Genome plasticity favours double chromosomal Tn4401b-blaKPC-2 transposon insertion in the Pseudomonas aeruginosa ST235 clone.

BACKGROUND: Pseudomonas aeruginosa Sequence Type 235 is a clone that possesses an extraordinary ability to acquire mobile genetic elements and has been associated with the spread of resistance genes, including genes that encode for carbapenemases. Here, we aim to characterize the genetic platforms involved in resistance dissemination in blaKPC-2-positive P. aeruginosa ST235 in Colombia. RESULTS: In a prospective surveillance study of infections in adult patients attended in five ICUs in five distant cities in Colombia, 58 isolates of P. aeruginosa were recovered, of which, 27 (46.6%) were resistant to carbapenems. The molecular analysis showed that 6 (22.2%) and 4 (14.8%) isolates harboured the blaVIM and blaKPC-2 genes, respectively. The four blaKPC-2-positive isolates showed a similar PFGE pulsotype and belonged to ST235. Complete genome sequencing of a representative ST235 isolate shows a unique chromosomal contig of 7097.241 bp with eight different resistance genes identified and five transposons: a Tn6162-like with ant(2″)-Ia, two Tn402-like with ant(3″)-Ia and blaOXA-2 and two Tn4401b with blaKPC-2. All transposons were inserted into the genomic islands. Interestingly, the two Tn4401b copies harbouring blaKPC-2 were adjacently inserted into a new genomic island (PAGI-17) with traces of a replicative transposition process. This double insertion was probably driven by several structural changes within the chromosomal region containing PAGI-17 in the ST235 background. CONCLUSION: This is the first report of a double Tn4401b chromosomal insertion in P. aeruginosa, just within a new genomic island (PAGI-17). This finding indicates once again the great genomic plasticity of this microorganism.

Intraindividual variability in neuropsychological performance predicts longitudinal cortical volume loss in early Parkinson's disease.

OBJECTIVE: Cognitive impairment is common among individuals with Parkinson's disease (PD). Intraindividual variability (IIV) is a measure of variability across multiple tasks of cognitive functioning. Due to the limited amount of research, particularly among individuals with PD, IIV has been an underutilized metric of cognitive functioning both in research and clinical practice. Previous research demonstrated that individuals with PD have greater variability in cognitive performance relative to controls, and that IIV is predictive of future cognitive impairments. The aim of this study is to investigate the association between baseline IIV and change in cortical and subcortical volumes among individuals with PD. METHOD: The present study used data from 80 newly diagnosed PD patients who were part of a longitudinal cohort study (Parkinson progression marker initiative [PPMI]). Participants completed neuropsychological measures and underwent T1 structural magnetic resonance imaging (MRI) at baseline and the first annual follow-up. Neuropsychological tests assessed attention, processing speed, visuospatial functioning, verbal fluency learning, and memory. T1 scans were processed using standard Freesurfer protocols for extraction of regional volumes. RESULTS: Greater IIV at baseline was predictive of change in cortical volume in posterior temporal/parietal regions over the 1-year period. Baseline IIV predicted cortical volume changes above and beyond the main effect of motor severity and the baseline statistical mean/global cognition score. CONCLUSION: Our results provide initial evidence that IIV is a marker of longitudinal cortical volume loss. Evidence is building that IIV is a sensitive marker of cognitive impairment and the underlying neurodegeneration among individuals with PD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Textiles Functionalized with Copper Oxides: A Sustainable Option for Prevention of COVID-19.

COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and healthcare-associated infections (HAIs) represent severe problems in health centers and public areas. Polyester/cotton (PES/CO) blend fabrics have been functionalized with copper oxides on an industrial scale. For functionalization, the impregnation dyeing technique was applied. The functionalized samples were tested virologically against SARS-CoV-2 and human coronavirus (229E) according to ISO 18184-2019 and microbiologically against Escherichia coli (ATCC 25922) bacteria according to ASTM E2149-2013. The results show that the fabric functionalized with copper oxides inactivated both viruses after 30 min of exposure, presenting excellent virucidal activity against 229E and SARS-CoV-2, respectively. Furthermore, its inactivation efficiency for SARS-CoV-2 was 99.93% and 99.96% in 30 min and 60 min exposure, respectively. The fabric inhibited bacterial growth by more than 99% before and after 10 and 20 washes. In conclusion, 265 m of PES/CO fabric (wide 1.7 m) was functionalized in situ on an industrial scale with copper oxide nanoparticles. The functionalized fabric presented virucidal and bactericidal properties against SARS-CoV-2 and Escherichia coli.

