Overnutrition as a risk factor for more serious respiratory viral infections in children: A retrospective study in hospitalized patients.

BACKGROUND: The prevalence of obesity has increased dramatically in children worldwide. Obesity has been recognized as a risk factor for more serious viral respiratory infections, mainly in adults. OBJECTIVE: To study the relationship between overnutrition (obesity and overweight) and clinical severity in children hospitalized with acute respiratory infections of viral origin. METHODS: One hundred and forty-three clinical records of children between 2 and 18 years old hospitalized for acute respiratory infection at Clínica Dávila (2014-2018) were analyzed, recording the respiratory viruses detected at the time of hospitalization, weight, and height. Nutritional status was estimated using Z score or body mass index, according to age. RESULTS: Eighty-tree3 children (58%) were positive for more than one respiratory virus. The main virus detected in monoinfection was adenovirus (9.8%), followed by respiratory syncytial virus (7.7%) and parainfluenza virus (7.7%). There were no deaths. Patients with obesity presented more days of hospitalization (P = .04), oxygen therapy (P = .03) and mechanical ventilation (P < .001), as well as a higher probability of requiring mechanical ventilation (P = .001) and of ICU admission (P = .003) compared with children with normal weight. Patients with overweight presented more days of mechanical ventilation (P < .001) than patients with normal weight. No significant differences were found between the presence of viral coinfection and nutritional status. CONCLUSION: Overnutrition is associated with greater severity of viral respiratory infection in hospitalized children.

Overnutrition, Nasopharyngeal Pathogenic Bacteria and Proinflammatory Cytokines in Infants with Viral Lower Respiratory Tract Infections.

Background: Little is known about the interaction between the nasopharyngeal bacterial profile and the nutritional status in children. In this study, our main goal was to evaluate the associations between overnutrition and the presence of four potentially pathogenic bacteria in the nasopharynx of infants with viral lower respiratory tract infections (LRTI). In addition, we determined whether changes in the nasopharyngeal bacterial profile were associated with mucosal and serum proinflammatory cytokines and with clinical disease severity. Methods: We enrolled 116 children less than 2 years old hospitalized for viral LRTI during two consecutive respiratory seasons (May 2016 to August 2017); their nutritional status was assessed, and nasopharyngeal and blood samples were obtained. S. aureus, S. pneumoniae, H. influenzae, M. catarrhalis, and respiratory viruses were identified in nasopharyngeal samples by qPCR. Cytokine concentrations were measured in nasopharyngeal and blood samples. Disease severity was assessed by the length of hospitalization and oxygen therapy. Results: Nasopharyngeal pathogenic bacteria were identified in 96.6% of the enrolled children, and 80% of them tested positive for two or more bacteria. The presence and loads of M. catarrhalis was higher (p = 0.001 and p = 0.022, respectively) in children with overnutrition (n = 47) compared with those with normal weights (n = 69). In addition, the detection of >2 bacteria was more frequent in children with overnutrition compared to those with normal weight (p = 0.02). Multivariate regression models showed that the presence and loads of S. pneumoniae and M. catarrhalis were associated with higher concentrations of IL-6 in plasma and TNF-α in mucosal samples in children with overnutrition. Conclusions: The nasopharyngeal profile of young children with overnutrition was characterized by an over representation of pathogenic bacteria and proinflammatory cytokines.

Sulfated Polysaccharide Extracted from the Green Algae Codium bernabei: Physicochemical Characterization and Antioxidant, Anticoagulant and Antitumor Activity.

