Consenso latinoamericano sobre la importancia de un sistema de gestión de datos microbiológicos para apoyar el programa de optimización de uso de antimicrobianos (PROA): Recomendaciones basadas en la evidencia. Parte 1 / Latin American consensus on the importance of a microbiological data management system to support antimicrobial use optimization program (PROA): Evidence-based recommendations. Part 1

La resistencia antimicrobiana es una amenaza para los logros de la medicina moderna y una de las medidas más efectivas para contrarrestarla son los programas de optimización del uso de antimicrobianos (PROA), en el cual el laboratorio de microbiología es uno de los principales componentes. La aplicación efectiva de tecnología de la información en los procesos es fundamental, pero existe poca información en Latinoamérica sobre el desarrollo y la articulación de las herramientas tecnológicas para apoyar los PROA. Este consenso hace recomendaciones sobre la gestión de los datos microbiológicos para la toma de decisiones. En la Parte I, se presentan las recomendaciones en cuanto al uso de un sistema informatizado de gestión de datos microbiológicos en la práctica clínica, los requerimientos de datos y de reporte en el laboratorio de microbiología, y los contenidos del sistema de gestión de calidad avanzado en el laboratorio. En la Parte II, se discuten los requerimientos de información para la gestión de PROA en estadios intermedios, iniciales y avanzados por el laboratorio y la farmacia; así como la integración del equipo de PROA con el Comité de Prevención y Control de Infecciones y la información para la gestión de PROA a nivel gerencial.

Antimicrobial resistance is a threat to the achievements of modern medicine and one of the most effective measures to counteract it is antimicrobial use optimization programs (AMS), in which the microbiology laboratory is one of the main components. The effective application of information technology in the processes is fundamental, but there is little information in Latin America on the development and articulation of technological tools to support AMSs. This consensus makes recommendations on the management of microbiological data for decision making. In Part I, recommendations on the use of a computerized microbiological data management system in clinical practice, data and reporting requirements in the microbiology laboratory, as well as the contents of the advanced quality management system in the laboratory are presented. In Part II, the information requirements for AMS management in intermediate, initial, and advanced stages by the laboratory and pharmacy are discussed; as well as the integration of the AMS team with the Infection Prevention and Control Committee and the information for AMS management at the management level.

Seroprevalence and detection of bovine leukosis virus in semen from breeding bulls in Costa Rica.

Bovine leukemia virus (BLV) causes enzootic bovine leukosis, a persistent infection and the most important neoplastic disease in cattle. It is spread primarily by transferring infected lymphocytes through blood from carriers to healthy animals. The present study is aimed at determining the seropositivity of BLV in breeding bulls from Costa Rica and at detecting for the first time in the country BLV DNA in bull semen. Between May 2011 and August 2018, 379 blood and 133 semen samples were collected from bulls distributed in 118 farms. The serum was analyzed by an enzymatic immunoassay and the semen by polymerase chain reaction and sequencing. BLV seropositivity was 43.5% (165/379), while 64.4% (76/118) of the farms had positive reactors. Holstein (75.7%) and Jersey (73.0%) breeds showed the highest seropositivity. In addition, Bos taurus bulls (68.1%), older than seven years (50.0%), and those belonging to dairy farms (75.5%) had higher seropositivity compared to Bos indicus (17.7%), younger than seven years (42.2%), and those from beef farms (15.5%), respectively. Moreover, Bos taurus bulls had a higher risk of being seropositive than Bos indicus (OR = 3.4; 95% CI: 1.7-6.8). BLV DNA was found in one semen sample (2.5%; 1/40) from a seropositive bull. The importance of serum and molecular BLV screening in semen samples and the potential role of some risk factors associated with the disease, such as the bull's age, genotype, and type of livestock productive system, is argued in the present report.

Antigenic and molecular characterization of isolates of the Brazilian genotype BR-I (GI-11) of infectious bronchitis virus supports its recognition as BR-I serotype.

