RESUMO

Since the recent introduction of the Asian longhorned tick (Haemaphysalis longicornis Neumann) in the United States, quantitative surveillance information remains lacking, which hinders accurate estimates of population structure and entomological risk. We conducted statewide, active tick surveillance from May to August 2019 and report data on H. longicornis geographical distribution and population density in Pennsylvania. In total, 615 H. longicornis were collected from four counties. Across samples recovering H. longicornis, mean density of H. longicornis was 9.2/100 m2, comparably greater than Ixodes scapularis Say (8.5/100 m2). Density of H. longicornis was also significantly greater in August, largely driven by larvae, and greater in recreational habitat types (12.6/100 m2) and in Bucks County (11.7/100 m2), situated adjacent to the location of the first U.S. discovery of intense infestations. These data are among the first to document H. longicornis from statewide tick surveillance and provide initial measures of population density enabling more quantitative characterizations of distributional patterns.

Assuntos

RESUMO

Resistant hypertension (RHT) is associated with obstructive sleep apnea (OSA) and increased aortic stiffness, measured by carotid-femoral pulse wave velocity (cf-PWV). We aimed to evaluate in a randomized controlled trial, the effect of Continuous positive airway pressure (CPAP) treatment on cf-PWV in comparison with a control group in patients with RHT and moderate-severe OSA. One-hundred and sixteen patients were randomized to 6-month CPAP treatment (56 patients) or no therapy (60 patients), while keeping their antihypertensive treatment unchanged. Carotid-femoral pulse wave velocity was performed at the beginning and end of the 6-month period. Intention-to-treat intergroup differences in cf-PWV changes were assessed by a generalized mixed-effects model with the allocation group as a fixed factor and adjusted for age, sex, changes in mean arterial pressure and the baseline cf-PWV values. Subgroup sensitivity analyses were performed, excluding patients with low CPAP adherence and low cf-PWV at baseline. CPAP and control groups had similar clinic-laboratorial characteristics. Patients had a mean cf-PWV of 9.4 ± 1.6 m/s and 33% presented cf-PWV > 10 m/s. During treatment, the control group had a mean increase in cf-PWV of +0.43 m/s (95% confidence interval [CI], +0.14 to +0.73 m/s; p = .005), whereas the CPAP group had a mean increase of +0.03 m/s (95% CI, -0.33 to +0.39 m/s; p = .87), resulting in a mean difference in changes between CPAP and control of -0.40 m/s (95% CI, -0.82 to +0.02 m/s; p = .059). Subgroup analyses did not change the results. In conclusion, a 6-month CPAP treatment did not reduce aortic stiffness, measured by cf-PWV, in patients with RHT and moderate/severe OSA, but treatment may prevent its progression, in contrast to no-CPAP therapy.

