RESUMO
Mycetoma is a localized, chronic, granulomatous disease that can be caused by fungi (eumycetoma) or bacteria (actinomycetoma). Of the 70 different causative agents implicated in mycetoma worldwide, Actinomadura madurae is the only one that causes multiple cases on all continents. Recently, new Actinomadura species were described as causative agents of human mycetoma. One of these new causative agents was Actinomadura mexicana, which was identified in Latin America. Here we demonstrate that this causative agent is not confined to Latin America and that it is also a causative agent of actinomycetoma in Sudan. The disease was managed by antibiotic treatment alone and resulted in complete cure after 6 months of treatment, which is quick when compared with actinomycetoma cases caused by other Actinomadura species.
Assuntos
Micetoma , Actinomadura , Antibacterianos/uso terapêutico , Humanos , Micetoma/tratamento farmacológico , Micetoma/epidemiologia , Sudão/epidemiologiaRESUMO
PURPOSE OF REVIEW: This review describes social determinants of HIV in two geographic and epidemic settings, the Dominican Republic (DR) and Tanzania, among female sex workers (FSW), their influence on HIV outcomes including 90-90-90 goals, and the development and impact of tailored, context driven, community empowerment-based responses in each setting. RECENT FINDINGS: Our review documents the significance of social determinants of HIV including sex work-related stigma, discrimination, and violence and the impact of community empowerment-based approaches on HIV incidence in Tanzania and other HIV prevention, treatment, and care outcomes, including care engagement and adherence, in the DR and Tanzania. Community empowerment approaches where FSW drive the response to HIV and strategically engage partners to target socio-structural and environmental factors can have a demonstrable impact on HIV prevention, treatment, and care outcomes. Such approaches can also support further gains towards reaching the 90-90-90 across geographies and types of epidemics.
Assuntos
Empoderamento , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Profissionais do Sexo/psicologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Adulto , República Dominicana/epidemiologia , Epidemias , Feminino , Humanos , Incidência , Profissionais do Sexo/estatística & dados numéricos , Estigma Social , Tanzânia/epidemiologia , Violência/estatística & dados numéricosRESUMO
The neglected tropical disease mycetoma is a chronic granulomatous inflammatory and infectious disease affecting various body parts. The most common causative agent is the fungus Madurella mycetomatis. In order to study the genetic diversity of this fungus and to monitor any potential outbreaks, a good typing method that can be used in endemic settings is needed. Previous typing methods developed were not discriminative and not easy to perform in resource-limited laboratories. Variable-Number-Tandem-Repeat (VNTR) typing overcomes these difficulties and further enables interlaboratory data comparison. Therefore, in this study we developed a VNTR method for typing M. mycetomatis. Six tandem-repeats were identified in the genome of M. mycetomatis isolate MM55 using an online tandem repeats software. The variation in these repeats was determined by PCR and gel-electrophoresis on DNA obtained from 81 M. mycetomatis isolates obtained from patients. These patients originated from Sudan, Mali, Peru, and India. The 81 isolates were divided into 14 genotypes which separated into two main clusters with seven and five subdivisions, respectively. VNTR typing confirms the heterogeneity of M. mycetomatis strains and can be used to study the epidemiology of M. mycetomatis. The results presented in this article are made fully available to the scientific community on request from the Eumycetoma Working Group. We hope that this open resource approach will bridge scientific community working with mycetoma from all around the world and lead to a deeper understanding of M. mycetomatis.
Assuntos
Variação Genética , Madurella/classificação , Madurella/genética , Repetições Minissatélites , Tipagem Molecular , Micetoma/microbiologia , Técnicas de Tipagem Micológica , África , Análise por Conglomerados , Eletroforese em Gel de Ágar , Genótipo , Humanos , Índia , Madurella/isolamento & purificação , Peru , Reação em Cadeia da PolimeraseRESUMO
BACKGROUND: Early detection and treatment of pediatric asthma could reduce morbidity and lessen burden on society. Currently there is no known research on the prevalence of pediatric asthma in the Dominican Republic (DR) and no known asthma risk assessment tool for one-time encounters in a fast-paced clinic. OBJECTIVES: To pilot a streamlined version of previously validated screening tools to estimate the prevalence of pediatric asthma risk in Santo Domingo Norte, DR. METHODS: A combined asthma questionnaire and clinical assessment tool was developed and administered to patients aged 2-12 years. FINDINGS: We found that 25.7% of the 74 study participants were categorized as probable asthma, 21.6% were at high risk for asthma, 14.9% elevated risk, and 37.8% not at risk. CONCLUSION: If the prevalence of 25.7% is representative of the DR as a whole, the DR would have one of the highest national rates in Latin America. The study assessment tool was convenient to use, but tool validation is needed.
