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In Mexico, hepatitis B and C infections are a significant burden on the health system. The aim of this narrative review was to analyze the state of the art on hepatitis B and C in Mexico by searching and studying available data in academic articles and government reports and statements on epidemiology, prevention, treatment, and elimination strategies undertaken by the Mexican government. Even where the government has implemented a hepatitis B vaccination strategy to reduce its incidence, a very low proportion of people complete the vaccination schedule. Regarding hepatitis C, there is a National Elimination Program that emphasizes the importance of screening, diagnosis, and treatment focused on the population at risk. With the implementation of this program, more than a million fast tests have been carried out and the positive cases have been verified by viral load. Infected patients are tested to determine liver function, fibrosis stage, and coinfection with HBV and/or HIV. Patients without cirrhosis and/or coinfections are treated in first-level care centers, while those with cirrhosis and/or comorbidities are referred to specialists. The possibility of hepatitis C eradication in Mexico seems more likely than eradication of hepatitis B; however, major challenges remain to be overcome to reach both infections' elimination.
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Biofilm-producing methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococci (MR-CoNS) pose clinical challenges in treating healthcare-associated infections. As alternative antimicrobial options are needed, in this study, we aimed to determine the effect of curcumin-chitosan magnetic nanoparticles (Cur-Chi-MNP) on the biofilms of staphylococcal clinical isolates. MRSA and CoNS clinical isolates were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Antimicrobial susceptibility testing was performed using the broth microdilutions. Nanoparticles were synthesized by the co-precipitation of magnetic nanoparticles (MNP) and encapsulated by the ionotropic gelation of curcumin (Cur) and chitosan (Chi). Biofilm inhibition and eradication by nanoparticles, with and without the addition of oxacillin (OXA), were assessed in Staphylococcus strains. Cur-Chi-MNP showed antimicrobial activity against planktonic cells of MRSA and MR-CoNS strains and inhibited MRSA biofilm. The addition of OXA to Cur-Chi-MNP increased the biofilm inhibition and eradication activity against all staphylococcal strains (P = 0.0007), and higher biofilm activity was observed in the early biofilm stages. Cur-Chi-MNP showed antimicrobial and biofilm inhibitory activities against S. aureus. Addition of OXA increased biofilm inhibition and eradication activity against all staphylococcal strains. A combination treatment of Cur-Chi-MNP and OXA could potentially be used to treat staphylococcal biofilm-associated infections in the early stages before the establishment of biofilm bacterial cells.
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Antibacterianos , Biofilmes , Quitosana , Curcumina , Staphylococcus aureus Resistente à Meticilina , Testes de Sensibilidade Microbiana , Infecções Estafilocócicas , Biofilmes/efeitos dos fármacos , Quitosana/farmacologia , Quitosana/química , Curcumina/farmacologia , Antibacterianos/farmacologia , Humanos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Nanopartículas de Magnetita/química , Oxacilina/farmacologia , Staphylococcus/efeitos dos fármacos , Staphylococcus/fisiologiaRESUMO
The aim of the present study was first to isolate Helicobacter pylori from gastric biopsy specimens and to test their antibiotic susceptibility. Second, it was to evaluate the efficacy of the standard triple therapy from patients of the west central region of Colombia. H. pylori positive patients received standard triple therapy with proton pump inhibitor (PPI) (40 mg b.i.d.), clarithromycin (500 mg b.i.d.), and amoxicillin (1 g b.i.d.) for 14 days. Thereafter, antibiotic susceptibility of the isolates was assessed by E-Test. From 94 patients enrolled, 67 were positive for H. pylori by histology or culture. Overall resistance to metronidazole, levofloxacin, rifampicin, clarithromycin, and amoxicillin was 81%, 26.2%, 23.9%, 19%, and 9.5%, respectively. No resistance was found for tetracycline. A total of 54 patients received standard triple therapy, 48 attended follow-ups testing, and of them, 30 had resistance test reports. Overall eradication rate was 81.2%. Second-line treatment was given to eight patients, four of whom were followed up with a 13C urea breath test (UBT) and remained positive for H. pylori. Eradication was significantly higher in patients with clarithromycin susceptible than in resistant strains (95.6% vs 42.8% P = 0.001). The updated percentages of resistance to clarithromycin in this geographical area had increased, so this value must be considered when choosing the treatment regimen.IMPORTANCEAntibiotic resistance in Helicobacter pylori has increased worldwide, as has resistance to multiple antimicrobials (MDRs), which seriously hampers the successful eradication of the infection. The ideal success rate in eradicating H. pylori infection (≥90%) was not achieved in this study (81.2%). This is the first time that MDR is reported (14.3%) in the region; the resistance to clarithromycin increased over time (3.8%-19%), and levofloxacin (26.2%) and rifampicin (23%) resistant isolates were detected for the first time. With these results, strain susceptibility testing is increasingly important, and the selection of treatment regimen should be based on local antibiotic resistance patterns.
