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Introduction: Happiness is understood as the perception of subjective well-being, it can be a quality, a result, or a state characterized by well-being or satisfaction that every person wants to achieve. In older adults, this satisfaction is a sum of lifelong achievements and triumphs; However, some factors influence this ideal. Objective: Analyze demographic, family, social, personal, and health factors associated with the subjective perception of happiness in older adults, using data from a study conducted in five cities in Colombia, in order to make a theoretical contribution in the search for improvement of their physical, mental and social health. Materials and methods: A quantitative, cross-sectional, analytical study was carried out, using primary source information, obtained with 2,506 surveys from voluntary participants aged 60 and over, who had no cognitive impairment, and who reside in urban areas but not in long-term centers. The variable happiness (classified as high or moderate/low) was used for: (1) A univariate explorative characterization of older adult, (2) a bivariate estimation of the relationships with the factors studied, and (3) a multivariate construction of profiles through multiple correspondences. Results: 67.2% reported high happiness levels, with differences by city: Bucaramanga (81.6%), Pereira (74.7%), Santa Marta (67.4), Medellín (64%), and Pereira (48.7%). Happiness was explained by the absence of risk of depression and little hopelessness, strengthened psychological well-being, a perception of high quality of life, and living in a functional family. Conclusion: This study provided an overview of possible factors that can be enhanced and strengthened with public policies (structural determinant), community empowerment, family strengthening (intermediate determinant), and educational programs (proximal determinant). These aspects are included in the essential functions of public health, in favor of mental and social health in older adults.
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Background: Bloodstream infections (BSI) are important causes of morbidity and mortality worldwide. Antimicrobial surveillance is essential for identifying emerging resistance and generating empirical treatment guides, the purpose of this study is to analyze trends in antimicrobial susceptibility of BSI from 2010 to 2019 in healthcare institutions from Medellin and nearby towns in Colombia. Methods: A Whonet database was analyzed from the GERMEN antimicrobial surveillance network; frequency and antibiotic susceptibility trends were calculated on more frequent microorganisms using Mann Kendall and Sen's Slope Estimator Test. Results: 61,299 isolates were included; the three microorganisms more frequent showed a significant increasing trend through time E. coli (Sen's Slope estimator = 0.7 p = <0.01) S. aureus (Sen's Slope estimator = 0.60 p = <0.01) and K. pneumonia (Sen's Slope estimator = 0.30 p = <0.01). E. coli showed a significant increase trend in cefepime and ceftazidime resistance, while K. pneumoniae showed a significant increase in resistance to cefepime, ciprofloxacin, and gentamicin. P. aeruginosa increases its susceptibility to all analyzed antibiotics and S. aureus to oxacillin. No increasing trend was observed for carbapenem resistance. Conclusion: An upward trends was observed in more frequent microorganisms and resistance to third and fourth-generation cephalosporins for E. coli and K pneumoniae; in contrast, not increasing trends in antibiotic resistance was observed for P. aeruginosa and S. aureus. The essential role of AMR-surveillance programs is to point out and identify these trends, which should improve antibiotic resistance control.
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Objetivo: evaluar la utilidad de la identificación directa de microorganismos en muestras de orina y hemocultivos empleando la tecnología MALDI-TOF MS, mediante el análisis de concordancia en la identificación, tiempo necesario para la obtención de un resultado y costos asociados a cada método de identificación. Materiales y métodos: estudio descriptivo de febrero de 2017 a octubre de 2017. Se seleccionaron a conveniencia 180 muestras de orinas y 129 hemocultivos de pacientes de la Clínica El Rosario, Medellín, se realizó identificación del microorganismo directamente de la muestra y a partir del cultivo por MALDI-TOF (Vitek® MS‚ bioMérieux). Se analizaron los costos y tiempo, para determinar la utilidad de esta tecnología en los procesos del laboratorio de microbiología. Resultados: En el 79,6% de las orinas positivas y en el 76% de los hemocultivos se obtuvo una identificación de microorganismos directamente por MALDI-TOF MS. El tiempo de identificación directa tuvo una media de 6 horas y por cultivo una media de 29 horas. El costo total por aislamiento identificado de forma directa (sin incluir el valor del equipo) fue de $8.200 (2,58 USD) en muestras de orina y de $9.720 (3,06 USD) en hemocultivos positivos. El equipo introduce un costo variable en cada identificación de acuerdo con el número de identificaciones que se realicen en el laboratorio. Conclusiones: Estos resultados confirman la utilidad del MALDI-TOF MS para generar identificaciones más rápidas cuando se utiliza directamente en muestras clínicas, sin embargo, tiene un bajo desempeño en la identificación directa de bacterias gram positivas, siendo necesario evaluar otros protocolos que mejoren la identificación directa. El costo de los consumibles es bajo, pero la adquisición de esta tecnología introduce un costo variable que depende del volumen de muestras identificadas en el laboratorio.
