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Abstract Introduction: At the end of 2019, SARS-CoV-2 was identified as the cause of a new global pandemic. The clinical course may vary depending on the geographical region. The factors associated with mortality in our setting must continue to be documented. Objective: To describe the clinical and biological characteristics of a cohort of patients hospitalized for COVID-19 in an intensive care unit (ICU), and the factors associated with their mortality. Materials and methods: Patients with a positive RT-PCR. The variables were recorded on admission to the ICU. The comparisons were made using the Mann-Whitney U, Chi2 or Fisher's exact test. Logistic regression was used for the multivariate model. Results: 148 patients were collected from March to December 2020, 102 (69.8%) of whom were males. The median age was 62 years; 137 (92.5%) of the patients met the criteria for acute respiratory distress syndrome (ARDS), 132 patients (89.2%) received mechanical ventilation, and 103 (69.6%) of the patients died. The factors associated with mortality on the bivariate analysis were hypertension (HTN), obesity, age, ferritin, lactate dehydrogenase (LDH), C-reactive protein (CRP) and the PaO2/Fio2 (P/F) ratio. The multivariate analysis showed that hypertensive patients had a higher risk of dying (odds ratio [OR] 3.57, 95% confidence interval [CI] 1.29 - 4.96). Conclusion: COVID-19 mortality in the ICU is high, and the risk factors found were similar to those reported in the literature. Understanding the differential behavior according to risk factors helps determine early intervention measures. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2610).
Resumen Introducción: Desde finales de 2019 se identificó el SARS-CoV2 como causante de una nueva pandemia global. El curso clínico puede variar dependiendo de la región geográfica. Es necesario seguir documentando factores asociados con la mortalidad en nuestro ambiente. Objetivo: Describir las características clínicas y biológicas de una cohorte de pacientes hospitalizados en unidad de cuidados intensivos (UCI) por COVID-19 y los factores asociados a su mortalidad. Material y métodos: Los pacientes con prueba RT-PCR positiva. Las variables se registraron al momento de su ingreso a la UCI. Las comparaciones se hicieron con prueba U de Mant Whitney, chi2 o test exacto de Fisher. Para el modelo multivariado usamos regresión logística. Resultados: Desde marzo hasta diciembre de 2020 se recolectaron 148 pacientes. 102 (69.8%) fueron hombres. La mediana de la edad fue 62 años; 137 (92.5%) de los pacientes cumplió criterios para síndrome de dificultad respiratoria aguda (SDRA),132 pacientes (89.2%) tuvieron ventilación mecánica, 103 (69.6%) de los pacientes fallecieron. Los factores asociados con mortalidad en el análisis bivariado fueron: hipertensión arterial (HTA), obesidad, edad, ferritina, deshidrogenasa láctica (LDH), proteína c reactiva (PCR) y la PAFI (PaO2/Fio2). En el análisis multivariado se observó que los hipertensos tuvieron mayor riesgo de morir (odds ratio -OR), 3.57 [intervalo de confianza (IC) 95%; 1.29 - 4.96]. Conclusión: la mortalidad por COVID-19 en UCI es alta y se documentaron factores de riesgo similares a los documentados por la literatura. Entender el comportamiento diferencial con base en factores de riesgo, permite establecer medidas de intervención temprana. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2610).
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RESUMEN Introducción. El nódulo tiroideo en niños generalmente es asintomático, de presentación múltiple y aislada, con dificultad para instaurar el riesgo de malignidad, sobre todo si no es palpable. Objetivo. Determinar las características epidemiológicas, clínicas, ecográficas y manejo quirúrgico del nódulo tiroideo en pacientes del Servicio de Cirugía de Cabeza, Cuello y Máxilo Facial del Instituto Nacional de Salud del Niño (INSN) - Breña, 2000 -2020. Métodos. Estudio observacional, descriptivo y retrospectivo. Se usó la clasificación Bethesda para los estudios citológicos. Los datos fueron analizados en el programa SPSS versión 22. Las variables cualitativas fueron expresadas en frecuencias absolutas y relativas; y las cuantitativas en medidas de tendencia central y dispersión. Resultados. Fueron 66 casos, el promedio de edad fue 10,94 ± 0,88 años, el 48,5% entre 11 a 15 años, el 78,8% fueron del sexo femenino, un 89,4% no referían antecedente familiar de cáncer. Predominó la forma asintomática (74,2%). Ecográficamente el 43,9% de nódulos se localizaron en lóbulo derecho, presentación única (68,2%) y menor a dos centímetros (43,9%). El 82,6% de los 23 casos Bethesda II fueron hemitiroidectomizados y el 86,4% de 22 casos Bethesda VI fueron tiroidectomizados. Conclusiones. En pacientes pediátricos, los nódulos tiroideos se presentaron mayormente en mujeres de 11 a 15 años, sin antecedente familiar de cáncer, asintomáticos, localizados en lóbulo derecho, únicos y menor a dos centímetros. El grado II de la clasificación Bethesda fue la más frecuente. La hemitiroidectomía fue la intervención quirúrgica más utilizada.
