Estimated burden of fungal infections in Panama.

Data published on Panamanian fungal disease are scarce, mostly case reports. To date, there is no paper that compiles the burden of fungal disease Here we estimate for the first time the incidence and prevalence of fungal diseases in Panama. Data on fungal disease were obtained from different search engines: PubMed, Google Scholar, Scielo and Lilacs. For population and at risk diseases, we used statistics from worldometer, UNAIDS, and WHO. Incidence, prevalence, and absolute numbers were calculated based on the population at risk. Panamanian population in 2022 was 4,429,739. We estimated that 85,530 (1.93 %) people suffer from fungal diseases. The most frequent fungal infection was recurrent Candida vaginitis (3285/100,000). There are 31,000 HIV-infected people in Panama and based on the number of cases not receiving anti-retroviral therapy (14,570), and previous reports of prevalence of opportunistic infections, we estimated annual incidences of 4.0/100,000 for cryptococcal meningitis, 29.5/100,000 for oral candidiasis, 23.1/100,000 for esophageal candidiasis, 29.5/100,000 for Pneumocystis pneumonia, 15.1/100,000, and for histoplasmosis. For chronic pulmonary aspergillosis (CPA) and fungal asthma we used data from Guatemala and Colombia to estimate COPD and asthma prevalence and WHO report for tuberculosis. We estimated annual incidences of 6.1/100,000 for invasive aspergillosis and prevalence of 31.5/100,000 for CPA, 60.2/100,000 for allergic bronchopulmonary aspergillosis, and 79.5/100,000 for severe asthma with fungal sensitisation. Other incidence estimates were 5.0/100,000 for candidaemia, 0.20/100,000 for mucormycosis, and 4.97/100,000 for fungal keratitis. Even though this report on burden of fungal disease is a forward step, more epidemiological studies to validate these estimates are needed.

Repercusión de la COVID-19 sobre los procesos sustantivos de la Universidad Municipal / Impact of COVID-19 on the Substantive Processes of the Municipal University

Introducción: Las funciones sustantivas universitarias constituyen claves en el análisis de los procesos de calidad de la universidad. Objetivo: Caracterizar la repercusión de la presencia de la COVID-19 en los procesos sustantivos desarrollados en el Departamento Docente de la Universidad de Ciencias Médicas del municipio Los Palacios durante el curso 2020-2021. Métodos: Investigación aplicada, que tuvo una fase descriptiva-evaluativa y una de evaluación de resultados. Se estudiaron los procesos sustantivos de la universidad (docente, investigativo y extensión); además, participaron 86 estudiantes de Medicina y 42 profesores aportando información. Se realizó revisión documental, entrevistas abiertas e intercambios virtuales y semipresenciales, se utilizó matriz DAFO estableciéndose prioridades por método de ranqueo. Resultados: Se identificaron dos prioridades por el área de docencia e investigación y una prioridad por el área de extensión, se acometieron acciones; entre los resultados positivos se destacaron: la culminación de estudios del 100 por ciento de los estudiantes previstos, uso intensivo de los recursos tecnológicos y de la educación a distancia, mayor adquisición de habilidades investigativas y fortalecimiento del proceso de extensión universitaria. Se identifica la necesidad de fortalecer la infraestructura tecnológica. Conclusiones: La repercusión de la COVID-19 sobre los procesos sustantivos se ha caracterizado por los cambios de la enseñanza presencial a la virtual, un uso intensivo de los recursos tecnológicos y una consolidación del proceso de extensión universitaria que ha fortalecido las relaciones universidad-sociedad(AU)

Introduction: University fundamental functions constitute keys in the analysis of university quality processes. Objective: To characterize the impact of the presence of COVID-19 on the substantive processes developed in the Teaching Department of the University of Medical Sciences of Los Palacios municipality during the academic year 2020-2021. Methods: Applied research, which had a descriptive-evaluative phase and a results evaluation phase. The substantive processes of the university (teaching, research and extension) were studied; in addition, 86 medical students and 42 professors participated and provided information. A documentary review, open interviews and virtual and semi-presential exchanges were carried out. In addition, the SWOT matrix was used to establish priorities by ranking method. Results: Two priorities were identified for the teaching and research area and one priority for the extension area and actions were undertaken. Among the positive results, the following stand out: completion of studies by 100percent of the expected students, intensive use of technological resources and distance education, greater acquisition of research skills and strengthening of the university extension process. The need to strengthen the technological infrastructure was identified. Conclusions: The impact of COVID-19 on substantive processes has been characterized by changes from face-to-face to virtual teaching, an intensive use of technological resources, and a consolidation of the university extension process that has strengthened university-society relations(AU)

Diagnostic Mycology Laboratories Should Have a Central Role for the Management of Fungal Disease.