Codium bernabei is a green alga that grows on Chilean coasts. The composition of its structural polysaccharides is still unknown. Hence, the aim of this work is to isolate and characterize the hot water extracted polysaccharide fractions. For this purpose, the water extracts were further precipitated in alcohol (TPs) and acid media (APs), respectively. Both fractions were characterized using different physicochemical techniques such as GC-MS, GPC, FTIR, TGA, and SEM. It is confirmed that the extracted fractions are mainly made of sulfated galactan unit, with a degree of sulfation of 19.3% (TPs) and 17.4% (ATs) and a protein content of 3.5% in APs and 15.6% in TPs. Other neutral sugars such as xylose, glucose, galactose, fucose, mannose, and arabinose were found in a molar ratio (0.05:0.6:1.0:0.02:0.14:0.11) for TPs and (0.05:0.31:1.0:0.03:0.1:0.13) for ATs. The molecular weight of the polysaccharide samples was lower than 20 kDa. Both polysaccharides were thermally stable (Tonset > 190 °C) and showed antioxidant activity according to the ABTS•+ and DPPH tests, where TPs fractions had higher scavenging activity (35%) compared to the APs fractions. The PT and APTTS assays were used to measure the anticoagulant activity of the polysaccharide fractions. In general, the PT activity of the TPs and APs was not different from normal plasma values. The exception was the TPs treatment at 1000 µg mL−1 concentration. The APTTS test revealed that clotting time for both polysaccharides was prolonged regarding normal values at 1000 µg mL−1. Finally, the antitumor test in colorectal carcinoma (HTC-116) cell line, breast cancer (MCF-7) and human leukemia (HL-60) cell lines showed the cytotoxic effect of TPs and APs. Those results suggest the potential biotechnological application of sulfate galactan polysaccharides isolated from a Chilean marine resource.

Smartphone screen testing, a novel pre-diagnostic method to identify SARS-CoV-2 infectious individuals.

The COVID-19 pandemic will likely take years to control globally, and constant epidemic surveillance will be required to limit the spread of SARS-CoV-2, especially considering the emergence of new variants that could hamper the effect of vaccination efforts. We developed a simple and robust - Phone Screen Testing (PoST) - method to detect SARS-CoV-2-positive individuals by RT-PCR testing of smartphone screen swab samples. We show that 81.3-100% of individuals with high-viral-load SARS-CoV-2 nasopharyngeal-positive samples also test positive for PoST, suggesting this method is effective in identifying COVID-19 contagious individuals. Furthermore, we successfully identified polymorphisms associated with SARS-CoV-2 Alpha, Beta, and Gamma variants, in SARS-CoV-2-positive PoST samples. Overall, we report that PoST is a new non-invasive, cost-effective, and easy-to-implement smartphone-based smart alternative for SARS-CoV-2 testing, which could help to contain COVID-19 outbreaks and identification of variants of concern in the years to come.

Performance of Saliva Samples for COVID-19 Diagnosis by Using the AllplexTM 2019-nCoV Assay Kit.

Background: Although the nasopharyngeal swab (NPS) is the reference sampling method for the detection of SARS-Cov-2, it is not always possible to collect NPS in some patients. Saliva represents an interesting sampling method because it is less invasive and more convenient in patients with nasal or pharyngeal lesions. Objective: To compare the RT-qPCR test performances of saliva samples with nasal mid-turbinate swab (NMTS) and NPS samples in a cohort of ambulatory patients suspected of having COVID-19. Study Design: For each of the 112 enrolled patients, NPS, NMTS, and saliva samples were collected and tested for SARS-Cov-2 detection using three different target genes (RdRP, N and E genes) by RT-qPCR. Results: Among the positive samples (56/112), saliva samples showed a lower percentage of SARS-Cov-2 detection compared to NPS samples, (85.7 vs. 96.4%), while still a lower percentage was observed for NMTS samples (78.6%). In average, saliva samples showed higher Ct values for all tested target genes, compared to those from NPS and NMTS samples. Conclusions: By using the AllplexTM 2019-nCoV Assay Kit, saliva samples showed lower sensitivity for SARS CoV-2 compared to NPS samples; however, the not detected cases had lower viral burden in NPS samples (CT values >33) representing an interesting alternative sampling method in patients in which it is not possible to take a NPS sample.

