Data-Mining Poultry Processing Bio-Mapping Counts of Pathogens and Indicator Organisms for Food Safety Management Decision Making.

Bio-mapping studies play an important role, as the data collected can be managed and analyzed in multiple ways to look at process trends, find explanations about the effect of process changes, activate a root cause analysis for events, and even compile performance data to demonstrate to inspection authorities or auditors the effect of certain decisions made on a daily basis and their effects over time in commercial settings not only from the food safety perspective but also from the production side. This study presents an alternative analysis of bio-mapping data collected throughout several months in a commercial poultry processing operation as described in the article "Bio-Mapping Indicators and Pathogen Loads in a Commercial Broiler Processing Facility Operating with High and Low Antimicrobial Interventions". The conducted analysis identifies the processing shift effect on microbial loads, attempts to find correlation between microbial indicators data and pathogens loads, and identifies novel visualization approaches and conducts distribution analysis for microbial indicators and pathogens in a commercial poultry processing facility. From the data analyzed, a greater number of locations were statistically different between shifts under reduced levels of chemical interventions with higher means at the second shift for both indicators and pathogens levels. Minimal to negligible correlation was found when comparing aerobic counts and Enterobacteriaceae counts with Salmonella levels, with significant variability between sampling locations. Distribution analysis and visualization as a bio-map of the process resulted in a clear bimodality in reduced chemical conditions for multiple locations mostly explained by shift effect. The development and use of bio-mapping data, including proper data visualization, improves the tools needed for ongoing decision making in food safety systems.

Clinical and Histopathologic Profile of Patients with Cutaneous Metastasis in a Tertiary Hospital in the Philippines.

INTRODUCTION: Cutaneous metastases represent 2% of skin tumors, with an overall incidence of 5.3%. Although rare, clinical presentations of cutaneous metastasis vary and can be mistaken for benign and malignant skin conditions. METHODOLOGY: This was a descriptive, retrospective review of all patients diagnosed with cutaneous metastasis seen at the Department of Dermatology from January 2013 to December 2019. Clinical and histopathologic data from the patients were collated from medical records, and slides were retrieved for review. RESULTS: A total of 115 patients were included and 122 slides reviewed. There were more female than males, the mean age was 52.3 ± 14.0 years of age. The most common primary cancer was the breast, and accordingly, the most common location was anterior chest. Among the 122 slides reviewed from 104 patients, the most common histologic type was adenocarcinoma (72.1%), and showed the infiltrative pattern (26.2%). Other histologic types seen were melanoma (13.1%), leukemic infiltrates (11.5%), squamous origin (2.5%), and epithelioid sarcoma (0.8%). Lymphovascular invasion and dermal sclerosis were observed. Immunohistochemical stains were performed in only 13.9% of the cases. There was a high concurrence of the clinical with the histopathologic diagnosis (95.6%). CONCLUSION: Although rare, patients with cutaneous metastasis may present in dermatology clinics. Knowledge of clinical features and low threshold for doing biopsies may prove useful for these patients. Similarly, dermatopathologists should be able to recognize histologic features of cutaneous metastasis morphologically. Histologic features may be subtle and may be reminiscent of benign inflammatory conditions, hence judicious use of immunohistochemical staining is recommended.

Synergies between environmental degradation and climate variation on malaria re-emergence in southern Venezuela: a spatiotemporal modelling study.

