Experiences, behaviours, and perspectives of young cancer survivors on physical activity.

This narrative review aimed to identify young cancer survivors' behaviours, experiences, and perspectives concerning physical activity, and identify useful strategies for promoting a healthy lifestyle. A manual search on the following databases was conducted: PubMed, Scopus, and Web of Science. The search was conducted between June 1, 2023, and April 12, 2024. Articles published from database inception up to April 12, 2024, were retrieved. Articles published in any language were considered. Perspectives including ideas, perceived barriers, and facilitators have been identified. Young cancer survivors seem to engage in physical activity as a useful coping strategy to regain normality and keep healthy after the cancer diagnosis. Although emotional and social support seems fundamental to increase participation, several other factors, including physical limitations, fatigue, sex, cancer type, and socio-economic status can influence physical activity participation. For those engaged in physical activity, the preferred activities are walking, biking, going to the gym, and exercising at home, while the least preferred are exercising at the hospital or boot camp-based exercises. Yoga is more frequently chosen by those still under treatment. Young cancer survivors appear to have unique needs different from those of adult cancer survivors. Mode of treatment delivery, increased awareness concerning the effects of physical activity, including families and friends, connecting survivors, and providing social support together with increasing motivation are key strategies for the promotion of physical activity in young cancer survivors. Fitness and healthcare professionals should consider these aspects to increase young cancer survivors' involvement in physical activities.

Short- and mid-term morbidity and primary-care burden due to infant respiratory syncytial virus infection: A Spanish 6-year population-based longitudinal study.

BACKGROUND: The morbidity burden of respiratory syncytial virus (RSV) in infants extends beyond hospitalization. Defining the RSV burden before implementing prophylaxis programs is essential for evaluating any potential impact on short- to mid-term morbidity and the utilization of primary healthcare (PHC) and emergency services (ES). We established this reference data using a population-based cohort approach. METHODS: Infants hospitalized for RSV from January 2016 to March 2023 were matched with non-hospitalized ones based on birthdate and sex. We defined the exposure as severe RSV hospitalization. The main study outcomes were as follows: (1) PHC and ES visits for RSV, categorized using the International Classification of Primary Care codes, (2) prescriptions for respiratory airway obstructive disease, and (3) antibacterial prescriptions. Participants were followed up from 30 days before hospitalization for severe RSV until the outcome occurrence or end of the study. Adjusted incidence rate ratios (IRRs) of the outcomes along with their 95% confidence intervals (CI) were estimated using Poisson regression models. Stratified analyses by type of PHC visit (nurse, pediatrician, or pharmacy) and follow-up period were undertaken. We defined mid-term outcomes as those taking place up to 24 months of follow-up period. RESULTS: The study included 6626 children (3313 RSV-hospitalized; 3313 non-hospitalized) with a median follow-up of 53.7 months (IQR = 27.9, 69.4). After a 3-month follow-up, severe RSV was associated with a considerable increase in PHC visits for wheezing/asthma (IRR = 4.31, 95% CI: 3.84-4.84), lower respiratory infections (IRR = 4.91, 95% CI: 4.34-5.58), and bronchiolitis (IRR = 4.68, 95% CI: 2.93-7.65). Severe RSV was also associated with more PHC visits for the pediatrician (IRR = 2.00, 95% CI: 1.96-2.05), nurse (IRR = 1.89, 95% CI: 1.75-1.92), hospital emergency (IRR = 2.39, 95% CI: 2.17-2.63), primary healthcare emergency (IRR: 1.54, 95% CI: 1.31-1.82), as well as with important increase in prescriptions for obstructive airway diseases (IRR = 5.98, 95% CI: 5.43-6.60) and antibacterials (IRR = 4.02, 95% CI: 3.38-4.81). All findings remained substantial until 2 years of post-infection. CONCLUSIONS: Severe RSV infection in infants significantly increases short- to mid-term respiratory morbidity leading to an escalation in healthcare utilization (PHC/ES attendance) and medication prescriptions for up to 2 years afterward. Our approach could be useful in assessing the impact and cost-effectiveness of RSV prevention programs.

Effectiveness and impact of universal prophylaxis with nirsevimab in infants against hospitalisation for respiratory syncytial virus in Galicia, Spain: initial results of a population-based longitudinal study.

