Genomic insights into the expansion of carbapenem-resistant Klebsiella pneumoniae within Portuguese hospitals.

Carbapenem-resistant Klebsiella pneumoniae (CR-KP) are a public health concern, causing infections with a high mortality rate, limited therapeutic options and challenging infection control strategies. In Portugal, the CR-KP rate has increased sharply, but the factors associated with this increase are poorly explored. In order to address this question, phylogenetic and resistome analysis were used to compare the draft genomes of 200 CR-KP isolates collected in 2017-2019 from five hospitals in the Lisbon region, Portugal. Most CR-KP belonged to sequence type (ST) 13 (29%), ST17 (15%), ST348 (13%), ST231 (12%) and ST147 (7%). Carbapenem resistance was conferred mostly by the presence of KPC-3 (74%) or OXA-181 (18%), which were associated with IncF/IncN and IncX plasmids, respectively. Almost all isolates were multi-drug resistant, harbouring resistance determinants to aminoglycosides, beta-lactams, trimethoprim, fosfomycin, quinolones and sulphonamides. In addition, 11% of isolates were resistant to colistin. Colonizing and infecting isolates were highly related, and most colonized patients (89%) reported a previous hospitalization. Moreover, among the 171 events of cross-dissemination identified by core genome multi-locus sequence typing data analysis (fewer than five allelic differences), 41 occurred between different hospitals and 130 occurred within the same hospital. The results suggest that CR-KP dissemination in the Lisbon region results from acquisition of carbapenemases in mobile genetic elements, influx of CR-KP into the hospitals by colonized ambulatory patients, and transmission of CR-KP within and between hospitals. Prudent use of carbapenems, patient screening at hospital entry, and improvement of infection control are needed to decrease the burden of CR-KP infection in Portugal.

Determinants of left ventricular diastolic dysfunction in hypertensive patients / Factores Asociados a la Disfunción Diastólica del Ventrículo Izquierdo en Pacientes con Hipertensión Arterial

Introduction: The progression of hypertensive heart disease leads to the left ventricular diastolic dysfunction (LVDD), which is associated with increased cardiovascular morbidity and mortality. The purpose of this analysis is to explore the determinants for LVDD in patients with hypertension. Methods: This is a secondary analysis of data of Impedance Cardiography in the Evaluation of Left Ventricular Diastolic Dysfunction in Patients with Arterial Hypertension (IMPEDDANS) Study. Mann-Whitney and Chi-square tests were used for univariable analysis. Multiple logistic regression was used to model for LVDD occurrence and discriminative capacity of the model assessed by the value of the area under the curve given by the receiver-operating characteristic curve. Results: Older age (65 vs. 58 years, p < 0.001), longer duration of hypertension (160 vs. 48 months, p < 0.001), uncontrolled hypertension (59.8 vs. 15.9%, p < 0.001), tobacco smoking (17.8 vs. 3.8%, p = 0.016), higher systolic blood pressure (133 vs. 124 mmHg, p = 0.001) and slower heart rate (62 vs. 66 bpm, p = 0.023) were associated with LVDD. Multivariate model identified uncontrolled hypertension (AdjOR 36.90; 95% CI 7.94-171.58; p < 0.001), smoking (AdjOR 6.66; 95% CI 1.63-27.26; p = 0.008), eccentric hypertrophy (AdjOR 3.59; 95% CI 0.89-14.39; p = 0.072), duration of hypertension (AdjOR 1.03; 95% CI 1.02-1.05; p < 0.001) and concentric remodeling (AdjOR 0.19; 95% CI 0.04-0.93; p = 0.041) as the more determinant for occurrence of LVDD. The discriminative capacity of the model was AUC = 0.95 (95% CI 0.91-0.98). Conclusion: The occurrence of LVDD in hypertensive patients was strongly associated to long-lasting, uncontrolled hypertension, tobacco smoking, concentric remodeling and eccentric hypertrophy