The antigenic and molecular characteristics of BR-I infectious bronchitis viruses (IBVs) isolated from Brazil are reported. IBVs isolated from commercial flocks with different clinical manifestations between 2003 and 2019 were submitted to antigenic and molecular characterization. The complete S1 glycoprotein gene of 11 field isolates was amplified and sequenced. The virus neutralization (VN) test showed 94.75% neutralization with a BR-I isolate and 30% or less against other worldwide reference strains. The nucleotide and amino acid sequence analyses revealed 84.3-100% and 83.5-100% identity among them, respectively. The identity values ranged from 57.1 to 82.6% for nucleotides and from 46.6-84.4% for amino acids compared with those of other genotypes. By phylogenetic tree analysis, the Brazilian isolates were branched into the BR-I genotype (lineage GI-11), which was differentiated from foreign reference strains. Selective pressure analyses of BR-I IBVs revealed evolution under purifying selection (negative pressure) for the complete S1 gene but four specific sites (87, 121, 279, and 542) under diversifying selection (positive pressure). Profiles of cleavage sites and potential N-glycosylation sites differed from those of other genotypes. The low molecular relationship among the Brazilian viruses and foreign serotypes was concordant with the VN test results. The low antigenic relatedness (ranging from 5.3-30% between Brazilian genotype BR-I and reference IBV serotypes of North America, Europe, and Asia) indicates that the BR-I genotype is a different serotype, referred to for the first time and hereafter as serotype BR-I. RESEARCH HIGHLIGHTSStrains of the BR-I genotype presented robust antigenic and molecular similarity.BR-I strains evolved under purifying selection mode (negative pressure).The BR-I genotype originated in Brazil and dispersed to other countries.BR-I genotype viruses can be referred to as the BR-I serotype.

Genetic Analysis of Infectious Bronchitis Virus S1 Gene Reveals Novel Amino Acid Changes in the GI-16 Lineage in Peru.

Infectious bronchitis is a highly contagious viral disease that represents an economic threat for poultry despite the wide use of vaccination. To characterize the virus circulating in Peru, we analyzed 200 samples, including nasopharyngeal swabs and multiple tissues collected from animals suspected of being infected with infectious bronchitis virus (IBV) between January and August in 2015. All animals had at least one positive sample for IBV by RT-PCR. Out of these positive samples, eighteen (18) were selected for viral isolation and a partial S1 sequencing. Phylogenetic analysis showed that sixteen isolates clustered with members of GI-16 lineage, also known as Q1, with nucleotide homology ranging from 93% to 98%. The two remaining isolates grouped with members of the GI-1 lineage. Our study reveals circulation of GI-16 lineage during this period in poultry systems in Peru, along with GI-1 lineage (vaccine-derived). Moreover, those IBV GI-16 isolates showed unique nucleotide and amino acid changes compared to their closest relatives. Altogether, these findings reveal the circulation of GI-16 lineage while describing changes at key regions of the S protein that might be of relevance for vaccine evasion. These results highlight the importance of genetic surveillance for improving vaccination strategies against infectious bronchitis.

Complete genome sequence data of two Salmonella enterica subsp. enterica serovar Gallinarum: A 9R vaccine strain and a virulent Brazilian field strain.

Salmonella Gallinarum (SG) is a host-restricted enterobacteria and the causative agent of fowl typhoid in poultry. Here, we report the complete genomes of two strains belonging to this serotype. SA68 is a field strain isolated from the livers of dead hen carcasses of a commercial layer farm presenting high mortality located in São Paulo city, Brazil, in 1990. Strain 9R corresponds to a live attenuated SG commercial vaccine. DNA was extracted from pure cultures and subjected to whole genome sequencing (WGS) using the Ion Torrent PGM System. The assemblies reached lengths of 4,657,435 (SA68) and 4,657,471 (9R) base pairs. Complete genomes were deposited in GenBank under the accession numbers CP110192 (SA68) and CP110508 (9R). Both genomes were analyzed and compared in terms of molecular typing, antibiotic resistance genes, virulence genes, Salmonella pathogenic islands (SPIs), insertion sequences and prophages. The data obtained show many similarities in the genetic content, with the exception of the SPI-12 and CS54 pathogenic islands, which are exclusive to the field strain. The information generated will help to understand the virulence differences of field and vaccinal SG strains and can be used to perform evolutionary and epidemiologic studies.

Marcadores hematológicos y bioquímicos para el diagnóstico precoz de bacteriemiascausadas por Enterobacteriaceae resistentes a los carbapenémicos / Haematological and biochemical markers for the early diagnosis of bacteremias caused bycarbapenem-resistant Enterobacteriaceae

