OBJECTIVES: To estimate the number and risk of imported infections resulting from people visiting Asian and Latin American countries.METHODS: The dataset of visitors to 5 Asian countries with dengue were analyzed for 2016 and 2017, and in the Philippines, Thailand and Vietnam, imported cases of zika virus infection were also reported. For zika virus, a single imported case was reported from Brazil in 2016, and 2 imported cases reported from the Maldives in 2017. To understand the transmissibility in 5 Southeast Asian countries, the estimate of the force of infection, i.e., the hazard of infection per year and the average duration of travel has been extracted. Outbound travel numbers were retrieved from the World Tourism Organization, including business travelers.RESULTS: The incidence of imported dengue in 2016 was estimated at 7.46, 15.00, 2.14, 4.73 and 2.40 per 100,000 travelers visiting Philippines, Indonesia, Thailand, Malaysia and Vietnam, respectively. Similarly, 2.55, 1.65, 1.53, 1.86 and 1.70 per 100,000 travelers in 2017, respectively. It was estimated that there were 60.1 infections (range: from 16.8 to 150.7 infections) with zika virus in Brazil, 2016, and 345.6 infections (range: from 85.4 to 425.5 infections) with zika virus in the Maldives, 2017.CONCLUSION: This study emphasizes that dengue and zika virus infections are mild in their nature, and a substantial number of infections may go undetected. An appropriate risk assessment of zika virus infection must use the estimated total size of infections.
Asia, Southeastern ; Asian Continental Ancestry Group ; Brazil ; Commerce ; Dataset ; Dengue ; Humans ; Incidence ; Indian Ocean Islands ; Indonesia ; Korea ; Latin America ; Malaysia ; Philippines ; Risk Assessment ; Thailand ; Vietnam ; Zika Virus ; Zika Virus Infection

BACKGROUND: Thyroid dysfunction is associated with negative neonatal and obstetric outcomes. Large differences in thyroid function reference intervals exist across different populations. These differences can be explained by population-specific factors, such as iodine status. Many countries in Latin America report iodine sufficiency, but relatively few countries have published up-to-date data on iodine levels and thyroid function in the overall population, and especially in pregnant women. We evaluated the iodine status of pregnant women in Chile and determined thyroid hormone reference ranges in this population. METHODS: This was a prospective observational study of healthy Chilean women at their first prenatal visit before week 14. Thyroid-stimulating hormone (TSH), total thyroxine (T4), free T4, antithyroid peroxidase antibody (TPOAb), and iodine levels from spot urine samples were measured. Iodine status and the reference ranges for TSH were calculated. RESULTS: A total of 1,022 pregnant women in the first trimester were selected. Urinary iodine levels were measured in 302 randomly-selected women. The median urinary iodine concentration was 173.45 µg/L (interquartile range, 108.11 to 249.35).The reference ranges of TSH were calculated in 670 patients selected according to the National Academy of Clinical Biochemistry guidelines. The median TSH level was 1.88 µIU/mL (2.5th percentile: 0.13 to 97.5th percentile: 5.37). Using the reference range in the 1,022 women, the prevalence of clinical hypothyroidism was 1.76%, and that of subclinical hypothyroidism was 3.92%. TPOAb positivity was more common in women with TSH levels above 3.5 µIU/mL. CONCLUSION: We found adequate iodine intake and a right-shifted distribution of serum TSH levels in pregnant women in Chile. The prevalence of hypothyroidism in our sample of pregnant women was higher than has been described in the literature.
Biochemistry ; Chile ; Female ; Humans ; Hypothyroidism ; Iodine ; Latin America ; Observational Study ; Peroxidase ; Pregnancy ; Pregnancy Trimester, First* ; Pregnancy* ; Pregnant Women ; Prevalence ; Prospective Studies ; Reference Values* ; Thyroid Gland ; Thyrotropin* ; Thyroxine

