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Comach G.,University of Carabobo | Teneza-Mora N.,Naval Medical Research Center | Kochel T.J.,Naval Medical Research Center | Kochel T.J.,Us Naval Medical Research Unit Six Namru 6 | And 12 more authors.
PLoS ONE | Year: 2012

Background: Limited information exists on the epidemiology of acute febrile respiratory illnesses in tropical South American countries such as Venezuela. The objective of the present study was to examine the epidemiology of influenza-like illness (ILI) in two hospitals in Maracay, Venezuela. Methodology/Principal Findings: We performed a prospective surveillance study of persons with ILI who presented for care at two hospitals in Maracay, Venezuela, from October 2006 to December 2010. A respiratory specimen and clinical information were obtained from each participant. Viral isolation and identification with immunofluorescent antibodies and molecular methods were employed to detect respiratory viruses such as adenovirus, influenza A and B, parainfluenza, and respiratory sincytial virus, among others. There were 916 participants in the study (median age: 17 years; range: 1 month - 86 years). Viruses were identified in 143 (15.6%) subjects, and one participant was found to have a co-infection with more than one virus. Influenza viruses, including pandemic H1N1 2009, were the most frequently detected pathogens, accounting for 67.4% (97/144) of the viruses detected. Adenovirus (15/144), parainfluenza virus (13/144), and respiratory syncytial virus (11/144) were also important causes of ILI in this study. Pandemic H1N1 2009 virus became the most commonly isolated influenza virus during its initial appearance in 2009. Two waves of the pandemic were observed: the first which peaked in August 2009 and the second - higher than the preceding - that peaked in October 2009. In 2010, influenza A/H3N2 re-emerged as the most predominant respiratory virus detected. Conclusions/Significance: Influenza viruses were the most commonly detected viral organisms among patients with acute febrile respiratory illnesses presenting at two hospitals in Maracay, Venezuela. Pandemic H1N1 2009 influenza virus did not completely replace other circulating influenza viruses during its initial appearance in 2009. Seasonal influenza A/H3N2 was the most common influenza virus in the post-pandemic phase.

Keiserman M.,University of Porto | Handa R.,Apollo Indraprastha Hospitals | Xibille-Friedmann D.,Autonomous University of the State of Morelos | Mysler E.,Organizacion Medica de Investigacion | And 2 more authors.
Expert Review of Clinical Immunology | Year: 2014

Biologic therapies, predominantly TNF-α inhibitors, have revolutionized the treatment of rheumatoid arthritis (RA). However, their clinical utility can be limited by the development of antidrug antibodies (ADAs). Immunogenicity is a complex phenomenon related to various drug, disease, and patient characteristics, and may be more common with the monoclonal antibodies than with etanercept, a soluble TNF receptor-Fc immunoglobulin fusion protein. Neutralizing antibodies-those that hinder bioactivity by preventing drug molecules from binding to TNF-are correlated with reduced serum drug concentrations, loss of therapeutic response, adverse events, and treatment discontinuation. Cost-effective use of these agents will depend on further research into drug and ADA assays, and how they should guide dose reduction or switching strategies. © 2014 Informa UK, Ltd.

Chagas disease is one of the main public health problems today in Central and South American countries. Patients infected with Trypanosoma cruzi who develop severe myocardial damage have a high risk of mortality from heart failure or sudden death. The continuous presence of low loads of the parasite, the immune response, alteration of the coronary microvasculature, and heart disautonomy are the proposed mechanisms explaining the development of a cardiomyopathy in the chronic phase. Other investigations suggest that the abnormalities of the parasympathetic nervous system and sympathetic prevalence present in Chagas cardiopathy are preceded by myocardial damage, similarly as in other cardiopathies in dilated phase, where this neurohumoral activation would contribute to the progress of the cardiomyopathy; and that favorable results in the natural course of the illness can be obtained with the use of medication for the control of this activity. Currently, there are few studies assessing the benefits of medications for the treatment of heart failure in Chagas cardiomyopathy, but evidence from randomized follow-up and observational studies suggests that medications such as angiotensin converting enzyme inhibitors, beta blocker adrenergic and antiarrhythmics like amiodarone, among others, are effective and safe for the treatment of this cardiopathy.

Lima-Martinez M.M.,University of the East Venezuela | Paoli M.,University of Los Andes, Venezuela | Donis J.H.,University of Los Andes, Venezuela | Odreman R.,University of Los Andes, Venezuela | And 2 more authors.
Endocrinologia y Nutricion | Year: 2013

Objective: To define an echocardiographically-assessed cut-off point for epicardial adipose tissue (EAT) thickness associated to metabolic syndrome (MS) components in Venezuelan subjects. Methods: Fifty-two subjects aged 20-65. years diagnosed with MS according to International Diabetes Federation criteria and 45. sex- and age-matched controls were selected. Blood glucose and plasma lipids were tested; EAT thickness and left ventricular mass were measured by echocardiography. Results: No significant age and sex differences were found between the two groups. Body weight, body mass index, waist circumference, and systolic and diastolic blood pressure were significantly higher (P = .0001) in the MS group. This group showed significantly higher levels of fasting blood glucose (P = .0001), total cholesterol (P = .002), LDL-C (P = .007), non-HDL-C (P = .0001), triglycerides (P = .0001), Tg-HDL-C ratio (P = .0001), and lower HDL-C levels (P = .0001) as compared to the control group. EAT thickness (P = .0001) and left ventricular mass (P = .017) were significantly higher in the MS group. The ROC curve showed an AUC of 0.852 (P = .0001) with a power of the test of 0.99. A 5-mm EAT thickness showed a sensitivity of 84.62% (95%. CI: 71.9-93.1) and a specificity of 71.11% (95%. CI: 55.7-83.6) for predicting MS. The odds ratio of this population for experiencing MS due to an EAT ≥ 5 mm was 8.25 (95%. CI: 3.15-21.56; P = .0001). Conclusion: An EAT value ≥ 5 mm has good sensitivity and specificity for predicting MS in the Venezuelan population. © 2012 SEEN.

Ramos-Luces O.,Instituto Venezolano Of Los Seguros Sociales
Cirugia y cirujanos | Year: 2011

The registration of cases of surgical site infection (SSI) for the period of hospitalization has a bias whose magnitude is not known in our environment. The aim of this study was to measure the incidence of SSI in primary interventions for patients using an ambulatory monitoring system. We designed a cross-sectional, descriptive study of patients undergoing primary surgery. All patients were assessed at the 2nd, 7th and 21st day after surgery. We used criteria of wound infection according to the Centers for Disease Control and Prevention (CDC), Atlanta, GA. Comparison of variables was performed using χ(2) and Fisher's exact test. Analysis of variables related to the risk of SSI and the control variables was performed using logistic regression. Of 152 patients (107 males and 45 females), 32 were diagnosed with SSI at 48 h and at 7 and 21 days after surgery, respectively. The type of surgery (emergency), surgical risk according to the American Society of Anesthesiologists (ASA), duration of surgery, body mass index (BMI) and underlying diseases are predictors of SSI and were statistically significant (p <0.05). Culture was performed in 32 cases and Escherichia coli were isolated in 25%. In this series of unselected patients, the incidence of SSI reached 21.1% after a 1-month minimum follow-up.

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