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OBJECTIVE: This study aimed to identify the physicochemical and phenotypic characteristics of circulating Extracellular Vesicles (EVs) in the plasma of patients with SLE, with or without Lupus Nephritis (LN), and their potential utility as disease biomarkers. METHODS: Plasma-circulating EVs were concentrated using differential centrifugation from adult female patients (n=38) who met the 'American College of Rheumatology/European Alliance of Associations for Rheumatology 2019' criteria for SLE diagnosis with (LN) or without LN (nLN), confirmed by renal biopsy. Controls (n=18) were healthy volunteers matched by gender and similar age. The structure, size and Energy Dispersion Spectrum (EDS) of EVs were observed by electron microscopy. The surface charge and size distribution were evaluated using dynamic light scattering. The counts and phenotype of EVs from patients (SLE-EVs) and controls (Ctrl-EVs) were obtained using flow cytometry. Non-parametric statistical tests and exploratory analysis of multiple variables were performed. The discriminatory power of some variables as potential biomarkers of the disease was also evaluated. RESULTS: Circulating EVs were heterogeneous in morphology and size, but SLE-EVs reached larger diameters than Ctrl-EVs (p<0.0001). Small SLE-EVs and large SLE-EVs were increased compared with Ctrl-EV (p<0.0001 and p<0.05, respectively). Likewise, patients with SLE (LN or nLN) had higher concentrations of large EVs compared with controls (p<0.001 and p<0.0001, respectively). SLE-EVs showed a different EDS (p<0.001) and were less electronegative (p<0.0001) than Ctrl-EVs. EV-CD45+, EV-CD14+ and EV-IgM+ were more frequent in patients with SLE compared with controls (p<0.001, p<0.05 and p<0.001, respectively). The concentrations of large EVs and EV-IgM+ allowed better discrimination of patients from controls. CONCLUSIONS: Plasma-circulating EVs from patients with SLE with and without nephritis are increased in peripheral blood and have different physicochemical properties than controls. Characteristics of EVs such as larger size and the presence of IgM on the surface could help discriminate patients from controls.
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Biomarcadores , Vesículas Extracelulares , Lúpus Eritematoso Sistêmico , Nefrite Lúpica , Fenótipo , Humanos , Feminino , Vesículas Extracelulares/metabolismo , Adulto , Lúpus Eritematoso Sistêmico/sangue , Biomarcadores/sangue , Nefrite Lúpica/sangue , Nefrite Lúpica/diagnóstico , Pessoa de Meia-Idade , Estudos de Casos e Controles , Citometria de Fluxo/métodosRESUMO
Wastewater surveillance represents an alternative approach to regulating contamination and the early detection of infectious agents and outbreaks of diseases of public health importance. This study evaluated domestic wastewater effects on recreational waters in estuarine and seawater bodies in Guayas and Santa Elena provinces in Ecuador, South America. Fecal indicator bacteria (thermotolerant coliforms) served as key indicators for evaluation. Physical, chemical, and microbiological quality markers following the Ecuadorian environmental quality standard and the discharge of effluents to the water resource were analyzed. Samples were collected from 44 coastal sites and 2 oxidation lagoons during the dry and rainy seasons of 2020 and 2021, respectively. SARS-CoV-2 RNA was detected in samples with higher E. coli concentrations using reverse transcription quantitative PCR to detect the genes N and ORF1ab. All samples analyzed for SARS-CoV-2 showed Ct Ë 40 for at least one gene. Four samples showed at least 20 genome copies of gene N per reaction. These were at an artisanal fishing port, an estuarine area (Palmar), a recreational bay, and an oxidation lagoon. A moderate correlation was found between SARS-CoV-2 RNA, thermotolerant coliform and E. coli (p-value ≤ 0.0037), and a strong and positive correlation between thermotolerant coliform and E. coli. (p-value ≤ 0.00001), highlighting the utility of these established parameters as a proxy of the virus. Significant differences were found in the concentrations of thermotolerant coliforms between seasons (p-value = 0.016) and sites (p-value = 0.005). The highest levels of coliforms were found in the dry season (63000 MPN/100 mL) in Anconcito and during the rainy season (14000 MPN/100 mL) at Esterillo in Playas County. It is recommended that the decentralized autonomous governments of the surveyed provinces in Ecuador implement urgent corrective actions and establish medium-term mechanisms to minimize a potential contamination route. Additional parameters must be included in the monitoring, such as Enterococcus and intestinal parasites, due to their public health implications. In the oxidation lagoons, maintenance actions must be carried out, including the dissolution of sediments, an increase in water retention times, and in situ treatment of the sludge, to improve the system's performance.
