Accurate detection of Zika virus IgG using a novel immune complex binding ELISA.

OBJECTIVES: Accurate serological assays are urgently needed to support public health responses to Zika virus (ZIKV) infection with its potential to cause foetal damage during pregnancy. Current flavivirus serology for ZIKV infections lacks specificity due to cross-reacting antibodies from closely related other flaviviruses. In this study, we evaluated novel serological tests for accurate ZIKV IgG detection. METHODS: Our ELISAs are based on immune complex binding. The high specificity is achieved by the simultaneous incubation of labelled ZIKV antigen and unlabelled flavivirus homolog protein competitors. Two assays were validated with a panel of 406 human samples from PCR-confirmed ZIKV patients collected in Brazil (n = 154), healthy blood donors and other infections from Brazil, Europe, Canada and Colombia (n = 252). RESULTS: The highest specificity (100% [252/252, 95% confidence interval (CI) 98.5-100.0]) was shown by the ZIKV ED3 ICB ELISA using the ED3 antigen of the ZIKV envelope. A similar test using the NS1 antigen (ZIKV NS1 ICB ELISA) was slightly less specific (92.1% [232/252, 95% CI 88.0-95.1]). The commercial Euroimmun ZIKV ELISA had a specificity of only 82.1% (207/252, 95% CI 76.8-86.7). Sensitivity was high (93-100%) from day 12 after onset of symptoms in all three tests. Seroprevalence of ZIKV IgG was analysed in 87 samples from Laos (Asia) confirming that the ED3 ELISA showed specific reactions in other populations. CONCLUSIONS: The novel ED3 ICB ELISA will be useful for ZIKV-specific IgG detection for seroepidemiological studies and serological diagnosis for case management in travellers and in countries where other flavivirus infections are co-circulating.

Excessive daytime somnolence is associated with hypoglycemia in adult Latinos with type 2 diabetes mellitus.

OBJECTIVE: This study aimed to determine the frequency of sleep disorders in hypoglycemic diabetic patients and possible relationships with scores of sleep disorders and restless legs syndrome in mestizo population in Guayaquil, Ecuador. METHODS: A multicenter, cross-sectional study conducted at an outpatient endocrinology clinic in urban and rural Ecuador regions, included 290 participants with type 2 diabetes mellitus with severe hypoglycemic episodes, completed, validated, and culturally adapted sleep questionnaires to assess daytime sleepiness, risk of sleep apnea and restless legs syndrome. Logistic regression analysis was conducted to identify factors associated with severe hypoglycemia. RESULTS: The prevalence of EDS was 56.8%, RLS prevalence of 46.2%, and 38.6% prevalence of high risk Berlin score. Multivariate logistic regression indicated hypoglycemic T2DM in the range of 56-75 years old were more likely to have high ESS (p 0.0001). CONCLUSION: A high prevalence of sleep disorders in diabetic Latinos living in Ecuador was evidenced. The presence of somnolence in patients older than 56 years and high HbA1c levels should alert the clinician for the occurrence of hypoglycemic episodes.

Imiquimod en el tratamiento de la infección vulvar por virus de papiloma humano / Imiquimod in the treatment of vulvar infection by human papilloma virus

Determinar la eficacia de imiquimod como tratamiento médico de la infección vulvar por VPH. Estudio descriptivo, prospectivo, longitudinal en el que 30 pacientes con verrugas genitales recibieron imiquimod crema al 5 por ciento interdiario por 12 semanas. Se evaluó el área de aplicación semanalmente por un mes y se realizó vulvoscopia a los 3, 6 y 12 meses después del tratamiento. La edad promedio de las pacientes fue 27,7 ± 6,5 años. Las lesiones más frecuentes fueron exofíticas, 30 por ciento estaban ubicadas en horquilla y 30 por ciento eran multifocales. A los tres y seis meses del tratamiento, se obtuvo una mejoría total del 96,7 por ciento y 3,3 por ciento de persistencia (P<0,001) Al año de seguimiento 83,3 por ciento se curaron, 13,3 por ciento recurrieron y en 3,3 por ciento persistió la lesión (P<0,001). El 66,7 por ciento de las pacientes presentaron efectos colaterales leves durante el tratamiento, predominaron el dolor (26,7 por ciento) y el ardor (23,3 por ciento). La diferencia entre la proporción de sintomáticas y asintomáticas fue estadísticamente significativa. Ninguna suspendió la terapia. Para el mes de culminado el tratamiento, el 73,3 por ciento no manifestó síntomas (P=0,0003). Las variables epidemiológicas y las características de las lesiones no afectaron el resultado. El imiquimod es eficaz en el tratamiento de la infección vulvar por VPH, con efectos adversos leves tolerados por las pacientes, con tasas de curación elevada y de recurrencia y persistencia bajas

