Whole genome analysis of Gram-negative bacteria using the EPISEQ CS application and other bioinformatic platforms.

OBJECTIVES: To determine genomic characteristics and molecular epidemiology of carbapenem non-susceptible Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii, and Pseudomonas aeruginosa from medical centres of Mexico using whole genome sequencing data analysed with the EPISEQⓇ CS application and other bioinformatic platforms. METHODS: Clinical isolates collected from 28 centres in Mexico included carbapenem-non-susceptible K. pneumoniae (n = 22), E. coli (n = 24), A. baumannii (n = 16), and P. aeruginosa (n = 13). Isolates were subjected to whole genome sequencing using the Illumina (MiSeq) platform. FASTQ files were uploaded to the EPISEQⓇ CS application for analysis. Additionally, the tools Kleborate v2.0.4 and Pathogenwatch were used as comparators for Klebsiella genomes, and the bacterial whole genome sequence typing database was used for E. coli and A. baumannii. RESULTS: For K. pneumoniae, both bioinformatic approaches detected multiple genes encoding aminoglycoside, quinolone, and phenicol resistance, and the presence of blaNDM-1 explained carbapenem non-susceptibility in 18 strains and blaKPC-3 in four strains. Regarding E. coli, both EPISEQⓇ CS and bacterial whole genome sequence typing database analyses detected multiple virulence and resistance genes: 20 of 24 (83.3%) strains carried blaNDM, 3 of 24 (12.4%) carried blaOXA-232, and 1 carried blaOXA-181. Genes that confer resistance to aminoglycosides, tetracyclines, sulfonamides, phenicols, trimethoprim, and macrolides were also detected by both platforms. Regarding A. baumannii, the most frequent carbapenemase-encoding gene detected by both platforms was blaOXA-72, followed by blaOXA-66. Both approaches detected similar genes for aminoglycosides, carbapenems, tetracyclines, phenicols, and sulfonamides. Regarding P. aeruginosa, blaVIM, blaIMP, and blaGES were the more frequently detected. Multiple virulence genes were detected in all strains. CONCLUSION: Compared to the other available platforms, EPISEQⓇ CS enabled a comprehensive resistance and virulence analysis, providing a reliable method for bacterial strain typing and characterization of the virulome and resistome.

Increment Antimicrobial Resistance During the COVID-19 Pandemic: Results from the Invifar Network.

Aim: This study aims to assess the changes in antimicrobial resistance among some critical and high-priority microorganisms collected previously and during the coronavirus disease 2019 (COVID-19) pandemic in Mexico. Methods: We collected antimicrobial susceptibility data for critical and high-priority microorganisms from blood, urine, respiratory samples, and from all specimens, in which the pathogen may be considered a causative agent. Data were stratified and compared for two periods: 2019 versus 2020 and second semester 2019 (prepandemic) versus the second semester 2020 (pandemic). Results: In the analysis of second semester 2019 versus the second semester 2020, in blood samples, increased resistance to oxacillin (15.2% vs. 36.9%), erythromycin (25.7% vs. 42.8%), and clindamycin (24.8% vs. 43.3%) (p ≤ 0.01) was detected for Staphylococcus aureus, to imipenem (13% vs. 23.4%) and meropenem (11.2% vs. 21.4) (p ≤ 0.01), for Klebsiella pneumoniae. In all specimens, increased ampicillin and tetracycline resistance was detected for Enterococcus faecium (p ≤ 0.01). In cefepime, meropenem, levofloxacin, and gentamicin (p ≤ 0.01), resistance was detected for Escherichia coli; and in piperacillin-tazobactam, cefepime, imipenem, meropenem, ciprofloxacin, levofloxacin, and gentamicin (p ≤ 0.01), resistance was detected for Pseudomonas aeruginosa. Conclusion: Antimicrobial resistance increased in Mexico during the COVID-19 pandemic. The increase in oxacillin resistance for S. aureus and carbapenem resistance for K. pneumoniae recovered from blood specimens deserves special attention. In addition, an increase in erythromycin resistance in S. aureus was detected, which may be associated with high azithromycin use. In general, for Acinetobacter baumannii and P. aeruginosa, increasing resistance rates were detected.

The Role of microRNAs in Pulp Inflammation.

