surveillance Regional Network (COVIGEN), LAC countries produced an important number of genomic sequencing data that made possible an enhanced SARS-CoV-2 genomic surveillance capacity in the Americas, paving the way for characterization of emerging variants and helping to guide the public health response. In this study we analyzed approximately 300,000 SARS-CoV-2 sequences generated between February 2020 and March 2022 by multiple genomic surveillance efforts in LAC and reconstructed the diffusion patterns of the main variants of concern (VOCs) and of interest (VOIs) possibly originated in the Region. Our phylogenetic analysis revealed that the spread of variants Gamma, Lambda and Mu reflects human mobility patterns due to variations of international air passenger transportation and gradual lifting of social distance measures previously implemented in countries. Our results highlight the potential of genetic data to reconstruct viral spread and unveil preferential routes of viral migrations that are shaped by human mobility patterns.

HIV-1 Low-Frequency Variants Identified in Antiretroviral-Naïve Subjects with Virologic Failure after 12 Months of Follow-Up in Panama.

Low-frequency mutations associated with drug resistance have been related to virologic failure in subjects with no history of pre-treatment and recent HIV diagnosis. In total, 78 antiretroviral treatment (ART)-naïve subjects with a recent HIV diagnosis were selected and followed by CD4+ T lymphocytes and viral load tests to detect virologic failure. We sequenced the basal samples retrospectively using next-generation sequencing (NGS), looking for low-frequency mutations that had not been detected before using the Sanger sequencing method (SSM) and describing the response to ART. Twenty-two subjects developed virologic failure (VF), and thirteen of them had at least one drug-resistance mutation associated with Reverse Transcriptase Inhibitors (RTI) and Protease Inhibitors (PIs) at frequency levels ≤ 1%, not detected previously in their basal genotyping test. No resistance mutations were observed to Integrase Strand Transfer Inhibitors (INSTIs). We identified a possible cause of VF in ART-naïve subjects with low-frequency mutations detected. To our knowledge, this is the first evaluation of pre-existing drug resistance for HIV-1 minority variants carried out on ART-naïve people living with HIV/AIDS (PLWHA) by analyzing the HIV-1 pol gene using NGS in the country.

Three new Glossoscolex (Annelida: Crassiclitellata: Glossoscolecidae) in the truncatus group from the Brazilian Atlantic Forest.

Three new earthworm species of Glossoscolex (Glossoscolex) in the truncatus species group (intra-clitellar male pores on segment 17) are described: Glossoscolex araucariaensis sp. nov., Glossoscolex cardosoi sp. nov., and Glossoscolex santarosaensis sp. nov. from the Brazilian Atlantic Forest. The three earthworm species were distinguished based on the shape and position of the copulatory pouches (all species), the shape of the calciferous glands (G. santarosaensis) and by the presence of tubercula pubertatis and seminal vesicles restricted to segment 12 (G. cardosoi). All are endogeic, unpigmented and were found in low abundances in the topsoil (0-20 cm depth) of Araucaria forest and plantations, a lowland grass pasture and a shrubby grassland, respectively, and are known only from their type-localities. A table containing some of the main internal and external morphological characteristics of the 29 species/subspecies of the Glossoscolex truncatus group is provided in order to assist comparisons within species. Glossoscolex grandis ibirai Righi, 1971 is raised to species rank due to longer extent of clitellum and presence of genital markings, compared to Glossoscolex grandis (Michaelsen, 1892); furthermore, a new subgroup (matogrossensis) of Glossoscolex (Glossoscolex) is proposed to accomodate G. matogrossensis Righi, 1984, with intraclitellar male pores in 15/16. Some considerations on the ecological and taxonomic affinities within the truncatus group are presented, but further studies, particularly genetic are needed in order to better assess phylogenetic relationships within Glossoscolex (Glossoscolex) species groups.

Complete Genome Sequence of Enterobacter Phage vB_EcRAM-01, a New Pseudotevenvirus against the Enterobacter cloacae Complex.

