vaRHC: an R package for semi-automation of variant classification in hereditary cancer genes according to ACMG/AMP and gene-specific ClinGen guidelines.

MOTIVATION: Germline variant classification allows accurate genetic diagnosis and risk assessment. However, it is a tedious iterative process integrating information from several sources and types of evidence. It should follow gene-specific (if available) or general updated international guidelines. Thus, it is the main burden of the incorporation of next-generation sequencing into the clinical setting. RESULTS: We created the vaRiants in HC (vaRHC) R package to assist the process of variant classification in hereditary cancer by: (i) collecting information from diverse databases; (ii) assigning or denying different types of evidence according to updated American College of Molecular Genetics and Genomics/Association of Molecular Pathologist gene-specific criteria for ATM, CDH1, CHEK2, MLH1, MSH2, MSH6, PMS2, PTEN, and TP53 and general criteria for other genes; (iii) providing an automated classification of variants using a Bayesian metastructure and considering CanVIG-UK recommendations; and (iv) optionally printing the output to an .xlsx file. A validation using 659 classified variants demonstrated the robustness of vaRHC, presenting a better criteria assignment than Cancer SIGVAR, an available similar tool. AVAILABILITY AND IMPLEMENTATION: The source code can be consulted in the GitHub repository (https://github.com/emunte/vaRHC) Additionally, it will be submitted to CRAN soon.

The inhibitory effect of a non-yessotoxin-producing dinoflagellate, Lingulodinium polyedrum (Stein) Dodge, towards Vibrio vulnificus and Staphylococcus aureus.

The increased bacterial resistance to antibiotics has caused global concern, prompting the search for new compounds. Because of their abundance and diversity, marine phytoplankton are an important potential source of such compounds. Research on dinoflagellates has led to the discovery of inhibitors of bacterial growth. The marine dinoflagellate Lingulodinium polyedrum blooms in different regions of the world, including Mexico, and is also known to regulate the growth of other species in coastal waters. Here, we investigated the taxonomy of this dinoflagellate and characterized the ability of its extracts to inhibit the growth of two bacteria of medical importance (Vibrio vulnificus and Staphylococcus aureus). Taxonomic characterization was performed by PCR and gene amplification of ITS, and confirmed that the species isolated off the Pacific coast of Mexico was L. polyedrum. To prove the inhibitory effect of L. polyedrum extracts, cultures were harvested by centrifugation. Pellets from three cellular abundances were extracted with water, methanol, hexane and chloroform. The experiments on V. vulnificus showed a high growth inhibition for the four extracts, ranging from 77 to 98 %. Surprisingly, the growth inhibition was lower when the extracts originated from a higher L. polyedrum cell abundance, ranging from 0 to 34 %. For S. aureus, the growth inhibition was also high, but not statistically different for all extracts and cell abundances, ranging from 62 to 99 %. This study obtained promising results for future pharmacological applications. Our Mexican strain of L. polyedrum did not produce any detectable yessotoxins.

[Case reports of drug-induced liver injury in a reference hospital of Zulia state, Venezuela]. / Reporte de casos de lesión hepática inducida por medicamentos en un centro hospitalario de referencia del estado Zulia, Venezuela.

Drug-induced liver injury (DILI) is an important cause of morbidity and mortality worldwide, with varied geographical differences. The aim of this prospective, descriptive, cross-sectional study was to identify and characterize cases of DILI in a hospital of Zulia state, Venezuela. Thirteen patients with a presumptive diagnosis of DILI attended by the Department of Gastroenterology, Hospital Universitario, Zulia state, Venezuela, from December-2012 to December-2013 were studied. Ibuprofen (n = 3; 23.1%), acetaminophen (n = 3; 23.1), isoniazid (n = 2; 15.4%) and Herbalife products (n = 2; 15.4%) were the main drugs involved with DILI. Acetaminophen and ibuprofen showed a mixed pattern of liver injury (n = 3; 23.1%) and isoniazid presented a hepatocellular pattern (n = 2; 15.4%). The CIOMS/RUCAMS allowed the identification of possible (n = 7; 53.9%), probable (n = 4; 30.8%) and highly-probable cases (n = 2; 15.4%) of DILI. Amoxicillin/clavulanate, isoniazid, isotretinoin, methotrexate and Herbalife nutritional products were implicated as highly-probable and probable agents. The highest percentage of DILI corresponded to mild cases that recovered after the discontinuation of the agent involved (n = 9; 69.3%). The consumption of Herbalife botanical products is associated with probable causality and fatality (n = 1; 7.7%). In conclusion, the frequency of DILI cases controlled by the Department of Gastroenterology of the Hospital Universitario of Maracaibo was low, being ibuprofen, acetaminophen, isoniazid and products Herbalife the products most commonly involved. It is recommended to continue with the prospective registration of cases, with an extended follow up monitoring period and to facilitate the incorporation of other hospitals in the Zulia State and Venezuela.

Building a Teleost Fish Traceability Program Based on Genetic Data from Pacific Panama Fish Markets.