Beyond PD-MCI: objectively defined subtle cognitive decline predicts future cognitive and functional changes.

OBJECTIVE: Cognitive impairment is prevalent among individuals with Parkinson's disease (PD). Effort has been made to identify individuals at risk for cognitive decline and dementia. Objectively-defined subtle cognitive decline (Obj-SCD) is a novel classification that may identify individuals at risk for cognitive decline prior to a diagnosis of mild cognitive impairment (MCI). We examined the utility of Obj-SCD criteria to predict future cognitive decline and difficulties with activities of daily living (ADLs) among individuals with PD. METHOD: The sample included 483 individuals newly diagnosed with PD. Participants were followed for a five-year span with yearly visits where they completed neuropsychological tests. Participants were categorized as cognitively normal (CN), the newly proposed Obj-SCD, PD-MCI or Parkinson's disease dementia (PDD). Analyses determined if utilization of Obj-SCD criteria predicted subsequent cognitive impairment and difficulties with ADLs. RESULTS: At baseline, 372 (77%) participants were classified as CN, 40 (8.3%) classified as Obj-SCD, and 71 (14.7%) classified as PD-MCI. Analyses revealed that relative to the CN group, participants classified as Obj-SCD at baseline, were more likely to develop PD-MCI or PDD within 5 years (odds ratio 2.413; 95% confidence interval 1.215-4.792). Furthermore, the Obj-SCD represented an intermediate level of impairment, relative to the CN and PD-MCI groups, on an independent measure of cognition (Montreal Cognitive Assessment) and ADL. CONCLUSIONS: Findings provide evidence that Obj-SCD criteria can identify individuals at risk for cognitive decline and impairments in ADL. Obj-SCD criteria may identify individuals at risk for cognitive impairment who are not detected by PD-MCI criteria.

A bidirectional relationship between anxiety, depression and gastrointestinal symptoms in Parkinson's disease.

INTRODUCTION: Anxiety, depression and gastrointestinal (GI) symptoms are common non-motor symptoms in Parkinson's disease (PD). Past studies provide evidence of a disrupted microbiome-gut-brain axis in PD, which is associated with certain motor and non-motor symptoms in PD. Additionally, there is evidence of a bidirectional association between mental health and gut health among individuals with GI disorders. The current study examined the bidirectional association between GI symptoms and anxiety/depression among individuals newly diagnosed with PD. METHODS: We conducted a secondary data analysis of the Parkinson's Progression Markers Initiative. This included 487 individuals newly diagnosed with PD and followed for up to 5 years. Participants completed questionnaires of anxiety, depression and GI symptoms (Scales for Outcomes in Parkinson's Disease Autonomic; SCOPA-AUT) at each annual visit. Multilevel models examined the bidirectional-lagged relationship between GI symptoms and anxiety/depression. RESULTS: Models provided evidence for a bidirectional relationship between GI symptoms and anxiety/depression. Specifically, more severe GI symptoms predicted more severe anxious/depressive symptoms within the same year and at the following year. There was also evidence of the inverse directionality, meaning that more severe anxiety/depression predicted more severe GI symptoms concurrently and in the following year. DISCUSSION: Findings provide preliminary evidence for a cyclical relationship among gut health and mental health in PD. Future studies are needed to examine if the microbiome-gut-brain axis plays a mechanistic role.

Dialysis adequacy indices and body composition in male and female patients on peritoneal dialysis.

OBJECTIVES: Creatinine clearance scaled to body surface area (BSA) and urea KT/V normalized to total body water (TBW) are used as indices for peritoneal dialysis (PD) adequacy. We investigated relationships of indices of dialysis adequacy (including KT/V, KT, clearance, dialysate over plasma concentration ratio) and anthropometric and body composition parameters (BSA, TBW, body mass index (BMI), weight, height, fat mass (FM), and fat-free mass (FFM)) in male and female patients on continuous ambulatory peritoneal dialysis. METHODS: Ninety-nine stable patients (56 males) performed four 24-hr collections of drained dialysate for four dialysis schedules with three daily exchanges of glucose 1.36% and one night exchange of either: 1) glucose 1.36%, 2) glucose 2.27%, 3) glucose 3.86% or 4) icodextrin 7.5%. RESULTS: KT and dialysate over plasma concentration ratio, CD/CP, for urea and creatinine were similar for males and females and, in general, did not depend on body-size parameters including V (= TBW), which means that the overall capacity of the transport system in females and males is similar. However, after normalization of KT to V or 1.73/BSA yielding KT/V and creatinine clearance, Cl(1.73/BSA), respectively, the normalized indices were substantially higher in females than in males and correlated inversely with body-size parameters, especially in males. CONCLUSIONS: As KT/V depends strongly on body size, treatment target values for KT/V should take body size and therefore also gender into account. As KT is less influenced by body size, body composition and gender, KT should be considered as a potential auxiliary index in PD.