OBJECTIVES: The purpose of this study was to describe the source, length, number of views, and content of the most widely viewed Zika virus (ZIKV)-related YouTube videos. We hypothesized that ZIKV-related videos uploaded by different sources contained different content. METHODS: The 100 most viewed English ZIKV-related videos were manually coded and analyzed statistically. RESULTS: Among the 100 videos, there were 43 consumer-generated videos, 38 Internet-based news videos, 15 TV-based news videos, and 4 professional videos. Internet news sources captured over two-thirds of the total of 8 894 505 views. Compared with consumer-generated videos, Internet-based news videos were more likely to mention the impact of ZIKV on babies (odds ratio [OR], 6.25; 95% confidence interval [CI], 1.64 to 23.76), the number of cases in Latin America (OR, 5.63; 95% CI, 1.47 to 21.52); and ZIKV in Africa (OR, 2.56; 95% CI, 1.04 to 6.31). Compared with consumer-generated videos, TV-based news videos were more likely to express anxiety or fear of catching ZIKV (OR, 6.67; 95% CI, 1.36 to 32.70); to highlight fear of ZIKV among members of the public (OR, 7.45; 95% CI, 1.20 to 46.16); and to discuss avoiding pregnancy (OR, 3.88; 95% CI, 1.13 to 13.25). CONCLUSIONS: Public health agencies should establish a larger presence on YouTube to reach more people with evidence-based information about ZIKV.
Africa ; Anxiety ; Health Communication ; Internet ; Latin America ; Pregnancy ; Public Health ; Social Media ; Zika Virus*

Zika is a re-emerging, mosquito-borne viral infection, which has been recently shown to cause microcephaly and Guillain-Barré syndrome. Since 2015 the number of infected patients has increased significantly in South America. The purpose of this study was to identify the epidemiologic and clinical characteristics of patients with Zika virus (ZIKV) infections in Korea. Patients who had visited areas of risk and tested positive in the ZIKV reverse transcriptase polymerase chain reaction (RT-PCR) in blood, urine, or saliva specimens were included. The first Korean case of ZIKV infection was reported in March 2016, and 14 cases had been reported by October 2016. The median age of the patients was 34 years (19–64 years). Ten patients had been exposed in Southeast Asia and 4 in Latin America. Rash was the most common symptom (92.9%; 13/14), followed by myalgia (50.0%; 7/14), and arthralgia (28.6%, 4/14). There were no neurologic abnormalities and none of the patients was pregnant. Results of biochemical tests were normal. Positivity rates of RT-PCR for ZIKV in serum, urine, and saliva were 53.8%, 100.0%, and 83.3%, respectively in the first week of symptoms. In conclusion, 14 patients with ZIKV infections were reported in Korea by October 2016 and all of them had mild clinical symptoms.
Arthralgia ; Asia, Southeastern ; Epidemiology* ; Exanthema ; Guillain-Barre Syndrome ; Humans ; Korea* ; Latin America ; Microcephaly ; Myalgia ; Reverse Transcriptase Polymerase Chain Reaction ; Saliva ; South America ; Virus Shedding ; Zika Virus*