To determine the efficacy of imiquimod as medical treatment of infection by HPV vulvar. Descriptive, prospective, longitudinal study in which 30 patients with genital warts received imiquimod cream 5 percent every 48 hours, for 12 weeks. The area of application was assessed weekly for a month and a vulvoscopia was made at 3, 6 and 12 months after treatment. The average age of the patients was 27.7 ± 6.5 years. The most common injuries were exophytics, 30 percent were located in fork and 30 percent were multifocal. At three and six months of treatment, obtained a total improvement of 96.7 per cent and 3.3 per cent of persistence (P<0.001) and after one year of follow up 83.3 percent were cured, there were 13.3 percent of recurrence and in 3.3 percent injury persisted (P<0.001). 66.7 percent of the patients had mild side effects during treatment, pain (26.7 percent) and the burning predominated (23.3 percent). The difference between the proportion of symptomatic and asymptomatic was statistically significant. No patient discontinued therapy. For the month of completed treatment, 73.3 percent said not symptoms (P=0.0003). Epidemiological variables and characteristics of the injury did not affect the result. The imiquimod is effective in the treatment of vulvar infection by HPV, with mild adverse effects tolerated by patients, with low recurrence and persistence and high cure rates

Role of average speed in N2O exhaust emissions as greenhouse gas in a huge urban zone (MVMZ): would we need a cold sun?

Nowadays, the drastic pollution problems, some of them related with greenhouse gas emissions, have promoted important attempts to face and diminish the global warming effects on the Mexico Valley Metropolitan Zone (MVMZ) as well as on the huge urban zones around the world. To reduce the exhaust gas emissions, many efforts have been carried out to reformulate fuels and design new catalytic converters; however, it is well known that other variables such as socio-economic and transport structure factors also play an important role around this problem. The present study analyzes the roles played by several commonly-used three-way catalytic converters (TWC) and the average traffic speed in the emission of N(2)O as greenhouse gas. According to this study, by increasing the average traffic flow and avoiding constant decelerations (frequent stops) during common trips, remarkable environmental and economic benefits could be obtained due to the diminution of N(2)O and other contaminant emissions such as ammonia (NH(3)) and even CO(2) with the concomitant reduced fossil fuel consumption. The actions mentioned above could be highly viable to diminish, in general, the global warming effects and contamination problems.

Intraosseous hypertonic saline solution for resuscitation of uncontrolled, exsanguinating liver injury in young Swine.

Fluid resuscitation administered before hemorrhage control for trauma victims sustaining blunt abdominal injury is controversial. Prehospital fluid resuscitation is limited by difficulty in delivering large volumes of fluid in the field and time delays associated with gaining vascular access. Venous access is often a clinical dilemma in severely hypovolemic children. Intraosseous infusion is considered a useful technique for the administration of fluids in emergency situations when peripheral intravascular access is not possible. This study investigated the effectiveness of intraosseous versus intravenous infusion of hypertonic saline solution in an uncontrolled hemorrhagic shock swine model. We also tested the effect of the different sites of infusion on the intra-abdominal bleeding. Relevant hemodynamic parameters were monitored and blood samples were collected. After liver injury, 20 anesthetized immature pigs were randomized to three groups: intraosseous access, intravenous access and control. After 20 min of uncontrolled hemorrhage, the hypertonic saline solution begins in the intraosseous access and intravenous access groups of animals. Thirty minutes later, the animals were killed and intra-abdominal blood loss was measured. All the pigs presented lower pressures and lower cardiac output after 20 min of hemorrhagic shock. The intravenous and intraosseous access groups did not show a better hemodynamic performance after 10 min of fluid resuscitation. At the end of the experiment, all animals were hemodynamically similar without an improved answer to a fluid resuscitation. There were no significant differences between groups regarding intra-abdominal blood loss. It was concluded that the hypertonic saline solution in this experimental model did not promote hemodynamic improvement and there were no differences between the two sites of fluid resuscitation regarding intra-abdominal blood loss.

