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1.
Braz. j. biol ; 83: e247422, 2023. tab, graf
Article in English | MEDLINE, LILACS, VETINDEX | ID: biblio-1285631

ABSTRACT

Abstract Plasmodium falciparum resistance to Chloroquine (CQ) is a significant cause of mortality and morbidity worldwide. There is a paucity of documented data on the prevalence of CQ-resistant mutant haplotypes of Pfcrt and Pfmdr1 genes from malaria-endemic war effected Federally Administered Tribal Areas of Pakistan. The objective of this study was to investigate the prevalence of P. falciparum CQ-resistance in this area. Clinical isolates were collected between May 2017 and May 2018 from North Waziristan and South Waziristan agencies of Federally Administrated Trial Area. Subsequently, Giemsa-stained blood smears were examined to detect Plasmodium falciparum. Extraction of malarial DNA was done from microscopy positive P. falciparum samples, and P. falciparum infections were confirmed by nested PCR (targeting Plasmodium small subunit ribosomal ribonucleic acid (ssrRNA) genes). All PCR confirmed P. falciparum samples were sequenced by pyrosequencing to find out mutation in Pfcrt gene at codon K76T and in pfmdr1 at codons N86Y, Y184F, N1042D, and D1246Y. Out of 121 microscopies positive P. falciparum cases, 109 samples were positive for P. falciparum by nested PCR. Pfcrt K76T mutation was found in 96% of isolates, Pfmdr1 N86Y mutation was observed in 20%, and 11% harboured Y184F mutation. All samples were wild type for Pfmdr1 codon N1042D and D1246Y. In the FATA, Pakistan, the frequency of resistant allele 76T remained high despite the removal of CQ. However, current findings of the study suggest complete fixation of P. falciparum CQ-resistant genotype in the study area.


Resumo A resistência do Plasmodium falciparum à cloroquina (CQ) é uma causa significativa de mortalidade e morbidade em todo o mundo. Há uma escassez de dados documentados sobre a prevalência de haplótipos mutantes CQ-resistentes dos genes Pfcrt e Pfmdr1 da guerra endêmica da malária em áreas tribais administradas pelo governo federal do Paquistão. O objetivo deste estudo foi investigar a prevalência de resistência a CQ de P. falciparum nesta área. Isolados clínicos foram coletados entre maio de 2017 e maio de 2018 nas agências do Waziristão do Norte e do Waziristão do Sul da Área de Ensaio Administrada Federalmente. Posteriormente, esfregaços de sangue corados com Giemsa foram examinados para detectar Plasmodium falciparum. A extração do DNA da malária foi feita a partir de amostras de P. falciparum positivas para microscopia, e as infecções por P. falciparum foram confirmadas por nested PCR (visando genes de ácido ribonucleico ribossômico de subunidade pequena de Plasmodium (ssrRNA)). Todas as amostras de P. falciparum confirmadas por PCR foram sequenciadas por pirosequenciamento para descobrir a mutação no gene Pfcrt no códon K76T e em pfmdr1 nos códons N86Y, Y184F, N1042D e D1246Y. De 121 microscopias de casos positivos de P. falciparum, 109 amostras foram positivas para P. falciparum por nested PCR. A mutação Pfcrt K76T foi encontrada em 96% dos isolados, a mutação Pfmdr1 N86Y foi observada em 20% e 11% abrigou a mutação Y184F. Todas as amostras eram do tipo selvagem para o códon N1042D e D1246Y de Pfmdr1. No FATA, Paquistão, a frequência do alelo resistente 76T permaneceu alta apesar da remoção de CQ. No entanto, as descobertas atuais do estudo sugerem a fixação completa do genótipo resistente a CQ de P. falciparum na área de estudo.


Subject(s)
Plasmodium falciparum/genetics , Antimalarials/pharmacology , Pakistan , Membrane Transport Proteins/genetics , Drug Resistance/genetics , Protozoan Proteins/genetics , Chloroquine/pharmacology , Multidrug Resistance-Associated Proteins/genetics , Alleles
2.
Medicina UPB ; 41(1): 51-60, mar. 2022. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1362696

ABSTRACT

Helicobacter pylori es un carcinógeno tipo I resistente a múltiples antibióticos y con alta prioridad en salud pública. La infección por este microorganismo está influenciada por una interacción compleja entre la genética del huésped, el entorno y múltiples factores de virulencia de la cepa infectante. Afecta al 50 % de la población mundial, provocando afecciones gastroduodenales graves, la mayoría de forma asintomática. El 20 % de los individuos con H. pylori pueden desarrollar a través del tiempo lesiones gástricas preneoplásicas y el 2 % de ellos un cáncer gástrico. Las manifestaciones clínicas gastrointestinales y extragastrointestinales están asociadas a su virulencia y a la respuesta del sistema inmunológico con la liberación de citosinas proinflamatorias, tales como TNF-alfa, IL-6, IL-10 e IL-8, causantes de inflamación aguda y crónica. Múltiples factores de virulencia han sido estudiados como el gen A asociado a la citotoxina (CagA) y la citotoxina vacuolante (VacA), los cuales juegan un rol importante en la aparición del cáncer gástrico. Dada la resistencia cada vez mayor a los antibióticos utilizados, las líneas de estudio en el futuro inmediato deben estar encaminadas en establecer la utilidad de los nuevos antibióticos y la determinación de profagos colombianos en todo el país. Esta revisión tiene como objetivo hacer una puesta al día sobre las características del H. pylori, los mecanismos patogénicos, genes de virulencia, su asociación con el mayor riesgo de cáncer gástrico, farmacorresistencia microbiana y su erradicación.


