Peritonitis caused by paracoccidioides spp. in a patient on continuous ambulatory peritoneal dialysis - A case report

ABSTRACT Paracoccidioidomycosis is a systemic mycosis found mainly in South America and is the most prevalent endemic and systemic mycosis in Brazil. The purpose of this paper was to report the case of a male patient who developed peritonitis caused by Paracoccidioides spp. Fortyeight-year-old, male patient, with type I Diabetes mellitus and chronic kidney disease who was undergoing a Continuous Ambulatory Peritoneal Dialysis (CAPD) program. After eighteen months of peritoneal dialysis, the patient developed turbidity of the peritoneal fluid and was diagnosed with peritonitis. Direct mycological examination of the peritoneal fluid revealed yeasts with morphology suggestive of Paracoccidioides spp. The patient was treated with sulfamethoxazole-trimethoprim (1,600 mg/320 mg dose/day) for 61 days, but he died because a bacterial septic shock. The diagnosis of opportunistic PCM peritonitis was later confirmed by autopsy and Paracoccidioides spp. isolation. This is the first reported case of a patient on CAPD who experienced complications due peritonitis caused by opportunistic PCM.

Significance of Aspergillus spp. isolation in defining cases of COVID-19 Associated Pulmonary Aspergillosis - CAPA

ABSTRACT COVID-19-Associated Pulmonary Aspergillosis (CAPA) is a relatively common complication in patients with severe forms of the disease caused by the SARS-CoV-2 virus. Diagnosing and confirming CAPA is challenging. In this study, Aspergillus spp. isolation in respiratory specimens from patients with COVID-19 was evaluated for identifying cases of CAPA. In 2020-2021, 17 Aspergillus spp. were isolated from 15 COVID-19 patients admitted to a university hospital in Brazil. Patient records were retrospectively reviewed to obtain clinical-epidemiological data and other markers of Aspergillus spp. infection and then compared with the ECMM/ISHAM criteria for defining CAPA. Probable CAPA was defined in 5/10 patients, who had Aspergillus spp. isolated from Bronchoalveolar Lavage (BAL) or a positive galactomannan blood test. Additionally, anti-Aspergillus antibodies were detected in two of these patients, during active or follow-up phases of CAPA. In another seven patients with Aspergillus spp. isolated from tracheobronchial aspirate or sputum, CAPA was presumed, mainly due to deterioration of clinical conditions and new lung imaging suggestive of fungal infection. Antifungal agents to control CAPA, particularly voriconazole, were used in 9/15 cases. In cases of probable CAPA and remaining patients, clinical conditions and comorbidities were similar, with lethality being high, at 60% and 71%, respectively. The number of CAPA cases defined by scientific criteria was lower than that assumed in the clinical context. This was largely due to the lack of BAL collection for fungal culture and the non-intensive use of other markers of invasive aspergillosis. The isolation of Aspergillus spp. in different respiratory specimens should alert clinicians to the diagnosis of CAPA.

Chylothorax and chylous ascites due to juvenile paracoccidioidomycosis: a case report

ABSTRACT Paracoccidioidomycosis (PCM) is a systemic fungal infection caused by Paracoccidioides species. Chylothorax is a rare complication of PCM. A 16-year-old adolescent presented daily fever, lymphadenomegaly, sweating, weight loss, ventilatory-dependent pain, and dysphagia, which confirmed PCM. During treatment, the patient developed chylothorax and chylous ascites. Chronic inflammatory and fibrotic lymphadenopathy may obstruct lymphatic vessels, resulting in the extravasation of lymph into the abdomen or pleural cavities. Chylothorax is one of several complications of PCM and can lead to respiratory insufficiency, even in patients undergoing antifungal therapy.

Does ascitic fluid filtration improve the microbiological diagnosis of spontaneous bacterial peritonitis? An experimental laboratory study / A filtração do líquido ascítico melhora o diagnóstico microbiológico da peritonite bacteriana espontânea? Um estudo experimental laboratorial

Background: Spontaneous Bacterial Peritonitis (SBP) is a serious and frequent complication among cirrhotic patients with ascites and can be diagnosed by cytological analysis of the ascitic fluid. The microbiological culture of ascitic fluid, however, is positive in less than 40% of SBP cases, which often results in inappropriate antimicrobial therapy. Empirical therapy may be suboptimal, increasing patient's risk of aggravation, or overestimated, unnecessarily boosting bacterial resistance. Objective: This experimental laboratory study aimed to standardize and verify the technical feasibility of ascitic fluid vacuum filtration, as a way to optimize the etiological diagnosis of SBP, compared to the automated method. Method: The method evaluated and standardized in this study was ascitic fluid vacuum filtration. Its principle is the concentration of bacteria on a filter membrane. Results: This study included 36 cirrhotic patients treated at a public university hospital between 11.13.2017 and 06.30.2019. Among them, 47.2% (17/36) presented cytology test results compatible with SBP. For these patients, culture sensitivity using the automated method was 35.3% (6/17), against 11.8% (2/17) with the vacuum filtration method. Conclusion: In conclusion, vacuum filtration does not improve the microbiological diagnosis of SBP in this population compared to the automated method (AU)

