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1.
Article in Spanish | LILACS, BDNPAR | ID: biblio-1337804

ABSTRACT

La resistencia a los antimicrobianos (RAM), representa un grave problema por el uso indiscriminado de antimicrobianos de amplio espectro. En nuestro país, durante el primer cuatrimestre del año, se observó un aumento inusual en el número de aislamiento de gérmenes multirresistentes, sobre todo de bacilos gramnegativos, los cuales fueron remitidos al laboratorio de referencia con el objetivo de caracterizar los genes de resistencia a los carbapenemes. Estudio observacional y prospectivo de corte transversal en 456 aislamientos de bacilos gramnegativos provenientes de 11 centros colaboradores de la Red Nacional de Vigilancia de la RAM, remitidos al Laboratorio Central de Salud Pública entre enero y abril de 2021, para la detección molecular (reacción en cadena de la polimerasa múltiple) de los genes de resistencia enzimática bla OXA-51, bla OXA-23, bla OXA-24, bla OXA-48, bla OXA-58, bla NDM, bla KPC, bla IMP, bla VIM. Trescientos sesenta correspondieron a bacilos gramnegativos no fermentadores: 346 Acinetobacter baumannii y 14 Pseudomonas aeruginosa; 96 fueron miembros de Enterobacterales, siendo prevalente Klebsiella pneumoniae (81). Todos los aislamientos de Acinetobacter baumannii resultaron ser productores de carbapenemasas: OXA-23 (94%), NDM (4%), NMD+OXA-58 (2%); en Pseudomonas aeruginosa, 7 de los 14 aislamientos (50%) fueron portadores de metalobetalactamasa del genotipo NDM (100%). Los genotipos NDM (92%) y KPC (8%) fueron confirmados en Enterobacterales. La resistencia plasmídica a carbapenemes es endémica en nuestro país, siendo prevalentes los genotipos OXA-23 en Acinetobacter baumannii y NDM en Pseudomonas aeruginosa y Enterobacterales


Antimicrobial resistance (AMR) represents a serious problem due to the indiscriminate use of broad-spectrum antimicrobials. During the first quarter of the year, an unusual increase in the number of isolation multi-resistant germs, especially gram-negative bacilli was observed, specially of Gram-negative bacilli which were referred to the reference laboratory in order to characterize the carbapenems resistance genes. Observational and prospective cross-sectional study in 456 isolates of Gram-negative bacilli from 11 collaborating centers of the National AMR Surveillance Network, referred to the Central Public Health Laboratory (LCSP) between January and April 2021, for molecular detection (multiple polymerase chain reaction) targeting the enzymatic resistance genes: bla OXA-51, bla OXA-23, bla OXA-24, bla OXA-48, bla OXA-58, bla NDM, bla KPC, bla IMP, bla VIM. Of the 456 isolates studied, 360 corresponded to non-fermenting Gram-negative bacilli, of which 346 were confirmed as Acinetobacter baumannii and 14 Pseudomonas aeruginosa; 96 were Enterobacterales, being Klebsiella pneumoniae (81) the most prevalent. All isolates of Acinetobacter baumannii carried genes encoding carbapenemases, being the OXA-23 (94%) followed by NDM (4%) and NDM +OXA-58 (2%). In Pseudomonas aeruginosa strains, 7 of the 14 isolates (50%) were carriers of NDM metallobetalactamase (100%). No carbapenemase gene was detected in the remaining 7. In all Enterobacterales strains, the presence of carbapenemases of the NDM (92%) and KPC (8%) genotypes were confirmed. Plasmid resistance to carbapenems is endemic in our country, being the OXA-23 genotypes prevalent in Acinetobacter baumannii and NDM in Pseudomonas aeruginosa and Enterobacterales


Subject(s)
Pseudomonas Infections , Acinetobacter baumannii , Carbapenem-Resistant Enterobacteriaceae , Pseudomonas aeruginosa , Bacteria , Drug Resistance , Polymerase Chain Reaction , Genotype
2.
Rev. bras. anal. clin ; 53(1): 58-63, 20210330. graf, tab
Article in Portuguese | LILACS | ID: biblio-1291397

ABSTRACT

Objetivo: Avaliar a prevalência e o perfil de suscetibilidade aos antimicrobianos das cepas de Acinetobacter baumannii e Pseudomonas aeruginosa isoladas de amostras de lavado traqueal. Métodos: Trata-se de um estudo retrospectivo, transversal, descritivo, no qual foram coletados resultados de cultura de lavado traqueal de pacientes com PAV, internados em uma UTI adulta de um hospital público da cidade de Juiz de Fora, MG. Os dados foram coletados nos registros eletrônicos do Serviço de Controle de Infecção Hospitalar, referentes ao período de janeiro a dezembro de 2018. Resultados: Foram analisadas 469 amostras de lavado traqueal de pacientes adultos internados na UTI, sendo consideradas culturas positivas, aquelas com contagem de colônias ≥106UFC/ mL, totalizando 242 (51,52%) das amostras de lavado traqueal positivas, sendo que, destas, 230 foram monomicrobianas e 12 com dois micro-organismos. Foram isoladas 59 (24,89%) cepas de Acinetobacter baumannii e 45 (18,98%) cepas de Pseudomonas aeruginosa. De acordo com os critérios do CLSI 2018, 100% das cepas de A. baumannii se mostraram resistentes a meropenem, cefepime, ceftriaxona, ceftazidima e piperaci- lina-tazobactam. Conclusão: A. baumannii e Pseudomonas aeruginosa são agentes importantes de PAV, sendo que A. baumannii foi o patógeno mais comumente associado e apresentou multirresistência aos fármacos testados.


Objective: The objective of this study is to evaluate the prevalence and antimicrobial susceptibility profile of strains of A. baumannii and P. aeruginosa isolated from tracheal lavage. Methods: This is a retrospective, cross-sectional, descriptive study where tracheal lavage culture results were collected from patients with VAP admitted to an adult ICU at a public hospital in the city of Juiz de Fora. Data were collected through the records of the Hospital Infection Control Service for the period from January to December 2018. Results: 469 tracheal lavage samples from adult patients admitted to the ICU were analyzed. Positive cultures were considered if ≥106CFU / mL, totaling 242 (51.52%) of the tracheal lavage samples were positive; 55 (24.89%) strains of A. baumannii and 45 (18.98%) strains of P. aeruginosa were isolated. According to the CLSI 2018 criteria, A. Baumannii presented 100% of the strains resistant to meropenem, cefepime, ceftriaxone, ceftazidime and piperacillin-tazobactam. Conclusion: A. baumannii and P. aeruginosa are important agents of PAV. Furthermore, A. baumannii was the most commonly associated pathogen and presented multiresistance to the drugs tested, being considered as a public health issue.