The dental pulp can be affected by thermal, physical, chemical, and bacterial phenomena that stimulate the inflammatory response. The pulp tissue produces an immunological, cellular, and vascular reaction in an attempt to defend itself and resolve the affected tissue. The expression of different microRNAs during pulp inflammation has been previously documented. MicroRNAs (miRNAs) are endogenous small molecules involved in the transcription of genes that regulate the immune system and the inflammatory response. They are present in cellular and physiological functions, as well as in the pathogenesis of human diseases, becoming potential biomarkers for diagnosis, prognosis, monitoring, and safety. Previous studies have evidenced the different roles played by miRNAs in proinflammatory, anti-inflammatory, and immunological phenomena in the dental pulp, highlighting specific key functions of pulp pathology. This systematized review aims to provide an understanding of the role of the different microRNAs detected in the pulp and their effects on the expression of the different target genes that are involved during pulp inflammation.

Resultados de la reparación de Bankart/plicatura y remplissage en el tratamiento de la luxación anteroinferior recurrente del hombro. Correlación con la escala de ISIS / Bankart repair and remplissage in recurrent anteroinferior shoulder dislocation, Correlation with ISIS scale

Introducción: La luxación recurrente anteroinferior del hombro es consecuencia de una luxación aguda traumática que, en pacientes jóvenes, menores de veinte años, se ha estimado puede llegar al 97% de recurrencia, pero que disminuye a medida que aumenta la edad, excepto en pacientes mayores con rupturas asociadas del manguito rotador. Al ser una patología incapacitante que afecta la calidad de vida de las personas, hay una mayor tendencia a tratarla por métodos quirúrgicos que con rehabilitación. La lesión fundamental es el desprendimiento del labrum anterior de la glenoides conocida como la lesión de Bankart-Perthes, estructura que tiene limitaciones para cicatrizar de manera anatómica con tratamientos incruentos, perpetuando la inestabilidad. A medida que recurre la luxación se presentan lesiones óseas asociadas tanto en la glenoides denominada Bankart ósea, así como en la cabeza humeral en su región posterosuperior o lesión de Hill-Sachs, que aumentan la posibilidad de recurrencia. Se han descripto diferentes técnicas abiertas y artroscópicas para corregir la luxación, pero por la heterogeneidad de la lesión no hay un tratamiento para corregirla que sea patrón de oro. Nuestro objetivo es describir los resultados clínicos en pacientes con luxación recurrente anteroinferior de hombro que fueron sometidos a cirugía artroscópica de reparación de Bankart/plicatura y remplissage y correlacionar los resultados con la escala preoperatoria de ISIS. Materiales y métodos: se revisaron las historias clínicas de pacientes con diagnóstico de luxación de la articulación del hombro (S430) (M253), que fueron llevados a cirugía entre junio de 2015 y enero de 2019, analizando características de la(s) lesión(es), clasificación preoperatoria de acuerdo con la escala de ISIS, tipo de procedimiento(s) quirúrgico realizado y número de implantes. Resultados: de veinticinco pacientes operados por el autor senior (MMA) de luxación recurrente de hombro, veintitrés completaron el seguimiento con los procedimientos de reparación de Bankart/plicatura y la adición de un remplissage en casos de lesiones Hill-Sachs enganchantes. Todos tenían una escala de ISIS preoperatoria igual o inferior a 6. Al final del seguimiento ningún paciente reportó recurrencia de su luxación. Conclusión: en nuestra casuística, la reparación de Bankart/plicatura en pacientes con lesiones Hill-Sachs no enganchantes en asocio del remplissage produce excelentes resultados a corto y mediano plazo cuando la escala de ISIS es igual o inferior a 6. Nivel de evidencia: IV

