Activity of ceftolozane/tazobactam and imipenem/relebactam against Gram-negative clinical isolates collected in Mexico-SMART 2017-2021.

Objectives: To investigate the activities of ceftolozane/tazobactam and imipenem/relebactam against Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa isolated from hospitalized patients in Mexico in 2017-2021. Methods: MICs were determined by CLSI broth microdilution and interpreted using CLSI M100 breakpoints. ß-Lactamase genes were identified in ceftolozane/tazobactam-, imipenem/relebactam-, and/or imipenem-non-susceptible isolates. Results: Ceftolozane/tazobactam and imipenem/relebactam inhibited 89% and 99% of E. coli isolates (n = 2337), and 87% and 94% of K. pneumoniae isolates (n = 1127). Sixty-four percent of E. coli and 47% of K. pneumoniae had an ESBL non-carbapenem-resistant Enterobacterales (ESBL non-CRE) phenotype. Eighty-six percent and 91% of ESBL non-CRE E. coli and K. pneumoniae were ceftolozane/tazobactam susceptible, and 99.9% and 99.8% were imipenem/relebactam susceptible. Ceftolozane/tazobactam was the most active agent studied against P. aeruginosa (n = 1068; 83% susceptible), 9-28 percentage points higher than carbapenems and comparator ß-lactams excluding imipenem/relebactam (78% susceptible). Ceftolozane/tazobactam remained active against 35%-58%, and imipenem/relebactam against 32%-42%, of P. aeruginosa in meropenem-, piperacillin/tazobactam-, and cefepime-non-susceptible subsets. The majority of isolates of ceftolozane/tazobactam-non-susceptible E. coli carried an ESBL, whereas among ceftolozane/tazobactam-non-susceptible K. pneumoniae and P. aeruginosa, the majority carried carbapenemases. The most prevalent carbapenemase observed among E. coli (estimated at 0.7% of all isolates), K. pneumoniae (4.8%) and P. aeruginosa (10.0%) was an MBL. Almost all imipenem/relebactam-non-susceptible E. coli and K. pneumoniae carried MBL or OXA-48-like carbapenemases, whereas among imipenem/relebactam-non-susceptible P. aeruginosa, 56% carried MBL or GES carbapenemases. Conclusions: Ceftolozane/tazobactam and imipenem/relebactam may provide treatment options for patients infected with ß-lactam-non-susceptible Gram-negative bacilli, excluding isolates carrying an MBL- or OXA-48-like carbapenemase.

Genomic insights into Mycobacterium simiae human colonization.

Mycobacterium simiae (Karassova V, Weissfeiler J, Kraszanay E, Acta Microbiol Acad Sci Hung 12:275-82, 1965) is a slow-growing nontuberculous Mycobacterium species found in environmental niches, and recently evidenced as an opportunistic Human pathogen. We report here the genome of a clinical isolate of M. simiae (MsiGto) obtained from a patient in Guanajuato, Mexico. With a size of 6,684,413 bp, the genomic sequence of strain MsiGto is the largest of the three M. simiae genomes reported to date. Gene prediction revealed 6409 CDSs in total, including 6354 protein-coding genes and 52 RNA genes. Comparative genomic analysis identified shared features between strain MsiGto and the other two reported M. simiae genomes, as well as unique genes. Our data reveals that M. simiae MsiGto harbors virulence-related genes, such as arcD, ESAT-6, and those belonging to the antigen 85 complex and mce clusters, which may explain its successful transition to the human host. We expect the genome information of strain MsiGto will provide a better understanding of infective mechanisms and virulence of this emergent pathogen.