INTRODUCCIÓN. Las bacteriemias causadas por Enterobacteriaceae resistentes a carbapenémicos se asocian con altas tasas de mortalidad a diferencia de las bacteriemias causadas por Enterobacteriaceae sensibles a carbapenémicos. Los hallazgos clínicos y de laboratorio son importantes para determinar los esquemas terapéuticos y su pronóstico; su diagnóstico precoz resulta esencial para un manejo adecuado. OBJETIVO. Relacionar valores de marcadores sanguíneos y bioquímicos en bacteriemias causadas por Enterobacteriaceae resistentes a carbapenémicos. MATERIALES Y MÉTODOS. Estudio analítico transversal. Población de 427 y muestra de 224 datos de hemocultivos positivos para Enterobacteriaceae de pacientes atendidos en el Hospital de Especialidades Carlos Andrade Marín en el periodo mayo 2016 a julio 2018. Criterios de inclusión: i) al menos un hemocultivo positivo; ii) recuperación del aislado de CRE o CSE y iii) recolección simultanea de muestras de sangre y pruebas de laboratorio. Criterios de exclusión: i) bacteriemias polimicrobianas; ii) valores fuera de rango y iii) reportes sin valores numéricos. El análisis de datos se realizó mediante el programa estadístico International Business Machines Statistical Package for the Social Sciences versión 24.0. RESULTADOS. Se demostró que el recuento de leucocitos [OR 1,21 (95% IC: 1,03-1,43)], el recuento de plaquetas [OR 1,65 (95% IC: 1,37-1,98)] y el tiempo parcial de tromboplastina [OR 1,29 (95% IC: 1,04-1,60)] fueron buenas variables predictoras independientes, mediante análisis de regresión logística multivariante. CONCLUSIÓN. La trombocitopenia y el tiempo parcial de tromboplastina prolongado se asociaron con bacteremia causada por Enterobacteriaceae resistentes a carbapenémicos.

INTRODUCTION. Bacteremias caused by carbapenem-resistant Enterobacteriaceae are associated with high mortality rates in contrast to bacteremias caused by carbapenem-sensitive Enterobacteriaceae. Clinical and laboratory findings are important in determining therapeutic regimens and prognosis; early diagnosis is essential for appropriate management. OBJECTIVE. To relate blood and biochemical marker values in bacteremia caused by carbapenem-resistant Enterobacteriaceae. MATERIALS AND METHODS. Cross-sectional analytical study. Population of 427 and sample of 224 blood culture data positive for Enterobacteriaceae from patients attended at the Carlos Andrade Marín Specialties Hospital in the period May 2016 to July 2018. Inclusion criteria: i) at least one positive blood culture; ii) recovery of CRE or CSE isolate and iii) simultaneous collection of blood samples and laboratory tests. Exclusion criteria: i) polymicrobial bacteremia; ii) out-of-range values and iii) reports without numerical values. Data analysis was performed using the statistical program International Business Machines Statistical Package for the Social Sciences version 24.0. RESULTS. Leukocyte count [OR 1.21 (95% CI: 1.03-1.43)], platelet count [OR 1.65 (95% CI: 1.37- 1.98)] and partial thromboplastin time [OR 1.29 (95% CI: 1.04-1.60)] were shown to be good independent predictor variables, by multivariate logistic regression analysis. CONCLUSION. Thrombocytopenia and prolonged partial thromboplastin time were associated with bacteremia caused by carbapenem-resistant Enterobacteriaceae.

Aerobic and anaerobic metabolic scaling in the burrowing freshwater crayfish Parastacus pugnax.

Metabolic scaling is a well-known biological pattern. Theoretical scaling exponents near 0.67 and 0.75 are the most widely accepted for aerobic metabolism, but little is known about the scaling of anaerobic metabolism. Furthermore, metabolic scaling has been mainly evaluated in organisms primarily relying on aerobic pathways. Here we evaluate both aerobic and anaerobic metabolic scaling in Parastacus pugnax, a burrowing freshwater crayfish endemic to Chile, which inhabits waters with low pO2 (~ 1 mg O2 L-1, measured in this study). We determined the metabolic rate, total oxidative capacity (Electron Transport System: ETS), critical oxygen tension (Pcrit) and muscular Lactate dehydrogenase (LHD) and Malate dehydrogenase (MDH) enzymatic activities (proxies of anaerobic metabolism) over a wide range of P. pugnax sizes (0.24-42.93 g wet mass). Aerobic metabolism scaled with crayfish size with an exponent of 0.78, remarkably similar to the 0.73 which scaled the ETS, the enzymatic complex behind respiration. Critical partial pressure of oxygen (Pcrit) was calculated as 15.6 ± 2.9 mmHg, showing that aerobic metabolism was efficiently maintained until ~ 10% air saturation. Below this threshold, P. pugnax switched to anaerobic metabolism, evidenced by a reduction in aerobic metabolism and ETS activity under chronic low oxygen conditions. None of the activities of MDH, LDH, their ratio (MDH/LDH), nor Pcrit scaled with crayfish size, indicating that these animals are equally adapted to hypoxic environments throughout their whole ontogeny. Given the particularities of its habitat, the information presented here is valuable for a proper management and successful conservation.

