Molecular Epidemiology of Candida auris in Colombia Reveals a Highly Related, Countrywide Colonization With Regional Patterns in Amphotericin B Resistance.

Background: Candida auris is a multidrug-resistant yeast associated with hospital outbreaks worldwide. During 2015-2016, multiple outbreaks were reported in Colombia. We aimed to understand the extent of contamination in healthcare settings and to characterize the molecular epidemiology of C. auris in Colombia. Methods: We sampled patients, patient contacts, healthcare workers, and the environment in 4 hospitals with recent C. auris outbreaks. Using standardized protocols, people were swabbed at different body sites. Patient and procedure rooms were sectioned into 4 zones and surfaces were swabbed. We performed whole-genome sequencing (WGS) and antifungal susceptibility testing (AFST) on all isolates. Results: Seven of the 17 (41%) people swabbed were found to be colonized. Candida auris was isolated from 37 of 322 (11%) environmental samples. These were collected from a variety of items in all 4 zones. WGS and AFST revealed that although isolates were similar throughout the country, isolates from the northern region were genetically distinct and more resistant to amphotericin B (AmB) than the isolates from central Colombia. Four novel nonsynonymous mutations were found to be significantly associated with AmB resistance. Conclusions: Our results show that extensive C. auris contamination can occur and highlight the importance of adherence to appropriate infection control practices and disinfection strategies. Observed genetic diversity supports healthcare transmission and a recent expansion of C. auris within Colombia with divergent AmB susceptibility.

Proteomics unravels extracellular vesicles as carriers of classical cytoplasmic proteins in Candida albicans.

The commensal fungus Candida albicans secretes a considerable number of proteins and, as in different fungal pathogens, extracellular vesicles (EVs) have also been observed. Our report contains the first proteomic analysis of EVs in C. albicans and a comparative proteomic study of the soluble secreted proteins. With this purpose, cell-free culture supernatants from C. albicans were separated into EVs and EV-free supernatant and analyzed by LC-MS/MS. A total of 96 proteins were identified including 75 and 61 proteins in EVs and EV-free supernatant, respectively. Out of these, 40 proteins were found in secretome by proteomic analysis for the first time. The soluble proteins were enriched in cell wall and secreted pathogenesis related proteins. Interestingly, more than 90% of these EV-free supernatant proteins were classical secretory proteins with predicted N-terminal signal peptide, whereas all the leaderless proteins involved in metabolism, including some moonlighting proteins, or in the exocytosis and endocytosis process were exclusively cargo of the EVs. We propose a model of the different mechanisms used by C. albicans secreted proteins to reach the extracellular medium. Furthermore, we tested the potential of the Bgl2 protein, identified in vesicles and EV-free supernatant, to protect against a systemic candidiasis in a murine model.

Design of Micelle Nanocontainers Based on PDMAEMA-b-PCL-b-PDMAEMA Triblock Copolymers for the Encapsulation of Amphotericin B.

The clinical application of amphotericin B (AmB), a broad spectrum antifungal agent, is limited by its poor solubility in aqueous medium and also by its proven renal toxicity. In this work, AmB was encapsulated in micelles obtained from the self-assembly of PDMAEMA-b-PCL-b-PDMAEMA triblock copolymers. The amount of encapsulated AmB depended on the copolymer composition, and short blocks of polycaprolactone (PCL) and poly(2-dimethylaminoethyl methacrylate) (PDMAEMA) showed better performance. All the studied formulations exhibited a controlled release of AmB along 150 h. The formulations presented reduced hemotoxicity while maintaining antifungal activities against Candida albicans, Candida krusei, and Candida glabrata comparable with free AmB. A reduction on the hemotoxicity was found to be due to the slow release and subsequent low aggregation achieved with the use of polymer micelle nanocontainers.

[Association of the Pediatric Appendicitis Score with hospital stay and postoperative complications]. / Asociación de la Escala pediátrica de apendicitis con la estancia hospitalaria y las complicaciones postoperatorias.

Background: Acute appendicitis (AA) is the most common surgical emergency in children. Assessment scales improve the timely detection of cases. Objective: To evaluate the association of the Pediatric Appendicitis Scale (PAS) with hospital stay (HS) and postoperative complications of appendectomy. Material and methods: Observational, analytical, longitudinal and retrolective study. Patients from 2 months to 15 years of age, without comorbidities, who underwent appendectomy for complicated (CAA) and uncomplicated (UCAA) acute appendicitis were included. PAS score prior to an appendectomy was obtained, and the time of HS and postoperative complications were evaluated. Results: 64 patients were evaluated, age 8 (IQR 8-12) years, PAS score 6 (IQR 4-8). The time from the onset of symptoms to the request for care in the emergency department was shorter (p < 0.0001) and the total neutrophil count was higher (p = 0.001) in the CAA group. No difference was shown in the PAS score between patients with CAA and UCAA (6 [4-7] vs. 7 [4-8], p = 0.087]. A PAS score ≥ 7 was associated with an increased risk of prolonged HE (p = 0.007), but was not associated with postoperative complications. The PAS score alongside the time elapsed from the onset of symptoms until the assistance in the Pediatric Emergency Department, were associated with an increased risk of prolonged HE (R2 = 0.2246, p = 0.003). Conclusions: A PAS score ≥ 7 is associated with prolonged HS, likewise, the PAS score alongside the time elapsed between the onset of symptoms and assistance in emergency care is associated with prolonged HS.