Introduction: Recurrent anteroinferior shoulder dislocation is the consequence of an acute traumatic dislocation which, in young patients, under twenty years old, has been estimated to reach 97% of recurrence, but which decreases with increasing age, except in older patients with associated rotator cuff tears. Being a disabling pathology that affects people's quality of life, there is a greater tendency to treat it by surgical methods than with rehabilitation. The fundamental lesion is the detachment of the anterior labrum of the glenoid known as the Bankart-Perthes lesion, a structure that has limitations to heal anatomically with bloodless treatments, perpetuating instability. As the dislocation recurs, there are associated bone lesions both in the glenoid called Bony Bankart, as well as in the humeral head in its posterior superior region or Hill-Sachs lesion, which increase the possibility of recurrence. Different open and arthroscopic techniques have been described to correct dislocation, but due to the heterogeneity of the lesion, there is no gold standard treatment to correct it. Our objective is to describe the clinical results in patients with recurrent anteroinferior shoulder dislocation who underwent arthroscopic Bankart/plication repair and fill surgery and correlate the results with the preoperative ISIS scale. Materials and methods: the medical records of patients with a diagnosis of shoulder joint dislocation (S430) (M253), who were taken to surgery between June 2015 and January 2019, were reviewed, analyzing characteristics of the injury(s), classification preoperative according to the ISIS scale, type of surgical procedure(s) performed and number of implants. Results: of twenty-five patients operated by the senior author (MMA) for recurrent shoulder dislocation, twenty-three completed follow-up with Bankart/plication repair procedures and the addition of a fill in Hill-Sachs engaging lesions. All had a preoperative ISIS scale equal to or less than 6. At the end of follow-up, no patient reported recurrence of their dislocation.Conclusion: in our casuistry, Bankart/plication repair in patients with non-engaging Hill-Sachs lesions in association with filling produces excellent results in the short and medium term when the ISIS scale is equal to or less than 6. Level of Evidence: IV

Prognostic implications of periodic epileptiform discharges.

BACKGROUND: Periodic epileptiform discharges (PEDs) are an abnormal finding on electroencephalograms (EEGs), the significance of which is uncertain. OBJECTIVE: To investigate long-term outcome in patients with PEDs. DESIGN: We retrospectively analyzed the outcomes of patients who had PEDs diagnosed during a 7-year period. We abstracted and tabulated clinical parameters from the time of EEG, imaging findings, EEG measurements, and subsequent clinical outcome from medical records. We used descriptive, inferential, and logistic regression analysis to determine the factors associated with clinical outcomes in patients with PEDs. We divided PEDs into the following subgroups: periodic lateralized epileptiform discharges (PLEDs), generalized PEDs, and bilateral PEDs and analyzed these subgroups individually. SETTING: University-affiliated teaching hospital. Subjects One hundred sixty-two patients with PEDs. RESULTS: We obtained complete clinical, neuroimaging, neurophysiologic, and long-term outcome data in 118 patients. In the subgroup of patients with PLEDs, absence of seizures at onset (odds ratio, 0.21 per point; 95% confidence interval, 0.04-0.97) and an acute etiology for the PLEDs (odds ratio, 0.14 per point; 95% confidence interval, 0.03-0.72) were associated with death. A nonneoplastic cause for PLEDs was associated with independent functionality (odds ratio, 0.45 per point; 95% confidence interval, 0.3-0.67). CONCLUSION: In patients with PLEDs, the absence of clinical seizures at the time of detection and presumed acute etiology are associated with death, whereas a nonneoplastic etiology was associated with a good clinical outcome.

Hallazgo incidental de timoma paracardiaco derecho en enferma con infarto del miocardio / Incidental finding of a right paracardiac thymoma in a woman with a myocardial infarction

Los timomas son tumores primarios que provienen de células epiteliales del timo. Es frecuente encontrarlos en el mediastino anterior y asociados a un síndrome paratímico. Aunque pueden ser asintomáticos, es posible que cursen con manifestaciones clínicas inespecíficas como dolor precordial, disnea y tos, que habitualmente desaparecen con la extirpación quirúrgica. En estas condiciones, el diagnóstico es incidental y habitualmente se establece por varios métodos de imagen como la radiografía de tórax, tomografía axial computada o la resonancia magnética, y se confirma por biopsia tumoral. La sobrevida depende del estadio clínico de Masaoka, tamaño tumoral, tipo de resección y el subtipo histológico. La extirpación quirúrgica completa es el objetivo principal. El uso de quimioterapia y/o radioterapia pre y/o posquirúrgica es aún controversial. Presentamos el caso clínico de una mujer quien, después de sufrir un infarto al miocardio, durante su estudio se encontró de manera incidental una masa paracardiaca derecha que correspondió a un timoma.