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Amoxicilina , Antibacterianos , Claritromicina , Quimioterapia Combinada , Infecções por Helicobacter , Helicobacter pylori , Testes de Sensibilidade Microbiana , Humanos , Helicobacter pylori/efeitos dos fármacos , Helicobacter pylori/isolamento & purificação , Helicobacter pylori/genética , Colômbia , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/microbiologia , Masculino , Feminino , Pessoa de Meia-Idade , Antibacterianos/uso terapêutico , Antibacterianos/farmacologia , Adulto , Claritromicina/farmacologia , Claritromicina/uso terapêutico , Amoxicilina/uso terapêutico , Amoxicilina/farmacologia , Idoso , Inibidores da Bomba de Prótons/uso terapêutico , Farmacorresistência Bacteriana , Adulto Jovem , Metronidazol/uso terapêutico , Metronidazol/farmacologia , Levofloxacino/farmacologia , Levofloxacino/uso terapêutico , Resultado do TratamentoRESUMO
Biofilms are a bacterial resistance strategy through which microorganisms organize themselves in the form of a colony fixed to a surface that is protected by a polymer matrix. Infectious diseases that result in biofilm formation have been considered a relevant public health problem due to the potential to increase patient morbidity and mortality, in addition to increasing the burden on health services. Such pathologies are treated with the use of antimicrobial drugs, the indiscriminate use of which has contributed to the process of bacterial resistance, demanding the need to invest in new alternatives to combat them. Based on this, the present work aimed to evaluate the anti-biofilm formation and eradication capacity of Hecogenin Acetate, a steroidal sapogenin of natural origin with important antibacterial properties. For this, we used strains of Streptococcus mutans INCQS 00,446 (ATCC 25,175), Enterococcus faecalis INCQS 00,018 (ATCC 14,506), Staphylococcus epidermidis INCQS 00,016 (ATCC 12,228), Staphylococcus aureus ATCC 25,923, Pseudomonas aeruginosa ATCC 9027 and Escherichia coli ATCC 259,223. The formation, formation inhibition and treatment assays were carried out in microdilution plates and revealed using the crystal violet method. Readings were carried out using absorbance at wavelengths of 492 nm. All tests were performed in triplicate and statistical analyzes were performed using Graphpad Prism v.5.0 software. It was observed that the bacterial strains used have a relevant capacity for biofilm formation, with the Gram positive ones identified in the present study as the best former. In the results of the analyzes with bacterial biofilm, it was identified that Hecogenin Acetate had a relevant antibiofilm capacity, and could therefore serve as a basis for further research into the development of new antimicrobial drugs.
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Anti-Infecciosos , Compostos de Espiro , Esteroides , Humanos , Antibacterianos/farmacologia , Anti-Infecciosos/farmacologia , Bactérias , Biofilmes , Testes de Sensibilidade MicrobianaRESUMO
In past decades, non-native species invasion has emerged as one of the leading drivers of biodiversity loss in terrestrial and aquatic ecosystems globally. In aquatic ecosystems, invasion by bivalve species has increased substantially due to their evolutionary resilience and adaptability. This study aimed to determine the habitat suitability of the South American bivalve Mytella strigata in the northern Indian Ocean using Species distribution modelling. The species occurrence and environmental data for model building were extracted from GBIF, Bio-ORACLE, The World Bank Data Catalogue and GMED. Pearson's correlation (<0.7) and Variance inflation factor (<10) analyses were used to select the environmental covariates. Individual models were built by combining the native range occurrence data of Mytella strigata with the bioclimatic data under the current climatic setting. Ten individual models were built and ensembled to create the final model using the biomod2 package. The variable importance score and the response curve plot were used to identify the most crucial variable and its influence on the models. Distance to port had the highest influence on predicting the distribution of Mytella strigata. The results indicated that the western coast of India as more susceptible to invasion. Our predictions indicate that the species has the potential to become highly invasive in the region, given the vast habitat suitability and documented introduction and presence of the species in the region. This research generated baseline information on the habitat suitability of M. strigata that will aid in managing and restricting its spread in the region. Considering the substantial impact of the species in other introduced ranges worldwide, immediate action should be initiated for the swift management of M. strigata from the Indian coast.