Introducción: la apendicitis aguda (AA) es la patología quirúrgica de urgencia más común en niños. Las escalas de valoración mejoran la detección oportuna de casos. Objetivo: evaluar la asociación de la Escala pediátrica de apendicitis (PAS) con la estancia hospitalaria (EH) y las complicaciones postoperatorias de apendicectomía. Material y métodos: estudio observacional, analítico, longitudinal y retrolectivo. Se incluyeron pacientes de 2 meses a 15 años, sin comorbilidades, intervenidos por apendicectomía por apendicitis aguda complicada (AAC) y no complicada (AANC). Se obtuvo el puntaje PAS previo a apendicectomía y se evaluó la EH y complicaciones postoperatorias. Resultados: se evaluaron 64 pacientes, edad 8 (RIC 8-12) años, puntaje de PAS 6 (RIC 4-8). El tiempo desde el inicio de los síntomas hasta la atención en urgencias fue menor (p < 0.0001) y la cuenta de neutrófilos totales fue mayor (p = 0.001) en el Grupo de AAC. No hubo diferencia en el puntaje PAS entre pacientes con AAC y AANC (6 [4-7] frente a 7 [4-8], p = 0.087). El puntaje PAS ≥ 7 se asoció con incremento del riesgo de EH prolongada (p = 0.007), pero no con complicaciones postoperatorias. El puntaje PAS en conjunto con el tiempo transcurrido desde el inicio de los síntomas hasta la atención en Urgencias Pediátricas se asoció a incremento del riesgo de EH prolongada (R2 = 0.2246, p = 0.003). Conclusiones: el puntaje PAS ≥ 7 se asocia con EH prolongada, y el puntaje PAS en conjunto con el tiempo transcurrido entre el inicio de síntomas y la atención en urgencias se asocia a EH prolongada.

Molecular and Pathological Characterization of Classical Swine Fever Virus Genotype 2 Strains Responsible for the 2013-2018 Outbreak in Colombia.

Classical swine fever (CSF) is a highly contagious transboundary viral disease of domestic and wild pigs. Despite mass vaccination and continuous eradication programs, CSF remains endemic in Asia, some countries in Europe, the Caribbean and South America. Since June 2013, Northern Colombia has reported 137 CSF outbreaks, mostly in backyard production systems with low vaccination coverage. The purpose of this study was to characterize the virus responsible for the outbreak. Phylogenetic analysis based on the full-length E2 sequence shows that the virus is closely related to CSF virus (CSFV) genotype 2.6 strains circulating in Southeast Asia. The pathotyping experiment suggests that the virus responsible is a moderately virulent strain. The 190 nucleotide stretch of the E2 hypervariable region of these isolates also shows high similarity to the CSFV isolates from Colombia in 2005 and 2006, suggesting a common origin for the CSF outbreaks caused by genotype 2.6 strains. The emergence of genotype 2.6 in Colombia suggests a potential transboundary spread of CSFV from Asia to the Americas, complicating the ongoing CSF eradication efforts in the Americas, and emphasizes the need for continuous surveillance in the region.

Relationship Among Treatment Adherence, Family Functioning, and Self-Care Agency in Colombian Patients With Cardiovascular Disease.

BACKGROUND: Multiple factors affect treatment adherence in individuals with cardiovascular disease. However, information on the relationships among treatment adherence, family functioning, and self-care agency in these patients and their families is limited. PURPOSE: This study was developed to determine the relationships among treatment adherence, family functioning, self-care agency, and sociodemographic variables in patients with cardiovascular disease. Self-care agency, as defined by Orem, is the dynamic process patients use to engage in their own healthcare that involves discerning and addressing factors that allow their making decisions that improve self-care abilities. METHODS: This cross-sectional, observational-analytical study enrolled 151 adult patients with cardiovascular diseases who had undergone pharmacological and nonpharmacological treatments and 108 family members of these patients who had consented to participate. Measurements were performed using the "Questionnaire for measuring treatment adherence in patients with cardiovascular disease," the "Family Functioning Assessment Scale," and the "Self-care Agency Scale." RESULTS: Of the 151 patients, 119 (78.8%) were assessed as having a low risk of nonadherence, 60 (39.7%) as having low family functioning, and 131 (86.8%) as having high self-care agency. Treatment adherence and self-care agency showed a moderate and significant correlation ( r = .66, p < .001). Similarly, treatment adherence and family functioning showed a low but significant correlation ( r = .35, p < .001). Moreover, significant multivariate associations were found among the variables of interest. Patients with a low risk of nonadherence were found to be more likely to have a secondary or postsecondary education, not to have vision or hearing problems, and to have a contributory affiliation mode with the health system or private health insurance. In addition, participants with moderate or high levels of family functioning were less likely to be workers or to not have hearing or vision problems. Finally, significant differences were noted between patients with low self-care agency and those with high self-care agency in terms of kinship relationship with family members and affiliation mode with the health system. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results of this research help clarify the issue of treatment adherence in patients with cardiovascular disease. Although family functioning and self-care agency were found to be low to moderately correlated with treatment adherence, relevant information regarding these variables and sociodemographic variables is presented in this study. Nurses may use these results as a reference to design nursing care plans and interventions to address the conditions of their patients more appropriately.

