Genomic analysis of virulence factors and antimicrobial resistance of group B Streptococcus isolated from pregnant women in northeastern Mexico.

INTRODUCTION: Group B Streptococcus (GBS) causes infections in women during pregnancy and puerperium and invasive infections in newborns. The genes lmb, cylE, scpB, and hvgA are involved with increased virulence of GBS, and hypervirulent clones have been identified in different regions. In addition, increasing resistance of GBS to macrolides and lincosamides has been reported, so knowing the patterns of antibiotic resistance may be necessary to prevent and treat GBS infections. This study aimed to identify virulence genes and antibiotic resistance associated with GBS colonization in pregnant women from northeastern Mexico. METHODS: Pregnant women with 35-37 weeks of gestation underwent recto-vaginal swabbing. One swab was inoculated into Todd-Hewitt broth supplemented with gentamicin and nalidixic acid, a second swab was inoculated into LIM enrichment broth, and a third swab was submerged into a transport medium. All samples were subcultured onto blood agar. After overnight incubation, suggestive colonies with or without hemolysis were analyzed to confirm GBS identification by Gram staining, catalase test, hippurate hydrolysis, CAMP test, and incubation in a chromogenic medium. We used latex agglutination to confirm and serotype GBS isolates. Antibiotic resistance patterns were assessed by Vitek 2 and disk diffusion. Periumbilical, rectal and nasopharyngeal swabs were collected from some newborns of colonized mothers. All colonized women and their newborns were followed up for three months to assess the development of disease attributable to GBS. Draft genomes of all GBS isolates were obtained by whole-genome sequencing. In addition, bioinformatic analysis to identify genes encoding capsular polysaccharides and virulence factors was performed using BRIG, while antibiotic resistance genes were identified using the CARD database. RESULTS: We found 17 GBS colonized women out of 1154 pregnant women (1.47%). None of the six newborns sampled were colonized, and no complications due to GBS were detected in pregnant women or newborns. Three isolates were serotype I, 5 serotype II, 3 serotype III, 4 serotype IV, and 2 serotype V. Ten distinct virulence gene profiles were identified, being scpB, lmb, fbsA, acp, PI-1, PI-2a, cylE the most common (3/14, 21%). The virulence genes identified were scpB, lmb, cylE, PI-1, fbsA, PI-2a, acp, fbsB, PI-2b, and hvgA. We identified resistance to tetracycline in 65% (11/17) of the isolates, intermediate susceptibility to clindamycin in 41% (7/17), and reduced susceptibility to ampicillin in 23.5% (4/17). The tetM gene associated to tetracyclines resistance was found in 79% (11/14) and the mel and mefA genes associated to macrolides resistance in 7% (1/14). CONCLUSIONS: The low prevalence of colonization and the non-occurrence of mother-to-child transmission suggest that the intentional search for GBS colonization in this population is not justified. Our results also suggest that risk factors should guide the use of intrapartum antibiotic prophylaxis. The detection of strains with genes coding virulence factors means that clones with pathogenic potential circulates in this region. On the other hand, the identification of decreased susceptibility to antibiotics from different antimicrobial categories shows the importance of adequately knowing the resistance patterns to prevent and to treat GBS perinatal infection.

Clinical and dosimetric factors associated with the development of hematologic toxicity in locally advanced cervical cancer treated with chemotherapy and 3D conformal radiotherapy.

AIM: To identify clinical and dosimetric factors associated with the development of hematologic toxicity (HT) for cervical cancer (CC) treated with chemotherapy and 3D conformal radiotherapy. BACKGROUND: Chemoradiotherapy is the standard of care management for CC patients with IB2-IVA clinical stages (CS). This treatment carries toxicities, standing out the one that occurs at the hematologic level. SUBJECTS AND METHODS: CC patients with IB2-IVA CS treated with chemotherapy and 3D conformal radiotherapy (50 Gy) plus Brachyterapy (7 Gy x3 or 9 Gy x2) at our institution between March 2016 and March 2017. Clinical and dosimetric factors were studied as was their probable association with the development of HT. RESULTS: 59 patients were analyzed. 89.8% of the subjects developed some grade of HT and 50.2% developed ≥grade 2 toxicity. No statistical relationship was found for the dosimetric factors: V10 > 90% (p = 0.47) and V20 > 80% (p = 0.17). Regarding clinical factors: neither age >50 years (p = 0.88) nor diabetes mellitus (DM) showed statistical relationship with development of ≥grade 2 HT (p = 0.88 and p = 0.61, respectively). On the contrary, obesity showed a significant association (p = 0.02). For other factors analyzed, we found statistical correlation for epidermoid histology and ≥III A CS (p = 0.01 and p = 0.02, respectively). CONCLUSIONS: We did not find statistical relationship between HT and the clinical factors of age >50 years and DM. Statistical relationship for the dosimetric factors V10 > 90% and V20 > 80% was not found as well. On the contrary, obesity, epidermoid histology and ≥IIIA CS, showed statistical significance for development of HT ≥grade 2.