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Ecossistema , Mytilidae , Animais , Oceano Índico , Biodiversidade , América do SulRESUMO
Recent decades have seen spectacular advances in understanding and managing atherosclerotic cardiovascular disease, but paradoxically, clinical progress has stalled. Residual risk of atherosclerotic cardiovascular disease events is particularly vexing, given recognized lifestyle interventions and powerful modern medications. Why? Atherosclerosis begins early in life, yet clinical trials and mechanistic studies often emphasize terminal, end-stage plaques, meaning on the verge of causing heart attacks and strokes. Thus, current clinical evidence drives us to emphasize aggressive treatments that are delayed until patients already have advanced arterial disease. I call this paradigm "too much, too late." This brief review covers exciting efforts that focus on preventing, or finding and treating, arterial disease before its end-stage. Also included are specific proposals to establish a new evidence base that could justify intensive short-term interventions (induction-phase therapy) to treat subclinical plaques that are early enough perhaps to heal. If we can establish that such plaques are actionable, then broad screening to find them in early midlife individuals would become imperative-and achievable. You have a lump in your coronaries! can motivate patients and clinicians. We must stop thinking of a heart attack as a disease. The real disease is atherosclerosis. In my opinion, an atherosclerotic heart attack is a medical failure. It is a manifestation of longstanding arterial disease that we had allowed to progress to its end-stage, despite knowing that atherosclerosis begins early in life and despite the availability of remarkably safe and highly effective therapies. The field needs a transformational advance to shift the paradigm out of end-stage management and into early interventions that hold the possibility of eradicating the clinical burden of atherosclerotic cardiovascular disease, currently the biggest killer in the world. We urgently need a new evidence base to redirect our main focus from terminal, end-stage atherosclerosis to earlier, and likely reversible, human arterial disease.
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Aterosclerose , Infarto do Miocárdio , Placa Aterosclerótica , Humanos , Aterosclerose/diagnóstico , Aterosclerose/prevenção & controle , ArtériasRESUMO
The antimicrobial and antibiofilm properties of arginine-based surfactants have been evaluated. These two biological properties depend on both the alkyl chain length and the spacer chain nature. These gemini surfactants exhibit good activity against a wide range of bacteria, including some problematic resistant microorganisms such us methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. Moreover, surfactants with a C10 alkyl chain and C3 spacer inhibit the (MRSA) and Pseudomonas aeruginosa biofilm formation at concentrations as low as 8 µg/mL and are able to eradicate established biofilms of these two bacteria at 32 µg/mL. The inhibitory activities of the surfactants over key enzymes enrolled in the skin repairing processes (collagenase, elastase and hyaluronidase) were evaluated. They exhibited moderate anti-collagenase activity while the activity of hyaluronidase was boosted by the presence of these surfactants. These biological properties render these gemini arginine-based surfactants as perfect promising candidates for pharmaceutical and biological properties.
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Anti-Infecciosos , Staphylococcus aureus Resistente à Meticilina , Hialuronoglucosaminidase , Anti-Infecciosos/farmacologia , Arginina , Biofilmes , Elastase Pancreática , Pseudomonas aeruginosaRESUMO
OBJECTIVE: Despite the availability of a highly effective and safe vaccine against hepatitis B virus (HBV) infection for 40 years, still almost 300 million persons are estimated to be chronically infected by this virus worldwide. The World Health Organization (WHO) has proposed a plan for hepatitis elimination by 2030. However, several factors, such as the reduction and limitation in vaccination campaigns or vaccine hesitancy (VH) in some regions of the World, might have played a role in limiting the worldwide coverage of hepatitis B prophylaxis. This review aims to describe which factors, such as VH, may be hampering the WHO 2030 goal for hepatitis B eradication. METHODS: The review describes the development and characteristics of the HBV vaccine, from the first plasma-derived to the recombinant one. Eventual limitations in its effectiveness and particularly VH were reviewed. RESULTS: The apparent pitfalls of the HBV vaccine, such as long-term effectiveness, vaccine-escape mutants, and adverse effects, were proven not to be a concern for this vaccine. However, VH persists and was even intensified by the COVID-19 pandemic. CONCLUSIONS: Many barriers still exist, such as vaccine availability, lack of awareness of the benefits of HBV vaccination, and VH. HBV VH seems to be eventually overcome in many settings with active education campaigns and information, stressing the importance of developing these strategies to achieve the 2030 goal of the WHO.
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AIMS: We investigated the putative fungistatic and fungicidal activities of pomegranate sarcotesta lectin (PgTeL) against Cryptococcus neoformans B3501 (serotype D), specifically the ability of PgTeL to inhibit yeast capsule and biofilm formation in this strain. METHODS AND RESULTS: PgTeL showed a minimum inhibitory concentration of 172.0 µg ml-1, at which it did not exhibit a fungicidal effect. PgTeL concentrations of 4.0-256.0 µg ml-1 reduced biofilm biomass by 31.0%-64.0%. Furthermore, 32.0-256.0 µg ml-1 PgTeL decreased the metabolic activity of the biofilm by 32.0%-93.0%. Scanning electron microscopy images clearly revealed disruption of the biofilm matrix. Moreover, PgTeL disrupted preformed biofilms. At concentrations of 8.0-256.0 µg ml-1, PgTeL reduced metabolic activity in C. neoformans by 36.0%-92.0%. However, PgTeL did not inhibit the ability of B3501 cells to form capsules under stress conditions. CONCLUSIONS: PgTeL inhibited biofilm formation and disrupted preformed biofilms, demonstrating its potential for use as an anticryptococcal agent.
