Evaluation of the economic benefits, administration times, and patient preferences associated with the use of biotechnological drugs administered subcutaneously and intravenously in patients with cancer: a systematic review.

INTRODUCTION: Cancer imposes a high economic burden with medical care and medication costs. We evaluate the costs, the use of resources, the administration time, and the patient preferences associated with the use of biotechnological drugs in SC and IV presentations. METHODOLOGY: A systematic literature search was conducted in PubMed, Embase, and seven additional databases. The search was carried out in September 2021 and included only studies directly comparing SC and IV presentations. Evidence was synthesized narratively. RESULTS: 34 references were included, which only analyzed bortezomib, daratumumab, rituximab, and trastuzumab. Reduction in preparation costs of SC compared to IV presentations ranged from 6.6% to 50.1%, and in administration costs from 4.5% to 95.3%. SC administration of rituximab and trastuzumab resulted in less productivity loss. More than 68% of patients reported greater satisfaction with the SC route. A reduction of time in the infusion chair, lower costs of resources for preparation, and health personnel for the administration process were identified with SC administration. CONCLUSIONS: The use of SC daratumumab, rituximab, and trastuzumab in patients with cancer reduces direct and indirect costs and adverse events compared to IV use. Patients prefer the SC administration, perceiving more comfort, and less pain at the administration site.

Case report: Multisystem inflammatory syndrome in children associated with COVID-19, macrophage activation syndrome, and incomplete Kawasaki disease.

Background: Multisystem inflammatory syndrome in children (MIS-C), is a severe complication of coronavirus disease 2019 (COVID-19), characterized by persistent fever, systemic inflammatory response, and organ failure. MIS-C with a history of COVID-19 may share clinical features with other well-defined syndromes such as macrophage activation syndrome, Kawasaki disease, hemophagocytic syndrome and toxic shock syndrome. Case 1: An 11-year-old male with a history of hypothyroidism and precocious puberty with positive antibody test for COVID-19 was admitted for fever, poor general condition, severe respiratory distress, refractory shock, and multiple organ failure. His laboratory examination showed elevated inflammatory parameters, and bone marrow aspirate showed hemophagocytosis. Case 2: A 13-year-old male with a history of attention deficit hyperactivity disorder and cognitive delay presented clinical manifestations of Kawasaki disease, fever, conjunctival congestion, exanthema, and hyperemia in oral mucosa, tongue, and genitals, with refractory shock and multiple organ failure. Reverse transcriptase polymerase chain reaction (RT-PCR) and antibodies for COVID-19 were negative, inflammation parameters were elevated, and bone marrow aspirate showed hemophagocytosis. Patients required intensive care with invasive mechanical ventilation, vasopressor support, intravenous gamma globulin, systemic corticosteroids, low molecular weight heparin, antibiotics, and monoclonal antibodies and, patient 2 required renal replacement therapy. Conclusions: Multisystemic inflammatory syndrome in children can have atypical manifestations, and identifying them early is very important for the timely treatment and prognosis of patients.

Towards Multimodal Equipment to Help in the Diagnosis of COVID-19 Using Machine Learning Algorithms.

COVID-19 occurs due to infection through respiratory droplets containing the SARS-CoV-2 virus, which are released when someone sneezes, coughs, or talks. The gold-standard exam to detect the virus is Real-Time Polymerase Chain Reaction (RT-PCR); however, this is an expensive test and may require up to 3 days after infection for a reliable result, and if there is high demand, the labs could be overwhelmed, which can cause significant delays in providing results. Biomedical data (oxygen saturation level-SpO2, body temperature, heart rate, and cough) are acquired from individuals and are used to help infer infection by COVID-19, using machine learning algorithms. The goal of this study is to introduce the Integrated Portable Medical Assistant (IPMA), which is a multimodal piece of equipment that can collect biomedical data, such as oxygen saturation level, body temperature, heart rate, and cough sound, and helps infer the diagnosis of COVID-19 through machine learning algorithms. The IPMA has the capacity to store the biomedical data for continuous studies and can be used to infer other respiratory diseases. Quadratic kernel-free non-linear Support Vector Machine (QSVM) and Decision Tree (DT) were applied on three datasets with data of cough, speech, body temperature, heart rate, and SpO2, obtaining an Accuracy rate (ACC) and Area Under the Curve (AUC) of approximately up to 88.0% and 0.85, respectively, as well as an ACC up to 99% and AUC = 0.94, respectively, for COVID-19 infection inference. When applied to the data acquired with the IMPA, these algorithms achieved 100% accuracy. Regarding the easiness of using the equipment, 36 volunteers reported that the IPMA has a high usability, according to results from two metrics used for evaluation: System Usability Scale (SUS) and Post Study System Usability Questionnaire (PSSUQ), with scores of 85.5 and 1.41, respectively. In light of the worldwide needs for smart equipment to help fight the COVID-19 pandemic, this new equipment may help with the screening of COVID-19 through data collected from biomedical signals and cough sounds, as well as the use of machine learning algorithms.