Assuntos

RESUMO

INTRODUCCIÓN: Las cicatrices queloides afectan hasta el 16% de la población hispana y pueden causar un deterioro en la calidad de vida. La mayoría de los estudios previos han estudiado pacientes con cicatrices hipertróficas secundarias a quemaduras. OBJETIVO: Determinar la calidad de vida en adultos con cicatrices queloides que acuden a un centro dermatológico. MÉTODO: Se realizó un estudio transversal analítico en el Centro Dermatológico Dr. Ladislao de la Pascua, en adultos con diagnóstico de cicatrices queloides. Se midió la calidad de vida mediante el instrumento DLQI (Dermatology Life Quality Index) y se estudiaron las siguientes variables clínicas: edad, sexo, tiempo de evolución, tamaño de la cicatriz, número de cicatrices y topografía afectada. Se aplicó el cuestionario de Beck para el tamizaje de la depresión. RESULTADOS: Se reclutaron 106 adultos con cicatrices queloides (61% hombres y 39% mujeres), con una mediana de edad de 26 años (rango intercuartilar: ±18 años). El puntaje promedio del DLQI fue de 5.58 (desviación estándar [DE]: ± 5.528), con un máximo obtenido de 22 puntos; dicho puntaje se interpreta como un deterioro mínimo de la calidad de vida. La dimensión que más contribuyó al total del puntaje fue la de síntomas y sentimientos, con el 50.36%. El número de cicatrices y la edad se asociaron directamente con el puntaje del DLQI. El puntaje promedio obtenido con el cuestionario de Beck fue de 6.45 (DE: ± 6.46 puntos) y se correlacionó con el puntaje del DLQI. CONCLUSIONES: Las cicatrices queloides tienen un efecto negativo mínimo en la calidad de vida. Dicho efecto se asoció al autorreporte de síntomas depresivos; sin embargo, los resultados de este estudio no permiten atribuirle una relación casual. Se recomienda aplicar el cuestionario de calidad de vida en adultos jóvenes con cicatrices. INTRODUCTION: Keloid scars affect up to 16% of the Hispanic population and may cause deterioration in the quality of life. Most of the previous studies have focused on patients with hypertrophic scars secondary to burns. OBJECTIVE: To determine the quality of life in adults with keloid scars that go to a dermatological center. METHODS: An analytical cross-sectional study was carried out at Centro Dermatológico Dr. Ladislao de la Pascua in adults with a diagnosis of keloid scars. The quality of life was measured using the Dermatology Life Quality Index (DLQI) and the following clinical variables were studied: age, sex, evolution time, scar size, number of scars and affected topography. The Beck questionnaire for depression was also applied. RESULTS: 106 adults with keloid scars were recruited, 61% men and 39% women, with a median age of 26 years (interquartile range: ± 18 years). The average score of the DLQI was 5.58 (standard deviation [SD]: ± 5.528), with a maximum obtained of 22 points, this score is interpreted as a minimum or small deterioration of the quality of life. The dimension that contributed most to the total score was symptoms and feelings, with 50.36%. The number of scars and age were directly associated with the DLQI score. The average score obtained with the Beck questionnaire was: 6.45 (SD: ± 6.46 points) and it correlates with the DLQI score. CONCLUSIONS: Keloid scars have a minimal negative effect on the quality of life of young adults. This effect was associated with the self-report of depressive symptoms; however, the results of this study do not allow to attribute a causal relationship. It is recommended to apply the quality of life questionnaire in young adults with scars.

Assuntos

RESUMO

ABSTRACT Objective: Several mechanisms account for carbapenem resistance in Pseudomonas (P) aeruginosa which is an emerging problem at a tertiary care hospital (TCH) in Jamaica. The observed pattern of carbapenem resistance that results from efflux mechanisms is unique because it is specific to meropenem (MEM). An investigation of efflux as a mechanism of carbapenem resistance was needed as the information obtained could inform therapeutic and infection control strategies. Methods: At the Microbiology Laboratory of a TCH in Jamaica, from May 2009 to March 2011, of 105 multidrug-resistant Gram-negative bacilli isolated from clinical specimens submitted for routine identification and susceptibility testing, all the MEM-resistant P aeruginosa isolates (a total of 10) were selected. They were tested for efflux using the efflux inhibitor phenylalanine-arginine-β-naphthylamide (PAβN) in a method described by Giske et al in 2008. Results: This study detected evidence of MEM efflux in 80% of MEM-resistant P aeruginosa implicated in nosocomial infections at this TCH in Jamaica, using the PAβN inhibition assay. Meropenem-efflux-positive isolates belonged to two unrelated chromosomal lineages. Conclusion: These results underscored the need for improved surveillance and control to prevent this mechanism from emerging in further P aeruginosa strains.

RESUMEN Objetivo: Varios mecanismos explican la resistencia al carbapenem en Pseudomonas (P) Aeruginosa - un problema que recientemente se está presentando en un hospital de atención terciaria (HAT) en Jamaica. El patrón observado de resistencia al carbapenem que resulta de los mecanismos de eflujo es único, porque es específico del meropenem (MEM). Fue necesario realizar una investigación del eflujo como mecanismo de resistencia al carbapenem, ya que la información obtenida podría usarse para las estrategias de terapia y de control de la infección. Métodos: En el Laboratorio de Microbiología de un HAT en Jamaica, de mayo de 2009 a marzo de 2011, de 105 bacilos gram-negativos polifármacorresistentes aislados de especímenes clínicos presentados para identificación de rutina y pruebas de susceptibilidad, se seleccionaron todos los aislados de P aeruginosa (un total de 10) resistentes a MEM. Estos aislados fueron sometidos a prueba de detección de eflujo, usando el inhibidor de eflujo de fenilalanina-arginina-β-naftilamida (PAβN) en un método descrito por Giske et al en 2008. Resultados: Este estudio detectó evidencia de eflujo de MEM en el 80% de P aeruginosa resistente a MEM implicado en infecciones nosocomiales en este HAT de Jamaica, usando el ensayo de inhibición PAβN. Los aislados positivos al eflujo de meropenem pertenecían a dos linajes cromosómicos no relacionados. Conclusión: Estos resultados subrayaron la necesidad de mejorar la vigilancia y el control para prevenir que este mecanismo vuelva a producirse en nuevas cepas de P aeruginosa.