The absence of awareness of fungal diseases as part of the differential diagnosis in at-risk populations has severe consequences. Here, we show how the active role of laboratories can improve patients' survival. Recently, major advances have been made in non-culture-based assays for fungal diseases, improving accuracy and turnaround time. Furthermore, with the introduction of proficiency control systems, laboratories are an easily monitored environment with good analytical accuracy. Diagnostic packages for opportunistic infections can overcome many deficiencies caused by the absence of awareness. In Guatemala, to make diagnosis accessible, we set up a diagnostic laboratory hub (DLH) providing screening for cryptococcosis, histoplasmosis and tuberculosis to a network of 13 healthcare facilities attending people living with HIV (PLWHIV). In two years, we screened 2127 newly HIV-diagnosed patients. The frequency of opportunistic infections was 21%, rising to 30.3% in patients with advanced HIV disease (<200 CD4); 8.1% of these patients had more than one infection. With the implementation of this diagnostic package, mortality decreased by 7%, a key goal of many public health interventions. Screening for serious infection in high-risk populations can partially overcome training or experiential deficiencies among clinicians for life-threatening fungal diseases.

Epidemiology and Mortality of Cryptococcal Disease in Guatemala: Two-Year Results of a Cryptococcal Antigen Screening Program.

Cryptococcal disease is an important opportunistic infection among people living with HIV. The cryptococcal antigen (CrAg) can be detected before the clinical onset of meningitis and its screening is recommended. Here, we evaluated CrAg frequency, and describe the epidemiological characteristics and mortality at 180 days in a cohort of HIV patients from Guatemala. A total of 3457 patients were screened with a CrAg lateral flow assay in serum between January 2017 and December 2018. CrAg positivity was 11.5% in patients with ≤100 CD4/mm3, 8.7% in patients with <200 CD4/mm3, and 6.3% in patients with <350 CD4/mm3. In Latin America, we estimated 9.2% CrAg positivity (IC95% 7.9−10.7%) in patients with ≤100 CD4/mm3. Among patients newly diagnosed with HIV, we estimated 4416 incident cases per year in Latin America in those with <200 CD4/mm3 and 5289 in those with <350 CD4/mm3. In addition, we calculated the burden in people not on ARV or without viral suppression and found 28,672 cases. CrAg screening should be considered in patients who have a CD4 cell count < 350 cells/mm3. Cryptococcal meningitis was associated with 30.8% mortality in Guatemala. Global access to diagnosis as well as to liposomal amphotericin B and flucytosine is a priority.

Factores asociados a la salud y el bienestar en adultos mayores centenarios / Factors associated with health and well-being in centenarian older adults

Introducción: Con el aumento del nivel de vida y la mejora de los sistemas de salud no es raro alcanzar edades extremas de la vida. A inicios del año 2019, en la provincia Pinar del Río, se declararon 109 centenarios; de ellos, 9 correspondían al municipio Los Palacios, donde se mostró un incremento de 3 individuos en comparación con el año precedente. Objetivo: Caracterizar clínica y funcionalmente a los adultos mayores centenarios del territorio. Métodos: Se realizó un estudio observacional descriptivo de corte transversal en el municipio Los Palacios en el período enero-marzo de 2019. Población objeto de estudio: 9 centenarios, a quienes se les aplicó una encuesta estructurada, el índice de Katz y el test de calidad de vida MGH. Se respetaron los criterios de inclusión y los principios de la ética médica. Resultados: Predominó la edad entre 100 y 104 años, el sexo masculino, el color de la piel blanca, la viudez, la convivencia con los hijos, el consumo de café y el déficit sensorial. Todos realizaron actividad física y sus hábitos alimenticios fueron saludables a lo largo de la vida. La mayoría no tuvo criterio de polifarmacia. En la evaluación funcional se analizó la calidad de vida y las alteraciones en las actividades básicas de la vida diaria. Conclusiones: El envejecimiento exitoso en las personas centenarias se caracterizó por tener buena salud percibida y cognitiva, mantener una actitud optimista ante la vida, buena red de apoyo social familiar, antecedentes de familiares longevos y estilos de vida saludables(AU)

