Universal Screening for SARS-CoV-2 in Obstetric Care: Clinical Characteristics and Maternofetal Outcomes in a Latin American High-Complexity Unit.

The asymptomatic population's role in COVID-19 transmission poses challenges for control efforts. Pregnant women are susceptible to severe manifestations, increasing maternal and perinatal morbidity and mortality. This study describes the clinical characteristics, maternal and fetal outcomes, and our experience in universal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening of pregnant women admitted to a high-complexity obstetric unit in Latin America. Of 568 pregnant women tested for SARS-CoV-2, 23 obtained a positive result. Among these patients, 17% had symptoms at admission, and 0.2% reported an epidemiological link. Pregnant women with positive were associated with an increased risk of eclampsia (16.7% vs 4.9%, P = .014) and acute respiratory distress (16.7% vs 4.9%, P = .014). In this group, 4 patients developed maternal near misses, and no maternal deaths were noted. Two early perinatal deaths occurred in the positive SARS-CoV-2 test group (2, 9.5% vs 17, 4.1%, P = .235). The high prevalence of asymptomatic pregnant women with SARS-CoV-2 and the adverse outcomes for those infected during pregnancy highlights the importance of universal screening upon hospital admission. This approach streamlines risk management, and enhances service structure, resource allocation, care pathways, patient management, follow-up, and overall outcomes.

Mass Spectrometry Imaging of In Vitro Cryptosporidium parvum-Infected Cells and Host Tissue.

Cryptosporidium parvum is a zoonotic-relevant parasite belonging to the phylum Alveolata (subphylum Apicomplexa). One of the most zoonotic-relevant etiologies of cryptosporidiosis is the species C. parvum, infecting humans, cattle and wildlife. C. parvum-infected intestinal mucosa as well as host cells infected in vitro have not yet been the subject of extensive biochemical investigation. Efficient treatment options or vaccines against cryptosporidiosis are currently not available. Human cryptosporidiosis is currently known as a neglected poverty-related disease (PRD), being potentially fatal in young children or immunocompromised patients. In this study, we used a combination of atmospheric pressure scanning microprobe matrix-assisted laser desorption/ionization (AP-SMALDI) mass spectrometry imaging (MSI) and liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) to determine and locate molecular biomarkers in in vitro C. parvum-infected host cells as well as parasitized neonatal calf intestines. Sections of C. parvum-infected and non-infected host cell pellets and infected intestines were examined to determine potential biomarkers. Human ileocecal adenocarcinoma cells (HCT-8) were used as a suitable in vitro host cell system. More than a thousand different molecular signals were found in both positive- and negative-ion mode, which were significantly increased in C. parvum-infected material. A database search in combination with HPLC-MS/MS experiments was employed for the structural verification of markers. Our results demonstrate some overlap between the identified markers and data obtained from earlier studies on other apicomplexan parasites. Statistically relevant biomarkers were imaged in cell layers of C. parvum-infected and non-infected host cells with 5 µm pixel size and in bovine intestinal tissue with 10 µm pixel size. This allowed us to substantiate their relevance once again. Taken together, the present approach delivers novel metabolic insights on neglected cryptosporidiosis affecting mainly children in developing countries.

A Phase 3, Randomized, Double-Blind, Comparator-Controlled Study to Evaluate Safety, Tolerability, and Immunogenicity of V114, a 15-Valent Pneumococcal Conjugate Vaccine, in Allogeneic Hematopoietic Cell Transplant Recipients (PNEU-STEM).