Assuntos
Asma/epidemiologia , Asma/diagnóstico , Criança , Pré-Escolar , República Dominicana/epidemiologia , Humanos , América Latina , Prevalência , Risco , Medição de RiscoAssuntos
Ascomicetos/isolamento & purificação , Dermatoses do Pé/microbiologia , Dermatoses do Pé/patologia , Itraconazol/uso terapêutico , Micetoma/patologia , Adulto , Antifúngicos/uso terapêutico , Biópsia por Agulha , Seguimentos , Dermatoses do Pé/tratamento farmacológico , Humanos , Imuno-Histoquímica , Masculino , Micetoma/diagnóstico , Micetoma/tratamento farmacológico , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
The in vitro susceptibilities of 66 molecularly identified strains of the Mucorales to eight antifungals (amphotericin B, terbinafine, itraconazole, posaconazole, voriconazole, caspofungin, micafungin, and 5-fluorocytosine) were tested. Molecular phylogeny was reconstructed based on the nuclear ribosomal large subunit to reveal taxon-specific susceptibility profiles. The impressive phylogenetic diversity of the Mucorales was reflected in susceptibilities differing at family, genus, and species levels. Amphotericin B was the most active drug, though somewhat less against Rhizopus and Cunninghamella species. Posaconazole was the second most effective antifungal agent but showed reduced activity in Mucor and Cunninghamella strains, while voriconazole lacked in vitro activity for most strains. Genera attributed to the Mucoraceae exhibited a wide range of MICs for posaconazole, itraconazole, and terbinafine and included resistant strains. Cunninghamella also comprised strains resistant to all azoles tested but was fully susceptible to terbinafine. In contrast, the Lichtheimiaceae completely lacked strains with reduced susceptibility for these antifungals. Syncephalastrum species exhibited susceptibility profiles similar to those of the Lichtheimiaceae. Mucor species were more resistant to azoles than Rhizopus species. Species-specific responses were obtained for terbinafine where only Rhizopus arrhizus and Mucor circinelloides were resistant. Complete or vast resistance was observed for 5-fluorocytosine, caspofungin, and micafungin. Intraspecific variability of in vitro susceptibility was found in all genera tested but was especially high in Mucor and Rhizopus for azoles and terbinafine. Accurate molecular identification of etiologic agents is compulsory to predict therapy outcome. For species of critical genera such as Mucor and Rhizopus, exhibiting high intraspecific variation, susceptibility testing before the onset of therapy is recommended.
Assuntos
Antifúngicos/farmacologia , Variação Genética , Mucorales/classificação , Mucorales/efeitos dos fármacos , Filogenia , Análise por Conglomerados , DNA Fúngico/química , DNA Fúngico/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Genes de RNAr , Humanos , Testes de Sensibilidade Microbiana , Dados de Sequência Molecular , Mucorales/genética , RNA Fúngico/genética , RNA Ribossômico/genética , Análise de Sequência de DNARESUMO
OBJECTIVE: : Overactive bladder is a common disease for which current pharmaceutical therapy is often unsatisfactory. Newer modalities, including Botox and InterStim, can be used when antimuscarinics fail. We compare InterStim and Botox using decision analysis. METHODS: : A Markov state transition decision analysis model was constructed using values for efficacy and complications from the literature. Overall utility was compared monthly. Multiple 1-way sensitivity analyses were performed. RESULTS: : For every month during the simulation, overall utility was higher for Botox than InterStim. After 54 months, cumulative utility was 3.86 versus 3.74, favoring Botox for an average yearly quality-adjusted life-year value of 0.86 versus 0.83. All differences were less than minimally important differences for utilities. Few meaningful thresholds were established supporting the robustness of the model. CONCLUSIONS: : Until appropriately powered randomized controlled trials are available, both InterStim and Botox are reasonable and effective strategies with similar outcomes.
