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Characteristics of a donor population in western Venezuela.

To determine the characteristics of blood donors in western Venezuela, we collected data from 1983 to 1985 on 31,320 volunteer donors at the Blood Bank of the State of Zulia in Maracaibo. Fifty-nine percent of the donors were blood group O, 30 percent were group A, 9 percent were group B, and 2 percent were group AB. Most of the donors (93%) were Rh positive. One percent of donors had positive reactions to hepatitis B surface antigen, 3.15 percent for syphilis, 1.43 percent for antibodies to Trypanosoma cruzi, and 0.32 percent to human immunodeficiency virus antibodies. About one-half of the donors were between 18 and 30 years old, and only 10 percent were women. To determine if iron deficiency anemia was a cause for the small size of the female donor pool, we measured serum ferritin in 50 first-time female donors. Ten of these (20%) had serum ferritin values below normal, and the distribution of serum ferritin levels of all 50 was very similar to that reported for frequent donors in Europe and the United States, with a clustering of ferritin values between 10 and 70 ng per ml. The data indicate that blood donors in western Venezuela are markedly different from those in the United States and that iron supplementation may be indicated for female Venezuelan donors.

Adolescent↗

Value of a dipstick based on recombinant RK39 antigen for differential diagnosis of American visceral leishmaniasis from other sympatric endemic diseases in Venezuela.

A laboratory trial using recombinant rK39 dipsticks for differential diagnosis of American visceral leishmaniasis (AVL) from other sympatric endemic diseases which share similar clinic features (Chagas disease, malaria, schistosomiasis and toxoplasmosis) was conducted in Venezuela. The 100% specificity of the test previously obtained in other countries was confirmed. The use of this test at the primary health care level in Venezuela for a rapid diagnosis of active AVL cases, which may avoid deaths, is recommended.

Antigens, Protozoan↗

Activity of Lutzomyia pseudolongipalpis and L. longipalpis s.l. (Diptera: Psychodidae) in Venezuela.

The nocturnal activity of the phlebotomine sandfly Lutzomyia pseudolongipalpis and two populations of L. longipalpis s.l. from different American visceral leishmaniasis foci in Venezuela was studied using collection bottle rotator traps. The activity of L. pseudolongipalpis from Lara State was continuous throughout the night, while that of L. longipalpis s.l. from El Layero, Guárico State and from Santa Ana del Valle, Margarita Island, was greatest before 23:00 h. The activity of sandflies of both populations and sexes steadily decreased thereafter. These different patterns seem to correlate with genetic data that indicate the presence in Venezuela of at least two sibling species in the L. longipalpis complex. The advantages of the bottle rotator trap for this type of study are discussed.

Animals↗

A new species of Hypocristata (Nematoda, Trichostrongyuna, Heligmosomoidea) a parasite of Sigmodon hispidus (Cricetidae, Sigmodontinae) from Venezuela.

Description of Hypocristata tercera n. sp. (Heligmonellidae, Nippostrongylinae) a parasite of the small intestine of Sigmodon hispidus (Rodent, Sigmodontinae) from Venezuela. Two other species were described in the genus, both from Colombia and parasitic in Sigmodontinae. H. thomosomysi Durette-Desset, 1970, a parasite of Thomasomys sp. has about the same number of cuticular ridges at mid-body but differs by ridges having chitinoid struts, a caudal bursa pattern of type 2-2-1 (vs 1-3-1). H. anguillula Durette-Desset, 1970, a parasite of Sigmodontomys alfari (= Nectomys alfari) has the same caudal bursa pattern (type 1-3-1) but differs by the presence of ridges at mid-body in both sexes (absent at that level in H. tercera) and by ridges having chitinoid struts in female. This is the first report of the genus Hypocristata Durette-Desset, 1971 in Venezuela and in the genus Sigmodon (Sigmodontinae).

Animals↗

Evidence for clonal propagation in natural isolates of Plasmodium falciparum from Venezuela.