Carbapenemasas y sensibilidad a los antibióticos no ß-lactámicos en Klebsiella pneumoniae resistente a los carbapenémicos en un hospital de tercer nivel de complejidad. Quito ­ Ecuador / Carbapenemases and sensitivity to non-ß-lactam antibiotics in Klebsiella pneumoniae resistant to carbapenems in a third level hospital. Quito - Ecuador

INTRODUCCIÓN. La resistencia de Klebsiella pneumoniae a carbapenémicos ha aumentado con los años, reduciendo opciones terapéuticas. Puede deberse a dos mecanismos principales, como: la producción de carbapenemasas y alteración de la permeabilidad de la membrana. OBJETIVO. Analizar la frecuencia de Klebsiella pneumoniae resistente a carbapenémicos, junto al mecanismo de resistencia informado por el Laboratorio Nacional de Referencia y la sensibilidad a antibióticos usados para uso terapéutico. MATERIA-LES Y MÉTODOS. Estudio retrospectivo, de población y muestra conocida. Se determinó la sensibilidad/resistencia de Klebsiella pneumoniae: todos los datos aislados de Klebsiella pneumoniae. Se reportaron 11 809 bacilos gram negativos pertenecientes a la familia Enterobacteriaceae. Se utilizó el sistema Whonet 5.6 2017 y BacLink2, así como la revisión de los resultados enviados al Centro Nacional de Referencia para la Resistencia a los Antimicrobianos del Instituto Nacional de Investigación de Salud Pública Izquieta Pérez para investigación de carbapenemasas en el Hospital de Especialidades Carlos Andrade Marín,en el período abril 2016 a mayo 2018. RESULTADOS. El 20,5% (2 421; 11 809) correspondieron a Klebsiella pneumoniae y de estos, 32,9% (797; 2 421) mostraron resistencia a Meropenem. Existió mayor frecuencia en muestra de orina, secreción, sangre y aspirado traqueal. Predominó en varones de más de 61 años. Se clasificó en 15 grupos fenotípicos según los perfiles de resistencia a los antibióticos utilizados como alternativa terapéutica. CONCLUSIÓN. La presencia de Klebsiella pneumoniae produjo una carbapenemasa resistente a los medi-camentos utilizados como tratamiento, llevó a pensar en el uso de otros medicamentos como: fosfomicina o ceftazidima/viabactam; sin embargo, se desarrolló medidas de control y prevención de infecciones, así como programas para el uso de antibióticos.

INTRODUCTION. The resistance of Klebsiella pneumoniae to carbapenems has increased over the years, reducing therapeutic options. It can be due to two main mechanisms, such as: the production of carbapene-mases and alteration of membrane permeability. OBJECTIVE. Analyse the frequency of carbapenem-resistant Klebsiella pneumoniae, along with the resistance mechanism reported by the National Reference Laboratory and sensitivity to antibiotics used for therapeutic use. MATERIALS AND METHODS. Retrospective study, po-pulation and known sample. The sensitivity / resistance of Klebsiella pneumoniae was determined: all isolated were Klebsiella pneumoniae. 11 809 gram negative bacillus belonging to the Enterobacteriaceae family were reported. The Whonet 5.6 2017 and BacLink2 system was used, as well as the review of the results sent to the National Reference Center for the Antimicrobial Resistance of the National Institute of Public Health Research Izquieta Pérez for carbapenemases research at the Carlos Andrade Marín Speciality Hospital, in the period april 2016 to may 2018. RESULTS. 20,5% (2 421; 11 809) were Klebsiella pneumoniae and of these, 32,9% (797; 2 421) showed resistance to Meropenem. There was a higher frequency in urine sample, secretion, blood and tracheal aspiration. Predominance in males over 61 years old. It was classified into 15 phenotypic groups according to antibiotic resistance profiles used as a therapeutic alternative. CONCLUSION. The pre-sence of Klebsiella pneumoniae produced a carbapenemase drug-resistance used as treatment, leading to thought on the use of other medicines such as phosphomycin or ceftazidima/avibactam; however, infection control and prevention measures were developed, as well as programs for the use of antibiotics.

A seminested RT-PCR for molecular genotyping of the Brazilian BR-I Infectious Bronchitis Virus Strain (GI-11).

Infectious bronchitis (IB) is one of the avian diseases with the greatest impact on poultry farming worldwide. In Brazil, strain BR-I (GI-11) is the most prevalent in poultry flocks. The present study aimed to develop a seminested RT-PCR assay specific for the diagnosis of BR-I IBV in Brazilian samples, targeting subunit 1 of the S gene. The detection limit of this assay was 10 copies of the IBV genome. In this study, 62.24% of 572 organ pools from the 5 regions of Brazil tested positive in a 3'UTR screening, and 84.83% were typed as BR-I IBV. BR-I was detected in the respiratory, digestive and urogenital tracts in pooled samples from all Brazilian geographical regions and in all the breeding systems analyzed. Specificity and sensitivity tests as well as phylogenetic analysis successfully confirmed the expected clustering of the sequences detected by this assay with the BR-I (GI-11) group. The nested PCR described in this study represents a suitable and valuable tool in the diagnosis, epidemiology, monitoring and vaccination decisions of IBV.