Helicobacter pylori is recognized as a class I carcinogen resistant to multiple antibiotics and with high priority in public health. The infection caused by this microorganism is influenced by a complex interaction between host genetics, environment, and multiple virulence factors of the infecting strain. It affects 50% of the world population, causing severe gastroduodenal conditions, most of them asymptomatic. Through time, 20% of individuals with H. pylori may develop preneoplastic gastric lesions and 2% of them develop gastric cancer. The gastrointestinal and extra-gastrointestinal clinical manifestations are associated with its virulence and the response of the immune system with the release of pro-inflammatory cytokines, such as TNF-alpha, IL-6, IL-10 and IL-8, which cause acute and chronic inflammation. Multiple virulence factors have been studied, such as cytotoxin-associated gene A (CagA) and vacuolating cytotoxin A (VacA), which play an important role in the development of gastric cancer. Due to the increasing antibiotics resistance, the research in the immediate future should be aimed at establishing the usefulness of the new antibiotics and the determination of Colombian prophages throughout the country. This paper aims to update the characteristics of H. pylori, its pathogenic mechanisms, virulence genes, its association with the increased risk of gastric cancer, microbial drug resistance, and eradication.


Helicobacter pylorié um carcinógeno tipo I resistente a múltiplos antibióticos e com alta prioridade na saúde pública. A infecção por este microrganismo está influenciada por uma interação complexa entre a genética do hospede, o entorno e múltiplos fatores de virulência da cepa infectante. Afeta a 50% da população mundial, provocando afeções gastroduodenais graves, a maioria de forma assintomática. 20% dos indivíduos com H. pylori podem desenvolver através do tempo lesões gástricas pré-neoplásicas e 2% deles um câncer gástrico. As manifestações clínicas gastrointestinais e extragastrointestinais estão associadas à sua virulência e à resposta do sistema imunológico com a liberação de citocinas pró-inflamatórias, tais como TNF-alfa, IL-6, IL-10 e IL-8, causantes de inflamação aguda e crónica. Múltiplos fatores de virulência hão sido estudados como o gene. A associado à citotoxina (CagA) e a citotoxina vacuolante (VacA), os quais jogam um papel importante no aparecimento do câncer gástrico. Dada a resistência cada vez maior aos antibióticos utilizados, as linhas de estudo no futuro imediato devem estar encaminhadas em estabelecer a utilidade dos novos antibióticos e a determinaçãode profagos colombianos em todo o país. Esta revisão tem como objetivo fazer uma atualização sobre as características do H. pylori, os mecanismos patogénicos, genes de virulência, sua associação com o maior risco de câncer gástrico, farmacorresistência microbiana e sua erradicação.


Subject(s)
Humans , Helicobacter pylori , Drug Resistance , Carcinogens , Virulence Factors , Disease Eradication , Immune System , Anti-Bacterial Agents
3.
Rev. cienc. salud ; 20(1): 1-9, ene.-abr. 2022. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1367576

ABSTRACT

Introducción:el síndrome de Dravet, también conocido como epilepsia mioclónica grave de la infancia, corresponde a una encefalopatía epiléptica resistente a fármacos que inicia generalmente en el primer año de vida. Se caracteriza por crisis epilépticas que suelen tener múltiples desencadenantes; el más asociado es la presencia de episodios febriles previos. Se considera una enfermedad rara, debido a su baja incidencia y prevalencia. Presentación del caso: niño de 10 años de edad con un cuadro de epilepsia de origen estructural, asociada con un retraso en el neurodesarrollo y anomalías craneofaciales meno-res, con antecedente de cardiopatía congénita no corregida, colpocefalia y agenesia del cuerpo calloso. Debido a la persistencia de las crisis convulsivas y su consiguiente resistencia farmacológica, se le rea-lizó un exoma genético que evidenció una mutación del gen SCN9. Discusión: el síndrome de Dravet debe ser sospechado en todo paciente menor de un año que tenga crisis convulsivas a repetición asociadas con episodios febriles cuantificados. Aproximadamente, entre el 70 % y el 85 % de los pacientes con el diagnóstico de síndrome de Dravet presenta una mutación en el gen SCN1A, por lo que mutaciones en otros genes que codifican para canales de sodio, ubicados en el mismo cromosoma, como el SCN9A, podrían contribuir de forma multifactorial a dicha entidad


Introduction: Dravet syndrome, also known as severe myoclonic epilepsy in infancy, is a drug resistant epileptic encephalopathy that usually begins in the first year of life. It is characterized by the presence of epileptic seizures that usually have multiple triggers; the most currently associated is the presence of previous febrile episodes. It is considered as a rare disease due to its low incidence and prevalence. Case presentation: We reported the case of a ten-year-old boy with structural epilepsy associated with a neuro-developmental delay and minor craniofacial anomalies. He had a history of uncorrected congenital heart disease, colpocephaly, and agenesis of the corpus callosum. Due to the persistence of seizures secondary to drug resistance, it was decided to perform a genetic exome that evidenced a mutation of the SCN9A gene. Conclusions: Dravet syndrome should be suspected in all patients under one year of age who have recu-rrent seizures associated with fever that does not respond to medication and modifies its presentation. Approximately 70%−85% of the patients diagnosed with Dravet syndrome have a mutation in the SCN1A gene; therefore, mutations in other genes that encode sodium channels located on the same chromosome, such as SCN9A, could contribute in a multifactorial way.


