Emergence of Plasmid-Borne dfrA14 Trimethoprim Resistance Gene in Shigella sonnei.

The most common mechanism of trimethoprim (TMP)-resistance is the acquisition of dihydrofolate reductase enzyme resistant to this drug. Previous molecular characterization of TMP-genes resistance in Chilean isolates of Shigella sonnei searching for dfrA1 and dfrA8, showed solely the presence of dfrA8 (formerly dhfrIIIc). However, these genetic markers were absent in S. sonnei strains further isolated during an outbreak in 2009. To identify the TMP-resistance gene in these strains, a genomic DNA library from a TMP-resistant (TMP(R)) S. sonnei representative strain for the outbreak was used to clone, select and identify a TMP-resistance marker. The TMP(R) clone was sequenced by primer walking, identifying the presence of the dfrA14 gene in the sul2-strA'-dfrA14-'strA-strB gene arrangement, harbored in a native 6779-bp plasmid. The same plasmid was isolated by transforming with a ~4.2 MDa plasmid extracted from several TMP(R) S. sonnei strains into Escherichia coli. This plasmid, named pABC-3, was present only in dfrA14-positive strains and was homologous to a previously described pCERC-1, but different due to the absence of an 11-bp repetitive unit. The distribution of dfrA1, dfrA8, and dfrA14 TMP-resistance genes was determined in 126 TMP(R) S. sonnei isolates. Most of the strains (96%) carried only one of the three TMP-resistance genes assessed. Thus, all strains obtained during the 2009-outbreak harbored only dfrA14, whereas, dfrA8 was the most abundant gene marker before outbreak and, after the outbreak dfrA1 seems have appeared in circulating strains. According to PFGE, dfrA14-positive strains were clustered in a genetically related group including some dfrA1- and dfrA8-positive strains; meanwhile other genetic group included most of the dfrA8-positive strains. This distribution also correlated with the isolation period, showing a dynamics of trimethoprim genetic markers prevalent in Chilean S. sonnei strains. To our knowledge, dfrA14 gene associated to a small non-conjugative plasmid was detected for the first time in Shigella. Apparently, the strain causing the outbreak must have been introduced, changing drastically the genetic distribution of trimethoprim resistance in Chilean S. sonnei strains.

Prevalence of Dehydration Before Training Sessions, Friendly and Official Matches in Elite Female Soccer Players.

This study aimed to evaluate and compare the hydration states prior to different sporting events (training sessions, friendly and official matches) in elite female soccer players and relate that to the importance that the player attached to the hydration state as a determinant of sports performance. The hydration state of 17 female elite soccer players (age: 21.5 ± 3 years; body mass: 62 ± 6 kg; body height: 165 ± 9 cm) was determined by measuring their urine specific gravity (USG) prior to three different sports events: training sessions (PT), friendly (PF) and official (PO) matches. The importance that each player attached to the hydration state as a determinant of sports performance was evaluated through a simple questionnaire. An average of 47.05% of the soccer players were severely dehydrated (USG > 1.030), 33.33% were significantly dehydrated (USG > 1.020), 17.64% were mildly dehydrated (USG > 1.010) and 1.96% were euhydrated (USG < 1.010). The average USG was 1.027 ± 0.007 (PT = 1.029 ± 0.009; PF = 1.023 ± 0.010 and PO = 1.030 ± 0.006). Differences were found between urine specific gravity prior to a friendly and an official match (p = 0.03). No relationship was found between urine specific gravity and the importance each player attached to the hydration state as a determinant of sports performance. The results show that dehydration is the most prevalent hydration state of elite soccer players before training sessions, friendly and official matches. Players were most dehydrated prior to official matches, which was unlinked to the players' perceived importance of hydration for sports performance.

Is globalization undermining the welfare state? The evolution of the welfare state in developed capitalist countries during the 1990s.

The authors analyze the evolution of macro-indicators of social and economic well-being during the 1990s in the majority of developed capitalist countries, grouped according to their dominant political traditions since the end of World War II. Their analysis shows that, despite the economic globalization of commerce and finance, "politics still matters" in explaining the evolution of the welfare states and labor markets in these countries; the impact of the globalization of financial capital in forcing reductions in the financial resources available for welfare state purposes has been exaggerated.

Cólera en gestantes en el Hospital Nacional Cayetano Heredia, Lima-Perú / Cholera in pregnant women at the Hospital Nacional Cayetano Heredia, Lima Perú

Este es un estudio retrospectivo de todos los casos de cólera en gestantes (84) que acudieron al Hospital Nacional Cayetano Heredia entre el 1º de febrero y el 31 de mayo de 1991. La mayoría de las pacientes provenían de las zonas pobres cercanas al hospital (90 por ciento), presentando diarrea acuosas abundantes y vómitos. Se identificó como agente causal al Vibrio cholerae 01 biotipo El Tor serotipo Inaba. Las 84 gestantes representaron menos de 1 por ciento de todos los pacientes atendidos por cólera en el hospital. Se hospitalizaron 20 pacientes con cuadros severos de deshidratación, una desarrolló insuficienca renal aguda. La proporción de gestantes que requirió internamiento fue mayor en el grupo de menores de 20 años (50 por ciento). Las pérdidas fetales ocurrieron principalmente en gestantes jóvenes (30 por ciento) y en pacientes en el primer y segundo trimestre (7 por ciento). El tratamiento se basó en rehidratación oral o parenteral y uso de antibióticos tempranamente