[Colonization by yeasts in newborns and healthcare personnel in a neonatal intensive care unit at a university hospital in Bogotá, Colombia]. / Colonización por levaduras en recién nacidos y personal de salud en la unidad de cuidados intensivos neonatales de un hospital universitario en Bogotá, Colombia.

Candida infections in the neonatal intensive care unit (NICU) are associated with high morbidity and mortality rates. The main objective of this work was to determine the risk factors for colonization by Candida species in the newborns in a hospital NICU in Bogota, Colombia, and to evaluate the colonization of intravascular devices and healthcare personnel. Fifty newborns at high risk (low birth-weight, gestational age under 35 weeks, previous exposure to antibiotics and eight days of stay in the NICU) were followed prospectively. Clinical specimens from conjunctiva, nasal orifices, oral cavity, inguinal skin, rectum, intravascular devices, and the resulting watery solution of the washing of hands of healthcare personnel were cultured. Samples were cultured on Sabouraud agar with chloramphenicol (50 ppm). Identification of yeasts was peformed using phenotypic and biochemical tests. A multivariate analysis of the risk factors for colonization in the newborns was performed. Growth of different Candida spp. was found in samples recovered from 38% of the newborns tested. However, no yeasts were obtained in cultures from intravascular devices. About 32% of the samples from healthcare personnel (paediatricians, undergraduate and postgraduate students, professional nurses and nurse assistants), showed presence of yeasts. In the multivariate regression analysis length of stay in the NICU was the only identified risk factor for colonization.

Validation of the Opening Minds Scale and patterns of stigma in Chilean primary health care.

OBJECTIVES: Stigma toward people with mental health problems (MHP) in primary health care (PHC) settings is an important public health challenge. Research on stigma toward MHP is relatively scarce in Chile and Latin America, as are instruments to measure stigma that are validated for use there. The present study aims to validate the Opening Minds Scale for Health Care Professionals (OMS-HC) among staff and providers in public Chilean PHC clinics, and examine differences in stigma by sociodemographic characteristics. METHODS: 803 participants from 34 PHC clinics answered a self-administered questionnaire. Confirmatory factor analysis was completed. Average 15-item OMS-HC scores were calculated, and means were compared via t-test or ANOVA to identify group differences. Correlations of OMS-HC scores with other commonly used stigma scores were calculated to evaluate construct validity. RESULTS: The 3-factor OMS-HC structure was confirmed in this population. The average OMS-HC (α = 0.69) score was 34.55 (theoretical range 15-75). Significantly lower (less stigmatizing) mean OMS-HC scores were found in those with additional training and/or personal experience with MHP. CONCLUSION: The validated, Spanish version of OMS-HC can be of use to further research stigma toward MHP in Chile and Latin America, advancing awareness and inspiring interventions to reduce stigma in the future.

[Aspergillus spp. in risk areas of transplant patients in a university hospital]. / Presencia de Aspergillus spp. en áreas de riesgo en pacientes trasplantados en un hospital universitario.

As a consequence of the increase in the number of immunocompromised patients, cases of aspergillosis, due to the opportunist character of this fungus, have increased considerably. Aspergillus fumigatus, Aspergillus flavus, and Aspergillus niger have been found in air and water samples of the majority of investigated hospitals. The aim of the present study was to investigate the presence of aspergilli in transplant patients areas at the Hospital Universitario of Bogotá, Colombia. Samples of air were collected using the MAS-100 Air Sampler from each of the investigated areas. A sample of 100 ml of water was also recovered from these areas. All samples were taken for triplicate and were cultured in 2% Sabouraud Dextrose Agar. The average of aspergilli in air samples was 2.8 CFU/l corresponding to A. flavus, A. niger, Aspergillus versicolor and Aspergillus terreus. In water samples, the average was 17.1 CFU/l corresponding to A. flavus and Aspergillus clavatus. Because potentially pathogenic Aspergillus species were found in the hospital areas were transplant patients are usually kept, active surveillance and a high clinical suspicion should be considered in those patients. Since Aspergillus infections haven't been found so far, a higher fungal load and other host factors might be needed to facilitate the infection.