Contexto: A Peritonite Bacteriana Espontânea (PBE) é uma complicação grave e frequente entre pacientes cirróticos com ascite, diagnosticada por meio da análise citológica do líquido ascítico. A cultura microbiológica do líquido ascítico, por sua vez, é positiva em menos de 40% dos casos de PBE, o que resulta frequentemente na instituição de terapia antimicrobiana inapropriada. A terapia empírica pode ser subótima, aumentando o risco de agravamento do paciente, ou superestimada, impulsionando desnecessariamente a resistência bacteriana. Objetivo: Estudo experimental laboratorial, propôs padronizar e verificar a viabilidade técnica da filtração a vácuo do líquido ascítico, como forma de otimizar o diagnóstico etiológico na PBE, comparativamente ao sistema automatizado de culturas de sangue. Método: O método avaliado e padronizado neste estudo foi a da filtragem a vácuo do líquido ascítico. Esse tem como princípio a concentração da bactéria em uma membrana filtrante. Resultados: Nesse estudo, foram incluídos 36 pacientes cirróticos atendidos em um hospital público universitário, entre 13.11.2017 e 30.06.2019. Entre eles, 47,2% (17/36) apresentaram citologia compatível com PBE. Nesses, a sensibilidade da cultura pelo método semi-automatizado foi de 35,3% (6/17) e da cultura pelo método da filtragem a vácuo foi de 11,8% (2/17). Conclusão: Em conclusão, a filtragem a vácuo não melhora o diagnóstico microbiológico da PBE em relação ao método automatizado (AU)

Does ascitic fluid filtration improve the microbiological diagnosis of spontaneous bacterial peritonitis? An experimental laboratory study / A filtração do líquido ascítico melhora o diagnóstico microbiológico da peritonite bacteriana espontânea? Um estudo experimental laboratoria

ABSTRAC: Background: Spontaneous Bacterial Peritonitis (SBP) is a serious and frequent complication among cirrhotic patients with ascites and can be diagnosed by cytological analysis of the ascitic fluid. The microbiological culture of ascitic fluid, however, is positive in less than 40% of SBP cases, which often results in inappropriate antimicrobial therapy. Empirical therapy may be suboptimal, increasing patient's risk of aggravation, or overestimated, unnecessarily boosting bacterial resistance. Objective: This experimental laboratory study aimed to standardize and verify the technical feasibility of ascitic fluid vacuum filtration, as a way to optimize the etiological diagnosis of SBP, compared to the automated method. Method: The method evaluated and standardized in this study was ascitic fluid vacuum filtration. Its principle is the concentration of bacteria on a filter membrane. Results: This study included 36 cirrhotic patients treated at a public university hospital between 11.13.2017 and 06.30.2019. Among them, 47.2% (17/36) presented cytology test results compatible with SBP. For these patients, culture sensitivity using the automated method was 35.3% (6/17), against 11.8% (2/17) with the vacuum filtration method. Conclusion: In conclusion, vacuum filtration does not improve the microbiological diagnosis of SBP in this population compared to the automated method. (AU)

RESUMO:Contexto: A Peritonite Bacteriana Espontânea (PBE) é uma complicação grave e frequente entre pacientes cirróticos com ascite, diagnosticada por meio da análise citológica do líquido ascítico. A cultura microbiológica do líquido ascítico, por sua vez, é positiva em menos de 40% dos casos de PBE, o que resulta frequentemente na instituição de terapia antimicrobiana inapropriada. A terapia empírica pode ser subótima, aumentando o risco de agravamento do paciente, ou superestimada, impulsionando desnecessariamente a resistência bacteriana. Objetivo: Estudo experimental laboratorial, propôs padronizar e verificar a viabilidade técnica da filtração a vácuo do líquido ascítico, como forma de otimizar o diagnóstico etiológico na PBE, comparativamente ao sistema automatizado de culturas de sangue. Método: O método avaliado e padronizado neste estudo foi a da filtragem a vácuo do líquido ascítico. Esse tem como princípio a concentração da bactéria em uma membrana filtrante. Resultados: Nesse estudo, foram incluídos 36 pacientes cirróticos atendidos em um hospital público universitário, entre 13.11.2017 e 30.06.2019. Entre eles, 47,2% (17/36) apresentaram citologia compatível com PBE. Nesses, a sensibilidade da cultura pelo método semi-automatizado foi de 35,3% (6/17) e da cultura pelo método da filtragem a vácuo foi de 11,8% (2/17). Conclusão: Em conclusão, a filtragem a vácuo não melhora o diagnóstico microbiológico da PBE em relação ao método automatizado. (AU)

Las relaciones interdisciplinarias: un reto para los docentes en la carrera de Medicina / Interdisciplinary relationships: a challenge for professors in the medical field