BACKGROUND: Galicia (Spain) was one of the first regions worldwide to incorporate nirsevimab for universal respiratory syncytial virus (RSV) prophylaxis in infants into its immunisation programme. The NIRSE-GAL longitudinal population-based study aimed to assess nirsevimab effectiveness in preventing hospitalisations (ie, admittance to hospital). METHODS: The 2023-24 immunisation campaign with nirsevimab in Galicia began on Sept 25, 2023, and concluded on March 31, 2024. The campaign targeted three groups: infants born during the campaign (seasonal group), infants younger than 6 months at the start of the campaign (catch-up group), and infants aged 6-24 months with high-risk factors at the start of the campaign (high-risk group). Infants in the seasonal group were offered immunisation on the first day of life before discharge from hospital. Infants in the catch-up and high-risk groups received electronic appointments to attend a public hospital or health-care centre for nirsevimab administration. For this interim analysis, we used data collected from Sept 25 to Dec 31, 2023, from children born up to Dec 15, 2023. Data were retrieved from public health registries. Nirsevimab effectiveness in preventing RSV-associated lower respiratory tract infection (LRTI) hospitalisations; severe RSV-related LRTI requiring intensive care unit admission, mechanical ventilation, or oxygen support; all-cause LRTI hospitalisations; and all-cause hospitalisations was estimated using adjusted Poisson regression models. Data from five past RSV seasons (2016-17, 2017-18, 2018-19, 2019-20, and 2022-23), excluding the COVID-19 pandemic period, were used to estimate the number of RSV-related LRTI hospitalisations averted along with its IQR. The number needed to immunise to avoid one case in the 2023-24 season was then estimated from the averted cases. Nirsevimab safety was routinely monitored. The NIRSE-GAL study protocol was registered on ClinicalTrials.gov (NCT06180993), and follow-up of participants is ongoing. FINDINGS: 9408 (91·7%) of 10 259 eligible infants in the seasonal and catch-up groups received nirsevimab, including 6220 (89·9%) of 6919 in the catch-up group and 3188 (95·4%) of 3340 in the seasonal group. 360 in the high-risk group were offered nirsevimab, 348 (97%) of whom received it. Only infants in the seasonal and catch-up groups were included in analyses to estimate nirsevimab effectiveness and impact because there were too few events in the high-risk group. In the catch-up and seasonal groups combined, 30 (0·3%) of 9408 infants who received nirsevimab and 16 (1·9%) of 851 who did not receive nirsevimab were hospitalised for RSV-related LRTI, corresponding to an effectiveness of 82·0% (95% CI 65·6-90·2). Effectiveness was 86·9% (69·1-94·2) against severe RSV-related LRTI requiring oxygen support, 69·2% (55·9-78·0) against all-cause LRTI hospitalisations, and 66·2% (56·0-73·7) against all-cause hospitalisations. Nirsevimab effectiveness against other endpoints of severe RSV-related LRTI could not be estimated because of too few events. RSV-related LRTI hospitalisations were reduced by 89·8% (IQR 87·5-90·3), and the number needed to immunise to avoid one RSV-related LRTI hospitalisation was 25 (IQR 24-32). No severe adverse events related to nirsevimab were registered. INTERPRETATION: Nirsevimab substantially reduced infant hospitalisations for RSV-associated LRTI, severe RSV-associated LRTI requiring oxygen, and all-cause LRTI when given in real-world conditions. These findings offer policy makers and health authorities robust, real-world, population-based evidence to guide the development of strategies for RSV prevention. FUNDING: Sanofi and AstraZeneca. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.

Assessment of effectiveness and impact of universal prophylaxis with nirsevimab for prevention of hospitalizations due to respiratory syncytial virus in infants. The NIRSE-GAL study protocol.

Nirsevimab has been recently licensed for universal RSV prophylaxis in infants. NIRSE-GAL is a three-year population-based study initiated in Galicia in September 2023. It aims to evaluate nirsevimab effectiveness against RSV-related hospitalizations lower respiratory tract infections (LRTI), severe RSV, all-cause LRTI, and all-cause hospitalization. NIRSE-GAL also aims to estimate nirsevimab impact on primary healthcare use in the short and mid-term, children's wheezing and asthma, and medical prescriptions for RSV. The immunization campaigns will be scheduled based on the expected start week for the RSV season and will last the whole season. Immunization will be offered to: i) infants born during the campaign (seasonal), ii) infants < 6 months at the start of the campaign (catch-up), and iii) infants with high-risk factors, aged 6-24 months at the start of the campaign (high-risk). The follow-up period will start: i) the immunization date for all immunized infants, ii) the start of the campaign, for the non-immunized catch-up or high-risk groups, or iii) the birthdate for the non-immunized seasonal group. Infants will be followed up until outcome occurrence, death, or end of study. Nirsevimab effectiveness will be estimated using Poisson and Cox regression models. Sensitivity and stratified analyses will be undertaken. The number of averted cases and the number needed to immunize will be estimated. Immunization failure and nirsevimab safety will be monitored. NIRSE-GAL was approved by the ethics committee of Galicia (CEIC 2023-377) and registered in ClinicalTrials.gov (ID: NCT06180993). Findings will be mainly shared via peer-reviewed publications and scientific conferences.