Fish tissue samples from 203 adult individuals were collected in the main ports and markets of the Pacific coast of Panama. Molecular identification based on a cytochrome oxidase I gene segment of all species was verified by GENBANK reference sequences. A total of 34 species from 14 families (Ariidae, Caranjidae, Centropomidae, Gerreidae, Haemulidae, Lobotidae, Lutjanidae, Malacanthidae, Mugilidae, Scianidae, Scombridae, Serranidae, Sphyraenidae, Stromateidae) were identified at the species level from 164 sequences. Additionally, three Caribbean species were molecularly identified among the analyzed samples (Mycteroperca xenarcha, Paralonchurus brasilensis and Lobotes surinamensis). Species diversity was slightly higher in the Gulf of Panama than in the Gulf of Chiriquí. For species with five or more individual sequences, genetic diversity and genetic connectivity parameters such as total number of haplotypes (H), haplotype diversity (Hd), and nucleotide diversity (π) were calculated. Overall, pelagic-migratory species showed higher values of genetic diversity than coastal and estuarine species with some exceptions. Connectivity between Gulf areas was compared using values of genetic distances and genetic differentiation (Fst). The high level of connectivity observed between the Gulf of Chiriqui and the Gulf of Montijo indicates the existence of a single stock in that area for the following species: Scomberomorus sierra, Caranx caninus and Lutjanus guttatus. The demographic history of the most common species was examined using Tajima's D values, suggesting population expansion for two snapper species, L. peru and L. argentiventris, having significant and higher values. Another important contribution from this research was the production of primers and dual-labeled probes for environmental DNA detection using qPCR for the five most abundant species (spotted rose snapper, yellow snapper, green jack, Pacific crevalle jack and the Pacific sierra fish). These markers represent a new set of tools for environmental DNA (eDNA) detection and molecular traceability of three commercially important fish species along the supply chain including landing sites and markets of the main fishery areas.

Biomarkers Predict In-Hospital Major Adverse Cardiac Events in COVID-19 Patients: A Multicenter International Study.

BACKGROUND: The COVID-19 pandemic carries a high burden of morbidity and mortality worldwide. We aimed to identify possible predictors of in-hospital major cardiovascular (CV) events in COVID-19. METHODS: We retrospectively included patients hospitalized for COVID-19 from 10 centers. Clinical, biochemical, electrocardiographic, and imaging data at admission and medications were collected. Primary endpoint was a composite of in-hospital CV death, acute heart failure (AHF), acute myocarditis, arrhythmias, acute coronary syndromes (ACS), cardiocirculatory arrest, and pulmonary embolism (PE). RESULTS: Of the 748 patients included, 141(19%) reached the set endpoint: 49 (7%) CV death, 15 (2%) acute myocarditis, 32 (4%) sustained-supraventricular or ventricular arrhythmias, 14 (2%) cardiocirculatory arrest, 8 (1%) ACS, 41 (5%) AHF, and 39 (5%) PE. Patients with CV events had higher age, body temperature, creatinine, high-sensitivity troponin, white blood cells, and platelet counts at admission and were more likely to have systemic hypertension, renal failure (creatinine ≥ 1.25 mg/dL), chronic obstructive pulmonary disease, atrial fibrillation, and cardiomyopathy. On univariate and multivariate analysis, troponin and renal failure were associated with the composite endpoint. Kaplan-Meier analysis showed a clear divergence of in-hospital composite event-free survival stratified according to median troponin value and the presence of renal failure (Log rank p < 0.001). CONCLUSIONS: Our findings, derived from a multicenter data collection study, suggest the routine use of biomarkers, such as cardiac troponin and serum creatinine, for in-hospital prediction of CV events in patients with COVID-19.

[Molecular and phenotypical typification of methicillin resistant Staphylococcus aureus (MRSA) strains in a university hospital]. / Tipificación molecular y fenotípica de Staphylococcus aureus resistentes a meticilina (SAMR) en un hospital universitario.

OBJECTIVE: To typify by molecular and phenotypical methods, MRSA strains, isolated from patients and nurses to establish their possible clonal origin. MATERIALS AND METHODS: 50 MRSA strains isolated in a teaching hospital in Maracaibo (Venezuela) were analyzed. The typification of MRSA strains was performed by means of pulsed-field gel electrophoresis (PFGE) and antibiotyping. RESULTS: In patients, 12 clusters (I-XII) and 19 antibiotypes were found; whereas in the health-care personnel, 6 clusters (I-VI) and two antbiotypes were detected. There was no statistically significative association between antibiotypes and band patterns obtained by PFGE (p>0.05). CONCLUSIONS: By means of detection of resistance markers and PFGE, it is feasible to discrimínate the nature of the clinical strains of MRSA. The obtained results show the possible nosocomial transmission of MRSA strains and their clonal spread in hospital departments, particularly at the ICU.

