ABSTRACT
Four extensively drug-resistant Pseudomonas aeruginosa strains, isolated from patients with pneumonia, were sequenced using PacBio RS-II single-molecule real-time (SMRT) technology. Genome sequence analysis identified great variability among mobile genetic elements, as well as some previously undescribed genomic islands and new variants of class 1 integrons (In1402, In1403, In1404, and In1408).
ABSTRACT
BACKGROUND: No information is available about the financial impact of central venous catheter (CVC)-associated bloodstream infection (BSI) in Mexico. OBJECTIVE: To calculate the costs associated with BSI in intensive care units (ICUs) in Mexico City. DESIGN: An 18-month (June 2002 through November 2003), prospective, nested case-control study of patients with and patients without BSI. SETTING: Adult ICUs in 3 hospitals in Mexico City. PATIENTS AND METHODS: A total of 55 patients with BSI (case patients) and 55 patients without BSI (control patients) were compared with respect to hospital, type of ICU, year of hospital admission, length of ICU stay, sex, age, and mean severity of illness score. Information about the length of ICU stay was obtained prospectively during daily rounds. The daily cost of ICU stay was provided by the finance department of each hospital. The cost of antibiotics prescribed for BSI was provided by the hospitals' pharmacy departments. RESULTS: For case patients, the mean extra length of stay was 6.1 days, the mean extra cost of antibiotics was US dollars 598, the mean extra hospital cost was US dollars 11,591, and the attributable extra mortality was 20%. CONCLUSIONS: In this study, the duration of ICU stay for patients with central venous catheter-associated BSI was significantly longer than that for control patients, resulting in increased healthcare costs and a higher attributable mortality. These conclusions support the need to implement preventive measures for hospitalized patients with central venous catheters in Mexico.
Subject(s)
Catheterization, Central Venous/adverse effects , Hospital Costs , Intensive Care Units , Length of Stay , Sepsis/economics , Adult , Case-Control Studies , Female , Humans , Intensive Care Units/economics , Intensive Care Units/statistics & numerical data , Male , Mexico/epidemiology , Middle Aged , Sepsis/epidemiology , Sepsis/mortality , Severity of Illness IndexABSTRACT
OBJECTIVE: To determine the time course of the expression of five toll-like receptors (TLRs 1-5) in mixed blood mononuclear cells and their relationship to pro-inflammatory and anti-inflammatory cytokines during acute respiratory distress syndrome (ARDS). MATERIAL AND METHODS: In a prospective, a longitudinal study was done at an intensive-care unit of a university-affiliated hospital. Seven consecutive patients with ARDS were studied. We followed the onset and progression of ARDS, and subsequent patient recovery or death, and compared patient data with data from a group of healthy volunteers. We separated mixed blood mononuclear cells using Ficoll-Hypaque to detect the transcripts of human TLRs 1-5. TLR mRNAs were isolated by semiquantitative reverse-transcription PCR (RT-PCR). Each signal was expressed as the ratio of TLR mRNA to beta-actin. Cytokines, including tumor necrosis factor alpha, interferon gamma, and interleukins 4, 6, 8, 10, and 12, were assayed using commercial ELISA kits. RESULTS: Dysregulation in the transcription of TLRs gene, principally in ARDS surviving patients, was observed. Down-regulated expressions of TLR1, TLR4, and TLR5 mRNAs were observed in the first 24 h in patients who survived, and probably played a key role in the survival of patients with ARDS caused by sepsis. Serum levels of cytokines such as IL-6, 8 and 10 were significantly increased in patients with ARDS as compared with levels in the healthy volunteers. However, serum levels of IL-12 were lower in patients with ARDS than in the healthy volunteers. There was difference in serum cytokines concentration between survivors and non-survivors patients with ARDS (except for interleukin-10). CONCLUSIONS: Thus, TLRs gene dysregulation and cytokine profiles are probably important prognostic factors for patient outcome and survival after ARDS.