RESUMO
A total of 40 bacteria have been successfully isolated from internal organs of the American bullfrog (Rana catesbeiana) raised in Malaysia, namely, eight isolates of Aeromonas spp., 21 of Edwardsiella spp., six of Flavobacterium spp. and five of Vibrio spp. In terms of antibiotic susceptibility testing, each isolate was tested against 21 antibiotics, resulting in 482 (57.3 percent) cases of sensitivity and 61 (7.3 percent) cases of partial sensitivity. Meanwhile, 297 (35.4 percent) bacterial isolates were registered as resistant. The multiple antibiotic resistance (MAR) index of each bacterial species indicated that bacteria from raised bullfrogs have been exposed to tested antibiotics with results ranging from 0.27 to 0.39. Additionally, high percentages of heavy metal resistance among these isolates were observed, with values ranging from 85.0 to 100.0 percent. The current results provided us information on bacterial levels of locally farmed bullfrogs exposed to copper, cadmium, chromium as well as 21 types of antibiotics.(AU)
Assuntos
Animais , Rana catesbeiana/microbiologia , Metais Pesados/administração & dosagem , Vibrio , Resistência Microbiana a Medicamentos , Flavobacterium , Aeromonas , EdwardsiellaRESUMO
A total of 40 bacteria have been successfully isolated from internal organs of the American bullfrog (Rana catesbeiana) raised in Malaysia, namely, eight isolates of Aeromonas spp., 21 of Edwardsiella spp., six of Flavobacterium spp. and five of Vibrio spp. In terms of antibiotic susceptibility testing, each isolate was tested against 21 antibiotics, resulting in 482 (57.3%) cases of sensitivity and 61 (7.3%) cases of partial sensitivity. Meanwhile, 297 (35.4%) bacterial isolates were registered as resistant. The multiple antibiotic resistance (MAR) index of each bacterial species indicated that bacteria from raised bullfrogs have been exposed to tested antibiotics with results ranging from 0.27 to 0.39. Additionally, high percentages of heavy metal resistance among these isolates were observed, with values ranging from 85.0 to 100.0%. The current results provided us information on bacterial levels of locally farmed bullfrogs exposed to copper, cadmium, chromium as well as 21 types of antibiotics.
RESUMO
PURPOSE: We assessed the relationships between bladder symptoms, demographic, and medical history variables and sexual dysfunction in women with overactive bladder (OAB) disorder. MATERIALS AND METHODS: Seventy-eight women diagnosed with OAB completed self-administered questionnaires related to overall heath status, bladder function, and sexual function. Data were compiled for questionnaire responses, and multivariate logistic regression analyses were performed to determine predictors of sexual dysfunction. RESULTS: Bothersome bladder symptoms were reported by > or = 60% of the sample. Sixty-percent of the sample was sexually active in the past month. Difficulty with sexual arousal, orgasm, and sexual enjoyment were reported by about 25% of the women. Sexual partner status was the best predictor of sexual arousal, orgasm, and sexual enjoyment. Menopausal status emerged as an important predictor of arousal and sexual enjoyment. CONCLUSION: The majority of women with symptoms of OAB viewed these symptoms as bothersome. However, the extent of symptom bother did not predict aspects of female sexual dysfunction (FSD). Instead, menopausal and partner status emerged as the best predictors of FSD in our sample.
Assuntos
Disfunções Sexuais Psicogênicas/etiologia , Incontinência Urinária/complicações , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Análise de Regressão , Parceiros Sexuais/psicologia , Inquéritos e Questionários , Incontinência Urinária/psicologiaRESUMO
PURPOSE: We assessed the relationships between bladder symptoms, demographic, and medical history variables and sexual dysfunction in women with overactive bladder (OAB) disorder. MATERIALS AND METHODS: Seventy-eight women diagnosed with OAB completed self-administered questionnaires related to overall heath status, bladder function, and sexual function. Data were compiled for questionnaire responses, and multivariate logistic regression analyses were performed to determine predictors of sexual dysfunction. RESULTS: Bothersome bladder symptoms were reported by ³ 60 percent of the sample. Sixty-percent of the sample was sexually active in the past month. Difficulty with sexual arousal, orgasm, and sexual enjoyment were reported by about 25 percent of the women. Sexual partner status was the best predictor of sexual arousal, orgasm, and sexual enjoyment. Menopausal status emerged as an important predictor of arousal and sexual enjoyment. CONCLUSION: The majority of women with symptoms of OAB viewed these symptoms as bothersome. However, the extent of symptom bother did not predict aspects of female sexual dysfunction (FSD). Instead, menopausal and partner status emerged as the best predictors of FSD in our sample.