Subject(s)
Humans , Male , Female , Pneumonia , Pseudomonas aeruginosa , Respiration, Artificial , Acinetobacter Infections , Drug Resistance , Acinetobacter baumannii
3.
Arq. ciências saúde UNIPAR ; 25(1): 79-85, jan-abr. 2021.
Article in Portuguese | LILACS | ID: biblio-1151426

ABSTRACT

Introdução: O diagnóstico da hanseníase possui números significativos que causam preocupação à saúde pública. Os casos de resistência medicamentosa nessa doença se iniciaram em meados dos anos 60 e diante do problema, a Organização Mundial da Saúde instituiu em 1981 a poliquimioterapia, associação dos antibióticos rifampicina, dapsona e clofazimina, tratamento atual de escolha. A resistência aos fármacos na hanseníase é reportada pela literatura, desvelando um obstáculo à sua eliminação. Apresentamos nessa revisão os principais aspectos da resistência medicamentosa no tratamento para hanseníase e seus impactos. Metodologia: Revisão sistemática sobre os aspectos da resistência medicamentosa utilizando a pesquisa exploratória como metodologia de abordagem. Foram pesquisados os termos resistência medicamentosa, hanseníase, recidiva, alterações genéticas e os operadores booleanos "and" e "or" na busca. Resultados e discussão: A dificuldade de tomar a medicação corretamente foi um dos principais fatores que acarretaram resistência do bacilo Mycobacterium leprae aos fármacos. Homens de países norte e sul-americanos e asiáticos foram os mais atingidos por episódios de resistência. A resistência medicamentosa é uma das principais causas de recidivas em hanseníase. O principal fármaco causador de resistência medicamentosa descrito nos trabalhos foi a dapsona (46,6%) e a maioria das alterações genéticas encontradas estão no gene rpoB; 23,2% dos registros relatados foram de resistência secundária aos fármacos e, também, sete casos de resistência múltipla a esses medicamentos. Conclusão: Os principais aspectos da resistência medicamentosa na hanseníase são os equívocos ao ingerir os medicamentos e as alterações genéticas na bactéria. Os impactos causados estão na dificuldade de refazer o tratamento, a possibilidade de nova transmissão e o aparecimento de sintomas mais graves.


Introduction: The diagnosis of leprosy has significant numbers causing public health concern. Reports of drug resistance in this disease begun in the mid-1960s and due to this problem, the World Health Organization instituted a multidrug therapy with rifampicin, dapsone, and clofazimine antibiotic association in 1981, which is currently the first-choice treatment for leprosy. Cases of drug resistance have been reported in literature, revealing an obstacle to the eradication of the disease. This paper has the purpose of presenting the key aspects and impacts of drug resistance in the treatment for leprosy. Methods: Systematic review of the drug resistance aspects using exploratory research as an approach methodology. The authors searched the terms drug resistance, leprosy, recurrence, genetic alterations, and the Boolean operators "and" and "or" between them. Results and discussion: The difficulty in taking the medication correctly was one of the key factors that led to drug resistance for Mycobacterium leprae. Men from North and South American, as well as from Asian countries, were the most affected by episodes of resistance. Drug resistance is one of the main causes of leprosy recurrences. Dapsone was the most frequently identified drug resistance in the studies (46.6%), while most of the genetic alterations were found in the rpoB gene; 23.2% of the cases were from secondary resistance episodes, and seven cases of multiple resistance were reported. Conclusion: The misconceptions when taking the treatment and the Mycobacterium leprae genetic alterations have been described as the key aspects of drugs resistance in leprosy and the impacts caused are the difficulty in redoing the treatment, the possibility of new transmission, and the appearance of more severe symptoms.


Subject(s)
Drug Resistance/drug effects , Drug Resistance, Bacterial/drug effects , Mycobacterium leprae/drug effects , Rifampin/adverse effects , Bacteria/genetics , Pharmaceutical Preparations , Clofazimine/adverse effects , Fluoroquinolones/adverse effects , Dapsone/adverse effects , Drug Therapy, Combination/adverse effects , Leprosy/drug therapy , Anti-Bacterial Agents/adverse effects
5.
San Salvador; MINSAL; ene. 11, 2021. 40 p. ilus, graf.
Non-conventional in Spanish | LILACS, BISSAL | ID: biblio-1146523

ABSTRACT

La presente guía clínica de atención integral de pacientes con tuberculosis farmacorresistente, será uno de los pilares de apoyo esencial para la reducción de la morbimortalidad causada por dicha enfermedad, ya que establece los criterios que el personal de salud debe tomar en cuenta para poder prevenir y detectar los casos e iniciar oportunamente el tratamiento para cortar la cadena de transmisión y evitar así su propagación


This clinical guide for the comprehensive care of patients with drug-resistant tuberculosis will be one of the essential support pillars for the reduction of morbidity and mortality caused by this disease, since it establishes the criteria that health personnel must take into account in order to prevent and detect cases and initiate treatment in a timely manner to cut the chain of transmission and thus prevent its spread


Subject(s)
Tuberculosis , Drug Resistance , Guideline , Comprehensive Health Care
6.
Rev. Soc. Bras. Med. Trop ; 54: e20200087, 2021. tab, graf
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1136920

ABSTRACT

Abstract INTRODUCTION: In this study, we report a clonal dissemination of carbapenem resistant Acinetobacter baumannii isolates due to the acquisition of blaOXA-23 in a regional hospital located in Brazilian Amazon Region. METHODS: The isolates were identified by MALDI-TOF and the carbapenemase-encoding genes were detected by multiplex-PCR. The genetic similarity was investigated by pulsed-field gel electrophoresis (PFGE). RESULTS: Only 10 (55.6%) isolates harbored the gene bla OXA-23. PFGE analysis revealed that these isolates belong to a single clone. CONCLUSIONS: This dissemination strategy indicates the need for surveillance, adoption of control procedures defined in guidelines, and the careful administration of antimicrobials should be reinforced.