Here, we present the complete genome sequence of Enterobacter phage vB_EcRAM-01, isolated from waters of the Río Abajo river, in Panama City, Panama. This phage has deployed lytic activity against the Enterobacter cloacae complex, a pathogen of clinical importance in intensive care units. It belongs to the Myoviridae family and has a double-stranded DNA genome that is 178,477 bp long and contains 293 open reading frames (ORFs).

Reestenosis de stents liberadores de paclitaxel frente a stents convencionales

RESUMEN Introducción: La reestenosis de los stents liberadores de paclitaxel utilizados en Cuba no ha sido estudiada. Objetivo: Evaluar la reestenosis de los stents liberadores de paclitaxel y los convencionales. Métodos: Se incluyeron 64 pacientes con reestenosis de stent, de un estudio prospectivo previo; en 318 pacientes seguidos por 3 años luego de intervención coronaria percutánea; 25 con stent liberador de paclitaxel y 39 stent metálico convencional. Se consideró reestenosis como nueva lesión ≥ 50 % de la luz del vaso con isquemia demostrada. Se describió el tiempo de aparición, patrón angiográfico y alternativa de revascularización. Resultados: La reestenosis en el grupo de stents liberadores de paclitaxel fue 15,7 % con tiempo medio de supervivencia sin reestenosis de 32,4 meses vs. 24,5 % en stents convencionales, con supervivencia sin reestenosis de 29,8 meses, (p= 0,047). En el grupo de stents liberadores de paclitaxel predominó el patrón IB, (30,3 %) y stent convencional el III (28,3 %). En el 28,0 % del grupo de stents liberadores de paclitaxel, se recurrió a la cirugía de revascularización vs. 5,1 % en el grupo de stent convencional. Conclusiones: El stent liberador de paclitaxel logra una supervivencia libre de reestenosis superior y más perdurable que el stent convencional. La reestenosis en los de stents liberadores de paclitaxel es focal, con mayor frecuencia de nueva revascularización por cirugía y en los stents convencionales es mayormente difusa.

ABSTRACT Introduction: The restenosis of the paclitaxel-eluting stents used in Cuba has not been studied. Objective: To evaluate the restenosis of paclitaxel-eluting stents and conventional stents. Methods: 64 patients with stent restenosis were included, from a previous prospective study; in 318 patients followed up for 3 years after percutaneous coronary intervention; 25 with a paclitaxel-eluting stent and 39 conventional metal stent. Restenosis was considered as a new lesion ≥ 50 % of the vessel lumen with proven ischemia. The time to onset, angiographic pattern and alternative revascularization were described. Results: Restenosis in the group with paclitaxel-eluting stents was 15.7 % with a mean survival time without restenosis of 32.4 months vs. 24.5 % in conventional stents, with restenosis-free survival of 29.8 months, (p = 0.047). In the group with paclitaxel-eluting stents, the IB pattern predominated (30.3 %) and the conventional stent III (28.3 %). In 28.0 % of the paclitaxel-eluting stent group, revascularization surgery was used vs. 5.1 % in the conventional stent group. Conclusions: The paclitaxel-eluting stent achieves a superior and more durable restenosis-free survival than the conventional stent. Restenosis in paclitaxel-eluting stents is focal, with a higher frequency of revascularization by surgery, and in conventional stents it is mostly diffuse.

Incidence and risk factors for acute kidney injury associated to surgery for congenital heart disease / Incidencia y factores de riesgo de falla renal aguda asociados a la corrección quirúrgica de cardiopatías congénitas

Abstract Background: Acute kidney injury (AKI) occurs frequently after cardiac surgery for congenital heart disease and it has a great impact on patient´s prognosis. Objective: The aims of this study were to determine the incidence and risk factors for AKI in children undergoing cardiac surgery and its impact on mortality, duration of mechanical ventilation, ICU and total hospital length of stay. Methods: This was a historical cohort study of children 0 - 18 years of age who underwent cardiac surgery between 2012 and 2014. We used the Risk Adjustment for Congenital Heart Surgery-1 (RACHS) scale to evaluate risk of the surgery. AKI was defined in accordance to the Acute Kidney Injury Network (AKIN) criteria. Results: A total of 485 patients were included. AKI occurred in 89 (18.3%) patients during the study period. Risk factors for AKI were age < 2 years, cardiopulmonary bypass (CPB) time > 120 min and RACHS score > 3. AKI increased the mortality risk (OR: 5.82, 95% CI: 2.24-15.10) and the time in mechanical ventilation and ICU stay from 1 to 5 days and 6 to 12 days, respectively. Conclusions: Risk factors for AKI are younger age, higher RACHS score, and time of CPB greater than 120 minutes. AKI increases mortality, days on MV and ICU stay. In the present study AKIN scale allowed us to classify the severity of AKI and it correlated with prognosis after cardiac surgery.