Translation initiation factor eIF1A rescues hygromycin B sensitivity caused by deleting the carboxy-terminal tail in the GPN-loop GTPase Npa3.

The essential yeast protein GPN-loop GTPase 1 (Npa3) plays a critical role in RNA polymerase II (RNAPII) assembly and subsequent nuclear import. We previously identified a synthetic lethal interaction between a mutant lacking the carboxy-terminal 106-amino acid tail of Npa3 (npa3ΔC) and a bud27Δ mutant. As the prefoldin-like Bud27 protein participates in ribosome biogenesis and translation, we hypothesized that Npa3 may also regulate these biological processes. We investigated this proposal by using Saccharomyces cerevisiae strains episomally expressing either wild-type Npa3 or hypomorphic mutants (Npa3ΔC, Npa3K16R, and Npa3G70A). The Npa3ΔC mutant fully supports RNAPII nuclear localization and activity. However, the Npa3K16R and Npa3G70A mutants only partially mediate RNAPII nuclear targeting and exhibit a higher reduction in Npa3 function. Cell proliferation in these strains displayed an increased sensitivity to protein synthesis inhibitors hygromycin B and geneticin/G418 (npa3G70A > npa3K16R > npa3ΔC > NPA3 cells) but not to transcriptional elongation inhibitors 6-azauracil, mycophenolic acid or 1,10-phenanthroline. In all three mutant strains, the increase in sensitivity to both aminoglycoside antibiotics was totally rescued by expressing NPA3. Protein synthesis, visualized by quantifying puromycin incorporation into nascent-polypeptide chains, was markedly more sensitive to hygromycin B inhibition in npa3ΔC, npa3K16R, and npa3G70A than NPA3 cells. Notably, high-copy expression of the TIF11 gene, that encodes the eukaryotic translation initiation factor 1A (eIF1A) protein, completely suppressed both phenotypes (of reduced basal cell growth and increased sensitivity to hygromycin B) in npa3ΔC cells but not npa3K16R or npa3G70A cells. We conclude that Npa3 plays a critical RNAPII-independent and previously unrecognized role in translation initiation.

KPC-2 allelic variants in Klebsiella pneumoniae isolates resistant to ceftazidime-avibactam from Argentina: blaKPC-80, blaKPC-81, blaKPC-96 and blaKPC-97.

Ceftazidime-avibactam (CZA) therapy has significantly improved survival rates for patients infected by carbapenem-resistant bacteria, including KPC producers. However, resistance to CZA is a growing concern, attributed to multiple mechanisms. In this study, we characterized four clinical CZA-resistant Klebsiella pneumoniae isolates obtained between July 2019 and December 2020. These isolates expressed novel allelic variants of blaKPC-2 resulting from changes in hotspots of the mature protein, particularly in loops surrounding the active site of KPC. Notably, KPC-80 had an K269_D270insPNK mutation near the Lys270-loop, KPC-81 had a del_I173 mutation within the Ω-loop, KPC-96 showed a Y241N substitution within the Val240-loop and KPC-97 had an V277_I278insNSEAV mutation within the Lys270-loop. Three of the four isolates exhibited low-level resistance to imipenem (4 µg/mL), while all remained susceptible to meropenem. Avibactam and relebactam effectively restored carbapenem susceptibility in resistant isolates. Cloning mutant blaKPC genes into pMBLe increased imipenem MICs in recipient Escherichia coli TOP10 for blaKPC-80, blaKPC-96, and blaKPC-97 by two dilutions; again, these MICs were restored by avibactam and relebactam. Frameshift mutations disrupted ompK35 in three isolates. Additional resistance genes, including blaTEM-1, blaOXA-18 and blaOXA-1, were also identified. Interestingly, three isolates belonged to clonal complex 11 (ST258 and ST11) and one to ST629. This study highlights the emergence of CZA resistance including unique allelic variants of blaKPC-2 and impermeability. Comprehensive epidemiological surveillance and in-depth molecular studies are imperative for understanding and monitoring these complex resistance mechanisms, crucial for effective antimicrobial treatment strategies. IMPORTANCE: The emergence of ceftazidime-avibactam (CZA) resistance poses a significant threat to the efficacy of this life-saving therapy against carbapenem-resistant bacteria, particularly Klebsiella pneumoniae-producing KPC enzymes. This study investigates four clinical isolates exhibiting resistance to CZA, revealing novel allelic variants of the key resistance gene, blaKPC-2. The mutations identified in hotspots surrounding the active site of KPC, such as K269_D270insPNK, del_I173, Y241N and V277_I278insNSEAV, prove the adaptability of these pathogens. Intriguingly, low-level resistance to imipenem and disruptions in porin genes were observed, emphasizing the complexity of the resistance mechanisms. Interestingly, three of four isolates belonged to clonal complex 11. This research not only sheds light on the clinical significance of CZA resistance but also shows the urgency for comprehensive surveillance and molecular studies to inform effective antimicrobial treatment strategies in the face of evolving bacterial resistance.

