ABSTRACT
Millions of people worldwide live at high altitude, being chronically exposed to hypobaric hypoxia. Hypertension is a major cardiovascular risk factor but data on its prevalence and determinants in highlanders are limited, and systematic studies with ambulatory blood pressure monitoring are not available. Aim of this study was to assess the prevalence of clinic and ambulatory hypertension and the associated factors in a sample of Andean highlanders. Hypertension prevalence and phenotypes were assessed with office and ambulatory blood pressure measurement in a sample of adults living in Cerro de Pasco, Peru (altitude 4340 m). Basic clinical data, blood oxygen saturation, hematocrit, and Qinghai Chronic Mountain Sickness score were obtained. Participants were classified according to the presence of excessive erythrocytosis and chronic mountain sickness diagnosis. Data of 289 participants (143 women, 146 men, mean age 38.3 years) were analyzed. Office hypertension was present in 20 (7%) participants, while ambulatory hypertension was found in 58 (20%) participants. Masked hypertension was common (15%), and white coat hypertension was rare (2%). Among participants with ambulatory hypertension, the most prevalent phenotypes included isolated nocturnal hypertension, isolated diastolic hypertension, and systodiastolic hypertension. Ambulatory hypertension was associated with male gender, age, overweight/obesity, 24-hour heart rate, and excessive erythrocytosis. Prevalence of hypertension among Andean highlanders may be significantly underestimated when based on conventional blood pressure measurements, due to the high prevalence of masked hypertension. In highlanders, ambulatory hypertension may be independently associated with excessive erythrocytosis.
Subject(s)
Altitude Sickness/physiopathology , Altitude , Blood Pressure Monitoring, Ambulatory/methods , Hypertension/physiopathology , Office Visits , Adult , Altitude Sickness/diagnosis , Cross-Sectional Studies , Female , Humans , Hypertension/diagnosis , Hypertension/epidemiology , Hypoxia/diagnosis , Hypoxia/physiopathology , Male , Masked Hypertension/diagnosis , Masked Hypertension/physiopathology , Middle Aged , Peru/epidemiology , PrevalenceABSTRACT
In Argentina, NDM metallo-ß-lactamase was first reported in 2013. By now, it has disseminated throughout the country in diverse Gram negative bacteria. Here, we report the case of a paediatric patient that underwent a 1-year hospitalisation due to erythrodermic psoriasis in 2014 and received multiple antimicrobial treatments. During his stay, five isolates were obtained from rectal swabs (rs) or blood culture (bc) suspicious of carbapenemase production: a K. quasipneumoniae subsp. quasipneumoniae (rs), Citrobacter freundii (rs), Escherichia coli (bc), Enterobacter cloacae (rs), and a Serratia marcescens (bc). The isolates were studied with broth microdilution, biparental conjugation and plasmid and whole genome sequencing (Illumina). All isolates harboured an 138,998-bp type 1 IncC plasmid that carried blaNDM-1, bleMBL, blaCMY-6, rmtC, aac(6')-Ib, and sul1 resistance genes. Additionally, the blaNDM-plasmids contained ISKpn8 an insertion sequence previously described as associated only to blaKPC. One isolate, a colistin-resistant E. coli, also carried a mcr-1-containing an IncI2 plasmid, which did not harbour additional resistance. The whole genome of K. quasipneumoniae subsp. quasipneumoniae isolate was fully sequenced. This isolate harboured, additionally to blaNDM, three plasmid-mediated quinolone resistance genes: qnrB4, qnrB52 and aac(6')-Ib-cr1. The E. cloacae isolate also harboured qnrA1. These findings alert to the underestimated horizontal dissemination of multidrug-resistant plasmids limiting treatment options with last resort antimicrobials.