ABSTRACT Introduction. The thyroid nodule in children is usually asymptomatic, multiple and isolated presentation, with difficulty in establishing the risk of malignancy, especially if it is not palpable. Objective. To determine the epidemiological, clinical and ultrasound characteristics and surgical management of thyroid nodules in patients of the Head, Neck and Maxillofacial Surgery Service of the Instituto Nacional de Salud del Niño (INSN) - Breña, 2000-2020. Methods. Observational, descriptive and retrospective study. The Bethesda classification was used for cytological studies. Qualitative variables were expressed in absolute and relative frequencies; and quantitative variables in measures of central tendency and dispersion. Results. There were 66 cases, the average age was 10.94 ± 0.88 years, 48.5% between 11 and 15 years, 78.8% were female, 89.4% had no family history of cancer. The asymptomatic form predominated (74.2%). Ultrasonographically, 43.9% of nodules were located in the right lobe, single presentation (68.2%) and smaller than two centimeters (43.9%). 82.6% of the 23 Bethesda II cases were hemithyroidectomized and 86.4% of 22 Bethesda VI cases were thyroidectomized. Conclusions. In pediatric patients, thyroid nodules occurred mostly in women aged 11 to 15 years, with no family history of cancer, asymptomatic, located in the right lobe, single and less than two centimeters. Grade II of the Bethesda classification was the most frequent. Hemithyroidectomy was the most used surgical intervention
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RESUMEN La espirometría es la prueba estándar para confirmar el diagnóstico de la enfermedad pulmonar obstructiva crónica (EPOC). En los servicios de hospitalización es frecuente encontrar pacientes que ingresan con sospecha de esta condición durante una exacerbación. Con base en las guías actuales, existe controversia sobre si se puede o no realizar la espirometría en este escenario. Objetivo: revisar la utilidad diagnóstica de la espirometría en pacientes hospitalizados con sospecha de EPOC exacerbada. Metodología: se realizó una revisión no sistemática hasta noviembre del 2019. Las bases de datos consultadas fueron PubMed, Cochrane, EMBASE, LILACS, Google Scholar. Se incluyeron estudios prospectivos en pacientes mayores de 18 años, en idioma inglés y español. Se encontraron 573 artículos y se seleccionaron 20 artículos de relevancia para la discusión. Conclusiones: en los pacientes hospitalizados por sospecha de EPOC exacerbada, la espirometría es una herramienta útil para confirmar el diagnóstico. El momento para realizarla es previo al egreso, una vez el paciente está estable. Anotamos que el VEF1 no sería útil para establecer la gravedad.
SUMMARY Spirometry is the standard test to confirm the diagnosis of Chronic Obstructive Pulmonary Disease (COPD). In hospitalization services it is common to find patients admitted with suspicion of this condition during an exacerbation. Based on current guidelines, there is controversy about use or not spirometry in this setting. Objective: To review the diagnostic utility of spirometry in hospitalized patients with suspected exacerbated COPD. Development: A nonsystematic review was carried out until November 2019. The databases consulted were PubMed, Cochrane, EMBASE, LILACS, Google Scholar. Prospective studies were included, in patients over 18 years of age, in English and Spanish. Were found 573 articles and 20 relevant articles were selected for discussion. Conclusions: In hospitalized patients with suspected exacerbated COPD, spirometry is a useful tool to confirm the diagnosis. The time to perform it would be prior to discharge, once the patient is stable. Of note, FEV1 would not be useful for establishing severity.