Subject(s)
Humans , Acinetobacter Infections/epidemiology , Acinetobacter baumannii/genetics , Bacterial Proteins/genetics , beta-Lactamases/genetics , Brazil/epidemiology , Drug Resistance , Microbial Sensitivity Tests , Electrophoresis, Gel, Pulsed-Field , Molecular Epidemiology , Hospitals , Anti-Bacterial Agents/pharmacology
7.
Article in Chinese | WPRIM | ID: wpr-880103

ABSTRACT

OBJECTIVE@#To investigate the effect of autophagy on the drug resistance of different human lymphoma cells.@*METHODS@#Human Burkitt's lymphoma cell Daudi, human B lymphoma cell SUDHL-4, and human mantle cell lymphoma cell JeKo-1 were taken as the research subjects. The expression of Atg5 was inhibited by the treatments of autophagy inhibitors or stable interference via lentivirus infection. The autophagy activity of B lymphoma cell was changed, and the changes of lymphoma cells to the drug resistance of ADR and VCR was observed.@*RESULTS@#JeKo-1 cells showed the strongest resistance to ADR and VCR, followed by SUDHL-4, and Daudi cells showed the weakest resistance to ADR and VCR. At the same time, JeKo-1 cells showed the strongest autophagy activity, followed by SUDHL-4, and Daudi cells showed the weakest autophagy activity. After the treatments of autophagy inhibitors or stable Atg5 interference, the resistance of lymphoma cells to ADR and VCR was significantly weakened, and there was the positive correlation at the drug resistance and the autophagy activity of B lymphoma cell.@*CONCLUSION@#The higher autophagy activity in lymphoma cells, the lower chemotherapy resistance of the lymphoma cells after autophagy was inhibited.


Subject(s)
Adult , Autophagy , Burkitt Lymphoma , Cell Line, Tumor , Drug Resistance , Humans , Lymphoma, B-Cell
8.
Rev. Soc. Bras. Med. Trop ; 54: e0375-2020, 2021. tab
Article in English | LILACS | ID: biblio-1155553

ABSTRACT

Abstract INTRODUCTION: Leprosy recurrence is the reappearance of the disease after treatment with current schemes and discharged for cure and may have variable incubation periods. METHODS: This is a descriptive observational study of leprosy recurrence in Espírito Santo diagnosed between January 2018 and January 2020. RESULTS: One hundred and ninety-two cases were available, of which 30 were diagnosed with leprosy recurrence. CONCLUSIONS: In 25 cases, the incubation period was 5-15 years after the first treatment, favoring bacillary persistence. In the remaining 5 cases, the disease had recurred after 15 years, pointing to reinfection as none of them exhibited drug resistance.


Subject(s)
Humans , Leprosy/drug therapy , Recurrence , Brazil , Drug Resistance , Tertiary Care Centers
9.
Clin. biomed. res ; 41(2): 167-169, 2021. graf
Article in English | LILACS | ID: biblio-1337839

ABSTRACT

For years, the management of schizophrenia has represented a challenge for clinicians, with antipsychotic treatments usually resulting in relapses and new hospitalizations. Clozapine has been shown to be an effective medication for treatment-resistant schizophrenia (TRS), but is currently underused due to its potential side effects. Nevertheless, research has suggested that clozapine reduces future hospitalizations in patients with TRS. This study aims to verify the rates of hospitalizations in patients with TRS under long-term use of clozapine. We retrospectively analyzed clinical data from 52 individuals with TRS before and after the use of clozapine. The mean duration of treatment with and without clozapine was 6.6 (± 3.9) and 8.5 years (± 6.6), respectively. Patients had a median of 0.5 (0.74) hospitalizations per year before the use of clozapine and 0 (0.74) hospitalizations after it (p = 0.001). Therefore, the use of clozapine resulted in an expected reduction in the number of hospitalizations per year in individuals with TRS. (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Schizophrenia/drug therapy , Drug Resistance , Clozapine/therapeutic use , Hospitalization
10.
Biomédica (Bogotá) ; 40(4): 626-640, oct.-dic. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1142429

ABSTRACT

Resumen. Introducción. La prueba Xpert MTB/RIF™ es una prueba molecular rápida para el diagnóstico de la tuberculosis y la resistencia a la rifampicina. Desde el 2010 es la recomendada por la Organización Mundial de la Salud (OMS) y, aunque fue introducida en Colombia en el 2012, se desconocen los resultados de su uso.Objetivo. Describir la cobertura y la fidelidad en el uso de la prueba Xpert MTB/RIF™ en pacientes con tuberculosis pulmonar en una ciudad con alta carga de la enfermedad en Colombia.Materiales y métodos. Se hizo un estudio retrospectivo descriptivo de casos del programa de tuberculosis en Cali entre el 2013 y el 2019. La cobertura se estimó como el total de pruebas empleadas en los casos registrados en el programa. La fidelidad se midió con base en los protocolos internacionales de uso de la Xpert MTB/RIF™. Además, se hizo un análisis de correspondencias múltiples entre la prueba y las variables sociodemográficas.Resultados. Se incluyeron 6.328 pacientes con tuberculosis pulmonar, de los cuales 181 eran resistentes a los fármacos. La cobertura total de la Xpert MTB/RIF™ durante el periodo de estudio fue de 10,3 % (n=655), con una variación anual entre 0,2 y 23 %. La fidelidad fue de 46,8 % para los grupos de mayor riesgo de tuberculosis multirresistente (TB-MDR). El uso de la prueba se relacionó con la condición de ser hombre, afrocolombiano, y tener entre 41 y 60 años de edad.Conclusiones. La cobertura de la prueba Xpert MTB/RIF™ en Cali es baja y su uso no responde a la priorización recomendada para su implementación. Se requieren estrategias para promover su uso adecuado, de manera que contribuya a la meta de poner fin a la tuberculosis.


