RESUMO
Alliances between the government and academic communities can be a key component of the public health response to an emergency such as the coronavirus disease 2019 (COVID-19) pandemic. The Governor of Puerto Rico designated the Puerto Rico Medical Task Force (MTF) COVID-19 to provide direct guidance and evaluation of the government response to the epidemic in Puerto Rico. Several work groups were formed within the MTF to create protocols and provide evidence-based recommendations on different public health aspects. The collaboration between the academia and the government enhanced the Puerto Rican public health response and contributed to the reduction seen in the contagion curve. Healthcare services and hospitals have not reached their maximum patient care capacity and the death toll has been controlled. Incorporating a national MTF with members of the academia into the government structure was beneficial during the COVID-19 response in Puerto Rico. A similar strategy could serve as a model for other states or territories and countries in similar scenarios.
Assuntos
Comitês Consultivos , Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Saúde Pública/métodos , Betacoronavirus , COVID-19 , Infecções por Coronavirus/prevenção & controle , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Porto Rico/epidemiologia , SARS-CoV-2 , Faculdades de MedicinaRESUMO
INTRODUCTION: Anaplastic large cell lymphoma associated with breast implants is receiving increased attention. Most cases have been reported in Europe, North America (USA and Canada), Australia and New Zealand. Fewer cases have been reported in Latin America (including Mexico), Africa and Asia. METHODS: This report was delivered during our national plastic surgery meeting in Cancun in May 2017. Before the meeting, two participants reviewed the literature. The review was performed using the following information sources: PubMed, Embase, Cochrane, Fisterra, Google Scholar and LILACS, with entries from 1980 to August 2015 in several languages (English, Spanish, French and Portuguese). The results were revealed during the meeting to the other participants. The consensus was divided into two parts. The first part included an open-ended question regarding the incidence and prevalence of the problem. The second part included clinical scenarios with different items that were rated by the participants. After this activity, accordance among the responses was evaluated. RESULTS: Seven cases were reported during the meeting (3 from Mexico, 3 from Chile and 1 from Argentina). Fifty percent of the participants reported consulting with guidelines and clinical centers to help with potential cases. Most agreed that further studies must be done in cases of chronic seroma where the capsule plays an important role. DISCUSSION: A current debate exists about the incidence of this problem in Latin America because we did not report the same number of cases as Europe, Australia or North America. More studies are required to determine the differences among reports in Latin America. CONCLUSION: Most representatives agreed that further studies must be done. Concern is increasing, and the problem is known. Other factors involved may be considered, and the problem must not be ignored. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Neoplasias da Mama/etiologia , Linfoma Anaplásico de Células Grandes/etiologia , Guias de Prática Clínica como Assunto , Adulto , Implante Mamário/métodos , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Consenso , Feminino , Humanos , Incidência , América Latina/epidemiologia , Linfoma Anaplásico de Células Grandes/epidemiologia , Linfoma Anaplásico de Células Grandes/patologia , Pessoa de Meia-Idade , Medição de RiscoRESUMO
This paper presents patients satisfaction using anatomical polyurethane breast implants. We performed surgery on 525 patients, 370 of which were primary and 155 were secondary to various causes such as capsular contracture, ruptured implants, volume changes, and incorrect positioning of the implant. The advantages of silicone polyurethane covers shown high level of patient satisfaction, low incidence of capsular contracture, and absence of implant rotation, and late seroma.
RESUMO
We report here the draft genome sequence of Acinetobacter baumannii strain M3AC14-8, sequence type 2 (ST2), carrying a chromosomally carried blaKPC-2 gene. The draft genome consists of a total length of 4.11 Mbp and a G+C content of 39.25%.