Objective: To evaluate the utility of the direct identification of microorganisms in urine and blood cultures samples, using MALDI-TOF by evaluating concordance for identification, time to obtain an identification result and associated costs. Materials and Methods: A descriptive study from February to October 2017 in 180 urine samples and 129 positive blood cultures samples of patients from the El Rosario Clinic in Medellin- Colombia. The clinical samples were processed directly for microorganisms identification by using MALDI-TOF (Vitek® MS‚ bioMérieux). This result was compared with the result obtained with Maldi tof -MS done for the cultured microorganism. An analysis of cost and time to achieve an identification result was made to determinate the utility of this technology in the laboratory procedures. Results: 79,6 % of positive urines and the 76 % of blood cultures were identified directly from the sample by MALDI-TOF. MALDI-TOF applied directly had a mean time for obtaining an identification of 6 hours compared to 29 hours to obtain an identification from cultures. The cost of direct identification was $8.200 (2,58 USD) in urine samples and $9.720 (3,06 USD) in blood cultures (without including the equipment cost). This cost is variable depending of the number of identifications that the laboratory performs. Conclusions: These results support the usefulness of MALDI-TOF for getting rapid identification results using the direct methodology in clinical samples. However, the capability to identify gram positive bacteria needs to be improved. The incorporation of this methodology in microbiology laboratories may improve the opportunity in the etiological diagnosis and should have a positive impact on patient care.
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Humanos , Bactérias , Urina , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Hemocultura , Espectrometria de Massas , Controle de CustosRESUMO
INTRODUCTION: Recurrence of papillary thyroid carcinoma after initial treatment is challenging. Surgical reintervention is recommended, but cure after surgery in uncertain and surgical morbidity may be high. This study evaluates the effect of compartment-oriented lymph node dissection (LND) on clinical and biochemical cure rate as well as the related complications. PATIENTS AND METHODS: All patients who underwent LND for recurrent papillary thyroid carcinoma between 2000 and 2015 were included. Demography, the extent of the initial surgery, usage of 131I, the pattern of recurrence, diagnosis, details of the surgical reintervention, histological findings, surgical morbidity, and clinical and biochemical outcomes were analyzed. RESULTS: There were 11 (12.7%) males and 75 (87.2%) females with a mean age of 42.8 ± 14.6 years. Seventy-seven patients had undergone total thyroidectomy and in 67 (77.9%) some type of LN resection. In 76 (88.3%), 131I was administered after the initial surgery. We localized suspicious lymph nodes by US in all patients, and metastases were documented before surgery by FNA in 63. Seven (8.13%) patients underwent central LND, 63 (73.2%) lateral LND and 16 (18.6%) both, central and lateral LND. Major complications occurred in 6 patients (6.9%). Sixty-two (72.0%) patients received 131I after surgery. A second surgical re-exploration was performed in 30 (34.8%) patients, and 7 patients required 3 or more additional LND. In a mean follow-up of 59.4 ± 39 months, 51 (59.3%) patients are clinically, radiologically and biochemically free of disease. CONCLUSIONS: In this series, compartment-oriented lymph node resection of recurrent papillary thyroid carcinoma leads to a final clinical and biochemical disease-free status of 59.3% with 6.9% of major complications.