Efecto Antibacteriano de enjuagues bucales pediátricos comercializados en el Ecuador sobre cepas de Streptococcus Mutans: Estudio in vitro / Efeito antibacteriano de colutórios pediátricos comercializados no Equador sobre ce-pas de Streptococcus Mutans: Estudo in vitro / Antibacterial effect of pediatric mouthwashes marketed in Ecuador on Streptococcus Mutans strains: In vitro study

La caries dental es considerada un problema de salud pública, siendo los niños la población más vulnerable por presentar hábitos alimentarios e higiene bucal inadecuados. Objetivo: Determinar y comparar el efecto antibacteriano de enjuagues bucales pediátricos a base de Cloruro de Cetilpiridinio (0,075%) y Xilitol (10%), sobre cepas de Streptococcus Mutans. Materiales y Métodos: Estudio experimental in vitro, conformado por 20 cepas de S. mutans obtenidas del repositorio del Instituto Nacional de Investigación en Salud Pública (INSPI) que fueron sembradas en medio agar tripticasa soya. Las 60 Placas Petri (N=60) fueron divididas en tres grupos experimentales (N=20 cada uno) de 10µL, 15µL y 20µL para cada enjuague, en cada placa se colocaron 5 discos de papel impregnados con la solucion de los grupos siendo: G1=Colgate Plax (Cloruro de Cetilpiridinio 0,075%), G2=Denture kids (Xilitol 10%), G3=Blendy (Xilitol 10%) C+= Control Positivo (Clor-hexidina 0,12%) C-= Control Negativo (Agua Destilada). Las placas fueron llevadas a incubación a temperatura de 37°C con baja presión de oxígeno. Luego de 48 horas se observaron para medir los halos de inhibición. Fue realizado el análisis estadístico de Kruskal Wallis y U Mann Whitney con nivel de significancia del 5%. Resultados: Las cantidades de 10, 15 y 20µL de Cloruro de Cetilpiridinio mostraron aumento significativo del halo > 14mm (p= 0,001) altamente sensible. Los enjuagues con Xilitol mostraron menor halo de inhibición ≥ 8mm (p=0,1) sensibilidad intermedia. La cantidad de 20µL de cloruro de cetilpiridinio no mostró diferencias significativas al compararlo con 15µL de Clorhexidina (p=1,0) Conclusio-nes: Los enjuagues bucales a base de Xilitol mostraron sensibilidad intermedia, siendo su efecto menor al compararlo con el Cloruro de Cetilpiridinio que se mostró altamente sensible.

Dental caries is considered a public health problem, children being the most vulnerable population due to inadequate eating habits and oral hygiene. Objective: To determine and compare the antibacterial effect of pediatric mouthwashes based on Cetilpiridinium Chloride (0.075%) and Xylitol (10%), on strains of StreptococcusMutans. MaterialsandMethods: In vi-tro experimental study, consisting of 20 strains of S. mutans obtained from the repository of the National Institute of Public Health Research (INSPI), which were planted in agar trypticase soy agar. The 60 Petri dishes (N = 60) were divided into three experimental groups (N = 20 each) of 10µL, 15µL and 20µL for each mouthwash, in each petri dishes were placed 5 paper discs impregnated with the solution of the groups being: G1= Colgate Plax (Cetylpyridinium Chloride 0.075%), G2= Denture kids (Xylitol 10%), G3= Blendy (Xylitol 10%) C+= Positive Control (Chlorhexidine 0.12%) C-= Negative Control (Distilled Water). Petri dishes were incubated at 37° C with low oxygen pressure. After 48 hours they were observed to measure the inhibition zones. The statistical analysis of Kruskal Wallis and U Mann Whitney with a level of significance of 5% was carried out. Results: The amounts of 10, 15 and 20µL of Cetilpiridinium Chloride showed a significant increase of halo > 14mm (p = 0.001) highly sensitive. The rinses with Xylitol showed a lower inhibition halo ≥ 8mm (p = 0.1) inter-mediate sensitivity. The amount of 20µL of cetylpyridinium chloride did not show significant differences when compared to 15µL of Chlorhexidine (p = 1.0). Conclusions: Mouthwashes based on Xylitol showed intermediate sensitivity, its effect being lower when compared to the Cetylpyridinium chloride that was highly sensitive.