Regulatory B Cells and Mechanisms.

Regulatory B cells have gained prominence in their role as modulators of the immune response against tumors, infectious diseases, and autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, and multiple sclerosis, among others. The concept of regulatory B cells has been strongly associated with interleukin (IL)-10 production; however, there is growing evidence that supports the existence of other regulatory mechanisms, such as the production of transforming growth factor ß (TGF-ß), induced cell death of effector T cells, and the induction of CD4(+)CD25(-)Foxp3(+) regulatory T cells. The regulatory function of B cells has been associated with the presence and activation of molecules such as CD40, CD19, CD1d, and BCR. Alterations in signaling by any of these pathways leads to a marked defect in regulatory B cells and to increased clinical symptoms and proinflammatory signs, both in murine models and in autoimmune diseases in humans. B cells mainly exert their regulatory effect through the inhibition of proliferation and production of proinflammatory mediators, such as TNF-α, IFN-γ, and IL-17 by CD4(+) T cells. A better understanding of how regulatory B cells function will offer new perspectives with regard to the treatment of various human diseases.

Anti-glucuronoxylomannan IgG1 specific antibodies production in Cryptococcus neoformans resistant mice.

BACKGROUND: Cryptococcus neoformans is a widely disseminated fungus shown to be responsible for infections in individuals with impaired cell mediated immunity, such as patients with human immunodeficiency virus (HIV). Cryptococcus neoformans has a polysaccharide capsule composed of glucuronoxylomannan (GXM), which acts as a major virulence factor and is considered to be a thymus independent type-2 antigen (TI-2). OBJECTIVE: In the current study, the production kinetics were evaluated for IgG subclasses specific for GXM, and assessed with the cross reactive antibodies to Streptococcus pneumoniae polysaccharide. In addition, spleen B cell subpopulations were quantified in murine models of cryptococcosis with different susceptibilities to the infection. MATERIALS AND METHODS: Antibodies were detected by ELISA at different time intervals after C. neoformans infection in moderately resistant (Balb/c), highly resistant (CBA/j) and susceptible (C57BL/6) mouse strains. B cells subpopulations were determined by flow cytometry analysis. RESULTS: Early production of IgG1, described as protector antibodies, coincided with a decrease of the number of C. neoformans colony forming units in the lungs. Polysaccharide cross-reactive antibodies were detected in each of the three mouse strains. Antibody titers were highest in the susceptible strain (C57BL/6), a strain which also showed the highest proportion of splenic CD5+ B lymphocytes. In contrast, CBA/J mice showed the highest levels of CD43+ B. CONCLUSIONS: These findings suggest that IgG1 antibodies specific for GXM, are implicated in host protection against C. neoformans infection and may be regulated by CD43+ cells. They also suggest that cross reactivity antibodies are not important in the protection against C. neoformans infection.

Chilean native fruit extracts inhibit inflammation linked to the pathogenic interaction between adipocytes and macrophages.

Obesity is characterized by an increase in the infiltration of monocytes into the adipose tissue, causing an inflammatory condition associated with, for example, the development of insulin resistance. Thus, anti-inflammatory-based treatments could emerge as a novel and interesting approach. It has been reported that Chilean native fruits maqui (Aristotelia chilensis) and calafate (Berberis microphylla) present high contents of polyphenols, which are known for their antioxidant and anti-inflammatory properties. The aim of this study was to evaluate the ability of extracts of these fruits to block the pathogenic interaction between adipocytes and macrophages in vitro and to compare its effect with blueberry (Vaccinium corymbosum) extract treatment, which has been already described to possess several biomedical benefits. RAW264.7 macrophages were treated with 5 µg/mL lipopolysaccharides (LPS), with conditioned media (CM) from fully differentiated 3T3-L1 adipocytes, or in a coculture (CC) with 3T3-L1 adipocytes, in the presence or absence of 100 µM [total polyphenolic content] of each extract for 24 h. The gene expression and secretion profile of several inflammatory markers were evaluated. Nitric oxide secretion induced by LPS, CM, and CC was reduced by the presence of maqui (-12.2%, -45.6%, and -14.7%, respectively) and calafate (-27.6%, -43.9%, and -11.8%, respectively) extracts. Gene expression of inducible nitric oxide synthase and TNF-α was inhibited and of IL-10 was induced by maqui and calafate extract incubation. In conclusion, the extracts of these fruits present important inhibitory-like features over the inflammatory response of the interaction between adipocytes and macrophages, comprising a potential therapeutic tool against comorbidities associated with obesity development.

[Accuracy of the slide agglutination method evaluated with PCR in typing Haemophilus influenzae isolates]. / Correlación entre la tipificación capsular de aislamientos colombianos de Haemophilus influenzae por el método de aglutinación en lámina y la técnica de PCR.