Chilean crab (Aegla cholchol) as a new source of chitin and chitosan with antifungal properties against Candida spp.

In the present work, the chemical composition of the Chilean freshwater crab Aegla cholchol exoskeleton was studied for the first time. α-Chitin was isolated from three main body parts (pincers, legs, carapace), and its content ranged from 9.0-10.4% (w/w). Moreover, chitosan was extracted by alkaline treatment at different temperature and time regimes. Aegla cholchol exoskeleton, chitin and chitosans were characterized by FTIR, TGA, and SEM. Chemical structure of chitin and chitosan was confirmed by NMR spectroscopy. Chitosan molecular weight determinations were carried out by GPC. The obtained chitosan samples had a degree of N-acetylation (DA) between 4 and 15% and molecular weight (Mw) in the range of 65-201 kDa. The antifungal activity of the chitosan samples and the chitooligomer were tested toward twenty isolated clinical strains of Candida yeast. Chitosan with lower DA (4%) and higher molecular weight showed the lowest minimum inhibitory concentration (MIC) values, which was evidenced by the highest antifungal activity toward Candida albicans, Candida tropicalis, Candida glabrata, and Candida parapsilosis. Results suggest that Aegla cholchol is an excellent natural source for production of bioactive materials with potential applications in the health system, to prevent infections associated with Candida strains.

Cumplimiento de las prácticas integrales del parto en los hospitales de segundo nivel del Ecuador: un aporte a la política pública / Compliance with comprehensive delivery practices in second-level hospitals in Ecuador: a contribution to public policy

Introducción: El Ministerio de Salud Pública del Ecuador (MSP) recomienda la aplicación de prácticas integrales del parto en todo parto normal; sin embargo, no se conoce el nivel del cumplimiento de estas por parte de los alumnos de obstetricia y medicina que están al final de su carrera.Objetivo: Determinar si los internos rotativos de las carreras de Obstetricia y Medicina de la Universidad Central del Ecuador (UCE) cumplen con las prácticas integrales del parto.Métodos: Estudio de Pruebas Diagnósticas realizado en pacientes que acudieron a la consulta externa del servicio de gastroeEstudio transversal en 365 nacimientos atendidos por internos rotativos de Obstetricia y de Medicina de la UCE en cinco hospitales generales del Ecuador. Se evaluó el cumplimiento de las prácticas integrales del parto me-diante observación y llenado de un formulario preestablecido sobre el cumplimiento de cada uno de los parámetros de las normas (secado del recién nacido, apego precoz, identificación del RN, lactancia materna, alojamiento con-junto y tiempo de pinzamiento de cordón). Se calculó el porcentaje de cumplimiento de cada uno de los parámetros y del cumplimiento total.Resultados: Los partos fueron atendidos por 361 personas (49.8% Obstetricia, 42.4% Medicina y 5.7% profesio-nales). Se observó cumplimiento general de las prácticas integrales del parto >86%, sin diferencias significativas con respecto al grupo que atendió el parto. Todos los parámetros cualitativos se cumplieron en más del 95%; pero el corte del cordón umbilical a los tres-cuatro minutos se cumplió en 49.6%.Conclusiones: Los internos rotativos de Obstetricia y Medicina cumplen en un alto porcentaje las normas, pero necesitan reforzar la práctica de corte de cordón umbilical al tiempo correcto.