RESUMEN Introducción: la interacción entre las disciplinas que conforman el currículo de las carreras, constituye en la actualidad una necesidad del proceso enseñanza aprendizaje, de ahí el nivel de actualidad de las relaciones interdisciplinarias como soporte metodológico en la solución de problemas profesionales. Objetivo: caracterizar el estado del proceso de relaciones interdisciplinarias entre Historia de Cuba y el resto de las disciplinas en el segundo año de la carrera de Medicina. Métodos: teóricos (modelación, análisis-síntesis y análisis documental), métodos empíricos (revisión documental, entrevistas y encuestas) y la estadística descriptiva para el procesamiento de los datos que se obtuvieron, todos desde el enfoque dialéctico materialista. Se seleccionó un universo de 465 estudiantes y una muestra de 237 a través de un muestreo aleatorio simple. Resultados: se apreciaron dificultades en el trabajo metodológico dentro del colectivo de año, las cuales se manifiestan en las insuficiencias que muestra el proceso de relaciones interdisciplinarias en segundo año de la carrera de Medicina. Conclusiones: la falta de una estrategia para el proceso en estudio limita su proyección en el trabajo metodológico que realizan los colectivos pedagógicos de la carrera, el estudio es novedoso al confirmar empíricamente que el elemento articulador de esas relaciones interdisciplinarias son el desarrollo de habilidades, el trabajo metodológico de los colectivos pedagógicos y el papel de la disciplina principal integradora.

ABSTRACT Introduction: the interaction between the disciplines that make up the curriculum of the medical studies constitutes a need at present for the teaching-learning process, hence the current level of interdisciplinary relations as a methodological support in the solution of professional problems. Objective: to characterize the state of the process of interdisciplinary relations between Cuban History and the rest of the disciplines in the second academic year of the medical studies. Methods: theoretical (modeling, analysis-synthesis and documentary analysis), empirical methods (documentary review, interviews and surveys) and descriptive statistics for the processing of the data collected, all from the dialectical materialist approach. A target group of 465 students and a sample of 237 students were chosen through simple random sampling. Results: difficulties were verified in the methodological work within the academic year group, which are manifested in the inadequacies shown by the process of interdisciplinary relations in the second academic year of Medicine major. Conclusions: the lack of a strategy for the process under study limits its projection in the methodological work carried out by the pedagogical collectives of the medical studies, the study is novel by empirically confirming that the articulating element of these interdisciplinary relations are the development of skills, the methodological work of the pedagogical collectives and the role of the main integrating discipline.

Nuevas opciones de tratamiento para el paciente con COVID-19. La experiencia hematológica / New therapeutic options for the COVID-19 patient. The experience from the hematologist

Resumen En la actual pandemia de enfermedad por coronavirus 2019 (COVID-19) se ha observado que las principales complicaciones se presentan como resultado de la liberación de múltiples citocinas como interleucina (IL) 1, IL-6, factor de necrosis tumoral alfa e interferones de tipo 1 que generan un estado proinflamatorio caracterizado por lesión tisular pulmonar y subsecuentemente falla orgánica múltiple. En el campo de la hematología se cuenta con experiencia en el uso de diversos fármacos diseñados para limitar estas citocinas los cuales se han utilizado ya en pacientes con COVID-19 entre los que se encuentran los inhibidores de la IL-6 como el tocilizumab, el sarilumab y el siltuximab, el inhibidor de IL-1 anakinra y los inhibidores de la janus cinasa ruxolitinib y baricitinib. Al conocer la base fisiopatológica de la COVID-19, la utilidad de este tipo de fármacos muestra resultados alentadores para los cuadros moderados a graves de la enfermedad y extender su uso en ensayos clínicos mayores.

Abstract In the current SARS-CoV-2 pandemic, it has been observed that the main complications arise as a result of the release of multiple cytokines such as IL-1, IL-6, TNF-α and type 1 interferons that generate a proinflammatory state characterized by lung tissue injury and subsequently multiple organ failure. In the hematology field, there is experience in the use of various drugs designed to limit these cytokines which have already been used in patients with COVID-19 including IL-6 inhibitors such as tocilizumab, sarilumab, and siltuximab; the IL-1 inhibitor anakinra; and the janus kinase inhibitors ruxolitinib and baricitinib. Knowing the pathophysiological basis of COVID-19, the usefulness of this type of drugs show encouraging results for moderate to severe symptoms of the disease and encourages its use in larger clinical trials.

Serological diagnosis of paracoccidioidomycosis using a Paracoccidioides spp. comercial antigen and the counterimmunoelectrophoresis method

ABSTRACT Purpose: In-house Paracoccidioides spp. antigens are commonly used in the serological diagnosis of paracoccidioidomycosis (PCM). The sensitivity and specificity of a commercial Paracoccidioides spp. antigen was assessed for PCM serological testing. Method: Counterimmunoelectrophoresis and double immunodiffusion were used to evaluate the Paracoccidioides ID Antigen reagent in sera from PCM cases and patients with other diseases. Results: All active PCM sera (n=24) were reactive using counterimmunoelectrophoresis (sensitivity = 100%), including 11 cases of infection by P. brasiliensis sensu stricto and one by P. americana. Fifteen (88%) out of 17 sera from patients on treatment or cured were reactive, including one case of P. lutzii infection. One to three bands of antigen-antibody precipitate were observed on the agarose gel, with a predominance of two to three bands in the test with untreated PCM sera or at the beginning of antifungal therapy. All sera from patients with histoplasmosis (n=7), aspergillosis (n=5), and other diseases (n=27) tested negative (specificity = 100%). The overall sensitivity and specificity using the commercial antigen and double diffusion test were 75% and 100%, respectively. Conclusion: The commercial antigen performed satisfactorily and may contribute to the dissemination of the use of serological tests for the PCM diagnosis.