In 1998, the Colombian government initiated an immunization program for children under one year of age with a Haemophilus influenzae capsular type b conjugate vaccine. After two years, the surveillance program of the Colombian Instituto Nacional de Salud Microbiology Group reported a 40% decrease in meningitis cases caused by H. influenzae. This effect was attributed to the vaccination. The surveillance program uses the standardized slide agglutination technique to serotype H. influenzae. The current study validated the accuracy of the slide agglutination method by means of the PCR technique. From children under five years of age, 146 isolates were obtained. These were collected between 1999 and 2002, and were characterized by biochemical tests and serotyped by the INS as part of the surveillance program. PCR confirmed 93% of the H. influenzae serotype b and 92% of the other serotypes. When the slide agglutination technique is conducted under a strict quality control program, it remains a sensitive and specific tool for serotyping H. influenzae.

Determinación de residuos de plaguicidas en trabajadores agrícolas del municipio de Barcelona, Quindío, Colombia / Determination of pesticide levels in farmers working in the Barcelona municipality, Quindio, Colombia

Objetivos: En este trabajo se determinaron los niveles de residualidad de plaguicidas organoclorados y organofosforados en muestras de sangre periférica de trabajadores agrícolas –fumigadores– en el municipio de Barcelona, Quindío, Colombia. Método: Los trabajadores fueron escogidos al azar dentro de los principales cultivos abastecedores de frutas y verduras de la región. Para la extracción y determinación de los analitos en sangre, se usó la técnica de micro-extracción en fase sólida en modo head space y cromatografía de gases capilar dotado con un detector de micro captura de electrones. Resultados: Como resultado se encontraron residuos de 21 plaguicidas de tipo organoclorados y organofosforados; la mayoría de estos en alta concentración (>0.01 ppm) y prohibidos por la legislación nacional e internacional, sugiriendo que aún siguen siendo utilizados ilegalmente. De la residualidad encontrada, los plaguicidas más representativos fueron: beta-BHC y endosulfan, hallados en el 50 por ciento de las personas evaluadas. Asimismo, se descubrió que entre el 20 y 40 por ciento de las personas tenían residuos de endrin aldehído, forato, sulfotep, disulfoton y thionazin, en circunstancia que la mayoría de estos son de categoría toxicología I y II, comprobando el alto riesgo al que se exponen constantemente los individuos que aplican estos compuestos y la falta de atención e información por parte de las entidades responsables de autorización y fiscalización de su uso. Conclusiones: En este sentido, los resultados encontrados en este trabajo demuestran la importancia de continuar con los estudios de monitoreo y control de calidad de los principales alimentos, fuentes hídricas y trabajadores agrícolas, para así informar a la población acerca de los riesgos a los que está expuesta.

Aim: To determine the levels of organochlorine and organophosphorus pesticide residues in peripheral blood samples of farm-workers in Barcelona, Quindío, Colombia. Methods: Farm-workers were randomly chosen to cover the major suppliers of fruits and vegetables crops in the region. Solid phase micro extraction in head space mode and capillary gas chromatography with a micro electron capture detector were used for extraction and determination of analytes from blood. Results: Twenty-one pesticides residues among organochlorine and organophosphorusclasses were found. Most of these pesticides were at high concentrations (>0.01 ppm) and represented concentrations forbidden by national and international legislation. Beta-BHC and endosulfan were found in 50 percent of persons tested. Residues of endrinaldehyde, phorate, sulfotep, disulfoton and thionazinwere found amongst 20-40 percent of the persons tested. Conclusions: These results demonstrate the high risks that farm-workers are exposed to, suggesting poor attention and provision of information by entities responsible for permits and supervision. Furthermore, we highlight the need for monitoring and quality control of food, water sources and farm-workers, and the necessity to inform workers and the community of the risks to which they are exposed.

Subpoblaciones de linfocitos B y su expresión de CD1d en pacientes con lupus eritematoso sistémico / B cell subsets and their expression of CD1d in patients with systemic lupus erythematosus

Resumen Introducción: Los linfocitos B (LB) se consideran el centro de la desregulación inmune en pacientes con lupus eritematoso sistémico (LES), principalmente, por su producción de autoanticuerpos. Recientemente, se demostró la existencia de LB, incluidos en los B transicionales, con capacidad reguladora (Breg) y fenotipo CD19+CD24hiCD38hi. En humanos se demostró la importancia de CD80 y CD86 en su función reguladora. El papel de CD1d aún no ha sido evaluado. Objetivo: Evaluar la frecuencia de LB maduros, memoria y transicionales, en controles y pacientes con LES, además de la expresión de CD1d y correlacionarla con la actividad de la enfermedad medida por SLEDAI (Systemic Lupus Erythematosus Disease Activity Index). Materiales y métodos: Se evaluó por citometría de flujo la frecuencia de subpoblaciones de LB basados en la expresión de CD19, CD24 y CD38, además de CD1d, en controles con otras enfermedades autoinmunes (OEA), individuos sanos y pacientes con LES, y se correlacionó con SLEDAI. Resultados: Se evidenció una disminución significativa en el porcentaje de LB de memoria en pacientes LES y OEA, sin alteraciones en las subpoblaciones de LB maduros y transicionales. La expresión de CD1d no evidenció diferencias significativas en ninguna de las subpoblaciones ni se correlacionó con SLEDAI. Conclusión: La disminución de la subpoblación de memoria fue previamente descrita en LES y se ha asociado a algunos tipos de tratamiento. Aunque CD1d se ha asociado a la función de Breg en murinos, no hubo diferencias significativas en su expresión en las subpoblaciones y queda por clarificar su papel en la función de las Breg humanas.