Background: Ministry of Public Health of Ecuador recommends the application of comprehensive childbirth practi-ces in all normal deliveries; however, the level of compliance with these by obstetric and medical students at the end of their career is not known.Objective: To determine if the internship students of medicine and obstetrics careers at Central University of Ecuador (UCE) comply with the integral practices of childbirth.Methods: Cross-sectional study in 365 births attended by internship students of medicine and obstetrics careers at UCE in five general hospitals in Ecuador. Compliance with comprehensive delivery practices was evaluated by ob-serving and filling out a pre-established form on compliance with each of the parameters of the standards (newborn drying, early attachment, newborn identification, breastfeeding, joint accommodation and time cord clamping). The percentage of overall compliance and with each of the parameters and of the total compliance were calculated.Results: 361 people (49.8% Obstetrics, 42.4% Medicine and 5.7% professionals) attended the deliveries. General compliance with the comprehensive delivery practices was observed in > 86%, without significant differences with respect to the group that attended the delivery. All qualitative parameters were fulfilled in more than 95%; but the cut of the umbilical cord at three to four minutes was completed in 49.6%.Conclusions: Practitioner students from Obstetrics and Medicine met the standards in a high percentage, but need to reinforce the practice of optimal time for clamping the umbilical cord after birth.

Use of Human Fallopian Tube Organ in Culture (FTOC) and Primary Fallopian Tube Epithelial Cells (FTEC) to Study the Biology of Neisseria gonorrhoeae Infection.

Epithelial cells represent one of the most important physical barriers to many bacterial pathogens. In the case of Neisseria gonorrhoeae, the epithelial cell response is critical because they are the main target of the tissue damage triggered by the pathogen, particularly when the organism reaches the Fallopian tube (FT). Although the irreversible damage triggered by N. gonorrhoeae in the FT has been previously reported (ectopic pregnancy, pelvic inflammatory disease and infertility), the mechanisms of gonococcal-induced tissue damage are not fully understood. In addition, the lack of animal models that efficiently mimic the human disease and the complexity of gonococcus-host interactions make studying gonococcal pathogenesis particularly difficult. The use of human immortalized cells is also limited, since a variety of commercial FT cell lines is not yet available. Finally, the phase and antigenic variation of many gonococcal surface molecules involved in attachment and invasion of epithelial tissues leads to a failure to reproduce results using different human cells lines used in previous studies. The FT organ in culture (FTOC) and primary human fallopian tube epithelial cell (FTEC) represent the closest ex vivo cell models to explore the biology of Neisseria gonorrhoeae during infection of the FT, since it is a natural host target of the gonococcus. In this chapter, we describe protocols to process human FT samples to obtain FTOC and FTEC and assess their response to infection with Neisseria gonorrhoeae.

A prospective, multi-center study of Candida bloodstream infections in Chile.

BACKGROUND: Active surveillance is necessary for improving the management and outcome of patients with candidemia. The aim of this study was to describe epidemiologic and clinical features of candidemia in children and adults in tertiary level hospitals in Chile. METHODS: We conducted a prospective, multicenter, laboratory-based survey study of candidemia in 26 tertiary care hospitals in Chile, from January 2013 to October 2017. RESULTS: A total of 780 episodes of candidemia were included, with a median incidence of 0.47/1,000 admissions. Demographic, clinical and microbiological information of 384 cases of candidemia, from 18 hospitals (7,416 beds), was included in this report. One hundred and thirty-four episodes (35%) occurred in pediatric patients and 250 (65%) in adult population. Candida albicans (39%), Candida parapsilosis (30%) and Candida glabrata (10%) were the leading species, with a significant difference in the distribution of species between ages. The use of central venous catheter and antibiotics were the most frequent risk factors in all age groups (> 70%). Three hundred and fifteen strains were studied for antifungal susceptibility; 21 strains (6.6%) were resistant to fluconazole, itraconazole, voriconazole, anidulafungin or micafungin. The most commonly used antifungal therapies were fluconazole (39%) and echinocandins (36%). The overall 30-day survival was 74.2%, significantly higher in infants (82%) and children (86%) compared with neonates (72%), adults (71%) and elderly (70%). CONCLUSIONS: Our prospective, multicenter surveillance study showed a low incidence of candidemia in Chile, with high 30-day survival, a large proportion of elderly patients, C. glabrata as the third most commonly identified strain, a 6.6% resistance to antifungal agents and a frequent use of echinocandins.

