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Pseudomonas aeruginosa is an opportunistic pathogen found in a wide variety of environments, including soil, water, and habitats associated with animals, humans, and plants. From a One Health perspective, which recognizes the interconnectedness of human, animal, and environmental health, it is important to study the virulence characteristics and antibiotic susceptibility of environmental bacteria. In this study, we compared the virulence properties and the antibiotic resistance profiles of seven isolates collected from the Gulf of Mexico with those of seven clinical strains of P. aeruginosa. Our results indicate that the marine and clinical isolates tested exhibit similar virulence properties; they expressed different virulence factors and were able to kill Galleria mellonella larvae, an animal model commonly used to analyze the pathogenicity of many bacteria, including P. aeruginosa. In contrast, the clinical strains showed higher antibiotic resistance than the marine isolates. Consistently, the clinical strains exhibited a higher prevalence of class 1 integron, an indicator of anthropogenic impact, compared with the marine isolates. Thus, our results indicate that the P. aeruginosa marine strains analyzed in this study, isolated from the Gulf of Mexico, have similar virulence properties, but lower antibiotic resistance, than those from hospitals.
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PURPOSE: We aimed to describe the clinical, immunological, and genetic features of patients with DOCK8 deficiency (DOCK8-Def) in a tertiary care center for children. METHODS: Retrospective chart review of patients' clinical, immunological, and genetic characteristics with DOCK8-Def. Genetic analysis was performed with targeted- or whole-exome sequencing; we also assessed DOCK8 protein expression and a lymphoproliferation assay and analyzed survival by the Kaplan-Meier method. RESULTS: We described 11 patients from 8 unrelated kindreds. The median age at symptoms' onset was 10 months (range 1-54 months). The median follow-up time was 53.4 months (4.8-118.8). All patients presented eczema and recurrent sinopulmonary and cutaneous infections. Besides those symptoms, the most frequent manifestations were bronchiectases (8/11), food allergies (6/11), and severe infections (6/11). Infrequent characteristics were detection of CMV in bronchial lavage, C. parvum-driven sclerosing cholangitis, Takayasu vasculitis, neurological syndromes, pulmonary tuberculosis, and lymphomatoid granulomatosis. CONCLUSION: DOCK8-Def has a broad spectrum of manifestations, including allergy, autoimmunity, inflammation, infection, and cancer. The hallmark of this inborn error of immunity is IEI-associated eczema with eosinophilia and increased IgE. Here, we report six new mutations causing human DOCK8 deficiency and symptoms previously unrecognized to occur in DOCK8-Def. Therefore, an early diagnosis of DOCK8-Def is essential to facilitate an adequate treatment such as HSCT.
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Eczema , Hipersensibilidade , Síndrome de Job , Criança , Humanos , Lactente , Pré-Escolar , Estudos Retrospectivos , Síndrome de Job/genética , Eczema/epidemiologia , Eczema/genética , Mutação , Fatores de Troca do Nucleotídeo Guanina/genéticaRESUMO
Pseudomonas aeruginosa is a widespread γ-proteobacterium and an important opportunistic pathogen. The genetically diverse P. aeruginosa phylogroup 3 strains are characterized by producing the pore-forming ExlA toxin and by their lack of a type III secretion system. However, like all strains of this species, they produce several virulence-associated traits, such as elastase, rhamnolipids and pyocyanin, which are regulated by quorum sensing (QS). The P. aeruginosa QS response comprises three systems (Las, Rhl and Pqs, respectively) that hierarchically regulate these virulence factors. The Pqs QS system is composed of the PqsR transcriptional factor, which, coupled with the alkyl-quinolones HHQ or PQS, activates the transcription of the pqsABCDE operon. The products of the first four genes of this operon produce HHQ, which is then converted to PQS by PqsH, while PqsE forms a complex with RhlR and stabilizes it. In this study we report that mutations affecting the Pqs system are particularly common in phylogroup 3 strains. To better understand QS in phylogroup 3 strains we studied strain MAZ105 isolated from tomato rhizosphere and showed that it contains mutations in the central QS transcriptional regulator, LasR, and in the gene encoding the PqsA enzyme involved in the synthesis of PQS. However, it can still produce QS-regulated virulence factors and is virulent in Galleria mellonella and mildly pathogenic in the mouse abscess/necrosis model; our results show that this may be due to the expression of pqsE from a different PqsR-independent promoter than the pqsA promoter. Our results indicate that using anti-virulence therapy based on targeting the PQS system will not be effective against infections by P. aeruginosa phylogroup 3 strains.