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COVID-19 , RNA Viral , SARS-CoV-2 , Esgotos , Qualidade da Água , Equador , Esgotos/virologia , Esgotos/microbiologia , SARS-CoV-2/isolamento & purificação , SARS-CoV-2/genética , RNA Viral/genética , RNA Viral/isolamento & purificação , RNA Viral/análise , COVID-19/epidemiologia , COVID-19/virologia , Humanos , Enterobacteriaceae/isolamento & purificação , Enterobacteriaceae/genética , Microbiologia da Água , Monitoramento Ambiental/métodos , Água do Mar/virologia , Água do Mar/microbiologia , Escherichia coli/genética , Escherichia coli/isolamento & purificação , Águas Residuárias/virologia , Águas Residuárias/microbiologiaRESUMO
Antibiotic overuse and the resulting antimicrobial resistance pose significant global public health challenges, providing an avenue for opportunistic pathogens like Acinetobacter baumannii to thrive. This study will report the trends of Acinetobacter baumannii antimicrobial resistance patterns at the Hospital Teodoro Maldonado Carbo, Ecuador. An observational, analytical, longitudinal, and prospective study was conducted involving patients diagnosed with hospital-acquired infections. Antimicrobial susceptibility testing was performed, followed by molecular analysis of carbapenemase genes in Acinetobacter baumannii isolates. We included 180 patients aged from 16 to 93 years. The hospital mortality rate was 63/180 (35%). Invasive mechanical ventilation (IMV) was indicated in 91/180 patients (50.4%). The overall survival (OS) rate in patients on IMV was 49.5% (45/91), with a median survival of 65 days. The OS rate in patients not on IMV was 80.9% (72/89), with a median survival of 106 days (HR 2.094; 95% CI 1.174-3.737; p = 0.012). From multivariate analysis, we conclude that ventilator-associated pneumonia is the most related factor to OS.
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Kodamaea ohmeri is an environmental yeast considered a rare emerging pathogen. In clinical settings, the correct identification of this yeast is relevant because some isolates are associated with resistance to antifungals. There is a lack of available data regarding the geographical distribution, virulence, and drug resistance profile of K. ohmeri. To contribute to the knowledge of this yeast, this study aimed to describe in depth three isolates of K. ohmeri associated with fungemia in Honduras. The identification of the isolates was carried out by sequencing the ribosomal ITS region. In addition, the susceptibility profile to antifungals was determined, and some properties associated with virulence were evaluated (exoenzyme production, biofilm formation, cell adhesion, and invasion). The isolates showed strong protease, phospholipase, and hemolysin activity, in addition to being biofilm producers. Adherence and invasion capacity were evident in the HeLa and Raw 264.7 cell lines, respectively. This study expands the understanding of the underlying biological traits associated with virulence in K. ohmeri, and it is the first report of the detection and identification of K. ohmeri in Honduras as a cause of human infection.
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The emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants of concern (VOCs) presents global heterogeneity, and their relative effect on pediatric severity is still limited. In this study, we associate VOCs with pediatric clinical severity outcomes in Mexico. Bioinformatics methods were used to characterize VOCs and single amino acid (aa) mutations in 75,348 SARS-CoV-2 genetic sequences from February 2020 to October 2022. High-predominance VOCs groups were calculated and subsequently associated with 372,989 COVID-19 clinical pediatric outcomes. We identified 21 high-frequency mutations related to Omicron lineages with an increased prevalence in pediatric sequences compared to adults. Alpha and the other lineages had a significant increase in case fatality rate (CFR), intensive critical unit (ICU) admission, and automated mechanical ventilation (AMV). Furthermore, a logistic model with age-adjusted variables estimated an increased risk of hospitalization, ICU/AMV, and death in Gamma and Alpha, in contrast to the other lineages. We found that, regardless of the VOCs lineage, infant patients presented the worst severity prognoses. Our findings improve the understanding of the impact of VOCs on pediatric patients across time, regions, and clinical outcomes. Enhanced understanding of the pediatric severity for VOCs would enable the development and improvement of public health strategies worldwide.
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BACKGROUND: Histopathological analysis of tissue samples is an ancillary complementary diagnostic tool in tuberculosis (TB) with variable sensitivity and specificity according to different clinical settings. We evaluated the spectrum of histological findings, their diagnostic sensitivity, diagnostic utility, and requests over time in a sample of archival biopsies. METHODS: Analysis of biopsies of confirmed TB cases between years 2011-2019 at a reference hospital in Chile. RESULTS: The series included patients with a histological study for TB confirmed by culture (88.9%) or PCR (11.1%). In total, 34 samples were available for analysis, most of them of extrapulmonary origin (82.4%). Biopsies were taken before the start of treatment in 26 cases (76.5%) or after the start-end of treatment for different reasons in 8 cases (23.5%). Restricting the analysis to the group with pretreatment biopsies, the prevalence/diagnostic sensitivity of granulomas was 93.3%, 69.2% for caseous necrosis, 26.9% for granulomas with caseous necrosis without acid-fast bacilli (AFB), and 46.2% for AFB in any histological context. A histological score was constructed to evaluate the homogeneity of lesions, observing that 76.9% had at least four of the six components of the score. The request for biopsies was maintained over time despite the increase in the use of molecular techniques. The presence of AFB contributed to the diagnosis before microbiological results in 23.1% of the cases. Conclusions: Histological study continues to contribute to the diagnosis of TB, especially in extrapulmonary forms.