Assuntos

RESUMO

BACKGROUND: Pathogens exert selective pressure which may lead to substantial changes in host immune responses. The human complement receptor type 1 (CR1) is an innate immune recognition glycoprotein that regulates the activation of the complement pathway and removes opsonized immune complexes. CR1 genetic variants in exon 29 have been associated with expression levels, C1q or C3b binding and increased susceptibility to several infectious diseases. Five distinct CR1 nucleotide substitutions determine the Knops blood group phenotypes, namely Kna/b, McCa/b, Sl1/Sl2, Sl4/Sl5 and KCAM+/-. METHODS: CR1 variants were genotyped by direct sequencing in a cohort of 441 healthy individuals from Brazil, Vietnam, India, Republic of Congo and Ghana. RESULTS: The distribution of the CR1 alleles, genotypes and haplotypes differed significantly among geographical settings (p≤0.001). CR1 variants rs17047660A/G (McCa/b) and rs17047661A/G (Sl1/Sl2) were exclusively observed to be polymorphic in African populations compared to the groups from Asia and South-America, strongly suggesting that these two SNPs may be subjected to selection. This is further substantiated by a high linkage disequilibrium between the two variants in the Congolese and Ghanaian populations. A total of nine CR1 haplotypes were observed. The CR1*AGAATA haplotype was found more frequently among the Brazilian and Vietnamese study groups; the CR1*AGAATG haplotype was frequent in the Indian and Vietnamese populations, while the CR1*AGAGTG haplotype was frequent among Congolese and Ghanaian individuals. CONCLUSION: The African populations included in this study might have a selective advantage conferred to immune genes involved in pathogen recognition and signaling, possibly contributing to disease susceptibility or resistance.

Assuntos

RESUMO

BACKGROUND: Extensive studies investigating the role of host genetic factors during malaria associate glucose-6-phosphate dehydrogenase deficiency with relative protection. G6PD deficiency had been reported to associate with anti-malarial drug induced with haemolytic anaemia. METHODS: A total of 301 Gabonese, Ghanaian, and Kenyan children aged 6-120 months with severe malaria recruited in a multicentre trial on artesunate were included in this sub-study. G6PD normal (type B), heterozygous (type A(+)) and deficient (type A(-)) genotypes were determined by direct sequencing of the common African mutations G202A and A376G. Furthermore, multivariate analyses were executed to associate possible contributions of G6PD deficiency with baseline haemoglobin levels, parasitaemia and with severe malarial anaemia. RESULTS: Two hundred and seventy-eight children (132 females and 146 males) were successfully genotyped for G6PD variants. The overall prevalence of G6PD deficiency was 13 % [36/278; 3 % (4/132) female homozygous and 22 % (32/146) male hemizygous], 14 % (40/278) children were female heterozygous while 73 % (202/278) were G6PD normal [67 % (88/132) females and 78 % (114/146) males] individuals. Multivariate regression revealed a significant association of moderately and severely deficient G6PD genotypes with haemoglobin levels according to the baseline data (p < 0.0001; G6PD heterozygous: p < 0.0001; G6PD deficient: p = 0.009), but not with severe malarial anaemia (p = 0.66). No association of G6PD genotypes with baseline parasitaemia. CONCLUSIONS: In this study, moderately (type A(+)) and severely (type A(-)) G6PD deficiency showed significant association with lower haemoglobin concentrations at baseline in African children with severe malaria without leading to severe malarial anaemia. In addition, there was no association of G6PD variant types with parasite densities on admission.