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Percepção de Quorum , Solanum lycopersicum , Animais , Camundongos , Percepção de Quorum/genética , Pseudomonas aeruginosa/metabolismo , Rizosfera , Transdução de Sinais/genética , Fatores de Virulência/genética , Fatores de Virulência/metabolismo , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Regulação Bacteriana da Expressão GênicaRESUMO
BACKGROUND: Microbiomes have been increasingly recognized as major contributors to host health and survival. In amphibians, bacterial members of the skin microbiota protect their hosts by inhibiting the growth of the fungal pathogen Batrachochytrium dendrobatidis (Bd). Even though several studies describe the influence of biotic and abiotic factors over the skin microbiota, it remains unclear how these symbiotic bacterial communities vary across time and development. This is particularly relevant for species that undergo metamorphosis as it has been shown that host physiology and ecology drastically influence diversity of the skin microbiome. RESULTS: We found that the skin bacterial communities of the axolotl A. altamirani are largely influenced by the metamorphic status of the host and by seasonal variation of abiotic factors such as temperature, pH, dissolved oxygen and conductivity. Despite high Bd prevalence in these samples, the bacterial diversity of the skin microbiota did not differ between infected and non-infected axolotls, although relative abundance of particular bacteria were correlated with Bd infection intensity. CONCLUSIONS: Our work shows that metamorphosis is a crucial process that shapes skin bacterial communities and that axolotls under different developmental stages respond differently to environmental seasonal variations. Moreover, this study greatly contributes to a better understanding of the factors that shape amphibian skin microbiota, especially in a largely underexplored group like axolotls (Mexican Ambystoma species).
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Introducción: el síndrome del incisivo central maxilar medio único (SMMCI) es un trastorno de etiología desconocida, con base genética heterogénea, que se caracteriza por la erupción de un único incisivo central en el maxilar y que se puede relacionar con multitud de patologías y síndromes, entre los que destacan las alteraciones de la línea media, obstrucción nasal congénita, disfunción hipofisaria, talla baja y holoprosencefalia. Caso clínico: neonato mujer con síndrome dismórfico no filiado y obstrucción nasal congénita, que es diagnosticada de SMMCI tras consultar en repetidas ocasiones por cuadros de dificultad respiratoria y problemas para alimentarse. Conclusiones: el conocimiento de este raro síndrome es fundamental para la realización de un diagnóstico precoz por parte del equipo pediátrico y obstétrico, ya que un diagnóstico temprano es posible, mejorando la evaluación prenatal ecográfica, así como el adecuado manejo posnatal multidisciplinar posterior de nuestros pacientes.
Introduction: the Solitary Median Maxillary Central Incisor Syndrome (SMMCI) is a disorder of unknown etiology, with a heterogeneous genetic basis, characterized by the eruption of a single central incisor in the maxilla and that can be linked to various pathologies and syndromes, among which the alterations of the midline, congenital nasal obstruction, pituitary dysfunction, short stature and holoprosencephaly stand out. Clinical case: female newborns with unknown dysmorphic syndrome and congenital nasal obstruction, diagnosed with SMMCI after repeated consultations due to respiratory distress and feeding problems. Conclusions: understanding this rare syndrome is essential for an early diagnosis to be carried out by the pediatric and obstetric team, since it will improve the ultrasound prenatal assessment, as well as the adequate subsequent multidisciplinary postnatal patient management procedures.
Introdução: a síndrome do incisivo central maxilar médio solitário (SICMMS) é uma desordem de etiologia desconhecida, com base genética heterogênea, caracterizada pela erupção de um único incisivo central na maxila e que pode estar relacionada a uma infinidade de patologias e síndromes. onde se destacam alterações da linha média, obstrução nasal congênita, disfunção hipofisária, baixa estatura e holoprosencefalia. Caso clínico: recém-nascida com síndrome dismórfica de origem desconhecida e obstrução nasal congênita, diagnosticada com SICMSS após várias consultas por desconforto respiratório e problemas de alimentação. Conclusões: o conhecimento desta rara síndrome é essencial para que a equipe pediátrica e obstétrica possa fazer um diagnóstico precoce, pois ele pode melhorar a avaliação ultrassonográfica pré-natal, bem como o adequado manejo pós-natal multidisciplinar pós-natal dos pacientes.