El análisis histopatológico de muestras de tejidos es una metodología antigua y auxiliar para el diagnóstico de tuberculosis (TB) con sensibilidad y especificidad variable de acuerdo al escenario clínico. Evaluamos el espectro de los hallazgos histológicos, su sensibilidad diagnóstica, su utilidad diagnóstica y cambios de solicitud en el tiempo. MÉTODOS: Análisis de biopsias de casos de TB confirmados entre los años 2011-2019 en un hospital de referencia en Chile. RESULTADOS: La serie incluye pacientes con estudio histológico por TB confirmados por cultivo (88,9%) o PCR (11,1%). En total se contó con 34 muestras para análisis, en su mayoría de origen extrapulmonar (82,4%). Las biopsias fueron tomadas antes del inicio del tratamiento en 26 casos (76,5%) o luego del inicio o al finalizar el tratamiento por diferentes razones en 8 casos (23,5%). Restringiendo el análisis al grupo con biopsias pretratamiento, la prevalencia/sensibilidad diagnóstica de granulomas fue de 93,3%, de necrosis caseosa 69,2%, de granulomas con necrosis caseosa sin bacilos ácido-alcohol resistentes (BAAR) de 26,9% y de BAAR en cualquier contexto histológico de 46,2%. Se construyó un score histológico para ver homogeneidad de lesiones, observando que el 76,9% tenía al menos 4 de los 6 componentes del score. La solicitud de biopsias se mantuvo en el tiempo a pesar del incremento de técnicas moleculares. La presencia de BAAR contribuyó al diagnóstico antes que los resultados microbiológicos en el 23,1% de los casos. Conclusiones: El estudio histológico sigue contribuyendo al diagnóstico, especialmente en las formas extrapulmonares de TB.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Tuberculose/diagnóstico , Tuberculose/microbiologia , Tuberculose/patologia , Sensibilidade e Especificidade , Biópsia/métodos , Chile , Estudos Retrospectivos , Granuloma/diagnóstico , Granuloma/microbiologia , Granuloma/patologia , Mycobacterium tuberculosis/isolamento & purificação , Mycobacterium tuberculosis/genéticaRESUMO
We thank the group headed by Jorge Valencia Alonso for taking the time to review in detail and prepare the letter about our article entitled: " Bibliometric analysis of scientific publications on COVID-19 elaborated by staff of the Instituto Mexicano del Seguro Social", which has recently been published in the Medical Journal of the Mexican Social Security Institute. Based on your observations and comments, we allow ourselves to make the following clarifications following the same sequence of your letter to the Editor.
Agradecemos al grupo encabezado por Jorge Valencia Alonso por tomarse el tiempo para revisar con detalle y elaborar la carta sobre nuestro artículo titulado: "Análisis bibliométrico de las publicaciones científicas sobre COVID-19 por personal del IMSS", que recientemente se ha publicado en la Revista Médica del Instituto Mexicano del Seguro Social. De acuerdo con sus observaciones y comentarios, nos permitimos realizar las siguientes aclaraciones siguiendo la misma secuencia de su carta al Editor.
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COVID-19 , Humanos , COVID-19/epidemiologia , México , Previdência Social , Academias e Institutos , BibliometriaRESUMO
Microgrids represent a promising energy technology, because of the inclusion in them of clean and smart energy technologies. They also represent research challenges, including controllability, stability, and implementation. This article presents a dSPACE-control-platform-based implementation of a fixed-switching-frequency modulated model predictive control (M2PC) strategy, as an inner controller of a two-level, three-phase voltage source inverter (VSI) working in an islanded AC microgrid. The developed controller is hierarchical, as it includes a primary controller to share the load equally with the other power converter with its own local modulated predictive-based controller. All details of the implementation are given for establishing the dSPACE-based implementation of the control on a dSPACE ds1103 control platform, using MATLAB/Simulink for the controller design, I/O implementation and configuration with the embedded dSPACE's real-time interface in Simulink, and then using the ControlDesk software for monitoring and testing of the real plant. The latter consists of the VSI operating with LCL filters, and sharing an RL load with a paralleled VSI with exactly the same controller. Finally, the obtained experimental waveforms are shown, with our respective conclusions representing this work, which is a very valuable tool for helping microgrid researchers implement dSPACE-based real-time simulations.