BACKGROUND: Individuals who receive allogeneic hematopoietic cell transplant (allo-HCT) are immunocompromised and at high risk of pneumococcal infections, especially in the months following transplant. This study evaluated the safety and immunogenicity of V114 (VAXNEUVANCE; Merck, Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA), a 15-valent pneumococcal conjugate vaccine (PCV), when given to allo-HCT recipients. METHODS: Participants received 3 doses of V114 or PCV13 (Prevnar 13; Wyeth LLC) in 1-month intervals starting 3-6 months after allo-HCT. Twelve months after HCT, participants received either PNEUMOVAX 23 or a fourth dose of PCV (if they experienced chronic graft vs host disease). Safety was evaluated as the proportion of participants with adverse events (AEs). Immunogenicity was evaluated by measuring serotype-specific immunoglobulin G (IgG) geometric mean concentrations (GMCs) and opsonophagocytic activity (OPA) geometric mean titers (GMTs) for all V114 serotypes in each vaccination group. RESULTS: A total of 274 participants were enrolled and vaccinated in the study. The proportions of participants with AEs and serious AEs were generally comparable between intervention groups, and the majority of AEs in both groups were of short duration and mild-to-moderate intensity. For both IgG GMCs and OPA GMTs, V114 was generally comparable to PCV13 for the 13 shared serotypes, and higher for serotypes 22F and 33F at day 90. CONCLUSIONS: V114 was well tolerated in allo-HCT recipients, with a generally comparable safety profile to PCV13. V114 induced comparable immune responses to PCV13 for the 13 shared serotypes, and was higher for V114 serotypes 22F and 33F. Study results support the use of V114 in allo-HCT recipients. Clinical Trials Registration. clinicaltrials.gov (NCT03565900) and European Union at EudraCT 2018-000066-11.

Clinicopathological profile of peritoneal tuberculosis and a new scoring model for predicting mortality: an international ID-IRI study.

Existing literature about peritoneal tuberculosis (TBP) is relatively insufficient. The majority of reports are from a single center and do not assess predictive factors for mortality. In this international study, we investigated the clinicopathological characteristics of a large series of patients with TBP and determined the key features associated with mortality. TBP patients detected between 2010 and 2022 in 38 medical centers in 13 countries were included in this retrospective cohort. Participating physicians filled out an online questionnaire to report study data. In this study, 208 patients with TBP were included. Mean age of TBP cases was 41.4 ± 17.5 years. One hundred six patients (50.9%) were females. Nineteen patients (9.1%) had HIV infection, 45 (21.6%) had diabetes mellitus, 30 (14.4%) had chronic renal failure, 12 (5.7%) had cirrhosis, 7 (3.3%) had malignancy, and 21 (10.1%) had a history of immunosuppressive medication use. A total of 34 (16.3%) patients died and death was attributable to TBP in all cases. A pioneer mortality predicting model was established and HIV positivity, cirrhosis, abdominal pain, weakness, nausea and vomiting, ascites, isolation of Mycobacterium tuberculosis in peritoneal biopsy samples, TB relapse, advanced age, high serum creatinine and ALT levels, and decreased duration of isoniazid use were significantly related with mortality (p < 0.05). This is the first international study on TBP and is the largest case series to date. We suggest that using the mortality predicting model will allow early identification of high-risk patients likely to die of TBP.

Una aproximación a la tuberculosis resistente a isoniazida: ¿un problema subestimado en Colombia? / An appraisal of the isoniazid resistant tuberculosis in Colombia: a underestimated problem in Colombia?

Objetivo: Describir las características clínicas y desenlaces al tratamiento de los pacientes con tuberculosis resistente a isoniazida (Hr-TB) en una institución del suroccidente colombiano. Materiales y métodos: Se realizó un estudio observacional retrospectivo. Se incluyeron pacientes con confirmación diagnóstica, aislamiento microbiológico, pruebas de susceptibilidad a fármacos y evidencia de Hr-TB. Resultados: Se incluyeron 32 pacientes con Hr-TB entre 2006-2018 que corresponden al 6% (32/528) de resistencia del total de casos. El 78% (n=25) fueron casos nuevos, resistencia primaria, y el 22% (n=7) previamente tratados, resistencia adquirida. La comorbilidad más frecuente fue infección por VIH (n=9). El patrón de Hr-TB mostró en 23 (72%) casos con alto nivel, 4 (12%) de bajo nivel y 5 (16%) con bajo y alto nivel. El análisis de resultados al tratamiento se realizó a 22 pacientes, presentando el 50% cura, el 41% tratamiento completo y 9% muerte relacionada con la tuberculosis. Conclusiones: La Hr-TB predomina en los casos nuevos, lo que supone un obstáculo al tratamiento donde no se realizan las pruebas de susceptibilidad de forma rutinaria.