Introduction: With the increase in living standards and the improvement of health systems, it is not unusual to reach extreme ages of life. At the beginning of 2019, in Pinar del Río Province, 109 centenarians were reported; of them, 9 belonged to Los Palacios Municipality, where there was an increase of 3 individuals compared to the previous year. Objective: To characterize clinically and functionally the centenarian adults from the territory. Methods: A cross-sectional, descriptive and observational study was carried out in Los Palacios Municipality, in the period from January to March 2019. The study population consisted of 9 centenarians, to whom a structured survey was applied: Katz index and MGH quality of life test. The inclusion criteria and the principles of medical ethics were respected. Results: There was a predominance of ages 100-104 years, the male sex, white skin color, widowhood, the condition of sharing house with children, coffee consumption and sensory deficit. All the patients did physical activity and their eating habits were healthy throughout life. Most of them did not have polypharmacy criteria. Regarding their functional assessment, quality of life and alterations in basic activities of daily life were analyzed. Conclusions: Successful aging in centenarians showed that they have good health, both cognitive and perceived, maintain an optimistic attitude towards life, have a good family social support network, a history of long-lived family members, and healthy lifestyles(AU)

Incidence of Histoplasmosis in a Cohort of People with HIV: From Estimations to Reality.

Among people with HIV, histoplasmosis represents an important cause of mortality. Previous studies provided estimates of the disease incidence. Here, we compared those estimates with the results obtained from a screening program implemented in Guatemala, which included histoplasmosis detection for people with HIV. To compare the results of this program with previous estimations, a literature search was performed and reports concerning histoplasmosis incidence were analyzed. The screening program enrolled 6366 patients. The overall histoplasmosis incidence in the screening program was 7.4%, which was almost double that estimated in previous studies. From 2017 to 2019, the screening program showed an upward trend in histoplasmosis cases from 6.5% to 8.8%. Histoplasmosis overall mortality among those who were newly HIV diagnosed showed a decrease at 180 days from 32.8% in 2017 to 21.2% in 2019. The screening approach using rapid diagnostic assays detects histoplasmosis cases more quickly, allowing a specific treatment to be administered, which decreases the mortality of the disease. Therefore, the use of these new techniques, especially in endemic areas of histoplasmosis, must be implemented.

Impact of the COVID-19 pandemic on HIV care in Guatemala.

OBJECTIVES: To describe the impact of the coronavirus disease 2019 (COVID-19) pandemic on the diagnosis of human immunodeficiency virus (HIV) and deaths from opportunistic infections in Guatemala. METHODS: A retrospective study was conducted to investigate the impact of the COVID-19 pandemic on people with HIV at a referral clinic (Clinica Familiar Luis Angel García, CFLAG), as well as the disruption of services at a diagnostic laboratory hub (DLH) which provides diagnosis for opportunistic infections to a network of 13 HIV healthcare facilities. Comparative analysis was undertaken using the months March-August from two different time periods: (i) pre-COVID-19 (2017-2019); and (ii) during the COVID-19 period (2020). RESULTS: During the COVID-19 period, 7360 HIV tests were performed at Clinica Familiar Luis Angel García, compared with an average of 16,218 tests in the pre-COVID-19 period; a reduction of 54.7% [95% confidence interval (CI) 53.8-55.4%],Deaths from opportunistic infections at 90 days were 10.7% higher in 2020 compared with 2019 (27.3% vs 16.6%; P = 0.05). Clinical samples sent to the DLH for diagnosis of opportunistic infections decreased by 43.7% in 2020 (95% CI 41.0-46.2%). CONCLUSION: The COVID-19 pandemic is having a substantial impact on HIV care in Guatemala. Diagnostic services for HIV have been severely affected and deaths from opportunistic infections have increased. The lessons learnt must guide the introduction of strategies to reduce the impact of the pandemic.

