Rehabilitación respiratoria oportuna y precoz en pacientes con neumonía COVID 19 en un hospital referencial / Timely and early respiratory rehabilitation in patients with covid 19 pneumonia in a referral hospital

El SARS-CoV-2 es un beta-coronavirus del mismo subgénero que los virus SARS y MERS, comparten el mismo receptor de unión del gen, la enzima convertidora de angiotensina (ACE2).(1)El espectro de severidad de la enfermedad es variado, siendo la forma leve la más frecuente (81%), y la enfermedad severa presente en el 14% de los casos, estando la presentación crítica en el 5%, con una mortalidad del 2,3%.

SARS-CoV-2 is a beta-coronavirus of the same subgenus as SARS and MERS viruses, they share the same gene binding receptor, angiotensin converting enzyme (ACE2)(1). The spectrum of disease severity is varied, with the mild form being the most frequent (81%), and severe disease present in 14% of cases, with critical presentation being present in 5%, with a mortality of 2.3%.

Single-step genomic prediction of Eucalyptus dunnii using different identity-by-descent and identity-by-state relationship matrices.

Genomic selection based on the single-step genomic best linear unbiased prediction (ssGBLUP) approach is becoming an important tool in forest tree breeding. The quality of the variance components and the predictive ability of the estimated breeding values (GEBV) depends on how well marker-based genomic relationships describe the actual genetic relationships at unobserved causal loci. We investigated the performance of GEBV obtained when fitting models with genomic covariance matrices based on two identity-by-descent (IBD) and two identity-by-state (IBS) relationship measures. Multiple-trait multiple-site ssGBLUP models were fitted to diameter and stem straightness in five open-pollinated progeny trials of Eucalyptus dunnii, genotyped using the EUChip60K. We also fitted the conventional ABLUP model with a pedigree-based covariance matrix. Estimated relationships from the IBD estimators displayed consistently lower standard deviations than those from the IBS approaches. Although ssGBLUP based in IBS estimators resulted in higher trait-site heritabilities, the gain in accuracy of the relationships using IBD estimators has resulted in higher predictive ability and lower bias of GEBV, especially for low-heritability trait-site. ssGBLUP based on IBS and IBD approaches performed considerably better than the traditional ABLUP. In summary, our results advocate the use of the ssGBLUP approach jointly with the IBD relationship matrix in open-pollinated forest tree evaluation.

Mutaciones genéticas que confieren resistencia a Isoniacida en pacientes con tuberculosis en Lima Centro, Perú 2017-2018 / Genetic mutations that confer resistance to Isoniazid in patients with Tuberculosis in Lima Centro, Perú 2017- 2018

RESUMEN Se reporta la frecuencia de mutaciones genéticas KatG e inhA que confieren resistencia a isoniacida en una muestra de 777 pacientes con resistencia a isoniacida. Se utilizó la prueba GenoType® MTBDRplus y la prueba de sensibilidad convencional por el método de agar en placa. Se encontró que 54 % presentó mutación en el gen KatG; este se asoció con resistencia a estreptomicina 76,6 % (p<0.05), rifampicina 66.7 % (p<0.05) y etionamida en un 33 % (p<0.05). La mutación en el gen inhA tuvo una frecuencia de 46 %, y se asoció con resistencia a etionamida en un 68,1 % (p<0.05), rifampicina 47,2 % (p<0,05) y estreptomicina 33 % (p<0,05). En estos pacientes, la presencia de genes que confieren resistencia a isoniazida se relacionó con resistencia a otros medicamentos antituberculosos.

ABSTRACT This a report of the frequency of KatG and inhA genetic mutations that confer resistance to isoniazid in a sample of 777 patients with resistance to isoniazid. GenoType® MTBDRplus test and conventional sensitivity tests by the agar plate method were used. It was found that 54% presented mutation in the KatG gene, associated with higher resistance to streptomycin 76.6% (p <0.05), rifampicin 66.7% (p <0.05) and ethionamide in 33% (p <0.05). inhA gene mutation has a frequency of 46% and was associated with resistance to ethionamide in 68.1% (p <0.05), rifampicin 47.2% (p <0.05) and streptomycin 33% (p <0.05). In this sample, the presences of mutations that confer resistance to isoniazid was associated with resistance to other antituberculosis drugs.

Identification and in silico structural and functional analysis of a trypsin-like protease from shrimp Macrobrachium carcinus.