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Humanos , Feminino , Recém-Nascido , Anormalidades Múltiplas/diagnóstico por imagem , Obstrução Nasal/diagnóstico por imagem , Constrição Patológica/diagnóstico por imagem , Síndrome , Anormalidades Múltiplas/patologia , Obstrução Nasal/cirurgia , Holoprosencefalia/diagnóstico por imagem , Incisivo/anormalidades , Anodontia/complicaçõesRESUMO
INTRODUCTION: Tuberculosis (TB) is an infectious, transmissible and immune disease caused by the Mycobacterium tuberculosis-complex (MTBC). Although osteoarticular tuberculosis (OATB) has been widely described, the ribcage variety remains a rare form. CASE REPORT: A thirteen-month-old male and a twenty-month-old female, both with pain and increased volume of anterolateral left rib cage were described. Physical examination revealed the presence of a soft consistent mass at the level of the 9th and 5th costal arches in the male and female patients respectively. Upon clinical evaluation, tuberculosis was suspected, which was confirmed by X-ray and histopathological studies. After confirmation, the management, based on anti-tuberculosis therapy was started as follows: nine months of anti-tuberculosis therapy for the male patient and fourteen months for the female. The outcomes were favorable for both patients. However, further interventions, consisting of abscess drainage in the male patient and excisional biopsy in the female patient were necessary. With these therapeutic interventions, to date, the patients are without any evidence of active TB.
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Mycobacterium tuberculosis , Tuberculose , Antituberculosos/uso terapêutico , Drenagem , Feminino , Humanos , Lactente , Masculino , Caixa Torácica , Tuberculose/tratamento farmacológicoRESUMO
Resumen El objetivo es mostrar el diagnóstico y la evolución de una paciente con estenosis de venas pulmonares y secuestro pulmonar. Se trata de una niña de 1 año de edad, con bronconeumonías de repetición, acrocianosis, 2R intenso, cardiomegalia, hipertensión venocapilar pulmonar, con diagnóstico clínico de comunicación interauricular. El ecocardiograma mostró estenosis de venas pulmonares izquierdas. El cateterismo cardiaco detectó fístulas arteriovenosas en la región apical del pulmón derecho. La imagen de resonancia magnética y la angiografía mostraron un vaso arterial aberrante paralelo a la aorta abdominal y con flujo dirigido al lóbulo pulmonar derecho. La angiotomografía reportó confluencia de las venas pulmonares del lado derecho. Se realizó lobectomía derecha. La paciente falleció en el posoperatorio debido a una hemorragia masiva pulmonar. Esta paciente es la primera descrita en la literatura con estenosis de venas pulmonares congénita asociada a secuestro pulmonar. La ecocardiografía es el estudio diagnóstico ideal inicial en los pacientes con estenosis congénita de venas pulmonares.
Abstract The objective is demonstrate the diagnostic process and evolution of a patient with a diagnosis of congenital pulmonary vein stenosis and broncho-pulmonary vascular malformation. One year old female patient with repeated bronchopneumonia, acrocyanosis, split S2, cardiomegaly, pulmonary hypertension, with a clinical diagnosis of atrial septal defect. The echocardiogram demonstrated left sided vein pulmonary stenosis. The cardiac catheterization demonstrated arterial-venous fistulas apical on the right lung. Magnetic Resonance image and angiography showed an aberrant arterial vessel parallel to the abdominal aorta which flow the right pulmonary lobe. The cardiac tomography angiography reported confluence of right-sided pulmonary veins. A lobectomy is performed. Patient died in post-operative due to massive pulmonary hemorrhaging. This is the first patient mentioned in written literature with pulmonary vein stenosis associated with pulmonary sequestration, with normal venous connection. Echocardiography represents the specific standard study ideal for initial diagnostic for patients with pulmonary vein stenosis.
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The objective is demonstrate the diagnostic process and evolution of a patient with a diagnosis of congenital pulmonary vein stenosis and broncho-pulmonary vascular malformation. One year old female patient with repeated bronchopneumonia, acrocyanosis, split S2, cardiomegaly, pulmonary hypertension, with a clinical diagnosis of atrial septal defect. The echocardiogram demonstrated left sided vein pulmonary stenosis. The cardiac catheterization demonstrated arterial-venous fistulas apical on the right lung. Magnetic Resonance image and angiography showed an aberrant arterial vessel parallel to the abdominal aorta which flow the right pulmonary lobe. The cardiac tomography angiography reported confluence of right-sided pulmonary veins. A lobectomy is performed. Patient died in post-operative due to massive pulmonary hemorrhaging. This is the first patient mentioned in written literature with pulmonary vein stenosis associated with pulmonary sequestration, with normal venous connection. Echocardiography represents the specific standard study ideal for initial diagnostic for patients with pulmonary vein stenosis.