Resumen Introducción: La insuficiencia renal aguda (IRA) ocurre frecuentemente después de las cirugías de cardiopatías congénitas e impacta el pronóstico del paciente. Objetivo: Determinar incidencia y factores de riesgo para IRA en niños sometidos a cirugía de cardiopatía congénita y su impacto en mortalidad, duración de ventilación mecánica, tiempo de hospitalización total y en Cuidados Intensivos (UCI). Métodos: Cohorte histórica de niños entre cero y 18 años sometidos a cirugía cardiaca entre 2012 y 2014. El riesgo de la cirugía fue calculado mediante la escala Risk Adjustment for Congenital Heart Surgery-1 (RACHS). La falla renal fue establecida de acuerdo a la escala de Acute Kidney Injury Network (AKIN). Resultados: Se incluyeron 485 pacientes. 89 pacientes (18.3%) desarrollaron IRA durante el postquirúrgico. Los factores de riesgo para IRA fueron edad < 2 años, tiempo de bypass cardiopulmonar > 120 minutos y escala de RACHS > 3. La ocurrencia de IRA aumento el tiempo de ventilación mecánica de 1 a 5 días, la estancia en UCI de 6 a 12 días y el riesgo de mortalidad (OR: 5.82, 95% IC: 2.24-15.10). Conclusiones: Los factores de riesgo para IRA fueron menor edad, mayor escala de RACHS y de tiempo de bypass. La ocurrencia de IRA aumentó la mortalidad, días en ventilación mecánica y estancia en UCI. En el presente estudio la escala de AKIN permitió clasificar la severidad de AKI y se correlaciono con el pronóstico después de cirugía de cardiopatía congénita.

Case Report: First Confirmed Case of Coinfection of SARS-CoV-2 With Choclo orthohantavirus.

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a major international public health concern. The World Health Organization (WHO) declared the pandemic of coronavirus disease 2019 (COVID-19) on March 11, 2020. In Panama, the first SARS-CoV-2 infection was confirmed on March 9, 2020, and the first fatal case associated to COVID-19 was reported on March 10. This report presents the case of a 44-year-old female who arrived at the hospital with a respiratory failure, five days after the first fatal COVID-19 case, and who was living in a region where hantavirus pulmonary syndrome cases caused by Choclo orthohantavirus (CHOV), are prevalent. Thus, the clinical personnel set a differential diagnosis to determine a respiratory disease caused by the endemic CHOV or the new pandemic SARS-CoV-2. This case investigation describes the first coinfection by SARS-CoV-2 and CHOV worldwide. PCR detected both viruses during early stages of the disease and the genomic sequences were obtained. The presence of antibodies was determined during the patient's hospitalization. After 23 days at the intensive care unit, the patient survived with no sequelae, and antibodies against CHOV and SARS-CoV-2 were still detectable 12 months after the disease. The detection of the coinfection in this patient highlights the importance, during a pandemic, of complementing the testing and diagnosis of the emergent agent, SARS-CoV-2, with other common endemic respiratory pathogens and other zoonotic pathogens, like CHOV, in regions where they are of public health concern.

SARS-CoV-2 reinfection with a virus harboring mutation in the Spike and the Nucleocapsid proteins in Panama.

We report a case of reinfection by SARS-CoV-2 with the second virus harboring amino acid changes in the Spike protein (141-143del, D215A, ins215AGY, L452R, D614G), orf1a, helicase, orf3a, and Nucleocapside. The virus associated with the reinfection, from an endemic lineage containing the S:L452R immune escape mutation, was circulating in Panama at the time.