Cáncer de mama en la mujer joven / Breast cancer in young women

Objetivo: Revisar las características que tiene el cáncer de mama (CM) en la mujer joven. Material y métodos: Para ello, se hace una exhaustiva revisión bibliográfica, indicando los factores etiológicos, los métodos diagnósticos y las opciones de tratamiento existentes, con mención especial a circunstancias que pueden concurrir en estas pacientes, tales como la menopausia temprana, la pérdida de fertilidad, el embarazo tras CM y el CM durante la gestación. Resultados: Destacan que el CM en la mujer joven es muy infrecuente, aunque se está constatando un aumento en su frecuencia. Es de mayor tamaño y con márgenes positivos, lo que le confiere una mayor agresividad y una mortalidad más alta. Para su diagnóstico, más difícil que en la mujer mayor, tiene gran importancia el triple test (mamografía, ecografía y biopsia) y sus opciones de tratamiento son las mismas que en las mujeres de más edad. Conclusiones: El CM en la mujer joven tiene unas características especiales que lo diferencian, en algunos aspectos, al CM que se diagnostica en la mujer de más edad (AU)

Objective: To review the characteristics of breast cancer in young women. Material and methods: The scientific literature was reviewed, indicating the etiological factors, diagnostic methods and treatment options, with special reference to the factors that can concur in young patients such as premature menopause, loss of fertility, pregnancy after breast cancer and breast cancer during pregnancy. Results: Importantly, breast cancer in young women is very rare but is on the increase. Tumors are larger in young women and have positive margins, making the disease more aggressive and leading to higher mortality. Diagnosis is more difficult than in older women and the triple test (mammography, ultrasound and biopsy) is of great importance. Treatment options are the same as in older women. Conclusions: Breast cancer in young women shows certain characteristics that differentiate it in some respects from breast cancer diagnosed in older women (AU)

[The value of an intervention for improving secondary prevention in patients undergoing cardiac surgery]. / Evaluación de una intervención para mejorar la prevención secundaria en pacientes sometidos a cirugía cardiaca.

Given that treatment for secondary prevention in patients undergoing cardiac surgery is underused, we devised a hospital intervention to increase its implementation. The intervention involved all physicians in the department of cardiac surgery agreeing to complete a report on each patient before hospital discharge. The document recorded the indications for the recommended treatments, and prompted for details of the drugs prescribed, the doses used, the reasons for not prescribing the recommended drugs, if that was the case, and the use of alternative medicines. The efficacy of the intervention was evaluated by comparing the rate of drug use in the year in which it was introduced (2003, n=341) with retrospective data on the rate in the previous year (n=369). The rates of use of aspirin, statins, angiotensin-converting enzyme inhibitors, and beta-blockers by patients who required them all showed an absolute increase, of 13.4%, 38.3%, 21.8%, and 21.5%, respectively. In conclusion, the introduction of a simple and inexpensive intervention was able to significantly increase the use of drugs for secondary prevention in patients undergoing cardiac surgery.

Evaluación de una intervención para mejorar la prevención secundaria en pacientes sometidos a cirugía cardiaca / The Value of an Intervention for Improving Secondary Prevention in Patients Undergoing Cardiac Surgery

Dada la infrautilización de los tratamientos de prevención secundaria en pacientes sometidos a cirugía cardiaca, se diseñó una intervención hospitalaria para mejorar su empleo consistente en el compromiso de los miembros del servicio de cirugía cardiaca de cumplimentar antes del alta hospitalaria un formulario que recordaba las indicaciones de los tratamientos recomendados, preguntaba por su prescripción, la dosis empleada, la causa de no prescribir, si era el caso, y el uso de fármacos alternativos. Su eficacia se evaluó comparando la tasa de utilización de los fármacos el año de su uso, 2003 (n = 341), con la del año previo, obtenida retrospectivamente (n =369). El uso de ácido acetilsalicílico, estatinas, inhibidoresde la convertasa angiotensínica y bloqueadores betaen candidatos ideales aumentó en total el 13,4, el 38,3, el 21,8 y el 21,5% respectivamente. En conclusión, una intervención sencilla y barata fue capaz de mejorar significativamente el empleo de fármacos de prevención secundaria en pacientes sometidos a cirugía cardiaca