Abstract. Introduction:The Xpert MTB/RIF™ is a rapid molecular test that diagnoses tuberculosis and rifampin resistance. Since 2010, it is recommended by the World Health Organization (WHO) and although it was introduced in Colombia since 2012, the results of its implementation are unknown.Objective: To describe the coverage and fidelity in the implementation of the Xpert MTB/RIF™ in patients with pulmonary tuberculosis in a city with a high burden for the disease in Colombia.Materials and methods: We conducted a retrospective, descriptive study of cases from a tuberculosis program in Cali between 2013 and 2019. We estimated the coverage as the total number of tests used compared to the cases registered in the program and the fidelity based on international Xpert MTB/RIF™ implementation protocols. We performed a multivariate analysis of multiple correspondences between the test and the sociodemographic variables.Results: We included 6,328 patients with pulmonary tuberculosis of whom 181 were drug-resistant. The Xpert MTB/RIF™ coverage was 10,3% (n=655) with an annual variation between 0.2% and 23%. Loyalty among the highest risk groups of MDR-TB was 46.8%. The use of the test was related to being an Afro-Colombian man between 41 and 60 years of age.Conclusions: The coverage of the Xpert MTB/RIF in Cali is low and its use does not follow the recommended prioritization for its implementation. Implementation strategies are required for its proper use to contribute to the goal of ending tuberculosis.


Subject(s)
Tuberculosis, Pulmonary , Molecular Diagnostic Techniques , Rifampin , Drug Resistance
11.
Rev. cuba. pediatr ; 92(4): e1082, oct.-dic. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1149921

ABSTRACT

El diagnóstico, evaluación y tratamiento del síndrome nefrótico en el niño data de los tiempos de Hipócrates. Sin embargo, en la actualidad algunos pacientes con la enfermedad siguen siendo un reto terapéutico para el médico. Nos proponemos examinar en la literatura reciente, distintas propuestas o protocolos de tratamiento y las nuevas drogas que pueden utilizarse en la atención al paciente con esta enfermedad. Los protocolos de tratamiento varían con relativa frecuencia y las drogas, tanto en los síndromes nefróticos recaedores frecuentes, corticodependientes o corticorresistentes, no garantizan en muchas ocasiones la curación del paciente. Cuando fracasan los esteroides se pueden utilizar agentes alquilantes, inhibidores de la calcineurina, antiproliferativos, anticuerpos monoclonales y otros fármacos, pero existen pacientes que no tienen remisión de la proteinuria con ninguno de estos tratamientos. Por sus características evolutivas, algunos pacientes con síndrome nefrótico idiopático siguen siendo un reto para el médico que trata de evitar su evolución hacia la pérdida de la función renal. A pesar de todos los avances en la atención del niño con síndrome nefrótico, desde el descubrimiento de los esteroides, antibióticos, diuréticos e inmunosupresores, en la actualidad no sabemos exactamente cuál es el mejor tratamiento en las formas resistentes del síndrome nefrótico idiopático en niños(AU)


Diagnosis, evaluation and treatment of nephrotic syndrome in children dates from Hypocrate times. However, nowadays some patients with this disease are still a therapeutic challenge for physicians. The aim of this work is to search in recent literature different proposals or treatment protocols, and new drugs that can be used in the care of patients with this disease. Treatment protocols vary with relative frequency and drugs, as well as in frequent relapsing nephrotic, corticodependent or corticoresistant syndromes, do not guarantee in many ocassions the cure of the patient. When steroids fail, alkylanting agents, calcineurin depressants, antispreading, monoclonal antibodies and other drugs can be ussed; but there are patients who do not have remission of proteinuria with any of these treatments. Due to their evolutive characteristics, some patients with idiopathic nephrotic syndrome are still a challenge for the physicians who try to avoid its evolution toward the loss of renal function. Although all the advances in the care of children with nephrotic syndrome due to the discover of steroids, antibiotics, diuretics and immunosupressive drugs, nowadays we do not exactly know which is the best treatment for the resistant types of idiopathic nephrotic syndrome in children(AU)


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Nephrotic Syndrome/drug therapy , Nephrotic Syndrome/therapy , Drug Resistance , Antibodies, Monoclonal/therapeutic use , Nephrotic Syndrome/prevention & control
12.
Rev. epidemiol. controle infecç ; 10(3): 1-12, jul.-set. 2020. ilus
Article in English | LILACS | ID: biblio-1247650

ABSTRACT

Background and Objectives: Knowledge about species diversity of non-tuberculous mycobacteria (NTM) and the frequency of tuberculosis (TB) is an important issue in rural-urban regions such as Piauí (northeast of Brazil), of low incidence rate of TB , can help to improve diagnosis and prevention strategies. The aim of this study is to examine some epidemiological aspects and the frequency of Mycobacterium tuberculosis (Mtb) and NTM isolated at the central public health reference laboratory, Dr. Costa Alvarenga, Piauí (LACEN-PI). Methods: Data records of all mycobacterosis and tuberculosis cases from January 2014 to March 2015 were analyzed. Results : Of the 20% (142/706) positive growths, 70% (99) were Mtb and 10% NTM. The remainde was of inadequate clinical samples, not allowing the identification of even the suspected NTM. The most frequent clinical form was pulmonary with TB patients younger than those infected with NTM (p = 0.001), the majority living in Teresina (52%). NTMs identified were M. abscessus (36%), M. avium, M. intracellulare, Mycobacterium sp. (14% each) and M. asiaticum, M. szulgai, M. kansasii 7% (each). Mtb drug resistance (7.8%) and TB co-infection with the human immunodeficiency virus (HIV-TB) found to be high (49%, 19/39). Conclusion: The frequencies of Mtb infection, drug resistance and HIV-TB co-infection are still underestimated and failures in the identification of NTM may decrease the actual frequency of these infections. Therefore, there is a need for improvements in TB control and in the diagnosis of NTMs in Piauí.(AU)