Nucleocytoplasmic shuttling of the GPN-loop GTPase Gpn3 is regulated by serum and cell density in MCF-12A mammary cells.

The best-known function of the essential GPN-loop GTPase Gpn3 is to contribute to RNA polymerase II assembly, a prerequisite for its nuclear targeting. Although this process occurs in the cytoplasm, we have previously shown that Gpn3 enters the cell nucleus before being polyubiquitinated. Here, we show that inhibiting Crm1-mediated nuclear export with leptomycin B, or the proteasome with MG132, caused the nuclear accumulation of recombinant and endogenous Gpn3 in MCF-12A cells. When added simultaneously, leptomycin B and MG132 had an additive effect. Analysis of Gpn3 primary sequence revealed the presence of at least five nuclear export sequence (NES) motifs, with some having a higher exposure to the solvent in the GTP-bound than GDP-bound state in a Gpn3 structural model. Inactivation of any of these NESes led to some degree of Gpn3 nuclear accumulation, although mutating NES1 or NES3 had the more robust effect. MCF-12A cells expressing exclusively a NES-deficient version of Gpn3R-Flag proliferated slower than cells expressing Gpn3R-Flag wt, indicating that nuclear export is important for Gpn3 function. Next, we searched for physiological conditions regulating Gpn3 nucleocytoplasmic shuttling. Interestingly, whereas Gpn3R-Flag was both nuclear and cytoplasmic in low-density growing MCF-12A cells, it was exclusively cytoplasmic in high-density areas. Furthermore, Gpn3R-Flag was cytoplasmic, mostly perinuclear, in sparse but starved MCF-12A cells, and serum-stimulation caused a rapid, although transient, Gpn3R-Flag nuclear accumulation. We conclude that Gpn3 nucleocytoplasmic shuttling is regulated by cell density and growth factors, and propose that Gpn3 has an unknown nuclear function positively linked to cell growth and/or proliferation.

National action plans on antimicrobial resistance in Latin America: an analysis via a governance framework.

In 2015, the World Health Assembly adopted a global action plan (GAP) on antimicrobial resistance (AMR). Member states were encouraged to develop their own national action plans (NAPs) in alignment with the GAP. To-date, in systematic assessments of NAPs, the Latin American specific context has not been previously analysed. Here we examined 11 Latin American NAPs published between 2015 and 2021 using content analysis. We focused on two approaches: (1) alignment between the strategic objectives and actions defined in the GAP, and those outlined in the NAPs via a content indicator; and (2) assessment of the NAPs via a governance framework covering 'policy design', 'implementation tools' and 'monitoring and evaluation' areas. We observed a high alignment with the strategic objectives of the GAP; however, the opposite was observed for the corresponding actions. Our results showed that the governance aspects contained within coordination and participation domains were addressed by every Latin American NAP, whereas monitoring and assessment areas, as well as incorporating the environment, would need more attention in subsequent NAPs. Given that AMR is a global health threat and collective efforts across regions are necessary to combat it, our findings can benefit member states by highlighting how to strengthen the AMR strategies in Latin America, while also supporting global policy formulation.