Introdução: a síndrome de Dravet, também conhecida como epilepsia mioclônica grave da infância, corresponde a uma encefalopatia epiléptica resistente a medicamentos que geralmente se inicia no primeiro ano de vida. É caracterizada pela presença de crises epilépticas que costumam ter múltiplos detonantes, sendo que o mais associado atualmente é a presença de episódios febris prévios. É conside-rada uma doença rara devido à sua baixa incidência e prevalência. Apresentação do caso: é apresentado o caso de um menino de 10 anos de idade com quadro de epilepsia de origem estrutural, associada a atraso no desenvolvimento neurológico e pequenas anomalias craniofaciais; com histórico de cardio-patia congênita não corrigida, colpocefalia e agenesia do corpo caloso. Devido à persistência das crises epilépticas e consequente resistência farmacológica, optou-se pela realização de um exoma genético que apresenta uma mutação do gene SCN9. Discussão: a síndrome de Dravet deve ser suspeitada em todos os pacientes com menos de um ano de idade que apresentam convulsões repetidas associadas a episódios febris quantificados. Aproximadamente 70 a 85% dos pacientes com diagnóstico de síndrome de Dravet apresentam mutação no gene SCN1A, portanto mutações em outros genes que codificam canais de sódio, localizados no mesmo cromossomo, como o SCN9A, poderiam contribuir de forma multifatorial para essa entidade


Subject(s)
Humans , Child , Epilepsies, Myoclonic , Seizures , Brain Diseases , Drug Resistance , Child , Epilepsy, Generalized , Drug Resistant Epilepsy
4.
Rev. Investig. Salud. Univ. Boyacá ; 8(2): 44-61, 20211201. tab
Article in Spanish | LILACS | ID: biblio-1369439

ABSTRACT

Introducción: Entre las infecciones asociadas con la atención en salud, las relacionadas con dispositivos constituyen la patología más común en los pacientes que ingresan al servicio de cuidados intensivos. Objetivos: Determinar la distribución de las infecciones asociadas con dispositivos, su perfil microbiológico y resistencia bacteriana en las unidades de cuidados intensivos del departamento de Casanare, Colombia entre 2019 y 2020. Materiales y métodos: Estudio observacional retrospectivo de corte transversal. La población de estudio fueron 93 pacientes admitidos entre enero de 2019 y diciembre de 2020 en dos unidades de cuidados intensivos del depar-tamento de Casanare. La información fue suministrada por la Secretaría de Salud Departamental, a través de los reportes de los laboratorios clínicos por medio del programa WHONET 5.6. Resultados: Las infecciones del torrente sanguíneo asociadas con el uso de catéter fueron las más frecuentes, con un 84 % (n: 78); seguidas de las infecciones sintomáticas de las vías urinarias asociadas con catéter, con un 12 % (n: 11), y en menor proporción las neumonías asociadas con ventilador mecánico, en un 4 % (n: 4). Las bacterias gramnegativas presentaron mayor frecuencia (61 %; n: 14) en relación con las grampositivas (39 %; n: 9). Conclusión: Las infecciones más frecuentes en los servicios analizados fueron las del torrente sanguíneo asociadas con el catéter y Pseudomonas aeruginosa fue el microrganismo más prevalente en los tres tipos de infección; mien-tras que el Enterococcus faecium fue resistente a una variedad de antibióticos. Tales resultados, al ser comparados con estudios realizados en varios países, demostraron que la distribución de estas infecciones es variable. Palabras clave: infecciones oportunistas; unidad de cuidados intensivos; dispositivos de acceso vascular; neumonía asociada al ventilador; infecciones relacionadas con catéteres; agentes antibacterianos; resistencia a medicamentos.


Introduction: Among health care associated infections, device associated infections are the most common pathology in patients admitted to the intensive care service. Objectives: To determine the distribution of device-associated infections, their microbiological profile and bacterial resistance, in the intensive care units of the Department of Casanare between 2019 and 2020. Materials and methods: An observational, retrospective, cross-sectional study was carried out. The study population was 93 patients admitted between January 2019 and December 2020 in two Inten-sive Care Units of the Department of Casanare. The information was provided by the Departmental Health Secretariat through the reports of the Clinical Laboratories through the WHONET 5.6 program. Results: Catheter-associated bloodstream infections were the most frequent with 84% (n: 78), fo-llowed by catheter-associated symptomatic urinary tract infections with 12% (n: 11) and associated pneumonia to a lesser extent 4% mechanical ventilator (n: 4). Gram negative bacteria had a higher frequency 61% (n: 14) compared to Gram positive ones 39% (n: 9). Conclusion: The infection associated with devices, the most frequent in the analyzed services were the infections of the blood stream associated with the catheter and P. aeruginosa was the most preva-lent microorganism in the three types of infection. E. faecium presented resistance to a variety of an-tibiotics, results that when compared with studies carried out in several countries worldwide showed that the distribution of these infections is variable.


Introdução: Entre as infecções associadas aos cuidados de saúde, as infecções associadas a dispositi-vos são a patologia mais comum em pacientes internados em terapia intensiva. Objetivo: Determinar a distribuição de infecções associadas a dispositivos, seu perfil microbiológico e resistência bacteriana em unidades de terapia intensiva no departamento de Casanare, Colômbia entre 2019 e 2020. Materiais e métodos: Estudo retrospectivo observacional transversal. A população do estudo foi de 93 pacientes admitidos entre janeiro de 2019 e dezembro de 2020 em duas unidades de terapia in-tensiva no departamento de Casanare. As informações foram fornecidas pela Secretaria de Saúde do Departamento, através de informes de laboratório clínico utilizando o programa WHONET 5.6. Resultado: As infecções da corrente sanguínea associadas a cateteres foram as mais frequentes com 84% (n: 78), seguidas pelas infecções do trato urinário sintomáticas associadas a cateteres com 12% (n: 11), e em menor grau as pneumonias associadas a ventiladores mecânicos com 4% (n: 4). As bac-térias gram-negativas eram mais frequentes (61%; n: 14) do que as gram-positivas (39%; n: 9). Conclusão: As infecções mais frequentes nos serviços analisados foram infecções associadas a cate-teres e Pseudomonas aeruginosa foi o microrganismo mais prevalente nos três tipos de infecção, en-quanto Enterococcus faecium era resistente a uma variedade de antibióticos. Tais resultados, quando comparados com estudos realizados em vários países, demonstraram que a distribuição dessas infe-cções é variável.