Justificativa e Objetivos: O conhecimento da diversidade de espécies de micobactérias não tuberculosas (MNT ) e a frequência da tuberculose (TB) é uma questão importante em regiões rurais-urbanas como o Piauí (nordeste do Brasil), com baixa incidência de TB, pode ajudar a melhorar o diagnóstico e estratégias de prevenção. O objetivo deste estudo é examinar alguns aspectos epidemiológicos e a frequência de Mycobacterium tuberculosis (Mtb) e MNT isolados, no Laboratório Central de Referência em Saúde Pública, Dr. Costa Alvarenga, Piauí (LACEN-PI). Métodos: Dados de todo s os casos de micobacterioses e tuberculose de janeiro de 2014 a março de 2015 foram analisados. Resultados: Dos 20% (142/706), de amostras com crescimento positivo 70% (99) foram Mtb e 10% MNT . O restante era de amostras clínicas inadequadas, não permitindo a identificação inclusive de MNT suspeitos. A forma clínica mais frequente foi pulmonar com pacientes TB mais jovens do que os infectados com MNT (p = 0,001), a maioria morando em Teresina (52%). As MNT s identificadas foram M. abscessus (36%), M. avium , M. intracellulare , M. sp. (14%, cada) e M. asiaticum, M. szulgai , M. kansasii 7% (cada). A droga resistência de Mtb (7,8%) e a co-infecção TB e vírus da imunodeficiência humana (HIV-TB) mostraram-se altas (49%, 19/39).Conclusão: As frequências de infecção por Mtb, de resistência a medicamentos e co-infecção HIV-TB ainda são subestimadas e as falhas na identificação de MNT podem diminuir a real frequência destas infecções . Portanto, há necessidade de melhorias no controle da TB e no diagnóstico de MNT s no Piauí.(AU)


Justificacion y objetivos: Conocer la diversidad de especies de micobacterias no tuberculosas (MNT) y la frecuencia de tuberculosis (TB) es tema importante en regiones rurales-urbanas como Piauí (noreste de Brasil) con baja tasa de incidencia de TB, y puede ayudar a mejorar el diagnóstico y las estrategias de prevenció. El objetivo de este estudio es examinar algunos aspectos epidemiológicos y la frecuencia de Mycobacterium tuberculosis (Mtb) y MNT aislado, en el laboratorio central de referencia de salud pública, Dr. Costa Alvarenga, Piauí (LACEN-PI). Métodos: Se analizaron los datos de todos los casos de micobacteriosis de enero de 2014 a marzo de 2015. Resultados: Del 20% (142/706), de las muestras con crecimiento positivo el 70% (99) fueron Mtb y el 10% MNT. El resto fue de muestras clínicas inadecuadas, no permitiendo la identificación de MNT incluso sospechosas. La forma clínica más frecuente fue la pulmonar y los pacientes con TB eran más jóvenes que los infectados con MNT (p = 0.001), la mayoría viviendo en Teresina (52%).Los MNT identificados fueron M.abscessus (36%), M.avium, M.intracellulare, Mycobacterium sp. (14% cada) y M.asiaticum, M.szulgai, M.kansasii 7% (cada ). La resistencia a los medicamentos de Mtb (7,8%) y la coinfección de TB y el virus de la inmunodeficiencia humana (VIH-TB) fueron altas (49%, 19/39 )Conclusión: Las frecuencias aún subestimadas de resistencia a los medicamentos, coinfección por VIH-TB y fallas de identificaciónidentificación de MNT pueden disminuir la frecuencia real de estas infecciones. Consecuentemente, es necesario mejorar el control y diagnóstico de TB y MNT en Piauí.(AU)


Subject(s)
Humans , Epidemiology , Mycobacterium , Nontuberculous Mycobacteria , Mycobacterium tuberculosis , Drug Resistance , AIDS Serodiagnosis , Health Services Research
13.
An. Fac. Cienc. Méd. (Asunción) ; 53(2): 25-36, 20200800.
Article in Spanish | LILACS | ID: biblio-1119329

ABSTRACT

Introducción: El propósito del estudio es determinar en los urocultivos, la prevalencia de los mecanismos enzimáticos de resistencia encontrados in vitro. Materiales y métodos: Se realizó un estudio retrospectivo, de ambos sexos, mayores de 18 años, que acudieron al Consultorio Externo de Clínica Médica y Urgencias por síntomas de infección urinaria. Se incluyeron todos los urocultivos en los que se aislaron uropatógenos con recuento ≥ 105 UFC/mL. Se excluyeron los urocultivos polimicrobianos, los que no contaban con antibiograma o aquellos con datos clínicos incompletos. Resultados: Se identificaron 1031 urocultivos que cumplieron con los criterios establecidos para la realización del estudio. El 56% correspondió al sexo femenino y el 43% al masculino. La edad media de las mujeres fue de 52± 20 años y el de los hombres fue de 62±16 años. Los uropatógenos más frecuentes fueron Escherichia coli 553 (52% en promedio) seguida de Klebsiella pneumoniae con 148 (14% en promedio). Urocultivos de varones: El principal mecanismo de resistencia de Escherichia coli fueron las BLEE, 55 aislamientos (91%); seguida de las MBL, 3 aislamientos (5%) y KPC, 2 aislamientos (3%). En Klebsiella pneumoniae en 53 aislamientos se puedo observar: BLEE, 31 aislamientos (58%); seguida de las KPC 13 aislamientos (25%) y MBL, 9 aislamientos en (16%). Urocultivos en mujeres: Las enzimas de Escherichia coli fueron 81 aislamientos, de los cuales fueron BLEE, 79 aislamientos (97%); seguido de las KPC, 1 aislamiento (1%) y las MBL, 1 aislamiento (1%). En Klebsiella pneumoniae se pudo observar los siguientes mecanismos enzimáticos en base a 35 aislamientos; BLEE, 19 aislamientos (54%), seguida de las KPC, 12 aislamientos (34%) y por último, MBL, 4 aislamientos (13%). Conclusión: En las IVU de nuestro estudio, Escherichia coli y Klebsiella pneumoniae fueron las principales bacterias que originan resistencia a los antibióticos y la BLEE fue la enzima más frecuentemente identificada en ambos sexos.