Objective: To describe the clinical characteristics and outcomes to the treatment of patients with isoniazid-resistant tuberculosis (Hr-TB) in an institution in southwest Colombia. Materials and methods: A retrospective observational study was conducted. Patients with diagnostic confirmation, microbiological isolation, drug susceptibility tests, and evidence of Hr-TB were included. Results: Thirty-two patients with Hr-TB were included between 2006-2018, corresponding to 6% (32/528) of resistance in total cases. 78% were new cases, primary resistance, and 22% previously treated, acquired resistance. The most frequent comorbidity was HIV infection (n = 9). The pattern of Hr-TB showed in 23 (72%) cases with high level, 4 (12%) of low level and 5 (16%) with low and high level. The analysis of treatment results was performed on 22 patients, presenting 50% cure, 41% completed treatment, and 9% death related to tuberculosis. Conclusions: Hr-TB predominates in new cases, which is an obstacle to treatment where susceptibility tests are not performed routinely.

Dengue Virus Infection in Solid Organ Transplant Recipients: A Case Series and Literature Review.

Dengue fever is the most prevalent arbovirus infection among humans, and tropical regions are hyperendemic for this infection. The number of solid organ transplant recipients is continuously increasing, and there are few data regarding the clinical course and outcomes of dengue infection among this population. We report on a retrospective case series of solid organ transplant recipients with dengue virus infection from 2001 to 2018 at Fundación Valle del Lili in Cali, Colombia. A total of 20 patients were included. The median age was 50.5 years (interquartile range [IQR] = 31-63.5 years) and 65% were female. Regarding the clinical course, 75% of patients had at least one warning sign, 45% were managed in the intensive care unit, and 30% had severe dengue. The median of time from transplant and dengue infection was 27.6 months (IQR = 3.82-59.12 months), and three patients had the disease in the first month after the transplant. All patients were discharged, and none of them had graft rejection. Dengue is an endemic disease in our region and represents a threat among solid organ transplantation recipients. All patients had a full recovery after the infection, suggesting that timely and effective management of patients and the access to high-complexity services could prevent fatal cases.

Curso clínico de pacientes de trasplante autógeno de médula ósea portadores del virus linfotrópico humano / Clinical evolution of carriers of human T-lymphotropic virus 1 after autologous hematopoietic stem cell transplantation

La infección por virus linfotrópico humano 1 es frecuente en la costa pacífica colombiana y se ha relacionado con leucemia/linfoma de células T del adulto y mielopatía en una proporción baja de los seropositivos. En pacientes con trasplante de órganos sólidos pareciera que estas patologías se desarrollan más rápidamente que en los otros escenarios pero se desconoce el curso de la infección por virus linfotrópico humano 1 en trasplante de médula ósea por lo cual describimos 3 casos de pacientes seropositivos y linfoma que fueron llevados a trasplante autógeno. Uno de ellos tuvo recaída de su patología hematológica y falleció a consecuencia de la misma, otra paciente presentó un cuadro compatible con mielopatía asociada al virus linfotrópico humano 1 y la última, una enfermedad injerto contra hospedero. En las personas seropositivas y que necesitan un trasplante de células hematopoyéticas se requiere una búsqueda activa de este virus para hacer seguimientos y evaluar su impacto real en los desenlaces y saber si el curso de la infección podría cambiar con el régimen condicionante del trasplante.

Human T-lymphotropic virus 1 infection is common in Colombia´s Pacific coast and has been linked to adult T-cell leukemia/lymphoma and human T-lymphotropic virus 1-associated myelopathy in a low percentage of cases. In patients with solid organ transplantation, these diseases occur more quickly than in other scenarios but in bone marrow transplantation the true impact is unknown. We describe 3 seropositive patients with lymphoma who underwent autologous stem cell transplantation; in one case there was relapse of the hematologic malignancy and death occurred as a result. Another patient had symptoms compatible with human T-lymphotropic virus 1-associated myelopathy and the last patient had a graft vs. host disease. In seropositive people who need hematopoietic cell transplantation, an active search for this virus is required to be able to follow and assess the virus´s impact on outcomes, as well as to assess whether the evolution could change according to the transplant conditioning regimen.

Resistencia a fármacos antituberculosis en pacientes coinfectados con tuberculosis y virus de la inmunodeficiencia humana, en un hospital de referencia de 2007 a 2010 en Cali (Colombia) / Resistance to anti-tuberculosis drugs in patients co-infected with tuberculosis and human immunodeficiency virus from 2007 to 2010 in a reference hospital in Cali (Colombia)