Protective effect of inactivated blastoconidia in keratinocytes and human reconstituted epithelium against C. albicans infection.

Candida albicans is commensal yeast that colonizes skin and mucosa; however, it can become an opportunist pathogen by changing from blastoconidia (commensal form) into hypha (pathogenic form). Each form activates a different cytokines response in epithelial cells. Little is known about the commensal role of C. albicans in the innate immunity. This work studied whether stimulation with C. albicans blastoconidia induces protection in keratinocytes and/or in a reconstituted human epithelium (RHE) infected with C. albicans. For this, inactivated C. albicans blastoconidia was used to stimulate keratinocytes and RHE prior to infection with C. albicans. Blastoconidia induced different cytokine expression profiles; in the case of RHE it decreased interleukin (IL)-1ß and IL-10 and increased IL-8, tumor necrosis factor α (TNF-α), and interferon γ (IFN-γ). A significant increase in the expression of human ß-defensins (HBD) 2 and HBD3 was observed in blastoconidia stimulated keratinocytes and RHE, associated with impaired growth and viability of C. albicans. Additionally, blastoconidia stimulation decreased the expression of virulence factors in C. albicans that are associated with filamentation (EFG1, CPH1 and NRG1), adhesion (ALS5), and invasion (SAP2). Blastoconidia stimulated RHE was significantly less damaged by C. albicans invasion. These results show that the commensal form of C. albicans would exert a protective effect against self-infection.

Microbiological characterisation of the colonisation by Candida sp in patients with orthodontic fixed appliances and evaluation of host responses in saliva.

OBJECTIVES: We investigated the colonisation by Candida spp in patients using orthodontic fixed appliances by characterising the isolated Candida strains and by evaluating the host oral mucosa response through the measure of human ß-defensins 3 (HBD-3) expression and Interleukin-1ß/IL-10. METHODS: Ninety patients were enrolled after signing an informed consent. Prevalence, susceptibility to fluconazole, genotyping and oral fungal burden of Candida sp. isolated were determined. Host responses were evaluated by measuring HBD-3 expression as well as IL-1ß and IL-10 in saliva. RESULTS: The colonisation rate reached 6.7% (6/90), and 5 patients were colonised with C. albicans strains and one with one with C. tropicalis. The fluconazole MIC90/susceptibility of C. albicans strains ranged 1/0.25-1 µg/mL. However, isolated strains did not present different genotype (SAB>0.9), C. albicans colonisation seems to be influenced by the duration of treatment and by level expression of HBD3 that were higher in colonised patients (not statistically different). A negative correlation between the fungal burden and IL-1ß levels was found in colonised patients but not for IL-10. CONCLUSIONS: Our study revealed that patients with orthodontic fixed appliances were mainly colonised by C. albicans, which was related to a decrease in HBD-3 expression and IL-1ß levels.

Percepción de los estudiantes y docentes de Enfermería con respecto a la pertinencia de la rúbrica de evaluación clínica / Perception of nursing students and teachers regarding the relevance of the clinical evaluation rubric

Introducción: La reflexión conjunta de estudiantes y docentes acerca de los procesos y factores involucrados tanto en el aprendizaje como en la enseñanza y evaluación, logrará mayores niveles de entendimiento a partir del intercambio de ideas, valoraciones y percepciones que se generan entre los distintos actores del proceso formativo. Objetivo: Conocer la percepción de los estudiantes y docentes de enfermería con respecto a la pertinencia de la rúbrica de evaluación clínica utilizada en la asignatura de enfermería médico quirúrgica, de tercer año de la carrera, en una universidad privada de Chile. Métodos: Investigación cualitativa con muestreo opinático. Se aplicaron encuestas semiestructuradas a un grupo de 16 participantes entre docentes y estudiantes de enfermería, las que fueron trascritas verbatim. Se realizó análisis de contenido, detallándose aspectos del fenómeno de estudio y buscando las categorías de significado que dieran respuesta al objetivo de la investigación. Resultados: El fenómeno de estudio emergió en tres grandes unidades de significado: impresión global de la utilidad del instrumento; dimensiones deficitarias de la rúbrica de evaluación y propuestas de mejora. Conclusiones: Es importante considerar la opinión de docentes y estudiantes sobre la rúbrica de evaluación a ser utilizada, ya que son un insumo para monitorizar de manera cualitativa el comportamiento del instrumento, considerando su carácter flexible, abierto y dinámico, que requiere de una permanente revisión, a fin de asegurar su calidad, para ser finalmente, un verdadero aporte al proceso de enseñanza-aprendizaje(AU)