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Criptococose , Cryptococcus neoformans , Punica granatum , Lectinas/farmacologia , Punica granatum/metabolismo , Plâncton/metabolismo , Biofilmes , Testes de Sensibilidade Microbiana , Antifúngicos/farmacologia , Antifúngicos/metabolismoRESUMO
Aim: This work aimed to synthesize magnesium-doped zinc oxide, silver and gold nanoparticles (Nps) and to evaluate their potential to prevent and eradicate Escherichia coli, Proteus mirabilis, Staphylococcus aureus, Acinetobacter baumannii and Pseudomonas aeruginosa biofilms. Materials & methods: The Nps were synthesized by precipitation and metallic reduction techniques. Physicochemical and biological characterization of Nps was performed. Results: All the Nps tested were able to inhibit the formation of E. coli, P. mirabilis, S. aureus and A. baumannii biofilms. The effects on the eradication of preformed biofilms were variable, although all the Nps tested were able to eradicate A. baumannii biofilms. Conclusion: The observed effects make the Nps suitable for coating surfaces and/or antibiotic carriers with medical interest.
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Nanopartículas Metálicas , Óxido de Zinco , Ouro/farmacologia , Óxido de Zinco/farmacologia , Óxido de Zinco/química , Magnésio/farmacologia , Prata/farmacologia , Prata/química , Zinco/farmacologia , Nanopartículas Metálicas/química , Staphylococcus aureus , Óxido de Magnésio/farmacologia , Escherichia coli , Biofilmes , Antibacterianos/farmacologia , Antibacterianos/químicaRESUMO
BACKGROUND: Gastric mucosa-associated lymphoid tissue (MALT) lymphoma (GML) is usually a low-grade B-cell neoplasia strongly associated with Helicobacter pylori (H. pylori)-induced chronic gastritis. Clinical practice guidelines currently recommend H. pylori eradication as the preferred initial treatment for early-stage GML. To determine the practical effect of bacterial eradication as the sole initial therapy for early-stage GML, an updated analysis and review of available evidence is imperative. AIM: To perform a meta-analysis to assess the rate of complete remission (CR) of H. pylori-positive early-stage GML following bacterial eradication. METHODS: We performed independent, computer-assisted literature searches using the PubMed/MEDLINE, Embase, and Cochrane Central databases through September 2022. Prospective and retrospective observational studies evaluating the CR of early-stage GML following bacterial eradication in H. pylori-positive patients. The risk of bias was assessed using Joanna Briggs Institute (JBI) Critical Appraisal Tools. The pooled estimate of the complete histopathological remission rate and respective confidence intervals (95%CI) were calculated following the random-effects model. Heterogeneity and inconsistency were assessed using Cochran's Q test and I2 statistic, and heterogeneity was defined as P < 0.01 and I² > 50%, respectively. Subgroup and meta-regression analyses were conducted to explore potential sources of heterogeneity. RESULTS: The titles and abstracts of 1576 studies were screened; 96 articles were retrieved and selected for full-text reading. Finally, 61 studies were included in the proportional meta-analysis (P-MA). Forty-six were prospective and fifteen were retrospective uncontrolled, single-arm, observational studies. The overall risk of bias was low to moderate in all but a single report, with an average critical appraisal score across all studies of 79.02%. A total of 2936 H. pylori-positive early-stage GML patients, in whom H. pylori was successfully eradicated, were included in the analysis. The pooled CR of H. pylori-positive early-stage GML after bacterial eradication was 75.18% (95%CI: 70.45%-79.91%). P-MA indicated the substantial heterogeneity in CR reported across studies (I 2 = 92%; P < 0.01). Meta-regression analysis identified statistically significant effect modifiers, including the proportion of patients with t(11;18)(q21;q21)-positive GML and the risk of bias in each study. CONCLUSION: Comprehensive synthesis of available evidence suggests that H. pylori eradication is effective as the sole initial therapy for early-stage GML. Although the substantial heterogeneity observed across studies limits the interpretation of the pooled overall CR, the present study is a relevant to informing clinical practice.
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Infecções por Helicobacter , Helicobacter pylori , Linfoma de Zona Marginal Tipo Células B , Neoplasias Gástricas , Humanos , Linfoma de Zona Marginal Tipo Células B/microbiologia , Antibacterianos/farmacologia , Estudos Retrospectivos , Estudos Prospectivos , Infecções por Helicobacter/microbiologia , Neoplasias Gástricas/patologiaRESUMO
This article analyzes the efforts of the International Health Division of the Rockefeller Foundation (IHDRF) in its project initiative that resulted in the extermination of the African mosquito Anopheles gambiae from Brazil in 1940. This species, which originated in Dakar, Senegal, was identified in the Brazilian city of Natal in 1930, where insufficient local emergency sanitation actions enabled it to spread into the interior of the Brazilian northeast, causing an unprecedented malaria epidemic in the Americas in 1938, after years of silent spread. We will analyse the formation of Brazil's Malaria Service of the Northeast (MSNE), discussing its political and scientific controversies and how the transition from the idea of extermination to the idea of eradication was consolidated in the political process of creating this successful sanitation campaign. In addition, we will discuss how the integration and transnational development of medical entomology at the time was a fundamental factor in the cooperation and challenges among scientists involved in this campaign. The international cooperation of scientists, albeit oriented towards the project of eradication of this mosquito, organised different research agendas and gained new insights into the global dissemination of mosquito-borne diseases.
