RESUMO
RESUMEN Dientamoeba fragilis es un protozoário que parasita el intestino grueso del hombre y animales domésticos. Hasta el momento, aún no son claros aspectos de su ciclo de vida, como el rango de hospedadores, reservorios, mecanismo de infección, entre otros. Se postula que el cerdo es un hospedador natural para este protozoario y que, debido a su cercanía con el humano, podría facilitar una transmisión zoonótica. En Colombia no existen a la fecha estudios sobre la presencia de D. fragilis en hospedadores animales, incluidos los cerdos, y los datos sobre la prevalencia de otros protozoarios intestinales en estos animales son escasos. El objetivo fue determinar la frecuencia de protozoarios intestinales, incluyendo D. fragilis, en cerdos de una granja tecnificada de una zona rural de Medellín (región Andina de Colombia). Se recolectaron muestras de materia fecal de 70 cerdos en etapa de preceba, que fueron evaluadas mediante examen directo, tinción tricrómica y Ziehl-Neelsen modificado. Se realizaron análisis univariados con medidas de frecuencia relativa y tendencia central y análisis bivariados para la exploración de factores de riesgo. Se detectó la presencia de D. fragilis en un 13% de las muestras y de otros parásitos como Entamoeba spp. (66%), Blastocystis spp. (64%), Balantioides coli (36%), Cryptosporidium spp. (36%), Iodamoeba butschlii (17%), coccidias (4%) y Giardia spp. (1,4%). En este primer reporte de D. fragilis en cerdos en Colombia se observó la alta prevalencia de otros protozoarios patógenos, lo que corrobora el papel de los cerdos como importantes reservorios de infecciones humanas. Estudios sobre la presencia de este protozoario tanto en cerdos como en el personal encargado de su manejo contribuirían al conocimiento sobre su dinámica de transmisión.
ABSTRACT Dientamoeba fragilis is a protozoan that parasitizes the large intestine of humans and domestic animals. To date, some aspects regarding D. fragilis life cycle, including hosts, reservoirs, infection mechanism, among others, are not yet clear. Swine are considered natural hosts for this protozoan, therefore their close contact with humans promotes its zoonotic transmission. In Colombia there are no studies on the presence of D. fragilis in animal hosts, including pigs, and data about other intestinal protozoa are scarce. The objective was to determine the prevalence of intestinal protozoan, including D. fragilis, in pigs raised in a farm from a rural area of Medellin (Andean region of Colombia). Fecal samples from 70 pigs in prefattening stage were collected. Direct fecal smear examination, trichrome and modified Ziehl-Neelsen stain were used in the study. Univariate analysis (frequency distribution and central tendency measures) and bivariate analysis were used to explore risk factors. Dientamoeba fragilis was found in 13% of the evaluated fecal samples. Other parasites detected included: Entamoeba spp. (66%), Blastocystis spp. (64%), Balantioides coli (36%), Cryptosporidium spp. (36%), Iodamoeba butschlii (17%), coccidias (4%), and Giardia spp. (1,4%). This is the first report of D. fragilis in swine in Colombia, and the high prevalence of other pathogen protozoa was also observed, which corroborates the role of pigs as important reservoirs for human infections. Studies focused on the evaluation of both swine and swine-exposed farm workers should be done in order to know the dynamics of transmission of this parasite.