Introduction: The objective of this study was to assess frequency of enzymatic resistance mechanisms isolated from community urinary tract infections (UTI) determined in vitro in urine cultures. Objectives: This is a retrospective study, a total of 1031 urine samples were included from patients with urinary tract infection who had consulted at the Outpatient Clinic and Emergencies Services. The following information was recorded, age, sex, urine sample. All urine cultures in which pathogens with a count of ≥ 105 CFU / mL were included. Were excluded polymicrobial urine cultures, those without an antibiogram or those with incomplete clinical data. Results: A total of 1031 urine samples met inclusion criteria, 56% of patients were female and 43% male. The mean age of the women was 52 ± 20 years and in men was 62 ± 16 years. 553 (52%) E. coli and 148 (14%) Klebsiella strains were isolated from community samples. Male urine cultures: The main resistance mechanism of Escherichia coli was ESBLs, 55 isolates (91%); followed by MBL, 3 isolates (5%) and KPC, 2 isolates (3%). In Klebsiella pneumoniae (53 isolates); ESBL, 31 isolates (58%); followed by KPC 13 isolates (25%) and MBL, 9 isolates in (16%). Female urine culture: Escherichia coli enzymes 81 isolates, of which ESBLs were 79 isolates (97%); followed by KPC, 1 isolate (1%) and MBL, 1 isolate (1%). In Klebsiella pneumoniae the following enzymatic mechanisms could be observed based on 35 isolates; ESBL, 19 isolates (54%), followed by KPCs, 12 isolates (34%) and finally, MBL, 4 isolates (13%). Conclusion: The result of our study showed high prevalence of Escherichia coli and Klebsiella pneumoniae causing resistance to antibiotics in culture bacteria from urine samples of patients with UTI, and ESBL was the main ß-lactamase resistance mechanism in Klebsiella and E. coli isolates in both male and female.


Subject(s)
Bacteria , Drug Resistance , Drug Resistance/immunology , Retrospective Studies
14.
Rev. Assoc. Med. Bras. (1992) ; 66(6): 800-805, June 2020. tab
Article in English | LILACS, SES-SP | ID: biblio-1136291

ABSTRACT

SUMMARY In patients with atrial fibrillation, standard anticoagulation with a vitamin K antagonist plus dual antiplatelet therapy with a P2Y12 inhibitor and aspirin is the standard of care after percutaneous coronary intervention (PCI). While this therapy reduces the risk of thrombosis and stroke, it increases the risk of bleeding. It is unclear whether the antiplatelet effect of aspirin and clopidogrel may worsen atrial fibrillation (AF). OBJECTIVE Thus we aimed to analyze platelet aspirin resistance (AR) and clopidogrel resistance (CR) in acute coronary (ACS) patients based on sinus rhythm (SR) and AF. METHODS In this prospective trial, we included 543 patients (mean age: 62± 12 years; range: 26 - 89 years) who were on aspirin and clopidogrel therapy after the diagnosis of acute coronary syndrome. AR and CR were analyzed by a Multiplate® MP-0120 device by using the method of whole blood aggregometry. RESULTS AF patients had significantly higher age, mean platelet volume, and High-Sensitivity C-Reactive Protein (p< 0.01 for each parameter). Similarly, Arachidonic-acid induced (ASPI) aggregation was higher in AF patients compared to SR patients (666±218 vs. 187±179, p<0.001). Among the ACS patients, significantly more female patients had AF (p<0.001). The incidence of hypertension in the AF group was higher compared to the SR group (p<0.001). However, adenosine diphosphate levels were not at a significant level in the two groups. CONCLUSION Our findings indicate that the platelet inhibitory effect of Aspirin was worse for patients with AF, suggesting that the effectiveness of aspirin may be less in the prophylaxis of thromboembolism and more a bleeding risk.


RESUMO Em pacientes com fibrilação atrial, a anticoagulação padrão com antagonista da vitamina K mais terapia antiplaquetária dupla (DAPT) com inibidor de P2Y12 e aspirina é o padrão de tratamento após intervenção coronária percutânea (ICP). Enquanto essa terapia reduz o risco de trombose e derrame, aumenta o risco de sangramento. Não está claro se o efeito antiplaquetário da aspirina e do clopidogrel pode piorar a fibrilação atrial (FA). OBJETIVO Analisar a resistência à aspirina plaquetária (AR) e ao clopidogrel (CR) em pacientes coronarianos agudos (SCA) com base no ritmo sinusal (SR) e na FA. MÉTODOS Neste estudo prospectivo, foram incluídos 543 pacientes (idade média: 62±12 anos; intervalo: 26-89 anos) em uso de aspirina e clopidogrel após o diagnóstico de síndrome coronariana aguda. AR e CR foram analisados por um dispositivo Multiplate® MP-0120, utilizando o método de agregometria de sangue total. RESULTADOS Os pacientes com FA apresentaram valores significativamente maiores para idade, volume médio de plaquetas e proteína C reativa de alta sensibilidade (p<0,01 para cada parâmetro). Da mesma forma, a agregação induzida por ácido araquidônico (Aspi) foi maior nos pacientes com FA em comparação com os pacientes com SR (666±218 vs. 187±179, p<0,001). Entre os pacientes com SCA, significativamente mais pacientes do sexo feminino apresentaram FA (p<0,001). A incidência de hipertensão no grupo FA foi maior em comparação com o grupo SR (p<0,001). No entanto, os níveis de difosfato de adenosina não foram expressivamente significativos nos dois grupos. CONCLUSÃO Nossos achados indicam que o efeito inibitório plaquetário da aspirina foi pior em pacientes com FA, sugerindo que a eficácia da aspirina pode ser menor na profilaxia do tromboembolismo, com maior risco de sangramento.


Subject(s)
Humans , Female , Adult , Aged , Aged, 80 and over , Atrial Fibrillation , Drug Resistance/physiology , Aspirin/therapeutic use , Acute Coronary Syndrome , Platelet Aggregation Inhibitors , Incidence , Prospective Studies , Drug Therapy, Combination , Percutaneous Coronary Intervention , Middle Aged , Anticoagulants
15.
Biomédica (Bogotá) ; 40(supl.1): 139-147, mayo 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1124251

ABSTRACT

Introducción. La aparición de enterobacterias multirresistentes y productoras de betalactamasas de espectro extendido en pacientes ambulatorios con infecciones urinarias representa un problema de salud pública en Perú. Objetivo. Comparar los perfiles de resistencia de Escherichia coli uropatógenas e identificar los fenotipos de cepas productoras de betalactamasas de espectro extendido en tres establecimientos privados de salud localizados en las regiones de la costa, la sierra y la selva de Perú. Materiales y métodos. Se llevó a cabo durante el 2016 un estudio descriptivo de 98 muestras de orina de pacientes con infección urinaria, 35 procedentes de Lima (costa), 38 de Juliaca (sierra) y 25 de Iquitos (selva), en el que se determinó la sensibilidad antimicrobiana utilizando ocho discos antibióticos. Asimismo, se evaluó la producción de betalactamasas de espectro extendido con discos de cefotaxima, de ceftazidima o de su combinación, con ácido clavulánico en agar Mueller-Hinton. Resultados. Se identificaron 18 perfiles de resistencia que incluían desde los sensibles a todos los antibióticos hasta los resistentes simultáneamente a siete antibióticos, con el 18,4 % de aislamientos resistentes a un antibiótico y el 54,0 % de multirresistentes. Se detectó producción de betalactamasas en el 28,6 % de las cepas procedentes de la región de Puno. También, se observó un mayor número de casos en el rango de edad de 31 a 45 años con resistencia a ceftazidima, ceftriaxona, gentamicina y trimetoprim-sulfametoxazol en el establecimiento de salud de Puno. Conclusión. Los perfiles de resistencia variaron según la localización geográfica del establecimiento de salud, observándose mayor resistencia a los antibióticos en la región de la sierra de Perú, con el 28,6 % de cepas productoras de betalactamasas de espectro extendido.