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Epidemias , Malária , Humanos , Animais , Senegal/epidemiologia , Malária/epidemiologia , Malária/prevenção & controle , Saneamento , Cooperação InternacionalRESUMO
Nuestro objetivo es determinar si el tratamiento para Helicobacter pylori (HP) con doxiciclina, furazolidona, bismuto y un inhibidor de bomba de protones mantiene su efectividad en nuestra población. Se realizó un estudio retrospectivo, no aleatorio, realizado en una clínica privada de Lima, Perú. Se obtuvo la información de la historia clínica digital. Se incluyó a pacientes con el diagnóstico de infección por HP por biopsia y/o test rápido de la ureasa, obtenidos al realizar una endoscopía entre enero 2017 a octubre 2022. Debían haber recibido el tratamiento cuádruple en estudio o un esquema triple alternativo con amoxicilina, levofloxacino e inhibidor de bomba de protones y tener una prueba de aliento para HP en el lapso de 1 a 6 meses después del tratamiento. El esquema cuádruple con furazolidona logró la erradicación en 117/122 casos (95,9%) mientras que el triple con levofloxacino en 5/16 (31,2%) cuando se usó por 7 dias y en 22/38 (57,9%) cuando se usó por 10 días, siendo las diferencias altamente significativas (p>0,001). En conclusión, el tratamiento cuádruple con furazolidona mostró alta efectividad, mientras que el triple con levofloxacino no alcanzó niveles aceptables.
Our objective is to determine the effectiveness of a therapeutic regimen for helicobacter pylori that includes a proton pump inhibitor, doxycycline, furazolidone and bismuth in our location. We carried out a retrospective study, non-randomized, in a private hospital in Lima, Peru. Patients with biopsy and/or rapid urease test proven helicobacter pylori infection after an endoscopy, from January 2017 to October 2022 were included. They received the therapeutic regimen of the study or an alternative triple regimen with a proton pump inhibitor, amoxicillin and levofloxacin and were followed with a urea breath test within 1 to 6 months upon completion of therapy. The quadruple therapy with furazolidone obtained success in 117/122 cases (95.9%) while the triple therapy with levofloxacin only in 5/16 (31.2%) when used for 7 days and 22/38 (57.9%) when used for 10 days, a statistically significant difference with p<0.001. Conclusion: Quadruple therapy with furazolidone reached high effectiveness in our location, while triple therapy with levofloxacin was not an acceptable alternative.
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INTRODUCTION AND OBJECTIVES: We aimed to analyze the trends of total and sex-stratified mortality from hepatitis C virus (HCV) and to estimate the proportion of non-alcoholic liver disease deaths in Mexico attributable to HCV from 2001-2017. MATERIALS AND METHODS: Using the mortality multiple-cause dataset, we selected the codes for acute HCV and chronic HCV to analyze trends from 2001 to 2017. We then estimated the proportion of HCV-related deaths out of non-alcoholic chronic liver disease deaths, by including in the denominator: other acute and chronic viral hepatitis, malignant neoplasm of the liver, liver failure, chronic hepatitis, fibrosis, and cirrhosis of the liver, and other inflammatory diseases of the liver. Average percent change (APC) for trends, overall and by sex, were estimated using Joinpoint regression. RESULTS: The trend in crude mortality rate significantly increased from 2001-2005 (APC 18.4%; 95%CI=12.5, 24.5; p value<0.001), and then significantly decreased from 2013-2017 (APC -6.5%; 95%CI=-10.1, -2.9; p value<0.001). Stratified by sex women experienced a more rapid decline in the 2014-2017 period than men. CONCLUSIONS: HCV mortality seems to have started to decrease, but much remains to be done in terms of prevention, diagnosis, and timely access to treatment.