Assessment of an Assistive Control Approach Applied in an Active Knee Orthosis Plus Walker for Post-Stroke Gait Rehabilitation.

The goal of this study is the assessment of an assistive control approach applied to an active knee orthosis plus a walker for gait rehabilitation. The study evaluates post-stroke patients and healthy subjects (control group) in terms of kinematics, kinetics, and muscle activity. Muscle and gait information of interest were acquired from their lower limbs and trunk, and a comparison was conducted between patients and control group. Signals from plantar pressure, gait phase, and knee angle and torque were acquired during gait, which allowed us to verify that the stance control strategy proposed here was efficient at improving the patients' gaits (comparing their results to the control group), without the necessity of imposing a fixed knee trajectory. An innovative evaluation of trunk muscles related to the maintenance of dynamic postural equilibrium during gait assisted by our active knee orthosis plus walker was also conducted through inertial sensors. An increase in gait cycle (stance phase) was also observed when comparing the results of this study to our previous work. Regarding the kinematics, the maximum knee torque was lower for patients when compared to the control group, which implies that our orthosis did not demand from the patients a knee torque greater than that for healthy subjects. Through surface electromyography (sEMG) analysis, a significant reduction in trunk muscle activation and fatigability, before and during the use of our orthosis by patients, was also observed. This suggest that our orthosis, together with the assistive control approach proposed here, is promising and could be considered to complement post-stroke patient gait rehabilitation.

Neuroanatomía funcional de la escala de coma de Glasgow / Functional neuroanatomy of the Glasgow coma scale

Introducción: La escala de coma de Glasgow (ECG) es una escala mundialmente reconocida para la clasificación de pacientes con trauma craneoencefálico de acuerdo a su compromiso neurológico. Esta escala evalúa la apertura ocular, la respuesta verbal y la respuesta motora. La neuroanatomía funcional representa un compromiso secuencial para el descenso en el puntaje de cada uno de estos ítems. El objetivo de esta revisión es describir la anatomía del sistema reticular activador ascendente (SRAA), la anatomía funcional del lenguaje, la anatomía del tallo cerebral y de las vías motoras que representan cada ítem evaluado por la ECG. Materiales y métodos: Se hizo una revisión narrativa bibliográfica de las principales vías para cada ítem de la ECG. Resultados: Las principales vías en relación con la apertura ocular se concentran en las vías del SRAA, las vías de la respuesta verbal incluyen las vías del lenguaje y las vías que provienen del putamen y del cerebelo que regulan la emisión del lenguaje, mientras que las vías que regulan la respuesta motora principalmente se relacionan con la vía piramidal, el sistema rubro-espinal y vestíbulo-espinal. Conclusiones: El descenso del puntaje en los tres ítems que evalúa la ECG se relacionan con vías específicas que predominan en los ganglios basales y en el tallo cerebral.