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Twenty years have passed since the emergence of hantavirus zoonosis in Panama at the beginning of this millennium. We provide an overview of epidemiological surveillance of hantavirus disease (hantavirus pulmonary syndrome and hantavirus fever) during the period 1999-2019 by including all reported and confirmed cases according to the case definition established by the health authority. Our findings reveal that hantavirus disease is a low-frequency disease, affecting primarily young people, with a relatively low case-fatality rate compared to other hantaviruses in the Americas (e.g., ANDV and SNV). It presents an annual variation with peaks every 4-5 years and an interannual variation influenced by agricultural activities. Hantavirus disease is endemic in about 27% of Panama, which corresponds to agroecological conditions that favor the population dynamics of the rodent host, Oligoryzomys costaricensis and the virus (Choclo orthohantavirus) responsible for hantavirus disease. However, this does not rule out the existence of other endemic areas to be characterized. Undoubtedly, decentralization of the laboratory test and dissemination of evidence-based surveillance guidelines and regulations have standardized and improved diagnosis, notification at the level of the primary care system, and management in intensive care units nationwide.
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Doenças Transmissíveis , Infecções por Hantavirus , Síndrome Pulmonar por Hantavirus , Febre Hemorrágica com Síndrome Renal , Orthohantavírus , Animais , Infecções por Hantavirus/epidemiologia , Síndrome Pulmonar por Hantavirus/epidemiologia , Panamá/epidemiologia , Roedores , SigmodontinaeRESUMO
OBJECTIVES: To characterize clinical aspects, evaluate the diagnostic opportunity, and identify factors associated with mortality in patients hospitalized for tuberculosis (TB). METHODS: Retrospective study of patients admitted for TB to a Regional Hospital in Chile between 2011 and 2019. RESULTS: 142 TB events required hospitalization in this period (38.2% of total cases). All risk groups were identified, with a significant increase in patients with diabetes mellitus. The pulmonary location was the most frequent (71.1%), followed by disseminated forms (16.2%). The sensitivity of microscopy smear in cases of pulmonary TB (isolated or combined) was 78.8% and lower in cases of bronchoalveolar lavage (58.3%). PCR was only occasionally applied (< 10%) with a sensitivity of 100% in sputum samples. Its use increased progressively and reached a positivity of 33% (6 out of 18 cases) in cases with negative sputum staining. The median time between symptom onset and diagnosis was prolonged (9 weeks), and 32.5% of all regional events were diagnosed at the hospital. Dose adjustments (22.1%), corticosteroid use (25%), and treatment interruptions were frequent (11%). Lethality reached 19%, and by multivariate analysis, only shock was associated with a fatal outcome. CONCLUSIONS: In this case series, the diagnosis of TB cases was delayed, scarcely diagnosed by molecular methods, highly concentrated at the hospital level, required admission in a large percentage of cases, and had a high case-fatality rate.
OBJETIVOS: Caracterizar aspectos clínicos, evaluar la oportunidad diagnóstica e identificar factores asociados a mortalidad en pacientes ingresados por tuberculosis (TB). MÉTODOS: Estudio retrospectivo de pacientes ingresados por TB a un Hospital Regional en Chile entre el 2011 y 2019. RESULTADOS: Un total de 142 eventos de TB requirieron hospitalización en el período (38,2% del total). Todos los grupos de riesgo fueron identificados con un aumento significativo de los pacientes con diabetes mellitus. La localización pulmonar fue la más frecuente (71,1%), seguida de la forma diseminada (2 o más sitios; 16,2%). La sensibilidad de la tinción de expectoración en casos de TB pulmonar (aislada o combinada) fue de 78,8% y más baja en casos de lavado broncoalveolar (58,3%). La PCR fue sólo ocasionalmente aplicada (< 10%) con una sensibilidad del 100% en muestras de expectoración. Su uso aumentó progresivamente en el período y el incremento diagnóstico de TB en casos con tinción negativa de expectoración estudiados con PCR fue de 33% (6 de 18 casos). La mediana entre inicio de síntomas y el diagnóstico fue prolongada (9 semanas) y el 32,5% de los eventos regionales fueron diagnosticados en el hospital. Los ajustes de dosis (22,1%), uso de corticoides (25%) e interrupciones del tratamiento fueron hechos frecuentes (11%). La letalidad alcanzó 19% y en el análisis multivariado sólo la aparición de shock se asoció a un desenlace fatal. CONCLUSIONES: En esta serie de casos, el diagnóstico de casos de TB fue tardío, infrecuentemente diagnosticado por métodos moleculares, concentrado en la atención terciaria, requirió hospitalización en un gran porcentaje de casos y tuvo una elevada letalidad.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/mortalidade , Tuberculose Pulmonar/epidemiologia , Escarro/microbiologia , Tuberculose/diagnóstico , Tuberculose/mortalidade , Tuberculose/epidemiologia , Chile/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Hospitalização/estatística & dados numéricosRESUMO
