Prevalence, drug resistance, and genotypic diversity of the RDRio subfamily of Mycobacterium tuberculosis in Ecuador: a retrospective analysis for years 2012-2016.

Introduction: A major sublineage within the Mycobacterium tuberculosis (MTB) LAM family characterized by a new in-frame fusion gene Rv3346c/55c was discovered in Rio de Janeiro (Brazil) in 2007, called RDRio, associated to drug resistance. The few studies about prevalence of MTB RDRio strains in Latin America reported values ranging from 3% in Chile to 69.8% in Venezuela, although no information is available for countries like Ecuador. Methods: A total of 814 MTB isolates from years 2012 to 2016 were screened by multiplex PCR for RDRio identification, followed by 24-loci MIRU-VNTR and spoligotyping. Results: A total number of 17 MTB RDRio strains were identified, representing an overall prevalence of 2.09% among MTB strains in Ecuador. While 10.9% of the MTB isolates included in the study were multidrug resistance (MDR), 29.4% (5/17) of the RDRio strains were MDR. Discussion: This is the first report of the prevalence of MTB RDRio in Ecuador, where a strong association with MDR was found, but also a very low prevalence compared to other countries in Latin America. It is important to improve molecular epidemiology tools as a part of MTB surveillance programs in Latin America to track the transmission of potentially dangerous MTB stains associated to MDR TB like MTB RDRio.

Rapid and accurate identification and differentiation of Mycobacterium tuberculosis and non-tuberculous mycobacteria using PCR kits available in a high-burden setting.

Infections caused by mycobacteria, including Mycobacterium tuberculosis complex (MTBC) and non-tuberculous mycobacteria (NTM), are a major public health issue worldwide. An accurate diagnosis of mycobacterial species is a challenge for surveillance and treatment, particularly in high-burden settings usually associated with low- and middle-income countries. In this study, we analyzed the clinical performance of two commercial PCR kits designed for the identification and differentiation of MTBC and NTM, available in a high-burden setting such as Ecuador. A total of 109 mycobacteria isolates were included in the study, 59 of which were previously characterized as M. tuberculosis and the other 59 as NTM. Both kits displayed great clinical performance for the identification of M. tuberculosis, with 100% sensitivity. On the other hand, for NTM, one of the kits displayed a good clinical performance with a sensitivity of 94.9% (CI 95%: 89-100%), while the second kit had a reduced sensitivity of 77.1% (CI 95%: 65-89%). In conclusion, one of the kits is a fast and reliable tool for the identification and discrimination of MTBC and NTM from clinical isolates.

A first insight into tuberculosis transmission at the border of Ecuador and Colombia: a retrospective study of the population structure of Mycobacterium tuberculosis in Esmeraldas province.

Objective: Tuberculosis (TB) is a major public health concern in Ecuador and Colombia, considering that both countries are high-burden TB settings. Molecular epidemiology is crucial to understand the transmission dynamics of Mycobacterium tuberculosis complex (MTBC) and to identify active transmission clusters of regional importance. Methods: We studied the potential transmission of TB between Colombia and Ecuador through the analysis of the population structure of MTBC lineages circulating in the Ecuadorian province of Esmeraldas at the border with Colombia. A total of 105 MTBC strains were characterized by 24-loci MIRU-VNTR and spoligotyping. Results: MTBC lineage 4 is only present in Esmeraldas; no MTBC strains belonging to Lineage 2-sublineage Beijing were found despite its presence in other provinces of Ecuador and, in Colombia. Genotyping results revealed a high degree of diversity for MTBC in Esmeraldas: Neither active transmission clusters within this province nor including MTBC strains from Colombia or other provinces of Ecuador were found. Conclusion: Our data suggest that tuberculosis dynamics in this rural and isolated area may be not related to highly transmitted strains but could be influenced by other health determinants that favor TB relapse such as poverty and poor health system access. Further studies including a larger number of MTBC strains from Esmeraldas are necessary to test this hypothesis.

Population structure of Mycobacterium tuberculosis in El Oro: A first insight into Ecuador-Peru tuberculosis transmission.