Macrobrachium carcinus (Linnaeus, 1758) is a species of freshwater shrimp widely distributed from Florida southwards to southern Brazil, including southeast of Mexico. In the present work, we identified a putative trypsin-like protease cDNA fragment of 736 nucleotides from M. carcinus hepatopancreas tissue by the 3'RACE technique and compared the deduced amino acid sequence to other trypsin-related proteases to describe its structure and function relationship. The bioinformatics analyses showed that the deduced amino acid sequence likely corresponds to a trypsin-like protease closely related to brachyurins, which comprise a subset of serine proteases with collagenolytic activity found in crabs and other crustacea. The M. carcinus trypsin-like protease sequence showed a global sequence identity of 94% with an unpublished trypsin from Macrobrachium rosenbergii (GenBank accession no. AMQ98968), and only 57% with Penaeus vannamei trypsin (GenBank accession no. CAA60129). A detailed analysis of the amino acid sequence revealed specific differences with crustacean trypsins, such as the sequence motif at the beginning of the mature protein, activation mechanism of the corresponding zymogen, amino acid residues of the catalytic triad and residues responsible for substrate specificity.

Rapid spread of an ongoing outbreak of Zika virus disease in pregnant women in a Mexican hospital

Abstract In the first nine weeks of implementation of a Zika Virus Preparedness Plan in a Mexican Public Hospital, we cared for 221 pregnant women with any signal or symptom suggesting Zika virus infection and 99 (44.8%) patients were found to be positive for Zika virus.The median age of patients was 25.3 years (range 13-49). Symptoms in PCR-positive patients were rash (91.4%) followed by headache (53.1%), myalgia (46.9%), arthralgia (45.7%), pruritus (35.8%), retroocular pain (29.6%), conjunctivitis (21%), and fever (21%). The women's epidemiologic exposure history indicates local transmission and a community outbreak.

Rapid spread of an ongoing outbreak of Zika virus disease in pregnant women in a Mexican hospital.

In the first nine weeks of implementation of a Zika Virus Preparedness Plan in a Mexican Public Hospital, we cared for 221 pregnant women with any signal or symptom suggesting Zika virus infection and 99 (44.8%) patients were found to be positive for Zika virus. The median age of patients was 25.3 years (range 13-49). Symptoms in PCR-positive patients were rash (91.4%) followed by headache (53.1%), myalgia (46.9%), arthralgia (45.7%), pruritus (35.8%), retroocular pain (29.6%), conjunctivitis (21%), and fever (21%). The women's epidemiologic exposure history indicates local transmission and a community outbreak.

Randomized double-blind placebo-controlled trial of buccal misoprostol to reduce the need for additional uterotonic drugs during cesarean delivery.

OBJECTIVE: To determine whether buccal misoprostol during cesarean delivery in conjunction with active management of the third stage of labor reduces the need for additional uterotonic drugs. METHOD: A double-blind, randomized, placebo-controlled trial was performed in Monterrey, Mexico, between February 2008 and December 2013. Eligible women had risk factors for uterine atony and were to undergo cesarean delivery under epidural block. Using a computer-generated sequence and blocks of six, patients were randomly assigned to receive 400µg misoprostol or 800µg placebo buccally after cord clamping. Both groups received an intravenous oxytocin infusion. The primary outcome was the need for additional uterotonic drugs. Analyses were performed per protocol. Patients, investigators, and data analysts were masked to group assignment. RESULTS: A total of 120 women were included in analyses (60 in each group). At least one additional uterotonic drug was required in 24 (40%) women in the placebo group versus 6 (10%) women in the misoprostol group (relative risk 0.16; 95% confidence interval 0.06-0.44). No adverse effects due to misoprostol were recorded. CONCLUSION: Buccal misoprostol during cesarean delivery reduced the need for additional uterotonic drugs to treat uterine atony. ClinicalTrials.gov:NCT01733329.

Human neutrophils produce extracellular traps against Paracoccidioides brasiliensis.

Neutrophils play an important role as effector cells and contribute to the resistance of the host against microbial pathogens. Neutrophils are able to produce extracellular traps (NETs) in response to medically important fungi, including Aspergillus spp., Candida albicans and Cryptococcus gattii. However, NET production in response to Paracoccidioides brasiliensis has yet to be studied. We have demonstrated that human neutrophils produce NETs against both conidia and yeasts of P. brasiliensis. Although the NADPH oxidase inhibitor diphenyleneiodonium chloride (DPI) did not alter NET production against conidia, it partially suppressed NET formation against P. brasiliensis yeasts. Cytochalasin D or IFN-γ did not affect the production of NETs against the fungus. Additionally, a mutant strain of P. brasiliensis with reduced expression of an alternative oxidase induced significantly higher levels of NETs in comparison with the WT strain. Finally, c.f.u. quantification of P. brasiliensis showed no significant differences when neutrophils were treated with DPI, DNase I or cytochalasin D as compared with untreated cells. These data establish that NET formation by human neutrophils appears to be either dependent or independent of reactive oxygen species production, correlating with the fungal morphotype used for stimulation. However, this mechanism was ineffective in killing the fungus.