Threefold peritoneal test of osmotic conductance, ultrafiltration efficiency, and fluid absorption.

BACKGROUND: Fluid removal during peritoneal dialysis depends on modifiable factors such as tonicity of dialysis fluids and intrinsic characteristics of the peritoneal transport barrier and the osmotic agent-for example, osmotic conductance, ultrafiltration efficiency, and peritoneal fluid absorption. The latter parameters cannot be derived from tests of the small-solute transport rate. We here propose a simple test that may provide information about those parameters. METHODS: Volumes and glucose concentrations of drained dialysate obtained with 3 different combinations of glucose-based dialysis fluid (3 exchanges of 1.36% glucose during the day and 1 overnight exchange of either 1.36%, 2.27%, or 3.86% glucose) were measured in 83 continuous ambulatory peritoneal dialysis (CAPD) patients. Linear regression analyses of daily net ultrafiltration in relation to the average dialysate-to-plasma concentration gradient of glucose allowed for an estimation of the osmotic conductance of glucose and the peritoneal fluid absorption rate, and net ultrafiltration in relation to glucose absorption allowed for an estimation of the ultrafiltration effectiveness of glucose. RESULTS: The osmotic conductance of glucose was 0.067 ± 0.042 (milliliters per minute divided by millimoles per milliliter), the ultrafiltration effectiveness of glucose was 16.77 ± 7.97 mL/g of absorbed glucose, and the peritoneal fluid absorption rate was 0.94 ± 0.97 mL/min (if estimated concomitantly with osmotic conductance) or 0.93 ± 0.75 mL/min (if estimated concomitantly with ultrafiltration effectiveness). These fluid transport parameters were independent of small-solute transport characteristics, but proportional to total body water estimated by bioimpedance. CONCLUSIONS: By varying the glucose concentration in 1 of 4 daily exchanges, osmotic conductance, ultrafiltration efficiency, and peritoneal fluid absorption could be estimated in CAPD patients, yielding transport parameter values that were similar to those obtained by other, more sophisticated, methods.

Cardiovascular and renal effects of bromocriptine in diabetic patients with stage 4 chronic kidney disease.

OBJECTIVE: The objective of this study was to investigate the effect of bromocriptine (BEC) on left ventricular mass index (LVMI) and residual renal function (RRF) in chronic kidney disease (CKD) patients with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS: A 6-month double-blind randomized controlled trial was conducted in 28 patients with T2D and stage 4 CKD with increased LVMI. Fourteen patients received BEC (2.5 mg, initially 1 tablet with subsequent increase to three times a day) and 14 received a placebo (PBO; initially 1 tablet with subsequent increase to three times a day). Cardiovascular changes were assessed by monitoring 24 h ambulatory blood pressure, two-dimensional-guided M-mode echocardiography, and N-terminal brain natriuretic peptide (NT-proBNP) plasma levels. RRF was evaluated by creatinine clearance and cystatin-C plasma levels. RESULTS: Both BEC and PBO groups decreased blood pressure-but the effect was more pronounced in the BEC group. Average 24 h, diurnal and nocturnal blood pressures, and circadian profile showed improved values compared to the PBO group; LVMI decreased by 14% in BEC and increased by 8% in PBO group. NT-proBNP decreased in BEC (0.54 ± 0.15 to 0.32 ± 0.17 pg/mL) and increased in PBO (0.37 ± 0.15 to 0.64 ± 0.17 pg/mL). Creatinine clearance did not change in the BEC group and decreased in the PBO group. CONCLUSIONS: BEC resulted in a decrease on blood pressure and LVMI. BEC also prevented the progression of CKD while maintaining the creatinine clearance unchanged.

Ultrafiltration and dialysis adequacy with various daily schedules of dialysis fluids.