Thymomas are primary tumors that arise from the epithelial cells of the thymus. Frequently, they are found in the anterior mediastinum, associated to a parathymic syndrome. Although they may stay asymptomatic, they may also give rise to unspecific clinical manifestations, which include chest pain, dyspnea, and cough, symptoms that generally disappear with surgical resection of the thy moma. In these cases, incidental diagnosis is usually established by using various image methods that may include chest X-ray, computed tomography, and magnetic resonance, and it is confirmed by tumor biopsy. Survival depends on Masaoka's clinical stage, the size of the tumor, the type of resection performed and the histológical subtype. Complete surgical resection is the main objective. The use of pre and/or postoperatory chemo and/or radiotherapy is still controversial. We present the case of a woman who suffered from a myocardial infarction. She was later incidentally diagnosed with a right paracardiac tumor that came out to be a thymoma.

Eficacia del clopidogrel como inhibidor de la agregación plaquetaria dependiente de ADP. un estudio en individuos con enfermedad arteral coronaria / Eficacy of clopidogrel as inhibitor of ADP-Induced platelet aggregation. A study in patients with coronary artery disease

El ácido acetil-salicílico, al inhibir la producción de tromboxano A2, reduce entre 20 y 25 por ciento el riesgo de eventos oclusivos arteriales. La ticlopidina inhibe la agregación plaquetaria dependiente de adenosín-difosfato, y reduce el mismo riesgo en 30 a 35 por ciento, pero tiene efectos indeseables. Su derivado, el clopidogrel, tiene el mismo mecanismo de acción y disminuye indirectamente la expresión del receptor de fibrinógeno en las plaquetas. Conserva la eficacia clínica de la ticlopidina, con menor frecuencia de efectos adversos. En este estudio, evaluamos la acción de 75 mg diarios de clopidogrel sobre la función plaquetaria de 33 individuos con enfermedad arterial coronaria; se les practicó agregometría plaquetaria inducida con adenosín-difosfato 5 mM y colágena 20 mg/mL, tiempo de hemorragia y fibrinógeno, antes del tratamiento y a las semanas 6 y 12. La agregación plaquetaria inducida con adenosín-difosfato fue de 90.7 por ciento ñ 13.2, 54.6 por ciento ñ 23.2 y 49.2 por ciento ñ 23.7 en las muestras basal y a las semanas 6 y 12, lo que representó una reducción significativa de 38.6 por ciento y 44.4 por ciento. La agregación plaquetaria inducida con colágena no disminuyó significativamente. El tiempo de hemorragia se prolongó de 4.1 ñ 1.6 a 15.43 ñ 13.1 y 14.6 ñ 14.4 minutos (3.7-3.5 veces). No se observaron modificaciones en la concentración de fibrinógeno. No se presentaron complicaciones hemorrágicas. Ocurrieron molestias digestivas con una frecuencia menor al 3 por ciento. Se concluye que el clopidogrel reduce eficazmente la agregación plaquetaria dependiente de adenosin-difosfato, y prolonga el tiempo de hemorragia. El perfil de seguridad clínico y de laboratorio son adecuados.

Tetralogía de Fallot en adultos / Tetralogy of fallot in adult patients

Presentamos los aspectos clínicos y hemodinámicos de 33 enfermos mayores de 18 años, portadores de tetralogía de Fallot. El diagnóstico se confirmó por cateterismo cardiaco y angiocardiografía. Fueron excluidos aquellos enfermos con atresia valvular pulmonar. La mayor parte de los pacientes estaban en clase funcional II o IV y tenían cianosis de grados variables. En el electrocardiograma de 23 enfermos se observó bloqueo de la rama derecha de grado intermedio. Ningún caso tenía cardiomegalia significativ y encontramos oligohemia pulmonar en 19 de 20 estudios radiológicos analizados. No hubo relación entre el grado de cianosis y la edad de los pacientes; sin embargo, la insaturación se correlacionó con la clase funcional. En todos los enfermos existía hipertensión ventricular derecha a nivel sistémico y solamente un caso con estenosis pulmonar infundibular ligera se presentó con hipertensión arterial pulmonar significativa. En los demás, el valor de presión arterial pulmonar fue normal o discretamente elevada, observándose sin embargo discreta tendencia al incremento a medida que aumentaba el gasto pulmonar total o efectivo. El análisis multivariado para la clase funcional mostró valores significativos para la cianosis. Se practicó fístula sistémica pulmonar en 10 enfermos con hipoplasia del tronco y de las ramas arteriales, que tenían circulación pulmonar poco desarrollada, con una muerte perioperatoria. No se observó mortalidad en 16 casos con corrección completa. Las características anatomofuncionales de este grupo de pacientes con tetralogía de Fallot permitieron una mejor tolerancia a la cardiopatía