ABSTRACT Introduction: Chlamydia trachomatis (CT) infection is recognized as the most common bacterial sexually transmitted infection (STI). The World Health Organization reports approximately 131 million cases annually. Objective: To evaluate the performance of the CROMATEST rapid test (Linear Chemicals. S.L. Barcelona España), using clinical samples. Methods: A total of 72 individuals were studied (27 women and 7 men), and the same number of clinical samples. Of which, 38 vaginal swabs from adolescents with symptoms of STI from two pediatric hospitals from Havana, and 34 urine samples from apparently healthy volunteers, from the “Pedro Kourí” Institute of Tropical Medicine (IPK). The CROMATEST assay was applied to the samples and a commercial RT-PCR was used as reference test. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results: Of the samples under study, six were positive by the CROMATEST rapid test, while five were reactive for CT by mean of RT-PCR. One sample was only reactive by the reference test. Of the 66 negative samples, 65 were non-reactive by both tests; one sample was negative by RT-PCR and positive by CROMATEST. The percentage of agreement between both tests was 95 % and the Kappa value 0.8182. A sensitivity 83.33 %, specificity 98.48 %, PPV 83.33 % and NPV 98.48 %, were obtained. Conclusion: The CROMATEST rapid test had an excellent performance when evaluated against the reference test; we recommend its use as a rapid test for the detection of CT.

RESUMEN Introducción: La infección por Chlamydia trachomatis (CT) se reconoce como la infección de transmisión sexual (ITS) bacteriana más frecuente. La Organización Mundial de la Salud, reporta aproximadamente 131 millones de casos anuales. Objetivo: Evaluar el desempeño de la prueba rápida CROMATEST (Linear Chemicals. S.L. Barcelona, España) en muestras clínicas. Métodos: Se estudiaron 72 individuos (27 mujeres y 7 hombres) y el mismo número de muestras. De ellas, 38 exudados vaginales de adolescentes con sospecha de ITS atendidas en dos hospitales pediátricos de La Habana, y 34 muestras de orina de voluntarios, aparentemente sanos, del Instituto de Medicina Tropical “Pedro Kourí”. Se aplicó el ensayo CROMATEST para la detección de CT y como prueba de referencia, una PCR-Tiempo Real (PCR-TR) comercial. Se calcularon, sensibilidad, especificidad, valor predictivo positivo (VPP) y negativo (VPN). Resultados: De las muestras estudiadas, seis resultaron positivas por la prueba rápida y cinco por la PCR-TR, una fue positiva sólo por la prueba de referencia. De las 66 muestras negativas, 65 fueron no reactivas por ambas pruebas, una fue negativa por PCR-TR y positiva por CROMATEST. El porcentaje de concordancia entre ambas pruebas fue del 95 % y el valor de Kappa 0,8182. Se obtuvo una sensibilidad de 83,33 %, una especificidad del 98,48 %, VPP de 83,33 % y VPN de 98,48 %. Conclusión: La prueba rápida CROMATEST tuvo un desempeño excelente al compararla con la prueba de referencia, por esta razón recomendamos su utilización como prueba rápida para la detección de CT.

Abstract INTRODUCTION Unlike most high-income countries where subtype B viruses predominate, the Cuban HIV-1 epidemic is characterized by a great diversity of subtypes and circulating recombinant forms. Some studies have shown that HIV variants exhibiting a preference for the CXCR4 co-receptor (X4-tropic) could have impacts on disease pathogenesis, with clinical implications for antiviral treatment plans. Determination of HIV co-receptor tropism is crucial for clinicians in deciding whether maraviroc is an appropriate antiviral. OBJECTIVE Characterize V3 sequence variability and its relation to viral tropism across different subtypes circulating in Cuba and explore how this may affect treatment success with maraviroc. METHODS We designed a cross-sectional study that included 72 plasma samples obtained at the Pedro Kourí Tropical Medicine Institute in Havana, Cuba. We sequenced the C2V3 env region and assessed subtype based both on env and pol sequences; tropism was predicted by Geno2pheno analysis. Additionally, 35 V3-loop Cuban sequences, obtained from a previous study, were incorporated into the analysis. Statistical associations among virological, clinical and epidemiological variables were assessed by a chi-square test. RESULTS Tropism prediction for 72 variants revealed that CRF19_cpx was associated with dual-tropic R5X4 viruses (p = 0.034). Moreover, when 35 sequences from a former study were added, the association was significant not only for R5X4 (p = 0.019) but also for X4-tropic variants (p = 0.044). Alignment of 107 V3-loop sequences showed wide diversity among the different HIV-1 subtypes circulating in Cuba. CONCLUSIONS In accordance with G2P, CRF19_cpx is a genetic variant with a high proportion of X4 and R5X4-tropic viruses. The results from the present study suggest that the Cuban recombinant could be a more pathogenic variant and that maraviroc may not be suitable for patients infected with CRF19_cpx.