Field and classroom initiatives for portable sequence-based monitoring of dengue virus in Brazil.

Brazil experienced a large dengue virus (DENV) epidemic in 2019, highlighting a continuous struggle with effective control and public health preparedness. Using Oxford Nanopore sequencing, we led field and classroom initiatives for the monitoring of DENV in Brazil, generating 227 novel genome sequences of DENV1-2 from 85 municipalities (2015-2019). This equated to an over 50% increase in the number of DENV genomes from Brazil available in public databases. Using both phylogenetic and epidemiological models we retrospectively reconstructed the recent transmission history of DENV1-2. Phylogenetic analysis revealed complex patterns of transmission, with both lineage co-circulation and replacement. We identified two lineages within the DENV2 BR-4 clade, for which we estimated the effective reproduction number and pattern of seasonality. Overall, the surveillance outputs and training initiative described here serve as a proof-of-concept for the utility of real-time portable sequencing for research and local capacity building in the genomic surveillance of emerging viruses.

Diversity of Rickettsia in ticks collected from wild animals in Panama.

This paper presents new data about Rickettsia species detected in ticks collected from wild animals, using 16S rRNA, gltA and ompA. Rickettsia DNA was found in 66 of 101 ticks. Using EZ BioCloud libraries were produced reads that identified Rickettsia aeschlimannii, and Illumina BaseSpace produced reads of Rickettsia rickettsii group, Rickettsia bellii group, and unclassified Rickettsia. Using gltA and ompA gene-specific primers, R. aeschlimannii could not be confirmed, but detection of Rickettsia amblyommatis was achieved in Amblyomma auricularium, Amblyomma geayi, Amblyomma mixtum, and Amblyomma pacae; R. bellii from Amblyomma dissimile, "Candidatus Rickettsia colombianensi" from A. dissimile, Rickettsia spp. closely related to R. raoultii from A. geayi, Rickettsia tamurae from A. dissimile, and Rickettsia endosymbionts of Ixodes from Ixodes affinis. There were no databases available specifically for 16S rRNA of Neotropical Rickettsia, highlighting the need to use species primers over only 16S rRNA primers to achieve more accurate interpretations and identifications. These findings increase the number of Rickettsia species detected in Panama and highlight the need to establish isolates to further characterize the nature of Rickettsia in the area.

Early Transmission Dynamics, Spread, and Genomic Characterization of SARS-CoV-2 in Panama.

We report an epidemiologic analysis of 4,210 cases of infection with severe acute respiratory syndrome coronavirus 2 and genetic analysis of 313 new near-complete virus genomes in Panama during March 9-April 16, 2020. Although containment measures reduced R0 and Rt, they did not interrupt virus spread in the country.

Prevalence and determinants of genital Chlamydia trachomatis among school-going, sexually experienced adolescents in urban and rural Indigenous regions of Panama.

OBJECTIVES: To determine the prevalence and risk factors of genital Chlamydia trachomatis (CT) among school-going sexually experienced male and female adolescents in Panama. METHODS: We conducted two multisite cross-sectional studies using two-stage cluster sampling to select adolescents aged 14-19 years attending urban public high schools (URB) in Panama City, San Miguelito, Colón and Panama Oeste from 2015 to 2018, and in the rural Indigenous Comarca Ngäbe-Buglé (CNB) from July-November 2018. CT testing was performed by real-time PCR on urine samples. Random-effects logistic regression accounting for sample clustering was used to identify risk factors. RESULTS: We enrolled 3166 participants (54.3% females), median age 17 years (IQR: 15.9-18.1), with no difference by sex. Sexual experience was reported by 1954 (61.7%) participants. Combined CT prevalence was 15.8% (95% CI: 14.2 to 17.4), with no significant differences by region (URB=16.5%, 95% CI: 14.7% to 18.6%; CNB=13.6%, 95% CI: 10.9% to 16.8%; p=0.12). In an age-and-region-adjusted analysis, CT prevalence was higher among female participants compared with males (21.6% vs 9.1%, adjusted OR (AOR)=2.87, 95% CI: 1.62 to 5.10). Among sexually experienced females, CT prevalence was higher among those who reported ≥3 lifetime sex partners compared with one partner (33.5% vs 15.3%, AOR=2.20, 95% CI: 1.09 to 4.07); and among those reporting at least one pregnancy compared with nulligravidae participants (30.9% vs 13.8%, AOR=1.89, 95% CI: 1.05 to 3.43). In unadjusted analyses among males, CT was associated with older age (11.5% among those aged 18-19 years vs 3.4% among those aged 14-15 years, OR=3.69, 95% CI: 1.10 to 12.33). CONCLUSIONS: We report high CT prevalence among sexually experienced, school-going adolescents in Panama. Female adolescents, particularly those with multiple sex partners and a history of pregnancy, were at highest risk. Adolescent-targeted CT screening should be implemented in Panama. Additionally, evidence-based comprehensive sexuality education will be imperative.

