Wickerhamiella martinezcruziae f. a., sp. nov., a yeast species isolated from tropical habitats.

Four yeast isolates with an affinity to the genus Wickerhamiella were obtained from beach sand, a marine zoanthid and a tree exudate at different localities in Brazil. Two other isolates with almost identical ITS and D1/D2 sequences of the large subunit rRNA gene were isolated from the small intestine of cattle and a grease trap in Thailand. These isolates represent a novel species phylogenetically related to Wickerhamiella verensis, Wickerhamiella osmotolerans, Wickerhamiella tropicalis, Wickerhamiella sorbophila and Wickerhamiella infanticola. The novel species differs by 15-30 nucleotide differences from these species in the D1/D2 sequences. The name Wickerhamiella martinezcruziae f.a., sp. nov. is proposed. The holotype of Wickerhamiella martinezcruziae sp. nov. is CBS 16104T. The MycoBank number is MB 839328.

Occurrence, antifungal susceptibility, and virulence factors of opportunistic yeasts isolated from Brazilian beaches.

BACKGROUND: Opportunistic pathogenic yeast species are frequently associated with water habitats that have pollution sources of human or animal origin. Candida albicans has already been suggested as a faecal indicator microorganism for aquatic environments. OBJECTIVES: The goal of this study was to investigate the occurrence of C. albicans and other opportunistic yeasts in sand and seawater samples from beaches in Brazil to assess their correlation with Escherichia coli, and to characterise the pathogenic potential of the yeast isolates. METHODS: Opportunistic species (yeasts that grow at 37ºC) were isolated from sand and seawater samples from eight beaches in Brazil during the summer and the winter. Opportunistic yeast species were evaluated for their susceptibility to antifungal drugs, virulence factors, and the in vitro and in vivo biofilm formation. Strains were selected to carry out virulence tests using BALB/c mice. FINDINGS: Several water samples could be classified as inappropriate for primary contact recreation in relation to E. coli densities. C. albicans was isolated in low densities. Of the 144 opportunistic yeasts evaluated, 61% displayed resistance or dose-dependent sensitivity to at least one tested drug, and 40% produced proteinase. Strains of C. albicans and Kodamaea ohmeri exhibited the highest rates of adhesion to buccal epithelial cells. All the C. albicans strains that were tested were able to undergo morphogenesis and form a biofilm on catheter fragments in both in vitro and in vivo experiments. It was possible to confirm the pathogenic potential of three of these strains during the disseminated infection test. MAIN CONCLUSIONS: The identification of opportunistic yeast species in seawater and sand samples from Brazilian beaches suggest a potential risk to the health of people who use these environments for recreational purposes.

Yamadazyma barbieri f.a. sp. nov., an ascomycetous anamorphic yeast isolated from a Mid-Atlantic Ridge hydrothermal site (-2300 m) and marine coastal waters.

Two yeast strains that are members of the same species were isolated from different marine habitats, i.e. one from Mid-Atlantic Ridge ocean water samples located in the direct vicinity of black smokers near the Rainbow deep-sea hydrothermal vent and one from Brazilian marine water samples off the Ipanema beach. Strains CLIB 1964T and CLIB 1965 are anamorphic ascomycetous yeasts affiliated to the Yamadazyma clade of Saccharomycetales. Interestingly, these strains were phylogenetically and distinctly positioned into a group of species comprising all species of the genus Yamadazyma isolated from marine habitats including deep-sea hydrothermal vents, i.e.Candida atmosphaerica,C. spencermartinsiae,C. atlantica,C. oceani and C. taylorii. These strains differed significantly in their D1/D2 domain sequences of the LSU rRNA gene from the closely related species mentioned above, by 2.6, 3.0, 3.4, 3.8 and 6.0 %, respectively. Internal transcribed spacer region sequence divergence was also significant and corresponded to 4.6, 4.7, 4.7, 12.0 and 24.7 % with C. atlantica,C. atmosphaerica, C. spencermartinsiae,C. oceani and C. taylorii, respectively. Phenotypically, strains CLIB 1964T and CLIB 1965 could be distinguished from closely related species by their inability to assimilate l-sorbose. CLIB 1964T (=CBS 14301T=UBOCC-A-214001T) is the designated type strain for Yamadazyma barbieri sp. nov. The MycoBank number is MB 815884.

Metaphyseal chondroblastoma in a pediatric patient.

Chondroblastoma is a rare, benign neoplasm usually located in the epiphyses and apophyses of the long bones in the immature skeleton. Radiologically, these tumors have a classic appearance of a lytic lesion with chondroid matrix surrounded by a thin sclerotic rim. Here, we describe the case of a 5-year-old male who presented with a chondroblastoma unusually located exclusively in the metaphyseal region, which led to an elusive diagnosis. The presence of tumors outlying the traditional location or epidemiological spectrum, along with the potential for histopathological misdiagnosis, can pose a diagnostic and therapeutic challenge for the treating team.