One more rep! The case for resistance training in young cancer survivors.

Resistance training is now seen as a powerful tool to improve the health and functionality of cancer survivors. Literature shows that it can be implemented both during and after cancer treatment, with the intent of preserving muscle mass in the former and increasing muscle mass in the latter case. However, currently available data on this matter are predominantly derived from adult cancer survivors (ACS), and it is questionable whether the exact same raining regimen should be implemented in young cancer survivors (YCS) given the unique challenges they experience throughout their disease trajectory. Therefore, the goal of this work is to distill the existing evidence on resistance training (RT) interventions in ACS and facilitate discussion on whether the same patterns of RT can be applied in YCS.

Characterization of third generation cephalosporin-resistant Escherichia coli clinical isolates from Ushuaia, Argentina / Caracterización de aislamientos clínicos de Escherichia coli resistente a cefalosporinas de tercera generación de Ushuaia, Argentina

Abstract Escherichia coli is one of the main human pathogens causing different hospital- and community-acquired infections. During the period from January 2013 to March 2015, 1.96% (32/1632) of E. coli isolates recovered at the Hospital Regional de Ushuaia, Tierra del Fuego province, were resistant to third-generation cephalosporins (TGCs). These isolates were resistant to cefotaxime (91%) and/or ceftazidime (28%). No resistance to carbapenems was detected. Twenty-six isolates were positive for blaCTX-M gene, grouped as CTX-M-1/15 (54%); CTX-M-9/14 (25%); CTX-M-2 (17%); and CTX-M-1/15 plus CTX-M-9/14 (4%). Five TGC-resistant strains were positive for blaCMY gene, while one strain harbored TEM-19 ESBL. Twelve isolates were identified as ST131 E. coli hyperepidemic clone, and one as ST69. Genome sequence analysis of seven blaCTX-M-15 E. coli selected isolates confirm the circulation of ST131, ST617 and ST405 international high-risk clones in the city of Ushuaia.

Resumen Escherichia coli es uno de los principales patógenos humanos causantes de diferentes infecciones de inicio hospitalario y comunitario. Se determinó que el 1,96% (32/1.632) de los aislamientos de E. coli recuperados entre enero de 2013 y marzo de 2015 en el Hospital Regional de Ushuaia, provincia de Tierra del Fuego, fueron resistentes a cefalosporinas de tercera generación (CTG). Estos aislamientos fueron resistentes a cefotaxima (91%) y/o a ceftazidima (28%). No se detectó resistencia a los carbapenemes. Veintiséis aislamientos fueron positivos para el gen blaCTX-M, agrupados como CTX-M-1/15 (54%), CTX-M-9/14 (25%), CTX-M-2 (17%) y CTX-M-1/15 más CTX-M-9/14 (4%). Cinco cepas resistentes a CTG dieron positivo para el gen blaCMY, mientras que un aislamiento presentó la BLEE TEM-19. Doce aislamientos se identificaron como clon hiperepidémico E. coli ST131 y uno como ST69. El análisis de las secuencias del genoma de siete aislamientos seleccionados de E. coli blaCTX-M-15 confirmó la circulación de los clones internacionales de alto riesgo ST131, ST617 y ST405 en la ciudad de Ushuaia.

Diálogos abiertos en un grupo multifamiliar dentro de un programa de atención a primeras crisis psicóticas / Open dialogues in a multifamily group within a program of care for first psychotic crises

Introducción: describimos la experiencia de un grupo multifamiliar, dirigido a jóvenes y su red social, afectados por primeras crisis psicóticas, en la práctica clínica real dentro del Sistema Sanitario Nacional de Salud de España, bajo la filosofía de Diálogos Abiertos, en el contexto de pandemia por COVID-19. Método: Participan 3 familias y 3 profesionales de la red de salud mental. Instrumentos: SCORE-15, SWLS, CSQ-8 y un registro de temas que aparecen en los diálogos. Resultados: tanto los 5 sujetos como las facilitadoras perciben mejoría a nivel de funcionamiento familiar y utilidad de la terapia; solo uno de los sujetos informa de mejoría a nivel de satisfacción vital al finalizar el grupo; observamos una alta satisfacción con la atención recibida en el grupo por parte de los participantes. Discusión: la fortaleza de este estudio es su validez ecológica. Los resultados obtenidos y las sinergias que se desarrollan en los encuentros dialógicos multifamiliares aquí descritos nos permiten confiar en que otras maneras de hacer más alineadas con los principios de Diálogos Abiertos, con los recursos de que disponemos en nuestro contexto sanitario, son posibles ya (AU)