Subject(s)
Enterobacteriaceae/genetics , Enterobacteriaceae/isolation & purification , Plasmids/genetics , Anti-Bacterial Agents/pharmacology , Child , Child, Preschool , Drug Resistance, Bacterial/genetics , Enterobacteriaceae/classification , Enterobacteriaceae/drug effects , Escherichia coli/genetics , Gene Transfer, Horizontal , Hospitals , Humans , Phylogeny , Psoriasis/microbiologyABSTRACT
This study investigated the molecular characteristics of six blaKPC-positive Enterobacteriaceae recovered from three patients in Argentina. Antimicrobial susceptibility testing was performed following Clinical and Laboratory Standards Institute (CLSI) 2014 recommendations. Molecular characterisation of the isolates was performed by biparental conjugation, PCR, sequencing, S1 nuclease restriction, and Southern blot hybridisation with a blaKPC probe using standard protocols and conditions. The isolates studied were as follows. Case 1: Escherichia coli (ECO-P1) and Klebsiella pneumoniae (KPN-P1) isolated from a rectal swab harboured blaKPC-2 in transposon Tn4401a on non-typeable and non-conjugative plasmids. Case 2: Enterobacter cloacae (ECL-P2) and K. pneumoniae (KPN-P2) were isolated from two blood cultures. blaKPC-2 was found in a novel genetic variant of ISKpn8-blaKPC-2-ISKpn6-like on conjugative plasmids of IncL/M type. Case 3, Citrobacter freundii (CFR-P3) and Klebsiella oxytoca (KOX-P3) were isolated from skin and skin-structure infection. The blaKPC gene was detected on ISKpn8-ΔblaTEM-blaKPC-2-ISKpn6-like located on an IncA/C conjugative plasmid. CFR-P3 and KOX-P3 harboured blaPER-2 in addition to the blaKPC gene. In conclusion, we document the horizontal dissemination of blaKPC-2 from diverse Enterobacteriaceae clinical isolates with different genetic backgrounds. This is the first report of E. coli harbouring blaKPC associated with Tn4401a in Argentina.
Subject(s)
Humans , Middle Aged , Argentina , Cross-Sectional Studies , Hospitals , Nutrition DisordersSubject(s)
Humans , Middle Aged , Cross-Sectional Studies , Nutrition Disorders , Hospitals , ArgentinaABSTRACT
Estudio prospectivo, randomizado. Se ingresaron 64 pacientes de ambos sexos, edad promedio 48 años. Criterios de inclusión: 5 evidencias clínicas de entre las siguientes: fiebre o hipotermia; oliguria; taquicardia; hipotensión; taquipnea; cianosis u otro signo de hipoxemia; modificaciones de la conciencia (obnubilo, confusión, signos meníngeos, exitación psicomotriz, delirio); trastornos digestivos (hemorragias, vómitos, diarreas); vasoplejía o vasoconstricción. Los criterios de exclusión fueron: taras orgánicas previas (insuficiencia adrenal o renal); diabetes; úlcera péptica; tuberculosis; micosis sistémica; sensibilidad corticoidea; enfermedades de inmunodeficiencia; edad (
Subject(s)
Humans , Female , Adult , Middle Aged , Shock, Septic/drug therapy , Methylprednisolone/administration & dosage , Case-Control Studies , Shock, Septic/mortality , Methylprednisolone/adverse effects , Methylprednisolone/therapeutic use , Outcome Assessment, Health Care/statistics & numerical data , Prospective Studies , Treatment OutcomeABSTRACT
Estudio prospectivo, randomizado. Se ingresaron 64 pacientes de ambos sexos, edad promedio 48 años. Criterios de inclusión: 5 evidencias clínicas de entre las siguientes: fiebre o hipotermia; oliguria; taquicardia; hipotensión; taquipnea; cianosis u otro signo de hipoxemia; modificaciones de la conciencia (obnubilo, confusión, signos meníngeos, exitación psicomotriz, delirio); trastornos digestivos (hemorragias, vómitos, diarreas); vasoplejía o vasoconstricción. Los criterios de exclusión fueron: taras orgánicas previas (insuficiencia adrenal o renal); diabetes; úlcera péptica; tuberculosis; micosis sistémica; sensibilidad corticoidea; enfermedades de inmunodeficiencia; edad (