Cárie dentária é considerada um problema de saúde pública, sendo as crianças a população mais vulneráveis por apresentar hábitos alimentários e higiene oral inadequados. Objectivo: Determinar e comparar o efeito antibacteriano de colutórios pediátricos de cloreto de cetilpiridínio (0,075%) e xilitol (10%), sob cepas de Streptococcus mutans. Materiais e Métodos: Estudo experimental in vitro, constituído por 20 cepas de S. mutans obtidas no repositório do Instituto Nacional de Pesquisa em Saúde Pública (INSPI), que foram semeadas em ágar tripticase de soja. 60 placas de Petri (N = 60) foram divididos em três grupos experimentais (n = 20 cada) 10 µL, 15µL e 20µL para cada colutório, em cada placa de petri 5 discos de papel impregnados com cada solução foram impregnados sendo os grupos: G1 = Colgate Plax (cloreto de cetilpiridínio 0,075%), G2 = Denture Kids (Xilitol 10%), G3 = Blendy (Xilitol 10%), C+= Controle positivo (0,12% de clorohexidina)e C-= Controle Negativo (Água Destilada). As placas de petri foram incubadas a 37° C com baixa pressão de oxigênio. Após 48 horas eles foram observados para medir as zonas de inibição. Foi realizada a análise estatística de Kruskal Wallis e Mann Whitney com um nível de significância de 5%. Resultados: As quantidades de 10, 15 e 20µL de cloreto de cetilpiridínio mostraram um incremento do halo de inibição > 14 mm (p = 0,001) sendo altamente sensível. Os colutórios com xilitol mostrou um menor halo de inibição ≥ 8 mm (p = 0,1) sensibilidade intermediária. A quantidade de 20µL de cloreto de cetilpiridínio não mostrou nenhuma diferença significativa quando comparado com 15µL de clorexidina (p = 1,0). Conclusão: Colutórios com xilitol mostraram sensibilidade intermediária, sendo menor o efeito quando comparado com Cloreto de cetilpiridínio que mostrou-se altamente sensível.

Inactivación del carbapenémico, un método alternativo para detectar carbapenemasa tipo KPC en Enterobacteriaceae / Carbapenem inactivation, an alternative method to detect carbapenemase type KPC in Enterobacteriacea

Objetivo: Evaluar al método de inactivación del carbapenémico (MIC*) frente a técnicas como el Test de Hodge modificado (THM), ácido 3-aminofenilborónico (APB) y la reacción en cadena de la polimerasa en enterobacterias productoras de carbapenemasas (EPC) tipo KPC. Materiales y métodos: Se seleccionaron 88 aislados clínicos de K. pneumoniae, K. oxytoca, E.coli, S. marcescens, C. freundii sensibles y 91 resistentes a los carbapenémicos. El APB y el método MIC* se realizaron siguiendo las publicaciones originales. El THM se realizó de acuerdo al CLSI 100S Edición 26-2016. El gen blaKPC se identificó por multiplex PCR. Resultados: El MIC* en EPC tipo KPC presentó una sensibilidad/especificidad cercana al 100% y kappa de 1 comparado con la PCR; se observó la ausencia de halo en todas los aislados EPC tipo KPC a diferencia de los aislados sensibles a los cabapenémicos que presentaron halo > 19mm. Se observó el 3 % de resultados falsos positivos y el 5 % de falsos negativos en THM y ABP respectivamente. Discusión y conclusiones: El MIC* y la PCR demuestran superioridad al THM y ABP para identificar carbapenemasas tipo KPC en EPC. Se recomienda su uso de forma rutinaria dentro del algoritmo para la contención de infecciones por este tipo de patógenos.

Objective: To compare the carbapenem inactivation method (CIM *) with the Modified Hodge Test (MHT), the acid 3-aminophenylboronic test(APB) and the polymerase chain reaction (PCR) detection of the blaKPC gene for the identification of KPC carbapenemase producing Enterobacteriaceae (ECP). Materials and Methods: We selected 88 susceptible and 91 carbapenems resistant clinical isolates of Klebsiella pneumoniae, Klebsiella oxytoca, Escherichia coli, Serratia marcescens and Citrobacter freundii. We performed APB and CIM* according to previously published methods and the MHT according to CLSI 100S Edition 26-2016. The blaKPC gene was identified by PCR multiplex. Results: The CIM* had a sensitivity and specificity close to 100% and a kappa score of 1 compared with gold standard PCR. The absence of zone diameter was observed in all isolated KPC producers, unlike in isolates susceptible to carbapenems, where a zone diameter >19mm was observed. Three percent of false positive and five percent of false negative was observed in THM and ABP respectively. Discussion and conclusions: The CIM* and the PCR were better than MHT and ABP at identifying carbapenemases in ECP. We recommend the routine use of the CIM* within the algorithm for ECP infection control.