A Rapid Screening Program for Histoplasmosis, Tuberculosis, and Cryptococcosis Reduces Mortality in HIV Patients from Guatemala.

Opportunistic infections (OIs) and advanced HIV disease (AHD) contribute to HIV-related mortality. Here, we analyzed the situation of AHD and OIs in a cohort of newly diagnosed HIV patients from Guatemala. We included 2127 adult patients from 13 facilities across the country during 2017 to 2018. Patients were screened for tuberculosis (TB), nontuberculous mycobacteria (NTM), histoplasmosis, and cryptococcal disease, independently of their CD4 cell count. Of the 2127 enrolled patients, 1682 (79.1%) had a CD4 cell count available; of which 52% presented with AHD. Of the Mayan population, 65% had AHD. The overall OI incidence was 21%. Histoplasmosis was the most frequent OI (7.9%), followed by TB (7.1%); 94.4% of these infections occurred in patients with a CD4 < 350 cells/mm3. Mortality at 180 days was significantly higher in those with OIs than without OIs (29.7% vs. 5.9%, p < 0.0001). In one year, this program decreased the OI mortality by 7% and increased the OI treatment by 5.1%. Early OI diagnosis and appropriate therapy reduced OI mortality among newly diagnosed HIV patients in Guatemala. Screening for OIs should be considered in all newly diagnosed HIV patients who have a CD4 cell count < 350 cells/mm3 or those without a CD4 cell count available. To improve results, interventions such as early HIV detection and access to flucytosine and liposomal amphotericin B are required.

Updated estimated incidence and prevalence of serious fungal infections in Trinidad and Tobago.

Objective: : To estimate the incidence and prevalence of serious fungal infections in Trinidad and Tobago (T&T), with a population of 1 394 973 million. Methods: : The medical literature was searched to obtain published data on the incidence and prevalence of fungal infections in the Caribbean. If data were unavailable, estimations were performed using the frequencies of fungal infection in populations at risk. Asthma and pulmonary tuberculosis rates were used to derive the prevalence of allergic bronchopulmonary aspergillosis (ABPA), severe asthma with fungal sensitization (SAFS), and chronic pulmonary aspergillosis (CPA). Results: : The estimated annual burden of fungal infections was 46 156 persons (3.3% of the population), including 21 455 women with recurrent vulvovaginal candidiasis, 118 persons with invasive aspergillosis, 3637 adults with ABPA, 4800 with SAFS, and 178 with CPA. Annually, we estimated 70 cases of candidemia and 14 647 cases of tinea capitis in children. Of the 11 000 persons living with HIV/AIDS, it was estimated that there were 40 cases of cryptococcal meningitis, 88 cases of disseminated histoplasmosis, and 124 cases of Pneumocystis pneumonia. Conclusion: : There seems to be an extensive burden of fungal infections in T&T. Hence, targeted interventions are required to improve clinical and laboratory diagnosis and a national surveillance system should be implemented.

Examining Signatures of Natural Selection in Antifungal Resistance Genes Across Aspergillus Fungi.

Certain Aspergillus fungi cause aspergillosis, a set of diseases that typically affect immunocompromised individuals. Most cases of aspergillosis are caused by Aspergillus fumigatus, which infects millions of people annually. Some closely related so-called cryptic species, such as Aspergillus lentulus, can also cause aspergillosis, albeit at lower frequencies, and they are also clinically relevant. Few antifungal drugs are currently available for treating aspergillosis and there is increasing worldwide concern about the presence of antifungal drug resistance in Aspergillus species. Furthermore, isolates from both A. fumigatus and other Aspergillus pathogens exhibit substantial heterogeneity in their antifungal drug resistance profiles. To gain insights into the evolution of antifungal drug resistance genes in Aspergillus, we investigated signatures of positive selection in 41 genes known to be involved in drug resistance across 42 susceptible and resistant isolates from 12 Aspergillus section Fumigati species. Using codon-based site models of sequence evolution, we identified ten genes that contain 43 sites with signatures of ancient positive selection across our set of species. None of the sites that have experienced positive selection overlap with sites previously reported to be involved in drug resistance. These results identify sites that likely experienced ancient positive selection in Aspergillus genes involved in resistance to antifungal drugs and suggest that historical selective pressures on these genes likely differ from any current selective pressures imposed by antifungal drugs.

