ABSTRACT
BACKGROUND: In Ecuador, data on molecular epidemiology, as well as circulating clones, are limited. Therefore, this study aims to know the population structure of Pseudomonas aeruginosa by identifying clones in clinical samples in Quito-Ecuador. METHODS: A significant set (45) clinical Pseudomonas aeruginosa isolates were selected, including multidrug and non-multidrug resistant isolates, which were assigned to sequence types (STs) and compared with their antibiotic susceptibility profile. The genetic diversity was assessed by applying the multilocus sequence typing (MLST) scheme and the genetic relationships between different STs were corroborated by phylogenetic networks. RESULTS: The MLST analysis identified 24 different STs and the most prevalent STs were ST-3750 and ST-253. The majority of the multidrug-resistance (MDR) isolates were included in ST-3750 and ST-253, also 3 singleton STs were identified as MDR isolates. The 21 different STs were found in non-multidrug resistance (non-MDR) isolates, and only 3 STs were found in more the one isolate. CONCLUSIONS: The population structure of clinical P. aeruginosa present in these isolates indicates a significant association between MDR isolates and the clonal types: all ST-3750 and ST-253 isolates were MDR. ST-3750 is a closely related strain to the clonal complex ST111 (CC111). ST-253 and ST111 are a group of successful high-risk clones widely distributed worldwide. The multiresistant isolates studied are grouped in the most prevalent sequence types found, and the susceptible isolates correspond mainly to singleton sequence types. Therefore, these high-risk clones and their association with multidrug-resistance phenotypes are contributing to the spread of MDR in Quito-Ecuador.
ABSTRACT
BACKGROUND: Neurological manifestations of Rheumatoid Arthritis (RA) are usually uncommon. However, a number of recent studies have reported that the burden of cognitive impairment in RA could be significant. We sought to explore the prevalence and clinical predictors of cognitive impairment in persons with RA. METHODS: This is a cross-sectional case-control study with patients with RA. Different trained and blinded interviewers registered clinical-epidemiological data and applied a standardized neurological assessment for each subject of the study. At baseline, functional limitations were characterized using the Health Assessment Questionnaire (HAQ). Cognitive impairment was evaluated with the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) while neuropsychiatric symptoms were investigated with the Hospital Anxiety and Depression Scale (HADS). Using a proper statistical analysis, we compared the neurological outcomes between case and controls and we determined the clinical predictors of cognitive decline. RESULTS: A total of 210 patients with RA and 70 healthy controls were included in our study. More than two thirds of our patients were classified as cognitively impaired. The mean MMSE and MoCA scores were significantly lower in RA subjects compared to the control group (pâ¯<â¯0.001). Neuropshychiatric impairment was more prevalent in RA patients (59.5%) than in controls (17.1%) as well (pâ¯<â¯0.001). Greater functional limitations were correlated with worse MMSE, MoCA and HADS scores (pâ¯<â¯0.001). CONCLUSION: The findings of this study suggest that there is evidence of cognitive impairment in adults with RA.
Subject(s)
Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/psychology , Cognitive Dysfunction/etiology , Adult , Aged , Case-Control Studies , Cognitive Dysfunction/diagnosis , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Neuropsychological TestsABSTRACT
The authors describe the clinical investigation of two cases of primary aldosteronism with adrenal hemorrhage (AH) following adrenal vein sampling. A literature review was conducted regarding the medical management of primary aldosteronism in patients with AH following adrenal vein sampling. Guidelines on the management of primary aldosteronism with AH following adrenal vein sampling are lacking. The two patients were followed with serial imaging to document resolution of AH and treated medically with excellent blood pressure response. Resolution of AH was achieved, but a repeat adrenal vein sampling was deferred given the increased morbidity risk associated with a repeat procedure.