Objetivo: La resistencia a los fármacos antituberculosis es de gran interés en salud pública. La coinfección con virus de la inmunodeficiencia humana (VIH) ha cambiado el comportamiento de dicha enfermedad. El objetivo de nuestro estudio es determinar la prevalencia de la resistencia a fármacos antituberculosis en pacientes coinfectados con tuberculosis (TB)/VIH. Método: Se realizó un estudio retrospectivo a partir de la revisión de los registros clínicos de casos nuevos y fracasos de TB coinfectados con VIH que consultaron a un centro de atención de nivel IV desde 2007 a 2010 y que contaban con pruebas de susceptibilidad. Resultados: Un 52% de los pacientes procedían de Santiago de Cali, y un 8%, de Buenaventura. La TB se presentó de forma extrapulmonar en el 80% de los pacientes. Del 48% de los sujetos que conocían su estado VIH previo al diagnóstico de la TB, el 40% estaban en terapia antirretroviral. El 16% de los casos eran fracasos, entre los cuales se detectó un caso multidrogorresistente. De los casos nuevos, se encontró monorresistencia a la isoniazida del 14%, y una resistencia total del 28%. Conclusiones: Se encontró una mayor prevalencia de resistencia a la esperada en población coinfectada TB/VIH; por lo que es necesario fortalecer el trabajo en equipo entre las entidades públicas y privadas para controlar dicha situación y fomentar el diagnóstico temprano y la realización de pruebas de susceptibilidad a fármacos antituberculosis.

Background: Resistance to anti-tuberculosis treatment is a matter of great interest in terms of public health. TB/HIV coinfection changed what was previously known about TB. Our study attempts to determine the prevalence of resistance to TB drugs among a local TB/HIV population. Methods: A retrospective study was conducted, which consisted of a review of the clinical records of new and relapsing cases of TB/HIV coinfected patients, with drug susceptibility tests, who attended an advanced medical care centre in Cali, Colombia, between 2007 and 2010. Results: Just over half (52%) of the patients were native from Cali, and 8% were from Buenaventura. An extra-pulmonary presentation of TB was seen in 80% of the subjects. Almost half (48%) were HIV positive before the diagnosis of tuberculosis was made, 40% of whom were on HAART treatment. Of the total cases, 16% were relapses, including one case of multi-drug resistant (MDR)-TB. Among the new cases, 14% were resistant to isoniazid only, making a total of 28% being resistant to this. Conclusions: There was a higher than expected prevalence of resistance in TB/HIV patients. There is an urgent need to improve the team work between public health organizations and private medical institutions, and this cooperation hould be of great priority, as it is a means to control and promote early diagnosis with drug-susceptibility tests.

Age-related morphological changes in smooth muscle and collagen content in human corpus cavernosum.

INTRODUCTION: Aging process has been related to erectile dysfunction (ED) possibly due to morphological changes in corpus cavernosum among many other causes. AIM: To evaluate smooth muscle and collagen content in human corpus cavernosum and to correlate it to age. METHODS: Cadaveric human cavernosal tissue was collected during the period of 1 year. Morphological analysis of a whole corpus cavernosum was performed in tissue sections stained with Masson's trichromic method to differentiate smooth muscle (red) from collagen (blue) content. MAIN OUTCOME MEASURES: Analysis was performed with specialized micrographs image analysis software. Pearson's correlation test was used to establish correlation between corpus cavernosum morphology (smooth muscle and collagen content) and age. RESULTS: A total sample of 89 tissues from different male cadavers were analyzed. The average age of the sample was 49.2 ± 19.1 years, with a range between 14 and 90 years. There was a statistically significant inverse correlation between age and the percentage of smooth muscle content (P = 0.012), direct correlation between age and percentage of collagen content (P = 0.019), and inverse correlation between age and the ratio of smooth muscle : collagen content (P = 0.007). CONCLUSIONS: Age-related morphological changes in terms of smooth muscle and collagen content are observed in human corpus cavernosum as a possible contributing factor to the development of ED.

Diátesis trombótica en paciente inmunocompetente con infección aguda por citomegalovirus / Thrombotic diathesis in an immunocompetent patient with acute cytomegalovirus infection

Se informa el caso de una mujer de 58 años, inmunocompetente, sin antecedentes de enfermedad procoagulante, quien desarrolla fenómenos trombóticos múltiples en el curso de una infección aguda por citomegalovirus.

Safety and elicitation of humoral and cellular responses in colombian malaria-naive volunteers by a Plasmodium vivax circumsporozoite protein-derived synthetic vaccine.