Preventive program based on multiple intelligences to promote oral health in disabled children from Chiclayo, Peru / Programa preventivo basado en inteligencias múltiples para promover la salud bucal en niños discapacitados de Chiclayo, Perú

Introduction: Children with physical disabilities often present deficient oral hygiene and eating habits that threaten optimal oral health. Objective: To evaluate the result of a preventive program based on multiple intelligences to pro-mote oral health care in children with physical disabilities in Chiclayo - Peru. Materials and Methods: A quasi-experimental, quan-titative, prospective and longitudinal study was carried out from the year 2020, to test a preventive intervention based on multiple intelligences (MI), comparing it with an intervention with traditional methodology, whose purpose was in both cases promote preventive oral health care in 167 boys and girls with physical disabilities from four Special Basic Education Centers (CEBES) in Chiclayo. For the pre- and post-test evaluation using a dental record of oral hygiene practices, oral hygiene index and dietary exposure to sugary carbohydrates, the Mann Whitney U test was required, with a confidence level of 95%. Results: After not very encouraging findings in the pretest for both groups, significant changes were observed in the posttest in favor of the IM-based program, for which 58% of schoolchildren registered an adequate oral hygiene index, 69.2% brushed twice to three times a day and that only 35.8% present regular exposure to carbohydrates. Statistical significance was evidenced in favor of the MI-based intervention for the three indicated variables (p= 0.000). Conclusions: The application of the IM-based program achieved better results in the significant promotion of oral hygiene practices with a favorable record of the IHO and by reducing the exposure to carbohydrates in a vulnerable population.Keywords: Health promotion; Oral health; Preventive dentistry; Health education; Children with disabilities.

Differences in Selected HIV Care Continuum Outcomes Among People Residing in Rural, Urban, and Metropolitan Areas-28 US Jurisdictions.

PURPOSE: The HIV care continuum is used to monitor success in HIV diagnosis and treatment among persons living with HIV in the United States. Significant differences exist along the HIV care continuum between subpopulations of people living with HIV; however, differences that may exist between residents of rural and nonrural areas have not been reported. METHODS: We analyzed the Centers for Disease Control and Prevention's National HIV Surveillance System data on adults and adolescents (≥13 years) with HIV diagnosed in 28 jurisdictions with complete reporting of HIV-related lab results. Lab data were used to assess linkage to care (≥1 CD4 or viral load test ≤3 months of diagnosis), retention in care (≥2 CD4 and/or viral load tests ≥3 months apart), and viral suppression (viral load <200 copies/mL) among persons living with HIV. Residence at diagnosis was grouped into rural (<50,000 population), urban (50,000-499,999 population), and metropolitan (≥500,000 population) categories for statistical comparison. Prevalence ratios and 95% CI were calculated to assess significant differences in linkage, retention, and viral suppression. FINDINGS: Although greater linkage to care was found for rural residents (84.3%) compared to urban residents (83.3%) and metropolitan residents (81.9%), significantly lower levels of retention in care and viral suppression were found for residents of rural (46.2% and 50.0%, respectively) and urban (50.2% and 47.2%) areas compared to residents of metropolitan areas (54.5% and 50.8%). CONCLUSIONS: Interventions are needed to increase retention in care and viral suppression among people with HIV in nonmetropolitan areas of the United States.

Compassionate Use of Lumacaftor/Ivacaftor in Cystic Fibrosis: Spanish Experience.

BACKGROUND: The most common cystic fibrosis (CF)-causing mutation is deltaF508 (F508del), which is present in 28% of CF Spanish patients. While the literature based on real-life studies on CF patients homozygous F508del treated with lumacaftor/ivacaftor is limited, it demonstrates the need for better strategies to prevent related adverse events (AEs) as well as the development of newer drugs. METHODS: We conducted a multicenter, retrospective, observational study to describe the effects of lumacaftor/ivacaftor treatment in real-life in Spain. 20 CF patients were included, all aged 6 and upwards and presented with ppFEV1<40%, chosen from CF units country-wide. For the purposes of the study, they were treated with lumacaftor/ivacaftor 200/125mg two tablets twice a day on a compassionate use programme throughout 2016. The primary endpoint was measured in all of the sample patients. Data were analysed from ppFEV1 at baseline and was measured every 6 months. RESULTS: The mean age was 26.65 (range of 10-45), while the mean ppFEV1 before the treatment was 32.4% and mean BMI was 19.9kg/m2. We analysed the changes in ppFEV1 and BMI from baseline during the treatment with lumacaftor/ivacaftor, but no differences were found. However, a moderate association between days of intravenous antibiotic needed and the use of lumacaftor/ivacaftor (p=0.001) was established. Indeed, under the lumacaftor/ivacaftor, patients required 5.8 days of intravenous antibiotic treatment compared to 14.9 days prior to study. Also, severe pulmonary exacerbations requiring hospitalisation were statistically fewer under lumacaftor/ivacaftor treatment (p=0.003). Finally, 75% of the sample presented with AEs, which led 35% of the subjects to discontinue the treatment. CONCLUSIONS: While treatment with lumacaftor/ivacaftor resulted in an improvement in the number of pulmonary severe exacerbations, no improvement in ppFEV1 or BMI was found.

[Vaginal colonization by genital mycoplasmas in pregnant and non-pregnant women]. / Colonización vaginal por micoplasmas genitales en mujeres embarazadas y no embarazadas.