We have analyzed 75 isolates of Plasmodium falciparum, collected in Venezuela during both the dry (November) and rainy (May-July) seasons, with a range of genetic markers including antigen genes and 14 random amplified polymorphic DNA (RAPD) primers. Thirteen P. falciparum stocks from Kenya and four other Plasmodium species are included in the analysis for comparison. Cross-hybridization shows that the 14 RAPD primers reveal 14 separate regions of the parasite's genome. The P. falciparum isolates are a monophyletic clade, significantly different from the other Plasmodium species. We identify three RAPD characters that could be useful as "tags" for rapid species identification. The Venezuelan genotypes fall into two discrete genetic subdivisions associated with either the dry or the rainy season; the isolates collected in the rainy season exhibit greater genetic diversity. There is significant linkage disequilibrium in each seasonal subsample and in the full sample. In contrast, no linkage disequilibrium is detected in the African sample. These results support the hypothesis that the population structure of P. falciparum in Venezuela, but not in Africa, is predominantly clonal. However, the impact of genetic recombination on Venezuelan P. falciparum seems higher than in parasitic species with long-term clonal evolution like Trypanosoma cruzi, the agent of Chagas' disease. The genetic structure of the Venezuelan samples is similar to that of Escherichia coli, a bacterium that propagates clonally, with occasional genetic recombination.

Animals↗

Vector competence of Simulium metallicum s.l. (Diptera: Simuliidae) in two endemic areas of human onchocerciasis in northern Venezuela.

Experimental infections of Simulium metallicum s.l. with Onchocerca volvulus were carried out in two onchocerciasis foci, Altamira and Trincheras, in northern Venezuela, to determine vector competence. Wild-caught flies, fed on infected volunteers, were maintained in the laboratory for 13-15 days at 27 degrees C. Parasite development was complete but asynchronous and retarded. No differences in the vector competence of the two populations of S. metallicum s.l. were found. However, a less efficient development of the parasite occurred during the dry season at both localities. The distribution of the parasite within the vector was aggregated and also displayed seasonal variation. The seasonal susceptibility may be a consequence of a density-dependence regulation mechanism of the parasite within the vector. These results indicate a relatively low vector competence for S. metallicum s.l. in northern Venezuela.

Animals↗

Pesticide exposure in a farming village in Venezuela--a developing country.

This study was designed and performed by the Universidad de Carabobo, Centro de Investigaciones Toxicológicas, Venezuela, and the University of Cincinnati Department of Environmental Health. The authors tested methodology and analyzed preliminary data on demographics, pesticide use, health, environment, and lifestyles in a farming community in Venezuela (population = 386; sample size = 81) to determine if pesticide misuse might have been contributing to public health problems. Questionnaire and geographic information were collected. There were statistically significant incidences of pesticide-related symptoms (p < .01) in farmers versus nonfarmers (odds ratio = 5.7; 95% confidence interval = 2.9, 18.8). In addition, in one area there was a cluster of farmers who experienced symptoms that appeared to be the result of foul air and proximity to farms where there was pesticide use. The results of the study indicated that this public health problem may have been associated with pesticide misuse; however, additional studies are needed to corroborate the findings.

Adolescent↗

Relationship between quality of life, social support and disease-related factors in HIV-infected persons in Venezuela.

This study examines the relationships among health-related quality of life (HRQL), social support, sociodemographic factors and disease-related factors in persons infected with the human immunodeficiency virus (HIV) living in Venezuela. A sample of 118 HIV-infected persons living in Caracas, Venezuela, was surveyed using a written questionnaire that included a Spanish translation of the Interpersonal Support Evaluation List (ISEL) developed for this study, the Medical Outcomes Study Short Form-36 (SF-36) and a symptom inventory. All three instruments showed good internal consistency reliability. Multiple regression analyses were used to model SF-36 sub-scale scores as a function of symptoms, social support, HIV-status and use of antiretroviral drugs. The models explained between 16 and 39% of the variance in the different HRQL domains. Controlling for other variables in the model, level of symptomatology was significantly associated with all HRQL domains except social functioning and role-emotional scores. Social support was significantly associated with all HRQL domains except physical functioning and bodily pain. The use of antiretroviral drugs was significantly associated with social functioning. The study indicates the importance of social support to the quality of life of HIV-infected individuals in this culture.

Adult↗

Characterization of enzootic foci of Venezuelan equine encephalitis virus in western Venezuela.