Introduction: The Glasgow Coma Scale (GCS) is a globally recognized scale for the classification of patients with traumatic brain injury according to their neurological impairment. This scale evaluates the ocular opening, the verbal response and the motor response. Functional neuroanatomy represents a sequential decrease in the score of each of these items. The objective of this review is to describe the anatomy of the ascending reticular activating system (ARAS), the functional anatomy of the language, and the anatomy of the brainstem and the motor pathways that represent each item evaluated by the GCS. Materials and methods: A narrative literature review of the main routes for each item of the scale was performed. Results: The main pathways in relation to the ocular opening are concentrated in the ARAS, the verbal response pathways include the language pathways and the connections that come from the putamen and the cerebellum that regulate the production of the language, while the pathways that regulate the motor response mainly relate to the pyramidal tract, the rubro-spinal and vestibulo-spinal systems. Conclusions: The decline of the score in the three items that evaluates the GCS is related to specific pathways that predominate in the basal ganglia and in the brainstem.

O paradoxo da institucionalização infantil: proteção ou risco? / The paradox of child institutionalization: protection or risk? / La paradoja de la institucionalización de niños: ¿protección o riesgo?

Desde meados do século XX, ganhou destaque o debate acerca dos efeitos da institucionalização de crianças. O abrigo adquire relação paradoxal entre proteção e risco, podendo ser facilitador ou dificultador para o desenvolvimento de crianças acolhidas. Assim, os objetivos do trabalho foram (1) analisar a produção científica sobre a institucionalização infantil, discutindo os benefícios e efeitos da institucionalização sobre o desenvolvimento de crianças e adolescentes; e (2) compreender como os artigos analisados identificam possíveis fatores de risco e de proteção. Como método, realizou-se uma revisão bibliográfica utilizando os descritores "abrigo"; "institucionalização infantil"; "fatores de risco e fatores de proteção"; "abrigamento prolongado"; "vínculo"; "apego"; "abrigo". Como resultado, 11 trabalhos foram selecionados. As produções analisadas apontaram que, embora o abrigo seja um local para acolhimento, assistência e proteção, deve-se estar atento aos fatores de risco e aos impactos negativos da institucionalização. Conclui-se que a institucionalização se faz necessária em alguns casos, devendo ocorrer com qualidade e responsabilidade junto às famílias e com o respaldo de políticas públicas.

Since the mid-twentieth century, the debate about the effects of children institutionalization has been on the spot. The institutional shelter has been getting into a paradoxical relationship between protection and risk and may be understood as either a facilitator or an impediment to children’s development. Thus, the objectives of this study are to (1) review scientific literature on child institutionalization, debating the benefits and effects of institutionalization on children’s and adolescents’ development; (2) understand how the articles analyzed identify possible risk and protection factors. Concerning methodology, we carried out a literature review using the descriptors "shelter"; "child institutionalization"; "risk factors and protective factors"; "prolonged shelter"; "bond"; "attachment"; "shelter". As a result, eleven articles were selected. Result analysis pointed out that although the shelter is a place for refuge, care and protection, one should be aware of the risk factors and the negative impact of institutionalization. It concludes that institutionalization is necessary in some cases, and it should occur with quality and responsibility together with the families and with the support of public policies.

Desde mediados del siglo XX, se hizo destacado el debate sobre los efectos de la institucionalización de los niños. El refugio adquiere una relación paradójica entre la protección y el riesgo, y puede ser un facilitador o un obstáculo para el desarrollo de los niños. Los objetivos del estudio fueron (1) revisar la literatura científica sobre la institucionalización de niños, la discusión de los beneficios y los efectos de la institucionalización en el desarrollo de los niños y adolescentes y (2) entender cómo los artículos analizados identifican posibles factores de riesgo y protección. Como método, se realizó una revisión de la literatura utilizando los descriptores "refugio"; "institucionalización de niños"; "factores de riesgo y factores de protección"; "refugio prolongado"; "vínculo"; "el apego", "la vivienda". Como resultado, fueron seleccionados once artículos. Las producciones analizadas señalaron que si bien el abrigo es un lugar de refugio, cuidado y protección, debe ser consciente de los factores de riesgo y el impacto negativo de la institucionalización. Se concluye que la institucionalización es necesaria en algunos casos, debe ocurrir con la calidad y la responsabilidad de las familias y con el apoyo de políticas públicas.