Cryptococcosis by Cryptococcus neoformans/Cryptococcus gattii Species Complexes in non-HIV-Infected Patients in Southeastern Brazil

Abstract INTRODUCTION: The clinical manifestations of cryptococcosis are usually associated with the infecting agents Cryptococcus neoformans (CN) and C. gattii (CG) species complexes and the host. In this study, non-HIV-infected patients, at a university hospital in southeastern Brazil, had epidemiological and clinical data associated with cryptococcal disease and isolated Cryptococcus species: CN - 24 patients and CG - 12 patients. METHODS: The comparison was comprised of demographic data, predisposing factors, clinical and laboratory manifestations, and outcomes of cryptococcosis patients treated between 2000 and 2016. Immunocompetent and immunosuppressed patients were also compared, irrespective of the infecting species. Cryptococcus spp. were genotyped by PCR-RFLP analysis of the URA5 gene. RESULTS: Infections by the CN species complex (100% VNI genotype) were associated with drug immunosuppression and fungemia, and patients infected with the CG species complex (83% VG II and 17% VGI genotypes) had more evident environmental exposure and higher humoral response. CN and CG affected patients with or without comorbidities. CONCLUSIONS: Diabetes mellitus, other chronic non-infectious diseases, and alcoholism were likely predisposing factors for infection by both CN and CG species. Immunocompetent patients, independent of the infecting Cryptococcus species complexes, showed a higher occurrence of meningitis and a trend toward less fungal dissemination and longer survival than immunosuppressed hosts.

Daño colateral de la pandemia por COVID-19 en centros privados de salud de Argentina / Collateral damage of COVID-19 pandemic in private healthcare centres of Argentina

Para contener la pandemia de COVID-19 se han adoptado medidas nacionales estrictas de aislamiento social y se han reorganizado los sistemas de salud. En este período, se observaron cambios en la atención de enfermedades no infecciosas. El objetivo de este trabajo fue describir las consecuencias de la pandemia de COVID-19 sobre la atención de enfermedades no transmisibles. Se realizó una encuesta estructurada retrospectiva a 31 centros asistenciales de la Asociación de Clínicas, Sanatorios y Hospitales Privados de la República Argentina y Cámara de Entidades de Diagnóstico y Tratamiento. Se compararon indicadores de abril de 2019 versus abril 2020. Se recolectaron datos sobre consultas de emergencia, ingresos hospitalarios, procedimientos invasivos, tratamiento y ocupación de áreas de internación. En ese periodo las consultas a emergencias y las hospitalizaciones disminuyeron en 75% y 48% respectivamente; los ingresos por angina de pecho y síndrome coronario agudo en 62% y los debidos a accidentes cerebrovascular e isquémico transitorio en 46%. Se encontró una disminución de las angioplastias coronarias (59%) e intervenciones percutáneas totales (65%), y un descenso tanto de las cirugías generales (73%) como de las cardíacas centrales (58%). Si bien el aislamiento social obligatorio es una estrategia clave de salud pública para aplanar la curva de propagación de la infección, la marcada disminución porcentual de consultas e intervenciones podría influir negativamente sobre la morbimortalidad cardiovascular, cerebrovascular y oncológica. Se requiere un esfuerzo conjunto para evitar una posible expansión del daño colateral del COVID-19.

To contain the coronavirus pandemic (COVID-19), a strict nationwide lockdown has been enforced and the health systems have been reorganized to deal with this entity. During this period, changes in the care of non-infectious diseases have been observed. Our aim was to describe the impact of the COVID-19 pandemic in the care of non-communicable diseases. A structured retrospective survey was carried out in 31 healthcare centers affiliated with the Asociación de Clínicas, Sanatorios y Hospitales Privados de la República Argentina y Cámara de Entidades de Diagnóstico y Tratamiento. We compared data for April 2019 versus April 2020 regarding emergency room consultations, hospital admissions, invasive procedures and treatments, and bed occupancy. In April 2020, we observed a decrease in emergency room visits (75%) and hospitalizations (48%). A 62% decrease in admissions was noted for angina pectoris and acute coronary syndromes and a 46% decrease in admissions for stroke and transient ischemic attack. A meaningful decrease was found in coronary angioplasties (59%) and total percutaneous interventions (65%), and also a decrease in general surgeries (73%), and cardiac surgeries (58%). Although social distancing measures are a key public health strategy to flatten the infection curve, the observed decrease in medical visits and interventions may impact negatively on cardiovascular, cerebrovascular and cancer related morbidity and mortality. A collective effort is required to avoid the unintended consequences and collateral damage of the COVID-19 pandemic.