The multi-reference contrast method: facilitating set enrichment analysis.

Set enrichment analysis (SEA) is used to identify enriched biological categories/terms within high-throughput differential expression experiments. This is done by evaluating the proportion of differentially expressed genes against a background reference (BR). However, the choice of the "appropriate" BR is a perplexing problem and results will depend on it. Here, a visualization procedure that integrates results from several BRs and a stability analysis of enriched terms is presented as a tool to aid SEA. The multi-reference contrast method (MRCM) combines results from multiple BRs in a unique picture. The application of the proposed method was illustrated in one proteomic and three microarray experiments. The MRCM facilitates the exploration task involved in ontology analysis on proteomic/genomic experiments, where consensus terms were found to validate main experimental hypothesis. The use of more than one reference may provide new biological insights. The tool automatically highlights non-consensus terms assisting SEA.

SPARC promotes cathepsin B-mediated melanoma invasiveness through a collagen I/α2ß1 integrin axis.

In melanoma, the extracellular protein SPARC (secreted protein acidic and rich in cysteine) is related to tumor progression. Some of the evidence that links SPARC to melanoma progression indicates that SPARC may be involved in the acquisition of mesenchymal traits that favor metastatic dissemination. However, no molecular pathways that link extracellular SPARC to a mesenchymal phenotype have been described. In this study, global protein expression analysis of the melanoma secretome following enforced downregulation of SPARC expression led us to elucidate a new molecular mechanism by which SPARC promotes cathepsin B-mediated melanoma invasiveness using collagen I and α2ß1 integrins as mediators. Interestingly, we also found that the transforming growth factor (TGF)-ß1 contribution to cathepsin B-mediated invasion is highly SPARC dependent. In addition, induction of the E-cadherin to N-cadherin switch by SPARC enabled melanoma cells to transmigrate across an endothelial layer through a mechanism independent to that of enhancing invasion. Finally, SPARC also enhanced the extracellular expression of other proteins involved in epithelial-mesenchymal transformation, such as family with sequence similarity 3, member C/interleukin-like EMT-inducer. Our findings demonstrate a previously unreported molecular pathway for SPARC activity on invasion and support an active role of SPARC in the mesenchymal transformation that contributes to melanoma dissemination.

Design of thermostable beta-propeller phytases with activity over a broad range of pHs and their overproduction by Pichia pastoris.

Thermostable phytases, which are active over broad pH ranges, may be useful as feed additives, since they can resist the temperatures used in the feed-pelleting process. We designed new beta-propeller phytases, using a structure-guided consensus approach, from a set of amino acid sequences from Bacillus phytases and engineered Pichia pastoris strains to overproduce the enzymes. The recombinant phytases were N-glycosylated, had the correct amino-terminal sequence, showed activity over a pH range of 2.5 to 9, showed a high residual activity after 10 min of heat treatment at 80°C and pH 5.5 or 7.5, and were more thermostable at pH 7.5 than a recombinant form of phytase C from Bacillus subtilis (GenBank accession no. AAC31775). A structural analysis suggested that the higher thermostability may be due to a larger number of hydrogen bonds and to the presence of P257 in a surface loop. In addition, D336 likely plays an important role in the thermostability of the phytases at pH 7.5. The recombinant phytases showed higher thermostability at pH 5.5 than at pH 7.5. This difference was likely due to a different protein total charge at pH 5.5 from that at pH 7.5. The recombinant beta-propeller phytases described here may have potential as feed additives and in the pretreatment of vegetable flours used as ingredients in animal diets.

[Autosomal chronic granulomatous disease: case report and mutation analysis of two Brazilian siblings]. / Doença granulomatosa crônica autossômica: relato de caso e análise genético-molecular de dois irmãos brasileiros.