The distribution of the sylvatic subtype ID Venezuelan equine encephalitis (VEE) viruses in the lowland tropical forests of western Venezuela was investigated using remote sensing and geographic information system technologies. Landsat 5 Thematic Mapper satellite imagery was used to study the reflectance patterns of VEE endemic foci and to identify other locations with similar reflectance patterns. Enzootic VEE virus variants isolated during this study are the closest genetic relatives of the epizootic viruses that emerged in western Venezuela during 1992-1993. VEE virus surveillance was conducted by exposing sentinel hamsters to mosquito bites and trapping wild vertebrates in seven forests identified and located by means of the satellite image. We isolated VEE viruses from 48 of a total of 1,363 sentinel hamsters in two of the forests on six occasions, in both dry and wet seasons. None of the 12 small vertebrates captured in 8,190 trap-nights showed signs of previous VEE virus infection. The satellite image was classified into 13 validated classes of land use/vegetation using unsupervised and supervised techniques. Data derived from the image consisted of the raw digital values of near- and mid-infrared bands 4, 5, and 7, derived Tasseled Cap indices of wetness, greenness, and brightness, and the Normalized Difference Vegetation Index. Digitized maps provided ancillary data of elevation and soil geomorphology. Image enhancement was applied using Principal Component Analysis. A digital layer of roads together with georeferenced images was used to locate the study sites. A cluster analysis using the above data revealed two main groups of dense forests separated by spectral properties, altitude, and soil geomorphology. Virus was isolated more frequently from the forest type identified on flat flood plains of main rivers rather than the forest type found on the rolling hills of the study area. The spatial analysis suggests that mosquitoes carrying the enzootic viruses would reach 82-97% of the total land area by flying only 1-3 km from forests. We hypothesize that humans within that area are at risk of severe disease caused by enzootic ID VEE viruses. By contrast, equines could actually become naturally vaccinated, thus preventing the local emergence of epizootic IC VEE virus strains and protecting humans indirectly.

Animals↗

Molecular characterization of human immunodeficiency virus type 1 isolates from Venezuela.

Eight HIV-1 isolates from Venezuela have been characterized by nucleotide sequencing of the entire reverse transcriptase (RT)- and surface glycoprotein (gp 120)-coding regions. Average mutant frequencies were 2.5 x 10(-2) substitutions per nucleotide (s/nt) for the RT-coding region, and 10 x 10(-2) or 6.8 x 10(-2) s/nt for the gp120-coding region, depending on whether gaps introduced for optimal alignment were or were not, respectively, considered in the calculations. Phylogenetic trees were derived by maximum-likelihood, neighbor-joining, and maximum parsimony methods. In the trees derived from both RT- and gp120-coding regions, Venezuelan isolates cluster with subtype B viruses. However, the relative position of some of the isolates is considerably different in the two trees. Unique V3 loop amino acid sequences, not represented in the current database, have been identified among the Venezuelan isolates. In addition to representing the first molecular characterization of HIV-1 from Venezuela, the extensive genetic heterogeneity observed reinforces the interest in characterizing additional HIV-1 isolates worldwide for adequate vaccine design.

Adult↗

Vectors of cutaneous leishmaniasis in north-central Venezuela.

An entomological survey was undertaken from January 1991 to February 1992 in El Ingenio, Miranda State, Venezuela, an endemic area of cutaneous leishmaniasis: prevalence of 10.7 cases per 100,000 inhabitants. A total of 4863 female sandflies (Phlebotominae) of fourteen species were collected in Shannon traps, then dissected and examined for leishmanial infections. Lutzomyia ovallesi (85.4%) and Lu. gomezi (11.2%) were the predominant anthropophilic species of sandfly. Fifty-one (1.19%) Lu.ovallesi and two (0.47%) Lu.gomezi had natural infection with Leishmania promastigotes. Identification of the parasites was done by using the polymerase chain reaction (PCR) and DNA hybridization. Two isolates from Lu.gomezi and forty-nine from Lu.ovallesi were typed as Leishmania braziliensis and three of the latter reacted with Le.mexicana also. This is the first report of Lu.gomezi with parasites typed as Le.braziliensis. We concluded that Lu.ovallesi is the primary vector of cutaneous leishmaniasis in the north-central area of Venezuela and Lu.gomezi should be regarded as an additional vector.

Animals↗

Leishmania and sand flies: proximity to woodland as a risk factor for infection in a rural focus of visceral leishmaniasis in west central Venezuela.