Minimum concentration of Amphotericin B in serum according to the formulation, dose, and daily or prolonged intermittent therapeutic regimen

Abstract INTRODUCTION: The therapeutic efficacy of daily amphotericin B infusion is related to its maximum concentration in blood; however, trough levels may be useful in intermittent regimens of this antifungal drug. METHODS : High performance liquid chromatography (HPLC) was used to determine the minimum concentration (Cmin) of amphotericin B in the serum of patients receiving deoxycholate (D-Amph) or liposomal amphotericin B (L-AmB) for the treatment of cryptococcal meningitis (n=28), histoplasmosis (n=8), paracoccidioidomycosis (n=1), and leishmaniasis (n=1). RESULTS: Daily use of D-Amph 30 to 50 mg or L-AmB 50 mg resulted in a similar Cmin, but a significant increase ocurred with L-AmB 100 mg/day. The geometric mean Cmin tended to decrease with a reduction in the dose and frequency of intermittent L-AmB infusions: 357 ng/mL (100 mg 4 to 5 times/week) > 263 ng/mL (50 mg 4 to 5 times/week) > 227 ng/mL (50 mg 1 to 3 times/week). The impact on Cmin was variable in patients whose dose or therapeutic scheme was changed, especially when administered the intermittent infusion of amphotericin B. The mean Cmin for each L-AmB schedule of intermittent therapy was equal or higher than the minimum inhibitory concentration of amphotericin B against Cryptococcus isolates from 10/12 patients. The Cmin of amphotericin B in patients with cryptococcal meningitis was comparable between those that survived or died. CONCLUSIONS: By evaluating the Cmin of amphotericin B, we demonstrated the therapeutic potential of its intermittent use including in the consolidation phase of neurocryptococcosis treatment, despite the great variability in serum levels among patients.

Human pulmonary dirofilariasis with secondary myocarditis

Abstract Dirofilariasis is a little-known zoonosis, with dogs and cats as definitive hosts. It is caused by nematodes and transmitted by mosquito bites. We report the case of a 67-year-old man with a consumptive syndrome with two subpleural pulmonary opacities. A transthoracic lung biopsy revealed a Dirofilaria worm. Myocardial nuclear magnetic resonance (NMR) demonstrated dilated cardiomyopathy after myocarditis related to dirofilariasis. Human infection is rare and occurs accidentally. The most common radiological alteration is a mainly subpleural coin lesion. Dirofilariasis is a neglected emergent disease and knowledge about it is important for differential diagnoses from neoplastic pulmonary nodules.

Is community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) an emerging pathogen among children in Brazil?

ABSTRACT Background: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is spreading worldwide, but little is known about the epidemiology of this pathogen in Brazil. Objective: To evaluate clinical and microbiological features of children with S. aureus infections admitted to a university hospital. Methods: This was a cross-sectional study evaluating the potential risk factors for CA-MRSA, and a retrospective cohort evaluating in-hospital clinical outcomes. To include patients with both community and hospital-associated infections, we screened the results of the microbiological laboratory tests from January 1, 2012, to December 31, 2016. According to the phenotype, we classified the isolates in Methicillin-Susceptible S. aureus (MSSA), Hospital-Associated Methicillin-Resistant S. aureus (HA-MRSA), and CA-MRSA. Clinical data were collected from the patients' medical records. Results: We identified 279 cases of S. aureus infections (MSSA = 163, CA-MRSA = 69, HA-MRSA = 41). Overall, the incidence density of CA-MRSA and MSSA infections increased while the HA-MRSA incidence density decreased over the study period. CA-MRSA infected patients were more likely to present with skin and soft tissue infections (OR: 2.83, 95%CI: 1.54-5.33, p < 0.001) and osteomyelitis (OR: 4.76; 95%CI: 1.16-22.71, p = 0.014) when compared to MSSA and HA-MRSA infections. Unadjusted case fatality rates were similar between MSSA-infected patients (3.14%, 5/159) and CA-MRSA infected patients (3.80%, 3/79, p = 0.792), while HA-MRSA infected patients were more likely to die in the hospital (12.20%, 5/41, p = 0.013). Conclusions: CA-MRSA is an emergent pediatric pathogen in Brazil. Our results highlight the relevance of choosing an appropriate initial antimicrobial drug for treating children with severe S. aureus infections.

Determinación de la frecuencia de PNUs en una población heterogénea cerrada y su utilidad como marcadores para estudios de asociación genética en casos de labio y paladar hendido no sindrómico / Determination of frequency of SNP's in a population of mixed genetic origin and its use as genetic markers for association studies in cases of not syndromic cleft lip and palate