BACKGROUND: There is an increasing interest in the study of non-criteria antiphospholipid antibodies (aPL) including antibodies targeting domain 1 of the B2 glycoprotein 1 (anti-D1 B2GP1) and antibodies anti phosphatidylserine/ prothrombin (PS/PT). OBJECTIVES: Our aim was to analyze a panel of conventional and non-criteria aPL in a cohort of patients with systemic lupus erythematosus (SLE) and primary antiphospholipid syndrome (APS), to describe if there are differences in aPL titers among groups, to evaluate clinical associations including risk of recurrent events of novel aPL. METHODS: Observational study that evaluated at baseline antibodies against anti-D1 B2GP1 and anti PS/PT. Anti-D1 B2GP1 antibodies were tested using a chemiluminescent immunoassay. IgG and IgM anti PS/PT, aCL and anti B2GP1 by ELISA techniques. Therefore, patients were followed in order to identify new thrombotic events. RESULTS: 133 patients with SLE and 23 with primary APS patients were included. Main APS manifestations were DVT (27%), obstetric morbidity (22%) and arterial thrombosis (10.1%). IgM anti PS/PT antibodies levels were (20.6 - 127) vs 21.9 (11.2 - 39.2) U/ml, p<0.001 in primary APS vs SLE with APS, respectively. Anti-D1 B2GP1, IgG and IgM anti PS/PT were associated with thrombotic and non-thrombotic manifestations. During follow-up, IgG B2GP1 were related with a significant cumulative risk of thrombosis. CONCLUSIONS: We found significant differences in serum titers of non-criteria aPL among patients with primary APS vs SLE with APS. Whether non-criteria aPL antibodies titers are useful to differentiate patients with primary and secondary APS requires further analysis in other populations.
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Síndrome Antifosfolipídica , Lúpus Eritematoso Sistêmico , Trombose , Feminino , Gravidez , Humanos , Síndrome Antifosfolipídica/complicações , Anticorpos Antifosfolipídeos , Lúpus Eritematoso Sistêmico/complicações , Imunoglobulina G , Imunoglobulina MRESUMO
OBJECTIVE: To validate a novel biomarker, airway impedance for extraesophageal disease. STUDY DESIGN: We prospectively recruited patients with respiratory symptoms undergoing combined endoscopy and direct laryngoscopy for the evaluation of symptoms. The direct laryngoscopy was performed and videotaped for blinded scoring by 3 otolaryngologists and an impedance catheter was placed onto the posterior larynx to obtain measurements. Following this, an endoscopy was performed and impedance measurements and biopsies were taken at 3 esophageal heights. Impedance values were compared within and between patients. RESULTS: Eighty-eight patients were recruited, of which 73 had complete airway and endoscopic exams. There was no significant correlation between airway impedance values and mean reflux finding scores (r2 = 0.45, P = .07). There was no significant positive correlation between airway impedance and esophageal impedance values (r2 = 0.097-0.138, P > .2). Patients taking proton pump inhibitors had significantly lower mean airway impedance values (706 ± 450 Ω) than patients not taking them (1069 ± 809 Ω, P = .06). Patients who had evidence of aspiration on video fluoroscopic swallow studies had lower airway impedance (871 ± 615 Ω) than patients without aspiration (1247 ± 360 Ω, P = .008). Inhaled steroids did not impact airway impedance levels (P = .7). CONCLUSIONS: Airway impedance may be an important diagnostic tool to diagnose gastroesophageal reflux or aspiration, eliminating the subjectivity of airway appearance alone.
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Refluxo Gastroesofágico , Humanos , Impedância Elétrica , Refluxo Gastroesofágico/diagnóstico , Laringoscopia , Inflamação , Inibidores da Bomba de Prótons , Endoscopia Gastrointestinal , Monitoramento do pH EsofágicoRESUMO
BACKGROUND: Histopathological analysis of tissue samples is an ancillary complementary diagnostic tool in tuberculosis (TB) with variable sensitivity and specificity according to different clinical settings. We evaluated the spectrum of histological findings, their diagnostic sensitivity, diagnostic utility, and requests over time in a sample of archival biopsies. METHODS: Analysis of biopsies of confirmed TB cases between years 2011-2019 at a reference hospital in Chile. RESULTS: The series included patients with a histological study for TB confirmed by culture (88.9%) or PCR (11.1%). In total, 34 samples were available for analysis, most of them of extrapulmonary origin (82.4%). Biopsies were taken before the start of treatment in 26 cases (76.5%) or after the start-end of treatment for different reasons in 8 cases (23.5%). Restricting the analysis to the group with pretreatment biopsies, the prevalence/diagnostic sensitivity of granulomas was 93.3%, 69.2% for caseous necrosis, 26.9% for granulomas with caseous necrosis without acid-fast bacilli (AFB), and 46.2% for AFB in any histological context. A histological score was constructed to evaluate the homogeneity of lesions, observing that 76.9% had at least four of the six components of the score. The request for biopsies was maintained over time despite the increase in the use of molecular techniques. The presence of AFB contributed to the diagnosis before microbiological results in 23.1% of the cases. CONCLUSIONS: Histological study continues to contribute to the diagnosis of TB, especially in extrapulmonary forms.