Introduction: Joint reflection of students and teachers about the processes and factors involved in both learning and teaching and evaluation will achieve higher levels of understanding from the exchange of ideas, assessments and perceptions that are generated among the different participants in the training process. Objective: To know the Nursing students' and teachers' perception about the relevance of the clinical evaluation method used in the subject Surgical-Medical Nursing during the third academic year of the major, at a private university in Chile. Methods: Qualitative research with opinion sampling. Semi-structured surveys were applied to a group of 16 participants among teachers and nursing students, which were transcribed verbatim. Content analysis was carried out, detailing aspects of the studied phenomenon and looking for the categories of meaning that would answer the objective of the research. Results: The studied phenomenon emerged in three large units of meaning: global impression about the usefulness of the instrument; deficit dimensions of the evaluation method, and improvement proposals. Conclusions: It is important to consider the professors' and students' opinion about the evaluation method to be used, since they are an input to monitor qualitatively the behavior of the instrument, considering its flexible, open and dynamic nature, which requires a permanent revision, in order to ensure its quality, to be finally a true contribution to the teaching-learning process(AU)

Differential Antifungal Activity of Human and Cryptococcal Melanins with Structural Discrepancies.

Melanin is a pigment found in all biological kingdoms, and plays a key role in protection against ultraviolet radiation, oxidizing agents, and ionizing radiation damage. Melanin exerts an antimicrobial activity against bacteria, fungi, and parasites. We demonstrated an antifungal activity of synthetic and human melanin against Candida sp. The members of the Cryptococcus neoformans and C. gattii species complexes are capsulated yeasts, which cause cryptococcosis. For both species melanin is an important virulence factor. To evaluate if cryptococcal and human melanins have antifungal activity against Cryptococcus species they both were assayed for their antifungal properties and physico-chemical characters. Melanin extracts from human hair and different strains of C. neoformans (n = 4) and C. gattii (n = 4) were investigated. The following minimum inhibitory concentrations were found for different melanins against C. neoformans and C. gattii were (average/range): 13.7/(7.8-15.6) and 19.5/(15.6-31.2) µg/mL, respectively, for human melanin; 273.4/(125->500) and 367.2/(125.5->500) µg/mL for C. neoformans melanin and 125/(62.5-250) and 156.2/(62-250) µg/mL for C. gattii melanin. Using Scanning Electron Microscopy we observed that human melanin showed a compact conformation and cryptococcal melanins exposed an amorphous conformation. Infrared spectroscopy (FTIR) showed some differences in the signals related to C-C bonds of the aromatic ring of the melanin monomers. High Performance Liquid Chromatography established differences in the chromatograms of fungal melanins extracts in comparison with human and synthetic melanin, particularly in the retention time of the main compound of fungal melanin extracts and also in the presence of minor unknown compounds. On the other hand, MALDI-TOF-MS analysis showed slight differences in the spectra, specifically the presence of a minor intensity ion in synthetic and human melanin, as well as in some fungal melanin extracts. We conclude that human melanin is more active than the two fungal melanins against Cryptococcus. Although some physico-chemical differences were found, they do not explain the differences in the antifungal activity against Cryptococcus of human and cryptococcal melanins. More detailed studies on the structure should be considered to associate structure and antifungal activity.