Assuntos

RESUMO

OBJECTIVE: Aminoglycosides were introduced into use over 60 years ago. The University Hospital of the West Indies (UHWI), a tertiary care teaching hospital, in Kingston, Jamaica, introduced the use of gentamicin in 1973 and amikacin in 1980. This report examined the susceptibility patterns to these agents in 1547 consecutive isolates of Gram negative bacilli (GNB) encountered between September 1 and November 30, 2011, at UHWI and compares the data with those observed previously in 1981 at the same institution. METHODS: The Vitek 2 (bioMeriéux, Durham, NC) was used for isolate identification, minimum inhibitory concentration determination and aminoglycoside susceptibility testing. Quality control was done using American Type Culture Collection standard strains of E coli (ATCC 25922) and Pseudomonas aeruginosa (ATCC 27853). RESULTS: Of the 1547 organisms, 267 had resistance to one or both aminoglycosides. Amikacin resistance increased from 0.6% (1981) to 7.2% [2011] (p < 0.05), while gentamicin resistance increased from 6.7% to 14.8% (p < 0.05) for the corresponding period. The majority of samples with aminoglycoside resistant organisms came from the intensive care unit and surgical inpatients. Urine samples persistently produced the largest amount of gentamicin resistant isolates. CONCLUSIONS: Although there has been a statistically significant rise in aminoglycoside resistance, aminoglycosides continue to remain highly effective against approximately 83% of GNB despite continuous usage at this institution for over three decades. Continued national surveillance, implementation of infection control policies and antibiotic stewardship are all essential in retaining low resistance levels.

RESUMO

OBJECTIVES: Correlates of serial aortic stiffness changes were scarcely evaluated. We aimed to evaluate them in patients with resistant hypertension, with particular attention to the importance of changes in clinic and ambulatory blood pressures (BP). METHODS: In a prospective study, two carotid-femoral pulse wave velocity (cf-PWV) measurements (three measures in each occasion) were performed with the Complior equipment in 442 resistant hypertensive patients over a mean follow-up of 4.6 years. Multivariable regressions assessed the independent correlates of changes in cf-PWV. All analyses were further adjusted for baseline cf-PWV and BP values, and for the time interval between measurements. RESULTS: Carotid-femoral PWV had a median increase of 0.11 m/s per year (1.1% per year). Overall, 224 patients (51%) had an increase or persisted with high cf-PWV, whereas 218 (49%) reduced or persisted with low values. On multivariable regressions, both changes in clinic SBP (partial correlation 0.34, P < 0.001) and in 24-h SBP (partial correlation 0.40, P < 0.001) were correlates of changes in cf-PWV. This means that the white-coat effect, defined as the difference between clinic and daytime BPs, affected cf-PWV changes (partial correlation 0.19, P < 0.001). The other independent correlates of aortic stiffness progression were older age, presence of diabetes, higher waist circumference and worse renal function. CONCLUSION: The exaggerated white-coat effect, by acutely increasing clinic BPs during cf-PWV examination, may partially obscure the beneficial effects of reducing ambulatory BP levels on aortic stiffness attenuation. Arterial stiffness measurements under ambulatory conditions may be needed to correctly assess aortic stiffness changes in resistant hypertensive patients.

Assuntos

RESUMO

Chemically chlorinated organic matter as well as natural background humic acids contain significant amounts of organically bound halogens that must be determined for assessment of environmental pollution. In this work the use of ion chromatography (IC) and inductively coupled plasma mass spectrometry (ICP-MS) is proposed for the determination of total organic Cl, Br and I concentration in humic acids extracted from various forest soil horizons after a single digestion by microwave-induced combustion (MIC). Samples were pressed as pellets and combusted using 20 bar of oxygen and ammonium nitrate solution as igniter. Analytes were absorbed in diluted alkaline solution (50mM (NH(4))(2)CO(3)) and a reflux step was applied after combustion to improve analyte recoveries (5 min, microwave power of 1400W). The accuracy was evaluated using certified reference materials (CRM) and spiked samples. Using MIC the agreement with CRM values and spike recoveries was higher than 97% for all analytes. As an advantage over conventional procedures, using MIC it was possible to digest up to eight samples in only 25 min, obtaining a single solution suitable for all halogens determination in humic acids samples by different techniques (IC and ICP-MS). The limit of detection (3σ) for Cl, Br and I obtained by IC was 1.2, 2.5 and 4.3µgg(-1) and by ICP-MS it was 1.4, 0.03 and 0.002µgg(-1), respectively.