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Sensibilidade e Especificidade , Tuberculose , Humanos , Biópsia/métodos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Tuberculose/diagnóstico , Tuberculose/patologia , Tuberculose/microbiologia , Chile , Mycobacterium tuberculosis/isolamento & purificação , Mycobacterium tuberculosis/genética , Idoso , Adulto Jovem , Estudos Retrospectivos , Adolescente , Granuloma/patologia , Granuloma/microbiologia , Granuloma/diagnósticoRESUMO
OBJECTIVES: To characterize clinical aspects, evaluate the diagnostic opportunity, and identify factors associated with mortality in patients hospitalized for tuberculosis (TB). METHODS: Retrospective study of patients admitted for TB to a Regional Hospital in Chile between 2011 and 2019. RESULTS: 142 TB events required hospitalization in this period (38.2% of total cases). All risk groups were identified, with a significant increase in patients with diabetes mellitus. The pulmonary location was the most frequent (71.1%), followed by disseminated forms (16.2%). The sensitivity of microscopy smear in cases of pulmonary TB (isolated or combined) was 78.8% and lower in cases of bronchoalveolar lavage (58.3%). PCR was only occasionally applied (< 10%) with a sensitivity of 100% in sputum samples. Its use increased progressively and reached a positivity of 33% (6 out of 18 cases) in cases with negative sputum staining. The median time between symptom onset and diagnosis was prolonged (9 weeks), and 32.5% of all regional events were diagnosed at the hospital. Dose adjustments (22.1%), corticosteroid use (25%), and treatment interruptions were frequent (11%). Lethality reached 19%, and by multivariate analysis, only shock was associated with a fatal outcome. CONCLUSIONS: In this case series, the diagnosis of TB cases was delayed, scarcely diagnosed by molecular methods, highly concentrated at the hospital level, required admission in a large percentage of cases, and had a high case-fatality rate.
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Tuberculose Pulmonar , Humanos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Chile/epidemiologia , Adulto , Fatores de Risco , Idoso , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/mortalidade , Adulto Jovem , Hospitalização/estatística & dados numéricos , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/mortalidade , Adolescente , Escarro/microbiologiaRESUMO
ABSTRACT For the researchers, physical literacy (AFi) is the objective to be achieved in Physical Education, for seeking competent subjects, capable of adhering to physical activity throughout their lives, with continuous personal, social, affective, and physical development. Quantitative, descriptive-correlational research was carried out, with a non-experimental design and a non-probabilistic sample of 322 subjects, students from 12 to 18 years old from private, public, and subsidized schools in Talca, Chile. The aim was to relate the level of AFi, engagement and perceived emotionality. Data were collected by the Perceived Physical Literacy Instrument (PPLI), Behavioral Engagement Questionnaire (BEQ) and Scale for Mood Assessment (EVEA). A positive relationship was identified with a higher level of physical literacy, higher levels of happiness (r=0.37) and emotional engagement (r=0.54), decreasing the indexes of hostility (r=-0.25) and the private establishments reach the highest levels of anxiety (X̅=3.2). It is concluded that the higher the level of AFi, the greater the commitment and the greater the regulation of emotional factors.
RESUMO A alfabetização física (AFi) é o objetivo para os pesquisadores na Educação Física, buscando sujeitos competentes e capazes de aderir à atividade física ao longo de suas vidas, com desenvolvimento contínuo pessoal, social, afetivo e físico. Esta pesquisa é de natureza quantitativa, descritiva-correlacional, com um desenho não experimental e uma amostra não probabilística de 322 sujeitos, estudantes de 12 a 18 anos de escolas particulares, municipais e subsidiadas na cidade de Talca, Chile. O objetivo foi relacionar o nível de AFi, comprometimento e emocionalidade percebida. Os dados foram coletados por meio do Perceived Physical Literacy Instrument (PPLI), Behavioral Engagement Questionnaire (BEQ) e Escala de Avaliação do Estado de Ânimo (EVEA). Identificou-se uma relação positiva com um maior nível de alfabetização física, maior nível de alegria (r=0,37) e comprometimento emocional (r=0,54), diminuindo os índices de hostilidade (r=-0,25). As escolas particulares atingem os níveis mais altos de ansiedade (X̅=3,2). Conclui-se que um maior nível de AFi está associado a um maior comprometimento e maior regulação dos fatores emocionais.