Abstract Introduction: B lymphocytes are considered the center of immune dysregulation in Systemic Lupus Erythematosus (SLE). It has recently been demonstrated that there is a B cell with regulatory capacities (Breg) included in transitional B lymphocytes with the phenotype CD19+CD24hiCD38hi. The importance of CD80 and CD86 in the regulatory function of the Bregs has been demonstrated in humans, but the role of CD1d has not been evaluated. Objective: To evaluate the frequency of mature, memory and transitional B cells in SLE patients and controls, the expression of CD1d among these cells, and its correlation with the activity of the disease measured using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Materials and methods: The frequency of the B cell subsets was evaluated by flow cytometry based on the expression of CD19, CD24 and CD38, as well as CD1d in these cells in SLE patients and controls, and were correlated with the activity of the disease measured using the SLEDAI. Results: A significant reduction in the percentage of memory B cells was observed in SLE patients and other autoimmune conditions, with no changes in the mature or transitional B cell subsets. Similarly, no significant differences were observed in the expression of CD1d in any of the subsets, nor was there any correlation with the SLEDAI. Conclusion: The reduction of the memory subset has been previously described in SLE, and has been associated with some types of treatment. The expression of CD1d in all the subsets was observed, but its role in the regulatory function of the CD19+CD24hiCD38hi cells is still not clear.

Evaluating the efficiency of using second-trimester nasal bone hypoplasia as a single or a combined marker for fetal aneuploidy.

OBJECTIVE: Although second-trimester nasal bone (NB) hypoplasia has been associated with fetal aneuploidy, its role as a single marker is still uncertain. Our objective was to evaluate the efficiency of NB hypoplasia as an independent marker for fetal aneuploidy. METHODS: This was a prospective cohort study of women undergoing an anatomic survey between 16 and 22 weeks' gestation. The fetal NB and other markers of fetal aneuploidy, including nuchal fold, femur and humeral lengths, choroid plexus cysts, major fetal anomalies, echogenic bowel, pyelectasis, and hypoplastic fifth digits, were evaluated. Nasal bone hypoplasia was defined either as an absent NB or by a ratio of the biparietal diameter to NB. Fetuses or infants with fetal aneuploidy were compared with those without for the presence of NB hypoplasia either as a single marker or in the presence of other markers for aneuploidy. RESULTS: Of 2885 women evaluated, NB measurements were obtained in 2465 (85%). There were 35 (1.4%) cases with fetal aneuploidy. The sensitivity and specificity of a single NB in detecting Down syndrome varied from 23% to 64% and 57% to 99%, respectively, depending on the definition of NB hypoplasia used. There was an improvement in the efficiency of using the NB when combined with other markers, with sensitivity and specificity increasing from 59% to 82% and 74% to 87%, respectively. CONCLUSIONS: Nasal bone hypoplasia is a marker for fetal aneuploidy. The combination of the NB with other makers was associated with an improvement in detection of fetal aneuploidy.

Efectos de una intervención educativa sobre la capacidad de afrontamiento y adaptación en familiares de pacientes hospitalizados en la unidad de cuidado intensivo / Effects of an educational intervention on the ability to cope and adapt in relatives of patients hospitalized in the intensive care unit

Objetivos General Determinar el efecto de una intervención educativa sobre la capacidad de afrontamiento y adaptación en familiares de pacientes hospitalizados en una Unidad de Cuidado Intensivo. Específicos Describir la capacidad de afrontamiento y adaptación de familiares de pacientes hospitalizados en una UCI antes y después de la intervención educativa; Comparar la capacidad de afrontamiento antes y después de la intervención. Metodología Estudio de tipo Cuantitativo. Diseño Pre Experimental con un solo grupo y medición Pre test y Pos test. Población conformada por familiares de pacientes hospitalizados en la UCI de la Clínica Shaio durante el periodo de tiempo Diciembre a Marzo del 2014 Resultados La Escala de medición del Proceso de Afrontamiento y Adaptación de Roy clasifica a los cuidadores con un alto nivel de afrontamiento antes de la intervención educativa. Después de la intervención educativa todos los cuidadores mantuvieron y optimizaron el nivel alto de afrontamiento a los que obtuvieron puntajes inferiores a la intervención. Conclusiones Las familias tuvieron alta capacidad de afrontamiento antes de la intervención educativa, el nivel de capacidad de afrontamiento en algunos casos se mantuvo y en otros mejoró, se tradujo en el aumento del puntaje de CAP`S posterior a la intervención educativa. Recomendaciones Se recomienda continuar con el diseño de nuevas intervenciones educativas dirigidas a familias de pacientes en estado crítico que permitan evaluar su efectividad y que incluya a un equipo interdisciplinario ya que es un fenómeno multicausal. (AU)