RESUMEN El labio y paladar hendido es una de las patologías congénitas con mayor prevalencia en el mundo. En el presente trabajo se hace un análisis de 12 PNU localizados en las secuencias genómicas de ABCA4, BMP4, MSX1, SUMO1, VAX1 y IRF6, bajo una perspectiva epidemiológica, de genética molecular, genómica y de genética de poblaciones; todo lo anterior aplicado a una población de Querétaro, México, de origen genético mixto. Material y métodos: Se realizó un estudio observacional, analítico y descriptivo a partir de muestras de 93 tríadas (sujetos de estudio y sus padres). Al seleccionar PNU que puedan ser diferenciados por medio de RFLP esperamos distinguir entre marcadores genéticos que: 1) cumplan con la ecuación de equilibrio de Hardy-Weinberg y 2) validarlos como potenciales marcadores genéticos para ser empleados en estudios de asociación en poblaciones cerradas de origen genético mixto con labio y paladar hendido (Amealco, Querétaro, México). De ser así, posteriormente se plantea probar las frecuencias obtenidas con una población seleccionada genéticamente cerrada de Amealco, Querétaro. Resultados: Después de realizar el análisis RFLP de 12 PNU localizados en la secuencia de genes ABCA4, BMP4, MSX1, SUMO1, VAX1 y IRF6, hallamos el mismo alelo para PNU analizado, el cual se encuentra en el 100% de la población. Conclusión: De los 12 PNU analizados, en este reporte, por primera vez se menciona la frecuencia de cinco de ellos. Los restantes siete presentaron la misma frecuencia reportada en la literatura. Aunque los PNU seleccionados no fueron de utilidad como marcadores genéticos debido a que el mismo alelo está presente en el 100% de la población general. El hecho de haberlos encontrado en el mismo genotipo de todas las muestras indica que la población de la ciudad de Querétaro es genéticamente cerrada y con base en esto extremadamente útil para futuras validaciones de otros PNU como posibles marcadores genéticos.

ABSTRACT The cleft lip and palate is one of the congenital pathologies with greater prevalence in the world. In the present work, there is an analysis of 12 SNP's located in genomic sequences of ABCA4, BMP4, MSX1, SUMO1, VAX1 andIRF6, under an epidemiological perspective, molecular genetics, genomics and population genetics. All of the above applied to a population of Queretaro, Mexico, of mixed genetic origin. Material and methods: A study was conducted of observation, analytic and descriptive study with samples from 93 triads (study subjects and their parents). When you select SNP's that can be differentiated by RFLP (Restriction Fragment Length Polymorphism)we hope to distinguish between genetic markers that: 1)comply with the equation of balance of Hardy-Weiner and 2) Validate them as potential genetic markers to be used in studies of association in closed populations of genetic origin mixed with cleft lip and palate in Amealco, Queretaro, Mexico. If so subsequently raises test the frequencies obtained with a selected population genetically closed in Amealco, Queretaro. Results: After performing the RFLP analysis of 12 SNP's located in the sequence of genes ABCA4, BMP4, MSX1, SUMO1, VAX1 and IRF6, we find the same allele for SNP analyzed which is located in the 100% of the population. Conclusion: Of the 12 SNP's analyzed in this report, for the fi rst time 5 of them are mentioned their frequency. The rest of them had the same frequency reported in the literature. Although the SNP's selected were not useful as a genetic markers due to the same allele is present in 100% of the general population. The fact of having found in the same genotype of all samples indicates that the population of the city of Queretaro is genetically closed and on the basis of this extremely useful for future validations of other SNP's as potential genetic markers.

Influence of hydrogel use on soybean cultivation hydrical stress / Influência do uso do hidrogel no cultivo da soja sob estresse hídrico

Among the agricultural production factors, the water deficit is one of the main reasons that limits soy production in Brazil. In order to mitigate losses due to water stress in the plants, hydrogels appear as soil water conditioners. They are polymers capable of absorbing large amounts of water and are being used as a viable alternative to improve the storage of water in areas of scarcity. Hydrogen concentrations between 14 and 18 kg ha-1 resulted in higher plant height, number of pods, one hundred grain mass and grain yield.

Dentre os fatores de produção agrícola, o déficit hídrico é um dos principais motivos que mais limita a produção de soja no Brasil. A fim de amenizar os prejuízos por estresse hídrico nas plantas, os hidrogéis surgem como condicionadores de água no solo, já são polímeros capazes de absorver grande quantidade de água e estão sendo utilizados como alternativa viável para melhorar o armazenamento de água em áreas de escassez. Objetivou-se com este trabalho avaliar a eficiência da utilização do hidrogel na retenção e disponibilização de água para o desenvolvimento e produção da cultura da soja quando submetido a estresse hídrico. As concentrações de hidrogéis entre 14 e 18 kg ha-1 resultaram em maior altura de plantas, número de vagens, massa de cem grãos e produtividades de grãos.

Estudio longitudinal: Cáncer de Ovario en el Instituto Nacional de Oncología y Radiobiología de Cuba (INOR), resultados del tratamiento / Longitudinal study: Ovarian cancer at the National Institute of Oncology and Radiobiology of Cuba (INOR), treatment results

