Consenso Mexicano para el Tratamiento de la Hepatitis C / The Mexican consensus on the treatment of Hepatitis C

El objetivo del Consenso Mexicano para el Tratamiento de la Hepatitis C fue el de desarrollar un documento como guía en la práctica clínica con aplicabilidad en México. Se tomó en cuenta la opinión de expertos en el tema con especialidad en: gastroenterología, infectología y hepatología. Se realizó una revisión de la bibliografía en MEDLINE, EMBASE y CENTRAL mediante palabras claves referentes al tratamiento de la hepatitis C. Posteriormente se evaluó la calidad de la evidencia mediante el sistema GRADE y se redactaron enunciados, los cuales fueron sometidos a voto mediante un sistema modificado Delphi, y posteriormente se realizó revisión y corrección de los enunciados por un panel de 34 votantes. Finalmente se clasificó el nivel de acuerdo para cada oración. Esta guía busca dar recomendaciones con énfasis en los nuevos antivirales de acción directa y de esta manera facilitar su uso en la práctica clínica. Cada caso debe ser individualizado según sus comorbilidades y el manejo de estos pacientes siempre debe ser multidisciplinario.

The aim of the Mexican Consensus on the Treatment of Hepatitis C was to develop clinical practice guidelines applicable to Mexico. The expert opinion of specialists in the following areas was taken into account: gastroenterology, infectious diseases, and hepatology. A search of the medical literature was carried out on the MEDLINE, EMBASE, and CENTRAL databases through keywords related to hepatitis C treatment. The quality of evidence was subsequently evaluated using the GRADE system and the consensus statements were formulated. The statements were then voted upon, using the modified Delphi system, and reviewed and corrected by a panel of 34 voting participants. Finally, the level of agreement was classified for each statement. The present guidelines provide recommendations with an emphasis on the new direct-acting antivirals, to facilitate their use in clinical practice. Each case must be individualized according to the comorbidities involved and patient management must always be multidisciplinary.

The Mexican consensus on the treatment of hepatitis C. / Consenso Mexicano para el Tratamiento de la Hepatitis C.

The aim of the Mexican Consensus on the Treatment of HepatitisC was to develop clinical practice guidelines applicable to Mexico. The expert opinion of specialists in the following areas was taken into account: gastroenterology, infectious diseases, and hepatology. A search of the medical literature was carried out on the MEDLINE, EMBASE, and CENTRAL databases through keywords related to hepatitisC treatment. The quality of evidence was subsequently evaluated using the GRADE system and the consensus statements were formulated. The statements were then voted upon, using the modified Delphi system, and reviewed and corrected by a panel of 34 voting participants. Finally, the level of agreement was classified for each statement. The present guidelines provide recommendations with an emphasis on the new direct-acting antivirals, to facilitate their use in clinical practice. Each case must be individualized according to the comorbidities involved and patient management must always be multidisciplinary.

[Antibodies against Toxoplasma gondii in patients with HIV in Yucatan]. / Anticuerpos contra Toxoplasma gondii en pacientes con VIH en Yucatán.

OBJECTIVE: To determine the prevalence of antibodies type IgG to T. gondii in patients with HIV infection type 1 in the Yucatan peninsula. METHODS: 95 patients with HIV and 100 blood donors as controls were studied. The search for IgG antibodies to T. gondii was done with a third generation solid-phase enzyme immunoassay. Clinical and demographic data were obtained. RESULTS: The prevalence of antibodies was higher (p = 0.003) in controls (69%, CI95 = 59-78%) than in patients (47%, CI = 36-57%). No relation was found between seroreactivity and the variables evaluated (gender, urban or rural home, age) nor with CD4 T-cell counts and clinical categories. CONCLUSIONS: The high prevalence of T. gondii antibodies in both groups suggests that the zoonosis is endemic in the Yucatan peninsula. This justifies the routine determination of antibodies and the use of therapeutic protocols for preventing encephalitis by toxoplasma in HIV patients as a high percentage of them would be at risk of developing it.

Low prevalence of HTLV-II in Mayan Indians in the Yucatan Peninsula, Mexico.

Infection with HTLV-II is endemic in Amerindians, with prevalence ranging from 0.89% - 33%. To determine the prevalence of HTLV-II among indigenous Mayans in the Yucatan Peninsula of Mexico, 440 indigenous Mayans were recruited, all native to and residents of one of six Mayan communities in the Yucatan Peninsula, (Xohuayan n=144, Yaxachen n=101, Kanxoc n=84, Xocen n=40, Nabalan n=46 and X'calot n=25) between May, 1992 and June, 1993. All of the above are pre-Hispanic settlements located in tropical forest with no immigrations for over 50 years. Of the 440 indigenous Mayans, only one woman from the X'calot tribe (0.23%) was shown to be infected with HTLV-II. A high percentage of indeterminate results was found (22/439, 5%), three of which were accounted for by the husband and two children of the positive female case. PCR analysis followed by specific restriction digestion demonstrated the virus to be of the HTLV-IIb subtype, similar to that described in the Guaymi Indians from Panama. The presence of HTLV-II in the Mayan ethnos, and in other Amerindian populations supports the idea that HTLV-II is an ancestral virus in America and that it has been sustained in "closed" communities.