Introducción: La progresión de la enfermedad cardiaca hipertensiva produce disfunción diastólica del ventrículo izquierdo (DDVI) y aumento de morbilidad y mortalidad. El objetivo de este estudio es evaluar los factores que se asocian a la DDVI en pacientes con hipertensión arterial. Métodos: Se trata de un análisis secundario del estudio IMPEDDANS. Se utilizaron las pruebas de la U de Mann-Whitney y la Chi-cuadrado para el análisis univariado, y posteriormente se realizó un análisis de regresión logística multivariado. La capacidad discriminativa del modelo fue evaluada por el valor del área bajo la curva (ABC) dada por la curva característica de funcionamiento del receptor. Resultados: Los pacientes con DDVI eran mayores (65 vs. 58 años; p < 0,001), tenían historia previa de hipertensión arterial más larga (160 vs. 48 meses; p < 0,001), presentaban frecuentemente hipertensión arterial no controlada (59,8 vs. 15,9%; p < 0,001), fumaban más (17,8 vs 3,8%; p = 0,016), presentaban presión arterial sistólica más alta (133 vs. 124 mmHg; p = 0,001) y frecuencia cardiaca más lenta (62 vs. 66 pm; p = 0,023). En el modelo multivariado se objetivó hipertensión no controlada (OR 36,90; IC 95% 7,94-171,58; p < 0,001), hábito tabáquico (OR 6,66; IC 95% 1,63-27,26; p = 0,008), hipertrofia excéntrica (OR 3,59; IC 95% 0,89-14,39; p = 0,072), la duración de la hipertensión (OR 1,03; IC 95% 1,02-1,05; p < 0,001) y remodelado concéntrico (OR 0,19; IC 95% 0,04-0,93; p = 0,041) eran factores asociados a la DDVI. La capacidad discriminativa del modelo se correspondió con un ABC = 0,95 (IC 95% 0,91-0,98). Conclusión: El desarrollo de la DDVI en pacientes con hipertensión arterial se asoció a la duración de la hipertensión, la hipertensión no controlada, el hábito tabáquico, el remodelado concéntrico y la hipertrofia excéntrica

Comb, cloaca and feet scores and testis morphometry in male broiler breeders at two different ages / Escores de crista, cloaca e de pé e morfometria testicular em galos de matriz pesada em duas diferentes idades

In broiler breeder roosters, the weight of the testes is positively associated with daily sperm production and fertility. In birds, the testes are located in the coelomic cavity, not being accessible to reproductive evaluation as mammalian testes. The reproductive evaluation of roosters is based on phenotypic traits. Any changes on testes will be reflected on fertility levels. The aim of this paper was to evaluate the potential of association of phenotypic traits as body weight (BW), comb scores (COS), cloaca scores (CLS) and feet scores (FS) with testicular morphometric parameters in adult Cobb® Mx roosters in two ages (25 and 45 weeks of age). The low BW roosters had lower testes weight (TW), smaller seminiferous tubule diameter (STD) and lower comb and cloaca scores than the medium and high BW roosters (P≤0.05). Heavy roosters had the highest COS and bigger seminiferous epithelium height (SEH). There was no statistical difference between the BW categories in FS and volumetric proportion of seminiferous tubule (ST) and interstitial tissue (IT). Considering the age effect, roosters with 45 weeks of age had lower TW and ST than 25-week roosters. Positive, moderate and significant correlation was found between testes weight and phenotypic characteristics as BW, COS and CLS in 45week roosters. A positive, moderate and significant correlation was found between body weight and histologic testicular characteristics as STD and SHE in both evaluated ages. In conclusion, there is a regression in the testes weight with age and it is more intense in Cobb® Mx roosters with lower BW. Furthermore, it is concluded that the BW positively influences the testes weight and histological quality of the testes. COS and CLS can be used with moderate potential prediction to identify roosters with low testes weight at 45 weeks of age.(AU)

Em galos de matriz pesada sabe-se que o peso dos testículos pode ser associado positivamente com a produção diária de espermatozoides e que alterações nos testículos irão refletir na fertilidade. Nas aves, os testículos estão localizados dentro da cavidade celomática, e, portanto, não são acessíveis para exame andrológico direto, como em mamíferos. A avaliação reprodutiva de galos se baseia principalmente em características fenotípicas. Buscou-se avaliar o potencial de associação de alguns parâmetros fenotípicos, como peso corporal (PC), escores de crista (ECR), escores de cloaca (ECL) e escores de pés (EP), com parâmetros morfológicos de testículos em galos Cobb® Mx em duas idades (25 e 45 semanas de idade). Galos leves apresentaram menor peso testicular (PT), menor diâmetro de túbulo seminífero (DT), e menores ECR e ECL que galos médios e pesados (P≤0.05). Galos pesados apresentaram os maiores ECR e maiores valores para altura do epitélio seminífero (AE), e DT. Não houve diferença estatisticamente significativa entre as categorias de peso para escores de pé e proporções de túbulo seminífero (TS) e interstício (INT). Considerando-se o efeito da idade, galos com 45 semanas de idade apresentaram menores PT e TS que galos com 25 semanas de idade. Correlação positiva, moderada e significativa foi encontrada entre peso de testículo e características fenotípicas como ECR, ECL e PC em galos de 45 semanas de idade. Foi encontrada correlação positiva, moderada e significativa entre PC e características testiculares como DT e AE nas duas idades avaliadas. Conclui-se que em galos Cobb® Mx ocorre regressão do testículo com o avanço da idade, e ela é mais intensa em galos com menor peso corporal. Conclui-se que o PC tem influência positiva no peso e índices histomorfométricos dos testículos, e que escores de crista e de cloaca podem ser utilizados com potencial moderado de predição para identificar galos com baixo peso de testículos em galos com 45 semanas de idade.(AU)