Dialysis regimens for continuous ambulatory peritoneal dialysis (CAPD) patients vary with the need for fluid removal, but also because of concerns about the local and systemic consequences of high glucose exposure. The implications of various regimens for dialysis adequacy--that is, fluid and small-solute removal--are not always clear. We therefore analyzed ultrafiltration (UF) and adequacy indices for 4 different combinations of dialysis fluid. Collections of 24-hour dialysate and urine were carried out in 99 patients on CAPD. On 4 separate occasions, each patient performed 4 exchanges in 24 hours, including 3 daily exchanges with 1.36% glucose and 1 night exchange with either 1.36% glucose (G1 schedule), 2.27% glucose (G2 schedule), 3.86% glucose (G3 schedule), or icodextrin (Ico schedule). Weekly, total, and dialysis Kt/V and KT were calculated for both urea and creatinine. The mean values of urea Kt/V and KT were significantly lower for the G1 schedule than for the G3 and Ico schedules. The adequacy indices for overnight application of 3.86% glucose and icodextrin were similar. Using dialysis fluids with 1.36% and 2.27% glucose overnight reduces glucose exposure, but those schedules may provide inadequate UF and small-solute removal in some patients (UF < 1 L daily, Kt/V < 1.7).

Frecuencia de hallazgos citológicos y factores de riesgo asociados a patologías cervicouterinas San Miguel Municipio Jiménez estado Lara mayo 2004 / Frecuency of cytologica finding and factors of risk associated to uterine neck pathology San Miguel Jimenez Municipality Lara state May 2004

Con la finalidad de identificar factores de riesgo asociados a patologías de cuello uterino, se realizó un estudio descriptivo en 57 mujeres que cumplieron los criterios de inclusión, a quienes se tomó muestra cervicouterina y con método de Papinicolaou fueron procesadas para identificar hallazgos citológicos según clasificación de Bethesda y a quienes se aplicó entrevista estructura que indagaba sobre aspectos personales y antecedentes de importancia, tales como edad, inicio de relaciones sexuales, némero de parejas, paridad, estrato socioeconómico, hábito tabaquito, uso de anticonceptivos y control citológico. De la muestras 61,40% presentaron cambios celulares benignos, predominando los inflamatorios (65,70%), siendo la inflamación leve la más común (45,71%); en 28,56% se identificaron procesos infecciosos, de estos 22,85% son atribuibles a Gardnerella vaginalis; 1,75% de las pacientes presentaron células epiteliales anormales, representando 100% de las neoplasias cervicales intraepiteliales (NIC I) y ninguna resultó insatisfactoria para la evaluación. Entre los factores de riesgos relevantes asociados a lesiones intraepiteliales de bajo grado se encontró la edad (15 a 45 años no menopáusica) en 75,43%; inicio temprano de relaciones sexuales (antes de 20 años) en 63,%; multiparidad (mas de dos partos) en 26,31% y uso de anticonceptivos orales y dispositivo intrauterino en 34,69% de la muestra para ambos métodos. No se pudo establecer diferencias según condiciones socioeconómicas considerando que 100% provenían del medio rural. Se sugiere aplicación de programas educativos que oriente a la población sobre factores de riesgo asociados a patologías cervicouterinas y promover el control citológico permanente para identificar patologías en estadíos preinvasores.

Resistencia primaria a drogas antituberculosas en Medellin / Primary resistance to antituberculous drugs in Medellin

Se presenta un informe de sensibilidad de 50 cepas de M. tuberculosis estudiadas para resistencia primaria (RP) a drogas antituberculosas. Para la isoniazida la RP es de 16% a la concentracion de 0.2 mcg/ml y 14% para 1 mcg/ml; 8% para la estreptomicina de 2 mcg/ml y de 2% para la rifampicina, el etambutol y la etionamida. El porcentaje de RP para la isoniazida se considera alto y sugiere analisis cuidadoso de esta droga en los esquemas de profilaxis y tratamiento.

Reevaluación del contenido de hierro en algunos alimentos Mexicanos / Reevaluation of the iron content in some Mexican foods

La presente investigación tuvo como objetivo reanalizar el contenido de hierro en 74 alimentos o productos seleccionados por tener un contenido de hierro mayor a 3 mg/100g o por su elevado consumo o inclusión frecuente en la dieta media de la población mexicana. Los alimentos y productos se compararon en el centro de abastos más importantes de la ciudad de México y se transportaron a temperatura ambiente a los laboratorios del Instituto Nacional de la Nutrición Salvador Zubirán. Para la cuantificación de hierro se aplicó la técnica colorimétrica del alfa alfa uno dipiridilo. Se presentan los valores de los cuales el 61 por ciento (45/74) tienen un contenido de hierro menor al 90 por ciento y un 26 por ciento (19/74) tienen valores mayores al 110 por ciento de los valores consignados en la actual base de datos de composición de alimentos del Instituto Nacional de la Nutrición Salvador Zubirán