Subject(s)
Comparative Study , Humans , Female , Adult , Middle Aged , Shock, Septic/drug therapy , Methylprednisolone/administration & dosage , Shock, Septic/mortality , Prospective Studies , Case-Control Studies , Methylprednisolone/adverse effects , Methylprednisolone/therapeutic use , Treatment Outcome , Outcome Assessment, Health Care/statistics & numerical dataABSTRACT
Se presentan los resultados referentes a la mortalidad en terapia intensiva en función de la determinación de niveles de gravedad MAPUCHE y fracasos orgánicos precoces en el marco del estudio multicéntrico de la SATI. En el mismo se recogieron los datos de dos mil doscientos pacientes provenientes de 22 centros de terapia intensiva de diversos puntos del país. La distribución de los enfermos mostró que la mayoría se hallaba en el nivel II. La mortalidad general fue del 30,9 por ciento y ella se incrementaba significativamente a medida que lo hacían los niveles MAPUCHE, siendo mayor en pacientes clínicos en el nivel I y II. Los subniveles demostraron idéntica correlación con la mortalidad. La presencia de fallas precoces determinó una mortalidad significativamente mayor y el número de las mismas se correlacionó significativamente con la mortalidad. Los resultados muestran la utilidad de los sistemas empleados en la determinación de los niveles de gravedad en pacientes críticos asistidos en centros diferentes. Se recalca la importancia de la realización de estudios multicéntricos para valorar la utilidad de uno o más indicadores
Subject(s)
Humans , Critical Illness/mortality , Intensive Care Units , Multiple Organ Failure , Severity of Illness Index , Argentina , Multicenter Studies as Topic , Multiple Organ Failure , PrognosisABSTRACT
Se presentan los resultados referentes a la mortalidad en terapia intensiva en función de la determinación de niveles de gravedad MAPUCHE y fracasos orgánicos precoces en el marco del estudio multicéntrico de la SATI. En el mismo se recogieron los datos de dos mil doscientos pacientes provenientes de 22 centros de terapia intensiva de diversos puntos del país. La distribución de los enfermos mostró que la mayoría se hallaba en el nivel II. La mortalidad general fue del 30,9 por ciento y ella se incrementaba significativamente a medida que lo hacían los niveles MAPUCHE, siendo mayor en pacientes clínicos en el nivel I y II. Los subniveles demostraron idéntica correlación con la mortalidad. La presencia de fallas precoces determinó una mortalidad significativamente mayor y el número de las mismas se correlacionó significativamente con la mortalidad. Los resultados muestran la utilidad de los sistemas empleados en la determinación de los niveles de gravedad en pacientes críticos asistidos en centros diferentes. Se recalca la importancia de la realización de estudios multicéntricos para valorar la utilidad de uno o más indicadores (AU)
Subject(s)
Humans , Multiple Organ Failure/diagnosis , Severity of Illness Index , Intensive Care Units/statistics & numerical data , Critical Illness/mortality , Argentina , Multicenter Studies as Topic , Multiple Organ Failure/epidemiology , Multiple Organ Failure/mortality , PrognosisABSTRACT
Os autores submeteram 500 recem-nascidos a teste simplificado (Rapi Tex IgM) que por simples reacao de aglutinacao evidencia quantidades anormalmente elevadas de IgM no sangue do cordao umbilical. Os resultados obtidos pela triagem foram avaliados atraves de dosagens de IgM no sangue do cordao umbilical exame morfologico de placentas (macro e microscopia), acompanhamento clinico e laboratorial de alguns casos e exame anatomopatologico dos casos em que ocorreu o obito. Concluem pela validade do teste na triagem de infeccoes pre-natais