Evaluación del método clínico en el diagnóstico de la cefalea oftalmológica en niños / Evaluation of the clinical method in the diagnosis of ophthalmic headache in children

Introducción: la cefalea constituye uno de los motivos de consulta más comunes por el cual las personas acuden a los servicios médicos, es una causa importante de discapacidad, que trae consigo consecuencias a nivel personal. Objetivo: evaluar la utilización del método clínico, en el diagnóstico de la cefalea de causa oftalmológica en la edad pediátrica. Método: se realizó un estudio observacional, descriptivo de corte transversal, a 192 pacientes que asistieron a los servicios de Urgencias de Oftalmología, en el Hospital Pediátrico Hermanos Cordové, en el período comprendido entre enero y diciembre del 2019. Se estudiaron las variables: edad y sexo, enseñanza escolar, antecedentes patológicos personales, características de la cefalea y diagnóstico presuntivo. Resultados: predominó los pacientes entre 6 y 7 años de edad del sexo femenino, cursando la enseñanza primaria, sin antecedentes patológicos personales, con una cefalea de inicio subagudo, episódica, que afecta las actividades cotidianas, que aparece en cualquier momento del día, acompañada principalmente de alteraciones visuales y náuseas y vómitos, predominando como diagnóstico presuntivo la cefalea migrañosa. Conclusiones: se demostró que el mayor por ciento de los pacientes que acudieron por cefalea a los servicios de urgencias de oftalmología, esta, no estaba relacionada a trastornos oftalmológicos(AU)

Introduction: headache is one of the most common reasons for consultation for which people go to medical services, it is an important cause of disability, which brings with it consequences on a personal level. Objective: to evaluate the use of the clinical method in the diagnosis of headache of ophthalmic cause in pediatric age. Method: an observational, descriptive, cross-sectional study was carried out of 192 patients who attended the Ophthalmology Emergency Services at the Hermanos Cordové Pediatric Hospital, in the period between January and December 2019. The variables were studied: age and sex, school education, personal pathological history, headache characteristics and presumptive diagnosis. Results: there was a predominance of female patients between 6 and 7 years of age, attending primary school, without personal pathological history, with a headache of subacute onset, episodic, which affects daily activities, which appears at any time of the day, accompanied mainly of visual disturbances and nausea and vomiting, prevailing as a presumptive diagnosis migraine headache. Conclusions: It was shown that the highest percentage of patients who attended the ophthalmology emergency department for headache, this was not related to ophthalmological disorders(EU)

Evaluación del método clínico en el diagnóstico de la cefalea oftalmológica en niños / Evaluation of the clinical method in the diagnosis of ophthalmic headache in children / Avaliação do método clínico no diagnóstico de cefaléia oftálmica em crianças