BACKGROUND: Environmental degradation facilitates the emergence of vector-borne diseases, such as malaria, through changes in the ecological landscape that increase human-vector contacts and that expand vector habitats. However, the modifying effects of environmental degradation on climate-disease relationships have not been well explored. Here, we investigate the rapid re-emergence of malaria in a transmission hotspot in southern Venezuela and explore the synergistic effects of environmental degradation, specifically gold-mining activity, and climate variation. METHODS: In this spatiotemporal modelling study of the 46 parishes of the state of Bolívar, southeast Venezuela, we used data from the Venezuelan Ministry of Health including population data and monthly cases of Plasmodium falciparum malaria and Plasmodium vivax malaria between 1996 and 2016. We estimated mean precipitation and temperature using the ERA5-Land dataset and used monthly anomalies in sea-surface temperature as an indicator of El Niño events between 1996 and 2016. The location of suspected mining sites in Bolívar in 2009, 2017, and 2018 were sourced from the Amazon Geo-Referenced Socio-Environmental Information Network. We estimated measures of cumulative forest loss and urban development by km2 using annual land cover maps from the European Space Agency Climate Change Initiative between 1996 and 2016. We modelled monthly cases of P falciparum and P vivax malaria using a Bayesian hierarchical mixed model framework. We quantified the variation explained by mining activity before exploring the modifying effects of environmental degradation on climate-malaria relationships. FINDINGS: We observed a 27% reduction in the additional unexplained spatial variation in incidence of P falciparum malaria and a 23% reduction in P vivax malaria when mining was included in our models. The effect of temperature on malaria was greater in high mining areas than low mining areas, and the P falciparum malaria effect size at temperatures of 26·5°C (2·4 cases per 1000 people [95% CI 1·78-3·06]) was twice as high as the effect in low mining areas (1 case per 1000 people [0·68-1·49]). INTERPRETATION: We show that mining activity in southern Venezuela is associated with hotspots of malaria transmission. Increased temperatures exacerbated malaria transmission in mining areas, highlighting the need to consider how environmental degradation modulates climate effect on disease risk, which is especially important in areas subjected to rapidly rising temperatures and land-use change globally. Our findings have implications for the progress towards malaria elimination in the Latin American region. Our findings are also important for effectively targeting timely treatment programmes and vector-control activities in mining areas with high rates of malaria transmission. FUNDING: Biotechnology and Biological Sciences Research Council, Royal Society, US National Institutes of Health, and Global Challenges Research Fund. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.

Bio-Mapping Indicators and Pathogen Loads in a Commercial Broiler Processing Facility Operating with High and Low Antimicrobial Intervention Levels.

The poultry industry in the United States has traditionally implemented non-chemical and chemical interventions against Salmonella spp. and Campylobacter spp. on the basis of experience and word-of-mouth information shared among poultry processors. The effects of individual interventions have been assessed with microbiological testing methods for Salmonella spp. and Campylobacter spp. prevalence as well as quantification of indicator organisms, such as aerobic plate counts (APC), to demonstrate efficacy. The current study evaluated the loads of both indicators and pathogens in a commercial chicken processing facility, comparing the "normal chemical", with all chemical interventions turned-on, at typical chemical concentrations set by the processing plant versus low-chemical process ("reduced chemical"), where all interventions were turned off or reduced to the minimum concentrations considered in the facility's HACCP system. Enumeration and prevalence of Salmonella spp. and Campylobacter spp. as well as indicator organisms (APC and Enterobacteriaceae-EB) enumeration were evaluated to compare both treatments throughout a 25-month sampling period. Ten locations were selected in the current bio-mapping study, including live receiving, rehanger, post eviscerator, post cropper, post neck breaker, post IOBW #1, post IOBW #2, prechilling, post chilling, and parts (wings). Statistical process control parameters for each location and processing schemes were developed for each pathogen and indicator evaluated. Despite demonstrating significant statistical differences between the normal and naked processes in Salmonella spp. counts ("normal" significantly lower counts than the "reduced" at each location except for post-eviscerator and post-cropper locations), the prevalence of Salmonella spp. after chilling is comparable on both treatments (~10%), whereas for Campylobacter spp. counts, only at the parts' location was there significant statistical difference between the "normal chemical" and the "reduced chemical". Therefore, not all chemical intervention locations show an overall impact on Salmonella spp. or Campylobacter spp., and certain interventions can be turned off to achieve the same or better microbial performance if strategic intervention locations are enhanced.

First wave of COVID-19 in Venezuela: Epidemiological, clinical, and paraclinical characteristics of first cases.