RESUMO
Carbapenems are considered the last-resort antibiotics to treat infections caused by multidrug-resistant Gram-negative bacilli. The Klebsiella pneumoniae carbapenemase (KPC) enzyme hydrolyses ß-lactam antibiotics including the carbapenems. KPC has been detected worldwide in Enterobacteriaceae and Pseudomonas aeruginosa isolates associated with transposon Tn4401 commonly located in plasmids. Acinetobacter baumannii has become an important multidrug-resistant nosocomial pathogen. KPC-producing A. baumannii has been reported to date only in Puerto Rico. The objective of this study was to determine the whole genomic sequence of a KPC-producing A. baumannii in order to (i) define its allelic diversity, (ii) identify the location and genetic environment of the blaKPC and (iii) detect additional mechanisms of antimicrobial resistance. Next-generation sequencing, Southern blot, PFGE, multilocus sequence typing and bioinformatics analysis were performed. The organism was assigned to the international ST2 clone. The blaKPC-2 was identified on a novel truncated version of Tn4401e (tentatively named Tn4401h), located in the chromosome within an IncA/C plasmid fragment derived from an Enterobacteriaceae, probably owing to insertion sequence IS26. A chromosomally located truncated Tn1 transposon harbouring a blaTEM-1 was found in a novel genetic environment within an antimicrobial resistance cluster. Additional resistance mechanisms included efflux pumps, non-ß-lactam antibiotic inactivating enzymes within and outside a resistance island, two class 1 integrons, In439 and the novel In1252, as well as mutations in the topoisomerase and DNA gyrase genes which confer resistance to quinolones. The presence of the blaKPC in an already globally disseminated A. baumannii ST2 presents a serious threat of further dissemination.
Assuntos
Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/enzimologia , Acinetobacter baumannii/genética , Proteínas de Bactérias/genética , Farmacorresistência Bacteriana , Genótipo , beta-Lactamases/genética , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/isolamento & purificação , Idoso , Idoso de 80 Anos ou mais , Animais , Infecção Hospitalar/microbiologia , Elementos de DNA Transponíveis , Feminino , Ordem dos Genes , Genes Bacterianos , Genoma Bacteriano , Humanos , Masculino , Pessoa de Meia-Idade , Tipagem Molecular , Porto Rico , Análise de Sequência de DNARESUMO
Coronary heart disease, a leading cause of death in western societies, is caused by the presence of atherosclerotic plaques in the coronary arteries. Calcification is a frequent complication of atherosclerotic plaques, and often a contributing factor to their instability and rupture. Endothelial cells, smooth muscle cells and plaque macrophages, all contribute to the calcification process, which is reminiscent of that underlying bone formation. In particular, the role of macrophages in calcification has long been recognized, but whether or not distinct macrophage subsets v.g., M1 or inflammatory, and M2 or antinflammatory have specific functions in osteogenic signaling within the context of plaque calcification remains poorly understood. Over the past few years, accumulated evidence has revealed novel roles of non-coding micro-RNAs (miRs) in atherorelevant functions of macrophages and in mechanisms linked to macrophage divergence into different subtypes. In this article we discuss some salient findings on potential roles of miRs in vascular calcification, with focus on those miRs that have also been associated to macrophage differentiation, and speculate on their potential relation to M1 and M2 macrophages in the context of calcification of atherosclerotic plaques. (AU)