Genetic characterisation and analysis of infectious bronchitis virus isolated from Brazilian flocks between 2010 and 2015.

1. Infectious bronchitis virus (IBV) variants in Brazil were isolated during 2010-2015 for epidemiological and molecular analysis to characterise the different variants and perform a bioinformatic analysis to compare with sequences of variants collected over the previous 40 years. 2. Of the 453 samples examined, 61.4% were positive for IBV and 75.9% of these were considered to have the BR-I genotype and were detected in birds of all ages distributed in all five Brazilian regions. 3. The ratio of non-synonymous substitutions per non-synonymous site (dN) to synonymous substitutions per synonymous site (dS), i.e. dN/dS, revealed a predominance of codons with non-synonymous substitutions in the first third of the S1 gene and a dN/dS ratio of 0.67. Additionally, prediction of N-glycosylation sites showed that most of the BR-I variants (from 2003 to early 2014) had an extra site at amino acid position 20, whereas the newest variants lacked this extra site. 4. These results suggest that Brazilian IBV variants probably underwent drastic mutations at various points between 1983 and 2003 and that the selection processes became silent after achieving a sufficiently effective antigenic structure for invasion and replication in their hosts. Brazilian IBV genotype BR-I is currently the predominant genotype circulating in Brazil and South America.

Fenomenografía de las competencias informacionales: perfiles y transiciones / Phenomenography of information skills: Profiles and transitions

Este artículo reporta los resultados de una investigación realizada con el objetivo de describir los eventos identificados por los estudiantes universitarios como significativos para el desarrollo de competencias informacionales, a partir de su experiencia durante los tres primeros años de formación. El estudio fenomenográfico tomó como unidad básica de análisis las experiencias de los jóvenes como usuarios de fuentes de información en contextos académicos, desde un punto de vista estructural y referencial. Esta aproximación metodológica permitió describir las categorías y jerarquización de las dimensiones que configuran los perfiles informacionales. El estudio evidenció la existencia de aspectos compartidos por los perfiles, así como la urgencia de categorías en las fronteras entre estos, las cuales corresponden a zonas de transición. La caracterización permitió también identificar la naturaleza de los factores atribuidos por los estudiantes como asociados al desarrollo de la competencia informacional y sus variaciones en función del perfil de las competencias. Se identificaron las estructuras interna y externa que configuran la experiencia de relación con la información.

This article reports the findings of a research project conducted to describe events identified by university students as being meaningful for the development of information literacy skills, based on their experience during the three first years of their course. Drawing on a phenomenological approach, this study analyses the experiences of the students as users of information sources in academic contexts, from structural and referential standpoints. This methodological approach allowed describing the categories and hierarchies of the dimensions which configure information literacy profiles. The findings show that information literacy profiles share features, and it is demonstrated that these features also characterise transitions within profiles. This characterisation also indicated the nature of features attributed by students as being associated with shaping their temporary information literacy skills according to information profile transitions. Internal and external structures that support the interphase between personal experience and information literacy were identified.

Profiling Information Literacy in Higher Education: Traces of a Local Longitudinal Study / Perfiles de la competencia informacional en estudiantes universitarios: huellas desde un estudio longitudinal

This article reports on a longitudinal study that seeks to understand university studentsinformation-literacy profiles in Colombian universities. The study draws on an understanding of information literacy based on a semiotic and sociocultural framework. Data was gathered at two moments between 2009 and 2012 using an information-literacy-profile questionnaire (ILPQ), and out loud protocols while doing an academic task and in-depth interviews. Findings demonstrate that university students tend to remain in the same information literacy profile during their university studies. Results also show a tendency to move between profiles qualifying processes of access, evaluation and use of information for academic tasks. These findings bring in a number of recommendations for higher education discussed at the end of the article.

El estudio longitudinal que se reporta busca comprender los perfiles de la competencia informacional de estudiantes universitarios. El estudio se fundamenta en una comprensión semiótica y sociocultural de la competencia informacional. Los datos se recogieron durante 2009 y 2012 mediante un cuestionario de perfil (ILPQ), protocolos en voz alta al realizar una tarea académica y mediante entrevistas en profundidad. Los hallazgos demuestran que los estudiantes universitarios tienden a permanecer en el perfil informacional durante su carrera universitaria y también tienden a movilizarse entre perfiles, especializando su manera de acceder, evaluar y utilizar la información para sus tareas académicas. Estos hallazgos aportan una serie de recomendaciones para la educación superior, que se discuten al final del artículo.

Persistence and spreading of field and vaccine strains of infectious laryngotracheitis virus (ILTV) in vaccinated and unvaccinated geographic regions, in Brazil.