Introduction: We describe the experience of a multi-family group, directed at young people affected by their first psychotic crisis and their social networks, in a real clinical environment within the Spanish national health system, based on the Open Dialogue philosophy, in the context of the COVID-19 pandemic. Method: three families and three mental health professionals took part in the study. Instruments: SCORE-15, SWLS, CSQ-8 and a list of themes that appear in the dialogues.Results: both the five subjects and the facilitators perceive an improvement in the level of family functioning and the usefulness of the therapy; only one of the subjects reports an improvement in the level of life satisfaction at the end of the group; we observe high satisfaction on the part of the participants with the care received in the group. Discussion: the strength of this study is its ecological validity. The results obtained, and the synergies developed in the multifamily meetings described here, demonstrate that different methods more aligned with the principles of Open Dialogues are now possible with the resources available in our clinical context (AU)

Role of cardiorespiratory fitness on the associations between endocannabinoid system and depressive symptoms in adults diagnosed with depression: the SONRIE study / Papel de la capacidad cardiorrespiratoria en la asociación entre el sistema endocannabinoide y los síntomasdepresivos en adultos diagnosticados de depresión: el estudio SONRIE / O papel da capacidade cardiorrespiratória na associação entre o sistema endocanobinóido e os sintomasdepressivos em adultos diagnostados com a depressão: o estudo SONRIE

Objective: Endocannabinoid system (ES) seems to be altered in patients with depression. Cardiorespiratory fitness (CRF) may be an interacting factor inthe relationship between ES biomarkers and depressive symptoms in people diagnosed with depression. The aim was to study the role of CRF on thepossible association between ES biomarkers and depressive symptoms in 73 adults diagnosed with depression. Method: This study examine the outcomes of cardiorespiratory fitness and plasma levels of the lipid mediators; anandamide (AEA) and 2-arachidonoylglycerol (2-AG) sampled from 73 adults diagnosed with depression.Results: Patients with high CRF level had significant and inverse association among depressive symptoms and 2-AG serum levels ( : -0.013; 95% CI: -β: -0.013; 95% CI: -0.262 to -0.000; R²=22.6; P<0.001).Conclusions: Higher CRF levels could have a protective role on depressive symptoms by increases in 2-AG.(AU)

Objetivo: El sistema endocannabinoide (SE) parece estar alterado en pacientes con depresión. La capacidad cardiorrespiratoria (CRF) puede ser un factor que interactúe en la relación entre los biomarcadores del SE y los síntomas depresivos en personas diagnosticadas de depresión. El objetivo de este trabajo es estudiar el papel del CRF en la posible asociación entre los biomarcadores de ES y los síntomas depresivos en 73 adultos diagnosticados de depresión. Método: Este estudio examina los resultados de la aptitud cardiorrespiratoria y los niveles plasmáticos de los mediadores lipídicos; anandamida (AEA) y 2-araquidoilglicerol (2-AG) en 73 adultos diagnosticados de depresión.Resultados: Los pacientes con alto nivel de CRF tuvieron una asociación significativa e inversa entre los síntomas depresivos y los niveles séricos de 2-AG ( : -0,013; IC 95%: -0,262 a -0,000; R²=22,6; P<0,001). β: -0.013; 95% CI: -Conclusiones: Los niveles más altos de CRF podrían tener un papel protector sobre los síntomas depresivos por el aumento de 2-AG.(AU)

Objetivo: O sistema endocannabinoide (ES) parece ser alterado em doentes com depressão. A aptidão cardiorrespiratória (CRF) pode ser um factor deinteracção na relação entre os biomarcadores SE e os sintomas depressivos em pessoas diagnosticadas com depressão. O objetivo deste estudo foiestudar o papel da CRF na possível associação entre biomarcadores de ES e sintomas depressivos em 73 adultos diagnosticados com depressão. Métodos: Este estudo examina resultados de aptidão cardiorrespiratória e níveis plasmáticos de mediadores lipídicos; anandamida (AEA) e 2-arachidonoylglycerol (2-AG) em 73 adultos diagnosticados com depressão.Resultados: Os doentes com CRF elevado tinham uma associação inversa significativa entre sintomas depressivos e níveis séricos 2-AG ( : -0,013; 95%β: -0.013; 95% CI: -CI: -0,262 a -0,000; R²=22,6; P<0,001).Conclusões: Níveis mais elevados de CRF poderiam ter um papel protector nos sintomas depressivos, aumentando o 2-AG.(AU)

