Bacterial community assessment of drinking water and downstream distribution systems in highland localities of Ecuador.

Bacterial communities in drinking water provide a gauge to measure quality and confer insights into public health. In contrast to urban systems, water treatment in rural areas is not adequately monitored and could become a health risk. We performed 16S rRNA amplicon sequencing to analyze the microbiome present in the water treatment plants at two rural communities, one city, and the downstream water for human consumption in schools and reservoirs in the Andean highlands of Ecuador. We tested the effect of water treatment on the diversity and composition of bacterial communities. A set of physicochemical variables in the sampled water was evaluated and correlated with the structure of the observed bacterial communities. Predominant bacteria in the analyzed communities belonged to Proteobacteria and Actinobacteria. The Sphingobium genus, a chlorine resistance group, was particularly abundant. Of health concern in drinking water reservoirs were Fusobacteriaceae, Lachnospiraceae, and Ruminococcaceae; these families are associated with human and poultry fecal contamination. We propose the latter families as relevant biomarkers for establishing local standards for the monitoring of potable water systems in highlands of Ecuador. Our assessment of bacterial community composition in water systems in the Ecuadorian highlands provides a technical background to inform management decisions.

Receiver operating characteristic (ROC) to determine cut-off points of clinical and biomolecular markers to discriminate mortality in severe COVID-19 living at high altitude.

BACKGROUND: In 2020, Ecuador had one of the highest death rates because of COVID-19. The role of clinical and biomolecular markers in COVID disease prognosis, is still not well supported by available data. In order for these markers to have practical application in clinical decision-making regarding patient treatment and prognosis, it is necessary to know an optimal cut-off point, taking into consideration ethnic differences and geographic conditions. AIM: To determine the value of clinical and biomolecular markers, to predict mortality of patients with severe COVID-19 living at high altitude. METHODS: In this study, receiver operating characteristic (ROC) curves, area under the curve (AUC) of ROC, sensitivity, specificity and likelihood ratios were calculated to determine levels of clinical and biomolecular markers that best differentiate survivors versus non-survivors in severe COVID subjects that live at a high altitude setting. RESULTS: Selected cut-off values for ferritin (≥ 1225 ng/dl, p = 0.026), IL-6 (≥ 11 pg/ml, p = 0.005) and NLR (≥ 22, p = 0.008) at 24 h, as well as PaFiO2 (≤ 164 mmHg, p = 0.015), NLR (≥ 16, p = p = 0.013) and SOFA (≥ 6, p = 0.031) at 72 h, appear to have good discriminating power to differentiate survivors versus non-survivors. Additionally, odds ratios for ferritin (OR = 3.38); IL-6 (OR = 17.07); PaFiO2 (OR = 4.61); NLR 24 h (OR = 4.95); NLR 72 h (OR = 4.46), and SOFA (OR = 3.77) indicate increased risk of mortality when cut-off points were taken into consideration. CONCLUSIONS: We proposed a straightforward and understandable method to identify dichotomized levels of clinical and biomolecular markers that can discriminate between survivors and non-survivors patients with severe COVID-19 living at high altitudes.

Diagnostic evaluation of nCoV-QS, nCoV-QM-N, and nCoV-OM detection kits based on rRT-PCR for detection of SARS-CoV-2 in Ecuador.