ABSTRACT INTRODUCTION By the end of 2017, there were more than 28,000 individuals living with HIV in Cuba, over 80% receiving antiretroviral therapy, which dramatically reduces viral replication, improves immune status and decreases risk of transmission. These results could be jeopardized by emergence of HIV-1 drug resistance. In 2009, a test for HIV-1 genotypic resistance was introduced in routine clinical practice in Cuba. OBJECTIVE Investigate antiretroviral resistance and its relation to subtype distribution in HIV-1 treatment-naïve and previously treated patients in Cuba. METHODS Resistance and HIV-1 subtype distribution were determined in 342 antiretroviral treatment-naïve patients and 584 previously treated for HIV-1 whose blood specimens were sent to the Pedro Kourí Tropical Medicine Institute during 2009–2014. Transmitted drug resistance was determined using the Calibrated Population Resistance Tool v.6. Drug resistance analysis was conducted using the algorithm Rega v9.1.0. RESULTS Prevalence of transmitted drug resistance was 11.4%, and 41% of mutated viruses exhibited dual-class resistance to nucleoside reverse transcriptase inhibitor and non-nucleoside reverse transcriptase inhibitor. Overall, 84.9% of patients had ≥1 resistance mutation, 80% had ≥1 nucleoside reverse transcriptase inhibitor mutation, 71.4% had ≥1 non-nucleoside reverse transcriptase inhibitor mutation and 31.7% had ≥1 protease inhibitor mutation. K65R and K101E mutations were significantly more frequent in subtype C, L210W in CRF19_cpx, and M47V/I in CRF BGs (20, 23, 24). Full class resistance to nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors and multidrug resistance were detected in 21.2%, 32.4%, 8% and 4.1% of patients, respectively. Average percentage resistance to nucleoside reverse transcriptase inhibitor, protease inhibitor, full class resistance to nucleoside reverse transcriptase inhibitor, protease inhibitor and multidrug resistance increased in patients failing two or more regimens. Nevertheless, after 2011, a declining trend was observed in the frequency of multidrug resistance and full class resistance to nucleoside reverse transcriptase inhibitors and protease inhibitors. CONCLUSIONS Detected levels of transmitted drug resistance highlight the need for a national surveillance study in treatment-naïve patients. Resistance prevalence is high in previously treated patients but appears to be decreasing over time. The frequency of resistance mutations in recombinant forms of HIV in Cuba needs further study.

Background The international recommendations of antiretroviral treatment include resistance tests to guide the treatment regimen in each patient, which is not available on a regular basis in Ecuador. Aim To describe mutations that confer resistance to antiretrovirals in a population of Ecuadorian patients. Methods Plasma samples from 101 HIV-1 patients with failure to antiretroviral therapy, divided into 15 children and 86 adults, were studied with the GS Junior (Roche) and the sequences were analyzed with the DeepChek program. Results The most frequent mutations were M184V/I, K101E/P/H, K103N/S, D30N, M46L/I, I54L/M, V82T/F/A/S/L and L90M in adults and F77L, K103N/S, M46L/I, V82T/F/A/S/L and L90M in children. High resistance to non-nucleoside reverse transcriptase (RT) inhibitors in minority viral populations of adults and children (34.9% and 70%) was detected; in children both viral populations (majority and minority viral populations) (> 45%) were protease inhibitor resistant. Patients who had a greater number of therapeutic regimens had higher levels of resistance to antiretrovirals. Most of the samples were subtype B in the TR and protease region, and CRF25_cpx in integrase. Conclusions Mutations and resistance to antiretrovirals are shown in a population of Ecuadorian patients with HIV-1. These results will make it possible to issue a warning to health authorities about the need for resistance studies.