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Humanos , Espirometría , Enfermedad Pulmonar Obstructiva CrónicaRESUMEN
Resumen Objetivo: describir los pacientes con egreso inoportuno de origen no médico, sus características sociodemográficas, clínicas y estimar los costos derivados, durante el 01 de junio y el 31 de agosto de 2017, en una institución de salud de alto nivel de complejidad. Material y métodos: estudio observacional, retrospectivo. La definición operativa de egreso inoportuno correspondía a pacientes que desde el punto de vista clínico podían ser dados de alta, pero continuaban ocupando una cama por problemas no médicos. Los datos fueron tomados de las historias clínicas y para el análisis de costo, se tuvieron en cuenta el total de los costos generados por la estancia inapropiada, incluyendo el costo día de hospitalización, insumos, medicamentos y evaluaciones médicas. La perspectiva del costo fue desde el pagador. Resultados: de los 3273 egresos durante el periodo analizado, se presentaron 79 casos de egresos inoportunos (2.4%). La edad media de los pacientes fue de 49 años. El 62% eran del régimen subsidiado; 60.7% eran procedentes de otros departamentos o municipios lejanos. El total de días hospitalización perdidos por esta causa fue de 547, con una media de 6.6 días por paciente. Los servicios más afectados fueron medicina interna y cuidados paliativos. Las principales causas fueron: necesidad de tiquetes para retornar al lugar de procedencia, alta temprana por medicamentos o insumos para el egreso y necesidad de oxígeno. El costo total que se generó por egreso inoportuno fue US$83 935, con un valor promedio de US$1062.47 por paciente. Conclusión: el egreso inoportuno es un problema evidente en la atención. Las principales causas que encontramos fueron problemas sociales y traslados regionales. Además genera un gasto adicional importante de recursos materiales y económicos tanto para las instituciones como para el sistema.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1255).
Abstract Objective: to describe the sociodemographic and clinical characteristics of patients with nonclinical delayed discharge and estimate the resulting costs in a tertiary healthcare facility from June 1 to August 31, 2017. Materials and methods: a retrospective observational study. The working definition of delayed discharge was patients who, from a clinical perspective, could be discharged but who continued to occupy a bed due to nonclinical problems. The data were taken from the medical charts, and the total costs incurred by the inappropriate length of stay were used for the cost analysis, including the cost per inpatient day, supplies, medications and medical assessments, from the payer's cost perspective. Results: of the 3,273 discharges during the study period, there were 79 cases of delayed discharge (2.4%). The mean age of the patients was 49 years. Sixty-two percent had subsidized medical insurance; 60.7% came from other departments or distant towns. The total number of inpatient days lost due to this cause was 547, with a me of 6.6 days per patient. The departments which were most affected were internal medicine and palliative care. The main causes were: the need for tickets to return to their place of origin, early discharge due to medications or discharge supplies and the need for oxygen. The total cost incurred due to delayed discharge was USD 83,935, with an average of USD 1,062.47 per patient. Conclusion: delayed discharge is an evident healthcare problem. The main causes found in this study were social and regional transport issues. Delayed discharge also causes a significant additional expense in material and financial resources for both the institutions and the system.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1255).
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Costos y Análisis de Costo , Organización Mundial de la Salud , Registros Médicos , Atención a la Salud , Equipos y SuministrosRESUMEN
Several pathogens including Gram-negative bacteria hijack complement regulators to escape host's innate response. Pathogenic Leptospira species bind Factor H, C4b binding protein and vitronectin from the complement system. We evaluated the ability of low passage (LP) and culture-attenuated (CA) pathogenic strains of Leptospira, to bind Factor H. We used LOCaS46 (Leptospira interrogans sv Canicola), LOVe30 (L. interrogans sv Icterohaemorrhagiae) and MOCA45 (L. santarosai sv Tarassovi), and ten high passage strains of Leptospira [used in the microscopic agglutination test (MAT)]. Afterwards, we assessed their survival in normal human serum (NHS). Interestingly, the ability in binding Factor H was higher for LOCaS46 and LOVe30 LP strains, than for the respective CA strains suggesting that the ability of evading the alternative complement pathway is lost after culture attenuation. Accordingly, the level of mRNA expression of the Factor H binding proteins, LigA, LigB and Lsa23 was higher in these LP strains than in the corresponding CA strains. Unexpectedly, no difference in Factor H binding and surviving was observed between LP and CA MOCA45 strains. The high passage MAT-reference strains showed variation in Factor H binding ability, but, in most cases, the ability for capturing Factor H by Leptospira strains correlated with their survival in NHS.