Plasmidic resistance to colistin mediated by mcr-1 gene in Escherichia coli clinical isolates in Argentina: A retrospective study, 2012–2018

[ABSTRACT]. Objective. To describe the resistance profile and the genetic characteristics of Escherichia coli isolates that harbor the mobilizable colistin resistance gene mcr-1 in Argentina. Methods. This was a retrospective study of 192 E. coli isolates positive for mcr-1 obtained from 69 hospitals of Buenos Aires City and 14 Argentinean provinces in 2012 – 2018. The antimicrobial susceptibility was performed by agar diffusion, broth macrodilution, and/or agar dilution. Standard polymerase chain reaction (PCR) was performed to detect resistance genes and incompatibility groups; specific PCR was applied to discriminate between blaCTX-M allelic groups and mcr-1.5 variant. The genetic relatedness among isolates was evaluated by XbaI-pulsed field gel electrophoresis and multilocus sequence typing in a subset of isolates. Results. All E. coli isolates showed minimal inhibitory concentrations to colistin ≥ 4μg/mL; nearly 50% were resistant to third-generation cephalosporins, with CTX-M-2 being the main extended-spectrum β-lactamase detected. Five E. coli were carbapenemase-producers (3 NDM, 2 KPC). The mcr-1.5 variant was detected in 13.5% of the isolates. No genetic relationship was observed among the mcr-1-positive E. coli clinical isolates, but a high proportion (164/192; 85.4%) of IncI2 plasmids was detected. Conclusions. The presence of IncI2 plasmids among highly diverse E. coli clones suggests that the mcr-1 gene’s wide distribution in Argentina may be driven by the horizontal transmission of IncI2 plasmids.

[RESUMEN]. Objetivo. Describir el perfil de resistencia y las características genéticas de aislamientos clínicos de Escherichia coli que portan el gen movilizable de resistencia a colistina mcr-1 en Argentina. Métodos. Se realizó un estudio retrospectivo para analizar 192 aislamientos de E. coli mcr-1 positivo, obtenidos en 69 hospitales de la Ciudad de Buenos Aires y 14 provincias de Argentina entre 2012 y 2018. La sensibilidad a los antimicrobianos se analizó mediante los métodos de difusión en agar, macrodilución en caldo y/o dilución en agar. Se aplicó la técnica estándar de reacción en cadena de la polimerasa (PCR) para detectar genes de resistencia y grupos de incompatibilidad; se aplicó PCR específica para distinguir entre variantes alélicas del gen blaCTX-M y la variante mcr-1.5. La relación genética entre los aislamientos fue evaluada mediante la técnica de electroforesis en gel de campo pulsado usando la enzima Xbal y la tipificación por secuencias de múltiples locus en un subconjunto de aislamientos. Resultados. Todos los aislamientos de E. coli mostraron concentraciones inhibitorias mínimas de colistina ≥ 4μg/mL. Casi el 50% mostró resistencia a las cefalosporinas de tercera generación y CTX-M-2 fue la β-lactamasa de espectro extendido que más se detectó. Cinco aislamientos de E. coli mostraron ser productoras de carbapenemasas (3 NDM, 2 KPC). La variante mcr-1.5 se detectó en 13,5% de las cepas aisladas. No se observó relación genética entre los aislamientos clínicos estudiados de E. coli positivas para mcr-1, aunque sí se detectó una proporción elevada (164/192; 85,4%) de plásmidos Incl2. Conclusiones. La elevada ocurrencia de plásmidos IncI2 en un grupo altamente diverso de clones de E. coli podría indicar que la amplia difusión del gen mcr-1 en Argentina estaría asociada a la transmisión horizontal de plásmidos IncI2.

