RESUMO
We characterized five carbapenemase-producing Enterobacterales (CPE) isolates from two health care institutions in Lima, Peru. The isolates were identified as Klebsiella pneumoniae (n = 3), Citrobacter portucalensis (n = 1), and Escherichia coli (n = 1). All were identified as blaOXA-48-like gene carriers using conventional PCR. Whole-genome sequencing found the presence of the blaOXA-181 gene as the only carbapenemase gene in all isolates. Genes associated with resistance to aminoglycosides, quinolones, amphenicols, fosfomycins, macrolides, tetracyclines, sulfonamides, and trimethoprim were also found. The plasmid incompatibility group IncX3 was identified in all genomes in a truncated Tn6361 transposon flanked by ΔIS26 insertion sequences. The qnrS1 gene was also found downstream of blaOXA-181, conferring fluoroquinolone resistance to all isolates. CPE isolates harboring blaOXA-like genes are an increasing public health problem in health care settings worldwide. The IncX3 plasmid is involved in the worldwide dissemination of blaOXA-181, and its presence in these CPE isolates suggests the wide dissemination of blaOXA-181 in Peru. IMPORTANCE Reports of carbapenemase-producing Enterobacterales (CPE) isolates are increasing worldwide. Accurate detection of the ß-lactamase OXA-181 (a variant of OXA-48) is important to initiate therapy and preventive measures in the clinic. OXA-181 has been described in CPE isolates in many countries, often associated with nosocomial outbreaks. However, the circulation of this carbapenemase has yet to be reported in Peru. Here, we report the detection of five multidrug-resistant CPE clinical isolates harboring blaOXA-181 in the IncX3-type plasmid, a potential driver of dissemination in Peru.
Assuntos
Infecções por Enterobacteriaceae , Enterobacteriaceae , Humanos , Enterobacteriaceae/genética , América Latina , Proteínas de Bactérias/genética , beta-Lactamases/genética , Escherichia coli/genética , Klebsiella pneumoniae/genética , Antibacterianos/farmacologia , Testes de Sensibilidade Microbiana , Infecções por Enterobacteriaceae/epidemiologiaRESUMO
This paper assesses the association of the insertion/deletion ACE (angiotensin-converting enzyme) variant (rs1799752 I/D) and the serum ACE activity with the severity of COVID-19 as well as its impact on post-COVID-19, and we compare these associations with those for patients with non-COVID-19 respiratory disorders. We studied 1252 patients with COVID-19, 104 subjects recovered from COVID-19, and 74 patients hospitalized with a respiratory disease different from COVID-19. The rs1799752 ACE variant was assessed using TaqMan® Assays. The serum ACE activity was determined using a colorimetric assay. The DD genotype was related to risk for invasive mechanical ventilation (IMV) requirement as an indicator of COVID-19 severity when compared to the frequencies of II + ID genotypes (p = 0.025, OR = 1.428, 95% CI = 1.046-1.949). In addition, this genotype was significantly higher in COVID-19 and post-COVID-19 groups than in the non-COVID-19 subjects. The serum ACE activity levels were lower in the COVID-19 group (22.30 U/L (13.84-32.23 U/L)), which was followed by the non-COVID-19 (27.94 U/L (20.32-53.36 U/L)) and post-COVID-19 subjects (50.00 U/L (42.16-62.25 U/L)). The DD genotype of the rs1799752 ACE variant was associated with the IMV requirement in patients with COVID-19, and low serum ACE activity levels could be related to patients with severe disease.