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Several SARS-CoV-2 variants of concern (VOC) and interest (VOI) co-circulate in Colombia, and determining the neutralizing antibody (nAb) responses is useful to improve the efficacy of COVID-19 vaccination programs. Thus, nAb responses against SARS-CoV-2 isolates from the lineages B.1.111, P.1 (Gamma), B.1.621 (Mu), AY.25.1 (Delta), and BA.1 (Omicron), were evaluated in serum samples from immunologically naïve individuals between 9 and 13 weeks after receiving complete regimens of CoronaVac, BNT162b2, ChAdOx1, or Ad26.COV2.S, using microneutralization assays. An overall reduction of the nAb responses against Mu, Delta, and Omicron, relative to B.1.111 and Gamma was observed in sera from vaccinated individuals with BNT162b2, ChAdOx1, and Ad26.COV2.S. The seropositivity rate elicited by all the vaccines against B.1.111 and Gamma was 100%, while for Mu, Delta, and Omicron ranged between 32 to 87%, 65 to 96%, and 41 to 96%, respectively, depending on the vaccine tested. The significant reductions in the nAb responses against the last three dominant SARS-CoV-2 lineages in Colombia indicate that booster doses should be administered following complete vaccination schemes to increase the nAb titers against emerging SARS-CoV-2 lineages.
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BACKGROUND: The higher number of cases and deaths caused by COVID-19 in Colombia occurred during the third epidemic peak, where the Mu variant was associated with 50% of the cases. OBJECTIVE: To evaluate the association between the clinical outcome of COVID-19 with health conditions and SARS-CoV-2 lineages. METHODS: In this study, clinical metadata and SARS-CoV-2 lineages from 535 patients with different degrees of COVID-19 severity were obtained after the SARS-CoV-2 genomic surveillance in Colombia. Then, the associations between these variables were determined using a multidimensional unfolding analysis. RESULTS: Asymptomatic, symptomatic, severe, and deceased outcomes represented 15.2%, 29.7%, 7.3%, and 47.8% of the cases, respectively. Males tend to develop more serious COVID-19, and severe or fatal outcomes were typically observed in patients aged >60 years with comorbidities, including chronic obstructive pulmonary disease, heart disease, kidney disease, obesity, asthma, and smoking history. The SARS-CoV-2 Mu and Gamma variants dominated the third epidemic peak and accounted for most fatal cases with odd ratio values of 128.2 (CI 53.0-310.1) and 18.6 (CI 8.294-41.917). CONCLUSION: This study shows the high impact of SARS-CoV-2 lineages with higher prevalence on public health and the importance of monitoring COVID-19 risk factors to control the associated mortality.
Assuntos
COVID-19 , Epidemias , Masculino , Humanos , SARS-CoV-2/genética , COVID-19/epidemiologia , Colômbia/epidemiologiaRESUMO
BACKGROUND: The ROX index (Respiratory rate-OXygenation) has been described as a prediction tool to identify the need for invasive mechanical ventilation (IMV) in community-acquired pneumonia (CAP) with acute hypoxaemic respiratory failure treated with high-flow nasal cannula in order to avoid delay of a necessary intubation. However, its use in predicting the need for ventilatory support in hospitalised patients with CAP has not been validated. METHODS: This is a retrospective cohort study including subjects with CAP treated in the general ward, emergency service or intensive care unit of a third-level centre in Cundinamarca, Colombia, between January 2001 and February 2020. The ROX index was estimated as the ratio of oxygen saturation/fraction of inspired oxygen to respiratory rate. RESULTS: A total of 895 patients were included, of whom 93 (10%) required IMV. The ROX index proved to be a good predictor, presenting an area under the curve of receiver operating characteristics (AUROC) of 0.733 (95% CI 0.671 to 0.795, p<0.001) when determined by pulse oximetry and an AUROC of 0.779 (95% CI 0.699 to 0.859, p<0.001) when estimated by arterial blood gas (ABG) parameters, with an intraclass correlation of 0.894. The estimated cut-off point was 14.8; a score less than 14.8 indicates high risk of requiring IMV. CONCLUSION: The ROX index is a good predictor of IMV in hospitalised patients with CAP. It presents good performance when calculated through pulse oximetry and can replace the one calculated by ABG.