Subject(s)
Opportunistic Infections , Drug Resistance , Pneumonia, Ventilator-Associated , Catheter-Related Infections , Vascular Access Devices , Intensive Care Units , Anti-Bacterial Agents
5.
Rev. bras. anal. clin ; 53(3): 219-223, 20210930.
Article in Portuguese | LILACS | ID: biblio-1368021

ABSTRACT

Os mecanismos de resistência bacteriana podem existir de maneira intrínseca ou adquirida, porém em ambos os casos podem dificultar a terapia antimicrobiana preconizada para tratamento de infecções. Este artigo tem como objetivo apresentar estudos recentes sobre o assunto. Foi realizada uma revisão da literatura sobre resistência bacteriana aos antimi- crobianos, utilizando as bases de dados MEDLINE, LILACS, Scopus e Web of Science. A busca identificou o total de 16 artigos, que foram publicados entre os anos de 2017 a 2021. A maioria dos artigos sobre Gram-negativos tratou do grupo das enterobactérias, assim como os de Gram-positivos tratou dos gêneros Staphylococcus , Enterococcus e Streptococcus. A resistência bacteriana foi encontrada em cefalosporinas, carbapenêmicos, quinolonas, aminoglicosídeos, entre outros. Em relação aos mecanismos de resistência, as ß-Lactamases de espectro estendido (ESBL), enterobactérias resistentes aos carbape- nêmicos (ERC), Staphylococcus aureus resistentes à meticilina (MRSA) e Enterococcus resistentes à vancomicina (VRE) foram relatados e observa-se que a maioria dos trabalhos corrobora que seu rastreamento visa minimizar a transmissão em instituições de saúde.


Bacterial resistance mechanisms can exist intrinsically or acquired, but in both cases they can make the antimicrobial therapy recommended for the treatment of infections difficult. This article aims to present recent studies on the subject. A literature review on bacterial resistance to antimicrobials was carried out using the MEDLINE, LILACS, Scopus and Web of Science databases. The search identified a total of 16 articles, which were published between 2017 and 2021. Most articles on Gram-negatives dealt with the enterobacteria group, as well as Gram-positive articles from the Staphylococcus, Enterococcus and Streptococcus genera. Bacterial resistance was found in cephalosporins, carbapenems, quinolones, aminoglycosides, among others. Regarding resistance mechanisms, Extended Spectrum Beta-Lactamases (ESBL), Carbapenem-Resistant Enterobacteria (ERC), Methicillin- Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE) have been reported and it is observed that most works corroborate that its tracking aims to minimize transmission in health institutions.


Subject(s)
Drug Resistance , Bacterial Infections , Microbiology
6.
Article in Spanish | LILACS, BDNPAR | ID: biblio-1337804

ABSTRACT

La resistencia a los antimicrobianos (RAM), representa un grave problema por el uso indiscriminado de antimicrobianos de amplio espectro. En nuestro país, durante el primer cuatrimestre del año, se observó un aumento inusual en el número de aislamiento de gérmenes multirresistentes, sobre todo de bacilos gramnegativos, los cuales fueron remitidos al laboratorio de referencia con el objetivo de caracterizar los genes de resistencia a los carbapenemes. Estudio observacional y prospectivo de corte transversal en 456 aislamientos de bacilos gramnegativos provenientes de 11 centros colaboradores de la Red Nacional de Vigilancia de la RAM, remitidos al Laboratorio Central de Salud Pública entre enero y abril de 2021, para la detección molecular (reacción en cadena de la polimerasa múltiple) de los genes de resistencia enzimática bla OXA-51, bla OXA-23, bla OXA-24, bla OXA-48, bla OXA-58, bla NDM, bla KPC, bla IMP, bla VIM. Trescientos sesenta correspondieron a bacilos gramnegativos no fermentadores: 346 Acinetobacter baumannii y 14 Pseudomonas aeruginosa; 96 fueron miembros de Enterobacterales, siendo prevalente Klebsiella pneumoniae (81). Todos los aislamientos de Acinetobacter baumannii resultaron ser productores de carbapenemasas: OXA-23 (94%), NDM (4%), NMD+OXA-58 (2%); en Pseudomonas aeruginosa, 7 de los 14 aislamientos (50%) fueron portadores de metalobetalactamasa del genotipo NDM (100%). Los genotipos NDM (92%) y KPC (8%) fueron confirmados en Enterobacterales. La resistencia plasmídica a carbapenemes es endémica en nuestro país, siendo prevalentes los genotipos OXA-23 en Acinetobacter baumannii y NDM en Pseudomonas aeruginosa y Enterobacterales


Antimicrobial resistance (AMR) represents a serious problem due to the indiscriminate use of broad-spectrum antimicrobials. During the first quarter of the year, an unusual increase in the number of isolation multi-resistant germs, especially gram-negative bacilli was observed, specially of Gram-negative bacilli which were referred to the reference laboratory in order to characterize the carbapenems resistance genes. Observational and prospective cross-sectional study in 456 isolates of Gram-negative bacilli from 11 collaborating centers of the National AMR Surveillance Network, referred to the Central Public Health Laboratory (LCSP) between January and April 2021, for molecular detection (multiple polymerase chain reaction) targeting the enzymatic resistance genes: bla OXA-51, bla OXA-23, bla OXA-24, bla OXA-48, bla OXA-58, bla NDM, bla KPC, bla IMP, bla VIM. Of the 456 isolates studied, 360 corresponded to non-fermenting Gram-negative bacilli, of which 346 were confirmed as Acinetobacter baumannii and 14 Pseudomonas aeruginosa; 96 were Enterobacterales, being Klebsiella pneumoniae (81) the most prevalent. All isolates of Acinetobacter baumannii carried genes encoding carbapenemases, being the OXA-23 (94%) followed by NDM (4%) and NDM +OXA-58 (2%). In Pseudomonas aeruginosa strains, 7 of the 14 isolates (50%) were carriers of NDM metallobetalactamase (100%). No carbapenemase gene was detected in the remaining 7. In all Enterobacterales strains, the presence of carbapenemases of the NDM (92%) and KPC (8%) genotypes were confirmed. Plasmid resistance to carbapenems is endemic in our country, being the OXA-23 genotypes prevalent in Acinetobacter baumannii and NDM in Pseudomonas aeruginosa and Enterobacterales