To compare vaginal colonization by genital micoplasmas in pregnant and non pregnant women and to determine the association between pregnancy and colonization by these microorganisms, samples of exocervix an endocervix from pregnant (n = 80) and non pregnant (n = 65) women, from two health centers of Maracaibo, Zulia State, Venezuela were processed. The Mycoplasma-Lyo kit (bioMérieux laboratories) was used for the culture and identification of genital micoplasmas. In pregnant women, prevalences of 10% for M. hominis and 26.25% for Ureaplasma spp. were found; 35.38% for M. hominis and 20% for Ureaplasma spp. in non-pregnant, were obtained. Among the pregnant, Ureaplasma spp. was the most frequently isolated micoplasma, in symptomatic and asymptomatic; while in the non pregnant group, M. hominis was more common among the symptomatic patients; only one case (1.54%) was an asymptomatic carrier of Ureaplasma spp. The highest positivity percentages were obtained in primigravidas (48.71%) and during the second gestational trimester (34.21%). No statistically significant differences were found between vaginal colonization by genital micoplasmas according to age, number of pregnancy and gestational trimester; but they were found between the presented symptomatology and vaginal colonization by genital micoplasmas. Genital micoplasmas were isolated from gravid women at approximately the same recovery rate as in non-pregnant women; being M. hominis the most frequently isolated in non-pregnant women and Ureaplasma spp. in the pregnant group.

Virtual reality applications to agoraphobia: a protocol.

Recently, educators and instructional designers have focused on the development and implementation of virtual learning environments that effectively combine theoretical and applied knowledge to teach university students. One of the trusts of the Psychology Virtual Teaching Laboratory in collaboration with the IXTLI observatory is to develop dissemination programs to promote the insertion of virtual reality (VR) technologies applied to rehabilitation in their clinical practice. This paper describes the development of (1) agoraphobia VR learning objects to be use as a teaching support tools in class and (2) a multimedia teaching program that incorporate digital video and VR scenarios address to students in the field of mental health. Promotion among professors and students about the use of this technology will allow us to initiate research in our country as well as to validate contextualized applications for our culture, therefore contributing with new advances in this field.

Perfiles de resistencia a fluoroquinolonas en cocos Gram positivos de importancia clínica / Fluoroquinolone's resistance profiles in Gram-positive cocci of clinical importance

Para evaluar la resistencia a fluoroquinolonas en aislamientos clínicos de cocos grampositivos se revisaron los resultados de los cultivos procesados en el Centro de Referencia Bacteriológica del Servicio Autónomo Hospital Universitario de Maracaibo, durante el periodo enero 2011-diciembre 2015. Los datos fueron analizados mediante el software WHONETTM, (versión 5,6) y el IBM® SPSS® Statistics para Windows, (versión 25). Se encontró una frecuencia de 29,70% para los cocos grampositivos (9.292 cepas), correspondiendo el 76,18% de los aislamientos al género Staphylococcus (7.072); 15,30% a Enterococcus (1.422) y 8,59% a Streptococcus (798). Para Staphylococcus, la resistencia fue mayor en cepas resistentes a meticilina. Las tasas de resistencia más elevadas se detectaron en los enterococos, especialmente en Enterococcus faecium resistente a vancomicina. No se detectó resistencia a fluoroquinolonas en las cepas de Enterococcus faecalis resistentes a vancomicina. Los estreptococos, incluyendo Streptococcus pneumoniae, se mostraron, mayormente, sensibles a las fluoroquinolonas. La mayoría de las cepas de estafilococos y enterococos; presentó, resistencia cruzada a todas las fluoroquinolonas probadas. La distribución de la resistencia a las fluoroquinolonas por año de estudio en cada género bacteriano fue diferente. La resistencia a las fluoroquinolonas muestra una tendencia creciente en los tres géneros de cocos grampositivos evaluados

To evaluate the resistance to fluoroquinolones in clinical isolates of Gram-positive cocci records of processed culture al the Bacteriological Reference Center of the Autonomous Service University Hospital of Maracaibo during the period January 2011-December 2015, were reviewed. The data was analyzed using WHONETTM software (version 5.6) and IBM® SPSS® Statistics for Windows (version 25). A frequency of 29.70% was found for Gram-positive cocci (9,292 strains), with 76.18% of isolates corresponding to the genus Staphylococcus (7,072); 15.30% to Enterococcus (1422) and 8.59% to Streptococcus (798). For Staphylococcus, resistance was higher in methicillin-resistant strains. The highest resistance rates were detected in enterococci, especially vancomycin-resistant Enterococcus faecium. No resistance to fluoroquinolones was detected in vancomycin-resistant Enterococcus faecalis strains. Streptococci, including Streptococcus pneumoniae, were mostly sensitive to fluoroquinolones. Most strains of staphylococci and enterococci; presented cross resistance to all tested fluoroquinolones. The distribution of resistance to fluoroquinolones per year of study in each bacterial genus was different. Resistance to fluoroquinolones shows an increasing trend in the three genera of Gram-positive cocci evaluated

Susceptibilidad a meticilina y vancomicina en Staphylococcus aureus aislados de hemocultivos / Susceptibility to methicillin and vancomycin in Staphylococcus aureus isolated from blood cultures