Background: Ecuador was harshly impacted by COVID-19, in the region was the epicenter of the pandemic with the highest mortality rates and with the lowest rates of processed samples. Real-time reverse transcription PCR assays are essential to identify and manage the SARS-CoV-2 outbreak. Because of the global emergency, in Ecuador several commercial kits were introduced for use without clinical validation. In this manner, having the need to perform an evaluation with clinical samples before use for population screening. Objective: This study aimed to evaluate the diagnostic performance of the nCoV-QS, nCoV-QM-N, nCoV-OM detection kits lately available in Ecuador, against the LightMix E/RdRp kit using nasopharyngeal swab (NPS) samples. Materials and methods: 198 nasopharyngeal samples were used (66 fresh NPS and 132 RNA stored samples). All samples were analyzed for SARS-CoV-2 with nCoV-QS, nCoV-QM-N, nCoV-OM detection kits and compared the concordance (Cohen's Kappa index, positive percentage agreement and negative percentage agreement) to LightMix E/RdRp as reference detection kit. Results: The 198 samples presented strong concordance (96% nCoV-QM-N, 100% nCoV-OM and 100% nCoV-QS). The individual performance of each gene showed that the nCoV-OM kit had a higher number of samples detected with the ORF3a (52.5%) and N (53.5%) genes. The combined genes demonstrated that ORF3a/N of nCoV-OM and nCoV-QS kits presented a higher percentage of detection with 52.5% and 48.5%, respectively. Finally, the detection rate and cycle threshold were not different between ORF3a, N, and E target genes. Conclusion: The nCoV-QS, nCoV-QM-N, and nCoV-OM Detection kits have comparable diagnostic performance to the emergency approved LightMix E/RdRp kit for SARS-CoV-2 detection in suspected COVID-19 patients.

Mean platelet volume and mean platelet volume to platelet count ratio as predictors of severity and mortality in sepsis.

INTRODUCTION: Sepsis is a public health problem due to its high prevalence and mortality. Mean platelet volume (MPV), a biomarker reported in routine blood counts, has been investigated and shows promise for determining fatal outcomes in septic patients. OBJECTIVE: Evaluate whether the mean platelet volume (MPV) and mean platelet volume-to-platelet count (MPV/P) ratio are predictors of clinical severity and mortality in patients with sepsis. METHODS: A prospective population cohort of 163 patients aged 18-97 years was recruited at the Intensive Care Unit of Pablo Arturo Hospital, Quito, Ecuador from 2017-2019 and followed up for 28 days. Patients were diagnosed with sepsis based on SEPSIS-3 septic shock criteria; in which the MPV and the MPV/P ratio were measured on days 1, 2, and 3. Sequential organ failure assessment (SOFA) score and presence of septic shock assessed clinical severity. Mortality on day 28 was considered the fatal outcome. RESULTS: The average age of the patients was 61,15 years (SD 20,94) and female sex was predominant. MPV cutoff points at days 1, 2 and 3 were >9,45fL, >8,95fL and >8, 85fL; and (MPV/P) ratio >8, 18, >4, 12 y >3, 95, respectively. MPV at days 2 (9,85fL) and 3 (8,55fL) and (MPV/P) ratio at days 1 (4,42), 2 (4,21), and 3 (8,55), were predictors of clinical severity assessed by septic shock, which reached significance in the ROC curves. MPV and (MPV/P) ratio were also predictors of clinical severity determined by SOFA at days 1, 2, and 3, where higher values were observed in non-survivors reaching significance in all categories. MPV and MPV/P ratio at days 1, 2 and 3 were independent predictor factors of mortality using Cox proportional hazards model (HR 2,31; 95% CI 1,36-3,94), (HR 2,11; 95% CI 1,17-3,82), (HR 2,13; 95% CI 1,07-4,21) and (HR 2,38; 95% CI 1,38-4,12), (HR 2,15; 95% CI 1,14-4,06), (HR 4,43; 95% CI, 1,72-11,37) respectively. CONCLUSIONS: MPV and the MPV/P ratio are predictors of clinical severity and mortality in sepsis. The MPV and its coefficient are indicators of the biological behavior of platelets in sepsis. They should be considered as a cost-effective and rapidly available tool that guides the treatment.

Immune Response to SARS-CoV-2 Infection in Obesity and T2D: Literature Review.

In December 2019, a novel coronavirus known as SARS-CoV-2 was first detected in Wuhan, China, causing outbreaks of the coronavirus disease COVID-19 that has now spread globally. For this reason, The World Health Organization (WHO) declared COVID-19 a public health emergency in March 2020. People living with pre-existing conditions such as obesity, cardiovascular diseases, type 2 diabetes (T2D), and chronic kidney and lung diseases, are prone to develop severe forms of disease with fatal outcomes. Metabolic diseases such as obesity and T2D alter the balance of innate and adaptive responses. Both diseases share common features characterized by augmented adiposity associated with a chronic systemic low-grade inflammation, senescence, immunoglobulin glycation, and abnormalities in the number and function of adaptive immune cells. In obese and T2D patients infected by SARS-CoV-2, where immune cells are already hampered, this response appears to be stronger. In this review, we describe the abnormalities of the immune system, and summarize clinical findings of COVID-19 patients with pre-existing conditions such as obesity and T2D as this group is at greater risk of suffering severe and fatal clinical outcomes.