The coronavirus disease 2019 (COVID-19) pandemic has particularly affected countries with weakened health services in Latin America, where proper patient management could be a critical step to address the epidemic. In this study, we aimed to characterize and identify which epidemiological, clinical, and paraclinical risk factors defined COVID-19 infection from the first confirmed cases through the first epidemic wave in Venezuela. A retrospective analysis of consecutive suspected cases of COVID-19 admitted to a sentinel hospital was carried out, including 576 patient cases subsequently confirmed for severe acute respiratory syndrome coronavirus 2 infection. Of these, 162 (28.1%) patients met the definition criteria for severe/critical disease, and 414 (71.2%) were classified as mild/moderate disease. The mean age was 47 (SD 16) years, the majority of which were men (59.5%), and the most frequent comorbidity was arterial hypertension (23.3%). The most common symptoms included fever (88.7%), headache (65.6%), and dry cough (63.9%). Severe/critical disease affected mostly older males with low schooling (p < 0.001). Similarly, higher levels of glycemia, urea, aminotransferases, total bilirubin, lactate dehydrogenase, and erythrocyte sedimentation rate were observed in severe/critical disease patients compared to those with mild/moderate disease. Overall mortality was 7.6% (44/576), with 41.7% (28/68) dying in hospital. We identified risk factors related to COVID-19 infection, which could help healthcare providers take appropriate measures and prevent severe clinical outcomes. Our results suggest that the mortality registered by this disease in Venezuela during the first epidemic wave was underestimated. An increase in fatalities is expected to occur in the coming months unless measures that are more effective are implemented to mitigate the epidemic while the vaccination process is ongoing.

Signatures of the Venezuelan Humanitarian Crisis in the First Wave of COVID-19: Fuel Shortages and Border Migration.

Testing and isolation have been crucial for controlling the COVID-19 pandemic. Venezuela has one of the weakest testing infrastructures in Latin America and the low number of reported cases in the country has been attributed to substantial underreporting. However, the Venezuelan epidemic seems to have lagged behind other countries in the region, with most cases occurring within the capital region and four border states. Here, we describe the spatial epidemiology of COVID-19 in Venezuela and its relation to the population mobility, migration patterns, non-pharmaceutical interventions and fuel availability that impact population movement. Using a metapopulation model of SARS-CoV-2 transmission dynamics, we explore how movement patterns could have driven the observed distribution of cases. Low within-country connectivity most likely delayed the onset of the epidemic in most states, except for those bordering Colombia and Brazil, where high immigration seeded outbreaks. NPIs slowed early epidemic growth and subsequent fuel shortages appeared to be responsible for limiting the spread of COVID-19 across the country.

Muerte súbita de jóvenes: rendimiento diagnóstico de un programa autonómico de autopsia molecular con secuenciación masiva / Sudden cardiac death in persons aged 50 years or younger: diagnostic yield of a regional molecular autopsy program using massive sequencing

Introducción y objetivos La muerte súbita (MS) de personas jóvenes suele tener una causa genética, por lo cual la «autopsia molecular» puede tener implicaciones importantes para los familiares. El objetivo del estudio es evaluar el rendimiento diagnóstico de un programa de autopsia molecular mediante secuenciación masiva. Métodos Estudio prospectivo de una cohorte de pacientes consecutivos de edad ≤ 50 años y fallecidos por MS no violenta, a los que se realizó autopsia molecular mediante paneles amplios por secuenciación masiva, con posterior cribado familiar clínico y genético. Se analizan datos demográficos, clínicos, toxicológicos y genéticos. Resultados Se estudiaron 123 casos consecutivos de MS a edades ≤ 50 años. La incidencia de MS fue de 5,8 casos/100.000 individuos/año, a una media de edad de 36,15±12,7 años; 95 (77%) eran varones. La causa fue cardiaca en el 53%; MS inexplicada en el 24%, tóxicos en el 10,6% y MS del lactante en el 4%. De las cardiacas, el 38% por cardiopatía isquémica, el 7% por miocardiopatía arritmogénica, el 5% por miocardiopatía hipertrófica y el 11% por hipertrofia ventricular izquierda idiopática. Se indicó análisis genético en 62 casos (50,4%). Se hallaron variantes genéticas en 42 (67,7%), con una media de 3,4±4 variantes/paciente, que se consideraron patogénicas o probablemente patogénicas en el 30,6%. De las MS inexplicadas, hasta el 70% presentó alguna variante genética. El estudio familiar permitió detectar a 21 portadores o afectos, 5 de ellos estaban en riesgo, por lo que se indicó implante de desfibrilador. Conclusiones El estudio protocolizado y exhaustivo de la MS cardiaca de personas jóvenes es factible y necesario. En un alto porcentaje la causa es genética y, por lo tanto, existen familiares en riesgo que pueden beneficiarse de un diagnóstico y un tratamiento precoces para evitar complicaciones. (AU)

