First sequenced cases of Omicron BA.2 sublineage in Ecuador.

The largest wave of infection with SARS-CoV-2 virus in Ecuador was observed in mid-December 2021 and early January 2022, driven by B.1.1.529/BA (Omicron) variant. During the second half of March, an increase in the number of daily cases was observed and coincided with the emergence of the BA.2 variant, which we describe in the present study. The first sequenced five cases of SARS-CoV-2 21L/BA.2 in Ecuador were identified using variant specific genotyping by qPCR and confirmed by whole genome sequencing (WGS). The first sequenced Ecuadorian BA.2 isolate was obtained from a person with international travel history who became symptomatic 3 days after travelling, whereas in the other cases no travel history was recorded.

First case of within-host co-infection of different SARS-CoV-2 variants in Ecuador.

Background: COVID-19 infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause mild symptoms to severe illness and death. Co-infections of SARS-CoV-2 with other respiratory viruses have been described. However, two SARS-CoV-2 lineage co-infection have been rarely reported. Methodology: A genotyping analysis and two different types of whole genome sequencing were performed (Illumina MiniSeq and ONT MinION). When examining the phylogenetic analysis in NextClade and Pangolin webservers, and considering the genotyping findings, conflicting results were obtained. Results: The raw data of the sequencing was analyzed, and nucleotide variants were identified between different reads of the virus genome. B.1 and P.1 lineages were identified within the same sample. Conclusions: We concluded that this is a co-infection case with two SARS-CoV-2 lineages, the first one reported in Ecuador.

Detection of sentinel bacteria in mangrove sediments contaminated with heavy metals.

Mangroves in the Northwest Coast of South America are contaminated with heavy metals due to wastewater discharges from industries, affecting the biota from this environment. However, bacteria proliferate in these harsh environmental conditions becoming possible sentinel of these contaminations. In this study, bacterial community composition was analyzed by throughput sequencing of the 16S rRNA gene from polluted and pristine mangrove sediments affected by marked differences in heavy metal concentrations. Core bacteria were dominated by Proteobacteria, Firmicutes, and Bacteroidetes phyla, with strong differences between sites at class and genus levels, correlated with metal levels. Increment of abundance on specific OTUs were associated with either elevated or decreased concentrations of metals and with the sulfur cycle. The abundance of Sulfurovum lithotrophicum, Leptolinea tardivitalis, Desulfococcus multivorans and Aminobacterium colombiense increases when metals rise. On contrary, Bacillus stamsii, Nioella nitrareducens and Clostridiisalibacter paucivorans abundance increases when metal levels are reduced. We propose these OTUs as bacterial sentinels, whose abundance can help monitor the restoration programs of contaminated mangrove sediments in the future.

Risk factors for methicillin-resistant Staphylococcus aureus skin and soft tissue infection in MRSA-colonized patients discharged from a Veterans Affairs hospital.

Currently, limited studies have quantified the risk of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) for MRSA-colonized patients on discharge from hospital. Our retrospective, case-control study identified independent risk factors for the development of MRSA SSTIs among such patients detected by active MRSA nasal screening in an acute care hospital by PCR on admission, and bacteriological cultures on discharge. Cases were MRSA-colonized patients aged ⩾18 years who developed a MRSA SSTI post-discharge and controls were those who did not develop a MRSA SSTI post-discharge. Controls were matched to cases by length of follow-up (±10 days) for up to 18 months. Potential demographic and clinical risk factors for MRSA infection were identified using electronic queries and manual chart abstraction; data were compared by standard statistical tests and variables with P values ⩽0·05 in bivariable analysis were entered into a logistic regression model. Multivariable analysis demonstrated prior hospital admission within 12 months (P = 0·02), prior MRSA infection (P = 0·05), and previous myocardial infarction (P = 0·01) were independently predictive of a MRSA SSTI post-discharge. Identification of MRSA colonization upon admission and recognition of risk factors could help identify a high-risk population that could benefit from MRSA SSTI prevention strategies.

Heavy metal concentration in mangrove surface sediments from the north-west coast of South America.