Control of a robotic knee exoskeleton for assistance and rehabilitation based on motion intention from sEMG

Introduction: This work presents the development of a novel robotic knee exoskeleton controlled by motion intention based on sEMG, which uses admittance control to assist people with reduced mobility and improve their locomotion. Clinical research remark that these devices working in constant interaction with the neuromuscular and skeletal human system improves functional compensation and rehabilitation. Hence, the users become an active part of the training/rehabilitation, facilitating their involvement and improving their neural plasticity. For recognition of the lower-limb motion intention and discrimination of knee movements, sEMG from both lower-limb and trunk are used, which implies a new approach to control robotic assistive devices. Methods A control system that includes a stage for human-motion intention recognition (HMIR), based on techniques to classify motion classes related to knee joint were developed. For translation of the user's intention to a desired state for the robotic knee exoskeleton, the system also includes a finite state machine and admittance, velocity and trajectory controllers with a function that allows stopping the movement according to the users intention. Results The proposed HMIR showed an accuracy between 76% to 83% for lower-limb muscles, and 71% to 77% for trunk muscles to classify motor classes of lower-limb movements. Experimental results of the controller showed that the admittance controller proposed here offers knee support in 50% of the gait cycle and assists correctly the motion classes. Conclusion The robotic knee exoskeleton introduced here is an alternative method to empower knee movements using sEMG signals from lower-limb and trunk muscles.

Potentialities of active membranes with immobilized laccase for Bisphenol A degradation.

Herein, we report the development of immobilized laccase based membrane bioreactor as a novel bio-catalytic system for the degradation of emerging endocrine disruptor i.e., Bisphenol A. Two laccase forms i.e. (1) in-house isolated and purified from an indigenous white-rot fungi Pycnoporus sanguineus (CS43) and (2) Trametes versicolor (commercial laccase from Sigma-Aldrich®) were immobilized on a multi-channel ceramic membrane (1.4µm in diameter) using 4% glutaraldehyde as a cross-linking agent. The immobilization yield and bisphenol A degradation activities of immobilized laccases were recorded at various pH levels. The surface topographies of immobilized-laccase membranes were accessed by scanning electron microscopy. In this study, 100% degradation of bisphenol A (20mg/L) was achieved in less than 24h in the presence of laccase from P. sanguineus (CS43) (620.55±14.85U/L) and T. versicolor (620.55±14.85U/L). The enzymes showed an optimal activity at pH 5 and 5.4 with a degradation rate of 204.8±1.8 and 79.0±0.1µmol/min/U for P. sanguineus (CS43) and T. versicolor, respectively. In conclusion, the highest immobilization of unit per square centimeter and efficient degradation potentiality strongly recommend the newly developed immobilized laccase based membrane bioreactor as a novel tool to tackle emerging contaminants degradation issues.

Adaptive Spatial Filter Based on Similarity Indices to Preserve the Neural Information on EEG Signals during On-Line Processing.

This work presents a new on-line adaptive filter, which is based on a similarity analysis between standard electrode locations, in order to reduce artifacts and common interferences throughout electroencephalography (EEG) signals, but preserving the useful information. Standard deviation and Concordance Correlation Coefficient (CCC) between target electrodes and its correspondent neighbor electrodes are analyzed on sliding windows to select those neighbors that are highly correlated. Afterwards, a model based on CCC is applied to provide higher values of weight to those correlated electrodes with lower similarity to the target electrode. The approach was applied to brain computer-interfaces (BCIs) based on Canonical Correlation Analysis (CCA) to recognize 40 targets of steady-state visual evoked potential (SSVEP), providing an accuracy (ACC) of 86.44 ± 2.81%. In addition, also using this approach, features of low frequency were selected in the pre-processing stage of another BCI to recognize gait planning. In this case, the recognition was significantly ( p < 0.01 ) improved for most of the subjects ( A C C ≥ 74.79 % ) , when compared with other BCIs based on Common Spatial Pattern, Filter Bank-Common Spatial Pattern, and Riemannian Geometry.

Knee Impedance Modulation to Control an Active Orthosis Using Insole Sensors.