Low expression of ZHX1 and ZHX2 impacts on the prognosis of chronic lymphocytic leukemia.

Experimental evidence points to the role of Zinc fingers and homeoboxes protein 1 and 2 (ZHX1 and ZHX2) in the development and progression of several types of cancer, including hematological malignancies. Here, we determined whether the altered expression of ZHX1 and ZHX2 has clinical implications in patients with CLL. Interestingly, CLL patients with low expression ZHX1 and ZHX2 presented higher WBC counts. Importantly, our data showed that CLL patients with cytogenetic alterations presented reduced transcriptional levels of ZHX1 and ZHX2 in comparison with patients with normal karyotype. Moreover, when stratifying CLL patients according to the karyotype prognosis value, we observed that the expression of ZHX1 and ZHX2 was significantly reduced in CLL patients presenting adverse karyotypes. Finally, we stratified patients according to the number of chromosomal aberrations and observed a negative association between ZHX1 and ZHX2 expression and the accumulation of chromosomal abnormalities in CLL patients. Our data showed that the low expression of ZHX1 and ZHX2 is associated with a worse prognosis in CLL, followed by a greater number of leukemic cells and unfavorable cytogenetics findings in the diagnosis. Further studies will be important to confirm the prognostic value of ZHX1 and ZHX2 in independent CLL cohorts.

The lifestyle of Brazilian medical students: What changed and how it protected their emotional wellbeing during the COVID-19 pandemic.

BACKGROUND AND OBJECTIVES: Adopting healthy lifestyle pillars promotes longer lives free from major chronic diseases. The COVID-19 pandemic imposed behavioural changes and psychological burdens. The aim of this study was to assess changes in medical students' six lifestyle pillars that were imposed by the COVID-19 pandemic. METHOD: This cross-sectional study included 548 Brazilian medical students' digitally collected demographic data and lifestyle characteristics from before and during the pandemic. RESULTS: The pandemic had a neutral impact on sleep quality and a predominantly negative impact on interpersonal relationships, exercise and eating. Approximately 67.5% students decreased their tobacco and alcohol use. Spirituality was maintained at 66%. Those who reported having emotional wellbeing (27.9%) during the pandemic fulfilled a higher number of pre-pandemic lifestyle pillars (median [IQR]) when compared with those who reported an absence of wellbeing (4 [3-4] pillars, compared with 3 [2-4], P = 0.006). DISCUSSION: The results reinforce the importance of adhering to as many lifestyle pillars as possible to preserve emotional wellbeing during periods of stress such as those experienced during the pandemic.

Phage-resistance linked to cell heterogeneity in the commercial strain Lactobacillus delbrueckii subsp. lactis Ab1.

The aim of this work was to study the relationship between the cell morphological heterogeneity and the phage-resistance in the commercial strain Lactobacillus delbrueckii subsp. lactis Ab1. Two morphological variants (named C and T) were isolated from this strain. Phage-resistant derivatives were isolated from them and the percentage of occurrence of confirmed phage-resistant cells was 0.001% of the total cellular population. Within these phage-resistant cell derivatives there were T (3 out of 4 total isolates) and C (1 out of 4 total isolates) variants. The study of some technological properties (e.g. proteolytic and acidifying activities) demonstrated that most of phage-resistant derivatives were not as good as the parental strain. However, for one derivative (a T variant), the technological properties were better than those of the parental strain. On the other hand, it was possible to determinate that the system of phage-resistance in the T variants was interference in adsorption step, with adsorption rates <15%. For the C variant derivative it was possible to demonstrate the presence of a restriction/modification system and, moreover, to determinate that this system could be Type I R/M.

Molecular autopsy in a cohort of infants died suddenly at rest.

Sudden infant death syndrome is the leading cause of death during the first year of life. A large part of cases remains without a conclusive cause of death after complete autopsy. In these situations, cardiac arrhythmia of genetic origin is suspected as the most plausible cause of death. Our aim was to ascertain whether genetic variants associated with sudden cardiac death might be the cause of death in a cohort of infants died suddenly. We analyzed 108 genes associated with sudden cardiac death in 44 post-mortem samples of infants less than 1 year old of age who died at rest. Definite cause of death was not conclusive in any case after a complete autopsy. Genetic analysis identified at least one rare variant in 90.90% of samples. A total of 121 rare genetic variants were identified. Of them, 33.05% were novel and 39.66% were located in genes encoding ion channels or associated proteins. A comprehensive genetic analysis in infants who died suddenly enables the unraveling of potentially causative cardiac variants in 2045% of cases. Molecular autopsy should be included in forensic protocols when no conclusive cause of death is identified. Large part genetic variants remain of uncertain significance, reinforcing the crucial role of genetic interpretation before clinical translation but also in early identification of relatives at risk.

