Highly pathogenic avian influenza A (H5N1) in marine mammals and seabirds in Peru

Highly pathogenic avian influenza (HPAI) A/H5N1 viruses (lineage 2.3.4.4b) are rapidly invading the Americas, threatening wildlife, poultry, and potentially evolving into the next global pandemic. In November 2022 HPAI arrived in Peru, triggering massive pelican and sea lion die-offs. We report genomic characterization of HPAI/H5N1 in five species of marine mammals and seabirds (dolphins, sea lions, sanderlings, pelicans and cormorants). Peruvian viruses belong to lineage 2.3.4.4b, but they are 4:4 reassortants where 4 genomic segments (PA, HA, NA and MP) position within the Eurasian lineage that initially entered North America from Eurasia, while the other 4 genomic segments (PB2, PB1, NP and NS) position within the American lineage (clade C) that circulated in North America. These viruses are rapidly accruing mutations, including mutations of concern, that warrant further examination and highlight an urgent need for active local surveillance to manage outbreaks and limit spillover into other species, including humans.

Minority Gene Expression Profiling: Probing the Genetic Signatures of Pathogenesis Using Ribosome Profiling

Minority Gene Expression Profiling (MGEP) refers to a scenario where the expression profiles of specific genes of interest are concentrated in a small cellular pool that is embedded within a larger, non-expressive pool. An example of this is the analysis of disease-related genes within sub-populations of blood or biopsied tissues. These systems are characterized by low signal-to-noise ratios that make it difficult, if not impossible, to uncover the desired signatures of pathogenesis in the absence of lengthy, and often problematic, technical manipulations. We have adapted ribosome profiling (RP) workflows from the Illumina to the Ion Proton platform and used them to analyze signatures of pathogenesis in an MGEP model system consisting of human cells eliciting <3% productive dengue infection. We find that RP is powerful enough to identify relevant responses of differentially expressed genes, even in the presence of significant noise. We discuss how to deal with sources of unwanted variation, and propose ways to further improve this powerful approach to the study of pathogenic signatures within MGEP systems.

Isolation of Complete Equine Encephalitis Virus Genome from Human Swab Specimen, Peru

While studying respiratory infections in Peru, we identified Venezuelan equine encephalitis virus (VEEV) in a nasopharyngeal swab, indicating that this alphavirus can be present in human respiratory secretions. Because VEEV may be infectious when aerosolized, our finding is relevant for the management of VEEV-infected patients and for VEEV transmission studies.

Medium term effects of physical conditioning on breath-hold diving performance

The current study aimed to analyze the effects of physical conditioning inclusion on apnea performance after a 22-week structured apnea training program. Twenty-nine male breath-hold divers participated and were allocated into: (1) cross-training in apnea and physical activity (CT; n = 10); (2) apnea training only (AT; n = 10); and control group (CG; n = 9). Measures were static apnea (STA), dynamic with fins (DYN) and dynamic no fins (DNF) performance, body composition, hemoglobin, vital capacity (VC), maximal aerobic capacity (VO2max), resting metabolic rate, oxygen saturation, and pulse during a static apnea in dry conditions at baseline and after the intervention. Total performance, referred as POINTS (constructed from the variables STA, DNF and DYN) was used as a global performance variable on apnea indoor diving. + 30, +26 vs. + 4 average POINTS of difference after-before training for CT, AT and CG respectively were found. After a discriminant analysis, CT appears to be the most appropriate for DNF performance. The post-hoc analysis determined that the CT was the only group in which the difference of means was significant before and after training for the VC (p < 0.01) and VO_2max (p < 0.05) variables. Inclusion of physical activity in apnea training increased VC and VO2max in breath hold divers; divers who followed a mixed training, physical training and hypoxic training, achieved increased DNF performance.

Full Genomic Characterization of a Saffold Virus Isolated in Peru

While studying respiratory infections of unknown etiology we detected Saffold virus in an oropharyngeal swab collected from a two-year-old female suffering from diarrhea and respiratory illness. The full viral genome recovered by deep sequencing showed 98% identity to a previously described Saffold strain isolated in Japan. Phylogenetic analysis confirmed the Peruvian Saffold strain belongs to genotype 3 and is most closely related to strains that have circulated in Asia. This is the first documented case report of Saffold virus in Peru and the only complete genomic characterization of a Saffold-3 isolate from the Americas.