PIP: Although not consistently associated with any specific disease, infection with HTLV-II is nonetheless endemic among Amerindians, with a prevalence of 0.89-33%. Findings are presented from a study conducted to determine the prevalence of HTLV-II among indigenous Mayans in the Yucatan Peninsula of Mexico. 440 indigenous Mayans were recruited, all native to and residents of 1 of 6 Mayan communities in the Yucatan Peninsula between May 1992 and June 1993. All participants were drawn from pre-Hispanic settlements located in tropical forest without immigration for more than 50 years. Of the 440 subjects, only 1 woman from the X'calot tribe (0.23%) was found to be infected with HTLV-II. However, 22 of the remaining 439 (5%) results were indeterminate, of which 3 were accounted for by the husband and 2 children of the positive female case. Polymerase chain reaction analysis determined the virus to be of HTLV-IIb subtype, similar to that described among the Guaymi Indians of Panama. These findings support the argument that HTLV-II is an ancestral virus in America and that it has been sustained in closed communities.

A novel in situ model to study Pneumocystis carinii adhesion to lung alveolar epithelial cells.

Pneumocystis carinii, an extracellular parasite thriving in the lungs of immunosuppressed mammals, is a major cause of death in AIDS patients in the USA. As a prelude to growth, the parasite adheres mostly to type I pneumocytes lining the alveolar spaces. The mechanism of adherence remains unknown, largely because of difficulties in isolating type I pneumocytes and maintaining them in vitro. As a first step to understand P. carinii adherence to its natural substrate, we developed an in situ method to directly study parasite binding to lung alveolar cells. We used formaldehyde-fixed paraffin-embedded sections of normal rat lung as substrate for adhesion. As in its binding to the lungs in vivo, P. carinii adhered preferentially to type I pneumocytes. Adherence was saturable, time and dose dependent, and selectively blocked by glycoconjugates, in particular bovine submaxillary mucin, fetuin, and asialofetuin, suggesting that it may be mediated by a lectin type of interaction. Further, IgG of rats with P. carinii pneumonia inhibited adherence, suggesting that it may react with parasite ligands involved in the recognition of type I cell receptors. Our results demonstrate the usefulness of the in situ model for studying the mechanisms of P. carinii adherence to alveolar cells. In addition, this method may be valuable for identifying neutralizing antibodies and drugs potentially useful for controlling the infection in vivo.

Human T lymphotropic virus type II (HTLV-II) infection among female prostitutes in Yucatan, Mexico.

The antibodies to human T-lymphotropic virus type I/II (HTLV-I/II) were determined in non-intravenous drug-using female prostitutes from Merida Yucatan, Mexico. Serum specimens from 282 female prostitutes collected during 1990 were tested initially by enzyme immunoassay and further confirmed by western blot assays. Of these, 5 (1.8%, 95% confidence interval 0.2 to 3.3) were shown to be HTLV-I/II positive (reactivity to p24gag and gp68/r21eenv). All five specimens were shown to be infected with HTLV-II by immunoassays using type-specific synthetic peptides and recombinant proteins. Long-term cell lines developed from two individuals demonstrated active viral replication and were of CD8 phenotype. Polymerase chain reaction analysis from four of these five prostitutes demonstrated HTLV-II-specific amplification of all four specimens, of which one was subtype a (HTLV-IIa) and three were subtype b (HTLV-IIb). These data show that HTLV-II is the predominant HTLV type among female prostitutes from the Yucatan.

[Recurrent respiratory infection in children: its clinical and laboratory evaluation]. / Infección respiratoria recurrente en el niño: evaluación clínica y de laboratorio.

Respiratory infections comprise the main cause of medical consultations, and one of two of the first causes of morbidity and mortality in children under five in developing countries. Epidemiological studies have shown that preschool children contract between four and six respiratory infections in the course of a year without this causing any alarm as a deviation from "normality". Yet, the general practitioner and the pediatrician are frequently faced with the dilemma of deciding whether the child who is "always ill" the use of the recurrent infections is, normal or has predisposing conditions to the infections. Among the predisposing conditions for recurrent respiratory infections in children are several host factors, such as immune defense mechanisms and non-immune mechanisms as well as the infections agent and/or the environment. This article is an overview of the clinical and laboratory evaluation findings of children with recurrent respiratory infections.

[Clinical manifestations of infection by human immunodeficiency virus in children]. / Manifestaciones clínicas de la infección por virus de la inmunodeficiencia humana en niños.

HIV infection in children presents a wide spectrum of clinical manifestations, from asymptomatic to opportunistic infections, neurologic deterioration and malignancy. This retrospective study describes the characteristics of 30 HIV infected children, attended at the Hospital Infantil de México. Six patients were asymptomatic and 24 symptomatic. Twenty four patients presented a secondary infection, 66% opportunistic infections, compared against the 100% who presented around 3 serious bacterial infections. The most frequent infections were: candidiosis 18 children, pneumonia 14, sepsis 8, cryptosporidiosis 5, urinary tract infection 5, and otitis 5. We were able to demonstrate P. carinii pneumonia in only one patient. These differences in the frequency of related infections may represent regional differences by country.