OBJECTIVE: To relate entomological, epidemiological and geographical data to understand the transmission dynamics of visceral leishmaniasis (VL) in a closed focus in western Venezuela. METHODS: Spatial and temporal patterns of Lutzomyia pseudolongipalpis, the most prevalent phlebotomine sand fly species (99.7%), were studied in El Brasilar, Curarigua, Lara State, Venezuela, a small rural community of 20 dwellings and 118 inhabitants. The sand fly population was monitored using Centers for Disease Control light traps monthly throughout 1 year in the domestic and sylvatic habitats and for 3 months in all inhabited houses. RESULTS: Temporal variation followed the yearly bimodal pattern of precipitation with the highest population densities in April and December. Infection with flagellates suggestive of Leishmania spp. was detected in 0.01% of 10,026 dissected females of L. pseudolongipalpis, which proved to be highly endophilic. Prevalence of Leishmania infection in people, as measured by the leishmanin skin test, was correlated with distance of the houses from the woodland and with sand fly abundance. A logistic regression model showed that for people who live in the village, the proximity to the woodland (linear) should be considered a risk factor for Leishmania infection (binary) (z = -2.02, P = 0.04, OR = 0.98, 95% CI = 0.97-0.99). This was consistent with the association between the proportion of VL infection and the log of sand fly abundance, which was negatively correlated with distance from the woodland. CONCLUSION: We discuss strategies that might be useful in controlling VL transmission in this endemic focus.

Animals↗

Access to and coverage of renal replacement therapy in minorities and ethnic groups in Venezuela.

Access to and coverage of renal replacement therapy in minorities and ethnic groups in Venezuela. Numerous studies have documented the presence of racial and minority disparities regarding the impact of renal disease and access to renal replacement therapy (RRT). This problem is less well documented in Latin America. Venezuela, like most countries in the region, is subject to severe constraints in the allocation of resources for high-cost chronic diseases, which limits the access of patients with chronic kidney disease to RRT. Although access to health care is universal, there is both a deficit in coverage and disparity in the access to RRT, largely as a result of socioeconomic limitations and budget constrains. With current rising trends of the incidence of end-stage renal disease (ESRD) and costs of medical technology, the long-term goal of complete RRT coverage will become increasingly out of reach. Current evidence suggests that prevention of progression of renal disease is possible at relatively low cost and broad coverage. Based on this evidence, the Ministry of Health has redesigned its policy with respect to renal disease based on 4 elements: 1. Prevention by means of early detection and referral to multidisciplinary health teams, as well as promotion of health habits in the community. 2. Prevention of progression of renal disease by pharmacologic and nonpharmacologic means. 3. An increase in the rate of coverage and reduction of disparities in the access to dialysis. 4. An increase in the rates of renal transplantation through better organ procurement programs and reinforcement of transplant centers. However, the projected increase in the number of patients with ESKD receiving RRT will represent a serious burden to the health care system. Therefore, implementation of these policies will require the involvement of international agencies as well as an adequate partnership between nephrologists and health care planners, so that meeting the increasing demands of ESKD programs may be balanced with other priorities of our national health system.

Ethnicity↗

Genetic characterization of rabies field isolates from Venezuela.

Twenty samples from cases of rabies in humans and domestic animals diagnosed in Venezuela between 1990 and 1994 and one sample from a vampire bat collected in 1976 were characterized by reactivity to monoclonal antibodies against the viral nucleoprotein and by patterns of nucleotide substitution in the nucleoprotein gene. Three antigenic variants were found: 1, 3, and 5. Antigenic variant 1 included all samples from dogs and humans infected by contact with rabid dogs. Unique substitutions permitted identification of two separate outbreaks of dog rabies in the Maracaibo Depression and Los Llanos region and in the Andean region of Venezuela. Samples from the vampire bat and two head of cattle were characterized as antigenic variant 3 and showed a nucleotide sequence homology of 96 to 98% to each other and to samples of vampire bat-associated rabies throughout Latin America. Ten of the remaining 12 samples were characterized as antigenic variant 5. Genetic studies indicated that 11 of these samples formed a highly homologous and distinctive group but were closely related to samples of vampire bat-associated rabies. The 12th sample of variant 5 (from a cat) showed only 78 to 80% genetic homology to samples of rabies associated with vampire bats. The application of antigenic and genetic typing to rabies surveillance in Latin America is essential to improve control programs. Recognition of the source of outbreaks of dog rabies and identification of wildlife species maintaining sylvatic cycles of rabies transmission permit better utilization of public health resources.

Animals↗

Endomyocardial disease in South America--report on 23 cases in Venezuela.