Diastolic dysfunction in hypertension / Disfunción diastólica en la hipertensión

Hypertension and coronary heart disease, often coexisting, are the most common risk factors for heart failure. The progression of hypertensive heart disease involves myocardial fibrosis and alterations in the left ventricular geometry that precede the functional change, initially asymptomatic. The left ventricular diastolic dysfunction is part of this continuum being defined by the presence of left ventricular diastolic dysfunction without signs or symptoms of heart failure or poor left ventricular systolic function. It is highly prevalent in hypertensive patients and is associated with increased cardiovascular morbidity and mortality. Despite its growing importance in clinical practice it remains poorly understood. This review aims to present the epidemiological fundamentals and the latest developments in the pathophysiology, diagnosis and treatment of left ventricular diastolic dysfunction

La hipertensión y la enfermedad coronaria, a menudo coexistentes, son los factores de riesgo más comunes para la insuficiencia cardíaca. La progresión de la enfermedad cardíaca hipertensiva implica fibrosis miocárdica y alteraciones en la geometría ventricular izquierda que preceden al cambio funcional, inicialmente asintomático. La disfunción diastólica ventricular izquierda es parte de este proceso y se define como la presencia de disfunción diastólica del ventrículo izquierdo sin signos ni síntomas de insuficiencia cardíaca o mala función sistólica ventricular izquierda. Es altamente prevalente en pacientes hipertensos y se asocia con un aumento de la morbimortalidad cardiovascular. A pesar de su creciente importancia en la práctica clínica, el conocimiento de la disfunción diastólica del ventrículo izquierdo sigue siendo escaso. Esta revisión tiene como objetivo presentar los fundamentos epidemiológicos y los últimos avances en la fisiopatología, el diagnóstico y el tratamiento de la disfunción diastólica del ventrículo izquierdo

Histological characteristics of the corpus luteum of Nelore cows in the first, second and third trimester of pregnancy / Características histológicas do corpo lúteo de vacas Nelore nos terços inicial, médio e final da gestação

Foram avaliadas características morfológicas do corpo lúteo de 48 vacas Nelore gestantes obtidos de abatedouros. Os ovários com o corpo lúteo foram coletados, identificados e divididos em três grupos, considerando o estágio da gestação determinado pelo tamanho do feto: Grupo I - onze animais com gestação até 90 dias; Grupo 2 - vinte animais com gestação de 90 a 180 dias, e Grupo 3 - 17 animais com gestação de 180 a 261 dias. Todos os corpos lúteos foram dissecados, submetidos a processamento histológico e avaliados utilizando microscopia de luz. As características morfológicas das células luteais esteroidogênicas não mudou durante a gestação. Porém, foi observado um aumento de tecido conjuntivo, fibroblastos e matriz extracelular durante o final da gestação. Células em degeneração foram observadas em todos os períodos da gestação, mas com maior intensidade no fim do terceiro trimestre. Grânulos foram observados após a coloração com Tricrômico de Gomory e Xylidine Ponceau, caracterizados como grânulos de proteína. Nenhuma explicação foi encontrada na literatura para coloração de grânulos pelo Tricrômico de Gomory.

Effects of simultaneous exposure to stress and nicotine on nicotine-induced locomotor activation in adolescent and adult rats

Preclinical studies have shown that repeated stress experiences can result in an increase in the locomotor response to the subsequent administration of drugs of abuse, a phenomenon that has been termed behavioral cross-sensitization. Behavioral sensitization reflects neuroadaptive processes associated with drug addiction and drug-induced psychosis. Although cross-sensitization between stress- and drug-induced locomotor activity has been clearly demonstrated in adult rats, few studies have evaluated this phenomenon in adolescent rats. In the present study, we determined if the simultaneous exposure to stress and nicotine was capable of inducing behavioral sensitization to nicotine in adolescent and adult rats. To this end, adolescent (postnatal day (P) 28-37) and adult (P60-67) rats received nicotine (0.4 mg/kg, sc) or saline (0.9 percent NaCl, sc) and were immediately subjected to restraint stress for 2 h once a day for 7 days. The control group for stress was undisturbed following nicotine or saline injections. Three days after the last exposure to stress and nicotine, rats were challenged with a single dose of nicotine (0.4 mg/kg, sc) or saline and nicotine-induced locomotion was then recorded for 30 min. In adolescent rats, nicotine caused behavioral sensitization only in animals that were simultaneously exposed to stress, while in adult rats nicotine promoted sensitization independently of stress exposure. These findings demonstrate that adolescent rats are more vulnerable to the effects of stress on behavioral sensitization to nicotine than adult rats.