Optimizing reporter constructs for in vivo bioluminescence imaging of interferon-γ stimulated mesenchymal stromal cells.

Mesenchymal stromal cells (MSCs) are a promising treatment modality for a variety of diseases. Strategies to investigate the fate of MSCs in vivo are important to unravel their therapeutic mechanisms. However, currently available techniques are hampered by their low sensitivity. We therefore aimed to optimize in vivo bioluminescence imaging of MSCs. We compared MSCs transduced with firefly luciferase (Fluc) and transmembrane-bound Gaussia luciferase driven by the human cytomegalovirus, spleen focus-forming virus (SFFV), and elongation factor 1-α (EF1α) promoters. Although cytomegalovirus-transmembrane-bound Gaussia luciferase-transduced MSCs showed the highest light intensity in vitro, the signal was almost undetectable in vivo. Spleen focus-forming virus-Fluc-transduced MSCs revealed a bright signal in vivo, but transgene expression was silenced upon in vitro stimulation with interferon (IFN)-γ. Therefore, the SFFV promoter was replaced by the EF1α promoter. Light emission of Fluc under the control of EF1α was similar to SFFV-Fluc. Although EF1α-Fluc light emission was decreased tenfold in the presence of IFN-γ when compared with unstimulated MSCs, the bioluminescent signal could still be detected and was clearly distinguishable from untransduced MSCs. Furthermore, stimulation of MSCs with tumor necrosis factor-α hardly affected transgene expression in EF1α-Fluc-transduced MSCs. Thus, the use of the EF1α promoter partially overcomes silencing and allows in vivo bioluminescence imaging of IFN-γ-stimulated MSCs.

Hamartoma fibroso de la infancia. Presentación de un caso / Fibrous hamartoma of the childhood. Presentation of a case

Presentación de un caso de hamartoma fi broso de la infancia, en un niño de 8 meses de edad. El tumor es benigno, muy poco frecuente y en el diagnóstico diferencial están los fi brosarcomas.

A rare case of fi brous hamartoma of childhood, in an eight month old child is presented. These are benign and very infrequent tumors. Fibrosarcoma have to be considered in diff erential diagnosis.

Perfil antropométrico en seleccionados nacionales dewaterpolo / The anthropometric profile in elite waterpolo players

El objetivo de este estudio fue describir las características morfológicas de 3 categorías de selecciqnados nacionales de waterpolo en nuestro país. Se realiza un estudio transversal descriptivo de los parámetros morfológicos (peso, talla composición corporal y somatotipo) de 37 seleccionados nacionales de waterpolo pertenecientes a las categorías: infantil (N = 13), juvenil (N = 12) Y junior (N = 12). Los cuales se encontraban dentro de su programa de entrenamiento en fase de preparación general. Presentando las siguientes características para cada categoría: junior edad 18,6 +/- 1,1 años, peso 70,9 +/- 7,3kg, talla 178,8 +/- 8,2cm, % de masa grasa 8,5 +/- 3,7, % de masa muscular 49 +/- 2,5 y somatotipo 2,6-5,0-3,1 (d.s. +/- 1,0-1,3-1,5). Juvenil edad 17,4 +/- 0,7 años, peso 73,6 +/- 1O kg., talla 177,7 +/-62,cm, % grasa 1O,4 +/- 3,4, % masa muscular 48,2 +/- 2,6 y somatotipo 3,1-5,5-2,3 (d.s. +/- 1,0-0,7-0,7). Infantil edad 14,5 +/- 0,7años, peso 56,4 +/-5,1 kg., talla 167,8 +/- 5,4 cm, % grasa 13,5 +/- 1,9, %masa muscular 43,4 +/- 2,3 y somatotipo 2,7-4,9-3,0 (d.s. +/- 0,6-0,8-0,9). El comportamiento de estos parámetros es de acuerdo a la edad ascendente en cuanto a talla, pero no en peso ya que la categoría juvenil presenta un mayor peso corporal promedio contra la junior, debido probablemente a que la primera presenta un rango más amplio. Con lo que respecta a la composición corporal la masa grasa tiene un decremento conforme aumenta la edad, no así la masa muscular cuyo comportamiento es a la inversa por estar interrelacionadas. En relación al somatotipo la mesomorfia predomino en todas las categorías, y además en la juvenil el valor de la endomorfia es ligeramente mayor, debido a la amplitud morfológica de sus integrantes como se menciono anteriormente. Existen escasos reportes internacionales en cuanto a aspectos morfológicos de jugadores de waterpolo y nulos en nuestro país, sin embargo es un deporte olímpico con gran número de aficionados y practicantes a nivel mundial, por lo que creemos importante mencionar estas características de nuestros seleccionados. Con este estudio podemos concluir que nuestros jugadores elite no presentan grandes diferencias en cuanto a composición corporal y somatotipo con lo reportado por otros autores