Assuntos
COVID-19 , Polimorfismo Genético , Humanos , COVID-19/genética , Genótipo , Peptidil Dipeptidase A/genética , Carboxipeptidases/metabolismoRESUMO
BACKGROUND: Mexico declared an obesity epidemic in 2000, and in response, became an early adopter of public policies in the form of natural experiments, which have not been evaluated for their effect on high BMI. We focus on children younger than 5 years due to the long-term outcomes of childhood obesity. METHODS: We used the Global Burden of Disease data to evaluate time trends in high BMI, defined as being overweight or obese based on the International Obesity Task Force standards, between 1990 and 2019. Marginalisation and poverty estimates from Mexico's Government were used to identify differences in socioeconomic groups. The time variable reflects the introduction of policies between 2006 and 2011. Our hypothesis was that poverty and marginalisation modify the effects of public policies. We tested for the change in prevalence of high BMI over time using Wald-type tests, correcting for the effect of repeated measures. We stratified the sample by gender, marginalisation index, and households under the poverty line. Ethics approval was not required. FINDINGS: Between 1990 and 2019, high BMI in children younger than 5 years increased from 23·5% (95% uncertainty interval 38·6-14·3) to 30·2% (46·0-20·4). After a period of sustained increase to 28·7% (44·8-18·6) in 2005, high BMI decreased to 27·3% (42·4-17·4; p<0·001) in 2011. Afterwards, high BMI increased constantly. We found an average gender gap of 12·2%, with a higher rate in males, in 2006, which remained constant. With respect to marginalisation and poverty, we observed a reduction in high BMI across all strata, except for the uppermost quintile of marginalisation in which high BMI remained flat. INTERPRETATION: The epidemic affected groups across different socioeconomic levels, thus weakening economic explanations for the decrease in high BMI, while gender gaps point to behavioural explanations of consumption. The observed patterns warrant investigation through more granular data and structural models to isolate the effect of the policy from secular trends in the population, including other age groups. FUNDING: Tecnológico de Monterrey Challenge-Based Research Funding Program.
Assuntos
Obesidade Infantil , Criança , Masculino , Humanos , Análise de Séries Temporais Interrompida , Índice de Massa Corporal , México/epidemiologia , Obesidade Infantil/epidemiologia , Obesidade Infantil/prevenção & controle , Política PúblicaRESUMO
México enfrenta retos de salud sin precedentes y es necesario pensar en estrategias que con- tribuyan a su solución con un enfoque hacia el personal de enfermería, que es el recurso humano más numeroso. En este sentido, se desarrolló un programa de capacitación integral, el cual considera un diplomado virtual de 165 horas y componentes semipresenciales para fortalecer el conocimiento en el abordaje integral de diabetes para enfermería en el primer nivel de atención (PNA). Este programa se inscribe dentro de la Estrategia Integral para la Ampliación del Rol de Enfermería (EIARE) en el PNA. La implementación del programa educativo tendrá un pilotaje en el sur del país, donde se consideran el seguimiento y la evaluación para identificar y solventar áreas susceptibles de mejora y buscar su implementación en otros estados. El programa educativo y la EIARE permitirán el desarrollo de una nueva carrera para la enfermería en el PNA y mejoras sustantivas a la salud.
Mexico faces unprecedented health challenges, and it is necessary to think of mindful strategies to solve this, focusing on the nursing workforce, which is the most numerous human resource. In this sense, it was developed a comprehensive training program, which considers a virtual diploma program of 165 hours, and blended-learning components to strengthen knowledge in comprehensive diabetes care to nursing in the primary level of care (PLC). This training program is part of the Estrategia Integral para la Ampliación del Rol de Enfermería (Comprehensive Strategy for Amplifying the Role of NursesEIARE, according to its initialism in Spanish]) in PLC. The implementation of the training program will have a pilot in the southern area of Mexico, where monitoring and evaluation are considered to identify and solve areas susceptible to improvement and seek its implementation in other states of Mexico. This training program and the EIARE will allow the development of a new career for nursing in PLC and substantive improvements to health.