Occurrence, antifungal susceptibility, and virulence factors of opportunistic yeasts isolated from Brazilian beaches

BACKGROUND Opportunistic pathogenic yeast species are frequently associated with water habitats that have pollution sources of human or animal origin. Candida albicans has already been suggested as a faecal indicator microorganism for aquatic environments. OBJECTIVES The goal of this study was to investigate the occurrence of C. albicans and other opportunistic yeasts in sand and seawater samples from beaches in Brazil to assess their correlation with Escherichia coli, and to characterise the pathogenic potential of the yeast isolates. METHODS Opportunistic species (yeasts that grow at 37ºC) were isolated from sand and seawater samples from eight beaches in Brazil during the summer and the winter. Opportunistic yeast species were evaluated for their susceptibility to antifungal drugs, virulence factors, and the in vitro and in vivo biofilm formation. Strains were selected to carry out virulence tests using BALB/c mice. FINDINGS Several water samples could be classified as inappropriate for primary contact recreation in relation to E. coli densities. C. albicans was isolated in low densities. Of the 144 opportunistic yeasts evaluated, 61% displayed resistance or dose-dependent sensitivity to at least one tested drug, and 40% produced proteinase. Strains of C. albicans and Kodamaea ohmeri exhibited the highest rates of adhesion to buccal epithelial cells. All the C. albicans strains that were tested were able to undergo morphogenesis and form a biofilm on catheter fragments in both in vitro and in vivo experiments. It was possible to confirm the pathogenic potential of three of these strains during the disseminated infection test. MAIN CONCLUSIONS The identification of opportunistic yeast species in seawater and sand samples from Brazilian beaches suggest a potential risk to the health of people who use these environments for recreational purposes.

Mortalidad prenatal en el Centro Hospitalario Pereira Rossell, Montevideo. Análisis de 845 casos de autopsia entre 2005 y 2016 / Stillbirth at Pereira Rossell Hospital in Montevideo. Analysis of 845 autopsies between 2005 and 2016

Resumen: Antecedentes: con la mejora de la atención del embarazo se ha reducido el número de mortinatos en el mundo desarrollado. Pero en los países subdesarrollados y en vías de desarrollo constituyen un problema sanitario. Objetivo: conocer las patologías que subyacen en los casos de autopsia de mortinatos del Centro Hospitalario Pereira Rossell, a los efectos de contribuir a la reducción de la mortalidad fetal. Material y método: se realiza un estudio observacional, descriptivo de recolección de información en forma retrospectiva de las autopsias de los de mortinatos del Centro Hospitalario Pereira Rossell de los últimos 12 años (2005-2016). Las autopsias y las placentas fueron realizadas de acuerdo al protocolo habitual en patología perinatal. Los datos del estudio se analizaron conjuntamente. Resultados: se constataron malformaciones congénitas en 17,7% e infección congénita en la autopsia en 20,4%. La infección en conjunto (en autopsia y/o placenta) se identificó en 383 casos (45,3%). Se identificó lúes en 10,5% de los mortinatos. Había elementos fetales de asfixia en 11,5% y una miscelánea de patologías en 3,5% de los casos. En 50,4% la autopsia propiamente dicha no tenía alteraciones, pero en 90% de ellas se identificaron lesiones placentarias que pudieron ser responsables de la muerte fetal. Se observó bajo flujo sanguíneo útero placentario en 14,2% de las placentas, corioamnionitis en 30,5% de las placentas, y hematoma retroplacentario en 26,6% de las placentas. La muerte fue indeterminada en 4,9% de los casos. Conclusiones: un elevado porcentaje de los casos tienen patologías evitables y tratables. Se identificaron patologías potencialmente recurrentes y enfermedades que ameritan tratar a la madre. Los estudios de los mortinatos deben ser considerados en los protocolos sanitarios a los efectos de reducir la mortalidad fetal.

Summary: Background: the number of stillbirth cases has been reduced in the developed countries due to improvements in pregnancy care. It is important to know the causes in order to prevent fetal death. Early identification of risk factors for stillbirth may reduce the number of cases. The objective of this paper is to identify the underlying pathologies of the cases that underwent an autopsy at Pereira Rossell Hospital in Montevideo, in order to contribute to the reduction of fetal mortality. Methods: this is a retrospective and descriptive study of autopsy and placental examinations, performed at the Pediatric Pathology Laboratory of Pereira Rossell Hospital in Montevideo. A standard protocol was applied. Data were analyzed overall. Results: congenital malformations were identified in 17.7% of cases; congenital infection in the fetus was found in 20.4%. Infection altogether (in the autopsy and/or the placenta) was identified in 383 cases (45.3%). Syphilis was diagnosed in 10.5% of the stillborn. Fetal evidence of asphyxia accounted for 11.5% and miscellaneous pathologies 3.5%. In 50.4% of cases the autopsy did not reveal alterations, but 90% of corresponding placentas had lesions that could have caused the death of the fetus. Maternal underperfusion or malperfusion was found in 14.2% of the placentas. Chorioamnionitis was seen in 30.5%. A retroplacental hematoma was seen in 26.6%. Stillbirth was of unexplained in 4.9% of the cases. Conclusion: a high percent of the cases studied had a preventable pathology. Many recurrent lesions were identified as well as cases that required additional medication to the mother. The results of the pathology examination should be considered in order to reduce the stillbirth rate.