Assuntos
Animais , Parasitos , Infecções Protozoárias em Animais , Suínos , Reservatórios de Doenças , Zoonoses , Fatores de Risco , Dientamoeba , Intestino Grosso , Animais Domésticos , Reservatórios de Água , Entamoeba , InfecçõesRESUMO
Idiopathic achalasia is a disease of unknown etiology. The loss of myenteric plexus associated with inflammatory infiltrates and autoantibodies support the hypothesis of an autoimmune mechanism. Thirty-two patients diagnosed by high-resolution manometry with achalasia were included. Twenty-six specimens from lower esophageal sphincter muscle were compared with 5 esophagectomy biopsies (control). Immunohistochemical (biopsies) and flow cytometry (peripheral blood) analyses were performed. Circulating anti-myenteric autoantibodies were evaluated by indirect immunofluorescence. Herpes simplex virus-1 (HSV-1) infection was determined by in situ hybridization, RT-PCR, and immunohistochemistry. Histopathological analysis showed capillaritis (51%), plexitis (23%), nerve hypertrophy (16%), venulitis (7%), and fibrosis (3%). Achalasia tissue exhibited an increase in the expression of proteins involved in extracellular matrix turnover, apoptosis, proinflammatory and profibrogenic cytokines, and Tregs and Bregs versus controls (P < 0.001). Circulating Th22/Th17/Th2/Th1 percentage showed a significant increase versus healthy donors (P < 0.01). Type III achalasia patients exhibited the highest inflammatory response versus types I and II. Prevalence of both anti-myenteric antibodies and HSV-1 infection in achalasia patients was 100% versus 0% in controls. Our results suggest that achalasia is a disease with an important local and systemic inflammatory autoimmune component, associated with the presence of specific anti-myenteric autoantibodies, as well as HSV-1 infection.
Assuntos
Doenças Autoimunes/imunologia , Doenças Autoimunes/patologia , Acalasia Esofágica/imunologia , Acalasia Esofágica/patologia , Inflamação/imunologia , Inflamação/patologia , Adulto , Idoso , Autoanticorpos/imunologia , Doenças Autoimunes/virologia , Estudos de Casos e Controles , Estudos Transversais , Acalasia Esofágica/virologia , Feminino , Técnica Indireta de Fluorescência para Anticorpo/métodos , Herpes Simples/imunologia , Herpesvirus Humano 1/imunologia , Humanos , Imuno-Histoquímica/métodos , Inflamação/virologia , Masculino , Pessoa de Meia-Idade , Plexo Mientérico/imunologia , Plexo Mientérico/patologia , Plexo Mientérico/virologiaRESUMO
PURPOSE: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control strategy including a practice bundle to reduce the rates of central line-associated bloodstream infection (CLAB) in patients hospitalized in pediatric intensive care units (PICUs) of hospitals, which are members of the INICC, from nine cities of five developing countries: Colombia, India, Mexico, Philippines, and Turkey. METHODS: CLAB rates were determined by means of a prospective surveillance study conducted on 1,986 patients hospitalized in nine PICUs, over a period of 12,774 bed-days. The study was divided into two phases. During Phase 1 (baseline period), active surveillance was performed without the implementation of the multi-faceted approach. CLAB rates obtained in Phase 1 were compared with CLAB rates obtained in Phase 2 (intervention period), after implementation of the INICC multidimensional infection control program. RESULTS: During Phase 1, 1,029 central line (CL) days were recorded, and during Phase 2, after implementing the CL care bundle and interventions, we recorded 3,861 CL days. The CLAB rate was 10.7 per 1,000 CL days in Phase 1, and in Phase 2, the CLAB rate decreased to 5.2 per 1,000 CL days (relative risk [RR] 0.48, 95% confidence interval [CI] 0.29-0.94, P = 0.02), showing a reduction of 52% in the CLAB rate. CONCLUSIONS: This study shows that the implementation of a multidimensional infection control strategy was associated with a significant reduction in the CLAB rates in the PICUs of developing countries.