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Proteínas Bacterianas/genética , Proteínas Bacterianas/metabolismo , Proteínas Portadoras/metabolismo , Regulación Bacteriana de la Expresión Génica , Leptospira/inmunología , Leptospira/patogenicidad , Proteínas Portadoras/genética , Factor H de Complemento/metabolismo , Humanos , Evasión Inmune/genética , Leptospira/genética , Leptospirosis/microbiología , Viabilidad Microbiana/genética , Viabilidad Microbiana/inmunología , Unión Proteica , ARN Mensajero/genéticaRESUMEN
Several pathogens including Gram-negative bacteria hijack complement regulators to escape host's innate response. Pathogenic Leptospira species bind Factor H, C4b binding protein and vitronectin from the complement system. We evaluated the ability of low passage (LP) and culture-attenuated (CA) pathogenic strains of Leptospira, to bind Factor H. We used LOCaS46 (Leptospira interrogans sv Canicola), LOVe30 (L. interrogans sv Icterohaemorrhagiae) and MOCA45 (L. santarosai sv Tarassovi), and ten high passage strains of Leptospira [used in the microscopic agglutination test (MAT)]. Afterwards, we assessed their survival in normal human serum (NHS). Interestingly, the ability in binding Factor H was higher for LOCaS46 and LOVe30 LP strains, than for the respective CA strains suggesting that the ability of evading the alternative complement pathway is lost after culture attenuation. Accordingly, the level of mRNA expression of the Factor H binding proteins, LigA, LigB and Lsa23 was higher in these LP strains than in the corresponding CA strains. Unexpectedly, no difference in Factor H binding and surviving was observed between LP and CA MOCA45 strains. The high passage MAT-reference strains showed variation in Factor H binding ability, but, in most cases, the ability for capturing Factor H by Leptospira strains correlated with their survival in NHS.
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Despite their essential role in the process of chromosome segregation in eukaryotes, kinetochore proteins are highly diverse across species, being lost, duplicated, created, or diversified during evolution. Based on comparative genomics, the duplication of the inner kinetochore proteins CenH3 and Cenp-C, which are interdependent in their roles of establishing centromere identity and function, can be said to be rare in animals. Surprisingly, the Drosophila CenH3 homolog Cid underwent four independent duplication events during evolution. Particularly interesting are the highly diverged Cid1 and Cid5 paralogs of the Drosophila subgenus, which are probably present in over one thousand species. Given that CenH3 and Cenp-C likely co-evolve as a functional unit, we investigated the molecular evolution of Cenp-C in species of Drosophila. We report yet another Cid duplication (leading to Cid6) within the Drosophila subgenus and show that not only Cid, but also Cenp-C is duplicated in the entire subgenus. The Cenp-C paralogs, which we named Cenp-C1 and Cenp-C2, are highly divergent. Both Cenp-C1 and Cenp-C2 retain key motifs involved in centromere localization and function, while some functional motifs are conserved in an alternate manner between the paralogs. Interestingly, both Cid5 and Cenp-C2 are male germline-biased and evolved adaptively. However, it is currently unclear if the paralogs subfunctionalized or if the new copies acquired a new function. Our findings point towards a specific inner kinetochore composition in a specific context (i.e., spermatogenesis), which could prove valuable for the understanding of how the extensive kinetochore diversity is related to essential cellular functions.