Introducción: El cáncer de ovario es una causa común de muerte entre las mujeres que desarrollan neoplasias ginecológicas. La supervivencia depende de factores clínicos y del tipo de cirugía. El objetivo del presente estudio es describir la supervivencia de un grupo de pacientes con diagnóstico de cáncer de ovario tomando en cuenta varios factores. Métodos: El presente estudio longitudinal retrospectivo se realizó en mujeres con cáncer de ovario tratadas en el Instituto Nacional de Oncología y Radiobiología, La Habana-Cuba entre el 1 de enero y el 31 de diciembre de 2005, con seguimiento de por lo menos 5 años. Las variables fueron edad, tipo histológico del tumor, etapa clínica de la FIGO, grado de diferenciación celular, valores del biomarcador CA-125, tipo de cirugía realizada, respuesta a la quimioterapia utilizada, supervivencia, recurrencias. El paquete estadístico utilizado fue SPSS 11.0 para Windows. Se aplicaron pruebas estadísticas como la prueba no paramétrica de Kruskal-Wallis, la prueba no paramétrica de MannWhitney y la prueba de Chi-cuadrado de Pearson. Resultados: Se registraron 29 casos de mujeres con cáncer de ovario. Once casos (37.9 %) fueron en menores de 45 años. En Etapa clínica III, 18 casos (62.1 %). De grado indiferenciado en 17 casos (58.6 %). 16 casos (55.2 %) fueron del tipo histológico seroso. El valor del CA-125 fue >35 U/mL en 13 casos (61.9 %). Las mujeres con etapa clínica I, tuvieron un Intervalo Libre de la Enfermedad (ILE) de 46 meses versus 27 meses en mujeres con etapa III y 12 meses en etapa IV (P>0.05). El grado de diferenciación celular Bien diferenciado determinó estadísticamente el mejor ILE: 55 meses versus 27 meses en el grado moderadamente diferenciado y de 21 meses en el grado indiferenciado (P=0.025). El tipo histológico así como los niveles de CA-125 no determinaron diferencias estadísticas de ILE, así como en Supervivencia Global Media (SGM). Según el tipo de tratamiento no existieron diferencias estadísticas significativas en el ILE, SGM. Sin embargo las cirugías clasificadas como "óptimas" por parte del equipo quirúrgico tuvieron mayor ILE (Delta 17 meses) P=0.038. Conclusión: En esta serie de casos presentada, las pacientes con cáncer de ovario en Etapa clínica I tuvieron una mejor supervivencia que las pacientes con Etapa clínica III. Así mismo las cirugías clasificadas como óptimas tuvieron mayor intervalo libre enfermedad y mayor supervivencia libre de enfermedad.

Introduction: Ovarian cancer is a common cause of death among women who develop gynecological neoplasms. Survival depends on clinical factors and the type of surgery. The objective of the present study is to describe the survival of a group of patients diagnosed with ovarian cancer taking into account several factors. Methods: The present retrospective longitudinal study was conducted in women with ovarian cancer treated at the National Institute of Oncology and Radiobiology, Havana-Cuba between January 1 and December 31, 2005, with follow-up of at least 5 years . The variables were age, histological type of the tumor, clinical stage of the FIGO, degree of cellular differentiation, values of the CA-125 biomarker, type of surgery performed, response to the chemotherapy used, survival, recurrences. The statistical package used was SPSS 11.0 for Windows. Statistical tests were applied, such as the non-parametric Kruskal-Wallis test, the nonparametric Mann-Whitney test and the Pearson Chi-square test. Results: There were 29 cases of women with ovarian cancer. Eleven cases (37.9%) were in children under 45 years of age. In Clinical Stage III, 18 cases (62.1%). Of undifferentiated degree in 17 cases (58.6%). 16 cases (55.2%) were of the serous histological type. The value of CA-125 was> 35 U/ mL in 13 cases (61.9%). Women with clinical stage I had a Disease Free Interval (DFI) of 46 months versus 27 months in women with stage III and 12 months in stage IV (P> 0.05). The degree of differentiated cellular differentiation statistically determined the best DFI: 55 months versus 27 months in the moderately differentiated degree and 21 months in the undifferentiated degree (P = 0.025). The histological type as well as CA-125 levels did not determine statistical differences of DFI, as well as in Average Global Survival (AGS). According to the type of treatment, there were no significant statistical differences in the FID and AGS. However, surgeries classified as "optimal" by the surgical team had a greater DFI (Delta 17 months) P = 0.038. Conclusion: In this case series presented, patients with ovarian cancer in clinical stage I had a better survival than patients with clinical stage III. Likewise, surgeries classified as optimal had greater free disease interval and greater disease-free survival.

Fluconazole levels in serum and cerebrospinal fluid according to daily dosage in patients with cryptococcosis and other fungal infections

ABSTRACT Fluconazole is extensively used for the treatment of candidiasis and cryptococcosis. Among other factors, successful treatment is related to appropriate fluconazole levels in blood and cerebrospinal fluid. In the present study, fluconazole levels were determined in 15 patients, 14 of whom had AIDS and 13 had neurocryptococcosis. The only selection criterion was treatment with fluconazole, which was performed with a generic or similar form of the drug. Fluconazole level was determined by high performance liquid chromatography and the susceptibility profile of Cryptococcus spp. isolated from the patients was assessed by broth microdilution. Blood and cerebrospinal fluid fluconazole levels were found to be related to the fluconazole daily dose, and exceeded the minimum inhibitory concentration of this antifungal for the Cryptococcus spp. isolates. A good correlation was observed between serum and cerebrospinal fluid drug concentration. In conclusion, treatment with non-original fluconazole under usual medical practice conditions results in appropriate blood and cerebrospinal fluid levels of the drug for inhibiting Cryptococcus spp. susceptible to this antifungal drug. The relatively common failures of neurocryptococcosis treatment appear not to be due to insufficient fluconazole levels in the cerebrospinal fluid, especially with the use of daily doses of 400-800 mg.