Introduction: The appearance of multidrug-resistant and beta-lactamase producing enterobacteria in outpatient care facilities represent a public health problem in Perú. Objective: To compare the resistance profiles of uropathogenic Escherichia coli and to identify extended-spectrum beta-lactamase-producing phenotypes in three private health facilities located in the Peruvian coast, Andean and jungle regions. Materials and methods: We conducted a descriptive study on 98 urine samples from Lima (coast), Juliaca (Andean region) and Iquitos (jungle region) during 2016. We determined the antimicrobial susceptibility in 35 samples from Lima, 38 from Juliaca and 25 from Iquitos using eight antibiotic disks in samples from patients diagnosed with urinary infection. We also evaluated the production of extended-spectrum beta-lactamases with cefotaxime and ceftazidime disks and a combination of both with clavulanic acid on Mueller-Hinton agar. Results: We identified 18 resistance profiles ranging from those sensitive to others simultaneously resistant to seven antibiotics: 18.4% resistant to one and 54.0% to multiple antibiotics. We detected beta-lactamase production in 28.6% of the strains from the Puno region. Likewise, we observed a greater number of cases with resistance to ceftazidime, ceftriaxone, gentamicin, and trimethoprim-sulfamethoxazole in Puno's health facility in patients within the 31 to 45 year age range. Conclusion: Resistance profiles varied according to the geographical location of the health facilities under study. Resistance to antibiotics was higher in the Andean region with 28.6% of strains producing extended-spectrum beta-lactamases.


Subject(s)
Urinary Tract Infections , Drug Resistance , Enterobacteriaceae , Peru , beta-Lactamases , Disk Diffusion Antimicrobial Tests
16.
Acta méd. costarric ; 62(1): 7-12, ene.-mar. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1088531

ABSTRACT

Resumen Objetivo: Sistematizar los principales mecanismos de acción de los desinfectantes y describir mecanismos de resistencia comunes entre biocidas y antibióticos. Métodos: Se realizó una revisión bibliográfica de artículos científicos entre 2000 y julio de 2019, sobre la relación entre la resistencia a biocidas y a los antibióticos, utilizando como palabras clave "antibiotic", "biocide", "resistance" y "bacteria", en las bases de datos PubMed y Google Scholar. Conclusiones: Existe numerosa evidencia científica que indica la relación entre bacterias resistentes a los desinfectantes y la adquisición de resistencia a los antibióticos, lo que implica un replanteamiento del uso de esas sustancias en diferentes contextos clínicos, con el fin de minimizar el impacto que puedan tener en la selección de microorganismos multirresistentes a los antibióticos.


Abstract Aim: To summarize the main mechanisms of action of disinfectants and to describe some common resistance mechanisms shared between biocides and antibiotics. Methods: A bibliographic review of scientific articles was carried out between 2000 and July 2019 on the relationship between resistance to biocides and antibiotics, using as keywords "antibiotic", "biocide", "resistance" and "bacteria" in the data bases of PubMed and Google Scholar. Conclusions: Numerous scientific studies indicate a relationship between disinfectant-resistant bacteria and the acquisition of antibiotic resistance. It is necessary to analyze the use of these substances in the clinical context in order to minimize the impact that they may have on the selection of antibiotic-resistant microorganisms.


Subject(s)
Bacteria , Drug Resistance , Drug Resistance, Microbial , Disinfectants , Anti-Bacterial Agents
17.
Article in Korean | WPRIM | ID: wpr-816606

ABSTRACT

BACKGROUND: Acinetobacter baumannii infection is a significant health problem worldwide due to increased drug resistance. The limited antimicrobial alternatives for the treatment of severe infections by multidrug-resistant A. baumannii (MDRAB) make the search for other therapeutic options more urgent. Linalool, the major oil compound in Coriandrum sativum, was recently found to have high antibacterial activity against A. baumannii. The purpose of this study was to investigate the synergistic effect of linalool and colistin combinations against MDRAB and extensively drug-resistant A. baumannii (XDRAB).METHODS: A total of 51 strains of A. baumannii clinical isolates, consisting of 10 MDRAB and 41 XDRAB were tested. We determined the minimum inhibitory concentration (MIC) of linalool for the test strains using the broth microdilution method and searched for interactions using the time-kill assay.RESULTS: The time-kill assay showed that the linalool and colistin combination displayed a high rate of synergy (92.1%) (by synergy criteria 2), low rate of indifference (7.8%), and a high rate of bactericidal activity (74.5%) in the 51 clinical isolates of A. baumannii. The synergy rates for the linalool and colistin combination against MDRAB and XDRAB were 96% and 92.1%, respectively. No antagonism was observed for the linalool and colistin combination.CONCLUSION: The combination of linalool and colistin showed a high synergy rate, which may be beneficial for controlling MDRAB infections. Therefore, this combination is a good candidate for in vivo studies to assess its efficacy in the treatment of MDRAB infections.


