Large Outbreak of Guillain-Barré Syndrome, Peru, 2019.

Outbreaks of Guillain-Barré syndrome (GBS) are uncommon. In May 2019, national surveillance in Peru detected an increase in GBS cases in excess of the expected incidence of 1.2 cases/100,000 population. Several clinical and epidemiologic findings call into question the suggested association between this GBS outbreak and Campylobacter.

Hiperplasia epitelial focal / Focal epithelial hyperplasia

La hiperplasia epitelial focal (HEF) o enfermedad de Heck es una patolog¡a poco frecuente de la mucosa oral, caracterizada por una proliferaci¢n benigna del epitelio debida a la infecci¢n por el papilomavirus humano (PVH) tipos 13 y 32. El nombre enfermedad de Heck deriva del nombre del m‚dico que evalu¢ al primer paciente, en M‚xico, en 1961. Sin embargo, una revisi¢n de la literatura latinoamericana revela publicaciones previas realizadas por Estrada, en 1956, quien observ¢ esta entidad en indios colombianos. Algunos a¤os despu‚s, Soneira y Fonseca realizaron la primera descripci¢n completa de la enfermedad, y se¤alaron sus caracter¡sticas cl¡nicas e histol¢gicas y, adem s, sugirieron el posible origen viral. Finalmente, en 1965, Archard y col. la denominaron HEF, aunque en la actualidad se sugiere utilizar el nombre de hiperplasia multifocal del epitelio, que describe mejor las caracter¡sticas cl¡nicas y microsc¢picas de la enfermedad. La HEF, aunque.

The focal epithelial hyperplasia (HEF) or Heck's disease is a rare disease of the oral mucosa, characterized by benign epithelial proliferation due to infection with human papillomavirus (HPV) ttypes 13 and 32. The disease name derives Heck the name of the doctor who evaluated the first patient in Mexico in 1961. However, a review of Latin American literature reveals previous publications by Estrada, in 1956, who observed this entity in Colombian Indians. Some years later, Soneira and Fonseca made the first complete description of the disease, noting their clinical and histological features and also suggested the possible viral origin. Finally in 1965, Archard et al. HEF called it, although at present it is suggested to use the name multifocal epithelial hyperplasia, which best describes the clinical and microscopic features of the disease. The HEF is presented with a clear predominance of Americans, Eskimos and Indians some communities in South Africa, although isolated cases in other ethnic groups. In South America it is more common in the Amazon basin of Peru, Venezuela, Colombia, Bolivia, Brazil and Paraguay.

Falla terapéutica y hepatotoxicidad de los esquemas de tratamiento endovenoso e intramuscular con estibogluconato de sodio en pacientes con leishmaniasis cutánea / Therapeutic failure and hepatotoxicity with schemes intravenous and intramuscular sodium stibogluconate treatment in patients with cutaneous leishmaniasis

OBJETIVO. Describir la falla terapéutica y hepatotoxicidad de los esquemas de tratamiento endovenoso e intramuscular con estibogluconato de sodio en pacientes con leishmaniasis cutánea. MATERIAL y MÉTODOS. Estudio de cohorte única retrospectivo. Los pacientes fueron tratados con estibogluconato de sodio con el esquema endovenoso continuo por 20 días en una sola dosis, los que presentaron falla terapéutica recibieron un segundo curso de estibogluconato de sodio con el esquema intramuscular dosis dividido en series de la días de tratamiento con intervalos de 7 días de descanso por 3 series. Se revisó las historias clínicas y se evaluó en ambos grupos la falla terapéutica y hepatotoxicidad. RESULTADOS. Cumplieron los criterios de inclusión/exclusión 64 pacientes, todos varones. Leishmania braziliensis fue la especie de leishmania infectante en 96,4 % de casos. La cura fue de 48,4 % en el esquema endovenoso, L. braziliensis fue la única especie identificada en los pacientes con falla terapéutica. La hepatotoxicidad fue de 28,1 % en el esquema endovenoso y 6,3 % en el esquema intramuscular. El grupo de pacientes que falló con el esquema endovenoso y repitió el tratamiento pero con el esquema intramuscular (32 pacientes) tuvo un porcentaje de cura de 100 %; solo 2 pacientes (6,3 %) que recibieron el esquema intramuscular desarrollaron hepatotoxicidad durante el tratamiento. CONCLUSIONES. Existe una alta frecuencia de falla terapéutica y hepatotoxicidad en pacientes con Leishmaniasis cutánea tratados con estibogluconato de sodio con el uso del esquema endovenoso. Los pacientes tratados con el esquema intramuscular no presentan falla terapéutica y tienen una baja frecuencia de hepatotoxicidad.