Robotic devices for rehabilitation and gait assistance have greatly advanced with the objective of improving both the mobility and quality of life of people with motion impairments. To encourage active participation of the user, the use of admittance control strategy is one of the most appropriate approaches, which requires methods for online adjustment of impedance components. Such approach is cited by the literature as a challenge to guaranteeing a suitable dynamic performance. This work proposes a method for online knee impedance modulation, which generates variable gains through the gait cycle according to the users' anthropometric data and gait sub-phases recognized with footswitch signals. This approach was evaluated in an active knee orthosis with three variable gain patterns to obtain a suitable condition to implement a stance controller: two different gain patterns to support the knee in stance phase, and a third pattern for gait without knee support. The knee angle and torque were measured during the experimental protocol to compare both temporospatial parameters and kinematics data with other studies of gait with knee exoskeletons. The users rated scores related to their satisfaction with both the device and controller through QUEST questionnaires. Experimental results showed that the admittance controller proposed here offered knee support in 50% of the gait cycle, and the walking speed was not significantly different between the three gain patterns (p = 0.067). A positive effect of the controller on users regarding safety during gait was found with a score of 4 in a scale of 5. Therefore, the approach demonstrates good performance to adjust impedance components providing knee support in stance phase.

Matriciamento em saúde do trabalhador: experiência do Centro de Referência em Saúde do Trabalhador de Santo Amaro / Health matriculation of workers: experience of the Center of Reference in Health of Santo Amaro Worker

A Saúde do Trabalhador (ST) compreende um conjunto de ações de saúde que abrangem promoção, prevenção, diagnóstico, assistência, reabilitação, vigilância à saúde, ao meio ambiente e às condições de trabalho. A Constituição Federal em 1988 incorporou as ações de Saúde do Trabalhador ao Sistema Único de Saúde (SUS) e a Rede Nacional de Atenção Integral à Saúde do Trabalhador (RENAST), criada em 2002, inclui as ações de Saúde do Trabalhador no SUS, organizadas a partir dos Centros de Referência em Saúde do Trabalhador (CRST). A Política Nacional de Saúde do Trabalhador e da Trabalhadora (PNST) tem como estratégia a estruturação da RENAST no contexto da Rede de Atenção à Saúde (RAS) com ações de Saúde do Trabalhador junto à atenção primária em saúde, que deve ser a ordenadora da rede e coordenadora do cuidado. Cabe aos Centros de Referência em Saúde do Trabalhador, desempenhar as funções de suporte técnico, educação permanente, coordenação de projetos de promoção, vigilância e assistência à saúde dos trabalhadores, no âmbito da sua área de abrangência; dar apoio matricial (AM) para o desenvolvimento das ações de saúde do trabalhador na atenção primária em saúde, nos serviços especializados e de urgência e emergência, bem como na promoção e vigilância nos diversos pontos de atenção da Rede de Atenção à Saúde (BRASIL, 2012). O objetivo deste trabalho foi relatar a construção da linha de cuidado em Saúde do Trabalhador no território. Como resultado observou-se o aumento e melhoria da qualidade dos encaminhamentos das unidades para o CRST-SA. Fortalecimento do vínculo do CRST-SA com as unidades por meio de contato pessoal, e-mail e telefone. Os profissionais das unidades que participam do matriciamento multiplicam o conhecimento adquirido junto à sua equipe e no atendimento ao usuário.

Genetic polymorphism of 15 STR loci in El Salvador.

The aim of this study was to estimate the allelic frequencies of the 15 short tandem repeat (STR) loci included in AmpFlSTRIdentifiler PCR Amplification Kit. Biological samples were obtained from 109 unrelated individuals from El Salvador. Allelic frequencies and forensic parameters were calculated. All loci showed no departure from Hardy-Weinberg equilibrium after Bonferroni correction. The obtained frequencies were compared with other previously reported population data. The multidimensional scaling plot and the neighbor-joining phylogeny supported a high native Mesoamerican contribution.