Resumen Introducción Las recomendaciones internacionales de tratamiento anti-retroviral incluyen pruebas de resistencia para orientar el régimen de tratamiento en cada paciente, lo que no está disponible de forma estable en Ecuador. Objetivo Describir las mutaciones que confieren resistencia a anti-retrovirales en una población de pacientes ecuatorianos. Metodología A partir de muestras de plasma de 101 pacientes con VIH-1 con fallo a la terapia anti-retroviral, 15 niños y 86 adultos, se realizó pirosecuenciación con el GS Junior (Roche) y se analizaron las secuencias con el programa DeepChek. Resultados Las mutaciones más frecuentes fueron M184V/I, K101E/P/H, K103N/S, D30N, M46L/I, I54L/M, V82T/F/A/S/L y L90M en adultos, y F77L, K103N/S, M46L/I, V82T/F/A/S/L y L90M en niños. Se encontró una elevada resistencia a los inhibidores de la transcriptasa reversa (TR) no análogos de nucleósidos en poblaciones minoritarias virales de adultos y niños (34,9 y 70%, respectivamente), en los niños, tanto las poblaciones virales mayoritarias como minoritarias, fueron resistente a inhibidores de proteasa (> 45%). Los pacientes que tuvieron un mayor número de esquemas terapéuticos presentaron mayores niveles de resistencia a los anti-retrovirales. La mayoría de las muestras fueron del subtipo B en la región de la TR y proteasa, y CRF25_cpx en integrasa. Conclusiones Se muestran las mutaciones y la resistencia a antiretrovirales en una población de pacientes ecuatorianos con infección por VIH-1, que permitirán realizar un llamado de alerta a las autoridades de salud sobre la necesidad de realizar estudios de resistencia.

A descriptive and cross-sectional study to characterize 157 pregnant women with gingival disease, belonging to the health area of "30 de Noviembre" University Polyclinic was carried out in Santiago de Cuba, from September, 2015 to March, 2016. The gingival state was evaluated by means of the Silness y Löe gingival index, according to the classification of gingivitis, and that of oral higiene by the simplified Green and Vermillion index. As a result, 40.8% of the pregnant women was in the third trimester of their pregnancies, as well as a prevalence of light and moderate gingivitis, with 52.2 and 40.1%, respectively. Equally, in 93.0% of the cases, gum inflammation was localized and in 70.7% it was edematous, while, the poor oral hygiene was present in a high percentage of pregnant women, which was increased with the severity of the gingival disease and escolarity level

Se realizó un estudio descriptivo y transversal para caracterizar a las 157 embarazadas con enfermedad gingival, pertenecientes al área de salud del Policlínico Universitario "30 de Noviembre" del municipio de Santiago de Cuba, durante el periodo de septiembre del 2015 a marzo del 2016. El estado gingival fue evaluado por medio del índice gingival de Silness y Löe, según clasificación de la gingivitis, y el de higiene bucal por el índice de Green y Vermillion simplificado. Se obtuvo que 40,8 % de las gestantes se encontraban en el tercer trimestre de embarazo, así como un predominio de la gingivitis leve y la moderada, con 52,2 y 40,1 %, respectivamente. Igualmente en 93,0 % de los casos la inflamación de la encía fue localizada y en 70,7 % edematosa, en tanto, la higiene bucal deficiente estuvo presente en un alto porcentaje de las grávidas, el cual se incrementaba con la gravedad de la enfermedad gingival y el nivel de escolaridad

68 patients divided into 2 groups were studied, one that received VIMANG during 6 months and another that was administered placebo. Titers of anti-p24 antibodies and concentration of antigen p24 were measured at 0 and 6 months. The differences found in the behavior of the titers of the antibodies between both groups were not significant, although the TPG were maintained in the group receiving VIMANG. In the placebo group, 2 patients elevated the antigen concentration and 2 were positive for this marker, whereas in the study group the Ag disappeared in a patient who became positive but with values 3 and 4 times lower than in the 2 patients of the control group, where it increased.