Objectives. General objective. To determine the effect of an educational intervention on the ability of coping and adaptation in relatives of patients hospitalized in an Intensive Care Unit (ICU). Specific Objectives. To describe the ability of coping and adaptation of relatives of patients hospitalized in an ICU before and after the educational intervention. To compare the ability of coping before and after the intervention. Methodology. Quantitative study. PreExperimental design with a single group and pre-test and post-test measurement. Population composed of family members of patients hospitalized in the ICU from the "Shaio" Clinic during the period of time from December up to March, 2014. Results. The scale for measuring the Roy´s Coping and Adaptation Process classifies to caregivers with a high level of coping before the educational intervention. After the educational intervention all caregivers kept and optimized the high level of coping to those who got lower scores to the intervention. Conclusions. The families had a high capacity of coping before the educational 7 intervention, the ability level of coping in some cases was maintained and improved in other cases, and this resulted in an increase of the CAPS score after the educational intervention. Recommendations. It is recommend to continue with the design of new educational interventions aimed to families of critically ill patients to assess their effectiveness and to include an interdisciplinary team because this is a multi-causal phenomenon. (AU)

Comparación de métodos de microdilución CLSI M27-A2 y EUCAST en aislamientos de Candida spp. en pacientes con cáncer / CLSI microdilution M27-A2 and EUCAST method comparison for Candida spp. in patients with cancer

Objetivo: comparar los métodos de referencia de microdilución en caldo de la CLSI M27-A2 y EUCAST, identificando la utilidad y las principales diferencias de cada uno de ellos para los agentes antifúngicos anfotericina B (1), fluconazol (FCZ) e itraconazol (ITZ), contra aislamientos clínicos de Candidaspp. de pacientes con cáncer. Materiales y métodos: se estudiaron 136 aislamientos de C. albicans, 36 de C. tropicalis y 17 de Candidaspp. Se utilizó el índice Kappa ponderado para medir el grado de acuerdo entre los dos métodos. Resultados: se estableció que el grado de concordancia entre los dos métodos para el total de los aislamientos fue alto con AB (κ: 1) y FCZ (κ: 0.74) y bajo al utilizar ITZ (κ: 0.49). La concordancia fue variable y especie-específica: para ITZ y FCZ en C. albicans fue de 0,45 y 0,64; en C. tropicalis, de 0,48 y 0,91; y en Candidaspp. de 0,73 y 0,87, respectivamente. Discusión: este estudio sugiere que las pruebas de sensibilidad antifúngica para los dos métodos son equivalentes en lo esencial. Deben considerarse las diferencias y discrepancias asociadas a la especie implicada, el tipo de antifúngico utilizado y los tiempos de incubación, que puede producir variaciones al interpretar los resultados obtenidos de acuerdo con la metodología empleada.

Objective: compare the broth microdilution testing reference standards CLSI M27-A2 and EUCAST, identifying the usefulness of each one of them and their main differences, against the antifungal agents amphotericin B (1), fluconazole (FCZ), and itraconazole (ITZ) using clinical isolates of Candidaspp. in cancer patients. Methods: isolates of C. albicans (n=136), C. tropicalis (n=36), and Candidaspp. (n=17) were tested by the two methods. The Kappa index was used to establish the degree of agreement between the methods. Results: the degree of agreement between the two methods was high for AB (κ: 1) and FCZ (κ: 0.74) and was low for ITZ (κ: 0.49). Agreement was variable and specific for the various species: for ITZ and FCZ in C. albicans, it was 0.45 and 0.64, respectively. In C. tropicalis, it was of 0.48 and 0.91, and in Candidaspp., it was 0.73 and 0.87 respectively. Discussion: this study suggests that antifungal susceptibility testing using both methods is equivalent. Attention should be focused on differences and discrepancies associated with the species tested, the type of antifungal agent, and the incubation times, which can cause variations at the moment of interpreting the results obtained.