Subject(s)
Pseudomonas Infections , Acinetobacter baumannii , Carbapenem-Resistant Enterobacteriaceae , Pseudomonas aeruginosa , Bacteria , Drug Resistance , Polymerase Chain Reaction , Genotype
7.
Arq. bras. cardiol ; 116(3): 485-491, Mar. 2021. tab
Article in English, Portuguese | LILACS | ID: biblio-1248884

ABSTRACT

Resumo Fundamento: A doença de Kawasaki (DK) é a principal causa de cardiopatia adquirida em idade pediátrica nos países desenvolvidos. Objetivos: Identificar fatores preditores de resistência à imunoglobulina intravenosa (IGIV), calcular a eficácia dos modelos preditores japoneses e caracterizar as complicações cardíacas. Métodos: Análise retrospectiva dos casos de DK entre janeiro de 2006 e julho de 2018 em um hospital pediátrico português. Foram construídas curvas ROC para encontrar fatores preditores de resistência e utilizada regressão logística multivariada para elaborar o modelo preditor. O nível de significância utilizado foi de 5%. Resultados: Foram incluídos 48 pacientes com mediana de idade de 36 meses. Verificou-se resistência à IGIV em 21%. Ocorreram alterações ecocardiográficas em 46%, com envolvimento coronário em 25%. Como variáveis preditoras de resistência, a proteína C-reativa (PC-R) apresentou uma AUC ROC = 0,789, ponto de corte = 15,1 mg/dL, sensibilidade (S) = 77,8% e especificidade (E) = 78,9%. A velocidade de sedimentação (VS) apresentou uma AUC ROC = 0,781, ponto de corte = 90,5 mm/h, S = 66,7% e E = 85,7%. O modelo com as duas variáveis apresentou valor p = 0,042 e AUC ROC = 0,790. O modelo Kobayashi apresentou S = 63,6% e E = 77,3%; Egami, S = 66,7% e E = 73,1%; e Sano, S = 28,6% e E = 94,1%. Conclusão: A PC-R e a VS são variáveis independentes que mostraram tendência preditora de resistência à IGIV com pontos de corte ótimos de 15,1 mg/dL e 90,5 mm/h, respectivamente. Cerca de metade dos pacientes teve algum tipo de envolvimento cardíaco. Os modelos japoneses não têm utilidade nessa população. (Arq Bras Cardiol. 2021; 116(3):485-491)


Abstract Background: Kawasaki disease (KD) is the leading cause of acquired cardiac disease in children, in developed countries. Objectives: To identify predictive factors for resistance to intravenous immunoglobulin (IVIG), calculate the effectiveness of Japanese predictive models and characterize cardiac complications. Methods: Retrospective analysis of KD cases admitted in a Portuguese paediatric hospital between january 2006 and july 2018. ROC curves were used to determine predictive factors for resistance and the multivariate logistic regression analysis was used to develop the predictive model. A significance level of 5% was used. Results: 48 patients with a median age of 36 months were included. The IVIG resistance was 21%. Echocardiographic anomalies were noted in 46%, with coronary involvement in 25% of the sample population. As predictive variable of resistance, the C-reactive protein (CRP) presented an AUC ROC = 0.789, optimal cut-off value 15.1 mg/dL, sensitivity (Sn) 77.8% and specificity (Sp) 78.9%. The erythrocyte sedimentation rate (ESR) presented an AUC ROC = 0.781, optimal cut-off value 90.5 mm/h, Sn 66.7% and Sp 85.7%. The model with the two variables showed p = 0.042 and AUC ROC = 0.790. Predictive strength of Japanese models were: Kobayashi (Sn 63.6%, Sp 77.3%), Egami (Sn 66.7%, Sp 73.1%), Sano (Sn 28.6%, Sp 94.1%). Conclusion: CRP and ESR are independent variables that were related to IVIG resistance, with optimal cut-off points of 15.1 mg/dL and 90.5 mm/h, respectively. About half of the patients had some form of cardiac involvement. The Japanese models appeared to be inadequate in our population. (Arq Bras Cardiol. 2021; 116(3):485-491)


Subject(s)
Humans , Infant, Newborn , Child, Preschool , Child , Heart Diseases , Mucocutaneous Lymph Node Syndrome/drug therapy , Drug Resistance , Retrospective Studies , Risk Factors , Immunoglobulins, Intravenous/therapeutic use
9.
Arq. ciências saúde UNIPAR ; 25(1): 79-85, jan-abr. 2021.
Article in Portuguese | LILACS | ID: biblio-1151426

