Algunos factores del estilo de vida y su relación con el cáncer de mama en mujeres mayores de 25 años de la región metropolitana de salud : años: 1996-1997

Considerando que el estilo de vida y los patrones de conducta son los principales factores determinantes de la morbimortabilidad de nuestra sociedad, destacándose la patológica maligna como una consecuencia de estos. Realizamos el presente estudio de casos y controles en las mujeres mayores de 25 años en la Región Metropolitana de Salud, con el objetivo de identificar la relación existente estos y el cáncer de mama. Los factores de riesgo seleccionados para este estudio fueron la obesidad/sobrepeso, el consumo de alcohol y el consumo de tabaco y la lactancia materna. La muestra estuvo constituida por 100 casos captados en el Instituto Oncológico Nacional en 1996 — 1997 procedentes de la Región Metropolitana de Salud y 211 controles que se escogieron mediante muestreo aleatorio estratificado de la misma área geográfica. Se detectaron como factores de riesgo de Cáncer de mama la obesidad / sobrepeso (0.R. = 2.77, X= 15.13, p= 2.7) y el consumo de alcohol (0.R. = 2.26, X2= 11.80, p 0.0008) y como factor protector la lactancia materna (0.R. = 0.30, X2= 18.27, p= 0.0000). No se detectó significancia estadística entre el consumo de tabaco y el cáncer de mama. En las variables de confusión estudiadas no se detectó dicho efecto, sólo la interacción del estado menstrual y el antecedente familiar de cáncer de mama para la relación con la obesidad/sobrepeso y el consumo de alcohol entre otras, no así para la lactancia materna. Es necesario fortalecer la educación a la población sobre los estilos de vida saludables, dado su rol en la génesis de este y muchos otros problemas de salud

Population genomics of Plasmodium vivax in Panama to assess the risk of case importation on malaria elimination

Malaria incidence in Panama has plateaued in recent years in spite of elimination efforts, with almost all cases caused by Plasmodium vivax. Notwithstanding, overall malaria prevalence remains low (fewer than 1 case per 1000 persons). We used selective whole genome amplification to sequence 59 P. vivax samples from Panama. The P. vivax samples were collected from two periods (2007–2009 and 2017–2019) to study the population structure and transmission dynamics of the parasite. Imported cases resulting from increased levels of human migration could threaten malaria elimination prospects, and four of the samples evaluated came from individuals with travel history. We explored patterns of recent common ancestry among the samples and observed that a highly genetically related lineage (termed CL1) was dominant among the samples (47 out of 59 samples with good sequencing coverage), spanning the entire period of the collection (2007–2019) and all regions of the country. We also found a second, smaller clonal lineage (termed CL2) of four parasites collected between 2017 and 2019. To explore the regional context of Panamanian P. vivax we conducted principal components analysis and constructed a neighbor-joining tree using these samples and samples collected worldwide from a previous study. Three of the four samples with travel history clustered with samples collected from their suspected country of origin (consistent with importation), while one appears to have been a result of local transmission. The small number of Panamanian P. vivax samples not belonging to either CL1 or CL2 clustered with samples collected from Colombia, suggesting they represent the genetically similar ancestral P. vivax population in Panama or were recently imported from Colombia. The low diversity we observe in Panama indicates that this parasite population has been previously subject to a severe bottleneck and may be eligible for elimination. Additionally, while we confirmed that P. vivax is imported to Panama from diverse geographic locations, the lack of impact from imported cases on the overall parasite population genomic profile suggests that onward transmission from such cases is limited and that imported cases may not presently pose a major barrier to elimination

Comparison of PvLAP5 and Pvs25 qRT-PCR assays for the detection of Plasmodium vivax gametocytes in field samples preserved at ambient temperature from remote malaria endemic regions of Panama