Potencialidades e fragilidades da incorporação da Saúde do Trabalhador na Atenção Primária à Saúde / Strengths and weaknesses of incorporating Workers' Health into Primary Health Care

Estudo de revisão integrativa realizado com o objetivo de analisar as potencialidades e fragilidades da incorporação da Saúde do Trabalhador na Atenção Primária à Saúde. Os objetivos específicos foram descrever os aspectos que interferem e potencializam o entendimento da complexidade dessa inclusão e relatar uma experiência profissional no Centro de Referencia em Saúde do Trabalhador de Santo Amaro. Foram selecionados 24 artigos nas bases de dados LILACS, SciELO e CAPES publicados em língua portuguesa sobre o tema do estudo. As principais potencialidades e fragilidades identificadas se referem às questões do apoio institucional, gestão, qualificação das portas de entradas do Sistema Único de Saúde. Os resultados possibilitaram concluir que o sistema de saúde necessita qualificar o processo do cuidado em saúde e o desenvolvimento de ações/intervenções que levem em conta o trabalho como determinante da saúde.

Potencialidades e fragilidades da incorporação da Saúde do Trabalhador na Atenção Primária à Saúde / Strengths and weaknesses of the merger of Occupational Health in Primary Health Care

Estudo de revisão integrativa realizado com o objetivo de analisar as potencialidades e fragilidades da incorporação da Saúde do Trabalhador na Atenção Primária à Saúde. Os objetivos específicos foram descrever os aspectos que interferem e potencializam o entendimento da complexidade dessa inclusão e relatar uma experiência profissional no Centro de Referencia em Saúde do Trabalhador de Santo Amaro. Foram selecionados 24 artigos nas bases de dados LILACS, SciELO e CAPES publicados em língua portuguesa sobre o tema do estudo. As principais potencialidades e fragilidades identificadas se referem às questões do apoio institucional, gestão, qualificação das portas de entradas do Sistema Único de Saúde. Os resultados possibilitaram concluir que o sistema de saúde necessita qualificar o processo do cuidado em saúde e o desenvolvimento de ações/intervenções que levem em conta o trabalho como determinante da saúde.(AU)

[Antimicrobial susceptibility and polyclonal dissemination of Staphylococcus aureus strains]. / Susceptibilidad antimicrobiana y diseminación policlonal de cepas de Staphylococcus aureus.

OBJECTIVES: To determine the prevalence ofmethicillin-resistant Staphylococcus aureus (MRSA), its antimicrobial susceptibility patterns and classify strains by pulsed-field gel electrophoresis (PFGE). MATERIAL AND METHODS: 106 S. aureus strains isolated from patients hospitalized at the Maracaibo city university hospital, Venezuela, were processed during the first quarter of 2009. The culture, isolation and identification of S. aureus were done by conventional methods. Antimicrobial susceptibility was determined by the disk diffusion method. The presence of mecA gene in MRSA strains was verified using the polymerase chain reaction (PCR). RESULTS: Fifty-four strains (50.94%) were MRSA and twenty three antibiotypes were detected. The most frequently observed was the one including beta-lactams, macrolides, lincosamides, aminoglycosides and quinolones. There were forty multi-resistant isolates (74.0%) between MRSA strains. All methicillin-resistant isolates were mecA positive. PFGE classified MRSA stains in 50 pulsotypes, each one containing between six and thirteen bands. Four small groups, of two strains each, had 80% of similarity. Five of the eight strains in these small clusters (62.50%) had the same pattern of resistance. CONCLUSION: There is a high prevalence of multi-resistant MRSA strains with polyclonal dissemination in the hospital.

Susceptibilidad antimicrobiana y diseminación policlonal de cepas de Staphylococcus aureus / Antimicrobial susceptibility and polyclonal dissemination of Staphylococcus aureus strains