OBJECTIVE: To report the case of two siblings with chronic granulomatous disease. Chronic granulomatous disease is a primary immunodeficiency disorder characterized by abnormal microbicidal activity. Mutations in the p47-phox gene (NCF-1) are present in about 30% of the patients with chronic granulomatous disease; this group presents a better prognosis and later onset of recurrent infections as compared with the X-linked variant, present in about 56% of patients. DESCRIPTION: Case 1 is a female presenting repeat infections since age 10, starting with impetigo followed by severe pneumonia six months later. The severity of the lung infection associated with liver abscess and the patient's resistance to treatment prompted laboratory investigation for immunodeficiency. The results of the nitroblue tetrazolium and superoxide release tests were consistent with a diagnosis of chronic granulomatous disease. The parents and siblings were assessed, revealing the presence of granulomatous disease in a brother (Case 2). He also presented repeat infections with impetigo at age 10, followed by pneumonia six months later, however in a non severe form. Single-strand conformational polymorphism analysis detected abnormal electrophoretic mobility of exon 2 of the NCF-1 gene. Sequence DNA analysis revealed a dinucleotide GT deletion in exon 2. COMMENTS: It is important to evaluate the relatives of chronic granulomatous disease patients, even in the absence of typical clinical signs. Defining the mutation and its correlation with phenotype is important to provide appropriate genetic counseling and clinical prognosis.

Doença granulomatosa crônica autossômica: relato de caso e análise genético-molecular de dois irmãos brasileiros / Autosomal chronic granulomatous disease: case report and mutation analysis of two Brazilian siblings

OBJETIVO: Relatar dois casos de irmãos com doença granulomatosa crônica. A doença granulomatosa crônica é uma imunodeficiência primária caracterizada por atividade microbicida deficiente. Mutações no gene que codifica a proteína p47-phox (NCF-1) estão presentes em 30 por cento dos casos de doença granulomatosa crônica. Essa forma da doença é de herança autossômica recessiva e resulta em fenótipo de evolução mais benigno e início tardio em relação à forma ligada ao X, que corresponde a 56 por cento dos casos. DESCRIÇAO: Caso 1 - paciente feminina, iniciou infecções de repetição aos 10 anos, com impetigo, seguido de pneumonia grave 6 meses após. A gravidade da infecção pulmonar associada a abscesso hepático e sua refratariedade ao tratamento demandaram investigação laboratorial para imunodeficiência, com teste do nitroblue tetrazolium e dosagem de ânion superóxido compatíveis com doença granulomatosa crônica. A avaliação dos familiares confirmou o mesmo diagnóstico em seu irmão (Caso 2), que também iniciou infecções de repetição com impetigo aos 10 anos e pneumonia 6 meses após, porém tratada com sucesso ambulatorialmente. A análise de polimorfismo conformacional de cadeia simples revelou alteração da mobilidade eletroforética do éxon 2 do gene NCF-1. Identificou-se uma deleção dos nucleotídeos GT no éxon 2 por seqüenciamento do DNA. COMENTARIOS: Este estudo mostra a importância da avaliação de familiares, mesmo quando não apresentam história clínica típica de doença granulomatosa crônica. A identificação da mutação e sua correlação com o fenótipo dos pacientes é importante para estabelecer o prognóstico e o aconselhamento genético.

The effect of IFN-gamma and TNF-alpha on the eosinophilic differentiation and NADPH oxidase activation of human HL-60 clone 15 cells.

The aim of this study was to investigate the effect of interferon-gamma (IFN-gamma) and tumor necrosis factor-alpha (TNF-alpha) on NADPH oxidase activity and gp91-phox gene expression in HL-60 clone 15 cells as they differentiate along the eosinophilic lineage. The results were compared to the eosoniphilic inducers interleukin-5 (IL-5) and butyric acid. IFN-gamma (100 U/ml) and TNF-alpha (1000 U/ml) or IL-5 (200 pM) caused a significant increase in the expression of the eosinophil peroxidase (EPO) and the major basic protein (MBP) genes. Similar results were observed when the cells were cultured with 0.5 mM butyric acid for 5 days. IFN-gamma (100 U/ml) and TNF-alpha (1000 U/ml) also caused a significant increase in superoxide release by HL-60 clone 15 cells after 2 days compared with control or with butyric acid-induced cells. After 5 days, these cytokines and butyric acid induced an even stronger release of superoxide. HL-60 clone 15 cells cultured with IFN-gamma and TNF-alpha for 2 days showed a significant increase in gp91-phox gene expression. We conclude that IFN-gamma and TNF-alpha are sufficient to induce the differentiation of HL-60 clone 15 cells to the eosinophilic lineage and to upregulate gp91-phox gene expression and activity of the NADPH oxidase system.