Do high MICs predict the outcome in invasive fusariosis?

BACKGROUND: Invasive fusariosis (IF) affects mostly severely immunocompromised hosts and is associated with poor outcome. Since Fusarium species exhibit high MICs for most antifungal agents, this could explain the poor prognosis. However, a clear-cut correlation between MIC and outcome has not been established. OBJECTIVE: To evaluate the correlation between MIC and outcome (6 week death rate) in patients with IF. METHODS: We performed a multicentre retrospective study of patients with IF who received treatment and had MIC levels determined by EUCAST or CLSI for the drug(s) used during treatment. We compared the MIC50 and MIC distribution among survivors and patients who died within 6 weeks from the diagnosis of IF. RESULTS: Among 88 patients with IF, 74 had haematological diseases. Primary treatment was monotherapy in 52 patients (voriconazole in 27) and combination therapy in 36 patients (liposomal amphotericin B + voriconazole in 23). The MIC50 and range for the five most frequent agents tested were: voriconazole 8 mg/L (range 0.5-64), amphotericin B 2 mg/L (range 0.25-64), posaconazole 16 mg/L (range 0.5-64), itraconazole 32 mg/L (range 4-64), and isavuconazole 32 mg/L (range 8-64). There was no difference in MIC50 and MIC distribution among survivors and patients who died. By contrast, persistent neutropenia and receipt of corticosteroids were strong predictors of 6 week mortality. CONCLUSIONS: Our study did not show any correlation between MIC and mortality at 6 weeks in patients with IF.

Estrategia de intervención para mejorar la calidad de vida del adulto mayor / Intervention Strategy for Improving the Quality of Life in the Aged Adult

Introducción: En la actualidad, el envejecimiento poblacional es uno de los problemas demográficos más relevantes. Constituye una prioridad del estado cubano la protección al adulto mayor y las acciones de salud para el aumento de la calidad de vida. Objetivo: Diseñar una estrategia de intervención para mejorar la calidad de vida de los adultos mayores. Métodos: Investigación aplicada con una primera etapa descriptiva - evaluativa y de diseño de la estrategia y una segunda etapa de realización de intervenciones y evaluación de resultados; efectuada en el Consultorio Médico número 7 del municipio Los Palacios, provincia Pinar del Río, durante el año 2018 y primer semestre 2019, con un universo de 294 adultos mayores y una muestra de 223 individuos que cumplieron los criterios de inclusión. Variables sociodemográficas: calidad de vida, autoestima y estilos de vida; se aplicó la Escala de Autoestima de Coopersmith, la Guía para el estudio del estilo de vida y la Escala MGH de calidad de vida en el adulto mayor. Resultados: Predominó el sexo femenino, la calidad de vida fue más alta en las personas con pareja, no existió correlación con el nivel de escolaridad ni se encontró polifarmacia en los adultos mayores; la autoestima, los estilos de vida saludables y la calidad de vida se elevaron considerablemente después de la intervención. Conclusiones: La estrategia de intervención diseñada contribuyó a elevar la calidad de vida en los adultos mayores(AU)

Introduction: Population aging is currently one of the most relevant demographic concerns. Protection of aged adults and health actions to increase their quality of life are a priority of the Cuban state. Objective: To design an intervention strategy to improve the quality of life of aged adults. Methods: Applied research with a first descriptive-evaluative stage for the design of the strategy, and a second stage of carrying out interventions and assessing outcomes. It was carried out in the family doctor's office number 7 of Los Palacios Municipality, in Pinar del Río Province, during 2018 and the first half of 2019, with a population of 294 aged adults and a sample of 223 individuals who met the inclusion criteria. The sociodemographic variables were quality of life, self-esteem and lifestyles. The Coopersmith Self-Esteem Inventory was applied, together with the Guide for the study of lifestyle and the M.G.H. Scale of quality of life in the aged adult. Results: The female sex predominated. Quality of life was higher in people with a partner. There was no correlation with the level of education. No polypharmacy was found in the aged adult. Self-esteem, healthy lifestyles and quality of life rose considerably after the intervention. Conclusions: The intervention strategy designed contributed to raising the quality of life in aged adults(AU)

Draft Genome Sequences of Four Aspergillus Section Fumigati Clinical Strains.