Twenty-three cases of endomyocardial disease (ED) are presented, studied in Venezuela, a tropical country in northern South America. The diagnosis was confirmed in 18 cases by means of pathological studies, and in 5 cases by angiocardiography which showed the characteristic obliterative ventricular lesions. Eosinophilia was present in 35% of the patients. The most frequent clinical feature was heart failure associated with mitral regurgitation. Systemic embolism was the first clinical feature in 5 cases. In 2 cases, ED was associated with autoimmune haemolytic anaemia or vasculitis. Necropsy revealed a predominance of the left-sided (9/16 cases) and biventricular (6/16 cases) types. The pathological lesions were characterised by fibrous thickening of the endocardium at the apex and the ventricular inflow tracts extending to the myocardium and involving the atrioventricular valves. ED is frequently misdiagnosed as rheumatic valvular cardiopathy. The two-dimensional echocardiogram is a very useful procedure for determining the spatial anatomy of ED. The echo findings were closely correlated with ventriculographic and necropsy findings. Even though ED is widely spread around the world, it is most frequently found in tropical and subtropical countries in Africa, Asia and America, such as Venezuela and Brazil. This suggests that there are aetiological factors in these latitudes, about which little is known.

Adolescent↗

International comparison of mortality from inflammatory bowel disease in the Latin-speaking countries Venezuela, Italy, and France.

Mortality data for ulcerative colitis, Crohn's disease, and unspecified inflammatory bowel disease were examined for the countries Venezuela, Italy, and France during the decade 1969-1978. These figures were compared with similar data from England and Wales obtained from 1965 to 1975. In Italy and France deaths from Crohn's disease and ulcerative colitis were low and showed little change during the period of observation. Figures for inflammatory bowel disease from Venezuela were high and appeared to show a marked fall which may simply reflect a change in diagnostic criteria.

Colitis, Ulcerative↗

Use of the pupal/demographic-survey technique to identify the epidemiologically important types of containers producing Aedes aegypti (L.) in a dengue-endemic area of Venezuela.

As dengue continues to emerge as a major public-health problem world-wide, efforts to control the dengue vector Aedes aegypti must become more effective and efficient. Results from larval and pupal surveys applied in Venezuela illustrate the uniqueness of the information gained from pupal surveys; information that is lost when traditional Stegomyia indices are calculated. As most Ae. aegypti pupae will emerge to become adults, controlling the containers that produce the most pupae could have the greatest impact on the adult population. Pupal-survey results in Venezuela showed that large (150- to 200-litre) water drums produce the greatest number of pupae throughout the year. In the rainy season, approximately 70% of all pupae are found in these drums or in tyres, buckets and tanks. Over 80% of pupae in the dry season are found in drums and tanks alone. By targeting only those domestic breeding containers that produce the greatest number of pupae, control efforts may be streamlined to have the greatest impact on reducing the local adult Ae. aegypti population.

Aedes↗

Americo Negrette (1924 to 2003): diagnosing Huntington disease in Venezuela.

OBJECTIVE: To elucidate the role of Dr. Americo Negrette in diagnosing and reclassifying the dancing mania in Maracaibo, Venezuela as Huntington disease (HD). METHODS: All of the medical and nonmedical books and articles by Negrette were collected and reviewed. Personal interviews with Negrette were performed to confirm the details of his life and original work. His childhood, medical education, and contribution to HD, as well as contributions to medicine, art, and poetry, were covered in interview sessions. Excerpts from his autobiography, Ciudad de Fuego, were translated into English for publication. A complete bibliography of 70 books and research articles authored by Negrette was assembled. Negrette himself reviewed the compilation of this manuscript just days before his sudden death on September 14, 2003. RESULTS: Americo Negrette, a Venezuelan physician, biochemist, artist, and poet, observed a dancing epidemic in 1952. He acquired, through interviews with locals, the knowledge that there were two other small towns along Lake Maracaibo devastated by a syndrome called el mal (the bad). Negrette changed the diagnosis of these patients from a dancing mania to what he believed was Huntington chorea, later termed HD. He presented his findings at the Venezuelan Sixth Congress of Medical Science in 1955. He was met with reluctance in the local scientific community and a passive ear from government authorities. His description, written in Spanish, was not widely distributed beyond Venezuela, and its importance would have to wait until one of his students shared his observations (more than a decade later) with the HD research community and the rest of the world. CONCLUSION: The "dancing mania" of Maracaibo, because of the work of Americo Negrette, has been reclassified as Huntington disease.

Attitude to Health↗