Substantial experimental evidence indicates that the Plasmodium circumsporozoite (CS) protein has great potential as a vaccine candidate. We tested the safety and immunogenicity of vaccines composed of P. vivax CS-derived synthetic peptides. Sixty-nine healthy, malaria-naive volunteers were randomized to receive three injections of placebo or synthetic proteins N, R, or C (10, 30, or 100 microg/dose) in a double-blinded fashion. Vaccines were well tolerated and no serious adverse events were observed. Peptides N and R elicited humoral responses at all doses; peptide C elicicted these responses only at doses of 30 and 100 microg. The N peptide at a dose of 100 microg elicited the greatest antibody response. Antibodies to the three peptides recognized P. vivax sporozoites in an immunofluorescent antibody test. Peripheral blood mononuclear cells from most immunized volunteers also produced interferon-gamma upon peptide in vitro stimulation. These vaccines appear safe, well tolerated, and immunogenic in malaria-naive volunteers. Further optimization and development of this vaccine is being attempted to conduct phase II clinical trials.

Proceso para el desarrollo de una vacuna contra la fase hepática de Plasmodium vivax / Process to development a vaccine against to hepatic phase of Plasmodium vivax

Introducción: Anualmente se producen en el mundo entre 80 y 100 millones de casos de malaria ocasionada por Plasmodium vivax, segunda especie de Plasmodium en importancia a nivel mundial y primera en el continente americano. Ante la falla de los métodos clásicos de control de la malaria, derivada de la creciente resistencia de los mosquitos a los insecticidas y de los parásitos a los medicamentos disponibles, se ha trabajado intensamente en la búsqueda de vacunas que puedan prevenir completamente la infección o limitar los efectos patológicos de la enfermedad. Objetivos: Este trabajo describe el proceso de desarrollo de una vacuna experimental dirigida contra las formas pre-eritrocíticas del parásito, para lo cual se ha seleccionado la proteína circumesporozoito (CS) que se expresa de forma abundante en la superficie del parásito y que se halla comprometida en el proceso de invasión hepática. Metodología: El proceso consistió en una exhaustiva caracterización inmunológica de la proteína, mediante péptidos sintéticos de diferente longitud, seguida de pruebas de toxicidad e inmunogenicidad en animales con los tres péptidos largos que cubren las regiones N, R y C de la CS. Como etapa inicial de la prueba en humanos, se hizo un ensayo clínico fase I que probó la seguridad e inmunogenicidad, de cada uno de los péptidos formulados en el adyuvante Montanide ISA-720. El ensayo fue al azar, doble ciego y comprometió a 23 voluntarios sanos, hombres y mujeres entre 18 y 33 años de edad, sin historia de malaria. Conclusiones: La vacuna fue muy bien tolerada y demostró buena seguridad e inmunogenicidad en los ensayos preclínicos así como en todos los voluntarios, facilitando el avance a ulteriores fases de investigaciónclinica

Diagnóstico por imágenes / Diagnoses through images

Mujer de 64 años, quien ingreso a la fundación Clinica Valle del Lili con un cuadro de aproximadamente un año de evolución consistente en fiebre intermitente de bajo grado, pérdida del estado general, debilidad y episodios nocturnos ocasionales de tos no producida. Como antedecedentes patológicos, la pasiente presentaba HTA crónica desde hace 30 años, manejada con diltiazem (30mg/día), dislipidemia mixta manejada con lovastatina (20mg/día) e infeccion recurrente de vias urinarias de 2 años de evolución, manejada con nitrofutatoina (100mg/día) tomada de manera continua, siendo suspendida de forma ocasional durante algunos meses. Detalles del artículo

Diagnóstico por imágenes / Diagnoses through images

Paciente de 23 años, quien fue remitido a la Fundacion Clinica Valle del Lili por cuadro de 10 dias de evolucion, iniciado luego de ser sometido a extraccion de la cordal inferior izquierda en un consultorio dental. Comienza con dolor y edema en el area del procedimiento, recibe Dicloxacilina y otros antibioticos con incremento de dolor y el edema. Aparece halitosis severa, dolor toracico y dificultad respiratoria progresiva. Al ingreso con una frecuencia respiratoria de 56 por minuto y cardiaca de 97 por minuto, tension arterial de 108/80 y temperatura de 37º C. Presentaba gran edema de cuello y un absceso periodontal izquierdo con salida de abundante material purulento fetido. A la auscultacion presentaba marcada hipoventilacion basal derecha.