Assuntos

RESUMO

Human memory is limited in the number of items held in one's mind--a limit known as "Miller's magic number". We study the emergence of such limits as a result of the statistics of large bitvectors used to represent items in memory, given two postulates: i) the Sparse Distributed Memory; and ii) chunking through averaging. Potential implications for theoretical neuroscience are discussed.

Assuntos

RESUMO

The subtypes of the human immunodeficiency virus - type 1 (HIV-1) strains from 54 HIV-1 - infected persons including 44 strains which were typed previously by heteroduplex mobility assay (HMA) were determined by DNA sequencing and phylogenetic analysis. Of 54 HIV- infected persons, 92.5% were infected with HIV-1 subtype B and 7.5% with other HIV-1 subtypes including subtypes D (3.7%), A (1.9%) and J (1.9%). In the phylogenetic analysis, the subtype A virus found in the sample clustered with subtype A reference strains and a circulating recombinant form (CRF) reference strain which originates in Central Africa and is circulating in Cuba indicating a close relationship between these viruses. There was 86% concordance between HMA and DNA sequencing in assigning subtype B viruses. For the non-B subtype viruses, there was less concordance between the two methods (67%). The results confirm the predominance of HIV-1 subtype B strains and the high genetic diversity of HIV-1 strains in circulation in Jamaica. The efficacies and some limitations of the HMA as a method of HIV-1 subtyping also were noted. It is important that the HIV/AIDS epidemic in Jamaica be monitored meticulously for possible expansions in non-B subtypes and the emergence of inter-subtype recombinant forms. We recommend that the more expensive DNA sequencing and phylogenetic analysis, including HIV-1 genotyping for antiretroviral drug resistance testing, be used as an adjunct to the more cost-effective HMA to track the HIV/AIDS epidemic in Jamaica.

Assuntos

RESUMO

OBJECTIVE: The relationship between human leukocyte antigens class II (HLA) and antinuclear antibodies was investigated in Jamaican patients with Systemic Lupus Erythematosus (SLE). METHODS: Samples of blood of 82 patients with SLE and 75 healthy controls were tested for antinuclear antibodies using the fluorescent antinuclear antibody (FANA) test, counterimmunoelectrophoresis (CIEP) and the Crithidia luciliae immunofluorescence test (CL-IFT). A DNA-based HLA typing method was used to determine the frequencies of alleles of HLA-DRB1, DRB3, DRB4 and DRB5 in patients and healthy controls. RESULTS: The FANA test was positive in all of the sera from patients with SLE. Anti-dsDNA antibodies were present in 49% (40/82), anti-Sm/RNP 44% (36/82) and anti-Ro/La 43% (35/82) of the sera from SLE patients. The frequency of HLA-DR4 was significantly lower in SLE patients than in healthy controls (2/82, 2% vs 15/75, 20%; RR = 0.12; p = 0.0004; CP = 0.005) but no other HLA-DRB1 SLE associations were found. A positive HLA-DR3 anti-Ro/La antibody association was found in the patients with SLE (9/21, 43% vs 5/55, 9%; odds ratio (OR) = 7.5; CP = 0.01). In contrast, possession of HLA-DR6 was negatively associated with the absence of anti-dsDNA antibodies (9/32, 28% vs 27/44, 61%; OR = 0.2; CP = 0.05). CONCLUSION: The HLA-DR6 allele is associated with the absence of antinuclear antibodies and HLA-DR3 with the presence of anti-Ro/La antibodies in Jamaican patients with SLE. However, these results and those of previous studies of Jamaican patients suggest that the HLA-DR3 association with the development of SLE reported in other populations might in fact reflect the association of HLA-DR3 with anti-Ro/La antibodies. Further investigations are needed to determine whether HLA-DRB antinuclear antibody associations define clinical subsets of SLE in Jamaican patients.