Assuntos
Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Infecção Hospitalar/epidemiologia , Controle de Infecções/métodos , Unidades de Terapia Intensiva Pediátrica , Adolescente , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Criança , Pré-Escolar , Infecção Hospitalar/prevenção & controle , Países em Desenvolvimento , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
BACKGROUND AND PURPOSE: The present study was designed to assess whether cyclooxygenase-2 (COX-2) activation is involved in the effects of chronic aldosterone treatment on endothelial function of mesenteric resistance arteries (MRA) from Wistar-Kyoto (WKY) and spontaneously hypertensive rats (SHR). EXPERIMENTAL APPROACH: Relaxation to acetylcholine was measured in MRA from both untreated and aldosterone-treated strains. Vasomotor responses to prostacyclin and U46619 were also analysed. Release of 6-oxo-prostaglandin (PG)F1alpha and thromboxane B2 (TxB2) was determined by enzyme immunoassay. COX-2 protein expression was measured by western blot. KEY RESULTS: Aldosterone reduced acetylcholine relaxation in MRA from both strains. In MRA from both aldosterone-treated strains the COX-1/2 or COX-2 inhibitor (indomethacin and NS-398, respectively), TxA2 synthesis inhibitor (furegrelate), prostacyclin synthesis inhibitor (tranylcypromine) or TxA2/ PGH2 receptor antagonist (SQ 29 548), but not COX-1 inhibitor SC-560, increased acetylcholine relaxation. In untreated rats this response was increased only in SHR. Prostacyclin elicited a biphasic vasomotor response: lower concentrations elicited relaxation, whereas higher concentrations elicited contraction that was reduced by SQ 29 548. Aldosterone increased the acetylcholine-stimulated production of 6-oxo-PGF(1alpha) and TxB2 in MRA from both strains. COX-2 expression was higher in both strains of rats treated with aldosterone. CONCLUSIONS AND IMPLICATIONS: Chronic treatment with aldosterone impaired endothelial function in MRA under normotensive and hypertensive conditions by increasing COX-2-derived prostacyclin and thromboxane A2. As endothelial dysfunction participates in the pathogenesis of many cardiovascular disorders we hypothesize that anti-inflammatory drugs, specifically COX-2 inhibitors, could ameliorate vascular damage in patients with elevated aldosterone production.
Assuntos
Aldosterona/farmacologia , Endotélio Vascular/efeitos dos fármacos , Epoprostenol/metabolismo , Tromboxano A2/metabolismo , Doenças Vasculares/induzido quimicamente , Ácido 15-Hidroxi-11 alfa,9 alfa-(epoximetano)prosta-5,13-dienoico/farmacologia , Animais , Western Blotting , Ciclo-Oxigenase 1/metabolismo , Ciclo-Oxigenase 2/metabolismo , Técnicas In Vitro , Masculino , Artérias Mesentéricas/patologia , Relaxamento Muscular/efeitos dos fármacos , Músculo Liso Vascular/efeitos dos fármacos , Norepinefrina/farmacologia , Cloreto de Potássio/farmacologia , Ratos , Ratos Endogâmicos SHR , Ratos Endogâmicos WKY , Doenças Vasculares/patologia , Resistência Vascular/efeitos dos fármacos , Vasoconstritores/farmacologiaRESUMO
Floriculture represents one of the major sources of income in the Ecuadorian Andean Region that can be carried out either in open fields as in greenhouses by using chemical compounds, growing hormones and xenobiotics. Among pesticides, ethylenbisdithiocarbamate (EBDTCs) fungicides represent the most extensively used. The aim of the study was the assessment of exposure to EBDTCs in Ecuadorian floricultural workers by the determination of the urinary excretion of the main metabolite of these compounds, ethylenethiourea (ETU). For this purpose, thirty-six floriculture workers and 7 unexposed healthy subjects were recruited for the study. Median level of ETU excretion in agricultural workers before the work shift was 3.2 micrograms/g creatinine, ranging from 0.4 to 34.5 micrograms/g creatinine. After pesticide application, urinary ETU increased to 6.2 micrograms/g creatinine (1.5-26.5) microgram/g creatinine. Urinary ETU resulted significantly higher in overall workers, taken as pre- and post-shift samples, when compared to controls (0.7, 0.4-2.1 micrograms/g creatinine, p < 0.01). According to jobs, applicators showed the highest levels of ETU excretion whereas growing, post-harvesting and maintenance workers showed similar levels of exposure. Higher level ETU excretion was observed in greenhouse compared to open field workers.
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Agricultura , Antifúngicos/toxicidade , Etilenobis (ditiocarbamatos)/toxicidade , Exposição Ocupacional/efeitos adversos , Equador , Etilenotioureia/análise , HumanosRESUMO
Resistance of Mycobacterium tuberculosis to antimycobacterial agents is a worldwide problem. The proposite of this study was to analyze the current resistance patterns of patients with initial episodes, as well as relapses, due to M. tuberculosis in western Mexico. From January 1993 to February 1999 a total of 237 strains of M. tuberculosis (120 from initial cases and 117 from relapse cases) were analyzed. Two hundred and four (86%) strains were isolated from the lower respiratory tract, and 33 strains (14%) from extrapulmonary sites. Twenty-three percent of M. tuberculosis isolated from patients with initial episodes were resistant to both isoniazid and rifampin, and 52% of M. tuberculosis isolated from relapse cases were also resistant to both isoniazid and rifampin.