BACKGROUND: Tuberculosis (TB) is a major public health concern in Ecuador and Peru, both settings of high burden of drug resistance TB. Molecular epidemiology tools are important to understand the transmission dynamics of Mycobacterium tuberculosis Complex (MTBC) and to track active transmission clusters of regional importance. This study is the first to address the transmission of TB between Peru and Ecuador through the population structure of MTBC lineages circulating in the Ecuadorian border province of "El Oro". METHODS: A total number of 56 MTBC strains from this province for years 2012-2015 were included in the study and analyzed by 24-loci MIRU-VNTR and spoligotyping. RESULTS: Genotyping revealed a high degree of diversity for MTBC in "El Oro", without active transmission clusters. MTBC L4 was predominant, with less than 2% of strains belonging to MTBC L2-Beijing. CONCLUSIONS: These results may suggest that TB dynamics in this rural and semi-urban area would not be linked to highly transmitted strains like MTBC L2-Beijing from Peru, but related to TB relapse; although further studies with larger MTBC cultures collection from recent years are needed. Nevertheless, we recommend to reinforce TB surveillance programs in remote rural settings and border regions in Ecuador.

Brucellosis in the Brazilian Pantanal wetland: threat to animal production and wildlife conservation.

This review was performed to gather knowledge about brucellosis in livestock and wildlife in the Brazilian Pantanal, a biome with a huge biodiversity and extensive livestock production. Following the preferred reporting items for narrative review guidelines and using the terms "Brucella" and "Pantanal," we explored the PubMed, SciELO, Jstor, Science Direct, and Scholar Google databases. Information on host species, diagnostic test, number of positive animals, and positivity rates were acquired. Articles dating from 1998 to 2022 registered 14 studies including cattle, dogs, and the following wildlife species: Ozotoceros bezoarticus, Sus scrofa, Tayassu peccari, Nasua nasua, Cerdocyon thous, Panthera onca, Dasypus novemcintus, Cabassous unicinctus, Euphractus sexcinctus, Priodontes maximus, Myrmecophaga tridactyla and Hydrochoerus hydrochaeris. Brucella occurrence in cattle was demonstrated through the serological confirmatory test 2-mercaptoetanol. Molecular diagnosis detected Brucella abortus in dogs, smooth Brucella in O. beoarticus, and Brucella spp. in T. peccari. Cattle may have a pivotal importance in maintenance and spreading of Brucella spp. due to their high population density, environmental contamination from abortion of infected cows, and eventual excretion of B. abortus S19 strain from vaccinated heifers. The occurrence of Brucella spp. in O. bezoarticus and T. peccari represent a risk for wildlife conservation. These data indicate that Brucella spp. are enzootic in the Pantanal wetland, sustained by a reservoir system including domestic and wild mammals. Due to marked seasonality and large populations of wildlife species sharing same environments with livestock, brucellosis acquires great complexity in Pantanal and, therefore, must be analyzed considering both animal production and conservation.

Transiciones migratorias de profesionales de enfermería mexicanos en alemania

RESUMEN Objetivo: Examinar las transiciones migratorias de profesionales de enfermería mexicanos que residen en Alemania. Material y Método: Estudio cualitativo de tipo etnográfico focalizado, guiado por la Teoría de Transiciones; se realizó entre los meses de noviembre de 2020 y mayo de 2021; se utilizó un muestreo por bola de nieve, donde los participantes de la red social Facebook, que aceptaron participar, hicieron referencia a otras personas. Se reclutaron a 11 profesionales de enfermería mexicanos; se realizaron entrevistas por Zoom, audiograbadas con previo consentimiento. La información obtenida fue transcrita en su totalidad y examinada mediante el análisis temático con el apoyo del software QUIRKOS. Resultados: El 63,6% fueron mujeres con una edad promedio de 30,8 años y un tiempo promedio de 1,26 años en Alemania. Las transiciones migratorias se clasificaron en 10 categorías: 1) Condiciones económicas y laborales, 2) Idioma, 3) Proceso de homologación de estudios, 4) Costos, 5) Discriminación, 6) Costumbres y tradiciones, 7) Gastronomía, 8) Clima, 9) Recreación y 10) Seguridad. Conclusiones. Conocer las transiciones migratorias de profesionales de enfermería mexicanos en Alemania permite realizar una serie de recomendaciones a la práctica, las políticas públicas y futuros proyectos de investigación e intervención.