Assuntos

RESUMO

OBJECTIVE: The relationship between human leukocyte antigens class II (HLA) and antinuclear antibodies was investigated in Jamaican patients with Systemic Lupus Erythematosus (SLE). METHODS: Samples of blood of 82 patients with SLE and 75 healthy controls were tested for antinuclear antibodies using the fluorescent antinuclear antibody (FANA) test, counterimmunoelectrophoresis (CIEP) and the Crithidia luciliae immunofluorescence test (CL-IFT). A DNA-based HLA typing method was used to determine the frequencies of alleles of HLA-DRB1, DRB3, DRB4 and DRB5 in patients and healthy controls. RESULTS: The FANA test was positive in all of the sera from patients with SLE. Anti-dsDNA antibodies were present in 49% (40/82), anti-Sm/RNP 44% (36/82) and anti-Ro/La 43% (35/82) of the sera from SLE patients. The frequency of HLA-DR4 was significantly lower in SLE patients than in healthy controls (2/82, 2% vs 15/75, 20%; RR = 0.12; p = 0.0004; CP = 0.005) but no other HLA-DRB1 SLE associations were found. A positive HLA-DR3 anti-Ro/La antibody association was found in the patients with SLE (9/21, 43% vs 5/55, 9%; odds ratio (OR) = 7.5; CP = 0.01). In contrast, possession of HLA-DR6 was negatively associated with the absence of anti-dsDNA antibodies (9/32, 28% vs 27/44, 61%; OR = 0.2; CP = 0.05). CONCLUSION: The HLA-DR6 allele is associated with the absence of antinuclear antibodies and HLA-DR3 with the presence of anti-Ro/La antibodies in Jamaican patients with SLE. However, these results and those of previous studies of Jamaican patients suggest that the HLA-DR3 association with the development of SLE reported in other populations might in fact reflect the association of HLA-DR3 with anti-Ro/La antibodies. Further investigations are needed to determine whether HLA-DRB antinuclear antibody associations define clinical subsets of SLE in Jamaican patients.

OBJETIVO Se investigó la relación entre los antígenos de leucocito humano (human leukocyte antigens o HLAs). Clase II y los anticuerpos antinucleares en pacientes jamaicanos con lupus eritematoso sistémico (LES). MÉTODOS: Se examinaron muestras de sangre de 82 pacientes con LES y 75 controles saludables para determinar la presencia de anticuerpos antinucleares, usando la prueba del anticuerpo antinuclear fluorescente (FANA), la contrainmunoelectroforesis (CIEP) y el test de inmunofluorescencia con Crithidia luciliae (CL-IFT). Un método de tipificación HLA basado en el ADN fue usado para determinar las frecuencias de aleles de HLA-DRB1, DRB3, DRB4 y DRB5 tanto en los pacientes como en los controles saludables. RESULTADOS: La prueba FANA fue positiva en todos los sueros de pacientes con LES. Anticuerpos anti-dsADN se hallaban presentes en 49% (40/82), anti-Sm/RNP en 44% (36/82) y anti-Ro/La en 43% (35/82) de los sueros de los pacientes de LES. La frecuencia de HLA-DR4 fue significativamente más baja en los pacientes con LES que en los controles saludables (2/82, 2% vs 15/75, 20%; RR = 0.12; p = 0.0004; CP = 0.005) pero no se hallaron otras asociaciones de LES con HLA-DRB1. Se halló una asociación positiva de anticuerpos HLA-DR3 anti-Ro/La en los pacientes con LES (9/21, 43% vs 5/55, 9%; odds ratio (OR) = 7.5; CP = 0.01). En contraste con ello, la posesión de HLA-DR6m estuvo asociada negativamente con la ausencia de anticuerpos anti-dsADN (9/32, 28% vs 27/44, 61%; OR = 0.2; CP = 0.05). CONCLUSIÓN: El alele HLA-DR6 está asociado con la ausencia de anticuerpos antinucleares y el de HLA-DR3 con la presencia de anticuerpos anti-Ro/La en pacientes jamaicanos con LES. Sin embargo, estos resultados al igual que los de los previos estudios de pacientes jamaicanos, sugieren que la asociación HLA-DR3 con el desarrollo de LES reportado en otras poblaciones podría de hecho reflejar la asociación de HLA-DR3 con anticuerpos anti-Ro/La. Se requieren investigaciones ulteriores a fin de determinar si las asociaciones de anticuerpo antinuclear HLA-DRB definen subconjuntos de LES en pacientes jamaicanos.