La enfermedad cardíaca coronaria, principal causa de muerte en occidente, es causada por la presencia de placas ateroscleróticas en las arterias coronarias. La presencia de depósitos de calcificación es una complicación frecuente de la placa, y puede contribuir a la inestabilidad y ruptura de la misma. El proceso de calcificación de la placa es similar al que ocurre en hueso, y contribuyen al mismo, mecanismos dependientes de células endoteliales, células musculares lisas y macrófagos, células que están presentes en todas las etapas de desarrollo de la placa aterosclerótica. El rol de los macrófagos en la calcificación de la placa se conoce desde hace tiempo, pero la contribución de los distintos tipos de macrófagos por ejemplo, M1 o tipo inflamatorio, y M2 o tipo antiinflamatorio a mecanismos de señalización osteogénica en dicho contexto aún no se conoce. Recientemente varios trabajos experimentales han revelado la existencia de nuevos roles de micro-ARNs no codificantes (miRs) en varias funciones de los macrófagos que son de relevancia en el proceso aterogénico, como así también en mecanismos relacionados a la diferenciación de macrófagos en subtipos específicos. En este artículo discutimos algunos de los hallazgos más importantes sobre posibles nuevos roles de miRs en calcificación vascular, poniendo énfasis en aquellos miRs que han sido también asociados a la diferenciación de macrófagos, y especulamos acerca de su posible relación con macrófagos M1 y M2 en el contexto de la calcificación de la placa aterosclerótica. (AU)
Assuntos
Humanos , MicroRNAs/fisiologia , Placa Aterosclerótica/classificação , Placa Aterosclerótica/fisiopatologia , Calcificação Vascular/fisiopatologia , Macrófagos/fisiologia , Osteogênese/fisiologia , Aterosclerose/complicações , Calcificação Vascular/prevenção & controle , Macrófagos/classificaçãoRESUMO
We report the draft genome of a multidrug resistant, Klebsiella pneumoniae carbapenemase (KPC)-producing Acinetobacter baumannii strain M3AC9-7 that belongs to the novel sequence type, ST250. The draft genome consists of a total length of 4.09 Mbp and a G+C content of 38.95%.
RESUMO
Carbapenems are the last-resort antibiotics for the treatment of infections caused by multidrug-resistant Gram-negative bacilli. Klebsiella pneumoniae carbapenemase (KPC) hydrolyses ß-lactam antibiotics including the carbapenems. KPCs have been detected in Enterobacteriaceae and Pseudomonas aeruginosa isolates worldwide associated with transposon Tn4401 commonly located in plasmids. Acinetobacter baumannii has become an important multidrug-resistant nosocomial pathogen capable of hydrolysing the carbapenem antibiotics. KPC-producing A. baumannii has so far only been reported in Puerto Rico. During a surveillance study, four KPC-producing A. baumannii with identical pulse type were identified in a single institution. The objectives of this study were to characterize the KPC genetic background and the allelic diversity of one of the isolates. Next-generation sequencing and multilocus sequence typing (MLST) were performed. Molecular characterization of the isolate demonstrated blaKPC in Tn4401b located in the bacterial chromosome within a 26.5 kb DNA fragment, which included a KQ-like element (18.9 kb) very similar to that described previously in a K. pneumoniae plasmid and a 7.6 kb DNA fragment with 98â% homology to a putative plasmid from Yersinia pestis strain PY-95. Our data suggested that the 26.5 kb DNA fragment harbouring blaKPC was integrated in the chromosome by a transposition event mediated by the transposase of ISEcp1 found in the KQ-like element. MLST showed a novel sequence type, ST250. To our knowledge, this is the first report of the identification of the genetic background of blaKPC in A. baumannii.