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Hepatite C Crônica , Hepatite C , Masculino , Humanos , Feminino , Hepacivirus , México/epidemiologia , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Cirrose Hepática , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/epidemiologiaRESUMO
Resumen Objetivo: Este estudio tiene como objetivo principal determinar la respuesta al esquema de tratamiento de primera línea con triple terapia estándar (amoxicilina, claritromicina, omeprazol), para erradicación de Helicobacter pylori en una determinada población, para determinar si este esquema propuesto en guías internacionales es aún una opción adecuada para pacientes en una determinada región de Costa Rica. Métodos: Se realizó una búsqueda en el servicio de gastroenterología del Hospital San Francisco de Asís, Grecia, Alajuela, Costa Rica; de todos los pacientes con infección por Helicobacter pylori y que recibieron tratamiento de primera línea con triple terapia (amoxicilina, claritromicina y omeprazol) por 14 días, en el periodo comprendido entre febrero 2017 a febrero 2019, incluyendo para el análisis solamente en los que se contaba con una prueba confirmatoria posterior a tratamiento, ya fuera por antígeno fecal de H. pylori o biopsia convencional. Resultados: Se identificaron un total de 369 casos. El diagnóstico se realizó con biopsia en el 96,4% de los pacientes. La respuesta al tratamiento de primera línea se alcanzó en un 90.5% corroborada por antígeno fecal en el 92.1% de los casos. Conclusiones: Este estudio muestra que la terapia triple con amoxicilina, claritromicina e Inhibidor de bomba de protones por 14 días mantiene un adecuado nivel de eficacia. Sin embargo, hay que tomar en cuenta que estos datos son únicamente de un área de atracción determinada y puede que no reflejen la realidad de todo el país.
Abstract Aim: The main objective of this study is to determine the response to the firstline treatment regimen with triple standard therapy (amoxicillin, clarithromycin, omeprazole), to eradicate Helicobacter pylori in a certain population. The goal is to determine if the proposed regimen in international guidelines services is still a suitable option for patients in a certain region of Costa Rica. Methods: The study took place in San Francisco de Asís Hospital, Grecia, Alajuela, Costa Rica. All patients with a Helicobacter pylori infection that were given first- line treatment with triple therapy (amoxicillin, clarithromycin and omeprazole) for its eradication for 14 days, in the period between February of 2017 and February of 2019, were included in the study. Results: A total of 369 cases were identified. The diagnosis was made with biopsy in 96.4% of patients. Response to first-line treatment was achieved in 90.5% corroborated by fecal antigen in 92.1% of all cases. Conclusions: This study shows that triple therapy with amoxicillin, clarithromycin and omeprazole for 14 days maintains an adequate level of efficacy. However, it must be considered that these results are from a specific area and may not reflect the reality of the entire country.
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Humanos , Masculino , Feminino , Omeprazol/uso terapêutico , Helicobacter pylori/efeitos dos fármacos , Infecções por Helicobacter/epidemiologia , Claritromicina/uso terapêutico , Amoxicilina/uso terapêutico , Costa Rica , Farmacorresistência BacterianaRESUMO
In this paper we analyze the behavior of the COVID-19 pandemic during a certain period of the year 2020 in the state of Mexico, Mexico. For this, we will use the discrete models obtained by the first, third and fourth authors of this work. The first is a one-dimensional model, and the second is two-dimensional, both non-linear. It is assumed that the population of the state of Mexico is constant and that the parameters used are the infection capacity, which we will initially assume to be constant, and the recovery and mortality parameters in that state. We will show that even when the statistical data obtained are disperse, and the process could be stabilized, this has been slow due to chaotic mitigation, creating situations of economic, social, health and political deterioration in that region of the country. We note that the observed results of the behavior of the epidemic during that period for the first variants of the virus have continued to be observed for the later variants, which has not allowed the eradication of the pandemic.
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COVID-19 , Humanos , COVID-19/epidemiologia , México/epidemiologia , Pandemias , Fatores de TempoRESUMO
BACKGROUND: Due to increasing resistance rates of Helicobacter pylori (H. pylori) to different antibiotics, failures in eradication therapies are becoming more frequent. Even though eradication criteria and treatment algorithms for first-line and second-line therapy against H. pylori infection are well-established, there is no clear recommendation for third-line and rescue therapy in refractory H. pylori infection. AIM: To perform a systematic review evaluating the efficacy and safety of rescue therapies against refractory H. pylori infection. METHODS: A systematic search of available rescue treatments for refractory H. pylori infection was conducted on the National Library of Medicine's PubMed search platform based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized or non-randomized clinical trials and observational studies evaluating the effectiveness of H. pylori infection rescue therapies were included. RESULTS: Twenty-eight studies were included in the analysis of mean eradication rates as rescue therapy, and 21 of these were selected for analysis of mean eradication rate as third-line treatment. For rifabutin-, sitafloxacin-, levofloxacin-, or metronidazole-based triple-therapy as third-line treatment, mean eradication rates of 81.6% and 84.4%, 79.4% and 81.5%, 55.7% and 60.6%, and 62.0% and 63.0% were found in intention-to-treat (ITT) and per-protocol (PP) analysis, respectively. For third-line quadruple therapy, mean eradication rates of 69.2% and 72.1% were found for bismuth quadruple therapy (BQT), 88.9% and 90.9% for bismuth quadruple therapy, three-in-one, Pylera® (BQT-Pylera), and 61.3% and 64.2% for non-BQT) in ITT and PP analysis, respectively. For rifabutin-, sitafloxacin-, levofloxacin-, or metronidazole-based triple therapy as rescue therapy, mean eradication rates of 75.4% and 78.8%, 79.4 and 81.5%, 55.7% and 60.6%, and 62.0% and 63.0% were found in ITT and PP analysis, respectively. For quadruple therapy as rescue treatment, mean eradication rates of 76.7% and 79.2% for BQT, 84.9% and 87.8% for BQT-Pylera, and 61.3% and 64.2% for non-BQT were found in ITT and PP analysis, respectively. For susceptibility-guided therapy, mean eradication rates as third-line and rescue treatment were 75.0% in ITT and 79.2% in PP analysis. CONCLUSION: We recommend sitafloxacin-based triple therapy containing vonoprazan in regions with low macrolide resistance profile. In regions with known resistance to macrolides or unavailability of bismuth, rifabutin-based triple therapy is recommended.