Subject(s)
Gene Expression Regulation , Membrane Glycoproteins/biosynthesis , Receptors, Cell Surface/biosynthesis , Respiratory Distress Syndrome/blood , Aged , Biomarkers , Female , Humans , Interferon-gamma/blood , Interleukins/blood , Leukocytes, Mononuclear/metabolism , Male , Membrane Glycoproteins/blood , Membrane Glycoproteins/genetics , Middle Aged , Prognosis , Prospective Studies , RNA, Messenger/biosynthesis , RNA, Messenger/blood , Receptors, Cell Surface/blood , Receptors, Cell Surface/genetics , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/mortality , Survival Analysis , Systemic Inflammatory Response Syndrome/complications , Toll-Like Receptor 1 , Toll-Like Receptor 4 , Toll-Like Receptor 5 , Toll-Like Receptors , Tumor Necrosis Factor-alpha/analysisABSTRACT
Se reporta el caso de una mujer de 21 años de edad, con diagnóstico de Síndrome de Anticoagulante Lúpico y embarazo de 14 semanas de gestación. Ingresó por un cuadro de trombosis venosa profunda con miembro pélvico izquierdo, con antecedentes de pérdidas fetales previas y tromboembolia pulmonar. La presencia de un anticoagulante circulante -Anticoagulante lúpico (AL)- fue evidenciado por un tiempo de tromboplastina parcial activado con caolín (TTPA) prolongado, que no corrigió con la adición de plasma normal, suero normal, ni plasma absorbido. Se reportó además un VDRL falsamente positivo, trombocitopenia, y anticuerpos anticardiolipina positivos. El presente caso ilustra acerca de una gama de fenómenos antoinmunes en relación con pérdidas fetales tempranas y tardías.
Subject(s)
Humans , Pregnancy , Female , Abortion, Habitual/etiology , Anticoagulants , Immunoglobulin M/immunology , Thromboembolism , Trophoblasts , Lupus Erythematosus, Systemic/immunologyABSTRACT
Se describen tres pacientes con hipotiroidismo primario que presentaron un síndrome quiasmático secundario a hiperplasia hipofisiaria. El cuadro clínico consistió en hipotiroidismo, amenorrea, galactorrea y la tomografía computada de cráneo mostró datos compatibles con un tumor hipofisiario. Con base en el cuadro clínico y la presencia de hiperprolcatinemia y niveles elevados de tirotropina (TSH) se inició tratamiento con hormonas tiroideas, con lo cual se consiguió la desaparición de los síntomas. A los seis meses se normalizó el campo visual y la hipófisis se redujo de tamaño en la nueva tomografía. Se concluye que en presencia de galactorrea es necesario determinar el nivel circulante de TSH para descartar hipotiroidismo y evitar tratamiento médico o quirúrgico equivocados.
Subject(s)
Humans , Adult , Female , Hyperprolactinemia , HypothyroidismABSTRACT
Se experimentó con diversos sistemas de preparación y metodologías educativas. Se utilizaron técnicas originales de repleción-corrosión de estructuras canaliculares con acrílicos y látex y posterior disección química para el estudio, en especial , de elementos vasculares. Se presentaron en forma de audiovisuales con disolvencias y videocomputacion. El objetivo es facilitar el estudio y aprendizaje de las estructuras tridimensionales obtenidas por medio de la técnica de inyección de sustancias. Se lograron excelentes resultados en el pregrado y se propone su aplicación a nivel del postgrado con la creación de diapotecas y videotecas
Subject(s)
Anatomy , Education, Medical, Undergraduate , Medical Laboratory Science/instrumentation , Computer SystemsABSTRACT
Se experimentó con diversos sistemas de preparación y metodologías educativas. Se utilizaron técnicas originales de repleción-corrosión de estructuras canaliculares con acrílicos y látex y posterior disección química para el estudio, en especial , de elementos vasculares. Se presentaron en forma de audiovisuales con disolvencias y videocomputacion. El objetivo es facilitar el estudio y aprendizaje de las estructuras tridimensionales obtenidas por medio de la técnica de inyección de sustancias. Se lograron excelentes resultados en el pregrado y se propone su aplicación a nivel del postgrado con la creación de diapotecas y videotecas (AU)