Infectious laryngotracheitis (ILT) is a highly infectious respiratory disease that causes morbidity and mortality in commercial chickens. Despite the use of attenuated vaccines, ILT outbreaks have been described in broiler and long-lived birds. Molecular approaches, including polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and DNA sequencing, are used to characterize ILT viruses (ILTVs) detected in vaccinated and unvaccinated geographical regions. As part of an ILT control program implemented in a region of commercial layer production, samples of conjunctiva, trachea, and trigeminal ganglia were collected from chickens in a vaccinated and quarantined region over a period of 8 years after initiation of vaccination. To determine the origin of new ILT outbreaks in unvaccinated regions, samples collected from ill chickens were also analyzed. Chicken embryo origin (CEO) vaccine viruses and the Bastos field strain were detected circulating in healthy chickens in the vaccinated region. CEO strains and field viruses molecularly related to the Bastos strain were also detected outside of the quarantined region in chickens showing clinical signs of ILT. This study reveals the persistence and circulation of a wild field strain, despite the intensive use of tissue culture origin (TCO) and CEO vaccines in a quarantined region. Spreading of CEO viruses to unvaccinated regions and the capacity of this virus to establish latent infections and cause severe outbreaks were also observed.

Detection of enteric pathogens in Turkey flocks affected with severe enteritis, in Brazil.

Twenty-two flocks of turkeys affected by enteric problems, with ages between 10 and 104 days and located in the Southern region of Brazil, were surveyed for turkey by PCR for turkey astrovirus type 2 (TAstV-2), turkey coronavirus (TCoV), hemorrhagic enteritis virus (HEV), rotavirus, reovirus, Salmonella spp., and Lawsonia intracellularis (Li) infections. Eleven profiles of pathogen combination were observed. The most frequently encountered pathogen combinations were TCoV-Li, followed by TCoV-TAstV-2-Li, TCoV-TastV-2. Only TCoV was detected as the sole pathogen in three flocks. Eight and 19 flocks of the 22 were positive for TAstV-2 and TCoV, respectively. Six were positive for Salmonella spp. and L. intracellularis was detected in 12 turkey flocks. Reovirus and HEV were not detected in this survey. These results throw new light on the multiple etiology of enteritis in turkeys. The implications of these findings and their correlation with the clinical signs are comprehensively discussed, illustrating the complexity of the enteric diseases.

Emergence of enteric viruses in production chickens is a concern for avian health.

Several viruses have been identified in recent years in the intestinal contents of chickens and turkeys with enteric problems, which have been observed in commercial farms worldwide, including Brazil. Molecular detection of these viruses in Brazil can transform to a big threat for poultry production due to risk for intestinal integrity. This disease is characterized by severely delayed growth, low uniformity, lethargy, watery diarrhea, delayed feed consumption, and a decreased conversion rate. Chicken astrovirus (CAstV), rotavirus, reovirus, chicken parvovirus (ChPV), fowl adenovirus of subgroup I (FAdV-1), and avian nephritis virus (ANV) were investigated using the conventional polymerase chain reaction (PCR) and the reverse transcription polymerase chain reaction (RT-PCR). In addition, the infectious bronchitis virus (IBV), which may play a role in enteric disease, was included. The viruses most frequently detected, either alone or in concomitance with other viruses, were IBV, ANV, rotavirus, and CAstV followed by parvovirus, reovirus, and adenovirus. This study demonstrates the diversity of viruses in Brazilian chicken flocks presenting enteric problems characterized by diarrhea, growth retard, loss weight, and mortality, which reflects the multicausal etiology of this disease.

Carcinoma endometroide con áreas semejantes a tumor estromal de cordones sexuales / Endometrioid carcinoma with similar areas of sex cord stromal tumor

Conocido antiguamente como el "asesino silencioso", el cáncer de ovario muestra un espectro de síntomas inespecíficos que, una vez reconocidos, facilitan un diagnóstico temprano y prolongan la supervivencia de la paciente. Se presenta el caso de una paciente de 57 años referida de consulta privada por sangrado post menopaúsico con US transvaginal que revela datos de malignidad ovárica, laboratorios de rutina y marcadores tumorales normales...

Enfermedad de Mondor de la mama / Mondor's disease of the breast

La enfermedad de Mondor es una lesión benigna caracterizada por una tromboflebitis superficial de la región mamaria. La etiología de esta enfermedad no es clara. Existen factores de riesgo, los cuales incluyen cirugía de mama, biopsia de mama, cáncer de mama, procesos inflamatorios y trauma. Los pacientes son tratados de manera conservadora para el control del dolor con analgésicos y antiinflamatorios.