Improved protease stability of the antimicrobial peptide Pin2 substituted with D-amino acids

Cationic antimicrobial peptides (AMPs) have attracted a great interest as novel class of antibiotics that might help in the treatment of infectious diseases caused by pathogenic bacteria. However, some AMPs with high antimicrobial activities are also highly hemolytic and subject to proteolytic degradation from human and bacterial proteases that limit their pharmaceutical uses. In this work a D-diastereomer of Pandinin 2, D-Pin2, was constructed to observe if it maintained antimicrobial activity in the same range as the parental one, but with the purpose of reducing its hemolytic activity to human erythrocytes and improving its ability to resist proteolytic cleavage. Although, the hydrophobic and secondary structure characteristics of L- and D-Pin2 were to some extent similar, an important reduction in D-Pin2 hemolytic activity (30-40 %) was achieved compared to that of L-Pin2 over human erythrocytes. Furthermore, D-Pin2 had an antimicrobial activity with a MIC value of 12.5 μM towards Staphylococcus aureus, Escherichia coli, Streptococcus agalactiae and two strains of Pseudomonas aeruginosa in agar diffusion assays, but it was half less potent than that of L-Pin2. Nevertheless, the antimicrobial activity of D-Pin2 was equally effective as that of L-Pin2 in microdilution assays. Yet, when D- and L-Pin2 were incubated with trypsin, elastase and whole human serum, only D-Pin2 kept its antimicrobial activity towards all bacteria, but in diluted human serum, L- and D-Pin2 maintained similar peptide stability. Finally, when L- and D-Pin2 were incubated with proteases from P. aeruginosa DFU3 culture, a clinical isolated strain, D-Pin2 kept its antibiotic activity while L-Pin2 was not effective.

Assessment of plaque assay methods for alphaviruses

Viruses from the Alphavirus genus are responsible for numerous arboviral diseases impacting human health throughout the world. Confirmation of acute alphavirus infection is based on viral isolation, identification of viral RNA, or a fourfold or greater increase in antibody titers between acute and convalescent samples. In convalescence, the specificity of antibodies to an alphavirus may be confirmed by plaque reduction neutralization test. To identify the best method for alphavirus and neutralizing antibody recognition, the standard solid method using a cell monolayer overlay with 0.4% agarose and the semisolid method using a cell suspension overlay with 0.6% carboxymethyl cellulose (CMC) overlay were evaluated. Mayaro virus, Una virus, Venezuelan equine encephalitis virus (VEEV), and Western equine encephalitis virus (WEEV) were selected to be tested by both methods. The results indicate that the solid method showed consistently greater sensitivity than the semisolid method. Also, a "semisolid-variant method" using a 0.6% CMC overlay on a cell monolayer was assayed for virus titration. This method provided the same sensitivity as the solid method for VEEV and also had greater sensitivity for WEEV titration. Modifications in plaque assay conditions affect significantly results and therefore evaluation of the performance of each new assay is needed.

Medical error prevention: The role of oncological nursing

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Background: The medical care of oncological patients is a multidisciplinary task. The nurse is a key member of the team. The aim of this study is to analyze the incidence rate and the type of intravenous chemotherapy prescription errors detected by the nurses in the the ambulatory setting at the IOHM in a 3 months period. Methods: The intravenous chemotherapy treatments (tx) prescribed by the IOHM's staff (14 oncologists and 4 onco-hematologists) between Aug 1, 2008 and Nov 1, 2008, were analyzed. A database was prospectively built with the following variables: attending physician, diagnosis, treatment cycle, drug, dosage, time of perfusion, type of error detected, and potential harm from it. Frequency tables were established for the type of error. The correlation between the rate of errors by prescribing physician and his expertise, weekly hours of work at the institution, number of patients under his care and number of consults were also studied. Results: A total of 5,015 tx administered to 2,492 pt were evaluated (mean of 2.1 tx per pt, range 1–5). The most common cancer diagnoses were breast (20%), colon (16%), lung (10%), and lymphoma (7%). Forty-five medical prescription errors before administration of treatment were found. There were no errors found in the preparation and administration of treatment. Of the 45 errors detected, 18 were related to drug selection (in 2 cases the error could lead to serious complications). Twenty seven errors were related to a dosage mistake (3 cases with serious potential harm). The frequency of medical errors between the attending physicians did not differ statistically (Fisher Exact Test 0.082) and due to the low error rate, none of the other variables could be properly studied. Conclusions: 1. Specialized nursing is a key element in the safety of the patient and the prevention of malpractice, 2. The rate of errors in this population is 0.9% (45 errors out of 5,015) and the rate of potentially serious harm to the patient is 1/1000 tx.; 3) All errors were corrected before drug administration.