Introduction and objectives Sudden cardiac death (SCD) in young people often has a genetic cause. Consequently, the results of “molecular autopsy” may have important implications for their relatives. Our objective was to evaluate the diagnostic yield of a molecular autopsy program using next-generation sequencing. Methods We performed a prospective study of a cohort of consecutive patients who died from nonviolent SCD, aged ≤ 50 years, and who underwent molecular autopsy using large panels of next-generation sequencing, with subsequent clinical and genetic family screening. We analyzed demographic, clinical, toxicological, and genetic data. Results We studied 123 consecutive cases of SCD in persons aged ≤ 50 years. The incidence of SCD was 5.8 cases/100 000 individuals/y, mean age was 36.15±12.7 years, and 95 were men (77%). The cause was cardiac in 53%, unexplained SCD in 24%, toxic in 10.6%, and infant SCD in 4%. Among cardiac causes, ischemic heart disease accounted for 38% of deaths, arrhythmogenic cardiomyopathy for 7%, hypertrophic cardiomyopathy for 5%, and idiopathic left ventricular hypertrophy for 11%. Genetic analysis was performed in 62 cases (50.4%). Genetic variants were found in 42 cases (67.7%), with a mean of 3.4±4 genetic variants/patient, and the variant found was considered to be pathogenic or probably pathogenic in 30.6%. In unexplained SCD, 70% showed some genetic variant. Family screening diagnosed 21 carriers or affected individuals, 5 of whom were at risk, indicating an implantable cardiac defibrillator. Conclusions Protocol-based and exhaustive study of SCD from cardiac causes in persons aged ≤ 50 years is feasible and necessary. In a high percentage of cases, the cause is genetic, indicating the existence of relatives at risk who could benefit from early diagnosis and treatment to avoid complications. (AU)

Malaria in Southern Venezuela: The hottest hotspot in Latin America.

Malaria elimination in Latin America is becoming an elusive goal. Malaria cases reached a historical ~1 million in 2017 and 2018, with Venezuela contributing 53% and 51% of those cases, respectively. Historically, malaria incidence in southern Venezuela has accounted for most of the country's total number of cases. The efficient deployment of disease prevention measures and prediction of disease spread to new regions requires an in-depth understanding of spatial heterogeneity on malaria transmission dynamics. Herein, we characterized the spatial epidemiology of malaria in southern Venezuela from 2007 through 2017 and described the extent to which malaria distribution has changed country-wide over the recent years. We found that disease transmission was focal and more prevalent in the southeast region of southern Venezuela where two persistent hotspots of Plasmodium vivax (76%) and P. falciparum (18%) accounted for ~60% of the total number of cases. Such hotspots are linked to deforestation as a consequence of illegal gold mining activities. Incidence has increased nearly tenfold over the last decade, showing an explosive epidemic growth due to a significant lack of disease control programs. Our findings highlight the importance of spatially oriented interventions to contain the ongoing malaria epidemic in Venezuela. This work also provides baseline epidemiological data to assess cross-border malaria dynamics and advocates for innovative control efforts in the Latin American region.

Sudden cardiac death in persons aged 50 years or younger: diagnostic yield of a regional molecular autopsy program using massive sequencing.

INTRODUCTION AND OBJECTIVES: Sudden cardiac death (SCD) in young people often has a genetic cause. Consequently, the results of "molecular autopsy" may have important implications for their relatives. Our objective was to evaluate the diagnostic yield of a molecular autopsy program using next-generation sequencing. METHODS: We performed a prospective study of a cohort of consecutive patients who died from nonviolent SCD, aged ≤ 50 years, and who underwent molecular autopsy using large panels of next-generation sequencing, with subsequent clinical and genetic family screening. We analyzed demographic, clinical, toxicological, and genetic data. RESULTS: We studied 123 consecutive cases of SCD in persons aged ≤ 50 years. The incidence of SCD was 5.8 cases/100 000 individuals/y, mean age was 36.15±12.7 years, and 95 were men (77%). The cause was cardiac in 53%, unexplained SCD in 24%, toxic in 10.6%, and infant SCD in 4%. Among cardiac causes, ischemic heart disease accounted for 38% of deaths, arrhythmogenic cardiomyopathy for 7%, hypertrophic cardiomyopathy for 5%, and idiopathic left ventricular hypertrophy for 11%. Genetic analysis was performed in 62 cases (50.4%). Genetic variants were found in 42 cases (67.7%), with a mean of 3.4±4 genetic variants/patient, and the variant found was considered to be pathogenic or probably pathogenic in 30.6%. In unexplained SCD, 70% showed some genetic variant. Family screening diagnosed 21 carriers or affected individuals, 5 of whom were at risk, indicating an implantable cardiac defibrillator. CONCLUSIONS: Protocol-based and exhaustive study of SCD from cardiac causes in persons aged ≤ 50 years is feasible and necessary. In a high percentage of cases, the cause is genetic, indicating the existence of relatives at risk who could benefit from early diagnosis and treatment to avoid complications.