Assuntos
Humanos , Atenção Primária à Saúde , Diabetes Mellitus , Educação Continuada em Enfermagem , Recursos Humanos de Enfermagem , Estratégias de Saúde , MéxicoRESUMO
Otoba is the third largest genus of Myristicaceae in the Neotropics with 12 species, nine of them native to Colombia. Two new species from the department of Antioquia, O. scottmorii sp. nov. and O. squamosa sp. nov., are described and illustrated. Otoba scottmorii occurs in humid, lowland forests, while O. squamosa occurs in premontane forest. Previously, Otoba scottmorii was confused with O. acuminata (which here is considered restricted to Costa Rica and Panama), while O. squamosa was confused with O. gordoniifolia. The similarities and differences between these and other species are discussed.
RESUMO
To describe a general overview of health services delivery in Mexico and geospatially analyze the current distribution and accessibility of Primary Health Care (PHC) facilities to contribute to new approaches to improve healthcare planning in Mexico. We performed a spatial analysis of official data to analyze current distances from health facilities to population, to determine the underserved areas of health services delivery in three selected states using a ranking of indicators. We estimated service area coverage of PHC facilities with road networks of three Mexican states (Chiapas, Guerrero, and Oaxaca). Our estimations provide an overview of spatial access to healthcare of the Mexican population in Mexico's three most impoverished states. We did not consider social security nor private providers. Geospatial access to health facilities is critical to achieving PHC and adequate coverage. Countries like Mexico must measure this to identify underserved areas with a lack of geospatial access to healthcare to solve it. This type of analysis provides critical information to help decision-makers decide where to build new health facilities to increase effective geospatial access to care and to achieve Universal Health Coverage.
Assuntos
Sistemas de Informação Geográfica , Acessibilidade aos Serviços de Saúde , Instalações de Saúde , Humanos , México , Cobertura Universal do Seguro de SaúdeRESUMO
Abstract To describe a general overview of health services delivery in Mexico and geospatially analyze the current distribution and accessibility of Primary Health Care (PHC) facilities to contribute to new approaches to improve healthcare planning in Mexico. We performed a spatial analysis of official data to analyze current distances from health facilities to population, to determine the underserved areas of health services delivery in three selected states using a ranking of indicators. We estimated service area coverage of PHC facilities with road networks of three Mexican states (Chiapas, Guerrero, and Oaxaca). Our estimations provide an overview of spatial access to healthcare of the Mexican population in Mexico's three most impoverished states. We did not consider social security nor private providers. Geospatial access to health facilities is critical to achieving PHC and adequate coverage. Countries like Mexico must measure this to identify underserved areas with a lack of geospatial access to healthcare to solve it. This type of analysis provides critical information to help decision-makers decide where to build new health facilities to increase effective geospatial access to care and to achieve Universal Health Coverage.
Resumo Descrever uma visão geral da prestação de serviços de saúde no México e analisar geoespacialmente a atual distribuição e acessibilidade das unidades de APS para contribuir com novas abordagens para melhorar o planejamento da saúde no México. Realizamos uma análise espacial de dados oficiais para analisar as distâncias atuais das unidades de saúde à população, para determinar as áreas descobertas de prestação de serviços de saúde em 3 estados selecionados usando uma classificação de indicadores. Estimamos a cobertura da área de serviço das unidades de APS com redes viárias de 3 estados do México (Chiapas, Guerrero e Oaxaca). Nossas estimativas fornecem uma visão geral do acesso espacial à saúde da população mexicana nos três estados mais pobres do México. Não consideramos seguridade social nem prestadores privados. O acesso geoespacial às unidades de saúde é fundamental para alcançar a cobertura universal de saúde e uma cobertura eficaz. Países, como o México, devem medir isso para identificar áreas não merecidas com falta de acesso geoespacial à saúde para resolvê-lo. Os governos devem gerar políticas e mecanismos para distribuir efetivamente novas instalações de saúde para aumentar o acesso geoespacial efetivo à saúde, bem como para evitar instalações de saúde não planejadas.