Given that treatment for secondary prevention inpatients undergoing cardiac surgery is underused, wedevised a hospital intervention to increase itsimplementation. The intervention involved all physiciansin the department of cardiac surgery agreeing to completea report on each patient before hospital discharge. Thedocument recorded the indications for the recommendedtreatments, and prompted for details of the drugsprescribed, the doses used, the reasons for notprescribing the recommended drugs, if that was the case,and the use of alternative medicines. The efficacy of theintervention was evaluated by comparing the rate of druguse in the year in which it was introduced (2003, n=341)with retrospective data on the rate in the previous year(n=369). The rates of use of aspirin, statins, angiotensinconverting enzyme inhibitors, and beta-blockers by patients who required them all showed an absolute increase, of 13.4%, 38.3%, 21.8%, and 21.5%,respectively. In conclusion, the introduction of a simpleand inexpensive intervention was able to significantlyincrease the use of drugs for secondary prevention inpatients undergoing cardiac surgerya

Tumores de colisión ováricos asociados con teratoma / Ovarian collision tumors associated with teratoma

Los tumores de colisión representan la coexistencia de 2 tumores contiguos en un órgano, pero histológicamente distintos, sin mezcla histológica. En el campo de la ginecología, se han descrito tumores de colisión en el útero (cuerpo y cérvix) y en el ovario. Se presenta aquí un caso de cistoadenoma mucinoso ovárico asociado con un teratoma quístico benigno

Collision tumors represent the coexistence of 2 adjacent but histologically distinct tumors without histologic admixture in an organ. In gynecology, collision tumors in the uterus (corpus and cervix) and ovary have been described. We report a case of ovarian mucinous cystadenoma coexisting with a benign cystic teratoma

Cistitis intersticial como causa de dolor pélvico crónico en ginecología / Interstitial cystitis as a cause of chronic pelvis pain in gynecology

La cistitis intersticial es un complejo síndrome crónico inflamatorio vesical, más común de lo que podría imaginarse, en cuya patogenia subyace una alteración de la permeabilidad del urotelio como fracaso de su función protectora de barrera. Sus síntomas más comunes son: frecuencia (incremento del número de micciones), urgencia miccional, dolor abdominal, uretral o genital, dispareunia y otros síntomas variados. Su diagnóstico es generalmente difícil de realizar; en muchas ocasiones se plantea por exclusión y, otras veces, con la mejoría clínica que suponen ciertas maniobras terapéuticas, como la sobredistensión. La cistoscopia desempeña un importante papel diagnóstico, que permite detectar la clásica úlcera de Hunner; también contribuyen a establecer el diagnóstico, entre otras pruebas, la biopsia vesical y el test de sensibilidad al potasio. Su tratamiento es empírico y sintomático, e incluye tratamientos físicos (distensión vesical, estimulación eléctrica), fármacos de uso intravesical (principalmente, el dimetilsulfóxido), diversos fármacos de uso sistémico (antidepresivos tricíclicos, antihistamínicos, pentosanpolisulfato, analgésicos, corticoides, etc.) y, en algunos casos, técnicas quirúrgicas. El ginecólogo siempre debe tener presente la cistitis intersticial como una de las posibles causas de dolor pélvico crónico en la mujer

Interstitial cystitis is a complex chronic inflammatory syndrome of the bladder that is more frequent than is commonly believed. The pathogenesis of this entity involves an alteration of the permeability of the urothelium, leading to a failure of its protective function of providing a barrier. The most common symptoms are frequency (an increase in the number of micturitions), voiding urgency, abdominal, urethral or genital pain, dyspareunia and a variety of other symptoms. Diagnosis of interstitial cystitis is generally difficult and is often made by exclusion or on the basis of clinical improvement produced by therapeutic maneuvers such as overdistension. Cystoscopy plays an important role in diagnosis, a classical finding being Hunner ulcer; among other tests, bladder biopsy and the potassium sensitivity test are also useful. Treatment of this entity is empirical and symptomatic, and includes physical treatments (bladder distension, electrical stimulation), intravesical drugs (mainly dimethyl sulfoxide), diverse systemic drugs (tricyclic antidepressants, antihistamines, pentosan polysulfate, analgesics, corticosteroids) and, in some cases, surgical techniques. Gynecologists should be alert to interstitial cystitis as one of the possible causes of chronic pelvic pain in women