Objectives: To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), its antimicrobial susceptibility patterns and classify strains by pulsed-field gel electrophoresis (PFGE).Material and Methods: 106 S. aureus strains isolated from patients hospitalized at the Maracaibo city university hospital, Venezuela, were processed during the first quarter of 2009. The culture, isolation and identification of S. aureus were done by conventional methods. Antimicrobial susceptibility was determined by the disk diffusion method. The presence of mecA gene in MRSA strains was verified using the polymerase chain reaction (PCR). Results: Fifty-four strains (50.94%) were MRSA and twenty three antibiotypes were detected. The most frequently observed was the one including β-lactams, macrolides, lincosamides, aminoglycosides and quinolones. There were forty multi-resistant isolates (74.0%) between MRSA strains. All methicillin-resistant isolates were mecA positive. PFGE classified MRSA stains in 50 pulsotypes, each one containing between six and thirteen bands. Four small groups, of two strains each, had 80% of similarity. Five of the eight strains in these small clusters (62.50%) had the same pattern of resistance. Conclusion: There is a high prevalence of multi-resistant MRSA strains with polyclonal dissemination in the hospital.

Objetivo: Determinar la prevalencia de Staphylococcus aureus resistente a meticilina (SARM), su patrón de susceptibilidad antimicrobiana y tipificar las cepas mediante electroforesis en gel de campo pulsado (EGCP). Materiales y Métodos: 106 cepas de S. aureus aisladas de pacientes recluidos en un hospital universitario de la ciudad de Maracaibo, Venezuela, fueron procesadas durante el primer trimestre del 2009. El cultivo, aislamiento e identificación de las cepas se hizo por los métodos convencionales. La susceptibilidad antimicrobiana fue determinada por el método de difusión con disco. Se verificó la presencia del gen mecA en las cepas de SARM mediante la reacción de polimerasa en cadena (RPC). Resultados: Cincuenta y cuatro cepas (50,9%) eran SARM y se detectaron veintitrés antibiotipos, siendo el que incluye β-lactámicos, macrólidos, lincosamidas, aminoglucósidos y quinolonas, el más frecuentemente observado (55,5%). Hubo cuarenta aislados (74,0%) multi-resistentes entre las cepas de SARM. Todas las cepas resistentes a meticilina fueron positivas para mecA. Por EGCP, las cepas de SARM fueron clasificadas en 50 pulsotipos, según el perfil de cortes obtenidos, conteniendo cada uno, entre seis y trece bandas. Cuatro grupos, de dos cepas cada uno, fueron detectados con 80% de similitud. Cinco de las ocho cepas en estos grupos (62,5%) tenían el mismo patrón de resistencia. Conclusión: En el hospital, existe una alta prevalencia de cepas SARM multi-resistentes con difusión policlonal.

Continent-wide decoupling of Y-chromosomal genetic variation from language and geography in native South Americans.

Numerous studies of human populations in Europe and Asia have revealed a concordance between their extant genetic structure and the prevailing regional pattern of geography and language. For native South Americans, however, such evidence has been lacking so far. Therefore, we examined the relationship between Y-chromosomal genotype on the one hand, and male geographic origin and linguistic affiliation on the other, in the largest study of South American natives to date in terms of sampled individuals and populations. A total of 1,011 individuals, representing 50 tribal populations from 81 settlements, were genotyped for up to 17 short tandem repeat (STR) markers and 16 single nucleotide polymorphisms (Y-SNPs), the latter resolving phylogenetic lineages Q and C. Virtually no structure became apparent for the extant Y-chromosomal genetic variation of South American males that could sensibly be related to their inter-tribal geographic and linguistic relationships. This continent-wide decoupling is consistent with a rapid peopling of the continent followed by long periods of isolation in small groups. Furthermore, for the first time, we identified a distinct geographical cluster of Y-SNP lineages C-M217 (C3*) in South America. Such haplotypes are virtually absent from North and Central America, but occur at high frequency in Asia. Together with the locally confined Y-STR autocorrelation observed in our study as a whole, the available data therefore suggest a late introduction of C3* into South America no more than 6,000 years ago, perhaps via coastal or trans-Pacific routes. Extensive simulations revealed that the observed lack of haplogroup C3* among extant North and Central American natives is only compatible with low levels of migration between the ancestor populations of C3* carriers and non-carriers. In summary, our data highlight the fact that a pronounced correlation between genetic and geographic/cultural structure can only be expected under very specific conditions, most of which are likely not to have been met by the ancestors of native South Americans.