ABSTRACT

Introdução: O diagnóstico da hanseníase possui números significativos que causam preocupação à saúde pública. Os casos de resistência medicamentosa nessa doença se iniciaram em meados dos anos 60 e diante do problema, a Organização Mundial da Saúde instituiu em 1981 a poliquimioterapia, associação dos antibióticos rifampicina, dapsona e clofazimina, tratamento atual de escolha. A resistência aos fármacos na hanseníase é reportada pela literatura, desvelando um obstáculo à sua eliminação. Apresentamos nessa revisão os principais aspectos da resistência medicamentosa no tratamento para hanseníase e seus impactos. Metodologia: Revisão sistemática sobre os aspectos da resistência medicamentosa utilizando a pesquisa exploratória como metodologia de abordagem. Foram pesquisados os termos resistência medicamentosa, hanseníase, recidiva, alterações genéticas e os operadores booleanos "and" e "or" na busca. Resultados e discussão: A dificuldade de tomar a medicação corretamente foi um dos principais fatores que acarretaram resistência do bacilo Mycobacterium leprae aos fármacos. Homens de países norte e sul-americanos e asiáticos foram os mais atingidos por episódios de resistência. A resistência medicamentosa é uma das principais causas de recidivas em hanseníase. O principal fármaco causador de resistência medicamentosa descrito nos trabalhos foi a dapsona (46,6%) e a maioria das alterações genéticas encontradas estão no gene rpoB; 23,2% dos registros relatados foram de resistência secundária aos fármacos e, também, sete casos de resistência múltipla a esses medicamentos. Conclusão: Os principais aspectos da resistência medicamentosa na hanseníase são os equívocos ao ingerir os medicamentos e as alterações genéticas na bactéria. Os impactos causados estão na dificuldade de refazer o tratamento, a possibilidade de nova transmissão e o aparecimento de sintomas mais graves.


Introduction: The diagnosis of leprosy has significant numbers causing public health concern. Reports of drug resistance in this disease begun in the mid-1960s and due to this problem, the World Health Organization instituted a multidrug therapy with rifampicin, dapsone, and clofazimine antibiotic association in 1981, which is currently the first-choice treatment for leprosy. Cases of drug resistance have been reported in literature, revealing an obstacle to the eradication of the disease. This paper has the purpose of presenting the key aspects and impacts of drug resistance in the treatment for leprosy. Methods: Systematic review of the drug resistance aspects using exploratory research as an approach methodology. The authors searched the terms drug resistance, leprosy, recurrence, genetic alterations, and the Boolean operators "and" and "or" between them. Results and discussion: The difficulty in taking the medication correctly was one of the key factors that led to drug resistance for Mycobacterium leprae. Men from North and South American, as well as from Asian countries, were the most affected by episodes of resistance. Drug resistance is one of the main causes of leprosy recurrences. Dapsone was the most frequently identified drug resistance in the studies (46.6%), while most of the genetic alterations were found in the rpoB gene; 23.2% of the cases were from secondary resistance episodes, and seven cases of multiple resistance were reported. Conclusion: The misconceptions when taking the treatment and the Mycobacterium leprae genetic alterations have been described as the key aspects of drugs resistance in leprosy and the impacts caused are the difficulty in redoing the treatment, the possibility of new transmission, and the appearance of more severe symptoms.


Subject(s)
Drug Resistance/drug effects , Drug Resistance, Bacterial/drug effects , Mycobacterium leprae/drug effects , Rifampin/adverse effects , Bacteria/genetics , Pharmaceutical Preparations , Clofazimine/adverse effects , Fluoroquinolones/adverse effects , Dapsone/adverse effects , Drug Therapy, Combination/adverse effects , Leprosy/drug therapy , Anti-Bacterial Agents/adverse effects
10.
Rev. bras. anal. clin ; 53(1): 58-63, 20210330. graf, tab
Article in Portuguese | LILACS | ID: biblio-1291397

ABSTRACT

Objetivo: Avaliar a prevalência e o perfil de suscetibilidade aos antimicrobianos das cepas de Acinetobacter baumannii e Pseudomonas aeruginosa isoladas de amostras de lavado traqueal. Métodos: Trata-se de um estudo retrospectivo, transversal, descritivo, no qual foram coletados resultados de cultura de lavado traqueal de pacientes com PAV, internados em uma UTI adulta de um hospital público da cidade de Juiz de Fora, MG. Os dados foram coletados nos registros eletrônicos do Serviço de Controle de Infecção Hospitalar, referentes ao período de janeiro a dezembro de 2018. Resultados: Foram analisadas 469 amostras de lavado traqueal de pacientes adultos internados na UTI, sendo consideradas culturas positivas, aquelas com contagem de colônias ≥106UFC/ mL, totalizando 242 (51,52%) das amostras de lavado traqueal positivas, sendo que, destas, 230 foram monomicrobianas e 12 com dois micro-organismos. Foram isoladas 59 (24,89%) cepas de Acinetobacter baumannii e 45 (18,98%) cepas de Pseudomonas aeruginosa. De acordo com os critérios do CLSI 2018, 100% das cepas de A. baumannii se mostraram resistentes a meropenem, cefepime, ceftriaxona, ceftazidima e piperaci- lina-tazobactam. Conclusão: A. baumannii e Pseudomonas aeruginosa são agentes importantes de PAV, sendo que A. baumannii foi o patógeno mais comumente associado e apresentou multirresistência aos fármacos testados.


Objective: The objective of this study is to evaluate the prevalence and antimicrobial susceptibility profile of strains of A. baumannii and P. aeruginosa isolated from tracheal lavage. Methods: This is a retrospective, cross-sectional, descriptive study where tracheal lavage culture results were collected from patients with VAP admitted to an adult ICU at a public hospital in the city of Juiz de Fora. Data were collected through the records of the Hospital Infection Control Service for the period from January to December 2018. Results: 469 tracheal lavage samples from adult patients admitted to the ICU were analyzed. Positive cultures were considered if ≥106CFU / mL, totaling 242 (51.52%) of the tracheal lavage samples were positive; 55 (24.89%) strains of A. baumannii and 45 (18.98%) strains of P. aeruginosa were isolated. According to the CLSI 2018 criteria, A. Baumannii presented 100% of the strains resistant to meropenem, cefepime, ceftriaxone, ceftazidime and piperacillin-tazobactam. Conclusion: A. baumannii and P. aeruginosa are important agents of PAV. Furthermore, A. baumannii was the most commonly associated pathogen and presented multiresistance to the drugs tested, being considered as a public health issue.