Mangrove ecosystems are coastal estuarine systems confined to the tropical and subtropical regions. The Estero Salado mangrove located in Guayaquil, Ecuador, has suffered constant disturbances during the past 20 years, due to industrial wastewater release. However, there are no published data for heavy metals present in its sediments and the relationship with anthropogenic disturbance. In the present study, metal concentrations were evaluated in surface sediment samples of the mangrove, showing that B, Cd, Cu, Pb, Se, V, and Zn levels exceeded those declared in international environmental quality standards. Moreover, several metals (Pb, Sn, Cd, Ag, Mo, Zn and Ni) could be linked to the industrial wastewater present in the studied area. In addition, heavy metal levels detected in this mangrove are higher than previous reports on mangrove sediments worldwide, indicating that this mangrove ecosystem is one of the most disrupted on earth.

Brucella canis peritonitis.

Although brucellosis is a common zoonotic disease worldwide, infection with Brucella canis is rare and often difficult to diagnose. We describe the clinical and epidemiological aspects of a case of B. canis peritonitis.

[Short bowel syndrome in children: a diagnosis and management update]. / Síndrome de intestino corto en niños: actualidades en su diagnóstico y manejo.

Short bowel syndrome (SBS) refers to the sum of the functional alterations that are the result of a critical reduction in the length of the intestine, which in the absence of adequate treatment, presents as chronic diarrhea, chronic dehydration, malnutrition, weight loss, nutriment and electrolyte deficiency, along with a failure to grow that is present with greater frequency during the neonatal period. The aim was to carry out a review of the literature encompassing the definition and the most frequent causes of SBS, together with an understanding of its physiopathology, prognostic factors, and treatment. An Internet search of PubMed articles was carried out for the existing information published over the last 20 years on SBS in children, using the keywords "short bowel syndrome". From a total of 784 potential articles, 82 articles were chosen for the literature review. The treatment of patients presenting with SBS is quite a challenge and therefore it is necessary to establish multidisciplinary management with a focus on maintaining optimal nutritional support that covers the necessities of growth and development and at the same time provides a maximum reduction of short, medium, and long-term complications. The diagnosis and treatment of a child with SBS require a team of professionals that are experts in gastroenterologic, pediatric, and nutritional management. The outcome for the child will be directly related to opportune management, as well as to the length of the intestinal resection and the presence or absence of the ileocecal valve.

Antifungal prophylaxis with voriconazole or itraconazole in lung transplant recipients: hepatotoxicity and effectiveness.

Invasive fungal infections (IFI) are common after lung transplantation and there are limited data for the use of antifungal prophylaxis in these patients. Our aim was to compare the safety and describe the effectiveness of universal prophylaxis with two azole regimens in lung transplant recipients. This is a retrospective study in lung transplant recipients from July 2003 to July 2006 who received antifungal prophylaxis with itraconazole or voriconazole plus inhaled amphotericin B to compare the incidence of hepatotoxicity. Secondary outcomes include describing the incidence of IFI, clinical outcomes after IFI and mortality. Sixty-seven consecutive lung transplants received antifungal prophylaxis, 32 itraconazole and 35 voriconazole and inhaled amphotericin B. There were no significant differences between groups in the acute physiology and chronic health evaluation (APACHE) score at the time of transplantation, demographic characteristics, comorbidities and concomitant use of hepatotoxic medications. Hepatotoxicity occurred in 12 patients receiving voriconazole and inhaled amphotericin B and in no patients receiving itraconazole (p < 0.001). There was no significant difference between groups with regard to the percentage of transplants with IFI, but one case of zygomycosis occurred in a transplant treated with voriconazole. Voriconazole prophylaxis after lung transplantation was associated with a higher incidence of hepatotoxicity and similar clinical effectiveness when compared to itraconazole.

Antibiotic cycling to decrease bacterial antibiotic resistance: a 5-year experience on a bone marrow transplant unit.