Assuntos
Infecções por Helicobacter , Helicobacter pylori , Humanos , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/tratamento farmacológico , Antibacterianos/efeitos adversos , Metronidazol/uso terapêutico , Bismuto/uso terapêutico , Levofloxacino/uso terapêutico , Inibidores da Bomba de Prótons/efeitos adversos , Quimioterapia Combinada , Macrolídeos/uso terapêutico , Farmacorresistência Bacteriana , Tetraciclina/uso terapêutico , Rifabutina/efeitos adversosRESUMO
Foot-and-mouth disease (FMD) is a viral disease that affects several animal species, including domestic and wildlife ones. The occurrence of an FMD outbreak can potentially cause a large negative impact on countries or regions' livestock production and economy. Performed over several decades, mass herd vaccination has been the main strategy to control the disease. However, countries are beginning the stage of eradicating FMD, which involves suspending vaccinations. The present study carried out a risk classification for FMD occurrence in Goiás State, Brazil by evaluating and combining multiple risk factors involved in FMD introduction and dissemination. Data from 126,345 rural properties were collected and categorized by municipality. The risk factors were grouped into two modules and then scores for each module were obtained by adding and weighting the risk factors. These combined scores resulted in the final FMD occurrence risk score. Most of the municipalities, as well as the herds were found in the lowest likelihood levels. Variables linked to herd density and animal movement played a key role in the score composition. We believed that this model can be a useful tool in the decision-making process regarding actions and strategies related to FMD eradication.
A febre aftosa (FA) é uma doença viral, febril, aguda e altamente contagiosa que afeta várias espécies domésticas e silvestres. Sua ocorrência resulta em grandes impactos negativos na cadeia pecuária e na economia de um país ou região. A FA está presente na América do Sul desde o fim do século XIX gerando esforços de órgãos oficiais no combate à enfermidade com vistas à erradicação, o que possibilitará futuramente a retirada da vacina, fato previsto no estado de Goiás para o ano de 2021. Neste sentido, o presente estudo objetivou classificar o risco de ocorrência de FA nos rebanhos do estado de Goiás. Para tanto, avaliou-se e combinou-se vários fatores de risco (FR) ligados à introdução e disseminação da FA obtidos de dados de 126.345 propriedades rurais. Estes FR foram agrupados em módulos formados por caminhos de introdução e disseminação da FA. A combinação dos FR se deu por meio de adição, sendo em seguida ponderados por pesos atribuídos por especialistas. Foram gerados os escores de introdução e disseminação de FA em Goiás, possibilitando a classificação do risco de ocorrência da doença no estado. Identificou-se que a maioria do rebanho e do território goiano se encontra em baixos níveis de risco. Foi identificada complexa composição nos níveis de risco obtidos, indicando ampla variação dos fatores que compuseram os escores de risco, especialmente nos municípios de mais alto escore de ocorrência. Variáveis ligadas à densidade de rebanho e trânsito e movimentação de animais apresentaram importante participação na composição dos escores. Acreditamos que os resultados deste trabalho podem compor uma ferramenta importante na tomada de decisão sobre as ações e estratégias de combate à FA em Goiás, ao passo que posteriores avaliações e adaptações poderão ser realizadas para a validação do modelo proposto.