Knowledge and attitude towards organ donation of medicine students of a Northwestern Mexico public university / Actitud y conocimiento sobre donación de órganos de estudiantes de medicina de una universidad pública del noreste de México

Objective: To evaluate the knowledge and attitude towards organ donation of medicine students of a Northwestern Mexico public university. Materials and Methods: A prolective, descriptive, observational, and cross-sectional study. A 34 items cross-sectional survey evaluating knowledge and attitude towards organ donation in 3,056 medicine students during 2013-2015. Descriptive statistics were used as absolute frequencies, percentages, mean and standard deviation, as well as the Chi-square test. A p < 0.05 was considered significant. Results: 74% of students would donate their own organs, mainly due to reciprocity (41%). 26% of students would not donate, 48% of them because of fear that their organs could be taken before death. 86% would donate organs from a relative. 64% have spoken about organ donation and transplantation with their family and 67% with friends. 50% said they had received no information about it. 68% understand the concept of brain death. Conclusion: Students received little information about organ donation during college. Despite that, most of them showed a positive attitude and are willing to donate.

Objetivo: Averiguar la actitud y el conocimiento que tienen los estudiantes de medicina de una universidad pública del noreste de México sobre la donación de órganos y tejidos. Material y métodos: Estudio prolectivo, descriptivo, observacional y trans- versal. Se incluyeron 3056 encuestas de 34 reactivos realizadas a estudiantes de medicina durante el periodo 2013-2015 y se eliminaron aquellas con menos del 80% de los reactivos contestados. Análisis estadístico: frecuencias absolutas, porcentajes, medias, desviación estándar y prueba de ji al cuadrado. Se consideró significativo un valor de p < 0.05. Resultados: El 74% de los estudiantes donaría sus órganos y el 41% lo haría por reciprocidad; del 26% que no donaría sus órganos, el 48% no lo haría por temor a que tomen sus órganos antes de estar muerto. Un 86% estaría dispuesto a donar los órganos de algún familiar. El 64% ha comentado el tema de la donación con su familia y el 67% con amigos. El 50% no ha recibido información alguna sobre el tema. El 68% entiende el concepto de muerte encefálica. Conclusión: Pocos estudiantes reciben información sobre donación de órganos al llegar a la universidad; pese a ello, la mayoría tiene una actitud positiva y estarían dispuestos a donar.

[Assessment of antibiotic use and impact of an intervention intended to modify the prescribing behavior in surgical prophylaxis in 6hospitals in the metropolitan area of Monterrey, Mexico]. / Evaluación del uso de antibióticos e impacto de una intervención dirigida a modificar la conducta prescriptiva en profilaxis quirúrgica en 6hospitales del área metropolitana de Monterrey.

BACKGROUND: Improper use of antibiotics increases antimicrobial resistance. OBJECTIVE: Evaluate the use of antibiotics and the impact of an intervention designed to improve antibiotic prescription for surgical prophylaxis in 6 hospitals of Monterrey, Mexico. MATERIAL AND METHODS: Design: A prospective multicenter survey and a pretest-postest experimental study. Phase 1: Survey to evaluate the use of antibiotics through an especially designed guide. Phase 2: Intervention designed to improve antibiotic prescription for surgical prophylaxis by the medical staff by using printed, audiovisual and electronic messages. Phase 3: Survey to evaluate the impact of the intervention. ANALYSIS: Frequencies, percentages, medians, ranges and X2 test. RESULTS: Phase 1: We evaluated 358 surgical patients, 274 prophylactic antibiotic regimens. A total of 96% of antibiotics regimens began with inappropriate timing (290/302), 82.8% were inappropriate regimens (274/331), 77.7% were in inappropriate dosage (230/296), 86% of inadequate length (241/280), and in 17.4% restricted antibiotics were used (52/299). Phase 2: 9 sessions including 189 physicians (14 department chairs, 58 general practitioners and 117 residents). Phase 3: We evaluated 303 surgical patients, 218 prophylactic antibiotics regimens. Inappropriate treatment commencement was reduced to 84.1% (180/214) (P<0.001), inappropriate regimens to 75.3% (162/215) (P=0.03), inappropriate dosages to 51.2% (110/215) (P<0.001), and use of restricted antibiotics to 8.3% (18/215) (P=0.003). CONCLUSIONS: Inappropriate use of prophylactic antibiotics in surgery is a frequent problem in Monterrey. The intervention improved the antibiotic prescription for surgical prophylaxis by reducing inappropriate treatment commencement, regimens, dosages, and overuse of restricted antibiotics. It is necessary to strengthen strategies to improve the prescription of antibiotics in surgical prophylaxis.