RESUMEN Introducción: la cefalea constituye uno de los motivos de consulta más comunes por el cual las personas acuden a los servicios médicos, es una causa importante de discapacidad, que trae consigo consecuencias a nivel personal. Objetivo: evaluar la utilización del método clínico, en el diagnóstico de la cefalea de causa oftalmológica en la edad pediátrica. Método: se realizó un estudio observacional, descriptivo de corte transversal, a 192 pacientes que asistieron a los servicios de Urgencias de Oftalmología, en el Hospital Pediátrico Hermanos Cordové, en el período comprendido entre enero y diciembre del 2019. Se estudiaron las variables: edad y sexo, enseñanza escolar, antecedentes patológicos personales, características de la cefalea y diagnóstico presuntivo. Resultados: predominó los pacientes entre 6 y 7 años de edad del sexo femenino, cursando la enseñanza primaria, sin antecedentes patológicos personales, con una cefalea de inicio subagudo, episódica, que afecta las actividades cotidianas, que aparece en cualquier momento del día, acompañada principalmente de alteraciones visuales y náuseas y vómitos, predominando como diagnóstico presuntivo la cefalea migrañosa. Conclusiones: se demostró que el mayor por ciento de los pacientes que acudieron por cefalea a los servicios de urgencias de oftalmología, esta, no estaba relacionada a trastornos oftalmológicos.

ABSTRACT Introduction: headache is one of the most common reasons for consultation for which people go to medical services, it is an important cause of disability, which brings with it consequences on a personal level. Objective: to evaluate the use of the clinical method in the diagnosis of headache of ophthalmic cause in pediatric age. Method: an observational, descriptive, cross-sectional study was carried out of 192 patients who attended the Ophthalmology Emergency Services at the Hermanos Cordové Pediatric Hospital, in the period between January and December 2019. The variables were studied: age and sex, school education, personal pathological history, headache characteristics and presumptive diagnosis. Results: there was a predominance of female patients between 6 and 7 years of age, attending primary school, without personal pathological history, with a headache of subacute onset, episodic, which affects daily activities, which appears at any time of the day, accompanied mainly of visual disturbances and nausea and vomiting, prevailing as a presumptive diagnosis migraine headache. Conclusions: It was shown that the highest percentage of patients who attended the ophthalmology emergency department for headache, this was not related to ophthalmological disorders.

RESUMO Introdução: a dor de cabeça é um dos motivos mais comuns de consulta para as quais as pessoas vão aos serviços médicos; é uma importante causa de incapacidade, o que traz conseqüências em nível pessoal. Objetivo: avaliar o uso do método clínico no diagnóstico de cefaleia de causa oftalmológica em idade pediátrica. Método: estudo observacional, descritivo, transversal, com 192 pacientes atendidos no Serviço de Emergência em Oftalmologia do Hospital Pediátrico Hermanos Cordové, no período de janeiro a dezembro de 2019. As variáveis ​​estudadas foram: idade e sexo, educação escolar, história patológica pessoal, características da dor de cabeça e diagnóstico presuntivo. Resultados: houve predomínio de pacientes do sexo feminino entre 6 e 7 anos de idade, frequentadoras do ensino fundamental, sem histórico patológico pessoal, com cefaléia de início subagudo, episódica, que afeta as atividades diárias, que aparecem a qualquer hora do dia, acompanhadas principalmente de distúrbios visuais e náuseas e vômitos, prevalecendo como diagnóstico presuntivo de enxaqueca. Conclusões: Foi demonstrado que o maior percentual de pacientes que compareceu ao pronto-socorro oftalmológico por cefaleia não estava relacionado a distúrbios oftalmológicos.

Evolution of late presentation to care and advanced HIV in newly HIV diagnosed subjects in the Republic of Panama: 2012-2017.

Most of the information on clinical factors related to HIV infection is focused on key populations and young people. Therefore, there is little information on clinical factors related to HIV infection in older persons (>45 years old). In this study, data on CD4 lymphocyte counts were analyzed on adults who are linked to care and have their first CD4 cell count done from different regions of the Republic of Panama from 2012 to 2017. Samples were grouped according to late presentation status, region of origin in the country, year, gender, and age groups. Factors associated with late presentation to care and advanced HIV were assessed on each group by multivariable logistic regression. Late presentation to care was observed in 71.6% of the evaluated subjects, and advanced HIV in 54.5%. Late presentation was associated with males (adjusted odds ratio [AOR] = 1.3, 95% confidence interval [CI]=1.1-1.6, p = 0.03), age greater than 45 years old (AOR = 2.3 CI= 1.8-2.9, p < 0.001), and being from regions where antiretroviral clinics are not well instituted (AOR = 2.1, CI = 1.6-2.7, p < 0.001). Despite an increase in subjects linked to care with a CD4 test performed over the years, late presentation remained constant. Therefore, prevention policies must be reformulated. Promotion of routine HIV testing, accessibility among all population groups, installation of antiretroviral clinics, and implementation of programs as rapid initiation of antiretroviral therapy should be rolled out nationally.