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Linfonodos/cirurgia , Esvaziamento Cervical/métodos , Recidiva Local de Neoplasia/cirurgia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Adulto , Feminino , Humanos , Radioisótopos do Iodo , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/efeitos adversos , Recidiva Local de Neoplasia/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Reoperação , Estudos Retrospectivos , Câncer Papilífero da Tireoide/secundário , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/efeitos adversos , Resultado do TratamentoRESUMO
The physiological condition and immune responses of organisms living at different elevations are expected to display local adaptations to the different climatic and biotic conditions. Small ectotherms with specialized diets are highly susceptible to environmental change, as their life cycle is largely affected by temperature and by the presence of specific resources. This study focuses on two species of rolled-leaf beetles (Chrysomelidae), both present at two different elevations in Costa Rica: Cephaloleia belti Baly, a diet-generalist, and Chelobasis bicolor Gray, a diet-specialist. Body size, energetic condition (lipid storage), muscle mass and immune condition (melanization response) were compared in beetle populations from a tropical rainforest (50 m elevation) and a tropical montane forest (2 000 m elevation). These measurements reflect current and past nutritional condition and hence are good estimators of individual fitness. We analyzed a total of 172 individuals from both species, sexes and elevations. We predicted that beetles at higher elevation would display larger body size, higher energetic condition and lower immune response associated with metabolic requirements and parasitic pressure in colder temperatures. In general, beetles at high altitude were larger, had more lipids and muscle and showed stronger melanization (i.e., immune response) than beetles at low altitudes. Such differences among populations at different elevations may reflect local adaptation to altitude or phenotypic plasticity. However, the effect of elevation was not equivalent amongst species or sex. Measuring physiological traits in organisms with broad elevational distributions could be useful in understanding possible species responses to climate change.
La condición fisiológica y la respuesta inmune de poblaciones que habitan a distintas altitudes pueden mostrar adaptación local a las condiciones abióticas y bióticas locales. Entre los organismos más susceptibles al cambio ambiental están los ectotermos pequeños con dietas especializadas, debido a que su ciclo de vida es, en gran medida, afectado tanto por la temperatura como por la presencia de recursos específicos. Este estudio se enfoca en dos especies de escarabajos (Chrysomelidae) presentes a lo largo de un gradiente altitudinal en Costa Rica: Cephaloleia belti Baly, una especie de dieta generalista, y Chelobasis bicolor Gray, de dieta especialista. Se comparó el tamaño corporal, la condición energética (almacenamiento de lípidos), la masa muscular y la condición inmunológica (respuesta de melanización) entre poblaciones de escarabajos de un bosque tropical (a 50 m de altitud) y un bosque tropical montano (a 2 000 m de altitud). Las variables seleccionadas reflejan las condiciones nutricionales actuales y pasadas y son buenos estimadores de la adecuación individual. Se analizaron un total de 172 escarabajos de ambas especies, sexos y elevaciones. Predecimos que los escarabajos a mayor elevación tendrán mayor tamaño corporal, mayor condición energética y menor respuesta inmune asociadas con los requerimientos metabólicos y la presión de los parásitos asociados con ambientes fríos. En general, los escarabajos a mayor altitud fueron más grandes, tuvieron más lípidos y masa muscular, y presentaron una mayor respuesta inmune de melanización que los escarabajos a menor altitud. Es posible que las diferencias entre las poblaciones a diferentes altitudes reflejen adaptaciones locales a las condiciones ambientales a distintas altitudes o plasticidad fenotípica. Sin embargo, el efecto de la altitud no fue de la misma magnitud entre las dos especies ni entre los dos sexos. La medición de caracteres fisiológicos en organismos ectotérmicos de amplia distribución altitudinal puede ser útil para entender las respuestas de ciertas especies al cambio climático.
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Objetivo: Caracterizar procedimientos para la toma, análisis, reporte y aseguramiento de la calidad en hemocultivos en pacientes adultos, en instituciones hospitalarias. Material Y método: Estudio descriptivo en 15 Hospitales de Medellín y alrededores. Se empleó un formulario semiestructurado para recolectarla información, se utilizó SPSS(r) para el análisis. Resultados: Todas las instituciones tienen protocolos basados en fuentes de autoridad reconocida; con diferencias importantes en procesos pre-analíticos y postanalíticos. Los Productos más empleados para la antisepsia fueron gluconato declorhexidina al 2-4%(66,7%) Y alcohol isopropílico o etílico al 70% (20,0%),Con discrepancias en los tiempos de acción. El 73,3% emplea guantes estériles y la misma proporción usa sistema abierto (jeringa) para la venopunción. En el 46,6% se toman dos botellas aerobias y una anaerobia por episodio y en 33,3% dos botellas aerobias. El 66,6% lleva un indicador de contaminación, 53,3% de positividad y 26,6% de volumen de sangre. La tasa promedio de hemocultivos contaminados durante el semestre de seguimiento fue 1,61%. Conclusión: Se observa heterogeneidad en los procedimientos, especialmente en fases pre-analítica y post-analítica. En La búsqueda de la excelencia y la seguridad del paciente son necesarios protocolos estandarizados e indicadores para medir y controlar el desempeño de los hemocultivos.