PURPOSE: Project Strengthening Emergency Medicine, Investing in Learners in Latin America (SEMILLA) created a novel, language and resource appropriate course for the resuscitation of cardiac arrest for Nicaraguan resident physicians. We hypothesized that participation in the Project SEMILLA resuscitation program would significantly improve the physician's management of simulated code scenarios. METHODS: Thirteen Nicaraguan resident physicians were evaluated while managing simulated cardiac arrest scenarios before, immediately, and at 6 months after participating in the Project SEMILLA resuscitation program. This project was completed in 2014 in Leon, Nicaragua. The Cardiac Arrest Simulation Test (CASTest), a validated scoring system, was used to evaluate performance on a standardized simulated cardiac arrest scenario. Mixed effect logistic regression models were constructed to assess outcomes. RESULTS: On the pre-course simulation exam, only 7.7% of subjects passed the test. Immediately post-course, the subjects achieved a 30.8% pass rate and at 6 months after the course, the pass rate was 46.2%. Compared with pre-test scores, the odds of passing the CASTest at 6 months after the course were 21.7 times higher (95% CI 4.2 to 112.8, P<0.001). Statistically significant improvement was also seen on the number of critical items completed (OR=3.75, 95% CI 2.71-5.19), total items completed (OR=4.55, 95% CI 3.4-6.11), and number of "excellent" scores on a Likert scale (OR=2.66, 95% CI 1.85-3.81). CONCLUSIONS: Nicaraguan resident physicians demonstrate improved ability to manage simulated cardiac arrest scenarios after participation in the Project SEMILLA resuscitation course and retain these skills.
Curriculum* ; Emergency Medicine ; Heart Arrest* ; Latin America ; Logistic Models ; Nicaragua ; Resuscitation*

OBJECTIVES: Zika virus currently poses a global threat and is a major public health issue throughout Latin America and the Caribbean. However, Zika virus infections in humans have also been observed in other regions, including Southeast Asia, where arboviral diseases are very common. In this study, we summarize the current status of Zika virus in Southeast Asia. This review aims to provide an overview of the current situation and also to suggest ways of adequately managing the emergence of Zika virus in Southeast Asia. METHODS: The literature searching for the reports on Zika virus in Southeast Asia was done using standard database PubMed and the re-analysis and summarization on the reports was done. RESULTS: A limited number of reports have addressed Zika virus disease in Southeast Asia, but it is has been confirmed that a problem already exists. Individual case reports and outbreaks of Zika virus have been confirmed in Southeast Asia. Several reports have also described patients becoming infected after visiting Southeast Asia. In addition, the concurrent circulation of Zika virus with other arboviruses has been confirmed. CONCLUSIONS: As a tropical region with a high prevalence of arboviral diseases, the emergence of Zika virus in Southeast Asia is a major concern. It is essential for local medical personnel to recognize this disease. Given the status of Southeast Asia as a globally important tourist destination, continuous updates on the status of Zika virus in Southeast Asia are required and should be incorporated into global health advisories regarding travel.
Arboviruses ; Asia, Southeastern* ; Caribbean Region ; Disease Outbreaks ; Global Health ; Humans ; Latin America ; Prevalence ; Public Health ; Zika Virus Infection ; Zika Virus*

OBJECTIVES: Zika virus, which was first discovered in 1947, has become a global threat to human health as it is rapidly spreading through Latin America, the Caribbean, the US and Asia, after causing a large outbreak in the Northeast region of Brazil in 2015. There is ample evidence to support that Zika virus is associated with neurological complications such as microcephaly. The review aims to provide an overview on the complex issues involved in the emergence of Zika virus's neurological disorders and to discuss possible explanations of Zika virus introduction and dissemination in Brazil. We also suggest national and global strategies to adequately respond to the Zika virus emergence. METHODS: We provide an analytical evaluation of the main issues related to the Zika outbreak in Brazil, based on available scientific literature, including government documents, and on epidemiological information from national surveillance databases. RESULTS: The studies on the clinical manifestations of the Zika virus infection coupled with the epidemiological surveillance information in Brazil have provided significant evidence that the Zika virus is associated with neurological disorders such as microcephaly and Guillain-Barré syndrome. Based on phylogenetic and molecular analysis, the hypothesis regarding the introduction of Zika virus in the country is that it took place following international events in 2013 and 2014, when many foreign visitors could have brought Zika virus into Brazil. The immunologically naïve status of populations in the Americas, previous infection with dengue virus, and the increased activity of Aedes aegypti might be the contributing factors for such an outbreak in Brazil. The Zika virus emergence emphasized the importance of cross-disciplinary perspective. Besides the scientific-based vector control strategies, it is important to understand the nature of the evolutionary processes involved in the viral evolution in complex ecosystems and to have social and anthropological knowledge on the conditions related to the spread of the disease in order to properly respond to the spread of the Zika virus. CONCLUSIONS: The experiences of Brazil have demonstrated the significance of multi-disciplinary approach in response to new and resurgent arboviral diseases and provided important lessons that could be applied to other developing countries.
Aedes ; Americas ; Asia ; Brazil* ; Caribbean Region ; Dengue Virus ; Developing Countries ; Ecosystem ; Epidemiology ; Guillain-Barre Syndrome ; Humans ; Latin America ; Microcephaly ; Nervous System Diseases ; Zika Virus ; Zika Virus Infection