ABSTRACT Objective: To examine the migration transitions of Mexican nursing professionals residing in Germany. Materials and Methods: A focused ethnography guided by the Theory of Transitions was conducted between the months of November 2020 and May 2021; snowball sampling was used, where the participants of the social network Facebook, who agreed to participate, referred to other people. Eleven Mexican nurses living in Germany were recruited; interviews were conducted using the Zoom platform and audio-recorded with prior consent. The information obtained was transcribed verbatim and examined through thematic analysis using the QUIRKOS software. Results: 63.6% of the nurses were women, with an average age of 30.8 years; and an average time of 1.26 years living in Germany. Migration transitions were classified into 10 categories: 1) Economic and labor conditions, 2) Language, 3) Study accreditation process, 4) Costs, 5) Discrimination, 6) Customs and traditions, 7) Gastronomy, 8) Climate, 9) Recreation, and 10) Safety. Conclusions: Understanding the migration transitions of Mexican nurses in Germany allows us to make a series of recommendations for practice, public policies, and future research and intervention projects.

RESUMO Objetivo: Examinar as transições migratórias de profissionais de enfermagem mexicanos que residem na Alemanha. Material e Método: Estudo qualitativo de tipo etnográfico focado, guiado pela Teoria das Transições e realizado entre os meses de novembro de 2020 e maio de 2021. Utilizou-se uma amostragem de bola de neve, na qual os participantes da rede social Facebook, que concordaram em participar, contactaram outras pessoas. Onze profissionais mexicanos residentes na Alemanha foram recrutados; foram realizadas entrevistas usando a plataforma Zoom e gravadas em áudio com consentimento prévio. As informações obtidas foram transcritas textualmente e examinadas por meio de análise temática utilizando o software QUIRKOS. Resultados: 63,6% dos profissionais de enfermagem eram mulheres, com idade média de 30,8 anos; e tempo médio de 1,26 anos vivendo na Alemanha. As transições migratórias foram classificadas em 10 categorias: 1) Condições econômicas e trabalhistas, 2) Idioma, 3) Processo de acreditação de estudos, 4) Custos, 5) Discriminação, 6) Costumes e tradições, 7) Gastronomia, 8) Clima, 9) Lazer, e 10) Segurança. Conclusões: Conhecer as transições migratórias dos profissionais de enfermagem mexicanos na Alemanha permite fazer uma série de recomendações para a prática, as políticas públicas e os futuros projetos de pesquisa e intervenção.

Disease presentation and surgical treatment of patients with foreign-body granulomas and ASIA syndrome: case series.

BACKGROUND: The result of illicit polymer injection is chronic inflammation with foreign-body granuloma (FBG) formation. Treatment can be divided into medical and surgical. Some patients develop severe complications with need surgical treatment. This study aims to describe patients who underwent surgical removal of the FBGs and autoimmune/inflammatory syndrome induced by adjuvants (ASIA); additionally, we evaluated the quality of life after surgery. METHODS: In this retrospective single-center study, the authors examined data of patients who underwent surgical removal of FBG caused by illicit polymer injection for cosmetic purposes and confirmed ASIA from 2015 to 2020 by three different surgical approaches. Descriptive summary statistics were reported on patient demographics, presenting symptoms and clinical examination features, treatment strategies, histopathology reports and quality of life. RESULTS: The cohort included 11 female patients with FBGs and ASIA. The most affected anatomical zones were the combination of gluteal region, thighs and legs (40%); and thighs with legs (20%). Main presentation was: skin hyperpigmentation (90.9%), skin induration (63.6%), chronic fatigue (63.6%), and ulcers (36.4%). Surgical modalities consisted of: ultrasonic-assisted liposuction in four patients (36.4%); open en bloc excision and primary closure in four patients (36.4%); and open en bloc excision and microsurgical reconstruction in three patients (27.2%). The postoperative quality of life visual analog scale score was 83.9. CONCLUSIONS: ASIA treatment represents a challenge for the plastic surgeon. Adequate surgical treatment emphasizing, when possible, the total or near-total resection of the FBG must be performed to improve ASIA evolution.

Enfermeros mexicanos en Alemania en tiempos de Covid-19.

Señor editor: La emigración de enfermeros mexicanos hacia el extranjero es un tema que cobra relevancia durante la pandemia por Covid-19, principalmente por la necesidad de contar con profesionales calificados que hagan frente a esta situación de emergencia sanitaria. Pero ¿por qué los enfermeros están emigrando cuando México también tiene escasez de estos profesionales?..