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Proteína A Centromérica/genética , Proteínas Cromosómicas no Histona/genética , Proteínas de Drosophila/genética , Drosophila melanogaster/genética , Evolución Molecular , Duplicación de Gen , Genes de Insecto , Células Germinativas/metabolismo , Animales , Sesgo , Proteína A Centromérica/metabolismo , Proteínas Cromosómicas no Histona/metabolismo , Cromosomas/genética , Proteínas de Drosophila/metabolismo , Funciones de Verosimilitud , Masculino , FilogeniaRESUMEN
Objetivo: Describir la atención de enfermería en pacientes postoperados por fracturas hospitalización dentro del Hospital de Especialidades San Bartolo.Metodología:La investigación se enmarca en un enfoque cuantitativo, con un nivel de recolección de datos empleada fue la encuesta, a través de un cuestionario de 15 preguntas cerradas, que fue aplicado a una población de 24 enfermeros (as).Resultados: Entre los resultados más resaltantes, se evidencia desfavorablemente que el 100% de los encuestados omite cuidados, como lo es el control de líquidos a los pacientes, población considero que la administración de medicamentos es el cuidado principal en el postoperatorio medConclusiones: Las fracturas óseas representan un problema de discapacidad funcional en los pacientes y es necesario que el cuidado de enfermería se dirija a satisfacer los requerimientos del paciente sin afectar la inmovilidad intencional que se establece como medida terapéutica operatoria
Objective: To describe the nursing care in patients postoperated by bone fractures in the in the San Bartolo Specialties Hospital.Methodology: The research is framed in a quantitative approach, with a descriptive technique used was the survey, through a questionnaire of 15 closed questions, which was applied to a population of 24 nurses.Results: Among the most outstanding results, it is unfavorably shown that 100% of do not identify the warning signs, however, 75% of the population considered that the administration of medications is the main care in the postoperative period.Conclusions: Bone fractures represent a problem of functional disability in patients and it is necessary that nursing care is aimed at satisfying the patient's requirements without
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Humanos , Vulnerabilidad SexualRESUMEN
INTRODUCTION: Treatment options are limited for HIV-1-infected individuals who have received extensive previous antiretroviral therapy. ETV has shown significant clinical benefits in treatment-experienced HIV-1+ patients with antiretroviral resistance. The aim of this study was to evaluate the effectiveness of ETV plus optimized background regimen in real-life conditions in a cohort of highly HIV-1 antiretroviral-experienced patients. METHODOLOGY: Retrospective cohort of treatment-experienced HIV-1-infected adults with virological failure who started therapy with an ETV-containing regimen. The effectiveness was evaluated using HIV-1 RNA viral load and changes in CD4+ cell count after 48 weeks of treatment. RESULTS: Forty-two patients ≥ 16 years of age were included; 74% were men, and the median age was 45 years (IQR 41-53). All participants had prior non-nucleoside reverse transcriptase inhibitor use (55% nevirapine, 83%, efavirenz, and 28% both). Baseline median HIV-1 RNA viral load was 15,598 copies/mL (IQR 2651-84,175) and CD4+ cell count was 276 cells/mL (IQR 155-436). After 48 weeks of treatment, 90.5% (95% CI 78-96) of patients had HIV-1 RNA viral load < 200 copies/mL and 76% (95% CI 61-86) had < 50 copies/mL. CD4+ cell counts increased from baseline to 48 weeks of treatment to a median of 407 cells/mL (IQR 242-579); p < 0.001. Virological outcome was associated with virological failure at baseline HIV-1 RNA viral load ≥ 100,000 copies/mL (OR 7.6; 95% CI 1.2-44.80; p = 0.025). CONCLUSIONS: Our study provides clinically important evidence of the effectiveness and safety of ETV in highly antiretroviral-experienced HIV-1-infected patients.
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Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa/métodos , Infecciones por VIH/tratamiento farmacológico , Piridazinas/uso terapéutico , Terapia Recuperativa/métodos , Adolescente , Adulto , Anciano , Fármacos Anti-VIH/efectos adversos , Terapia Antirretroviral Altamente Activa/efectos adversos , Recuento de Linfocito CD4 , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nitrilos , Piridazinas/efectos adversos , Pirimidinas , ARN Viral/sangre , Estudios Retrospectivos , Terapia Recuperativa/efectos adversos , Resultado del Tratamiento , Carga Viral , Adulto JovenRESUMEN
OBJECTIVE: The aim of this study is to differentially identify MAC by PCR in patients with AIDS and disseminated mycobacteriosis. METHODS: A cross sectional study was conducted in Mexico to identify MAC by Molecular Biology. Two sets of primers were synthesized: MAV and MIN, for M. avium and M. intracellulare, respectively. Whole-cell DNAs obtained from 29 clinical isolates and clinical serum specimens from other 24 patients with AIDS and disseminated mycobacterial infection were extracted and amplified by PCR with the MAV and MIN primers. The MAV and MIN primers each amplified one highly specific 1.3-kb segment of the homologous DNA, respectively. RESULTS: Twenty-nine DNAs from MAC clinical isolates identified by Gen-Probe AccuProbes were amplified with the MAV primers. Of the 24 clinical samples, 3 were positive for M. avium and 6 for M. tuberculosis. CONCLUSIONS: Our results demonstrated that PCR technique could be applied for the differentiation of M. avium and M. intracellulare by specific 16S rRNA primers. In patients with advanced stage AIDS and in whom disseminated mycobacteriosis is suspected, the presence of anemia (even with negative cultures), elevated alkaline phosphatase and a median CD4 count of 15.9/mL, the diagnosis of infection by MAC should be strongly considered; we suggest that in accordance with our findings, a more precise stratification of patients in terms of their CD4 T cell counts is warranted.