Se estudiaron 68 pacientes divididos en 2 grupos, uno que recibió VIMANG durante 6 meses y otro que recibió placebo. Se midieron títulos de anticuerpos anti-p24 y concentración de antígeno p24 al tiempo 0 y 6 meses. Las diferencias encontradas en el comportamiento de los títulos de anticuerpos entre ambos grupos no resultaron ser significativas, aunque se mantuvieron los TPG en el grupo que recibió VIMANG. En el grupo placebo, 2 pacientes elevaron la concentración de antígeno y 2 se mantuvieron positivos para este marcador, mientras que en el grupo estudio desapareció el antígeno en un paciente, que se tornó positivo pero con valores 3 y 4 veces menor que en los 2 pacientes del grupo control, donde este se elevó.

The polimerase chain reaction techniques was introduced for the intratypic characterization of Poliovirus. Primers were used only to promote the amplification of the Sabin vaccine strains proved by electrophoretic run of the amplified DNA products (Sabin 1 - 97 pb, Sabin 2 - 71 pb, Sabin 3 - 44 pb) and whose specificity was satisfactorily verified. 23 Cuban poliovirus strains isolated and identified at the Laboratory of Enterovirus of the "Pedro Kourí" Tropical Medicine Institute from 1993 to 1994 were studied by this technique. All of them were of the vaccine type. It was observed how the Sabin vaccine poliovirus may be the cause of viral meningoencephalitis as a milder neurological complication. Tghis study provided one more evidence about the non circulation of the wild poliovirus in Cuba.

Se introdujo la técnica de la reacción en cadena de la polimerasa para la caracterización intratípica de Poliovirus. Se usaron cebadores que sólo promueven la ampliación de las cepas vacunales de Sabin, comprobada por corrida electroforética de los productos de ADN amplificados (Sabin 1-97 pb, Sabin 2-71 pb, Sabin 3-44 pb) y cuya especificidad se verificó satisfactoriamente. Se estudiaron por esta técnica 23 cepas cubanas de Poliovirus aisladas e identificadas en el Laboratorio de Enterovirus del Instituto de Medicina Tropical "Pedro Kourí" de 1993 a 1994, y todas resultaron ser del tipo vacunal. Se observó cómo el Poliovirus vacunal de Sabin puede ser causa de meningoencefalitis viral como complicación neurológica más leve. Este estudio aportó una evidencia más a favor de la no circulación del Poliovirus salvaje en Cuba.

An increase of the cases of viral meningoencephalitis was reported in our country from October to December, 1995. 23 faeces specimens were received from 2 provinces aimed at obtaining the viral isolation by their inoculation in cell culture and in newborn mice at the same time in order to compare the sensitivity of both systems in isolation. A higher number of isolations was obtained in cell culture. The cell culture from kidney of a normal adult green African monkey (Vero) proved to be more sensitive. 18 isolations were obtained and identified as Coxsackievirus B5. An anatomical and pathological study was conducted in inoculated mice and injuries compatible with the enteroviral infection were observed.

Entre los meses de octubre y diciembre de 1995 se reportó un incremento en los casos de meningoencefalitis viral en nuestro país. Se recibieron 23 muestras de heces fecales, que procedían de 2 provincias, con la finalidad de obtener el aislamiento viral mediante la inoculación de éstas en cultivo de células y ratones recién nacidos simultáneamente, para comparar la sensibilidad de ambos sistemas en el aislamiento. Se obtuvo un mayor número de aislamientos en cultivo de células que en ratones, el cultivo de células de riñón de mono verde africano adulto normal (Vero) resultó el más sensible. Se lograron 18 aislamientos, que fueron identificados como Coxsackievirus B5. Se realizó un estudio anatomo-patológico en ratones inoculados y se observaron lesiones compatibles con la infección enteroviral.