Aspergillus fungi in section Fumigati include important human pathogens. Here, we sequenced the genomes of two strains of Aspergillus hiratsukae and two strains of Aspergillus felis The average genome sizes are 29.5 Mb for A. hiratsukae and 31.8 Mb for A. felis.

Comparative performance of the laboratory assays used by a Diagnostic Laboratory Hub for opportunistic infections in people living with HIV.

OBJECTIVES: We evaluated the comparative performance of different assays used in a Diagnostic Laboratory Hub that linked 13 HIV healthcare facilities for the diagnosis of tuberculosis (TB), histoplasmosis, and cryptococcosis, and describing its functions in Guatemala compared with other National Reference Laboratories. METHODS: The following diagnostic techniques were analyzed in 24 months (2017-2018) in a cohort of patients with HIV: smear microscopy, mycobacterial and fungal cultures, isolator blood culture, PCR assays, and antigen detection tests. RESULTS: A total of 4245 patients were included, 716 (16.2%) had an opportunistic infection: 249 (34.7%) TB, 40 (5.6%) nontuberculous mycobacteria, 227 (31.7%) histoplasmosis, 138 (19.3%) cryptococcosis, and 62 (8.6%) had multiple opportunistic infections. Two hundred sixty-three [92.6%; 95% confidence interval (CI), 89-95.1] of TB cases were diagnosed by PCR. Urine antigen assay detected 94% (95% CI, 89-96) of the disseminated histoplasmosis cases. A lateral flow assay to detect cryptococcal antigen diagnosed 97% (95% CI, 93.3-98.7%) of the cryptococcal cases. In 85 patients (51.5%) with a cerobrospinal fluid sample, cryptococcal meningitis was diagnosed in 55 (64.7%), of which 18 (32.7%) were only detected by cryptococcal antigen. CONCLUSION: Validated commercial antigen tests, as used in this program, should be the new gold standard for histoplasmosis and cryptococcosis diagnosis. In their absence, 35% of disseminated histoplasmosis and 32.7% of cryptococcal meningitis cases would have been missed. Patients with multiple opportunistic infections were frequently diagnosed and strategies should be designed to screen patients irrespective of their clinical presentation. In low resource settings, Diagnostic Laboratory Hubs can deliver quality diagnostics services in record time at affordable prices.

Genomic and Phenotypic Heterogeneity of Clinical Isolates of the Human Pathogens Aspergillus fumigatus, Aspergillus lentulus, and Aspergillus fumigatiaffinis.

Fungal pathogens are a global threat to human health. For example, fungi from the genus Aspergillus cause a spectrum of diseases collectively known as aspergillosis. Most of the >200,000 life-threatening aspergillosis infections per year worldwide are caused by Aspergillus fumigatus. Recently, molecular typing techniques have revealed that aspergillosis can also be caused by organisms that are phenotypically similar to A. fumigatus but genetically distinct, such as Aspergillus lentulus and Aspergillus fumigatiaffinis. Importantly, some of these so-called cryptic species are thought to exhibit different virulence and drug susceptibility profiles than A. fumigatus, however, our understanding of their biology and pathogenic potential has been stymied by the lack of genome sequences and phenotypic profiling of multiple clinical strains. To fill this gap, we phenotypically characterized the virulence and drug susceptibility of 15 clinical strains of A. fumigatus, A. lentulus, and A. fumigatiaffinis from Spain and sequenced their genomes. We found heterogeneity in drug susceptibility across species and strains. We further found heterogeneity in virulence within each species but no significant differences in the virulence profiles between the three species. Genes known to influence drug susceptibility (cyp51A and fks1) vary in paralog number and sequence among these species and strains and correlate with differences in drug susceptibility. Similarly, genes known to be important for virulence in A. fumigatus showed variability in number of paralogs across strains and across species. Characterization of the genomic similarities and differences of clinical strains of A. lentulus, A. fumigatiaffinis, and A. fumigatus that vary in disease-relevant traits will advance our understanding of the variance in pathogenicity between Aspergillus species and strains that are collectively responsible for the vast majority of aspergillosis infections in humans.