Multidrug-resistant pathogens have important effects on clinical outcomes. Antibiotic cycling is one approach to control anti-microbial resistance, but few studies have examined cycling in hematology-oncology units. Antibiotic cycling was implemented in January 1999 at our hematology-oncology unit, alternating piperacillin-tazobactam (pip-tazo) and cefepime in 3 months periods, until June 2004. Clinical isolates were compared in post- and pre-intervention periods and with the susceptibility among the solid organ transplant intensive care unit (TICU) isolates. The rate of Gram-negative isolates remained stable. Among Gram-negatives, susceptibility to cefepime and pip-tazo remained stable. There was an increase in Enterococcus spp. (P=0.007), and susceptibility to ampicillin and vancomycin decreased (odds ratio (OR): 0.04, 95% confidence interval (CI): 0.17-0.89 and OR: 0.23, 95% CI: 0.09-0.58). Compared with the TICU, there was increased susceptibility to pip-tazo and cefepime among enterics (OR: 7.32, 95% CI: 4.44-12.07 and OR: 8.82, 95% CI: 2.1-37.13) and Pseudomonas aeruginosa (OR: 4.27, 95% CI: 1.47-12.4 and OR: 4.61, 95% CI: 1.75-12.1) and decreased susceptibility to ampicillin and vancomycin among enterococci (OR: 0.44, 95% CI: 0.30-0.63 and OR: 0.38, 95% CI: 0.26-0.56). Cycling was associated with preserved antibiotic susceptibility among Gram-negatives, but with an increase in Enterococcus spp. and vancomycin and ampicillin resistance among enterococci.

Determination of DNA damage in floriculturists exposed to mixtures of pesticides.

The aim of the study was to determine possible DNA damage in floriculturists chronically exposed to pesticides. Leukocytes from 52 workers, 46 environmentally exposed, and 38 control individuals were evaluated with the comet assay. Serum from all individuals was also analyzed for pesticides using gas chromatography coupled to mass spectrometry. A statistically significant difference in DNA fragmentation in the pesticide exposed group compared to the other two groups (P < .001) was found. No differences between environmentally exposed and control individuals were detected. The statistical analysis showed no significant correlation between DNA damage and sex, age, drinking or smoking habits, as well as years of exposure. One or more pesticides were detected in 50% of the floriculturists, while in the rest of the individuals, a chemical related with the preparation of pesticides, such as additives, plasticizers, or solvents, was found. Our study shows that chronic exposure to pesticides produces DNA damage in floriculturists. It also suggests that this type of monitoring could be valuable in recommending preventive measures.

Analysis of IL1B, TAP1, TAP2 and IKBL polymorphisms on susceptibility to tuberculosis.

Genetic determinants of human susceptibility to tuberculosis (TB) have not been completely elucidated. Interleukin-1 beta (IL-1beta) and the inhibitor of kB-like (IkBL) are important molecules that participate in the inflammatory response required for the immunological control of a broad spectrum of infectious agents. The transporter associated with antigen processing (TAP) is involved in the antigen processing via major histocompatibility complex class I molecules and in turn might regulate the T-cell response against Mycobacterium tuberculosis. To better characterize the host genetic factors determining the susceptibility to TB, we evaluated the influence of functional polymorphisms in IL1B, TAP and IKBL genes on the risk of developing pulmonary TB in a Northwestern Colombian population, an endemic area of M. tuberculosis infection. A total of 122 TB patients and 166 healthy controls (N = 166) negative for human immunodeficiency virus infection were examined for IL1B-511 and +3,953, TAP1 and TAP2 and IKBL+738 polymorphisms. Univariate analysis disclosed significant differences between patients and controls for IL1B+3,953 polymorphism. After unconditional logistic regression analysis, a strong protection conferred by IL1B+3,953 T-allele-carrying genotypes was observed. A trend between TAP2*0201 allele and disease was observed. Association between IL1B-511, TAP1 or IKBL polymorphisms and TB disease was not found. These results indicate that a functional polymorphism in the IL1B gene influences the susceptibility to TB and suggest a role for IL-1beta in the pathogenesis of mycobacterial infection.

Deamination of the amino acid fragment in imine metallacycles: unexpected synthesis of an NH-aldimine organometallic compound.

We report that the action of Lewis bases, such as triphenylphosphine, pyridine, or trimethylamine, on imine metallacycles derived from amino acids leads to the formation of the first organometallic compound of an NH aldimine, a highly reactive organic species, and the corresponding alpha-ketoester, in a deamination reaction that mimics the metabolism of alpha-amino acids. The synthesis of different cyclopalladated compounds by a reaction between palladium acetate and the Schiff bases 2,4,6-Me(3)C(6)H(2)CH=NCH(R(1))COOR(2) (R(1) = CH(2)Ph, R(2) = Et and R(1) = Ph, R(2) = Me) is also reported.