A randomized clinical trial on the effectiveness of a symbiotic product to decolonize patients harboring multidrug-resistant Gram-negative bacilli

Abstract INTRODUCTION: We aimed to evaluate the effectiveness of a symbiotic product to decolonize the intestinal tract of patients harboring multidrug-resistant (MDR) Gram-negative bacilli and to prevent nosocomial infections. METHODS: This was a randomized, double blind, placebo-controlled clinical trial, conducted in a tertiary-care university hospital. All adult hospitalized patients with a positive clinical culture and a positive rectal swab for any MDR Gram-negative bacilli were potentially eligible. Exclusion criteria were pregnancy, immunosuppression, and bowel obstruction/perforation. The intervention consisted of administering a symbiotic product (Lactobacillus bulgaricus, Lactobacillus rhamnosus, and fructo-oligosaccharides) twice a day for seven days via the oral/enteral route. RESULTS: Between August 1, 2012 and December 22, 2013, 116 of 275 eligible patients were allocated to treatment (n=57) and placebo (n=59). Overall, 101 patients received at least four doses of the study products and were included in the modified intention-to-treat analysis. The primary study outcome, a negative rectal swab for MDR Gram-negative bacilli after treatment, was identified in 16.7% (8/48) and 20.7% (11/53) of patients in the experimental and placebo group, respectively (p=0.60). The secondary outcome, the combined incidence of nosocomial respiratory and urinary tract infections, was 37.5% (18/48) in the experimental group versus 22.6% (12/53) in the control group (adjusted odds ratio: 1.95, 95% confidence interval: 0.69-5.50, p=0.21). Length of stay after the beginning of the intervention, incidence of adverse events, and in-hospital mortality rates were similar in both study groups. CONCLUSIONS: Under the present study conditions, symbiotic administration was not effective for decolonizing hospitalized patients harboring MDR Gram-negative bacilli.

Epidemiological overview, advances in diagnosis, prevention, treatment and management of epithelial ovarian cancer in Mexico / Panorama epidemiológico, avances diagnósticos, prevención, tratamiento y manejo de cáncer ovárico epitelial en México

Abstract The epithelial ovarian cancer (EOC) has been underdiagnosed because it does not have a specific clinical presentation, and the signs and symptoms are similar to the irritable bowel syndrome and pelvic inflammatory disease. EOC is less common than breast and cervical cancer, but it is more lethal. On the whole, EOC has an early dissemination to peritoneal cavity, which delays a timely diagnosis and increases the rate of advanced diagnosed disease. The diagnosis usually surprises the women and the primary care physician. Therefore, it is necessary to count on prevention and early diagnosis programs. EOC has 80% response to surgical treatment, but nearly 70% of the patients may relapse in five years. The objectives of this document are presenting a summary of the EOC epidemiology and comment about advancements in prevention, diagnosis, and treatment of this cancer. That will raise awareness about the importance of this disease.

Resumen El cáncer ovárico epitelial (COE) ha sido subdiagnosticado debido a que no tiene presentación clínica específica y a que los signos y síntomas son similares al síndrome de colon irritable y a la enfermedad inflamatoria pélvica. Es menos común que el cáncer de mama o el cervicouterino, pero es más letal. En general, tiene diseminación temprana a cavidad peritoneal, lo cual retrasa un pronóstico oportuno e incrementa la tasa de diagnóstico de enfermedad avanzada. Usualmente, el diagnóstico sorprende a la mujer y al médico de primer contacto. Entonces, es necesario contar con programas de prevención y diagnóstico temprano. El COE tiene 80% de respuesta quirúrgica, pero cerca de 70% de las pacientes puede recaer en cinco años. Los objetivos de este documento son presentar un resumen de la epidemiología del COE y comentar los avances en prevención, diagnóstico y tratamiento de este cáncer. Esto despertará la conciencia acerca de la importancia de esta enfermedad.

Secular trends in Klebsiella pneumoniae isolated in a tertiary-care hospital: increasing prevalence and accelerated decline in antimicrobial susceptibility

Abstract: INTRODUCTION Klebsiella pneumoniae has become an increasingly important etiologic agent of nosocomial infections in recent years. This is mainly due to the expression of virulence factors and development of resistance to several antimicrobial drugs. METHODS This retrospective study examines data obtained from the microbiology laboratory of a Brazilian tertiary-care hospital. To assess temporal trends in prevalence and antimicrobial susceptibility, K. pneumoniae isolates were analyzed from 2000 to 2013. The relative frequencies of K. pneumoniae isolation were calculated among all Gram-negative bacilli isolated in each period analyzed. Susceptibility tests were performed using automated systems. RESULTS: From 2000-2006, K. pneumonia isolates comprised 10.7% of isolated Gram-negative bacilli (455/4260). From 2007-2013, this percentage was 18.1% (965/5331). Strictly considering isolates from bloodstream infections, the relative annual prevalence of K. pneumoniae increased from 14-17% to 27-32% during the same periods. A progressive decrease in K. pneumoniae susceptibility to all antimicrobial agents assessed was detected. Partial resistance was also observed to antimicrobial drugs that have been used more recently, such as colistin and tigecycline. CONCLUSIONS Our study indicates that K. pneumoniae has become a major pathogen among hospitalized patients and confirms its recent trend of increasing antimicrobial resistance.