No significant financial relationships to disclose.

Noninfectious dermatological diseases associated with chronic exposure to mine tailings in a Peruvian district

BACKGROUND

Mine tailings are metallic wastes which are deposited in the environment due to mining activity. Long-term exposure to these metals is harmful to human health.

OBJECTIVE

To determine if chronic exposure to mine tailings constitutes a risk factor for the development of dermatological diseases in the district of San Mateo de Huanchor (Lima, Peru).

METHODS

An observational case-control study was carried out in the communities of Mayoc, Daza and Tamboraque (exposed to mine tailings, case group) located in the district of San Mateo de Huanchor, and also in the communities of Choccna and Caruya (not exposed to mine tailings, control group) located in the same district. Out of 230 adults, 121 were exposed and 109 were not exposed to mine tailings and out of 135 children, 71 were exposed and 64 were not exposed to mine tailings.

RESULTS

In the adult group, 71% of the exposed cases had some noninfectious dermatological disease while in the nonexposed group the frequency was 34% [P < 0.001; odds ratio (OR) 5.40; 95% confidence interval (CI) 3.02-9.68]. A statistically significant difference between groups was found for arsenical dermatitis, nonpruritic papulovesicular eruption, atopic dermatitis, contact dermatitis, seborrhoeic dermatitis and xerosis. In the paediatric population, 71 exposed and 64 nonexposed children were evaluated. Sixty-nine per cent of the exposed group had some noninfectious dermatological disease vs. 30% in the nonexposed group (P < 0.001; OR 6.00; 95% CI 2.71-13.31). A statistically significant difference between groups was found for xerosis and atopic dermatitis.

CONCLUSION

Chronic exposure to mine tailings represents a risk factor for development of noninfectious dermatological diseases in both adults and children.

Standard therapy deviations in the practice of clinical oncology

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Background: “Errors can be prevented by designing systems that make it hard for people to do the wrong thing and easy for people to do the right thing” (To Err is Human: Building a Safer Health System - report from the Institute of Medicine- USA). The current paper was designed to evaluate, prospectively, the different types of prescription deviation from standards as well as the way they are worked out in the daily practice. Methods: Between October 2004 and December 2006, the Tx of 6611 patients ( pt) were progressively entered into a database and compared with the national and international Tx recommendations (Evidence Based Oncology). The deviations between actual and recommended Tx were classified in two groups: Type I, or deviation from “Gold standard” (Off label prescription, experimental treatments or application of translational research with no evidence of better results regarding survival and/or quality of life over a standard Tx) and Type II, or medical errors with high malpractice risk (misdiagnosis, or drug prescription error in dosage, administration or schedule). The deviation was then pointed out to the attending physician, and their response was catalogued as: “A” (Immediate Correction), ‘B‘ (Administrative appeal to determine the treatment) or “C” (Court appeal to determine the treatment). Results: Eight hundred and sixty two errors were identified in the 6611 pt (13%). Six hundred and forty four (74,7%) were Type I and 218 (25,3%) were Type II.. The physicians were more reluctant to recognize Type I than Type II deviations. The response to the deviations were the following: Type I, response A= 454 cases (71%), Type I, response B 184 cases (28%), Type I, response C: 6 cases (1%). Type II response A: 196 cases (90%), Type II response B: 22 cases (10%). Type II response C: 0. Conclusions: 1) The implementation of a treatment-supervision system is the first step towards providing safer health care in oncology. 2) The 644 Type I prescriptions deviation appear to increase in relation to diffusion of innovations, and their modification is more conflictive. However, 71% are corrected immediately. 3) The 218 Type II prescriptions deviation appear to be related with medical expertise, and their resolution is simpler (90 % with immediate correction). An exhaustive taxonomy of deviations will be presented.

No significant financial relationships to disclose.