Proporção volumétrica dos constituintes do corpo lúteo de vacas Nelore nos terços inicial, médio e final da gestação / Volumetric proportion of the corpus luteum of Nelore cows in the first, second and third trimester of gestation

A proporção volumétrica dos constituintes do corpo lúteo foi estudada em 48 ovários de vacas Nelore gestantes, coletados em frigorífico e distribuídos em três grupos, considerando-se o terço da gestação. No primeiro terço, utilizaram-se 11 animais em gestação de até 90 dias; no segundo terço, 20 animais em gestação entre 91 e 180 dias, e no terceiro terço 17 animais em gestação entre 181 e 261 dias. O corpo lúteo foi dissecado e submetido a processamento histológico para avaliação em microscopia óptica. Os animais em gestação de até 90 dias apresentaram maior proporção volumétrica de células endoteliais e pericitos, e nos acima de 181 dias de gestação ocorreu menor proporção de citoplasma (42,7 por cento) e núcleo (5,1 por cento) de células lúteas esteroidogênicas, bem como aumento do tecido conjuntivo e fibroblastos (47,7 por cento).

The volumetric proportion of the corpus luteum was evaluated in 48 ovaries from pregnant Nelore cows slaughtered in abattoirs, and divided into three groups, considering the trimester of gestation, and classified by the size of the fetus: First trimester - eleven animals with gestation up to 90 days; Second trimester - twenty animals with gestation between 91 and 180 days, and Third trimester - 17 animals with gestation between 181 and 261 days. The corpus luteum was dissected and submitted to histological processing and evaluations under light microscopy. The animals with gestation up to 90 days presented a higher proportion of endotelial cells and pericites. In the Third trimester there occurred a smaller proportion of cytoplasm (42,7 percent) and nucleus (5,1 percent) of steroidogenic luteal cells, and an increase in the conjunctive tissue, fibroblasts (47,7 percent).

Synaptic vesicle pool size, release probability and synaptic depression are sensitive to Ca2+ buffering capacity in the developing rat calyx of Held

The calyx of Held, a specialized synaptic terminal in the medial nucleus of the trapezoid body, undergoes a series of changes during postnatal development that prepares this synapse for reliable high frequency firing. These changes reduce short-term synaptic depression during tetanic stimulation and thereby prevent action potential failures during a stimulus train. We measured presynaptic membrane capacitance changes in calyces from young postnatal day 5-7 (p5-7) or older (p10-12) rat pups to examine the effect of calcium buffer capacity on vesicle pool size and the efficiency of exocytosis. Vesicle pool size was sensitive to the choice and concentration of exogenous Ca2+ buffer, and this sensitivity was much stronger in younger animals. Pool size and exocytosis efficiency in p5-7 calyces were depressed by 0.2 mM EGTA to a greater extent than with 0.05 mM BAPTA, even though BAPTA is a 100-fold faster Ca2+ buffer. However, this was not the case for p10-12 calyces. With 5 mM EGTA, exocytosis efficiency was reduced to a much larger extent in young calyces compared to older calyces. Depression of exocytosis using pairs of 10-ms depolarizations was reduced by 0.2 mM EGTA compared to 0.05 mM BAPTA to a similar extent in both age groups. These results indicate a developmentally regulated heterogeneity in the sensitivity of different vesicle pools to Ca2+ buffer capacity. We propose that, during development, a population of vesicles that are tightly coupled to Ca2+ channels expands at the expense of vesicles more distant from Ca2+ channels.

Electrophysiological evidence for glial-subtype glutamate transporter functional expression in rat cerebellar granule neurons

A glutamate-sensitive inward current (Iglu) is described in rat cerebellar granule neurons and related to a glutamate transport mechanism. We examined the features of Iglu using the patch-clamp technique. In steady-state conditions the Iglu measured 8.14 ± 1.9 pA. Iglu was identified as a voltage-dependent inward current showing a strong rectification at positive potentials. L-Glutamate activated the inward current in a dose-dependent manner, with a half-maximal effect at about 18 æM and a maximum increase of 51.2 ± 4.4 percent. The inward current was blocked by the presence of dihydrokainate (0.5 mM), shown by others to readily block the GLT1 isoform. We thus speculate that Iglu could be attributed to the presence of a native glutamate transporter in cerebellar granule neurons

Persistência da artéria ciática com aneurisma associada à artéria femoral superficial hipoplásica / Persistent sciatic artery with aneurism associated with hypoplastic superficial femoral artery

Um caso de persistência da artéria ciática com aneurisma associada à artéria femoral hipoplásica no membro inferior direito é relatado. Esta associação é rara, sendo o primero caso descrito na literatura brasileira. As peculiaridades anatômicas, ultra-sonográficas desta observação são revistas