Alteraciones puberales en adolescentes con leucemia en fase de vigilancia.

OBJECTIVE: To evaluate which factors are associated with alterations in pubertal development in pediatric patients with leukemia in the surveillance phase. METHOD: A case-control study was carried out, including patients aged 8-14 years with diagnosis of acute lymphoblastic leukemia under surveillance. Demographic data were collected, age at diagnosis, type of leukemia, risk of leukemia, duration and type of treatment received, time of surveillance phase; and pubertal development was assessed by Tanner stage, bone age, pelvic ultrasound for women, and LH levels. Fisher's exact test and Mann-Whitney U-test were used. RESULTS: Twenty-five pediatric patients with a diagnosis of acute lymphoblastic leukemia between 8 and 14 years of age with a median of 8 were included, only 4 (16%) presented pubertal alterations, 1 had pubertal delay and 3 advanced puberty. The history of radiotherapy was related to pubertal alterations (p = 0.03). CONCLUSIONS: The antecedent of having received radiotherapy as part of the treatment in patients with acute lymphoblastic leukemia is a risk factor for developing pubertal abnormalities.

Asociación de la hemorragia prerretiniana con la presencia y la gravedad de la retinopatía del prematuro en pacientes de alto riesgo.

OBJECTIVE: To assess whether preretinal hemorrhage (PRH) is associated with the presence and severity of retinopathy of prematurity (ROP) in high-risk patients. METHOD: Prospective cohort study, patients referred to the Department of Ophthalmology for ROP screening during October-November 2016 were evaluated weekly on 4 occasions to assess the relationship with PRH and the development of ROP as well as degree of severity associated. We used absolute, median frequencies with minimum and maximum values, χ2 test and Mann-Whitney U-test, as well as relative risk with 95% confidence interval. RESULTS: A total of 30 patients, in the first week 11 females (36%) and 4 males (13%) had PRH; in the 2nd week 13 patients (43%) presented PRH and 14 (46%) developed ROP; on the 3rd week there were no changes; in the last week 8 presented HPR (26%) and 11 patients (36%) with ROP. Stage I severity occurred more frequently. Statistical significance (p = 0.040) was found in the presence of PRH and the development of ROP in the first week with. CONCLUSIONS: HPR is a risk factor for the development of ROP during the first weeks of life and is associated with stages of mild severity.

[Clinical and immunological characteristics in pediatric patients with coccidioidomycosis in northeastern Mexico]. / Características clínicas e inmunológicas en pacientes pediátricos con coccidioidomicosis del noreste de México.

BACKGROUND: Coccidioidomycosis is a systemic fungal disease caused by Coccidioides spp. Patients with phagocytic, cellular, or humoral immunodeficiencies exhibit immunodeficiencies that confer increased susceptibility to fungal infections. In Mexico there is an underreporting of this disease and no studies currently describe the immune status of these patients in an endemic area. OBJECTIVE: To describe the clinical and immunological characteristics of pediatric patients with coccidioidomycosis. MATERIALS AND METHODS: Pediatric patients with diagnosis of coccidioidomycosis from two tertiary level hospitals of northeastern Mexico were included, from the period 2008-2012; immune status was assessed by clinical history, immunoglobulins levels, levels of lymphocytes T, B, and NK (natural killer), and the nitroblue tetrazolium test. RESULTS: Thirty patients were included, 18 male (60%). The age at diagnosis was five years (median, range 0.25-13). Twelve were from Coahuila (40%). Residual pulmonary coccidioidomycosis was the clinical type presentation found in 16 patients (53%). A primary humoral immunodeficiency was found in three patients (10%) and a secondary immunodeficiency in another three (10%). Case fatality rate was 16%. CONCLUSIONS: . The disease predominated in male patients. In 33% of patients, levels of IgG were elevated, probably due to stimulation by chronic fungal infection. In 20% of patients, immunodeficiency was documented. There was a high mortality rate.

Profilaxis antibiótica en amigdalectomías y su relación con la morbilidad postoperatoria / Antibiotic prophylaxis in tonsillectomy and its relationship with postoperative morbidity