Assuntos
Doenças Transmissíveis , Medição de Risco , Erradicação de Doenças , Febre Aftosa/epidemiologiaRESUMO
Background: Mycobacterium avium subsp. paratuberculosis is the causative agent of paratuberculosis (PTB), incurable enterocolitis, affecting domestic and wild ruminants. Economic losses, impacts on animal health and welfare, and public health concerns justify its herd-level control. Aim: To systematically collect information to answer: What are the control and eradication strategies of PTB in dairy cattle worldwide? Methods: The search procedure was carried out on October 2nd, 2019, and updated on August 3rd, 2021, using OVID®, SciELO, and Redalyc databases, and the registers from the International Colloquium on Paratuberculosis (1991-2018). The inclusion criteria considered articles published in English, Portuguese, and Spanish and in peer-reviewed journals. The exclusion criteria included irrelevant topics, species other-than bovines, and not original articles. Definitive studies were obtained through the consensus of the authors on eligibility and quality. Data extraction was performed, considering bibliographic information, control and outcome strategies, follow-up time, and results. Results: Twenty-six relevant studies were found, reporting the use of three grouped control strategies: hygiene and management strategy (HMS), test-and-cull strategy (TCS), and vaccination strategy (VS). The HMS was the most common one (20/26), followed by TCS (17/26) and VS (7/26). Combined control strategies such as TCS-HMS (12/26), TCS-VS (1/26), and HMS-VS (1/26) were also described, and the consideration of the three control strategies (TCS-HMS-VS) was reported in two articles. The HMS included practices such as neonates/juvenile livestock hygiene, biosecurity, prevention of infection introduction into the herd, and environmental management. Within HMS, the most frequent practices were to remove calves from their dams as soon as possible after birth and to keep the minimal exposure of calves and heifers to adult cattle. As limitations, within the HMS, it is considered that some strategies cannot be included due to lack of compliance, or the application of the same strategy among one study and another may have a different degree of interpretation; publication bias was not controlled since the results of the control programs in endemic countries may be not available. Conclusion: The main PTB control strategies in dairy cattle worldwide are HMS, TCS, and VS. The use of one or several combined strategies has been found to succeed in controlling the disease at the herd-level.
Assuntos
Doenças dos Bovinos , Mycobacterium avium subsp. paratuberculosis , Paratuberculose , Animais , Bovinos , Doenças dos Bovinos/microbiologia , Feminino , Paratuberculose/epidemiologiaRESUMO
BACKGROUND AND AIMS: Potassium-Competitive Acid Blockers (P-CABs) have been used in Helicobacter pylori (H. pylori) eradication therapies in recent years. However, the efficacy and safety of P-CABs compared to Proton-Pump Inhibitors (PPIs) in this setting remain controversial. METHODS: The efficacy and safety of P-CABs and PPIs for H. pylori eradication were compared in a meta-analysis based on a systematic literature search of major electronic databases for relevant Randomized Controlled Trials (RCTs). RESULTS: Seven studies and 1,168 patients were included. The pooled eradication rate determined by Intention-To-Treat (ITT) analysis was 90.2% for P-CAB-based and 75.5% for PPI-based triple therapy (pooled RR [95% CI] = 1.17 [1.08-1.28], p < 0.001). The Per-Protocol (PP) analysis also demonstrated significant superiority of P-CABs (pooled eradication rate = 92.4% vs. 77.8%; pooled RR [95% CI] = 1.14 [1.03-1.26], p < 0.01). In a subgroup evaluation, P-CABs were significantly better than PPIs as a first-line eradication therapy, in both the ITT analysis (pooled eradication rate = 91.8% vs. 76.4%; pooled RR [95% CI] = 1.18 [1.10-1.28], p < 0.0001) and the PP analysis (pooled eradication rate = 93.0% vs. 78.6%; pooled RR [95% CI] = 1.13 [1.02-1.26], p < 0.05). However, P-CABs were not superior to PPIs when administered as salvage therapy, as determined in the ITT (75.0% vs. 66.0%, pooled RR [95% CI] = 1.11 [0.69-1.78], p = 0.66) and PP (85.7% vs. 70.0%, pooled RR [95% CI] = 1.20 [0.82-1.75], p = 0.34) analyses. In a subgroup analysis limited to Japanese patients, both the ITT analysis (pooled eradication rate = 89.6% vs. 73.9%; RR [95% CI] = 1.21 [1.14-1.29], p < 0.01) and the PP analysis (pooled eradication rate = 92.0% vs. 75.7%; RR [95% CI] = 1.18 [1.06-1.32], p < 0.01) showed that P-CABs were significantly superior compared to PPIs as triple eradication therapy. However, in the subgroup analysis of patients from other countries, there was no significant difference in either the ITT analysis (pooled eradication rate = 93.8% vs. 85.2%; RR [95% CI] = 1.10 [0.99-1.22], p = 0.07) or PP analysis (pooled eradication rate = 95.0% vs. 90.8%; RR [95% CI] = 1.05 [0.98-1.14], p = 0.17). The incidence of adverse events associated with the two regimens did not significantly differ (P-CABs vs. PPIs: 33.6% vs. 40.0%; RR [95% CI] = 0.84 [0.71â1.00], p = 0.05). The incidence of serious adverse events and dropout rate due to adverse events also did not differ (p = 0.44 and p = 0.67, respectively). CONCLUSIONS: The efficacy of P-CAB-based triple therapy is superior to that of PPI-based triple therapy as a first-line approach to H. pylori eradication, particularly in Japanese patients. As salvage therapy, the efficacy of the two treatments did not significantly differ. The tolerability of P-CAB-based and PPI-based triple therapy was comparable, as was the incidence of adverse events.