Dance Intervention for Mexican Family Caregivers of Children With Developmental Disability: A Pilot Study.

Introduction: There are 7.1 million people living with a disability in Mexico. Of these individuals, 7% are children and adolescents with developmental disabilities. Mexican women caring for children with a developmental disability are at risk of psychological stress, which may be prevented with physical activity such as dance. Therefore, the purpose of this pilot study was to examine (a) the feasibility of implementing the dance intervention, (b) the mothers' satisfaction with the intervention, and (c) the changes in stress level experienced by the mothers on completion of the intervention. Method: A one-group pretest-posttest design was used. The Salsa dance intervention was given in nine 60-minute sessions, twice a week in Veracruz, Mexico. The sample included 14 mothers of children with disabilities. The outcome, stress level, was measured with the validated Questionnaire of Perceived Stress. Feasibility of intervention implementation was maintained by having the interventionist follow the interventionist manual. Satisfaction was assessed by the Satisfaction with Therapy and Therapist Scale. Results: The intervention was feasible as all participants completed the intervention sessions. They reported high satisfaction (100%) with the intervention and interventionist. At posttest, participants showed reduced stress levels (p = .028). Discussion: The dance intervention is promising in reducing women's stress levels and worth further development in order to benefit the Mexican women caring for children with developmental disability and experiencing stress. Nurses can implement the Salsa dance intervention with the Mexican population while improving the clients' retention, outcomes, and overall satisfaction.

Can We Improve the Outcomes of Multivessel Disease Using Modified SYNTAX and Residual SYNTAX Scores?

PURPOSE OF REVIEW: In spite of the benefits of drug eluting (DES), these advantages were not translated to better outcome when percutaneous coronary interventions (PCI) were compared with coronary artery bypass surgery. PCI strategy allowing stent deployment in all intermediate lesions including small vessels together with DES design may be the reasons of these findings. RECENT FINDINGS: Recently randomized and observational studies demonstrated using functional flow reserve analysis, residual Syntax score risk, or residual ERACI score after PCI that a reasonably incomplete revascularization was associated with good long-term outcome and low events rate at follow-up. In the ERACI IV study, which included patients with multiple vessel disease and left main, all intermediate lesions and severe lesions in small vessels were excluded from the revascularization strategy, and the 3-year follow-up results showed a remarkable low incidence of death/MI and stroke. Intermediate stenosis or severe lesions in small vessels should not be incorporated in the PCI strategy in order to define patient clinical cardiac prognosis or completeness of revascularization.

Aesthetic and functional outcomes of the innervated and thinned anterolateral thigh flap in reconstruction of upper limb defects.

Background. The anterolateral thigh (ALT) flap has been widely described in reconstruction of the upper extremity. However, some details require refinement to improve both functional and aesthetic results. Methods. After reconstruction of upper extremity defects using thinned and innervated ALT flaps, functional and aesthetic outcomes were evaluated with the QuickDASH scale and a Likert scale for aesthetic assessment of free flaps, respectively. Results. Seven patients with a mean follow-up of 11.57 months and average flap thickness of 5 mm underwent innervation by an end-to-end neurorrhaphy. The average percentage of disability (QuickDASH) was 21.88% with tenderness, pain, temperature, and two-point discrimination present in 100% of cases, and the aesthetic result gave an overall result of 15.40 (good) with the best scores in color and texture. Conclusions. Simultaneous thinning and innervation of the ALT flap lead to a good cosmetic result and functional outcome with a low percentage of disability, which could result in minor surgical procedures and better recovery of motor and sensory function. Level of Evidence. IV.

Shaping synaptic plasticity: the role of activity-mediated epigenetic regulation on gene transcription.