Introducción: el objetivo de este artículo es Identificar y diferenciar el complejo MAC por PCR en pacientes con SIDA y micobacteriosis diseminada. Métodos: se llevó a cabo un estudio transversal para identificar MAC por biología molecular. Se sintetizaron dos conjuntos de iniciadores: MAV y MIN, para M. avium y M. intracellulare, respectivamente. El ADN total de células obtenidas de 29 aislados clínicos y muestras de suero de otros 24 pacientes con SIDA e infección micobacteriana diseminada fue extraído y se amplificó por PCR con los iniciadores MAV y MIN. Cada uno de los iniciadores MAV y MIN amplificó un segmento altamente específico de 1.3 kb del ADN homólogo, respectivamente. Resultados: veintinueve ADN de los aislados clínicos de MAC identificadas por Gen-Probe AccuProbes se amplificaron con los iniciadores MAV (M. avium). De las 24 muestras clínicas, 3 fueron positivas para M. avium y 6 para M. tuberculosis. Conclusiones: nuestros resultados demostraron que la técnica de PCR se puede aplicar para la diferenciación de M. avium y M. intracellulare por iniciadores específicos 16S rRNA. En pacientes con estadio avanzado de SIDA y en quienes se sospecha micobacteriosis diseminada, la presencia de anemia (incluso con cultivos negativos) fosfatasa alcalina elevada y una mediana de CD4 de 15.9/ml, se debe considerar seriamente el diagnóstico de infección por MAC; sugerimos que, de acuerdo con nuestros resultados, se justifica una estratificación más precisa de los pacientes en términos de sus recuentos de células T CD4.
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Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , ADN Bacteriano/análisis , Complejo Mycobacterium avium/genética , Infección por Mycobacterium avium-intracellulare/diagnóstico , Reacción en Cadena de la Polimerasa , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Adulto , Estudios Transversales , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complejo Mycobacterium avium/aislamiento & purificación , Infección por Mycobacterium avium-intracellulare/microbiologíaRESUMEN
OBJECTIVE: We evaluated the effectiveness of darunavir (DRV) treatment plus an optimized background regimen in 120 HIV-1 treatment-experienced patients. DESIGN: Retrospective cohort, multicenter study. METHODS: Adults >16 years with virological treatment failure starting therapy with a DRV-containing regimen were included. Effectiveness was evaluated as the percentage of patients with an undetectable HIV-1 RNA viral load (<50 and <200 copies/mL) after 48 weeks, and changes in CD4+ cell counts. We evaluated the risk factors associated with treatment failure. RESULTS: Of the cohort, 83 % were men with a median age of 45 years (interquartile range, IQR 40-51). They had experienced treatment for a median of 13 years (IQR 9-17) with a median of six previous regimens (IQR 4-7), all using protease inhibitors. After treatment, 82 % (95 % confidence interval, CI 74-88 %) of patients had an HIV-1 RNA viral load <200 copies/mL and 69 % (95 % CI 60-76 %) had <50 copies/mL. The CD4+ cell count increased by 378 cells/µL (IQR 252-559; P < 0.001 vs. baseline). Risk factors associated with poor outcome were age >40 years [odds ratio, OR 0.15 (95 % CI 0.10-0.78); P = 0.015], use of raltegravir in the regimen [OR 0.37 (95 % CI 0.10-0.97); P = 0.046], and baseline CD4+ cell count <200 cells/µL [OR 2.79 (95 % CI 1.11-6.97); P = 0.028]. CONCLUSION: In this Mexican cohort Darunavir was metabolically safe, well tolerated and achieved high rates of virological suppression in highly treatment-experienced patients infected with HIV-1.