El objetivo es mostrar el diagnóstico y la evolución de una paciente con estenosis de venas pulmonares y secuestro pulmonar. Se trata de una niña de 1 año de edad, con bronconeumonías de repetición, acrocianosis, 2R intenso, cardiomegalia, hipertensión venocapilar pulmonar, con diagnóstico clínico de comunicación interauricular. El ecocardiograma mostró estenosis de venas pulmonares izquierdas. El cateterismo cardiaco detectó fístulas arteriovenosas en la región apical del pulmón derecho. La imagen de resonancia magnética y la angiografía mostraron un vaso arterial aberrante paralelo a la aorta abdominal y con flujo dirigido al lóbulo pulmonar derecho. La angiotomografía reportó confluencia de las venas pulmonares del lado derecho. Se realizó lobectomía derecha. La paciente falleció en el posoperatorio debido a una hemorragia masiva pulmonar. Esta paciente es la primera descrita en la literatura con estenosis de venas pulmonares congénita asociada a secuestro pulmonar. La ecocardiografía es el estudio diagnóstico ideal inicial en los pacientes con estenosis congénita de venas pulmonares.
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Asymptomatic carriers are a likely source of transmission of Neisseria meningitidis to close contacts who are placed at a higher risk for invasive meningococcal disease (IMD). Although N. meningitidis ciprofloxacin-resistance is rare, there have been an increase in the reports of resistant isolates mainly in patients diagnosed with IMD, and little is known about the N. meningitidis ciprofloxacin-resistance in the carrier populations. We performed a pharyngeal carriage study during a 2017 military setting outbreak in Peru, caused by a ciprofloxacin-resistant N. meningitidis B. The isolates analysed came from two hospitalized cases and six asymptomatic carriers. Whole-genome sequence-based analysis was performed and showed that strains carrying the Thr91Ile mutation, in the gene encoding for subunit A of DNA gyrase (gyrA), were responsible for the fluoroquinolone resistance (MICs ≥0.256 µg ml-1) and were closely related to highly virulent strains from France, Norway and the UK. Phylogenetic analysis of the gyrA gene revealed that likely these Peruvian isolates acquired resistance through horizontal gene transfer from Neisseria lactamica. Our study provides evidence for the emergence and propagation of ciprofloxacin-resistant N. meningitidis B from asymptomatic carriers, and recommends the introduction of serogroup B vaccines for high-risk populations.
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Antibacterianos/farmacologia , Portador Sadio/microbiologia , Ciprofloxacina/farmacologia , Farmacorresistência Bacteriana , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/isolamento & purificação , Portador Sadio/epidemiologia , Humanos , Infecções Meningocócicas/epidemiologia , Testes de Sensibilidade Microbiana , Neisseria meningitidis/classificação , Neisseria meningitidis/efeitos dos fármacos , Neisseria meningitidis/genética , Peru/epidemiologia , FilogeniaRESUMO
Resumen Diferentes investigaciones han evidenciado que el tratamiento con vareniclina es efectivo para dejar de fumar cuando se combina con un tratamiento psicológico. Sin embargo, existe una carencia de estudios respecto a cuánta efectividad aporta la vareniclina al tratamiento psicológico. El objetivo del presente estudio piloto fue evaluar si la efectividad de una intervención psicológica cognitivo-conductual incrementa con la inclusión de la vareniclina. La muestra de este estudio la conformaron 22 fumadores (M edad = 30.5; de = 15.4 años), con un consumo diario promedio de 12.29 (de = 5.7) cigarrillos. Cada participante eligió una de dos intervenciones: 11 fumadores recibieron la Intervención Breve Motivacional para Dejar de Fumar (ibmdf) y 11 la misma intervención más vareniclina. Los resultados indican que no hay diferencias significativas entre las intervenciones. Así, la inclusión de la vareniclina no incrementó la efectividad de la intervención psicológica. Las conclusiones de este estudio deben ser tomadas con cautela debido al tamaño de la muestra, por lo tanto, es necesario aumentar las investigaciones al respecto.
Abstract Different studies have shown that treatment with varenicline is effective for smoking cessation when it is combined with psychological treatment. However, there are few studies on the effectiveness that varenicline adds to psychological treatment. The aim of this pilot study was to assess if the effectiveness of a cognitive behavioral intervention increases with the inclusion of varenicline. The sample of this study were 22 smokers (M age = 39.5, SD = 15.4 years), with an average daily consumption of 12.29 cigarettes (SD = 5.7). Each participant chose one of the two interventions: 11 smokers received the Motivational Smoking Cessation Brief Intervention (mscbm) and 11 the same intervention plus varenicline. The results showed no significant differences between interventions. Thus, the inclusion of varenicline did not increase the effectiveness of psychological intervention. The findings of this study should be taken with caution due to the sample size. More research is therefore needed.