Introducción y objetivos: El dolor postoperatorio en amigdalectomía es el síntoma principal y el más incapacitante. La prescripción de antibióticos es una práctica común para disminuir el dolor postoperatorio. El objetivo del estudio fue comparar la eficacia del control de la morbilidad postoperatoria de un esquema de profilaxis antibiótica intravenoso dosis única preoperatorio contra un antibiótico vía oral postoperatorio en pacientes pediátricos sometidos a amigdalectomía. Métodos: Ensayo clínico controlado aleatorizado abierto, realizado a pacientes de 4-15 años sometidos a amigdalectomía. Grupo experimental: cefalotina iv dosis única; grupo control: cefalotina iv dosis única más amoxicilina/ácido clavulánico durante 7 días. Se comparó la presencia e intensidad del dolor, tolerancia a vía oral, limitación de actividades, halitosis, otalgia y náuseas en los primeros 7 días del postoperatorio mediante la escala visual analógica del dolor de Wong-Baker y un cuestionario contestado por los padres. Resultados: Ciento dos pacientes sometidos a amigdalectomía, 51 por grupo. No hubo diferencia en la presencia ni intensidad del dolor postoperatorio entre ambos grupos (p > 0,05). No se encontró diferencia en los días para la reincorporación a las actividades habituales, dieta normal, días con halitosis, otalgia o náuseas. Solo se presentó un caso de sangrado postoperatorio en el grupo control. No ocurrieron complicaciones infecciosas. Conclusiones: El uso de cefalotina iv dosis única en el preoperatorio tiene la misma eficacia que el uso de amoxicilina/ácido clavulánico por vía oral durante 7 días para el control de la morbilidad en los pacientes pediátricos operados de amigdalectomía y ofrece una profilaxis antimicrobiana segura, por lo que el uso rutinario de antibióticos vía oral debe ser evitado (AU)

Introduction and objectives: Postoperative pain is the main symptom and the most incapacitating one in tonsillectomy, and prescribing oral antibiotics to reduce postoperative pain is common. The objective of this study was to evaluate the efficacy of 2 different prophylactic antibiotic schemes to reduce postoperative morbidity in paediatric patients undergoing tonsillectomy. One scheme consisted of a single-dose preoperative cephalothin, while the second was an oral antibiotic. Methods: This was an open randomized trial on patients aged 4-15 years undergoing tonsillectomy. The experimental group received single-dose intravenous cephalothin, while the control group received single-dose intravenous cephalothin plus oral suspension of amoxicillin/clavulanate for 7 days. We compared the presence and intensity of pain, limitations to normal diet, habitual activities, halitosis, otalgia and nausea within 7 days after surgery using the Wong-Baker FACES Pain Scale and a questionnaire for the parents. Results: For the 102 patients that underwent tonsillectomy (51 per group), there was no difference in the presence and severity of postoperative pain between the 2 groups (P>0.05). Neither was there any difference in the days needed to return to normal activities, normal diet, and duration of days with halitosis, otalgia or nausea. Just 1 patient from the control group had postoperative bleeding. There were no infectious complications. Conclusions: The use of single-dose preoperative intravenous cephalothin has the same efficacy as the use of oral amoxicillin/clavulanate for 7 days in reducing morbidity in paediatric patients undergoing tonsillectomy and offers safe antimicrobial prophylaxis. Consequently, the routine use of oral antibiotics should be avoided (AU)

Antibiotic prophylaxis in tonsillectomy and its relationship with postoperative morbidity.

INTRODUCTION AND OBJECTIVES: Postoperative pain is the main symptom and the most incapacitating one in tonsillectomy, and prescribing oral antibiotics to reduce postoperative pain is common. The objective of this study was to evaluate the efficacy of 2 different prophylactic antibiotic schemes to reduce postoperative morbidity in paediatric patients undergoing tonsillectomy. One scheme consisted of a single-dose preoperative cephalothin, while the second was an oral antibiotic. METHODS: This was an open randomized trial on patients aged 4-15 years undergoing tonsillectomy. The experimental group received single-dose intravenous cephalothin, while the control group received single-dose intravenous cephalothin plus oral suspension of amoxicillin/clavulanate for 7 days. We compared the presence and intensity of pain, limitations to normal diet, habitual activities, halitosis, otalgia and nausea within 7 days after surgery using the Wong-Baker FACES Pain Scale and a questionnaire for the parents. RESULTS: For the 102 patients that underwent tonsillectomy (51 per group), there was no difference in the presence and severity of postoperative pain between the 2 groups (P>.05). Neither was there any difference in the days needed to return to normal activities, normal diet, and duration of days with halitosis, otalgia or nausea. Just 1 patient from the control group had postoperative bleeding. There were no infectious complications. CONCLUSIONS: The use of single-dose preoperative intravenous cephalothin has the same efficacy as the use of oral amoxicillin/clavulanate for 7 days in reducing morbidity in paediatric patients undergoing tonsillectomy and offers safe antimicrobial prophylaxis. Consequently, the routine use of oral antibiotics should be avoided.

[First case of HIV-1 subtype C infection in Mexico]. / Infección por VIH-1 subtipo C. Primer caso informado en México.

We herein report the first case of HIV-1 subtype C described in Mexico, which was detected in a South African patient who died in Mexico of an AIDS-related non-Hodgkin lymphoma. Although HIV-1 subtype B is the predominant virus circulating in Mexico, the case reported highlights the importance of molecular monitoring of the spreading of HIV-1 subtypes.