Para determinar la susceptibilidad a meticilina y vancomicina en cepas de Staphylococcus aureus aisladas de hemocultivos, se analizaron los registros de pacientes ingresados en las Unidades de Cuidados Intensivos del Servicio Autónomo Hospital Universitario de Maracaibo durante el período enero 2011-diciembre 2015. Se procesaron 35.341 hemocultivos; 5.072 (14,35%) fueron positivos; en 455 (8,97%) se aislaron 96 cepas de Staphylococcus aureus (21,09%), de las cuales, 78 (81,25%) fueron resistentes y 18 (18,75%), sensibles a meticilina. Todos los aislados resultaron sensibles a vancomicina. El 61,45% de las cepas expresó multirresistencia. No se encontró diferencia estadísticamente significativa en la frecuencia de aislamiento de Staphylococcus aureus por año, edad y sexo del paciente (p > 0,05); pero si según el tipo de unidad y la presencia de co-resistencia antimicrobiana (p < 0,05). Los elevados niveles de resistencia a meticilina y la evidencia de fenotipos sensibles a vancomicina con valores elevados de concentración inhibitoria mínima (> 1 µg/ml), demandan la vigilancia sistemática del patrón de susceptibilidad antimicrobiana a fin de guiar a los clínicos para elegir la terapia empírica adecuada, contribuyendo al reforzamiento continuo de las precauciones estándar y al establecimiento de las políticas locales de administración y regulación del uso de antimicrobianos

To determine susceptibility to methicillin and vancomycin in blood-isolated strains of Staphylococcus aureus isolated from blood cultures, patient records entered in the Intensive Care Units of the Autonomous Hospital University Service of Maracaibo were analyzed during the period January 2011-December 2015. 35,341 blood cultures were processed; 5.072 (14,35%) were positive; in 455 (8.97%)96 strains of Staphylococcus aureus (21.09%) were isolated, of which 78 (81.25%) were resistant and 18 (18.75%), sensitive to methicillin. All isolates were sensitive to vancomycin. 61.45% of the strains expressed multi-resistance. No statistically significant difference in the frequency of isolation of Staphylococcus aureus per year, age and sex of the patient (p > 0.05) was found; but if according to the type of unit and the presence of antimicrobial co-resistance (p ˂ 0.05). The high levels of methicillin resistance and the evidence of vancomycin-sensitive phenotypes with high minimum inhibitory concentration values (>1 µg/ml), require systematic monitoring of the antimicrobial susceptibility pattern in order to guide clinicians to choose appropriate empirical therapy, contributing to the continuous strengthening of standard precautions and the establishment of local policies for the administration and regulation of the use of antimicrobials

Prevalence of partial edentulism according to Kennedy and Applegate in patients treated at a university dental clinic in Lambayeque-Peru / Prevalencia de edentulismo parcial según Kennedy y Applegate en pacientes de la clínica odontológica de una universidad de Lambayeque-Perú

Introduction: Edentulism is an irreversible chronic condition that seriously affects the stomatognathic system. Consequently, determining its prevalence may contribute to prioritize preventive and rehabilitative oral health interventions. Objective: To determine the prevalence of partial edentulism according to the Kennedy and Applegate classification in patients attending the Dental Clinic at Universidad San Martín de Porres - Lambayeque Campus, Peru, in the years 2016 and 2017. Materials and methods: A descriptive, retrospective and cross-sectional study was designed. The study comprised 321 clinical records that previously underwent a quality control stage, which included a calibration process (k=0.86). The criteria and rules proposed by Kennedy and Applegate were applied to estimate the prevalence of edentulism in each jaw according to sex; tables of frequency distribution containing percentage results were used. Results: The highest prevalence of partial edentulism in the upper jaw corresponded to Class III (42.4%), followed by Class I (34.6%), and Class II (16.5%). In the lower jaw, the most prevalent were Class I (42.4%), Class III (36.4%), and Class II (15.6%). According to sex, Class III and Class I were the most prevalent in both females and males. Conclusion: Class III and I were the most prevalent in the upper jaw in both females and males; while in the lower jaw, Classes I and III were the most prevalent for both sexes.

El edentulismo se presenta como una alteración irreversible y crónica, que genera consecuencias en el sistema estomatognático, por lo cual es necesario conocer su prevalencia para priorizar intervenciones de salud bucal preventivas y de rehabilitación. Objetivo: Determinar la prevalencia de edentulismo parcial según la clasificación de Kennedy y Applegate en pacientes atendidos en la Clínica Odontológica de la Universidad San Martín de Porres - Filial Lambayeque, en los años 2016 y 2017. Material y Método: Se diseñó un estudio descriptivo, retrospectivo y transversal, con 321 historias clínicas que pasaron previamente por un control de calidad que incluyó un proceso de calibración (k=0.86). Para estimar la prevalencia de edentulismo en cada maxilar y de acuerdo al género, fueron aplicados los criterios y reglas de kennedy y Applegate, utilizando tablas de distribución de frecuencias con resultados porcentuales. Resultados: La mayor prevalencia de edentulismo parcial para maxilar superior corresponde a la Clase III con 42,4%, siguiendo en orden descendente la Clase I con 34.6% y la Clase II con 16.5%. En el maxilar inferior, la más prevalente fue la Clase I con 42,4%, continuando la Clase III con 36.4% y la Clase II con 15.6%. De acuerdo a género, resultaron más prevalentes la Clase III y la Clase I tanto para mujeres como para hombres. Conclusiones: Las clases III y I fueron las más prevalentes en el maxilar superior, tanto para género masculino como femenino; mientras que en el maxilar inferior, fueron las clases I y III las más prevalentes también para ambos géneros.