Patología forense y microbiología hospitalaria: una experiencia de coordinación clínico-forense / Forensic pathology and clinical microbiology: An experience of coordination in clinical practice

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Síndrome de dolor miofascial como causa de dolor agudo postoperatorio en la cirugía de cadera / Myofascial pain syndrome as a cause of postoperative acute pain in hip surgery

El síndrome de dolor miofascial (SDM) es un cuadro de dolor regional de origen muscular. Normalmente se presenta como una causa de dolor crónico, siendo una patología no poco frecuente en las consultas de la Unidad de Dolor. El presente trabajo hace referencia al caso de un paciente intervenido de artroplastia de cadera que desarrolló un SDM en el postoperatorio inmediato, generando así una situación de dolor agudo postoperatorio. En este caso clínico se hace referencia a la gran importancia que tiene un correcto diagnóstico diferencial de cara al tratamiento de un síndrome doloroso. Como es sabido, los pacientes sometidos a cirugía de reemplazo articular experimentan un dolor postoperatorio intenso y sostenido si no se lleva a cabo una adecuada analgesia perioperatoria. El mal control del dolor impediría la recuperación precoz y el alta hospitalaria del paciente. En el caso que nos ocupa, el control del dolor perioperatorio fue llevado a cabo de forma satisfactoria, y no fue hasta el tercer día postintervención cuando apareció un dolor inguinal irradiado a muslo y rodilla que se acompañaba de espasmos musculares a la movilización, coincidiendo este hecho con el inicio de la rehabilitación del miembro. Hasta llegar al diagnóstico final, se descartó en primer lugar las causas atribuibles a la propia prótesis (luxación, fricción, mal posición...). Posteriormente se descartó una posible lesión nerviosa que pudiera haber tenido lugar durante el acto quirúrgico y, finalmente, tras la valoración por la Unidad del Dolor se sospechó un posible síndrome miofascial con afectación del músculo psoas derecho y se trató como tal. Para el tratamiento del cuadro se realizó una infiltración muscular con 40 mg de triamcinilona y 5 ml de levobupivacaína al 0,25 %. La localización se realizó mediante fluoroscopia y contraste hidrosoluble. Tras el procedimiento se obtuvo una clara mejoría sintomatológica, pudiendo comenzar el paciente nuevamente la rehabilitación del miembro. A los cuatro días de la infiltración con anestésico local y corticoides, el paciente volvió a presentar dolor de características similares al previo, por lo que se decidió realizar infiltraciones del músculo psoas derecho con 100 UI de toxina botulínica, además de repetir la dosis de anestésico local y corticoides ya realizada previamente, con el objetivo de controlar el dolor en el periodo ventana que se requiere hasta que la toxina botulínica surte efecto, obteniéndose resultados satisfactorios. Como ya hemos dicho, el dolor atribuido al síndrome miofascial suele presentarse como un dolor crónico, aunque en el caso que nos ocupa debutó en el postoperatorio inmediato, presentándose de forma aguda. En la literatura revisada solamente hay descrito un caso de SM en el postoperatorio de artroplastia de cadera, siendo más frecuente la aparición de este síndrome en la artroplastia de rodilla. No existe una causa clara que explique el motivo desencadenante del síndrome. En artroplastia de rodilla se habla de la isquemia intraoperatoria como posible factor desencadenante del PG, aunque esto no está demostrado