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Humanos , Sistemas de Informação Geográfica , Acessibilidade aos Serviços de Saúde , Cobertura Universal do Seguro de Saúde , Instalações de Saúde , MéxicoRESUMO
Resumen ANTECEDENTES: El lupus eritematoso sistémico es una enfermedad autoinmunitaria y multisistémica. El daño pericárdico es la complicación cardiaca más común y el taponamiento cardiaco es infrecuente, más aún en embarazadas y con lupus eritematoso sistémico. OBJETIVO: Exponer las características clínicas, diagnósticas, tratamiento y evolución del taponamiento cardiaco en una embarazada que inició con lupus eritematoso sistémico y valorar la información de la bibliografía a propósito de otros casos. CASO CLÍNICO: Paciente de 24 años, con 27.5 semanas de embarazo, con anasarca, disnea que evolucionó a ortopnea y dolor torácico punzante de tres semanas de evolución. La radiografía de tórax mostró cardiomegalia grado II, campos pulmonares congestivos y derrame pleural a la altura de los senos cardiofrénicos. En el ecocardiograma se encontró derrame pericárdico de 500 mL, con datos de taponamiento cardiaco. Tuvo deterioro progresivo con afectación de la capacidad pulmonar e insuficiencia renal aguda con aumentos progresivos de creatinina; se encontró hemodinámica inestable, con pulso paradójico e hipotensión. Anticuerpos antinucleares positivos y proteinuria. La biopsia renal reportó patrones histopatológicos correspondientes a nefritis lúpica. Se trató con pulsos esteroideos y ciclofosfamida por vía intravenosa. El derrame pericárdico desapareció por medio de una ventana subxifoidea y la extracción del líquido del pericardio. La evolución posterior fue satisfactoria para la madre y su hijo. CONCLUSIÓN: El taponamiento cardiaco es infrecuente en pacientes con lupus eritematoso sistémico y más raro aún durante el embarazo. Es una urgencia clínica que requiere atención multidisciplinaria porque el embarazo, en una paciente con lupus eritematoso sistémico, implica mayor riesgo de complicaciones sistémicas, como se señala en la bibliografía.
Abstract BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic, multisystemic disease of unknown etiology, whose clinical manifestations are heterogeneous. Pericardial involvement is the most common cardiac complication; however, the development of cardiac tamponade is rare, and even more so in pregnant patients presenting with SLE. OBJECTIVE: To present the clinical characteristics, diagnosis, treatment, and evolution of cardiac tamponade in a pregnant patient that presents with systemic lupus erythematosus. CLINICAL CASE: A 24-year-old patient, who is 27.5 weeks pregnant, presenting with anasarca, dyspnea that evolved to orthopnea and stabbing chest pain for three weeks. Her chest X-ray showed cardiomegaly grade II, congestive lung fields and pleural effusion at the level of cardiophrenic sinuses. The echocardiogram found a 500 mL pericardial effusion with evidence of cardiac tamponade. Progressive deterioration with compromised lung capacity, and the appearance of acute renal failure with progressive increases in creatinine; showing hemodynamic instability characterized by paradoxical pulse and hypotension. With positive Antinuclear Antibodies (ANA) and proteinuria, renal biopsy reports histopathological patterns corresponding to lupus nephritis, treated with steroid pulses and intravenous cyclophosphamide in a risk-benefit assessment, with subsequent satisfactory maternal-fetal evolution. CONCLUSION: Cardiac tamponade is not common in patients with SLE, and it is even rarer as the initial manifestation, even more so during pregnancy. It is a clinical emergency and requires multidisciplinary management since pregnancy in a patient with SLE implies an increased risk of systemic complications.