High Prevalence of Sexually Transmitted Infections, and High-Risk Sexual Behaviors Among Indigenous Adolescents of the Comarca Ngäbe-Buglé, Panama.

BACKGROUND: There is scant information on sexually transmitted infection (STI) prevalence and risk factors among Latin American indigenous populations. We investigated STI prevalence and risk factors among adolescents of the Comarca Ngäbe-Buglé indigenous region of Panama. METHODS: A population-based cross-sectional study was conducted among school-going adolescents aged 14 to 19 years. Eligible consenting participants self-completed a questionnaire and provided blood and urine samples. Female participants provided additional self-administered genital swabs. Seroprevalences of human immunodeficiency virus (HIV), syphilis, hepatitis B (HBsAg, anti-HBc), and herpes simplex virus type 2 (HSV-2) were determined in all participants; genital Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) by PCR among participants who reported sexual experience or were seropositive for HIV/syphilis/HSV2/HBsAg; high-risk human papillomavirus (HPV) by qualitative DNA assay and bacterial vaginosis (BV) by Gram-stain among female participants. Risk factors were identified by estimating adjusted odds ratios (AOR) using random-effects logistic regression. RESULTS: We enrolled 700 participants (median age, 17 years [female participants]; 18 years [male participants]) from 20 schools. Sexual experience was reported by 536 participants (76.6%). The HIV/STI prevalences among females and males were: HIV 0.4% and 1.0%, high-titer active syphilis 1.3% and 6.6%, HSV-2 16.1% and 16.1%, HBsAg 1.3% and 1.4%, anti-HBc 3.2% and 1.4%, NG 1.8% and 1.7%, CT 17.5% and 10.7%; among females: BV 42.9% and HPV 33.2%. CT was independently associated with being female (AOR, 2.02; 95% confidence interval [CI], 1.20-3.41); high-titer active syphilis with being male (AOR, 4.51; 95% CI, 1.17-17.40). Bacterial vaginosis was associated with sexual behavior (≥3 lifetime sex partners: AOR, 3.81; 95% CI, 1.29-11.26), HPV with sexual experience (AOR, 4.05; 95% CI, 1.62-10.09). CONCLUSIONS: School-going indigenous adolescents in rural Panama have substantial STI burden. Targeted STI screening is required.

International prospective observational cohort study of Zika in infants and pregnancy (ZIP study): study protocol.

BACKGROUND: Until recently, Zika virus (ZIKV) infections were considered mild and self-limiting. Since 2015, they have been associated with an increase in microcephaly and other birth defects in newborns. While this association has been observed in case reports and epidemiological studies, the nature and extent of the relationship between ZIKV and adverse pregnancy and pediatric health outcomes is not well understood. With the unique opportunity to prospectively explore the full spectrum of issues related to ZIKV exposure during pregnancy, we undertook a multi-country, prospective cohort study to evaluate the association between ZIKV and pregnancy, neonatal, and infant outcomes. METHODS: At research sites in ZIKV endemic regions of Brazil (4 sites), Colombia, Guatemala, Nicaragua, Puerto Rico (2 sites), and Peru, up to 10,000 pregnant women will be recruited and consented in the first and early second trimesters of pregnancy and then followed through delivery up to 6 weeks post-partum; their infants will be followed until at least 1 year of age. Pregnant women with symptomatic ZIKV infection confirmed by presence of ZIKV RNA and/or IgM for ZIKV will also be enrolled, regardless of gestational age. Participants will be tested monthly for ZIKV infection; additional demographic, physical, laboratory and environmental data will be collected to assess the potential interaction of these variables with ZIKV infection. Delivery outcomes and detailed infant assessments, including physical and neurological outcomes, will be obtained. DISCUSSION: With the emergence of ZIKV in the Americas and its association with adverse pregnancy outcomes in this region, a much better understanding of the spectrum of clinical outcomes associated with exposure to ZIKV during pregnancy is needed. This cohort study will provide information about maternal, fetal, and infant outcomes related to ZIKV infection, including congenital ZIKV syndrome, and manifestations that are not detectable at birth but may appear during the first year of life. In addition, the flexibility of the study design has provided an opportunity to modify study parameters in real time to provide rigorous research data to answer the most critical questions about the impact of congenital ZIKV exposure. TRIAL REGISTRATION: NCT02856984 . Registered August 5, 2016. Retrospectively registered.