Objective: To characterize the procedures that are performed for the collection, analysis, reporting and quality assurance of blood cultures in adult patients in hospital institutions. Material and Methods: Descriptive study in 15 hospitals of Medellin and its surroundings. A semi-structured collection instrument was used to collect the information provided by each hospital; SPSS(r) was used for the analysis. Results: All Institutions have protocols based o nauthorized sources; there were important differences in the pre-analytic and post-analytic processes. The Products employed for skin antisepsis were2-4% Chlorhexidine gluconate (66.7%)And70% Isopropyl or ethyl alcohol(20.0%), with discrepancies in product action times. 73.3% use sterile gloves and an equal proportion uses an open system (syringe) for venipuncture. Two aerobic and one anaerobic bottles are taken per episode in adult patients in 46.6% of institutions and only two aerobic bottles in 33.3% of them. Indicators of contamination were used by 66.6 % of institutions, of positivity in 53.3% and of blood volume in 26.6%. The average rate of contaminated blood cultures during the follow-up period was 1.61%. Conclusion: Heterogeneity in the procedures was observed especially in the pre-analytic and post-analytical phases. In the pursuit of excellence and patient safety, standardized protocols and the use of indicators to measure and control the performance of blood cultures are needed.
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Humanos , Manejo de Espécimes , Hemocultura , Risco , Epidemiologia Descritiva , Colômbia , Assistência ao Paciente , Hospitais , LaboratóriosRESUMO
Los métodos fenotípicos empleados para la identificación de microorganismos dependen de procesos metabólicos que requieren de tiempos de incubación mínimos para alcanzar resultados confiables. La espectrometría de masas MALDI-TOF (desorción/ionización láser asistida por una matriz con detección de masas por tiempo de vuelo) se ha instaurado como una metodología relevante para la identificación de microorganismos mediante el análisis de proteínas, a través de la creación de un espectro de masas específico de género y especie. En esta revisión, se presenta MALDI-TOF MS como una tecnología precisa para la identificación de bacterias, levaduras, mohos, en incluso de virus ,que además, permite la reducción del tiempo para obtener un resultado de identificación, que puede impactar los costos de atención y duración de la estancia hospitalaria. La identificación de microorganismos directamente de muestras biológicas y la detección de mecanismos de resistencia a antimicrobianos, prometen un mayor impacto clínico y epidemiológico con el desarrollo e implementación de esta tecnología en los laboratorios de microbiología clínica.
Phenotypic methods used for the identification of microorganisms depend on metabolic processes that require minimum incubation times to achieve reliable results. For this reason, MALDI-TOF MS (Matrix Assisted Laser Desorption/Ionization Mass Spectrometry) has been established as a relevant methodology for the identification of microorganisms using analysis of proteins, through the creation of a mass spectrum specific for genus and species. In the present review, MALDI TOF MS is presented as an accurate technology for identifying bacteria, yeasts, molds and viruses; Its use allows reduction of the time to obtain an identification result, which may impact the costs of care and length of hospital stay. The identification of microorganisms directly from biological samples and the detection of mechanisms of antimicrobial resistance, promise an additional clinical and epidemiological impact with the development and implementation of this technology in clinical microbiology laboratories.