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Ficolins recognize pathogen associated molecular patterns and activate the lectin pathway of complement system. However, our knowledge regarding pathogen recognition of human ficolins is still limited. We therefore set out to explore and investigate the possible interactions of the two main serum ficolins, ficolin-2 and ficolin-3 with different Gram-negative bacteria. We used recombinant ficolin molecules and normal human serum, which were detected with anti-ficolin monoclonal antibodies. In addition we investigated the capacity of these pathogens to activate the lectin pathway of complement system. We show for the first time that human ficolin-2 recognizes the nonpathogenic spirochete Leptospira biflexa serovar Patoc, but not the pathogenic Leptospira interrogans serovar Kennewicki strain Fromm. Additionally, human ficolin-2 and ficolin-3 recognize pathogenic Pasteurella pneumotropica, enteropathogenic Escherichia coli (EPEC) serotype O111ab:H2 and enteroaggregative E. coli (EAEC) serogroup O71 but not four enterohemorrhagic E. coli, three EPEC, three EAEC and two nonpathogenic E. coli strains (DH5α and HB101). The lectin pathway was activated by Pasteurella pneumotropica, EPEC O111ab:H2 and EAEC O71 after incubation with C1q depleted human serum. In conclusion, this study provide novel insight in the binding and complement activating capacity of the lectin pathway initiation molecules ficolin-2 and ficolin-3 towards relevant Gram-negative pathogens of pathophysiological relevance.
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Lectina de Unión a Manosa de la Vía del Complemento/inmunología , Escherichia coli/inmunología , Glicoproteínas/inmunología , Lectinas/inmunología , Leptospira/inmunología , Pasteurella pneumotropica/inmunología , Humanos , Proteínas Recombinantes/inmunología , FicolinasRESUMEN
Pasteurella pneumotropica is an opportunist Gram negative bacterium responsible for rodent pasteurellosis that affects upper respiratory, reproductive and digestive tracts of mammals. In animal care facilities the presence of P. pneumotropica causes severe to lethal infection in immunodeficient mice, being also a potential source for human contamination. Indeed, occupational exposure is one of the main causes of human infection by P. pneumotropica. The clinical presentation of the disease includes subcutaneous abscesses, respiratory tract colonization and systemic infections. Given the ability of P. pneumotropica to fully disseminate in the organism, it is quite relevant to study the role of the complement system to control the infection as well as the possible evasion mechanisms involved in bacterial survival. Here, we show for the first time that P. pneumotropica is able to survive the bactericidal activity of the human complement system. We observed that host regulatory complement C4BP and Factor H bind to the surface of P. pneumotropica, controlling the activation pathways regulating the formation and maintenance of C3-convertases. These results show that P. pneumotropica has evolved mechanisms to evade the human complement system that may increase the efficiency by which this pathogen is able to gain access to and colonize inner tissues where it may cause severe infections.
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Proteína de Unión al Complemento C4b/inmunología , Factor H de Complemento/inmunología , Pasteurella pneumotropica/inmunología , Convertasas de Complemento C3-C5/metabolismo , HumanosRESUMEN
Transposable elements (TEs) and satellite DNAs (satDNAs) are abundant components of most eukaryotic genomes studied so far and their impact on evolution has been the focus of several studies. A number of studies linked TEs with satDNAs, but the nature of their evolutionary relationships remains unclear. During in silico analyses of the Drosophila virilis assembled genome, we found a novel DNA transposon we named Tetris based on its modular structure and diversity of rearranged forms. We aimed to characterize Tetris and investigate its role in generating satDNAs. Data mining and sequence analysis showed that Tetris is apparently nonautonomous, with a structure similar to foldback elements, and present in D. virilis and D. americana. Herein, we show that Tetris shares the final portions of its terminal inverted repeats (TIRs) with DAIBAM, a previously described miniature inverted transposable element implicated in the generation of chromosome inversions. Both elements are likely to be mobilized by the same autonomous TE. Tetris TIRs contain approximately 220-bp internal tandem repeats that we have named TIR-220. We also found TIR-220 repeats making up longer (kb-size) satDNA-like arrays. Using bioinformatic, phylogenetic and cytogenomic tools, we demonstrated that Tetris has contributed to shaping the genomes of D. virilis and D. americana, providing internal tandem repeats that served as building blocks for the amplification of satDNA arrays. The ß-heterochromatic genomic environment seemed to have favored such amplification. Our results imply for the first time a role for foldback elements in generating satDNAs.