The aim of this study was to analyze the morphological characteristics in three national teams ofwaterpolo players. This study was transversal and descriptive of the morphology characteristics in 37 elite players belonging to the three categories: infantile (N = 13), youth (N= 12) andjunior (N = 12). Reporting the next results for every group. Junior: age 18.6 +/- 1.1 years weight 70.9 +/-7.3 kg, height 178.8 +/- 8.2 cm, % body fat 8.5 +/- 3.7, % muscle mass 49 +/- 2.5 and somatotype 2.6-5.0-3.1 (sd. +/- 1.0-1.3-1.5). Youth: age 17.4 +/- 0.7 years, weight 73.6 +/- 1O.0 kg, height 177.7 +/- 6.2 cm, % body fat 1O.4 +/- 3.4, % muscle mas s 48.2 +/- 2.6 and somatotype 3.1-5.5-2.3 (sd. +/- 1.0-0.7-0.7). Infantile: age 14.5 +/-0.7 years, weight 56.4 +/- 5.1 kg, height 167.4 +/- 5.49 cm, % body fat 13.5 +/- 1.9 % muscle mas s 43.4 +/- 2.3 and somatotype 2.7-4.9-3.0 (sd. 0.6-0.8-0.9).These yardisticks are according to age in an upwards scale regarding size but not in average weight due to the fact that the youth has an average body weight against the junior. These national players show weight and size above the media of the population. Regarding the body composition the fat mas s decreases as coming of age, the opposite applies in muscular mass. In relation to the somatotype there are no major important differences. There are a few international reports regarding morphological aspects in waterpolo players and none in our country even though it is an olympic sport with a considerable number of followers and world wide players so it is important to mention the characteristics of our national players. With this study we can conclude that our elite players do not show great differences within body composition and somatotype with the data reported by others authors

Famotidina en el tratamiento de la úlcera péptica / Famotidine in peptic duodenal ulcer treatment

Este estudio abierto, multicéntrico, estuvo destinado a evaluar la eficacia, tolerancia y seguridad del nuevo antagonista de los receptores H2, Famotidina, en el tratamiento de la úlcera péptica duodenal. Treinticuatro pacientes con úlcera péptica duodenal, demostrada endoscópicamente, recibieron una tableta de Famotidina, 40mg. noche, hasta por seis semanas. Se mantuvo el tratamiento hasta documentar cicatrización de la lesión, mediante endoscopía realizada a la segunda, cuarta y sexta semana. Un paciente fue excluído por desviación del protocolo. La curación acumulativa en los 33 pacientes evaluables fue de 48.5 por ciento, 91 por ciento y 97 por ciento a la segunda, cuarta y sexta semana de tratamiento, respectivamente. El 52 por ciento de los pacientes se tornó asintomático a las 72 horas y el 79 por ciento al finalizar la primera semana. La droga fue bien tolerada y no se registraron reacciones adversas clínicas, ni de laboratorio en los treinticuatro pacientes estudiados. Se concluye que Famotidina es eficaz y bien tolerada en el tratamiento de la mayoría de pacientes con úlcera péptica duodenal