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INTRODUCTION: Several factors have been associated with the development of preeclampsia in women with systemic lupus erythematosus (SLE). OBJECTIVE: To identify risk factors associated with preeclampsia in patients with SLE and its impact on fetal outcomes. PATIENTS AND METHODS: We studied a prospective cohort of pregnancies in women with SLE from January 2009 to December 2018. Demographic, clinical, serological and drug use characteristics were compared between patients who developed preeclampsia and those who did not, as well as the main neonatal outcomes. An adjusted logistic regression analysis was performed to identify factors potentially associated with preeclampsia. RESULTS: We studied 316 pregnancies of 20 or more weeks of gestation. A total of 46 pregnancies (14.5%) were complicated by preeclampsia. A higher frequency of active disease before pregnancy (24.4% vs 11.3%, P = .01) and history of lupus nephritis (56.5% vs 30.1%, P < .001) were found in those patients who developed preeclampsia compared to those who did not. Preeclampsia was associated with a higher rate of prematurity, births of very low birth weight, stillbirth, and neonatal death. The multivariate analysis showed that the activity of the disease before (relative risk [RR] 2.7, 95% CI 1.04-7.4, P = .04) and during pregnancy (RR 3.0, 95% CI 1.0-9.1, P = .04) was associated with the development of preeclampsia. The use of antimalarial drugs during pregnancy was associated with a lower risk of preeclampsia (RR 0.21, 95% CI 0.08-0.53, P < .001). CONCLUSIONS: Our study suggests that the use of antimalarial drugs during pregnancy reduces the risk of preeclampsia in lupus pregnancies.
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Antimaláricos/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Pré-Eclâmpsia/prevenção & controle , Adulto , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/etiologia , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Adulto JovemRESUMO
Primary rib cage tuberculosis (TB) is an infrequent form of presentation and represents 1% of all cases of osteoarticular TB. We report three cases of children who were previously healthy and who began with swelling of the anterior surface of the rib as initial manifestation of TB. The most important clinical presentations in this series were swelling and pain, with lytic lesions and a soft tissue mass in image studies simulating oncologic pathologies. Because none of the cases had positive epidemiological contact, TB was initially not considered, so the delay in diagnosis from the onset of symptoms was 4, 1, and 2 months, respectively. The diagnosis was made through histomorphological analyses. Treatment was administered during 12, 10, and 9 months. Posttreatment studies did not show any evidence of extrapulmonary TB and until date, the patients remained without relapse or active disease. The findings in our cases illustrate that the diagnosis of chest wall TB should be suspected in all patients from endemic areas who present rib injury.
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Antituberculosos/uso terapêutico , Parede Torácica/patologia , Tuberculose Osteoarticular/diagnóstico , Tuberculose Osteoarticular/patologia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Tuberculose Osteoarticular/tratamento farmacológicoRESUMO
Abstract Introduction: Pseudomonas aeruginosa display several resistance mechanisms to carbapenems and such variety makes it difficult to infer from the antibiogram. The aim of this study was to determine the carbapenem resistance genes in P. aeruginosa isolates with different profiles of phe-notypic susceptibility to these antibiotics. Materials and methods: From a microbial collection of P aeruginosa isolates from infected patients, 40 isolates with different carbapenem resistance profiles were selected. The carbapenemases genes, and expression of the OprD porin, the MexAB-OprM efflux pump and the p-lactamase AmpC were determined. Results: From a total of 40 isolates evaluted, in 21 (52.5%) any mechanism of resistance evaluated were detected. In the meropenem-resistant group, overexpression of AmpC (n = 1) and decreased expression of MexAB-OprM (n = 2) and OprD (n = 1) were found. A decrease in the expression of MexAB-OprM was observed in imipenem-resistant group (n = 3) and mutations in the gene encoding the OprD porin (n = 1). Finally, the presence of carbapenemases (VIM, n= 3, KPC-2 / VIM, n = 1) was detected in imipenem-meropenem resistant isolates. Conclusion: The phenotypic susceptibility profiles in P aeruginosa isolates were not explained by the molecular mechanisms explored, with the exception of carbapenemase-producing isolates. These results evidence the complexity of the antibiotic resistance mechanisms involved in this bacterium.