Vinculación universidad-comunidad en la calidad de vida del adulto mayor / University-community contribution in the quality of life of the elderly

RESUMEN Introducción: la sociedad y la universidad tienen una relación directa, bilateral e indisoluble vinculada al desarrollo histórico - social de las naciones, y dentro de los problemas actuales de la sociedad se encuentra el envejecimiento poblacional. Objetivo: mostrar los resultados de la vinculación universidad-comunidad en la calidad de vida del adulto mayor, de 2016 a 2018 en Los Palacios. Métodos: investigación cuali - cuantitativa que contó con una primera parte descriptiva - evaluativa y de intervenciones de la universidad en la comunidad, y una segunda parte, de evaluación de resultados. El universo, los 41 consultorios médicos del territorio y una población de adultos mayores de 7 847 personas. Se utilizó la matriz DAFO y se priorizaron los problemas por método de ranqueo. Resultados: lograda la participación del claustro y los residentes en tres cátedras de adultos mayores y en exámenes periódicos de salud que fueron cumplidos al 113 %, impartidos cursos y diplomados, relacionados con el adulto mayor. Se logró la disminución en un 6 % de la mortalidad general en adultos mayores y en cuatro de las cinco enfermedades trazadoras tratadas en el Área Intensiva Municipal; proyección comunitaria en 22 especialidades médicas con actividades docente educativas impartidas a los Equipos Básicos de Salud. Conclusiones: la vinculación universidad - comunidad en Los Palacios ha desarrollado una cultura y un estilo participativo que involucra la acción integrada de los actores sociales, en una actitud promocional para el mejoramiento de la calidad de vida de los adultos mayores.

ABSTRACT Introduction: the community and the university have a direct, bilateral and indissoluble relationship associated with the historical-social development of nations, and within the current problems of society, aging of the population is one of them. Objective: to show the results of the university-community contribution in the quality of life of the elderly, from 2016 to 2018 in Los Palacios municipality. Methods: qualitative-quantitative research with a first descriptive-evaluative part and interventions of the university in the community, and a second part, evaluation of results. The target group was comprised of 41 doctors' offices of the territory and a population of old adults of 7 847 people. The SWOT matrix (strengths, weaknesses, opportunities, and threats), was applied and problems were prioritized applying the ranking method. Results: the participation of the teaching staff and old adults who were residents in three Chairs of seniors and underwent in periodic health examinations were achieved at 113 %, training and diploma courses were taught, related to the elderly. A 6 % reduction in mortality rate was general achieved in old adults and in four of the five diseases traced and treated in the Intensive Municipal Area; the community projection in the 22 medical specialties that included the teaching of educational activities given by the Basic Health Teams. Conclusions: the university-community contribution in Los Palacios has developed a participative culture and style that involves the integrated action of social actors, in a promotional attitude for the improvement of the quality of life of the elderly.

SUSCEPTIBILITY TEST FOR FUNGI: CLINICAL AND LABORATORIAL CORRELATIONS IN MEDICAL MYCOLOGY.

During recent decades, antifungal susceptibility testing has become standardized and nowadays has the same role of the antibacterial susceptibility testing in microbiology laboratories. American and European standards have been developed, as well as equivalent commercial systems which are more appropriate for clinical laboratories. The detection of resistant strains by means of these systems has allowed the study and understanding of the molecular basis and the mechanisms of resistance of fungal species to antifungal agents. In addition, many studies on the correlation of in vitro results with the outcome of patients have been performed, reaching the conclusion that infections caused by resistant strains have worse outcome than those caused by susceptible fungal isolates. These studies have allowed the development of interpretative breakpoints for Candida spp. and Aspergillus spp., the most frequent agents of fungal infections in the world. In summary, antifungal susceptibility tests have become essential tools to guide the treatment of fungal diseases, to know the local and global disease epidemiology, and to identify resistance to antifungals.