Etiología de la diarrea infantil en Shushufindi, Ecuador / Etiology of the child diarrhea in Shushufindi, Ecuador

La diarrea infecciosa es un importante problema de salud mundial; sin embargo, poco se sabe sobre su etiología en la ciudad de Shushufindi, Ecuador. El objetivo de esta investigación fue determinar la etiología de la diarrea infecciosa en niños. Se recolectaron 154 muestras fecales provenientes de niños de ambos sexos que acudieron al laboratorio de un centro de salud durante el periodo enero-marzo 2018. Se realizó coprocultivo, examen parasitológico directo e inmunoensayo cromatográfico. En 124 muestras (80,52%) se detectó la presencia de organismos enteropatógenos, de las cuales 74 (59,68%) fueron positivas para bacterias; 36 (29,03%) para parásitos y 14 (11,29%) para rotavirus. Los organismos aislados fueron: 35 (28,23%) Salmonella sp.; 26 (20,97%) Shigella sp.; 13 (10,48%) Campylobacter sp.; 15 (12,10%) G. intestinalis; 10 (8,06%) T. trichiura; 5 (4,03%) E. histolytica/dispar/moshkovskii; 3 (2,42%) A. lumbricoides; S. stercoralis y rotavirus14 (11,29%), cada uno. Se encontró asociación estadísticamente significativa entre la presencia de parásitos y la edad y sexo del paciente; así como también entre la presencia de bacterias y la edad de los niños. Este estudio demuestra la participación de un pequeño grupo de patógenos como los principales agentes causales de la diarrea infecciosa en la población infantil estudiada.

Infectious diarrhea is a major global health problem; however, little is known about its etiology in the city of Shushufindi, Ecuador. The objective of this investigation was to determine the etiology of infectious diarrhea in children. 154 fecal samples were collected from children of both sexes who attended the laboratory of a health center during the period January-March 2018. Stool culture, direct parasitological examination and immunochromatographic assay were performed. In 124 samples (80.52%) the presence of enteropathogenic organisms was detected, of which 74 (59.68%) were positive for bacteria; 36 (29.03%) for parasites and 14 (11.29%) for rotavirus. The isolated organisms were: 35 (28.23%) Salmonella spp.; 26 (20.97%) Shigella spp.; 13 (10.48%) Campylobacter spp.; 15 (12.10%) G. intestinalis; 10 (8.06%) T. trichiura; 5 (4.03%) E. histolytica/dispar/moshkovskii; 3 (2.42%) A. lumbricoides; S. stercoralis and rotavirus 14 (11.29%), each one. A statistically significant association was found between the presence of parasites and the age and sex of the patient; as well as between the presence of bacteria and the age of children. This study demonstrates the participation of a small group of pathogens as the main causative agents of infectious diarrhea in the child population studied.

Calidad microbiológica del agua subterránea como riesgo epidemiológico en la producción de enfermedad diarreica infantil. Revisión Sistemática / Microbiological quality of groundwater as an epidemiological risk in the production of Childhood Diarrheal Disease. Systematic review

El agua de consumo humano y su calidad son determinantes para la salud pública. Esta revisión pretende recopilar y analizar información acerca de la relación entre la enfermedad diarreica en niños menores de cinco (5) años y la contaminación de las fuentes de agua subterránea. Se consultaron las bases: PubMed, ScienceDirect, SpringerLink, SciELO y Google Scholar, sin limitación en fechas de publicación; utilizando los descriptores: agua subterránea, diarrea, enfermedad gastrointestinal infantil, contaminación microbiana, calidad del agua, diarrea infantil, agua potable, técnicas moleculares y técnicas bioquímicas, analizándose un total de ciento sesenta y nueve (169) publicaciones. Se encontró relación entre la contaminación microbiana del agua subterránea y la diarrea infantil. El agua subterránea se contamina debido a fugas de fosas sépticas, métodos inadecuados de manejo de desechos y escorrentías de agua de lluvia, determinando la prevalencia de diarrea infantil. De allí, la importancia de monitorear la calidad del agua como factor de riesgo, con la detección y cuantificación de bioindicadores, mediante métodos rutinarios y novedosos, e incorporar intervenciones dirigidas a mejorar la accesibilidad a fuentes de agua controladas y la educación sanitaria en la búsqueda de asegurar la protección del agua y la disminución en la prevalencia de la diarrea infantil. Esta revisión está registrada en PROSPERO bajo el número ID 129254

Water for human consumption and its quality are determinants for public health. This review aims to collect and analyze information about the relationship between diarrheal disease in children under five (5) years of age and contamination of groundwater sources. The bases: PubMed, ScienceDirect, SpringerLink, SciELO and Google Scholar, without limitation on publication dates, using the descriptors: groundwater, diarrhea, childhood gastrointestinal disease, microbial contamination, water quality, childhood diarrhea, drinking water, molecular techniques and biochemical techniques, were consulted, analyzing a total of one hundred sixty-nine (169) publications. A relationship was found between microbial contamination of groundwater and childhood diarrhea. Groundwater is contaminated due to septic tank leaks, inadequate methods of waste management and rainwater runoff, determining the prevalence of childhood diarrhea. From there, the importance of monitoring water quality as a risk factor, with the detection and quantification of bioindicators, through routine and novel methods, and incorporating interventions aimed at improving accessibility to controlled water sources and health education in the search to ensure water protection and the decrease in the prevalence of childhood diarrhea. This revision is registered in PROSPERO under the number ID 129254.