Resumen Introducción: Pseudomonas aeruginosa presenta diferentes mecanismos de resistencia a los carbapenémicos, dificultando su inferencia a partir del antibiograma. El objetivo fue determinar los genes de resistencia a car-bapenémicos en aislados de Pseudomonas aeruginosa con diferentes perfiles de susceptibilidad a estos antibióticos. Materiales y métodos: A partir de una colección microbiana de aislados de P. aeruginosa provenientes de pacientes infectados se seleccionaron 40 aislados con diferentes perfiles de resistencia a carbapenémicos y en los cuales se determinaron los genes de car-bapenemasas, la expresión de la porina OprD, la bomba de expulsión MexAB-OprM y la betalactamasa AmpC. Resultados: El 52,5 % de los aislados no presentó ninguno de los mecanismos de resistencia evaluados. En los resistentes a meropenem se encontró sobreexpresión de AmpC (n=1) y disminución de la expresión de MexAB-OprM (n=2) y OprD (n=1). En los resistentes a imipenem se observó disminución en la expresión de MexAB-OprM (n=3) y mutaciones en el gen que codifica la porina OprD (n=1). En aislados resistentes a imipenem y meropenem se detectó la presencia de carbapenemasas (VIM, n=3, KPC/VIM, n=1). Conclusión: Los mecanismos moleculares hallados no explican el fenotipo de resistencia a carbapenémicos, excepto en los aislados productores de carbapenemasas. Estos resultados evidencian la complejidad de los mecanismos implicados en la resistencia antibiótica en esta bacteria.
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ABSTRACT High performance liquid chromatography profiling with mass spectrometry detection was applicable to identify known and novel multidrug-resistance glycolipid inhibitors from the complex resin glycosides mixture of Ipomoea alba L., Convolvulaceae, seeds. Albinosides X and XI were purified by recycling liquid chromatography and their structural elucidation was accomplished by nuclear magnetic resonance. Albinoside XI exerted a strong potentiation of vinblastine susceptibility in multidrug-resistant human breast carcinoma cells.
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To compare the maternal and fetal outcomes between childhood-onset and adult-onset systemic lupus erythematosus (SLE), we reviewed the medical records of SLE pregnant women treated from January 2005 to August 2013. For comparison, patients were allocated to one of the two groups, those pregnant patients with SLE onset before 18 years of age (childhood-onset) and ≥18 years (adult-onset). The patients were evaluated at least once in each trimester and postpartum. Relevant maternal and fetal outcomes were extracted, such as lupus flare, preeclampsia/eclampsia, rate of liveborns, fetal loss (spontaneous abortion and stillbirth), term delivery, preterm birth, neonatal death, low birth weight, low birth weight at term, and congenital malformations. We studied 186 pregnancies (in 180 women), 58 of them had childhood-onset SLE, and the remaining 128 had adult-onset SLE. The rate of maternal and fetal complications was similar in both groups. Multivariate analysis showed that active SLE before pregnancy, primigravida, renal flare, preeclampsia, lupus flare, anticardiolipin antibodies, and low serum complement were associated with an increased risk of poor maternal and fetal outcomes. The diagnosis of childhood-onset had no impact on maternal-fetal outcome. The maternal and fetal outcome in women with childhood-onset SLE is similar to that reported in women with adult-onset SLE. Pregnancy in women with childhood-onset SLE should not be contraindicated if the disease is well controlled.
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Lúpus Eritematoso Sistêmico/diagnóstico , Complicações na Gravidez/diagnóstico , Resultado da Gravidez , Adolescente , Adulto , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Campylobacter is a leading cause of bacterial gastroenteritis, but sensitive diagnostic methods such as culture are expensive and often not available in resource limited settings. Therefore, direct staining techniques have been developed as a practical and economical alternative. We analyzed the impact of replacing Campylobacter staining with culture for routine stool examinations in a private hospital in Chile. METHODS: From January to April 2014, a total of 750 consecutive stool samples were examined in parallel by Hucker stain and Campylobacter culture. Isolation rates of Campylobacter were determined and the performance of staining was evaluated against culture as the gold standard. Besides, isolation rates of Campylobacter and other enteric pathogens were compared to those of past years. RESULTS: Campylobacter was isolated by culture in 46 of 750 (6.1 %) stool samples. Direct staining only identified three samples as Campylobacter positive and reached sensitivity and specificity values of 6.5 and 100 %, respectively. In comparison to staining-based detection rates of previous years, we observed a significant increase of Campylobacter cases in our patients. CONCLUSION: Direct staining technique for Campylobacter had a very low sensitivity compared to culture. Staining methods might lead to a high rate of false negative results and an underestimation of the importance of campylobacteriosis. With the inclusion of Campylobacter culture, this pathogen became a leading cause of intestinal infection in our patient population.