Susceptibility eest for fungi: clinical and laboratorial correlations in medical mycology / Teste de suscetibilidade para fungos: correlações clínico-laboratoriais em Micologia médica

SUMMARYDuring recent decades, antifungal susceptibility testing has become standardized and nowadays has the same role of the antibacterial susceptibility testing in microbiology laboratories. American and European standards have been developed, as well as equivalent commercial systems which are more appropriate for clinical laboratories. The detection of resistant strains by means of these systems has allowed the study and understanding of the molecular basis and the mechanisms of resistance of fungal species to antifungal agents. In addition, many studies on the correlation of in vitro results with the outcome of patients have been performed, reaching the conclusion that infections caused by resistant strains have worse outcome than those caused by susceptible fungal isolates. These studies have allowed the development of interpretative breakpoints for Candida spp. and Aspergillus spp., the most frequent agents of fungal infections in the world. In summary, antifungal susceptibility tests have become essential tools to guide the treatment of fungal diseases, to know the local and global disease epidemiology, and to identify resistance to antifungals.

RESUMONas últimas décadas, os testes de suscetibilidade a antifúngicos foram padronizados e, atualmente, servem tal como os testes de suscetibilidade a antibacterianos em laboratórios de microbiologia. Métodos de referência norte americanos e europeus foram desenvolvidos, assim como os equivalentes sistemas comerciais, estes últimos mais apropriados a laboratórios clínicos. A detecção de cepas resistentes por meio de tais sistemas permitiu o estudo e a compreensão das bases moleculares dos mecanismos de resistência de espécies fúngicas a fármacos antifúngicos. Além disso, foram realizados muitos estudos sobre a correlação de resultados obtidos in vitro com o desfecho clínico de pacientes permitindo a conclusão de que infecções por cepas resistentes têm pior evolução em relação às causadas por cepas sensíveis. Os estudos permitiram o estabelecimento de pontos de corte interpretativos (interpretative breakpoints development) para Candida spp. e Aspergillus spp., os agentes etiológicos mais frequentes de infecções fúngicas em todo o mundo. Em resumo, os testes de suscetibilidade representam uma ferramenta essencial para a orientação do tratamento de doenças fúngicas, para o conhecimento da epidemiologia local e global, bem como para a identificação de resistência a antifúngicos.

Molecular identification and susceptibility testing of Trichosporon isolates from a Brazilian hospital.

In this study the molecular identification and susceptibility profile of 21 clinical isolates, from a Brazilian hospital, belongs to six different species of Trichosporon were described. Trichosporon asahii was the predominant species and corresponded to 43% of isolates. Eighty three percent of the strains isolated from deep sites were identified as T. asahii, while only 17% belong to a non-T. asahii species (Trichosporon inkin). In general, the MICs were high and independent of the species of Trichosporon as well as the clinical origin of strain. Amphotericin B and fluconazole were less effective against Trichosporon spp. and high MIC values of voriconazole, posaconazole and ravuconazole were observed. Fifty-six percent (5/9) of T. asahii strains were isolated from deep sites, whereas 8% (1/12) of non-T. asahii species were isolated from those sites. A total of 89% of T. asahii isolates exhibited resistance to amphotericin B in vitro.

Genotype distribution of clinical isolates of Trichosporon asahii based on sequencing of intergenic spacer 1.

The sequence polymorphisms of intergenic transcribed spacer and the antifungal susceptibility profile of 18 Trichosporon asahii isolates from Spain, Argentina, and Brazil together with 43 intergenic transcribed spacer 1 sequences deposited in the GenBank were analyzed. Six genotypes were detected instead of 5 genotypes described previously. Genotype 1 was the most common found comprising 57.3% of all strains, followed by genotype 3 (14.7%) and genotype 5 (13.1%). Spanish strains had members in all genotypes except 2, whereas South American isolates were grouped with genotypes 1, 3, and 6. Our results indicate that all genotypes are present in at least 2 countries suggesting a worldwide distribution. On the other hand, genotype 6 was not previously described but was only composed of 2 South American strains isolated from a subcutaneous abscess and skin. All isolates showed amphotericin B MICs>or=2 mg/L supporting the in vitro resistance of this species to this antifungal. Three isolates from South America showed high MICs to all antifungals analyzed. The true epidemiologic usefulness of classifying T. asahii in genotypes should be ascertaining analyzing a high number of isolates from many countries.