The first NH aldimine organometallic compound. Isolation and crystal structure.

The first NH aldimine organometallic derivative is unexpectedly formed by the cleavage of the nitrogen-carbon bond of the amino acid fragment of the Schiff base 2,4,6-Me3C6H2CH=NCH(CH2Ph)COOEt when the imine is treated with palladium acetate.

Synthesis, resolution, and reactivity of benzylmesitylphenylphosphine: a new p-chiral bulky ligand.

The synthesis of P,P'-dimesityl-P,P'-diphenyldiphosphine and benzylmesitylphenylphosphine is described as well as the resolution of the latter ligand by means of homochiral organometallic complexes. The absolute configuration of the phosphine is assigned by NMR spectra, using the homochiral palladacycle as a reference point. The configuration has been confirmed by single crystal X-ray diffraction. Molecular mechanics calculations were performed in [PdCl-(R)-(+)-C10H6CH(Me)NH2(PBnMesPh)], and showed that the rotation around the Pd-P bond is restricted in this complex. [Pd(eta3-2-MeC3H4)Cl(PBnMesPh)] was obtained and used as a precursor in the catalytic hydrovinylation of styrene. Benzylmesitylphenylphosphine has a strong tendency to form phosphapalladacycles by activation of one of the ortho-methyl groups. The formation of this metallacycle from cyclopalladated N-donor derivatives by a ligand-exchange reaction is also described.

[Gastric carcinoma associated with other primary malignant neoplasms. A retrospective study of 25 cases]. / Carcinoma gástrico asociado a otras neoplasias malignas primarias. Estudio retrospectivo de 25 casos.

BACKGROUND: The risk of developing a second neoplasm in a person with gastric carcinoma (GC) is higher than among general population. OBJECTIVE: To analyze the clinical findings in patients with GC associated with other primary malignant neoplasms. PATIENTS AND METHODS: A total of 25 patients with GC associated with extragastric tumours were retrospectively studied. The following characteristics were studied: age, sex, location and staging, free interval, therapy, and survival. Survival of 13 patients with GC diagnosed as primary tumour was compared with that observed in a control group of 62 patients with GC alone. RESULTS: Twenty-five out of 792 (3.1%) patients with GC had other primary malignant neoplasms (seven synchronous and 18 metachronous). GC was associated with respiratory tumours in 7 cases. Sixty percent of patients with GC who had a second neoplasm had it diagnosed within the first year after gastric tumour was diagnosed (8 out of 13). Survival at 18 months was similar, both in the GC group with a second tumour as in the control group. CONCLUSIONS: The development of a second neoplasm among patients with GC usually occurs within the first year after diagnosis. Most commonly, the second neoplasm seats in the respiratory tract.

Carcinoma gástrico asociado a otras neoplasias malignas primarias. Estudio retrospectivo de 25 casos / Gastric carcinoma associated with other primary malignant neoplasms. Retrospective study of 25 cases

Objetivo. El riesgo de padecer una segunda neoplasia en una persona con carcinoma gástrico (CG) es superior al de la población general. El objetivo del estudio ha sido valorar los datos clínicos de los pacientes con CG asociado a otras neoplasias malignas primarias. Pacientes y método. Se estudian retrospectivamente 25 enfermos con CG asociado a tumores extragástricos. Se evaluaron edad, sexo, tipo, localización y estadio de las neoplasias, intervalo libre, tratamiento y supervivencia. Se compara la supervivencia de 13 pacientes con un CG diagnosticado como primera neoplasia con la de un grupo control de 62 pacientes con sólo un CG. Resultados. De 792 pacientes con CG, 25 (3,1 por ciento) tuvieron otras neoplasias malignas primarias (siete eran sincrónicas y 18 metacrónicas). El CG se asoció a tumores respiratorios en siete casos. De los pacientes con CG que tuvieron una segunda neoplasia, en el 60 por ciento ésta apareció en el primer año después del diagnóstico del tumor gástrico (ocho de trece). La supervivencia fue la misma a los 18 meses, tanto en el grupo de CG con una segunda neoplasia como en el grupo control. Conclusiones. Los pacientes con un CG que desarrollan una segunda neoplasia lo hacen en un 60 por ciento en el primer año. Esta segunda neoplasia es, más frecuentemente, del tracto respiratorio. (AU)