The diversity and antifungal susceptibility of the yeasts isolated from coconut water and reconstituted fruit juices in Brazil.

The aims of this study were to characterise the yeasts present in the reconstituted fruit juices and coconut water extracted with "coconut machines", both collected from commercial outlets in a Brazilian city, and to investigate the antifungal resistance of isolates from these beverages that were able to grow at 37°C. The yeast population counts in the coconut water samples ranged from 1.7 to >6.5logcfu/ml, and in the reconstituted fruit juices, the counts ranged from 1.5 to >5.5logcfu/ml. Aureobasidium pullulans, Candida boidinii, Candidaintermedia, Candidaoleophila, Candidaparapsilosis, Candidasantamariae, Candidatropicalis, Clavispora lusitaniae, Kloeckera apis, Lachancea fermentati, Pichia fermentans and Rhodotorula mucilaginosa were the most frequent species isolated from these beverages. At least 18 yeast species isolated from these beverages have been reported as opportunistic pathogens. Eight yeast isolates were resistant to fluconazole, seven were resistant to itraconazole, and 26 to amphotericin B. Some yeast species were resistant to more than one of the antifungal drugs tested. Two isolates of C. tropicalis from the reconstituted fruit juices exhibited resistance to all three drugs. The presence of yeast strains that are resistant to commonly used antifungal drugs suggests a potential risk, at least to immunocompromised individuals who consume these beverages.

Prevalência de infecções hospitalares em unidade de terapia intensiva / Prevalence of nosocomial infection in intensive care unit

JUSTIFICATIVA E OBJETIVOS: A infecção hospitalar (IH) representa uma condição grave que influencia na morbimortalidade dos pacientes que permanecem internados. Em unidade de terapia intensiva (UTI), os pacientes encontram-se acamados por tempo prolongado, imunodeprimidos, com doenças graves que necessitam de monitoramento invasivo e uso de antibióticos de largo espectro, tornando-os mais suscetíveis às IH. O objetivo deste estudo foi avaliar a prevalência e o perfil microbiológico das IH na UTI, bem como a evolução dos pacientes notificados.MÉTODO: O estudo foi realizado no Hospital Pró-Clínicas no período de fevereiro a dezembro de 2008. Os casos de IH ocorridos foram notificados através da Ficha de Notificação de Infecção Hospitalar e os respectivos dados foram analisados no programa Doctor Clean versão 3.0.3.RESULTADOS: No período do estudo foram notificados 26 casos de IH. Sua prevalência foi no sexo masculino (57,69%), entre a 7ª e 8ª décadas, sendo o trato respiratório o local mais acometido (44,19%) e o micro-organismo mais isolado foi o Proteus mirabilis (22,22%).CONCLUSÃO: A partir dos resultados obtidos pode-se traçar um perfil microbiológico próprio da UTI, sendo possível programar uma terapêutica empírica mais eficaz e direcionada, reduzindo os custos hospitalares, o tempo de internação dos pacientes e o surgimento de micro-organismos multirresistentes.(AU)

BACKGROUND AND OBJECTIVES: The nosocomial infection (NI) is a serious condition that affects the mortality of patients who remain hospitalized. In an Intensive Care Unit (ICU) patients are bedridden for long periods, compromised, with serious illnesses that require invasive monitoring and use of broad spectrum antibiotics, making them more susceptible to NI's. The study aims to assess the prevalence and microbiological profile of NI's in the ICU and the evolution of the patients reported.METHOD: The study was performed at Hospital Pró-Clínicas from February to December of 2008. The cases of IH occurred were reported through the Notification Form Hospital Infection and the data were analyzed with the Doctor Clean program version 3.0.3.RESULTS: Throughout the study period were reported 26 cases of IH. Its prevalence was among males (57.69%), between the 7th and 8th decades, the respiratory tract was the most commonly affected (44.19%) and the most isolated microorganism was Proteus mirabilis (22.22%).CONCLUSION: From the results obtained one can draw a microbiological profile of the ICU itself, it is possible to implement an empirical therapy more accurately and efficiently, reducing hospital costs, length of hospital patients and the emergence of resistant microorganisms.(AU)