Subject(s)
Humans , Male , Female , Pneumonia , Pseudomonas aeruginosa , Respiration, Artificial , Acinetobacter Infections , Drug Resistance , Acinetobacter baumannii
12.
San Salvador; MINSAL; ene. 11, 2021. 40 p. ilus, graf.
Non-conventional in Spanish | LILACS, BISSAL | ID: biblio-1146523

ABSTRACT

La presente guía clínica de atención integral de pacientes con tuberculosis farmacorresistente, será uno de los pilares de apoyo esencial para la reducción de la morbimortalidad causada por dicha enfermedad, ya que establece los criterios que el personal de salud debe tomar en cuenta para poder prevenir y detectar los casos e iniciar oportunamente el tratamiento para cortar la cadena de transmisión y evitar así su propagación


This clinical guide for the comprehensive care of patients with drug-resistant tuberculosis will be one of the essential support pillars for the reduction of morbidity and mortality caused by this disease, since it establishes the criteria that health personnel must take into account in order to prevent and detect cases and initiate treatment in a timely manner to cut the chain of transmission and thus prevent its spread


Subject(s)
Tuberculosis , Drug Resistance , Guideline , Comprehensive Health Care
13.
Article in Chinese | WPRIM | ID: wpr-880103

ABSTRACT

OBJECTIVE@#To investigate the effect of autophagy on the drug resistance of different human lymphoma cells.@*METHODS@#Human Burkitt's lymphoma cell Daudi, human B lymphoma cell SUDHL-4, and human mantle cell lymphoma cell JeKo-1 were taken as the research subjects. The expression of Atg5 was inhibited by the treatments of autophagy inhibitors or stable interference via lentivirus infection. The autophagy activity of B lymphoma cell was changed, and the changes of lymphoma cells to the drug resistance of ADR and VCR was observed.@*RESULTS@#JeKo-1 cells showed the strongest resistance to ADR and VCR, followed by SUDHL-4, and Daudi cells showed the weakest resistance to ADR and VCR. At the same time, JeKo-1 cells showed the strongest autophagy activity, followed by SUDHL-4, and Daudi cells showed the weakest autophagy activity. After the treatments of autophagy inhibitors or stable Atg5 interference, the resistance of lymphoma cells to ADR and VCR was significantly weakened, and there was the positive correlation at the drug resistance and the autophagy activity of B lymphoma cell.@*CONCLUSION@#The higher autophagy activity in lymphoma cells, the lower chemotherapy resistance of the lymphoma cells after autophagy was inhibited.


Subject(s)
Adult , Autophagy , Burkitt Lymphoma , Cell Line, Tumor , Drug Resistance , Humans , Lymphoma, B-Cell
14.
Article in Chinese | WPRIM | ID: wpr-888007

ABSTRACT

Drug resistance resulting from bacterial biofilms can invalidate antibacterial agents. Therefore,eradicating bacterial biofilms to reverse drug resistance is a hotspot in the pharmaceutical research. In recent years,numerous studies have revealed the complicated mechanism of bacterial biofilm formation and strong drug resistance with multiple influential factors involved. This paper gives a comprehensive review on the process of biofilm formation and intervention by natural drugs,which can provide some reference and evidence for the following studies.


Subject(s)
Anti-Bacterial Agents/pharmacology , Bacteria/genetics , Biofilms , Drug Resistance , Pharmaceutical Preparations
15.
Rev. Soc. Bras. Med. Trop ; 54: e20200087, 2021. tab, graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1136920

ABSTRACT

Abstract INTRODUCTION: In this study, we report a clonal dissemination of carbapenem resistant Acinetobacter baumannii isolates due to the acquisition of blaOXA-23 in a regional hospital located in Brazilian Amazon Region. METHODS: The isolates were identified by MALDI-TOF and the carbapenemase-encoding genes were detected by multiplex-PCR. The genetic similarity was investigated by pulsed-field gel electrophoresis (PFGE). RESULTS: Only 10 (55.6%) isolates harbored the gene bla OXA-23. PFGE analysis revealed that these isolates belong to a single clone. CONCLUSIONS: This dissemination strategy indicates the need for surveillance, adoption of control procedures defined in guidelines, and the careful administration of antimicrobials should be reinforced.


Subject(s)
Humans , Acinetobacter Infections/epidemiology , Acinetobacter baumannii/genetics , Bacterial Proteins/genetics , beta-Lactamases/genetics , Brazil/epidemiology , Drug Resistance , Microbial Sensitivity Tests , Electrophoresis, Gel, Pulsed-Field , Molecular Epidemiology , Hospitals , Anti-Bacterial Agents/pharmacology
16.
Frontiers of Medicine ; (4): 693-703, 2021.
Article in English | WPRIM | ID: wpr-922501

ABSTRACT

Resistome is a cluster of microbial genes encoding proteins with necessary functions to resist the action of antibiotics. Resistome governs essential and separate biological functions to develop resistance against antibiotics. The widespread clinical and nonclinical uses of antibiotics over the years have combined to select antibiotic-resistant determinants and develop resistome in bacteria. At present, the emergence of drug resistance because of resistome is a significant problem faced by clinicians for the treatment of Salmonella infection. Antibiotic resistome is a dynamic and ever-expanding component in Salmonella. The foundation of resistome in Salmonella is laid long before; therefore, the antibiotic resistome of Salmonella is reviewed, discussed, and summarized. We have searched the literature using PubMed, MEDLINE, and Google Scholar with related key terms (resistome, Salmonella, antibiotics, drug resistance) and prepared this review. In this review, we summarize the status of resistance against antibiotics in S. typhi, highlight the seminal work in the resistome of S. typhi and the genes involved in the antibiotic resistance, and discuss the various methods to identify S. typhi resistome for the proactive identification of this infection and quick diagnosis of the disease.