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Técnicas Bacteriológicas/métodos , Infecções por Campylobacter/microbiologia , Campylobacter/isolamento & purificação , Fezes/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Chile , Corantes , Humanos , Lactente , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Coloração e Rotulagem , Adulto JovemRESUMO
OBJECTIVE: To report our experience in maternal-fetal outcome in women with RA in a national medical referral center. METHODS: A retrospective analysis of the records of pregnant women with rheumatoid arthritis attending at a Pregnancy and Autoimmune Rheumatic Diseases Clinic was performed. Maternal-fetal outcomes such as disease activity, preclampsia/eclampsia, rate of live births, abortions, stillbirths, preterm birth, weeks of gestation, birth weight, congenital malformations and use of anti-rheumatic drugs were studied. RESULTS: We included 73 pregnancies in 72 patients. Disease activity was documented in 47.2% of patients during pregnancy and/or postpartum and 87.7% of patients received some antirheumatic drug. Preclampsia developed in 8.2% of cases. The live birth rate was 98.6%, with preterm delivery in 15.9% and low weight at term in 17.6% of cases. Cesarean section was performed in 77.1% of cases. The disease activity was not associated with a higher percentage of maternal-fetal complications. CONCLUSIONS: Our study showed that most patients do not experience significant activity of RA during pregnancy, fetal outcome is satisfactory and disease activity did not appear to influence significantly the obstetric outcome.
Objetivo: reportar la experiencia en el desenlace materno-fetal de mujeres con artritis reumatoide en un centro médico nacional de referencia.Métodos: se realizó un análisis retrospectivo de los expedientes de mujeres embarazadas con artritis reumatoide que fueron atendidas en una clínica de embarazo y enfermedades reumáticas autoinmunes. Se estudió el desenlace materno-fetal considerado como: actividad de la enfermedad, preeclampsia/eclampsia, tasa de nacidos vivos, abortos, óbitos, parto pretérmino, semanas de gestación, peso al nacer, malformaciones congénitas y uso de fármacos antirreumáticos.Resultados: se incluyeron 73 embarazos en 72 pacientes. Se documentó actividad de la enfermedad en el 47.2 % de las pacientes durante el embarazo y/o posparto. El 87.7 % de las pacientes recibió algún fármaco antirreumático. Se desarrolló preeclampsia en el 8.2 % de los casos. La tasa de nacidos vivos fue de 98.6 %, con parto pretérmino en el 15.9 % y bajo peso a término en el 17.6 % de los casos. El 77.1 % de los productos nació vía cesárea. La actividad de la enfermedad no se asoció a un mayor porcentaje de complicaciones materno-fetales.Conclusiones: nuestro estudio mostró que la mayoría de las pacientes no experimenta actividad significativa de la AR durante el embarazo, el desenlace fetal es satisfactorio y la actividad de la enfermedad no influye de manera importante el desenlace obstétrico.
Assuntos
Artrite Reumatoide , Complicações na Gravidez , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/etiologia , Adulto , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Cesárea/estatística & dados numéricos , Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/etiologia , Feminino , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/etiologia , Seguimentos , Humanos , Recém-Nascido , México , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/etiologia , Gravidez , Complicações na Gravidez/tratamento farmacológico , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Retrospectivos , Natimorto/epidemiologiaRESUMO
The prefrontal cortex (PFC) participates in cognitive functions and stress regulation. Noradrenaline (NA) and serotonin (5-HT) levels in some regions of the central nervous system are modified by acute stress. The effects depend on the type of stressor and the time elapsed between the presence of the stressor and the assessment. The aims of the present study were to assess the acute effect of different stressors on NA and 5-HT activities in the PFC and its relation with corticosterone levels. Independent groups of male Wistar rats (250-280 g) were submitted to restraint, footshock or training in the elevated T-maze (ETMT). The animals were sacrificed immediately (T0) or one hour (T1) after stress exposure. An untreated group sacrificed concurrently with treated animals was included as control. Samples of the PFC were dissected and the concentration of NA, 5-HT and their metabolites were measured by HPLC. Corticosterone levels were measured in serum. None of the treatments modified NA levels in the PFC. Animals exposed to footshock or ETMT showed significantly higher concentrations of 5-HT at T0. Restraint and footshock treatments were associated with higher corticosterone levels at T0 and T1 after the respective treatment. Taken together the results show that in the PFC, the noradrenergic and serotonergic systems, and the corticosterone levels respond in different ways to different stressors.