Infección urinaria en pacientes con diabetes mellitus tipo 2: frecuencia, etiología, susceptibilidad antimicrobiana y factores de riesgo / Urinary infection in patients with type 2 diabetes mellitus: frequency, etiology, antimicrobial susceptibility and risk factors

Las infecciones urinarias son comunes en pacientes diabéticos. El objetivo de esta investigación fue: determinar la frecuencia, etiología, susceptibilidad antimicrobiana y factores de riesgo asociados a infección urinaria en pacientes con diabetes tipo 2. Se estudiaron 108 pacientes ambulatorios, con diagnóstico presuntivo de infección de vías urinarias, durante el periodo mayo 2016 - mayo 2017, en la ciudad de Jipijapa, Ecuador. Para el urocultivo se utilizó la técnica del asa calibrada. La susceptibilidad a los antibióticos se determinó mediante el método de Kirby & Bauer. Las variables cualitativas se compararon con ji cuadrado o la prueba exacta de Fisher. Se calculó el Odd radio (OR) y sus intervalos de confianza (IC) del 95%. Valores de p ≤ 0,05 fueron considerados significativos. La frecuencia de infección urinaria fue de 73,15%. El microorganismo más frecuentemente aislado fue Escherichia coli (78,48%). Los mayores porcentajes de resistencia se observaron para amoxicilina (78,87%) y cefalexina (71,83%). Los malos hábitos de higiene, la presencia de cálculos renales y una vida sexual activa resultaron factores de riesgo para las infecciones urinarias. La nitrofurantoina, fosfomicina, fluoroquinolonas y algunos betalactámicos, todavía representan una alternativa de utilidad en la quimioterapia de las infecciones urinarias no complicadas en pacientes diabéticos.

Urinary infection is common in diabetic patients. The objective of this research was to determine the frequency, etiology, antimicrobial susceptibility and risk factors associated with urinary tract infection in patients with type 2 diabetes. 108 outpatients with a presumptive diagnosis of urinary tract infection during May 2016-May 2017, in the city of Jipijapa, Ecuador, were studied. For the uroculture the calibrated loop technique was used. The susceptibility to antibiotics was determined by the Kirby & Bauer method. The qualitative variables were compared with chi-squared or Fisher's exact test. The Odd radio (OR) and its 95% confidence intervals (CI) were calculated. Values of p ≤ 0.05 were considered significant. A frequency of 73.15% of urinary infection was found. The microorganism most frequently isolated was Escherichia coli (78.48%). The highest percentages of resistance were observed for amoxicillin (78.87%) and cephalexin (71.83%). Bad hygiene habits, the presence of kidney stones and an active sex life were risk factors for urinary tract infections. Nitrofurantoin, fosfomycin, fluoroquinolones and some beta-lactams still represent a useful alternative in the chemotherapy of uncomplicated urinary tract infections in diabetic patients.

Frecuencia y resistencia antimicrobiana en Staphylococcus / Frequency and antimicrobial resistance in Staphylococcus

La presente investigación tuvo como objetivo establecer la frecuencia de aislamiento de las diferentes especies de estafilococos y determinar la resistencia antimicrobiana de las cepas aisladas. Se realizó un estudio retrospectivo, en cepas aisladas en el Centro de Referencia Bacteriológica del Servicio Autónomo Hospital Universitario de Maracaibo, durante el período enero 2011 ­ diciembre 2015. Se obtuvo un porcentaje de aislamiento para S. aureus del 61,36% y 38,64% para coagulasa negativa, observándose mayor frecuencia de aislamiento en el área de hospitalización para ambos grupos de microorganismos. Las muestras de piel y tejidos blandos representaron las principales fuentes de aislamiento para S. aureus; mientras que para el grupo coagulasa negativa, fueron las muestras de sangre. Todas las cepas fueron sensibles a los glicopéptidos. La resistencia para los b-lactámicos fue acentuada para ambos grupos bacterianos, mostrando variabilidad para macrólidos y lincosamidas y para los restantes antibióticos probados, se encontraron bajos porcentajes de resistencia. Los resultados demuestran que S. aureus es la especie más frecuente del género; seguida de S. epidermidis y S. haemolyticus entre coagulasa negativa. Ambos grupos de microorganismos expresan fenotipos de resistencia a penicilina y eritromicina, sensibilidad a vancomicina y teicoplanina y susceptibilidad variable al resto de antibióticos evaluados.

The objective of the present investigation was to establish the frequency of isolation of the different species of staphylococci and to determine the antimicrobial resistance of the isolated strains. A retrospective study was carried out in isolated strains at the Bacteriological Reference Center of the Autonomous Service of the University Hospital of Maracaibo during the period January 2011 to December 2015. A percentage of isolation was obtained for S. aureus of 61.36% and 38,64% for coagulase negative, showing a higher frequency of isolation in the hospitalization area for both groups of microorganisms. Skin and soft tissue samples represented the main sources of isolation for S. aureus; while for the coagulase negative group, they were blood samples. All strains were sensitive to glycopeptides. Resistance for ß-lactams was accentuated for both bacterial groups, showing variability for macrolides and lincosamides and for the remaining antibiotics tested, low percentages of resistance were found. The results show that S. aureus is the most frequent species of the genus; followed by S. epidermidis and S. haemolyticus, among coagulase negative. Both groups of microorganism express phenotypes of resistance to penicillin and erythromycin, sensitivity to vancomycin and teicoplanin and variable susceptibility to the rest of evaluated antibiotics.