Qualitative evaluation of the blood-brain barrier after the use of hypertonic saline solution in young rats.

The blood-brain barrier (BBB) controls the biochemical environment of the brain with variable permeability when comparing adults to children. Based on the knowledge that there is a greater vulnerability in the BBB of young subjects submitted to biochemical variations in the blood and in the brain, an experimental model was designed to study small volume resuscitation. Young Wistar rats were submitted to hemorrhage and resuscitated with 7.5% NaCl solution before undergoing a qualitative evaluation of their BBB. Thirty male rats were anesthetized and divided into four groups: Group 1 - submitted to hemorrhagic shock restored with hypertonic saline solution (HSS); Group 2 - submitted to hemorrhagic shock without volume restoration; Group 3 - receiving only HSS, and Group 4 - control. The data analyzed were: mean arterial blood pressure, base excess, sodium, chloride, urea, blood osmolarity and blood glucose levels. After infusing a 2% Evans blue solution, qualitative analysis of the BBB was carried out. Group 1 presented final mean blood pressure levels equivalent to groups 3 and 4. Group 2 had a significant difference in the final base excess when compared to the other groups. In groups 1 and 3, mean sodium and chloride, as well as serum osmolarity, were more elevated than groups 2 and 4. Macroscopic examination of the brain did not reveal any changes in color, which could be attributed to the opening of the BBB. It was concluded that the 7.5% NaCl solution in this experimental model did not promote qualitative changes in the BBB.

Trauma torácico en la infancia. Estudio retrospectivo de 43 casos / Thoracic trauma in childhood. Restrospective study in 43 cases

Frente a la importancia que adquirió el trauma pediátrico, analizamos retrospectivamente en un período de 9 años, los casos de niños y adolescentes en la sala de primeros auxilios y guardia general pediátrica de la Santa Casa de San Pablo, con especial interés en la epidemiología y morbimortalidad del trauma torácico. Cuarenta y tres niños ingresaron con 56 lesiones torácicas. Hubo un predominio de hemoneumotórax, neumotórax, hemotórax y contunsión pulmonar. Veintiun pacientes sufrieron heridas penetrantes. Alrededor de un 55 por ciento tenían lesiones asociadas. El 90 por ciento fueron tratados con drenaje simple u observación clínica exclusiva. Se presentaron complicaciones en 12 casos (28 por ciento), la mayoría de tipo infeccioso. Fallecieron 3 niños, que ppresentaron lesiones asociadas severas, con TRISS<0,81. Las conclusiones que surgen de la casuística presentada son la universalidad de los parámetros investigados, una mayor gravedad del traumatismo contuso, el mayor nivel de agresividad urbana y la necesidad de organizar y sistematizar la atención del niño traumatizado

Trauma torácico en la infancia. Estudio retrospectivo de 43 casos / Thoracic trauma in childhood. Restrospective study in 43 cases

Frente a la importancia que adquirió el trauma pediátrico, analizamos retrospectivamente en un período de 9 años, los casos de niños y adolescentes en la sala de primeros auxilios y guardia general pediátrica de la Santa Casa de San Pablo, con especial interés en la epidemiología y morbimortalidad del trauma torácico. Cuarenta y tres niños ingresaron con 56 lesiones torácicas. Hubo un predominio de hemoneumotórax, neumotórax, hemotórax y contunsión pulmonar. Veintiun pacientes sufrieron heridas penetrantes. Alrededor de un 55 por ciento tenían lesiones asociadas. El 90 por ciento fueron tratados con drenaje simple u observación clínica exclusiva. Se presentaron complicaciones en 12 casos (28 por ciento), la mayoría de tipo infeccioso. Fallecieron 3 niños, que ppresentaron lesiones asociadas severas, con TRISS<0,81. Las conclusiones que surgen de la casuística presentada son la universalidad de los parámetros investigados, una mayor gravedad del traumatismo contuso, el mayor nivel de agresividad urbana y la necesidad de organizar y sistematizar la atención del niño traumatizado