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Humanos , Sistema Urinário , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Laboratórios , Microbiologia , Espectrometria de Massas , Bactérias , Vírus , Necessidades Específicas do Gênero , Anti-InfecciososRESUMO
OBJECTIVES: Invasive candidiasis has a high impact on morbidity and mortality in hospitalised patients. Accurate and timely methods for identification of Candida spp. and determination of echinocandin susceptibility have become a priority for clinical microbiology laboratories. METHODS: This study was performed to compare matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF/MS) identification with sequencing of the D1/D2 region of the rRNA gene complex 28 subunit in 147 Candida spp. isolates obtained from patients with candidaemia. Antimicrobial susceptibility testing was performed by broth microdilution (BMD) and Etest. Sequencing of the FKS1 and FKS2 genes was performed. RESULTS: The most common species isolated were Candida albicans (40.8%), followed by Candida parapsilosis (23.1%) and Candida tropicalis (17.0%). Overall agreement between the results of identification by MALDI-TOF/MS and molecular identification was 99.3%. Anidulafungin and caspofungin susceptibility by the BMD method was 98.0% and 88.4%, respectively. Susceptibility to anidulafungin and caspofungin by Etest was 93.9% and 98.6%, respectively. Categorical agreement between Etest and BMD was 91.8% for anidulafungin and 89.8% for caspofungin, with lower agreements in C. parapsilosis for anidulafungin (76.5%) and C. glabrata for caspofungin (40.0%). No mutations related to resistance were found in the FKS genes, although 54 isolates presented synonymous polymorphisms in the hotspots sequenced. CONCLUSIONS: MALDI-TOF/MS is a good alternative for routine identification of Candida spp. isolates. DNA sequencing of the FKS genes suggested that the isolates analysed were susceptible to echinocandins; alternatively, unknown resistance mechanisms or limitations related to antifungal susceptibility tests may explain the resistance found in a few isolates.
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Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candida/genética , Candidemia/epidemiologia , Equinocandinas/farmacologia , Anidulafungina/farmacologia , Hemocultura , Candida/isolamento & purificação , Caspofungina/farmacologia , Colômbia , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Genes de RNAr , Sequenciamento de Nucleotídeos em Larga Escala , Hospitais/estatística & dados numéricos , Humanos , Testes de Sensibilidade Microbiana , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por MatrizRESUMO
INTRODUCTION: Carbapenems resistance is a growing phenomenon and a threat to public health because of the reduced therapeutic options for resistant infections. METHODS: A retrospective case-control study was conducted in 2 tertiary-care hospitals in Medellín, Colombia. Fifty patients infected with ertapenem-resistant enterobacteriaceae were compared with a control group consisting of 100 patients with infections caused by ertapenem susceptible enterobacteriaceae. A multivariate logistic regression model was used to identify factors that best explain ertapenem-resistant enterobacteriaceae infections. RESULTS: The factors associated with ertapenem-resistant enterobacteriaceae infections were prior exposure to carbapenems (adjusted OR 3.43; 95% IC 1.08-10.87) and prior exposure to cefepime (adjusted OR 6.46; 95% IC 1.08-38.38). CONCLUSION: Prior exposure to antibiotics is the factor that best explains the ertapenem-resistant enterobacteriaceae infection in this population, highlighting the importance of antimicrobial stewardship programs in hospitals.
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Infecção Hospitalar/microbiologia , Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/efeitos dos fármacos , Ertapenem/farmacologia , Centros de Atenção Terciária/estatística & dados numéricos , Resistência beta-Lactâmica , Idoso , Gestão de Antimicrobianos , Carbapenêmicos/uso terapêutico , Estudos de Casos e Controles , Cefepima/uso terapêutico , Colômbia/epidemiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Grupos Diagnósticos Relacionados , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
The critical thermal maximum (CTmax), the temperature at which motor control is lost in animals, has the potential to determine if species will tolerate global warming. For insects, tolerance to high temperatures decreases with latitude, suggesting that similar patterns may exist along elevational gradients as well. This study explored how CTmax varies among species and populations of a group of diverse tropical insect herbivores, the rolled-leaf beetles, across both broad and narrow elevational gradients. Data from 6,948 field observations and 8,700 museum specimens were used to map the elevational distributions of rolled-leaf beetles on two mountains in Costa Rica. CTmax was determined for 1,252 individual beetles representing all populations across the gradients. Initial morphological identifications suggested a total of 26 species with populations at different elevations displaying contrasting upper thermal limits. However, compared with morphological identifications, DNA barcodes (cytochrome oxidase I) revealed significant cryptic species diversity. DNA barcodes identified 42 species and haplotypes across 11 species complexes. These 42 species displayed much narrower elevational distributions and values of CTmax than the 26 morphologically defined species. In general, species found at middle elevations and on mountaintops are less tolerant to high temperatures than species restricted to lowland habitats. Species with broad elevational distributions display high CTmax throughout their ranges. We found no significant phylogenetic signal in CTmax, geography, or elevational range. The narrow variance in CTmax values for most rolled-leaf beetles, especially high-elevation species, suggests that the risk of extinction of insects may be substantial under some projected rates of global warming.