Detección de cassette cromosómico en cepas de Staphylococcus aureus resistente a meticilina aisladas en un hospital universitario de la ciudad de Maracaibo / Detection of chromosomal cassette in MRSA Staphylococcus aureus strains isolated in a University Hospital in Maracaibo City

Staphylococcus aureus resistente a meticilina, es un importante patógeno nosocomial y comunitario. El determinante genético de resistencia es el gen mecA. Se han descrito 11 tipos de SCCmec, encontrándose con frecuencia los tipos II, III en infecciones hospitalarias, y los tipos IV y V en infecciones comunitarias. La presente investigación se llevó a cabo para estudiar la distribución de los tipos de SCCmec y su relación con la Leucocidina Panton-Valentine, tipificados mediante la reacción en Cadena de la Polimerasa. Para ello se estudiaron un total de 42 cepas resistentes a meticilina portadoras del gen mecA. Veintinueve (29) cepas mostraron la presencia del cassette cromosomal tipo IV (69,05%); 30,95% presentaron el SCCmec tipo I. Un 61,95% (n=13) de las cepas fueron portadoras del SCCmec IV resultando todas positivas para el gen PVL. Cabe destacar la diseminación del cassette tipo IV en cepas intrahospitalarias portadoras de PVL, lo que es preocupante tanto para la terapéutica como para el agravamiento de las infecciones en los pacientes.

Methicillin-resistant Staphylococcus aureus is an important nosocomial and community pathogen. The genetic determinant of resistance is the mecA gene. 11 types of SCCmec have been described, with types II, III frequently found in hospital infections, and types IV and V in community infections. The present investigation was carried out to study the distribution of the SCCmec types and their relation with the Panton-Valentine Leucocidin, typified by the reaction in the Polymerase Chain. To this end, a total of 42 methicillin-resistant strains carrying the mecA gene were studied. Twenty-nine (29) strains showed the presence of type IV chromosomal cassette (69.05%); 30.95% presented SCCmec type I. A 61.95% (n= 13) of the strains were carriers of SCCmec IV, all of which were positive for the PVL gene. It is worth noting the dissemination of the type IV cassette in intrahospital strains carrying PVL, which is worrisome both for the therapeutic and for the aggravation of infections in patients.

Distribución de especies y susceptibilidad antimicrobiana en cepas de Enterococcus de origen clínico / Distribution of species and antimicrobial susceptibility in Enterococcus strains of clinical origin

A fin de establecer la frecuencia de aislamiento de las diferentes especies de enterococos, su distribución de acuerdo al tipo de muestra y servicio de atención al paciente y determinar la resistencia antimicrobiana, se analizaron 1.624 cepas provenientes de cultivos bacteriológicos de pacientes atendidos en el Centro de Referencia Bacteriológica del Servicio Autónomo Hospital Universitario de Maracaibo, durante el período Enero 2010 - Diciembre 2015. Las especies más frecuentes fueron E. faecalis (52,46%) y E. faecium (41,38%). El mayor número de cepas se obtuvo a partir de muestras de piel y tejidos blandos (54,92%), orina (23,15%) y sangre (17,27%). Los servicios con mayor frecuencia de aislamiento fueron: hospitalización de adultos (47,71%) y hospitalización pediátrica (16,38%). No se encontró asociación estadísticamente significativa entre la especie de enterococos y el tipo de muestra o el servicio de atención al paciente (p>0,05). Se detectó más resistencia en E. faecium que en E. faecalis. Los enterococos están adquiriendo cada vez mayor resistencia antimicrobiana y, por lo tanto, se hace necesario mantener una vigilancia permanente sobre ellos, realizar su adecuada identificación y detectar oportunamente la resistencia, con el fin de aplicar medidas preventivas adecuadas antes de que estos microorganismos causen un mayor impacto intrahospitalario.

In order to establish the frequency of isolation of the different species of enterococci, their distribution according to the type of sample and patient care service and determine the antimicrobial resistance, 1,624 strains obtained from bacteriological cultures of patients attended in the Bacteriological Reference Center at the Autonomous Service University Hospital of Maracaibo, during the period January 2010 - December 2015, were analyzed. The most frequent species were E. faecalis (52.46%) and E. faecium (41.38%). The greatest number of strains was obtained from skin and soft tissues samples (54.92%), urine (23.15%) and blood (17.27%). Services with increased frequency of isolation were: hospitalization of adults (47.71%) and pediatric hospitalization (16.38%). It did not find statistically significant association between the specie of enterococci and sample type, or patient care service (p > 0.05). It was detected more resistance in E. faecium than in E. faecalis. The enterococci are acquiring ever greater antimicrobial resistance, and therefore, it is necessary to maintain permanent vigilance over them, perform their proper identification and timely detect resistance, in order to apply preventive measures before these microorganisms cause a greater intrahospital impact.