Asunto(s)
Elementos Transponibles de ADN , ADN Satélite/genética , Drosophila/genética , Animales , Cromosomas de Insectos , Genoma de los Insectos , FilogeniaRESUMEN
Using highly precise and accurate Monte Carlo simulations of 20,000,000 replications and 102 independent simulation experiments with extremely low simulation errors and total uncertainties, we evaluated the performance of four single outlier discordancy tests (Grubbs test N2, Dixon test N8, skewness test N14, and kurtosis test N15) for normal samples of sizes 5 to 20. Statistical contaminations of a single observation resulting from parameters called δ from ±0.1 up to ±20 for modeling the slippage of central tendency or ε from ±1.1 up to ±200 for slippage of dispersion, as well as no contamination (δ = 0 and ε = ±1), were simulated. Because of the use of precise and accurate random and normally distributed simulated data, very large replications, and a large number of independent experiments, this paper presents a novel approach for precise and accurate estimations of power functions of four popular discordancy tests and, therefore, should not be considered as a simple simulation exercise unrelated to probability and statistics. From both criteria of the Power of Test proposed by Hayes and Kinsella and the Test Performance Criterion of Barnett and Lewis, Dixon test N8 performs less well than the other three tests. The overall performance of these four tests could be summarized as N2â N15 > N14 > N8.
Asunto(s)
Método de Montecarlo , Simulación por Computador , Modelos EstadísticosRESUMEN
The hAT superfamily comprises a large and diverse array of DNA transposons found in all supergroups of eukaryotes. Here we characterized the Drosophila buzzatii BuT2 element and found that it harbors a five-exon gene encoding a 643-aa putatively functional transposase. A phylogeny built with 85 hAT transposases yielded, in addition to the two major groups already described, Ac and Buster, a third one comprising 20 sequences that includes BuT2, Tip100, hAT-4_BM, and RP-hAT1. This third group is here named Tip. In addition, we studied the phylogenetic distribution and evolution of BuT2 by in silico searches and molecular approaches. Our data revealed BuT2 was, most often, vertically transmitted during the evolution of genus Drosophila being lost independently in several species. Nevertheless, we propose the occurrence of three horizontal transfer events to explain its distribution and conservation among species. Another aspect of BuT2 evolution and life cycle is the presence of short related sequences, which contain similar 5' and 3' regions, including the terminal inverted repeats. These sequences that can be considered as miniature inverted repeat transposable elements probably originated by internal deletion of complete copies and show evidences of recent mobilization.
Asunto(s)
Elementos Transponibles de ADN , Drosophila/genética , Transferencia de Gen Horizontal , Animales , Drosophila/clasificación , Drosophila/enzimología , Proteínas de Drosophila/genética , Evolución Molecular , Filogenia , Transposasas/genéticaRESUMEN
The organisms of Rickettsia species are gram (-) bacteria that cause severe illnesses in humans and are an important health problem in several countries around the world, including Mexico. The presence of different antigens between species and also in different strains of the same specie is an obstacle for vaccine development and serological diagnosis. There are important advances in the knowledge of the rickettsial antigenic structure and the resulting immune response in infected hosts, including humans. This review covers these topics and provides an overview about the development of vaccines and accessible diagnostic methods for diseases caused by Rickettsia.
Asunto(s)
Proteínas Bacterianas/inmunología , Epítopos Inmunodominantes/inmunología , Infecciones por Rickettsia/inmunología , Rickettsia/inmunología , Animales , Fiebre Botonosa/diagnóstico , Fiebre Botonosa/inmunología , Humanos , Infecciones por Rickettsia/diagnóstico , Vacunas contra Rickettsia/inmunologíaRESUMEN
El presente es un estudio de costos, prospectivo, analítico y comparativo, realizado en una muestra de 148 pacientes con patología neuroquirúrgica de alta complejidad y durante un período de seis meses. Objetivo: Mostrar las ventajas económicas y clínicas del uso de flujos bajos de gas fresco en la administración de anestesia inhalatoria. Metodología: Como agentes inhalatorios fueron utilizados sevoflurane e isoflurane a flujos bajos y flujos medios de gas fresco. Como parámetros de seguridad se evaluó la presión de CO2 arterial y la concentración alveolar mínima, calculándose y comparándose el costo de la hora anestésica con flujos bajos y flujos medios de gas fresco. Resultados: No hubo diferencia estadística al evaluar las pCO2 y MAC entre los grupos. El consumo de anestésico (ml/h) usando FB es 50 por ciento menor que cuando se emplean flujos medios. Analizando los costos de la hora anestésica se comprueba una economía del 6 por ciento usando FB con isoflurane y del 30 por ciento utilizando sevoflurane a FB, valores en dólares. Conclusión: El uso de flujos bajos tiene innumerables ventajas económicas, integrando una estrategia de disminución de costos en la institución; además, su uso no constituye ningún riesgo para el paciente, permitiendo administrar una anestesia segura y de calidad. (AU)