Assuntos

RESUMO

The prevalence and significance of coagulase negative staphylococci (CoNS) isolated from blood cultures at the University Hospital of the West Indies (UHWI) during a six-month period were investigated. Standard and automated microbiological procedures were used to process 3001 blood culture specimens received from 2363 patients and 658 (21.9%) of the blood cultures yielded 854 bacterial isolates. The highest prevalence of positive blood cultures (60%) and the lowest prevalence of blood isolates of CoNS (12%) were found in the intensive care unit (ICU). The blood isolates of CoNS were most frequent in the surgical wards (13%) and lowest in obstetrics and gynaecology (2%). High rates of resistance to methicillin, other anti-staphylococcal penicillins, and cephalosporins used in the treatment of CoNS were observed All blood isolates of CoNS (100%) were susceptible to vancomycin. In conclusion, the results show that coagulase-negative staphylococci are the most prevalent bacterial isolates in blood cultures at the UHWI occurring mostly as contaminants. The practice of proper venepuncture and hand-washing techniques by medical staff are recommended to facilitate appropriate antibiotic usage.

Assuntos

RESUMO

The prevalence and significance of coagulase negative staphylococci (CoNS) isolated from blood cultures at the University Hospital of the West Indies (UHWI) during a six-month period were investigated. Standard and automated microbiological procedures were used to process 3001 blood culture specimens received from 2363 patients and 658 (21.9) of the blood cultures yielded 854 bacterial isolates. The highest prevalence of positive blood cultures (60) and the lowest prevalence of blood isolates of CoNS (12) were found in the intensive care unit (ICU). The blood isolates of CoNS were most frequent in the surgical wards (13) and lowest in obstetrics and gynaecology (2). High rates of resistance to methicillin, other anti-staphylococcal penicillins, and cephalosporins used in the treatment of CoNS were observed All blood isolates of CoNS (100) were susceptible to vancomycin. In conclusion, the results show that coagulase-negative staphylococci are the most prevalent bacterial isolates in blood cultures at the UHWI occurring mostly as contaminants. The practice of proper venepuncture and hand-washing techniques by medical staff are recommended to facilitate appropriate antibiotic usage.

Se investigó la prevalencia e importancia de los estafilococos coagulasa negativos (ECoN) aislados de cultivos de sangre en el Hospital Universitario de West Indies (HUWI) por un período de seis meses. Se utilizaron procedimientos microbiológicos estándar y automatizados para procesas 3001 cultivos de sangre recibidos de 2363 pacientes y 658 (21.9%) de los cultivos dieron 854 aislados bacterianos. La más alta prevalencia de cultivos de sangre positivos (60%) y la más baja prevalencia de aislados de ECoN (12%) se encontraron en la Unidad de Cuidados Intensivos (UCI). Los aislados de sangre de ECoN fueron más frecuentes en las salas de cirugía (13%) y más bajos en las de obstetricia y ginecología (2%). Se observaron altas tasas de resistencia a la meticilina, así como a otras penicilinas anti-estafilocócicas y cefalosporinas usadas en el tratamiento de ECoN. Todos los aislados de sangre de ECoN (100%) fueron susceptibles a la vancomicina. En conclusión, los resultados muestran que los estafilococos coagulasa negativos son los aislados bacterianos más prevalentes en cultivos de sangre en el HUWI, presentándose en la mayor parte de los casos como contaminantes. Se recomienda la práctica de técnicas adecuadas de venepuntura y lavado de manos por parte del personal médico a fin de facilitar un uso antibiótico correcto.