Subject(s)
Acinetobacter baumannii , Acinetobacter , Colistin , Coriandrum , Drug Resistance , Methods , Microbial Sensitivity Tests
18.
Article in Chinese | WPRIM | ID: wpr-827173

ABSTRACT

OBJECTIVE@#To investigate the distribution and drug resistance of nosocomial infection pathogens in AL patients with hematological agranulocytosis, so as to provide evidence for the clinical rational use of antibiotics.@*METHODS@#Pathogenic data of 504 hospitalized patients with agranulocytosis caused by nosocomial infection in the Department of Hematology, the First Hospital of Lanzhou University from May 2015 to May 2018 were collected and retrospectively analyzed for the distribution of pathogenic bacteria and the results of drug susceptibility.@*RESULTS@#The isolated pathogenic bacteria strains amounted to 184, out of which, 168 strains (91.3%) orginated from the patients with acute leukemia, while 16 strains (8.7%) originated from the patients with non-acute leukemia. The positive samples mainly originated from blood stream, the isolated bacteria from which were 81 straims (44%); then originated from sputam and pharynx swabs, from which isolated bacteria amounted to 54 strains (29.3%) and 35 strains (19%) respectively. In the pathogenic bacteria, the Gram-negative bacteria amounted to 126 strains accounting for 68.46%, out of which the most commond bacteria strains were Klebseilla pneumoniae, cscherichia coli and Pseudomonas aeruginosa; the Gram positive bocteria amounted to 23 strains accounting for 12.5%, mainly staphy lococeus anreus, and Staphylococcus epitermidis; the fungi amounted to 35 strains accounting for 19.02%, mainly Candida albicans. The detection rates of Escherichia coli and Klebsiella pneumoniae producing extended-spectrum β-lactamases (ESBLs) were 40.0% and 22.2%, respectively. They were 100% sensitive to amikacin and 27.8% resistant to carbapenems. Klebsiella pneumoniae had the highest sensitivity to amikacin, 94.44% to ampicillin, 97.22% to carbapenems and 100% sensitive to ammonia. Their penicillin-resistance rate was the highest, up to 80%; Pseudomonas aeruginosa was sensitive to the antibiotics (>80%). Methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococcus were detected in Gram-positive bacteria. The susceptibility rate of main Gram-positive bacteria to vancomycin and linezolid was 100%, and they were 100% resistant to penicillin.@*CONCLUSION@#Gram-negative bacteria are the main pathogens of nosocomial infection in patients with hematological agranulocytosis. Pathogens have different resistance to antimicrobial agents. It is important to know the distribution and susceptibility of common pathogens for rational selection of antimicrobial agents and control of nosocomial infection.


Subject(s)
Cross Infection , Drug Resistance , Drug Resistance, Bacterial , Gram-Negative Bacteria , Humans , Methicillin-Resistant Staphylococcus aureus , Microbial Sensitivity Tests , Retrospective Studies
19.
Article in English | WPRIM | ID: wpr-762473

ABSTRACT

BACKGROUND: Although the incidence of tuberculosis (TB) is decreasing, cases of multidrug-resistant (MDR) TB and extensively drug-resistant (XDR) TB continue to increase. As conventional phenotype drug susceptibility testing (pDST) takes six to eight weeks, molecular assays are widely used to determine drug resistance. we developed QuantaMatrix Multiplexed Assay Platform (QMAP) MDR/XDR assay (QuantaMatrix Inc., Seoul, Korea) that can simultaneously detect mutations related to both first- and second-line drug resistance (rifampin, isoniazid, ethambutol, fluoroquinolones, second-line injectable drugs, and streptomycin). METHODS: We used 190 clinical Mycobacterium tuberculosis (MTB) strains isolated from Myanmar, compared QMAP and pDST results, and determined concordance rates. Additionally, we performed sequence analyses for discordant results. RESULTS: QMAP results were 87.9% (167/190) concordant with pDST results. In the 23 isolates with discordant results, the QMAP and DNA sequencing results completely matched. CONCLUSIONS: The QMAP MDR/XDR assay can detect all known DNA mutations associated with drug resistance for both MDR- and XDR-MTB strains. It can be used for molecular diagnosis of MDR- and XDR-TB to rapidly initiate appropriate anti-TB drug therapy.


Subject(s)
Diagnosis , DNA , Drug Resistance , Drug Therapy , Ethambutol , Extensively Drug-Resistant Tuberculosis , Fluoroquinolones , Incidence , Isoniazid , Myanmar , Mycobacterium tuberculosis , Phenotype , Seoul , Sequence Analysis , Sequence Analysis, DNA , Tuberculosis , Tuberculosis, Multidrug-Resistant
20.
Article in Chinese | WPRIM | ID: wpr-879347

ABSTRACT

OBJECTIVE@#To study the distribution and drug resistance of pathogens causing periprosthetic infections after hip and knee arthroplasty, and to formulate prevention and treatment strategies for drug-resistant bacteria.@*METHODS@#The data of 146 cases of periprosthetic infection after primary hip and knee arthroplasty from 2010 to 2015 were collected, including 111 cases of periprosthetic infection after hip arthroplasty and 35 cases of periprosthetic infection after knee arthroplasty. The culture positive rate, pathogenic bacteria composition and drug resistance rate were counted over the years, and the change trend of pathogen distribution and drug resistance was analyzed.@*RESULTS@#One hundredand eight strains of pathogenic bacteria were detected in 146 cases, and the positive rate of culture was 73.97%. Gram positive bacteria accounted for 55.48%, Staphylococcus epidermidis and Staphylococcus aureus accounted for 25.34% and 15.07% respectively. Gram negative bacteria accounted for 13.01%, including Enterobacter cloacae, Pseudomonas aeruginosa and Escherichia coli. There were 4 cases of Mycobacterium tuberculosis infection and mixed infection. The results of culture over the years showed that the constituent ratio of Gram positive bacteria had an increasing trend, fluctuating from 39.13% to 76.47%. The results of drug sensitivity showed that the pathogens were highly resistant to β-lactams, quinolones, clindamycin and gentamicin, and the drug resistance rate was increasing, but it was still sensitive to rifampicin, nitrofurantoin, tigecycline, linezolid and vancomycin.@*CONCLUSION@#Gram positive bacteria are the main pathogens of periprosthetic infection, and the proportion is increasing gradually.The pathogens have high resistance to many kinds of antibiotics, and the resistance rate is still increasing. To strengthen the monitoring of the distribution and drug resistance of pathogenic bacteria is helpful to grasp its change trend and formulate targeted prevention and control strategies.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Arthroplasty, Replacement, Knee/adverse effects , Drug Resistance , Drug Resistance, Bacterial , Gram-Positive Bacteria , Microbial Sensitivity Tests , Retrospective Studies
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