Learning and memory are basic functions of the brain that allowed human evolution. It is well accepted that during learning and memory formation the dynamic establishment of new active synaptic connections is crucial. Persistent synaptic activation leads to molecular events that include increased release of neurotransmitters, increased expression of receptors on the postsynaptic neuron, thus creating a positive feedback that results in the activation of distinct signaling pathways that temporally and permanently alter specific patterns of gene expression. However, the epigenetic changes that allow the establishment of long term genetic programs that control learning and memory are not completely understood. Even less is known regarding the signaling events triggered by synaptic activity that regulate these epigenetic marks. Here we review the current understanding of the molecular mechanisms controlling activity-dependent gene transcription leading synaptic plasticity and memory formation. We describe how Ca(2+) entry through N-methyl-d-aspartate-type glutamate neurotransmitter receptors result in the activation of specific signaling pathways leading to changes in gene expression, giving special emphasis to the recent data pointing out different epigenetic mechanisms (histone acetylation, methylation and phosphorylation as well as DNA methylation and hydroxymethylation) underlying learning and memory.

Factores relacionados con el estado nutricional de los pacientes internados en el pabellón de crónicos Instituto Psiquiátrico "San Juan de Dios", 2009 / Factors related to nutritional status of patients hospitalized in the pavilion of Chronic Psychiatric Institute

La investigación realizada es un esfuerzo para identificar qué factores se relacionan con el estado nutricional de los pacientes del pabellón crónicos del Instituto Psiquiátrico “San Juan de Dios” durante el año 2009, éste, contempla aspectos personales, dietéticos, terapéuticos y patológicos que influyen en el estado nutricional de estos pacientes. La importancia de esta investigación radica en la no existencia de anteriores trabajos sobre la mencionada temática, por ende, éste será un aporte para mejorar el manejo de los pacientes psiquiátricos a nivel nutricional. La metodología utilizada para esta investigación corresponde a un enfoque cuantitativo, descriptivo, exploratorio, prospectivo y transversal, tomando en cuenta la totalidad de pacientes del pabellón citado, a los que se aplicó una guía de valoración clínica y observación. Las conclusiones más importantes son: que el 43.8% de los pacientes estudiados atraviesan estados de mal nutrición, los aportes calóricos que reciben en la institución no responden a exigencias de la OMS., no existe una relación directa entre la enfermedad psiquiátrica y el estado nutricional, los factores personales como bucodentales, sensoriales y motores afectan a todos los/as pacientes con algún grado de desnutrición y los factores terapéuticos interfieren en la alimentación y nutrición de los/as pacientes

Nitric oxide binding and photodelivery based on ruthenium(II) complexes of 4-arylazo-3,5-dimethylpyrazole.

Two fluorescent ligands, 3,5-dimethyl-4-(6'-sulfonylammonium-1'-azonaphthyl)pyrazole (dmpzn, 1) and 3,5-dimethyl-4-(4'-N,N'-dimethylaminoazophenyl)pyrazole (dmpza, 2) were obtained by condensation of ketoenolic derivatives with hydrazine. 1 and 2 formed the novel dinuclear complexes [(H(2)O)(3)ClRu(micro-L)(2)RuCl(H(2)O)(3)] (3 or 4) and [(H(2)O)(NO)Cl(2)Ru(micro-L)(2)RuCl(2)(NO)(H(2)O)] (6 or 7) (where L 1 = 2 or , respectively) which were characterized by IR, NMR and elemental analysis. The nitrosyl complexes were prepared by bubbling purified nitric oxide through methanol solutions of the corresponding ruthenium(II) chloroderivative or by reaction of the appropriate ligands with Ru(NO)Cl(3). Complexes 3 and 4 were found to bind NO, resulting in an increase in fluorescence. Ligand 1 also formed the mononuclear nitrosyl complex [Ru(NO)(bpy)(2)(dmpzn)]Cl(2) (8) which released NO in water at physiological pH and in the solid state as revealed by fluorescence and IR measurements, respectively.

Infecciones causadas por streptococcus beta hemolítico grupo B (S agalactiar) en adultos

El Streptococcus beta hemolítico del grupo B, ha sido asociado con infecciones en neonatología y enfermedades relacionadas al parto, sin embargo su reporte como patógeno oportunista y nosocomial en infecciones graves en población adulta no embarazada ha experimentado un aumento en las últimas décadas. Describimos los aislamientos de esta bacteria de los pacientes adultos que fueron atendidos en el Hospital Vozandes. Se presentan 25 pacientes con distintos cuadros infecciosos: 1 con sepsis, 9 con infecciones de piel y tejidos blandos 14 con infección de vías urinarias y 1 de tracto respiratorio. Se encontró asociación con los siguientes factores: edad avanzada, diabetes, alcoholismo, cirrosis y neoplasias.