Assuntos

RESUMO

The subtypes of 141 isolates of human immunodeficiency virus type-1 (HIV-1) from Jamaica were determined by a combination of env and gag heteroduplex mobility analysis (HMA) genotyping. The majority of HIV-1 isolates were subtype B (131/141, 93.0); one (0.8) isolate each of subtypes C, D and E was found and 7 (4.9) were indeterminate. These results and the failure of the sets of primers used to amplify some of the HIV-1 isolates provide strong evidence of genetic diversity of the HIV/AIDS epidemic in Jamaica. Surveillance of the circulating HIV-1 genetic subtypes is a pre-requisite for developing regional vaccine strategies and understanding the transmission patterns of the virus. This is the first study of its kind in Jamaica and the findings complement data from other Caribbean countries. This work supports the view of colleagues from the French and Spanish-speaking Caribbean that an epidemiological network supported by regional laboratories will help track this epidemic accurately with positive outcomes for the public.

Los subtipos de 141 aislados del virus tipo 1 de la inmunodeficiencia humno (VIH-1) en Jamaica, fueron determinados combinando la genotipificación por análisis de heterodúplex (HMA) en los genes env y gag. La mayor parte de los aislados HIV-1 fueron del subtipo B (131/141, 93.0%), se halló uno (0.8%) aislado para cada uno de los subtipos C, D y E, en tanto que 7 (4.9%) fueron indeterminados. Estos resultados y el fallo de los conjuntos de primers usados para amplificar algunos de los aislados de VIH-1, ofrecen fuerte evidencia de la diversidad epidémica del VIH/SIDA en Jamaica. La vigilancia de los subtipos genéticos de VIH-1 en circulación, constituye un pre-requisito, tanto para desarrollar estrategias de vacunas a nivel regional, como para entender los patrones de transmisión del virus. Este es el primer estudio de este tipo en Jamaica, y nuestros hallazgos complementan los datos obtenidos en otros países del Caribe. Coincidimos con nuestros colegas del Caribe francófono e hispano-parlante en cuanto a que una red epidemiológica apoyada por los laboratorios regionales, nos ayudaría a continuar rastreando esta epidemia con exactitud, y con resultados positivos para el público.

Assuntos

RESUMO

The subtypes of 141 isolates of human immunodeficiency virus type-1 (HIV-1) from Jamaica were determined by a combination of env and gag heteroduplex mobility analysis (HMA) genotyping. The majority of HIV-1 isolates were subtype B (131/141, 93.0%); one (0.8%) isolate each of subtypes C, D and E was found and 7 (4.9%) were indeterminate. These results and the failure of the sets of primers used to amplify some of the HIV-1 isolates provide strong evidence of genetic diversity of the HIV/AIDS epidemic in Jamaica. Surveillance of the circulating HIV-1 genetic subtypes is a pre-requisite for developing regional vaccine strategies and understanding the transmission patterns of the virus. This is the first study of its kind in Jamaica and the findings complement data from other Caribbean countries. This work supports the view of colleagues from the French and Spanish-speaking Caribbean that an epidemiological network supported by regional laboratories will help track this epidemic accurately with positive outcomes for the public.

Assuntos

RESUMO

OBJECTIVES: Graves' disease is associated with different human leucocyte antigen (HLA) genes in different populations. This studywasdesigned to examinethe HLA class II associations with Graves' disease in Jamaicans. PATIENTS: One hundred and six Jamaicans with Graves' disease and 104 controls. DESIGN: Oligotyping for HLA-DRB1, DRB3, DQA1 and DQB1 alleles was performed using the polymerase chain reaction sequence specific oligonucleotide probe (PCR-SSOP) technique. RESULTS The frequency of HLA-DRB3 *0101 was increased significantly in the patients compared to controls (38.7% vs. 19.2%; RR = 2.72; Pc < 0.015). The protective alleles for Graves' disease were DRB1 *0901 (0.9% vs. 20.2%; RR = 0.04; Pc < 0.001), DRB1*1001 (0.0% vs. 11%; RR = 0.0%; Pc < 0.01) and DRB4 *0101 (0.0% vs. 12.5%; RR = 0.0; Pc < 0.05). A high female to male ratio of Graves' disease, 25 :1, was observed. Other associated autoimmune diseases were rare and no significant HLA class II associations were found with clinical markers of disease. CONCLUSIONS: Jamaican patients with Graves' disease share the DRB3 *0101 susceptible allele and the DRB4 *01 protective allele but not the susceptible haplotype DRB1 *0301, DRB3*0101, DQA1*0501 with Caucasians.

Assuntos