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is the most common hereditary heart disease with diverse phenotipyc, genetic expession and clinical presentations. The evolution of patients with HCM in Latin America has not been properly described being the frequency, the long-term prognosis as well as the predominant phenotypic expression still unknown. The aim of this study was to determine the survival rate of HCM patients having different phenotypes in a Mexican cohort of patients. METHODS: Clinical and echocardiographic data obtained from 77 Mexican patients with recently diagnosed HCM were analyzed. The follow-up was of 12.5 years. RESULTS: 96.1% of patients were in functional class I/II according to the New York Heart Association, 2.6% in class III and 1.3% in class IV. Only 3.9% of them went to surgery for myectomy. During the follow-up, 17 patients (22%) died: 4/9 (44%) had apical HCM, 5/20 (25%) had obstructive septal asymmetric HCM, 6/35 (17%) had nonobstructive septal asymmetric HCM and 2/3 (15%) had concentric HCM. The survival rate was worse for patients with apical HCM, followed by those with obstructive and nonobstructive septal asymmetric HCM and patients showing concentric HCM had the best survival rates. There is significant difference in survival rates which declined in 65% in a 9 years-period. Log rank test showed significant differences (p < 0.002). CONCLUSION: The survival rate of patients with HCM was worse in those with apical variety. The majority of patients received medical treatment. The indication for myectomy was below that observed in other international centers.
Cardiomyopathy, Hypertrophic* ; Cohort Studies* ; Echocardiography ; Follow-Up Studies ; Heart ; Heart Diseases ; Humans ; Latin America ; Phenotype ; Prognosis ; Survival Rate

Myiasis is a parasitic infestation of vertebrate animal tissues due to maggots of two-winged flies (Diptera) that feed on living or necrotic tissue. Dermatobia hominis occurs widely in tropical parts of Latin America; it is the most common cause of furuncular myiasis in this region. The continuous increase in international travel has increased the possibility of observing this pathology outside endemic countries, especially in travelers returning from the tropics. If clinicians are aware of the possibility of the disease and its treatment options, this dermatosis can be easily managed. However, diagnostic delay is very common because the disease is often misdiagnosed as a bacterial skin infection. Here, we report 2 cases of furuncular myiasis caused by D. hominis in travelers returning to Italy from Latin America. Surgical and noninvasive treatment approaches are also described.
Animals ; Diptera ; Humans ; Italy ; Larva ; Latin America ; Myiasis ; Pathology ; Skin Diseases ; Skin* ; Transients and Migrants* ; Vertebrates

Brucellosis is a systemic, infectious disease caused by the bacterial genus Brucella and a common zoonosis that still remains a major health problem in certain parts of the world such as the Mediterranean region, the Middle East, and Latin America. It may involve multiple organs and tissues. Osteoarticular involvement is the most frequent complication of brucellosis, in which the diagnosis of brucellar spondylitis is often difficult since the clinical presentation may be obscured by many other conditions. There are only a few reports on brucellar spondylitis in Korea. Here, we report a case of spondylitis due to brucella in an elderly male.
Aged ; Back Pain ; Brucella ; Brucellosis ; Communicable Diseases ; Humans ; Korea ; Latin America ; Lumbosacral Region ; Male ; Mediterranean Region ; Middle East ; Spondylitis