Assuntos
Acinetobacter baumannii/enzimologia , Acinetobacter baumannii/genética , Cromossomos Bacterianos , Elementos de DNA Transponíveis , Recombinação Genética , beta-Lactamases/genética , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/classificação , Acinetobacter baumannii/isolamento & purificação , Evolução Molecular , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Dados de Sequência Molecular , Tipagem de Sequências Multilocus , Porto Rico , Análise de Sequência de DNA , Homologia de Sequência do Ácido NucleicoRESUMO
BACKGROUND: We aimed to describe orbital positron emission tomography/computed tomography (PET/CT) imaging findings, both structural and metabolic, in different clinical stages of Graves ophthalmopathy (GO). This prospective, observational, cross-sectional study examined 32 eyes of 16 patients with GO. METHODS: Patients were assessed with a complete ophthalmological evaluation and assigned a VISA classification for GO. All patients underwent serum thyroid hormone measurement, antibody profile, and 18-fluorodeoxyglucose positron emission tomography/computed tomography (18-FDG PET/CT) of the orbits. The 18-FDG uptake on PET images was expressed in terms of maximum standard uptake value (SUVmax). CT images were analyzed, and orbital structures were measured in millimeters. Vision, inflammation, strabismus, and overall appearance were assessed according to the VISA classification system, thyroid hormone levels, antibody values, 18-FDG uptake, and thickness of orbital structures. RESULTS: Altogether, 32 eyes of 16 patients (10 women, 6 men; mean age 44.31 ± 13 years, range 20-71 years) were included. Three patients were hypothyroid, seven were euthyroid, and six were hyperthyroid. CT measurements of extraocular muscle diameter were elevated (P < 0.05), and muscle 18-FDG uptake values were increased. Eyes with a clinical VISA inflammation score of ≤ 4 had an average extraocular muscle SUVmax of 3.09, and those with a score of ≥ 5 had an average SUVmax of 3.92 (P = 0.09), showing no clear correlation between clinically observed inflammation and 18-FDG uptake. 18-FDG uptake values also did not show a correlation with extraocular muscle diameter as measured by CT (R2 = 0.0755, P > 0.05). CONCLUSIONS: We demonstrated a lack of correlation between 18-FDG extraocular muscle uptake and either clinical inflammation score or muscle diameter. Although 18-FDG uptake has been used as an inflammation marker in other pathologies, inflammation in GO may be clinically detected in PET/CT-negative cases, and cases with negative clinical findings may show inflammation on PET/CT. Clinical evaluation is mandatory but may be insufficient and inaccurate for classifying GO. A larger and homogeneous sample size and further research is needed to define the role of PET/CT in detecting, grading, and follow-up of GO to optimize treatment of the inflammatory stage respect clinical methods currently used.
Assuntos
Oftalmopatia de Graves/diagnóstico , Órbita/patologia , Glândula Tireoide/fisiopatologia , Adulto , Idoso , Estudos Transversais , Feminino , Fluordesoxiglucose F18/metabolismo , Oftalmopatia de Graves/sangue , Oftalmopatia de Graves/patologia , Oftalmopatia de Graves/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Estudos Prospectivos , Índice de Gravidade de Doença , Glândula Tireoide/metabolismo , Hormônios Tireóideos/sangue , Tomografia Computadorizada por Raios XRESUMO
Es de todos conocido el problema de las restricciones para el desarrollo de trabajo y otras operaciones imprescindibles, cuando se cambia de escenario informático. Se enfrentan conflictos frente a las diferentes configuraciones de las computadoras que se encuentren disponibles, falta de privacidad, falta de privilegios para operar los equipos, limitación de instalaciones, problemas con desinstalaciones fallidas o incompletas, ausencia del software necesario o acostumbrado y, en consecuencia, una gran pérdida de tiempo. El uso masivo de memorias y discos externos por puerto USB facilitan y extienden la frecuencia de ocurrencia de los fenómenos anteriormente mencionados. El objetivo del presente trabajo consiste en presentar una respuesta adecuada a este problema. Para ello se recurrió a la búsqueda y análisis de información y software; programación de scripts; configuración de arquitectura, selección y evaluación de herramientas. Se logró determinar un conjunto general de más de 700 herramientas portables clasificadas en 20 categorías. Se precisaron reglas y requisitos para el correcto enfoque y funcionamiento de conjuntos portables(AU)
We all frequently face problems of restrictions with developing work and other necessary operations when changing the computing scenario. Conflict with different computers configurations arise as well as lack of privacy, lack of privileges to operate the equipment, limitation of facilities, problems with failed or incomplete uninstalls, absence of required software and as a result, a predictable waste of time. The massive use of external USB drives facilitates and extends the frequency of occurrence of the above phenomena. This paper presents an adequate response to this problem. This was done through the search and analysis of information and software, scripts programming, configuration of architecture, selection and assessment of tools. It was possible to determine a general set of more than 700 portable tools, classify them in 20 categories. Rules and requirements were established for the proper focus and functioning of portables(AU)