Sensibilidad in vitro de hongos miceliales de aislamientos clínicos en pacientes con cáncer en el Instituto Nacional de Cancerología ESE / in vitro susceptibility of clinical isolates of filamentous fungi in patients with cancer in the Instituto Nacional de Cancerología

Introducción: la sensibilidad antifúngica in vitro en hongos filamentosos no ha tenido el mismo desarrollo que en levaduras. Se dispone de limitada información sobre la susceptibilidad en este tipo de aislamientos en Colombia. Materiales y métodos: se determinó la actividad in vitro de fluconazol, voriconazol, itraconazol, anfotericina B y caspofungina mediante el método de E-Test, de los géneros Aspergillus (36 A. fumigatus, 12 A. flavus, 9 A. niger, 6 A. terreus, 4 A. nidulans y 1 A. versicolor) e hifomicetes hialinos (9 Fusarium sp., 2 Geotrichum sp. y 2 Paecilomyces sp.), provenientes en su mayoría de lavados broncoalveolares (30%) y biopsias pulmonares (36%); 9% provenían de hemocultivos. Resultados: el perfil de resistencia general fue 28% para itraconazol, 15% para caspofungina, 14% para anfotericina B y 5% para voriconazol. En general, todos los aislamientos presentaron una sensibilidad disminuida para fluconazol e itraconazol. La mejor actividad farmacológica la presentaron voriconazol, caspofungina y anfotericina B. Fusarium sp. presentó una mayor actividad con el voriconazol. Se encontraron diferencias entre el tipo de micelio (Aspergillus vs no Aspergillus) y la susceptibilidad a voriconazol, anfotericina B y caspofungina. Conclusión: en general, los antimicóticos disponibles para el tratamiento de infecciones por miceliales muestran una sensibilidad disminuida in vitro en relación con el género y la especie identificada.

Introduction: fungal susceptibility against micelial fungi has not been developed at the same pace as susceptibility against yeasts. Scarce information is available about that kind of isolates in Colombia. Materials and methods: in vitro susceptibility against micelial isolates from patients with cancer was determined. The E-test method was used to find out susceptibility against fluconazole, voriconazole, itraconazole, amphotericin B, and caspofungin. Isolates of the genera Aspergillus (36 A. fumigatus, 12 A. flavus, 9 A. niger, 6 A. terreus, 4 A. nidulans and one A. versicolor isolate), Fusarium (n=9), Geotrichum and Paecilomyces (n=2 each one) obtained from patients with cancer were tested. These isolates were obtained from bronchoalveolar lavage (30%), pulmonary biopsies (36%) and bloodstream infections (9%). Results: The general pattern of resistance was 28% against intraconazole, 15% against caspofungin, 14% against amphotericin B, and 5% against voriconazole. In general, susceptibility against fluconazole and itraconazole showed a diminishing trend. Voriconazole, caspofungin, and amphotericin B showed the best pharmacologic potency. Fusarium sp. presented a higher activity level against voriconazole. There were differences in the susceptibility against voriconazole, anphotericin B, and caspofungin depending on the type of micelial isolate (Aspergillus vs. Non- Aspergillus). Conclusion: In general, the available antifungal treatments against mycelial fungi identified in the cancer center show diminished susceptibility.

Valor diagnóstico del galactomanano y proteína C reactiva (PCR) en pacientes con neoplasia hematolinfoide y neutropenia con factor de riesgo de aspergilosis invasiva / Diagnostic value of galactomannan and C reactive protein (CRP) in patients with neutropenia and hematolymphoid neoplasia risk factor for invasive aspergillosis

Introducción: Es importante tener herramientas serológicas que permitan un diagnóstico precoz de la aspergilosis invasiva. Se evaluó el valor diagnóstico del galactomanano y la PCR en 36 pacientes con neoplasias hematolinfoides y neutropenia, y con factor de riesgo de aspergilosis invasiva. Métodos: Estudio observacional descriptivo de serie de casos, de pacientes neutropénicos, con títulos serológicos de galactomanano y PCR, y seguimiento por 30 días. La detección del antígeno galactomanano fue mediante de Platelia® Aspergillus, donde una DO superior a 0,550 ng/ml fue considerada positiva, y la detección de PCR, de Products VITROSchemistry®, donde resultados >1,0 mg/dl se consideraron elevados. Resultados: De acuerdo con los criterios EOR-TC, 23 pacientes fueron calificados como “sin sospecha”; 11, como “posibles”; y 2, como “probadas”. Respecto a los títulos séricos de galactomanano, 7 de los pacientes presentaron títulos >0,550 ng/ml, por lo cual se los consideró como positivos. Al comparar las funciones de supervivencia se encontró un pronóstico menos favorable en el grupo con resultados positivos. En las funciones de supervivencia, en relación con los resultados de PCR tuvieron un mejor pronóstico los miembros del grupo con PCR negativa. De los 7 pacientes que tuvieron títulos séricos positivos para galactomanano, 85,7% tuvieron títulos mayores de 9 mg/dl de PCR, lo que sugiere una relación entre estas 2 pruebas. Conclusiones: El uso de la detección de galactomanano y la PCR es útil para el diagnóstico de aspergilosis invasiva, ya que existe una correlación entre sus resultados y la evidencia clínica para el diagnóstico de la infección invasiva.