Background: As the elimination of malaria in Mesoamerica progresses, detection of Plasmodium vivax using light microscopy (LM) becomes more difficult. Highly sensitive molecular tools have been developed to help determine the hidden reservoir of malaria transmission in low transmission settings. In this study we compare the performance of PvLAP5 and Pvs25 qRT-PCR assays to LM for the detection of Plasmodium vivax gametocytes in field samples preserved at ambient temperature from malaria endemic regions of Panama. Methods: For this purpose, we collected a total of 83 malaria field samples during 2017-2020 preserved in RNAprotect (RNAp) of which 63 (76%) were confirmed P. vivax by LM and selected for further analysis. Additionally, 16 blood samples from local healthy malaria smear negative volunteers, as well as, from 15 malaria naïve lab-bred Aotus monkeys were used as controls. To optimize the assays, we first determined the minimum blood volume sufficient for detection of PvLAP5 and Pv18SrRNA using P. vivax infected Aotus blood that was preserved in RNAp and kept either at ambient temperature for up to 8 days before freezing or was snap-frozen at -80° Celsius at the time of bleeding. We then compared the mean differences in gametocyte detection rates of both qRT-PCR assays to LM and performed a multivariate correlation analysis of study variables. Finally, we determined the sensitivity (Se) and specificity (Sp) of the assays at detecting gametocytes compared to LM. Results: Blood volume optimization indicated that a blood volume of at least 60 μL was sufficient for detection of PvLAP5 and Pv18SrRNA and no significant differences were found between RNA storage conditions. Both PvLAP5 and Pvs25 qRT-PCR assays showed a 37-39% increase in gametocyte detection rate compared to LM respectively. Strong positive correlations were found between gametocytemia and parasitemia and both PvLAP5 and Pvs25 gametocyte markers. However, no significant differences were detected in the Se and Sp of the Pvs25 and PvLAP5 qRT-PCR assays, even though data from control samples suggested Pvs25 to be more abundant than PvLAP5. Conclusions: This study shows that the PvLAP5 qRT-PCR assay is as Se and Sp as the gold standard Pvs25 assay and is at least 37% more sensitive than LM at detecting P. vivax gametocytes in field samples preserved in RNAp at ambient temperature from malaria endemic regions of Panama. Author summary: Plasmodium vivax is one of the five species of malaria (P. falciparum, P. malariae, P. ovale and P. knowlesi) that are transmitted to man by the bite of female anopheles mosquitoes. It causes ~14.3 million cases mainly in Southeast Asia, India, the Western Pacific and the Americas annually. In the Americas, malaria remains a major problem in underdeveloped areas and indigenous communities in the Amazon region and eastern Panama, where it is endemic and difficult to eliminate. As malaria elimination progresses, detection of P. vivax by light microscopy (LM) becomes more difficult. Therefore, highly sensitive molecular tools have been developed that use genetic markers for the parasite to help determine the hidden reservoir of malaria transmission. This study compares the performance of two molecular assays based on the genetic markers of mature gametocytes PvLAP5 and Pvs25 with LM. The study shows that the PvLAP5 qRT-PCR assay is as sensitive and specific as the gold standard Pvs25 assay and is at least 37% more sensitive than LM at detecting P. vivax gametocytes. These data suggest that the PvLAP5 qRT-PCR assay can be a useful tool to help determine the hidden reservoir of transmission in endemic foci approaching elimination

Adult immunization practices, challenges and opportunities in Central America and the Caribbean: Advisory board proceedings

As individuals age, they become increasingly prone to infectious diseases, many of which are vaccine-preventable diseases (VPDs). Adult immunization has become a public health priority in the modern era, yet VPDs vaccination rates for adults are low worldwide. In Central America and Caribbean, national recommendations and vaccination practices in adults differ across countries, and adult vaccination coverage data are limited. An advisory board comprised infectious disease experts, pulmonologists, geriatricians, occupational health, and public health professionals for Central America and Dominican Republic was convened to: a) describe adult immunization practices in these countries; b) discuss challenges and barriers to adult vaccination; and c) find strategies to increase awareness about VPDs. The advisory board discussions reflect that national immunization guidelines typically do not include routine vaccine recommendations for all adults, but rather focus on those with risk factors. This is the case for influenza, pneumococcal, and hepatitis B immunizations. Overall, knowledge lacks about the VPD burden among health-care professionals and the general public. Even more, there is insufficient information on vaccinology for students in medical schools. Actions from the responsible authorities – medical schools and scientific societies which can advocate for vaccination and a better knowledge in vaccinology – can help address these issues. A preventive medicine culture in the workplace may contribute to the advancement of public opinion on vaccination. Promoting vaccine education and research could be facilitated via working groups formed by disease experts, public and private sectors, and supranational authorities, in an ethical and transparent manner

Comparison of the incidence rates of CHIKV and DENV infection in 2014 and 2015 in Panama.

<p>Comparison of the incidence rates of CHIKV and DENV infection in 2014 and 2015 in Panama.</p

Confirmed chikungunya cases distribution in all Panamanian national territory.

<p>Map of Panama with a closer view of Panama City and its surrounding areas. Red triangles represent the cases of 2014 while green dots cases of 2015.</p

Epidemic curve of chikungunya and dengue cases reported in Panama country from 2014 to July 2015.

<p><b>A.</b> Red bar represents Chikungunya imported cases and blue bar autochthonous cases. <b>B.</b> Blue dots represent dengue positive cases in the country of Panama from the National Dengue surveillance program (left axis). From this surveillance ICGES detected ~10% (577/6459) of the national dengue positive cases (green broken line, right axis). All the positive Chikungunya cases (red bar, right axis) from the National Chikungunya Surveillance program were analyzed at ICGES.</p

Epidemic curve and vector infestation level reported for each epidemiological week during 2014 and 2015 in Panama and San Miguelito districts.

<p><b>(A)</b> Epidemic curve of CHIKV infections (97/107) from epidemiological week 19 in 2014 to 26 in 2015; autochthonous (red) and impor (blue) cases reported. (<b>B)</b> Time serial analysis showing data collected (black), interpolated (grey) and predicted (red) of <i>Ae</i>. <i>aegypti</i> and <i>Ae</i>. <i>albopictus</i> infestation level. (<b>C)</b> Abundance tendency of <i>Ae</i>. <i>aegypti</i> (blue bars) and <i>Ae. albopictus</i> (black line).</p