Artritis reumatoide temprana: resultados clínicos y funcionales de una cohorte en un centro de alta complejidad, Cali-Colombia / Early rheumatoid arthritis: Clinical and functional outcomes of a cohort treated in a high complexity hospital, Cali-Colombia

La artritis reumatoide (AR) es una enfermedad crónica, inflamatoria, autoinmune y multisistémica, cuyo principal blanco es la membrana sinovial. El manejo adecuado y temprano mejora la evolución y pronóstico de la enfermedad. Objetivo: Evaluar los resultados clínicos y funcionales en pacientes con AR temprana. Metodología: Estudio observacional, con seguimiento longitudinal, de una cohorte de pacientes con AR temprana de menos de 12 meses de evolución, clasificados según los criterios de la Liga Europea Contra el Reumatismo y del Colegio Americano de Reumatología (ACR 2010). Se tuvieron en cuenta los criterios de remisión según la Escala de Actividad de la Enfermedad (DAS28-VSG) y el índice de actividad clínica de la enfermedad. Estado funcional según Cuestionario modificado de Evaluación de la Salud. Resultados: Se analizaron 99 pacientes. La edad promedio de los pacientes fue de 47,8 ± 15,5 años, el 93%(92) eran mujeres. Todos los pacientes fueron tratados con fármacos antirreumáticos modificadores de la enfermedad sintéticos. Durante el seguimiento a los 3 meses se observó una disminución significativa en los puntajes del DAS28y actividad clínica de la enfermedad respecto al valor en la visita basal (p <0,05). No se encontraron diferencias significativas en la evolución de pacientes diagnosticados antes y después de 3 meses desde el inicio de los síntomas (p>0,05). Conclusiones: Se evidencia mejoría sustancial de los pacientes con AR temprana tratados durante el primer año de inicio de los síntomas. El seguimiento continuo y periódico de la patología es una herramienta indispensable para evaluar el progreso de la enfermedad y hacer ajustes en el manejo terapéutico

Rheumatoid arthritis (RA) is a chronic, inflammatory, autoimmune multisystemic disease that affects the synovial joints. An appropriate and early management improves prognosis and course of the disease. Objective: To evaluate the clinical and functional outcomes of patients with RA. Methodology: Observational study with longitudinal follow up in a cohort of patients with early RA, with less than 12 months of evolution, classified according to the European League Against Rheumatism and American College of Rheumatology (ACR 2010) criteria. Remission criteria were taking into account according to Disease Activity Scale (DAS28-VSG), clinical activity disease index, and functional status according to Modified Health Assessment Questionnaire. Results: The analysis included 99 patients with a mean age of 47.8 + 15.5 years, and of which 92 (93%) were women. All patients were treated with synthetic disease-modifying antirheumatic drugs. At 3 months of follow-up, a significant decrease was observed in DAS28 scores and clinical activity disease index compared to the value at baseline values (p<.05). No significant differences were found between patients diagnosed before and after 3 months from onset of symptoms (p>.05). Conclusions: A substantial improvement was observed in patients with early RA treated during first year from onset symptoms. Continuous and periodic monitoring of the pathology is an indispensable tool for evaluating disease progress and making adjustments in the therapeutic management