OBJECTIVE. Describe the therapeutic failure and hepatotoxicity schemes intravenous and intramuscular sodium stibogluconate treatment in patients with cutaneous leishmaniasis (CL). MATERIAL AND METHODS. Retrospective single cohort study. Patients were treated with sodium stibogluconate with continuous intravenous scheme for 20 days in a single dose; those with therapeutic failure received a second course of sodium stibogluconate with intramuscular scheme doses divided into sets of 10 days of treatment with intervals 7 days off per 3 series. The medical records were reviewed and evaluated in both groups treatment failure and hepatotoxicity. RESULTS. They met the inclusion/exclusion of 64 patients, all males. The specie of leishmania was present in 96,4 % of cases was the Leishmania braziliensis. Curing was 48,4 % for the intravenous scheme, L. braziliensis was the only species identified in patients with therapeutic failure. Hepatotoxicity was 28,1% in the scheme intravenous and intramuscular 6,3 % in the scheme. The group of patients who failed with the scheme and repeated intravenous treatment but with the intramuscular scheme (32 patients) had a cure rate of 100 %; only 2 patients (6,3 %) who received intramuscular scheme developed hepatotoxicity during treatment. CONCLUSIONS. There is a high rate of treatment failure and hepatotoxicity in patients treated with CL with sodium stibogluconate intravenous use scheme. Patients treated with intramuscular scheme have no therapeutic failure and have a low frequency of hepatotoxicity.

Brain-derived neurotrophic factor in the nucleus tractus solitarii modulates glucose homeostasis after carotid chemoreceptor stimulation in rats.

Neuronal systems, which regulate energy intake, energy expenditure and endogenous glucose production, sense and respond to input from hormonal related signals that convey information from body energy availability. Carotid chemoreceptors (CChr) function as sensors for circulating glucose levels and contribute to glycemic counterregulatory responses. Brain-derived neurotrophic factor (BDNF) that plays an important role in the endocrine system to regulate glucose metabolism could play a role in hyperglycemic glucose reflex with brain glucose retention (BGR) evoked by anoxic CChr stimulation. Infusing BDNF into the nucleus tractus solitarii (NTS) before CChr stimulation, showed that this neurotrophin increased arterial glucose and BGR. In contrast, BDNF receptor (TrkB) antagonist (K252a) infusions in NTS resulted in a decrease in both glucose variables.

[Study on the resilience internal factors in a sample of Puerto Rican centenarians]. / Estudio sobre los factores internos de resiliencia en una muestra de centenarios Puertorriquenos.

UNLABELLED: Old age is a stage that is usually characterized by lost at the physiological, psychological and social level that generates much distress to individuals. However, the centenaries have been identified as an example of successful aging, within other factors, because they have adequate managed skills that help them to deal with healthy normal losses. Resilience could be one of the factors that may help the Centennials to age successfully. It is necessary more studies with Puerto Rico Centennials since we lack such investigations. METHODOLOGY: This study has an expo facto design; in addition we evaluate psychometrically the Symptoms Check List 90-R (SCL-90-R). The scale of Internal Resilience Factors (EFIR), a semi structured interview and the SCL-90-R were used to identify factors associated with successful aging in the centennials. In addition we explore if there exist gender differences in internal factors of resilience within the sample. SAMPLE: 23 Centennials, 15 men and 8 women, of different parts of Puerto Rico (average age = 101. 5 years). RESULTS: Internal resilience factors associated with the aging process were identifying, those were: emotional stability, optimism, behavioral factor and behavioral and emotional skills component. These factors are consistent with the revised literature on positive emotions and adaptive ageing. On the other hand, no statistically significant difference was identified (p <. 05) for the internal factors of resilience on the basis of gender, a finding agreed with the revised literature. The multiple tests administered showed adequate internal consistency (EFIR: (=. 726); SCL-90-R: (=. 941). The Symptoms Check list 90-R (SCL-90-R) was valid with a Cronbach's alpha of. 941. CONCLUSIONS AND LIMITATIONS: We identified internal resilience factors that could be linked with successfully aging: those factors are encouraging the elderly population. In addition used tests showed adequate internal consistency. Limitations in relation to the size of the sample and the distribution of gender were identified, thus we suggest further research with larger samples.

Usefulness and applicability of the revised dengue case classification by disease: multi-centre study in 18 countries.