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Antituberculosos/farmacologia , Isoniazida/farmacologia , Mycobacterium tuberculosis/efeitos dos fármacos , Rifampina/farmacologia , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose/microbiologia , Resistência Microbiana a Medicamentos , Resistência a Múltiplos Medicamentos , Humanos , México/epidemiologia , Testes de Sensibilidade Microbiana/métodos , Mycobacterium tuberculosis/isolamento & purificação , Recidiva , Tuberculose/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/microbiologiaRESUMO
From July to December 1998, a hospital- and health center-based surveillance system for dengue was established at selected sites in Nicaragua to better define the epidemiology of this disease. Demographic and clinical information as well as clinical laboratory results were obtained, and virus isolation, reverse transcriptase-polymerase chain reaction, and serologic assays were performed. World Health Organization criteria were used to classify disease severity; however, a number of patients presented with signs of shock in the absence of thrombocytopenia or hemoconcentration. Therefore, a new category was designated as "dengue with signs associated with shock" (DSAS). Of 1,027 patients enrolled in the study, 614 (60%) were laboratory-confirmed as positive cases; of these, 268 (44%) were classified as dengue fever (DF); 267 (43%) as DF with hemorrhagic manifestations (DFHem); 40 (7%) as dengue hemorrhagic fever (DHF); 20 (3%) as dengue shock syndrome (DSS); and 17 (3%) as DSAS. Interestingly, secondary infection was not significantly correlated with DHF/DSS, in contrast to previous studies in Southeast Asia. DEN-3 was responsible for the majority of cases, with a minority due to DEN-2; both serotypes contributed to severe disease. As evidenced by the analysis of this epidemic, the epidemiology of dengue can differ according to geographic region and viral serotype.
Assuntos
Vírus da Dengue/classificação , Dengue/epidemiologia , Surtos de Doenças , Adolescente , Criança , Pré-Escolar , Dengue/sangue , Dengue/diagnóstico , Dengue/virologia , Vírus da Dengue/isolamento & purificação , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Lactente , Masculino , Nicarágua/epidemiologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Estações do Ano , Índice de Gravidade de DoençaRESUMO
Diversas alternativas de terapia se han empleado en el tratamiento del osteoma osteoide, desde manejo médico hasta la excisión quirúrgica en bloque, incluso procedimientos percutáneos bajo control de tomografía computada; presentamos el manejo percutáneo con excisión por aspiración del nido, bajo control fluoroscópico, mediante uso de agujas tipo "Osti-cut" y tipo trocar de "Craig-Kogler", con mejoría del paciente
Assuntos
Adolescente , Humanos , Masculino , Osteoma Osteoide , Osteoma Osteoide/terapia , Terapia Assistida por Computador , Fluoroscopia , Sucção , Tomografia Computadorizada por Raios XRESUMO
We report the case of a three week old newborn who developed bilateral adrenal hemorrhage. This is an extraordinary case because of the late presentation of the hemorrhage as well as the excessive amount of blood involved. The newborn was the product of a normally evolved to full-term pregnancy, with a prolonged and traumatic delivery. The child had severe neonatal hypoxia and encephalopathy which required intensive care. The child was discharged in good conditions a week later. A week after that, the child is readmitted due to circulatory collapse, extreme paleness and a hemoglobin count of 3 g/dL. The newborn was treated for hypovolemic shock and improved substantially. The bilateral intraabdominal mass was detected and using an intravenous pyelography, ultrasonography and a CAT scan, a severe bilateral adrenal hemorrhage was seen. Adrenal failure was excluded and the child's care allowed for him to be discharged a week later in excellent conditions an followed as an outpatient until the hematomas subsided. This problem should be suspected in hypoxic newborns for which they should be submitted to abdominal ultrasonography before being discharged.