Assuntos
Infecções Comunitárias Adquiridas , Pneumonia , Insuficiência Respiratória , Infecções Comunitárias Adquiridas/terapia , Humanos , Pneumonia/terapia , Respiração Artificial , Insuficiência Respiratória/terapia , Estudos RetrospectivosRESUMO
INTRODUCTION: Monkeypox virus (MPXV) is an enveloped double-stranded DNA virus with a genome of approximately 197.209 bp. The current classification divides MPXV into three clades: Clade I (Central African or Congo Basin clade) and clades IIa and IIb (West African clades). OBJECTIVE: To report the complete genome and phylogenetic analysis of a human monkeypox case detected in Colombia. MATERIALS AND METHODS: Exudate from vesicular lesions was obtained from a male patient with recent travel history to Spain. A direct genomic approach was implemented in which total DNA from the sample was purified through a column-based method, followed by sequencing on the Nanopore GridION. Reads were aligned against the MPXV reference genome using minimap2 v.2.24 and phylogenetic inference was performed using maximum likelihood estimation. RESULTS: A total of 11.951 reads mapped directly to a reference genome with 96.8% of coverage (190.898 bp). CONCLUSION: Phylogenetic analysis of the MPXV circulating in Colombia demonstrated its close relationship to clade IIb responsible for the multi-country outbreak in 2022.
Introducción. El virus de la viruela del mono (MPXV) está compuesto por un genoma de ADN bicatenario, aproximadamente, de 197.209 pb. La clasificación actual agrupa el MPXV en tres clados: clado I (de la cuenca del Congo en África central), y clados IIa y IIb (de África occidental). Objetivo. Reportar el genoma completo y el análisis filogenético de un caso humano de viruela símica detectado en Colombia. Materiales y métodos. Se obtuvo exudado de lesiones vesiculares de un paciente varón con el antecedente de un viaje reciente a España. Se implementó un enfoque directo, en el cual se purificó el ADN total de la muestra mediante un método basado en columnas, seguido de la secuenciación directa en la plataforma Nanopore GridION. Las lecturas se alinearon con el genoma de referencia del MPXV, utilizando minimap2, v.2.24, y la inferencia filogenética fue realizada mediante la estimación por máxima verosimilitud. Resultados. Un total de 11.951 lecturas se alinearon directamente con el genoma de referencia con una cobertura del 96,8 % (190.898 pb). Conclusión. El análisis filogenético del MPXV circulante en Colombia demostró su estrecha relación con el clado de África occidental (clado IIb) responsable del brote en múltiples países en el 2022.
Assuntos
Monkeypox virus , Mpox , Colômbia , Humanos , Masculino , Mpox/diagnóstico , Mpox/epidemiologia , Mpox/patologia , Monkeypox virus/genética , Filogenia , Análise de Sequência de DNARESUMO
Introduction: Monkeypox virus (MPXV) is an enveloped double-stranded DNA virus with a genome of approximately 197.209 bp. The current classification divides MPXV into three clades: Clade I (Central African or Congo Basin clade) and clades IIa and IIb (West African clades). Objective: To report the complete genome and phylogenetic analysis of a human monkeypox case detected in Colombia. Materials and methods: Exudate from vesicular lesions was obtained from a male patient with recent travel history to Spain. A direct genomic approach was implemented in which total DNA from the sample was purified through a column-based method, followed by sequencing on the Nanopore GridION. Reads were aligned against the MPXV reference genome using minimap2 v.2.24 and phylogenetic inference was performed using maximum likelihood estimation. Results: A total of 11.951 reads mapped directly to a reference genome with 96.8% of coverage (190.898 bp). Conclusion: Phylogenetic analysis of the MPXV circulating in Colombia demonstrated its close relationship to clade IIb responsible for the multi-country outbreak in 2022.
Introducción. El virus de la viruela del mono (MPXV) está compuesto por un genoma de ADN bicatenario, aproximadamente, de 197.209 pb. La clasificación actual agrupa el MPXV en tres clados: clado I (de la cuenca del Congo en África central), y clados IIa y IIb (de África occidental). Objetivo. Reportar el genoma completo y el análisis filogenético de un caso humano de viruela símica detectado en Colombia. Materiales y métodos. Se obtuvo exudado de lesiones vesiculares de un paciente varón con el antecedente de un viaje reciente a España. Se implementó un enfoque directo, en el cual se purificó el ADN total de la muestra mediante un método basado en columnas, seguido de la secuenciación directa en la plataforma Nanopore GridION. Las lecturas se alinearon con el genoma de referencia del MPXV, utilizando minimap2, v.2.24, y la inferencia filogenética fue realizada mediante la estimación por máxima verosimilitud. Resultados. Un total de 11.951 lecturas se alinearon directamente con el genoma de referencia con una cobertura del 96,8 % (190.898 pb). Conclusión. El análisis filogenético del MPXV circulante en Colombia demostró su estrecha relación con el clado de África occidental (clado IIb) responsable del brote en múltiples países en el 2022.