La corteza prefrontal (CPF) participa en las funciones cognitivas y la regulación del estrés. Las concentraciones de noradrenalina (NA) y serotonina (5-HT) en algunas regiones en el sistema nervioso central son modificadas por el estrés agudo. El efecto depende del estresor y del tiempo que transcurra entre el estresor y la evaluación. El objetivo del presente estudio fue evaluar el efecto agudo de diferentes estresores en la actividad de la NA y 5-HT en la CPF y su relación con los niveles de corticosterona. Grupos independientes de ratas (250-270 g) fueron sometidos a restricción, choque o entrenamiento en el laberinto elevado en T (ELET). Los animales fueron sacrificados inmediatamente (T0) o una hora (T1) después de la exposición al estrés. Un grupo no tratado, sacrificado al mismo tiempo que los animales tratados, se incluyó como control. Las muestras de la CPF fueron disecadas y la concentración de NA, 5-HT y sus metabolitos fue detectada por la técnica de HPLC. Las concentraciones de corticosterona fueron medidas en el suero. Ninguno de los tratamientos modificó las concentraciones de NA en la CPF. Al T0 los animales expuestos a choque o al ELET mostraron concentraciones de 5-HT significativamente mayores que el control. Los tratamientos de restricción y choque estuvieron asociados con altas concentraciones de corticosterona al T0 y a T1 después del tratamiento respectivo. En conjunto, los resultados mostraron que en la CPF los sistemas noradrenérgico y serotonérgico y la concentración de corticosterona responden en forma diferente a los distintos estresores.
O córtex pré-frontal (CPF) participa nas funções cognitivas e na regulação do estresse. As concentrações de noradrenalina (NA) e serotonina (5-HT) em algumas regiões do sistema nervoso central são modificadas pelo estresse agudo. O efeito depende do estressor e do tempo que transcorra entre o estressor e a avaliação. O objetivo do presente estudo foi avaliar o efeito agudo de diferentes estressores na atividade da NA e 5-HT no PFC e sua relação com os níveis de corticosterona. Grupos independentes de ratos (250-270 g) foram submetidos a restrição, choque ou treinamento no labirinto elevado em T (ELET). Os animais foram sacrificados imediatamente (T0) ou uma hora (T1) depois da exposição ao estresse. Um grupo não tratado, sacrificado ao mesmo tempo que os animais tratados, incluiu-se como controle. As mostras do PFC foram dissecadas e a concentração de NA, 5-HT e seus metabolitos foi detectada pela técnica de HPLC. As concentrações de corticosterona foram medidas no soro. Nenhum dos tratamentos modificou as concentrações de NA no PFC. Em T0 os animais expostos a choque o ao ELET mostraram concentrações de 5-HT significativamente maiores que o controle. Os tratamentos de restrição e choque estiveram associados com altas concentrações de corticosterona em T0 e em T1 depois do tratamento respectivo. Em conjunto, os resultados mostraram que no PFC os sistemas noradrenérgico e serotonérgico e a concentração de corticosterona respondem de maneira diferente aos diferentes estressores.
Assuntos
Humanos , Masculino , Feminino , Estresse Psicológico , Corticosterona , Serotonina , Norepinefrina , Córtex Pré-FrontalRESUMO
As part of an ongoing project to identify inhibitors of multidrug efflux pumps, three new resin glycosides, albinosides I-III (1-3), were isolated from a CHCl(3)-soluble extract from the seeds of moon vine (Ipomoea alba). Their structures were established through NMR spectroscopy and mass spectrometry as partially acylated branched pentasaccharides derived from three new glycosidic acids, named albinosinic acids A-C (4-6). The same oligosaccharide core formed by two D-quinovose, one D-glucose, and two L-rhamnose units was linked to either convolvulinolic or jalapinolic acid for 1 and 3, respectively. They were partially esterified with (2R,3R)-3-hydroxy-2-methylbutanoic, acetic, or 2-methyl-2-butenoic acid. Compound 2 has two D-quinovose and three L-rhamnose units, linked to convolvulinolic acid, and its esterifying residues were characterized as two units of 2-methyl-2-butenoic acid. The aglycone lactonization site was located at C-2 of the terminal rhamnose unit (Rha) for 1, at C-3 of the terminal rhamnose unit (Rha') for 2, and at C-3 of the second saccharide unit (Glc) for 3. Reversal of multidrug resistance by this class of plant metabolites was also evaluated in vinblastine-resistant human breast carcinoma cells (MCF-7/Vin). The noncytotoxic compound 3 exerted the strongest potentiation effect of vinblastine susceptibility to over 2140-fold, while a moderate activity was observed for 1 (3.1-fold) and 2 (2.6-fold) at a concentration of 25 µg/mL.