Glut 1 expression in transitional cell carcinoma of the urinary bladder is associated with poor patient survival

Cancer cells show increased glucose uptake compared to normal cells. Glut1 has been shown to be expressed in many human cancers, including transitional cell carcinoma of the urinary bladder (TCCB). The aim of this study was to determine the biologic significance of Glut1 expression, as determined by immunohistochemistry, in TCCB. Using the polyclonal anti-Glut1 antibody MYM, microwave-aided antigen retrieval, and standard immunoperoxidase ABC technique, we immunostained sections of formalin-fixed and paraffin-embedded tissue from cystectomy specimens from 40 patients with TCCB, who received no adjuvant therapy. The percent of positive cancer cells was scored on a semiquantitative scale as 1) 0%, 2) 1-10%, 3) 11-25%, 4) 26-50%, 5) 5.1-75%, and 6) > 75%. Statistical analysis was performed using the Kaplan-Meier survival method, the Log rank test, and Fisher's exact test. Glut1 immunoreactivity was detected in 58% of the cases. Glut1 expression in > 10% of cancer cells was associated with worse patient survival than expression in < 10% of the cancer cells (p = 0.0064). Tumors with > 10% Glut1-positive cancer cells were more likely to be of pT2 stage or higher than tumors with < 10% Glut1-positive cells (100% vs 68%, respectively, p = 0.0109), but showed no significant difference in the incidence of nodal metastasis (p = 0.4258). Our results suggest that Glut1 expression in TCCB is a marker of aggressive biologic potential in patients undergoing cystectomy.

[Chemical composition of Creole cattle meat]

Proximal composition was determined in meat's Creole cattle (CGBC). For this purpose, four raw cuts of CGBC were analyzed: buttock, flank, loin blade steak, and shoulder blade steak. The mentioned names of the meat cuts come from the National Meat Bureau from the Republic of Argentina. These cuts were taken from an experimental lot of Creole cattle (n = 11) in Jujuy province. Comparisons were made with data extracted from Argentine Table of Food Composition, edited by National Nutrition Institute, Buenos Aires, Argentina (1942). The results show that the level of protein is slightly inferior (in the case of CGBC varies between 18.44 +/- 0.30 and 21.06 +/- 0.11 g/100 g, while in the CTE varies between 20 and 23.8 g/100 g). The content of lipids in the cuts without visible fat is variable (1.06 +/- 0.01 to 2.74 +/- 0.61 g/100 g in the cuts of CGBC and 1.4 to 8.4 for the cuts of CTE). The content of minerals is similar (Fe 2.26 +/- 0.18 to 2.35 +/- 0.23 mg/100 g in CGBC, while in the CTE varies between 3.15 and 3.46 mg/100 g; Phosphorous varies between 142 +/- 10 and 170 +/- 11 mg/100 g in CGBC and 186 to 213 mg/100 g in CTE). These outcomes allow to affirm that the quality of CGBC beef is very similar to CTE beef with regard to principal nutrients.

Pheochromocytoma associated with neuroendocrine carcinoma. A new type of composite pheochromocytoma

The coexistence of pheochromocytoma and other tumor types in a single adrenal gland has been rarely documented. This type of pheochromocytoma is designated "composite" or "mixed," depending on whether the pheochromocytoma and the nonpheochromocytoma components show the same embryologic origin. The nonpheochromocytoma components reported in the composite pheochromocytoma include ganglioneuroma, ganglioneuroblastoma, neuroblastoma, and malignant schwannoma. The components found in the mixed pheochromocytoma include adrenal cortical neoplasms and spindle cell sarcoma. We report a unique case of composite pheochromocytoma in which the nonpheochromocytoma element is a neuroendocrine carcinoma. The histologic and the immunohistochemical profiles of the 2 distinct components of this tumor were typical for those of pheochromocytoma and neuroendocrine carcinoma. This dual differentiation was also supported by ultrastructural findings. This case not only broadens the morphologic spectrum of composite pheochromocytoma but also provides some additional insight into the histogenesis of this rare but fascinating type of tumor.

Obstruction of the bile duct by a papillary adenoma of the gallbladder

A case of papillary adenoma of the gallbladder unassociated with cholelithiasis and showing detachment of part of the growth with obstruction of the common bile duct is described. One the basis of a search of the literature, it would appear that this is the first time such a case has been reported. The bibliography is discussed and a distinction drawn between this kind of adenoma and other benign tumors of the gallbladder.