Myofascial pain syndrome (MPS) is a regional pain of muscular origin, usually presents as a cause of chronic pain, being a pathology not uncommon in the consultations of the Pain Unit. The present work refers to the case of a patient undergoing hip arthroplasty who developed an MDS in the immediate postoperative period, thus generating a situation of acute postoperative pain. In this clinical case reference is made to the great importance of a correct differential diagnosis for the treatment of a painful syndrome. As is known, patients undergoing joint replacement surgery experience intense and sustained postoperative pain if adequate perioperative analgesia is not carried out. Poor pain control would prevent early recovery and discharge from the patient. In the case in question, the control of perioperative pain was carried out satisfactorily, and it was not until the third day postintervention when an inguinal pain irradiated to the thigh and knee appeared that it was accompanied by muscular spasms to the mobilization. Coinciding this fact with the beginning of the rehabilitation of the member. Until the final diagnosis was reached, first the causes attributable to the prosthesis itself (dislocation, friction, malposition...) were discarded, later a possible nerve injury that could have occurred during the surgical act was ruled out and finally, after the evaluation for the Pain Unit, a possible myofascial syndrome with involvement of the right psoas muscle was suspected and treated as such. For the treatment of the condition, a muscle infiltration was performed with 40 mg of Triamcinilone and 5 ml of 0.25% levobupivacaine. The location was made by fluoroscopy and water-soluble contrast. After the procedure, a clear symptomatic improvement was obtained, and the patient could begin the rehabilitation of the limb again. After 4 days of infiltration with local anesthetic and corticosteroids, the patient presented pain similar to the previous one, so it was decided to perform infiltrations of the right psoas muscle with 100 IU of botulinum toxin, in addition to repeating the dose of local anesthetic and corticosteroids already done previously, with the aim of controlling the pain in the window period that is required until the botulinum toxin takes effect, obtaining satisfactory results. As we have already said, the pain attributed to the myofascial syndrome usually presents as a chronic pain, although in the present case it debuted in the immediate postoperative period, presenting itself acutely. In the literature reviewed, only one case of MS has been described in the postoperative period of hip arthroplasty, the occurrence of this syndrome being more frequent in knee arthroplasty. There is no clear cause to explain the reason for the syndrome. In knee arthroplasty, intraoperative ischemia is discussed as a possible triggering factor for PG, although this is not proven

Venezuela's humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region.

In the past 5-10 years, Venezuela has faced a severe economic crisis, precipitated by political instability and declining oil revenue. Public health provision has been affected particularly. In this Review, we assess the impact of Venezuela's health-care crisis on vector-borne diseases, and the spillover into neighbouring countries. Between 2000 and 2015, Venezuela witnessed a 359% increase in malaria cases, followed by a 71% increase in 2017 (411 586 cases) compared with 2016 (240 613). Neighbouring countries, such as Brazil, have reported an escalating trend of imported malaria cases from Venezuela, from 1538 in 2014 to 3129 in 2017. In Venezuela, active Chagas disease transmission has been reported, with seroprevalence in children (<10 years), estimated to be as high as 12·5% in one community tested (n=64). Dengue incidence increased by more than four times between 1990 and 2016. The estimated incidence of chikungunya during its epidemic peak is 6975 cases per 100 000 people and that of Zika virus is 2057 cases per 100 000 people. The re-emergence of many vector-borne diseases represents a public health crisis in Venezuela and has the possibility of severely undermining regional disease elimination efforts. National, regional, and global authorities must take action to address these worsening epidemics and prevent their expansion beyond Venezuelan borders.

Resurgence of Vaccine-Preventable Diseases in Venezuela as a Regional Public Health Threat in the Americas.

Venezuela's tumbling economy and authoritarian rule have precipitated an unprecedented humanitarian crisis. Hyperinflation rates now exceed 45,000%, and Venezuela's health system is in free fall. The country is experiencing a massive exodus of biomedical scientists and qualified healthcare professionals. Reemergence of arthropod-borne and vaccine-preventable diseases has sparked serious epidemics that also affect neighboring countries. In this article, we discuss the ongoing epidemics of measles and diphtheria in Venezuela and their disproportionate impact on indigenous populations. We also discuss the potential for reemergence of poliomyelitis and conclude that action to halt the spread of vaccine-preventable diseases within Venezuela is a matter of urgency for the country and the region. We further provide specific recommendations for addressing this crisis.

Analgesic Effect of Botulinum Toxin A in Myofascial Pain Syndrome Patients Previously Treated with Local Infiltration of Anesthetic and Steroids.