Subject(s)
Anti-Bacterial Agents/pharmacology , Drug Resistance , Humans , Microbial Sensitivity Tests , Salmonella , Salmonella typhi/genetics
17.
Frontiers of Medicine ; (4): 551-561, 2021.
Article in English | WPRIM | ID: wpr-888745

ABSTRACT

Glioma is the most common lethal tumor of the human brain. The median survival of patients with primary World Health Organization grade IV glioma is only 14.6 months. The World Health Organization classification of tumors of the central nervous system categorized gliomas into lower-grade gliomas and glioblastomas. Unlike primary glioblastoma that usually develop de novo in the elderly, secondary glioblastoma enriched with an isocitrate dehydrogenase mutant typically progresses from lower-grade glioma within 5-10 years from the time of diagnosis. Based on various evolutional trajectories brought on by clonal and subclonal alterations, the evolution patterns of glioma vary according to different theories. Some important features distinguish the normal brain from other tissues, e.g., the composition of the microenvironment around the tumor cells, the presence of the blood-brain barrier, and others. The underlying mechanism of glioma recurrence and evolution patterns of glioma are different from those of other types of cancer. Several studies correlated tumor recurrence with tumor heterogeneity and the immune microenvironment. However, the detailed reasons for the progression and recurrence of glioma remain controversial. In this review, we introduce the different mechanisms involved in glioma progression, including tumor heterogeneity, the tumor microenvironment and drug resistance, and their pre-clinical implements in clinical trials. This review aimed to provide new insights into further clinical strategies for the treatment of patients with recurrent and secondary glioma.


Subject(s)
Aged , Brain Neoplasms/genetics , Drug Resistance , Glioblastoma , Glioma/genetics , Humans , Mutation , Neoplasm Recurrence, Local/drug therapy , Tumor Microenvironment
18.
Braz. J. Pharm. Sci. (Online) ; 57: e181086, 2021. tab, graf
Article in English | LILACS | ID: biblio-1350237

ABSTRACT

Malaria is nowadays one of the most serious health concerns in a global scale and, although there is an evident increase in research studies in this area, pointed by the vast number of hits and leads, it still appears as a recurrent topic every year due to the drug resistance shown by the parasite exposing the urgent need to develop new antimalarial medications. In this work, 38 molecules were synthesized via copper(I)-catalyzed alkyne-azide cycloaddition (CuAAC) or "click" chemistry, following different routes to produce 2 different organic azides, obtained from a 4,7 dicholoquinoline, reacted with 19 different commercially available terminal alkynes. All those new compounds were evaluated for their in vitro activity against the chloroquine resistant malaria parasite Plasmodium falciparum (W2). The cytotoxicity evaluation was accomplished using Hep G2 cells and SI index was calculated for every molecule. Some of the quinoline derivatives have shown high antimalarial activity, with IC50 values in the range of 1.72-8.66 µM, low cytotoxicity, with CC50>1000 µM and selectivity index (SI) in the range of 20-100, with some compounds showing SI>800. Therefore, the quinolinotriazole hybrids could be considered a very important step on the development of new antimalarial drugs


Subject(s)
In Vitro Techniques/instrumentation , Chloroquine/administration & dosage , Malaria/drug therapy , Antimalarials/analysis , Plasmodium falciparum/metabolism , Research/classification , Drug Resistance/drug effects , Chimera/abnormalities , Inhibitory Concentration 50 , Click Chemistry
19.
Clin. biomed. res ; 41(2): 167-169, 2021. graf
Article in English | LILACS | ID: biblio-1337839

ABSTRACT

For years, the management of schizophrenia has represented a challenge for clinicians, with antipsychotic treatments usually resulting in relapses and new hospitalizations. Clozapine has been shown to be an effective medication for treatment-resistant schizophrenia (TRS), but is currently underused due to its potential side effects. Nevertheless, research has suggested that clozapine reduces future hospitalizations in patients with TRS. This study aims to verify the rates of hospitalizations in patients with TRS under long-term use of clozapine. We retrospectively analyzed clinical data from 52 individuals with TRS before and after the use of clozapine. The mean duration of treatment with and without clozapine was 6.6 (± 3.9) and 8.5 years (± 6.6), respectively. Patients had a median of 0.5 (0.74) hospitalizations per year before the use of clozapine and 0 (0.74) hospitalizations after it (p = 0.001). Therefore, the use of clozapine resulted in an expected reduction in the number of hospitalizations per year in individuals with TRS. (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Schizophrenia/drug therapy , Drug Resistance , Clozapine/therapeutic use , Hospitalization
20.
Rev. Soc. Bras. Med. Trop ; 54: e0375-2020, 2021. tab
Article in English | LILACS | ID: biblio-1155553

ABSTRACT

Abstract INTRODUCTION: Leprosy recurrence is the reappearance of the disease after treatment with current schemes and discharged for cure and may have variable incubation periods. METHODS: This is a descriptive observational study of leprosy recurrence in Espírito Santo diagnosed between January 2018 and January 2020. RESULTS: One hundred and ninety-two cases were available, of which 30 were diagnosed with leprosy recurrence. CONCLUSIONS: In 25 cases, the incubation period was 5-15 years after the first treatment, favoring bacillary persistence. In the remaining 5 cases, the disease had recurred after 15 years, pointing to reinfection as none of them exhibited drug resistance.


Subject(s)
Humans , Leprosy/drug therapy , Recurrence , Brazil , Drug Resistance , Tertiary Care Centers
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