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BACKGROUND: Crohn's disease (CD) is a multifactorial disease characterized by chronic intestinal inflammation. The increased visceral adiposity near the affected intestinal area, of which mesenteric adipose tissue (MAT) is the main component, is a feature of CD. Both protective and pathological roles have been attributed to this disease-associated tissue in CD. To understand the contribution of MAT to CD pathophysiology, a molecular and cellular signature of disease-associated MAT in CD patients was provided. METHODS: We performed an observational study with whole transcriptional analysis by RNA sequencing (RNA-seq) of MAT and ileal mucosa from CD patients with active disease and controls. qPCR and immunohistology were performed for validation analysis. RESULTS: RNA-seq identified 17 significantly regulated genes (|FC| > 1.5; FDR < 0.05) in CD-MAT compared to non-IBD controls, with a marked upregulation of plasma cell genes (i.e., IGLL5, MZB1, CD79A, POU2AF1, FCRL5, JCHAIN, DERL3, SDC1, PIM2). A less strict statistical cutoff value (|FC| > 1.5, nominal p ≤ 0.05) yielded a larger list of 651 genes in CD-MAT compared to controls. CD ileum showed the significant regulation compared to control ileum of 849 genes (|FC| > 1.5; FDR < 0.05) or 2654 genes (|FC| > 1.5, nominal p ≤ 0.05). Ingenuity Pathway Analysis revealed the significant regulation of pathways related to T- and B cell functionality in the MAT of CD patients. Despite the differences between the MAT and ileal signatures of CD patients, we identified a subset of 204 genes significantly modulated in both tissues compared to controls. This common signature included genes related to the plasma cell signature. Genes such as S100A8, S100A9 (calprotectin) and IL1B, which are associated with acute inflammatory response, were exclusively regulated in the ileal mucosa of CD disease. In contrast, some genes encoding for lymphocyte receptors such as MS4A1, CD3D and CD79A were exclusively regulated in CD-MAT, exhibiting a different pattern of immune cell activation compared to the ileal mucosa in CD patients. qPCR and immunohistology confirmed the presence of large infiltrates of CD3+ CD20+ lymphocytes and CD138+ plasma cells in CD-MAT. CONCLUSION: Our data strongly supports the role of CD-associated MAT as a site for T-, B- and plasma cell activation, and suggests that it could also act as a reservoir of memory immune responses.
Assuntos
Doença de Crohn , Tecido Adiposo , Linfócitos B , Doença de Crohn/genética , Humanos , Íleo , Mucosa Intestinal , Mesentério , Plasmócitos , Transdução de Sinais/genética , Linfócitos TRESUMO
Several screening tests have been used for cognitive evaluation in Parkinson's disease (PD). OBJECTIVE: To evaluate the usefulness of the Montreal Cognitive Assessment (MoCA) in patients with Parkinson's disease and no cognitive impairment complaints. METHODS: A total of 40 PD patients with no complaints of cognitive problems were included. Patients were selected using the Mini-Mental State Examination (MMSE) and the MoCA was then administered. RESULTS: 80% of patients exhibited Mild Cognitive Impairment (MCI) according to the MoCA. Statistically significant differences in visuospatial, attention and delayed recall functions were evident between the normal and abnormal MoCA groups. CONCLUSION: The study results suggest that MoCA may be a good screening test in patients with PD who do not present cognitive complaints.
Vários testes de triagem foram utilizados para avaliação cognitiva na doença de Parkinson (DP). OBJETIVO: Avaliar a utilidade da Avaliação Cognitiva de Montreal (MoCA) em pacientes com doença de Parkinson sem queixa de comprometimento cognitivo. MÉTODOS: Um total de 40 pacientes com TP sem queixas de problemas cognitivos foram admitidos e com o Estado de Exame do Estado Mental Mini (MEEM) foram selecionados e receberam o MoCA. RESULTADOS: 80% apresentaram dados de Comprometimento Cognitivo Leve (ICM) segundo o MoCA, sendo as funções visoespaciais, atenção e memória atrasada aquelas que apresentaram diferenças estatisticamente significantes entre os grupos MoCA normal e anormal. CONCLUSÃO: Este estudo sugere que o MoCA pode ser um bom teste de triagem em pacientes com DP que não apresentam queixas cognitivas.