The purpose of this study was to evaluate the analgesic effect of botulinum toxin A (BoNTA) injections in patients with myofascial pain syndrome (MPS) who were previously treated with the local infiltration of anesthetic and steroids (LIAS). The study included a retrospective phase and a longitudinal open-label prospective phase, which were conducted on consecutive patients with MPS previously treated with the local infiltration of anesthetic (levobupivacaíne 0.25%) and steroids (triamcinolone 40 mg). Eligible patients were treated with a single intramuscular injection of BoNTA (Botox; Allergan, Inc., Irvine, CA). The treatment efficacy was determined according to the degree of pain relief obtained. Eighty-two patients met the inclusion/exclusion criteria and were included in the study. Successful results were obtained for 32 (39.0%) and 30 (36.6%) patients, during treatment with BoNTA and LIAS, respectively. The mean (standard deviation) length of the analgesic effect was significantly longer with BoNTA (29.6 [SD = 17.7] weeks) than with LIAS (8.5 [SD = 6.4] weeks), P <.0001. As regards the side effects, 19 (23.2%) patients reported transient soreness at the injection site for 2 to 3 days with BoNTA. The MPS patients previously treated with a local infiltration of anesthetic and steroids who then received a single injection of BoNTA experienced significantly reduced pain for a relatively long time.

Muerte súbita en varón joven / Sudden death in a young adult

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2-Phenylaminonaphthoquinones and related compounds: synthesis, trypanocidal and cytotoxic activities.

A series of new 2-aminonaphthoquinones and related compounds were synthesized and evaluated in vitro as trypanocidal and cytotoxic agents. Some tested compounds inhibited epimastigote growth and trypomastigote viability. Several compounds showed similar or higher activity and selectivity as compared with current trypanocidal drug, nifurtimox. Compound 4l exhibit higher selectivity than nifurtimox against Trypanosoma cruzi in comparison with Vero cells. Some of the synthesized quinones were tested against cancer cells and normal fibroblasts, showing that certain chemical modifications on the naphthoquinone moiety induce and excellent increase the selectivity index of the cytotoxicity (4g and 10). The results presented here show that the anti-T. cruzi activity of 2-aminonaphthoquinones derivatives can be improved by the replacement of the benzene ring by a pyridine moiety. Interestingly, the presence of a chlorine atom at C-3 and a highly lipophilic alkyl group or aromatic ring are newly observed elements that should lead to the discovery of more selective cytotoxic and trypanocidal compounds.

Brief report: effectiveness of combination antiretroviral therapy on survival and opportunistic infections in a developing world setting: an observational cohort study.

BACKGROUND: The prolonged effectiveness of antiretroviral therapy (ART) in a developing country is not well established. METHODS: An observational database was established at the HIV clinic of the Almenara Hospital in Lima, Peru in 1996. All 564 initially antiretroviral-naive HIV-infected persons (mean CD4 count of 91 cells/mm3) who received combination ART were followed over time. RESULTS: The overall survival rate was 96% at year 2, 94% at year 4, and 91% at year 5. Among persons who initiated therapy with CD4 counts <100 cells/mm3, the overall survival rate at 3 years was 95%. Opportunistic infections while on ART occurred in 20% of persons. Patients who received 2 reverse transcriptase (RT) inhibitors plus a protease inhibitor had slightly better survival rates and less opportunistic disease in the first year of therapy as compared with those receiving 2 RT inhibitors and a nonnucleoside reverse transcriptase inhibitor or 3 RT inhibitors. CONCLUSIONS: This study demonstrates the long-term effectiveness of ART in a developing country urban setting. It provides evidence of the importance of continuing global financing initiatives to provide widespread HIV therapy for countries in the developing world.

High proportion of T-cell systemic non-Hodgkin lymphoma in HIV-infected patients in Lima, Peru.

OBJECTIVE: Few reports have described the clinical and pathologic characteristics of HIV-related systemic non-Hodgkin lymphoma (sNHL) in developing countries. We aimed to determine these characteristics from a national HIV reference center in Peru and to evaluate factors associated with survival. METHODS: A retrospective/prospective study of patients with HIV-related sNHL from the Guillermo Almenara General Hospital in Lima, Peru between 1993 and 2004. Clinical characteristics at diagnosis included age, gender, risk behavior, previous AIDS diagnosis, opportunistic diseases, previous highly active antiretroviral therapy, Karnofsky score, origin, clinical stage and B-cell symptoms of sNHL, and CD4 cell count. Cases of sNHL were classified according to the criteria of the World Health Organization. RESULTS: Thirty-three cases were identified (26 male, age range: 38 +/- 10 years). Ten patients (30%) had a prior history of AIDS, 14 (42%) had a Karnofsky score of