BACKGROUND: In view of the long term discussion on the appropriateness of the dengue classification into dengue fever (DF), dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS), the World Health Organization (WHO) has outlined in its new global dengue guidelines a revised classification into levels of severity: dengue fever with an intermediary group of "dengue fever with warning sings", and severe dengue. The objective of this paper was to compare the two classification systems regarding applicability in clinical practice and surveillance, as well as user-friendliness and acceptance by health staff. METHODS: A mix of quantitative (prospective and retrospective review of medical charts by expert reviewers, formal staff interviews), semi-quantitative (open questions in staff interviews) and qualitative methods (focus group discussions) were used in 18 countries. Quality control of data collected was undertaken by external monitors. RESULTS: The applicability of the DF/DHF/DSS classification was limited, even when strict DHF criteria were not applied (13.7% of dengue cases could not be classified using the DF/DHF/DSS classification by experienced reviewers, compared to only 1.6% with the revised classification). The fact that some severe dengue cases could not be classified in the DF/DHF/DSS system was of particular concern. Both acceptance and perceived user-friendliness of the revised system were high, particularly in relation to triage and case management. The applicability of the revised classification to retrospective data sets (of importance for dengue surveillance) was also favourable. However, the need for training, dissemination and further research on the warning signs was highlighted. CONCLUSIONS: The revised dengue classification has a high potential for facilitating dengue case management and surveillance.

Viscerotropic disease following yellow fever vaccination in Peru.

Five suspected cases of yellow fever vaccine-associated viscerotropic disease (YEL-AVD) clustered in space and time following a vaccination campaign in Ica, Peru in 2007. All five people received the same lot of 17DD live attenuated yellow fever vaccine before their illness; four of the five died of confirmed YEL-AVD. The surviving case was classified as probable YEL-AVD. Intensive investigation yielded no abnormalities of the implicated vaccine lot and no common risk factors. This is the first described space-time cluster of yellow fever viscerotropic disease involving more than two cases. Mass yellow fever vaccination should be avoided in areas that present extremely low risk of yellow fever.

Enzootic transmission of yellow fever virus in Peru.

The prevailing paradigm of yellow fever virus (YFV) ecology in South America is that of wandering epizootics. The virus is believed to move from place to place in epizootic waves involving monkeys and mosquitoes, rather than persistently circulating within particular locales. After a large outbreak of YFV illness in Peru in 1995, we used phylogenetic analyses of virus isolates to reexamine the hypothesis of virus movement. We sequenced a 670-nucleotide fragment of the prM/E gene region from 25 Peruvian YFV samples collected from 1977 to 1999, and delineated six clades representing the states (Departments) of Puno, Pasco, Junin, Ayacucho, San Martin/Huanuco, and Cusco. The concurrent appearance of at least four variants during the 1995 epidemic and the genetic stability of separate virus lineages over time indicate that Peruvian YFV is locally maintained and circulates continuously in discrete foci of enzootic transmission.

Inocencias mutiladas: la explotación sexual comercial como forma de violencia contra la niña y la adolescente en Panamá / Mutilated innocences: the commercial sexual exploitation as a way of violence against the girl and the adolescent in Panama

Presenta la problemática de la explotación sexual contra las niñas y adolescentes, una forma de violencia de género, las implicaciones jurídicas en Panamá

Arthropod-Borne viral Diseases in Peru

Arthropode-Borne viral diseases have been a significant cause of morbidity and mortality for several decades in Peru. Epidemics and epizootics of Venezuelan equine encephalitis (VEE), subtype IAB virus occurred among humans and equine at intermittent intervals from 1925 through 1973 along the Pacific coastal plains, extending southward from the most northern Departament of Tumbes to the Departament of Ica. While the VEE IAB virus has not been detected since 1973, several isolates of VEE ID and an isolate VEE IIIC were obtained during 1971 and 1975 from mosquitoes and/or sentinel hamster in Quistococha, northeastern Amazon region. In 1994, the first human cases, associated with VEE virus ID were diagnosed among Peruvian soldiers near Pantoja, northern Amazon region, and during 1995, primarily among students and military personnel in Iquitos, northastern Amazon region. As early as 1913 , a disease resembling yellow fever was recognized in the Amazon region Peru. Outbreaks of this disease have continued to occur, apparently at annual interval, with the most recent and the largest sylvan outbreak ever recorded in Peru being documented during 1995 along the eastern foothills of the Andes Mountains. In 1990, dengue (DEN) 1 and DEN4 were first isolated in Peru during an outbreak of DEN fever among residents of the city of Iquitos, northeastern Amazon basin region. Seroepidemiological and case surveillance studies conducted 1992 through 1995 documented that DEN 1 continued to cause cases of DEN fever in Iquitos, and in 1995, an outbreak was associated with the introduction of DEN 2 into the community. Outbreaks of DEN fever, associated with DEN 1 occurred during 1994 and 1995 in the northern coastal cities of Tumbes and Piura, and in Pucallpa, Amazon basin region. In 1995, the first isolations of DEN 2 were obtained from febriles cases in Tumbes, Piura and Pucallpa. Although 2 serotypes of DEN were associated with human infection, none of the cases presented with hemorragic manifestations. The first isolations of Oropouche (ORO) fever virus were obtained during 1992 from febrile patients in Iquitos. The virus was isolated during 1994 from febrile cases and serological results revealed that ORO was the cause of an outbreak in the southeastern Amazon region. A single isolate of ORO virus was obtained during 1995 from a febrile patient in Iquitos