Secuestro pulmonar / Pulmonary sequestration

El secuestro pulmonar es una anomalía congénita rara. En general representa el 1 a 2 por ciento de todas las resecciones pulmonares. Analizamos en forma retrospectiva las fichas clínica de 20 pacientes con diagnóstico postoperatorio de secuestro pulmonar, tratados en el Servicio de Cirugía del INER y CT durante 17 años, desde enero de 1977 a diciembre de 1993. Se estudiaron 13 (64 por ciento) hombres y 7 (35 por ciento) mujeres con una relación de 1,8:1. La media de edad fue de 40,8 años,con un margen de 15 a 63 años. Se estudiaron 17 secuestros intralobares y 3 extralobares. De ellos, 12 (60 por ciento) se ubicaron en el pulmón izquierdo y 8 (40 por ciento) en el pulmón derecho, con una relación de 1,5:1. La aortografía constituyó el método diagnóstico específico. El tratamiento fue quirúrgico. En los secuestros intralobares se realizó en un caso trisegmentectomía, en otro segmentectomía basal y en el resto lobectomía. En los secuestros extralobares se realizó extirpación del secuestro. Las complicaciones postoperatorias fueron dos empiemas pleurales tratados con drenajes, antibióticos y en un caso con toracotomía mínima. No hubo mortalidad en la serie

Submandibulectomía: análisis de 24 casos / Submandibulectomy: analysis of 24 cases

Presentamos nuestra experiencia en 24 pacientes sometidos a submandibulectomía en un período de 15 años. Se trata de 14 hombres y 10 mujeres, con edad promedio de 44,6 años. Todos los casos se manifestaron como aumento de volumen en la región sumbandibular y en 6 (25 por ciento) éste se acompañó de dolor. El diagnóstico preoperatorio de las masas submandibulares se planteó en base a datos clínicos. Se realizó citología por punción aspirativa en 2 casos. No realizamos biopsias incisionales. La biopsia diferida corroboró 15 de 16 (93,7 por ciento) diagnósticos realizados por biopsia contemporánea. El diagnóstico histológico correspondió a 11 lesiones tumorales benignas (10 adenomas pelomórficos y 1 lipoma). 3 tumores malignos (2 carcinomas adenoideo quísticos y 1 hemangiopericitoma maligno) y 10 lesiones inflamatorias (9 submandibulitis crónicas y 1 adenitis tuberculosa). En todos los casos se realizó la resección completa de la glándula submandibular, siendo necesario en un caso ampliar el procedimiento quirúrgico. Los 3 carcinomas fueron sometidos a radioterapia postoperatoria hasta completar 55 Gy. En 2 (8,3 por ciento) casos se observó hematoma postoperatorio. La submandibulectomía es el procedimiento mínimo para realizar el diagnóstico histológico postoperatorio. La submandibulectomía es el procedimiento mínimo para realizar el diagnóstico histológico definitivo de una masa submandibular, presenta escasa morbimortalidad y constituye en la mayoría de los casos el tratamiento de la afección

Tratamiento quirúrgico de las várices esenciales / Surgical treatment of essentials varices

Entre 1985 y 1989, en el Servicio e Instituto de Cirugía del Hospital Base de Valdivia, se operaron 256 pacientes portadores de várices esenciales de acuerdo a un protocolo de evaluación y tratamiento. Todos los pacientes fueron estudiados con pruebas funcionales, estudio velocimétrico Doppler y flebografía en aquellos en que existió sospecha que eran portadores de várices secundarias. Los enfermos se operaron con una técnica quirúrgica estandarizada, que se analiza en detalle la cual fue practicada por el mismo equipo quirúrgico. Las complicaciones postoperatorias fueron escasas y de poca importancia: 23 infecciones de heridas distales, 2 hemorragias menores y 14 cefaleas postrraquídea. La recidiva a 5 años fue de 2,7 por ciento . Se discuten y comenta la cirugía conservadora de safena interna. Se concluye que esta patología afecta a un número importante de la población y conlleva un alto índice de incapacidad. Un adecuado manejo preoperatorio y una técnica quirúrgica normada permiten reducir significativamente el porcentaje de complicaciones y evitan secuelas funcionales subsecuentes