[RESUMO]. Objetivo. Descrever o perfil de resistência e as características genéticas de isolados clínicos de Escherichia coli que carregam o gene mobilizábel de resistência à colistina mcr-1 na Argentina. Métodos. Neste estudo retrospectivo, foram analizados 192 isolados de E. coli positivos para mcr-1 obtidos em 69 hospitais da Cidade de Buenos Aires e 14 províncias da Argentina, entre 2012 e 2018. A sensibilidade aos antimicrobianos foi examinada usando métodos de difusão em ágar, macrodiluição em caldo e/ou diluição em ágar. A técnica padrão de reação em cadeia da polimerase (PCR) foi aplicada para detectar genes de resistência e grupos de incompatibilidade; a PCR específica foi aplicada para discriminar entre variantes alélicas do gene blaCTX-M e a variante mcr-1.5. A relação genética entre os isolados foi avaliada por eletroforese em gel de campo pulsado usando a enzima XbaI e a tipagem por sequências de múltiplos lócus, em um subconjunto de isolados. Resultados. Todos os isolados de E. coli apresentaram concentrações inibitórias mínimas de colistina ≥4μg/ mL. Quase 50% foram resistentes às cefalosporinas de terceira geração, e CTX-M-2 foi a β-lactamase de espectro estendido mais detectada. Cinco isolados de E. coli foram produtores de carbapenemase (3 NDM, 2 KPC). A variante mcr-1.5 foi detectada em 13,5% dos isolados. Não foi observada relação genética entre os isolados clínicos de E. coli positivos para mcr-1, mas foi detectada uma alta proporção (164/192; 85,4%) de plasmídeos IncI2. Conclusões. A alta ocorrência de plasmídeos IncI2 em um grupo altamente diverso de clones de E. coli sugere que a ampla distribuição do gene mcr-1 na Argentina estaria associada a transmissão horizontal de plasmídeos IncI2.

Experiencia de una clínica de anticoagulación / Experience of an anticoagulation clinic

Introducción: La Clínica de Anticoagulación de la Fundación Santa Fe surgió como una estrategia para reducir las complicaciones asociadas a la anticoagulación. En ella se evalúan las indicaciones, contraindicaciones e interacciones farmacológicas que potencialmente pueden desencadenar desenlaces incapacitantes en los pacientes que reciben esta terapia. Objetivo: Describir la demografía, las indicaciones y el comportamiento de la terapia anticoagulante de los pacientes de la Clínica de Anticoagulación del Hospital Universitario Fundación Santa Fe de Bogotá. Metodología: Se realizó un estudio descriptivo retrospectivo que incluyó a 257 pacientes tratados en la Clínica de Anticoagulación entre abril de 2008 y diciembre de 2013, que recibieron terapia anticoagulante con warfarina, enoxaparina, rivaroxabán, apixabán o dabigatrán. Resultados: El 62,6% correspondía a mujeres con un promedio de edad de 65,3 años (DE 17,38); 71,20% recibió warfarina, 5,05% enoxaparina, 14,78% rivaroxabán, 8,17% dabigatrán y 0,77% apixabán. Las principales indicaciones de anticoagulación fueron trombosis venosa (47,08%) y fibrilación auricular (36,96%). Las complicaciones asociadas fueron sangrado mayor en el 1,16%, sangrado no mayor en el 8,17% y eventos trombóticos en el 3,5%. El tiempo en el rango terapéutico con INR 2-3 fue del 53,5% en los pacientes tratados con warfarina. Conclusión: Este estudio concuerda con la literatura internacional al proponer que la selección de la terapia anticoagulante y su vigilancia pueden disminuir la frecuencia de efectos adversos (sangrado y trombosis). La clínica de anticoagulación también permite optimizar el tiempo en rango terapéutico de los pacientes tratados con warfarina.

Introduction: The anticoagulation clinic emerged as a strategy to reduce the complications associated with anticoagulation therapy. There, the indications, contraindications and drug interactions that could cause potential functional disabilities of individual patients receiving this treatment are evaluated. Objective:To describe the demographic profile and pharmacologic indications and to determine the behavior of anticoagulant therapy of patients consulting at the Anticoagulation Clinic of the University Hospital Fundación Santa Fe de Bogotá. Methods: A descriptive retrospective study was carried out that included 257 patients of the anticoagulation clinic between April 2008 and December 2013, who received anticoagulation therapy with warfarin, enoxaparin, rivaroxaban, apixaban or dabigatran. Results: 62.6% were female; the average age was 65.3 years old; 71.20% received warfarin, 5.05% enoxaparin, rivaroxaban 14.78%, 8.17% dabigatran and 0.77% apixaban. The chief indications for anticoagulation were venous thrombosis (47.08%) and atrial fibrillation (36.96%.) Leading complications associated with total anticoagulant strategy were: major bleeding (1.16%), mild bleeding (8.17%) and re-thrombotic events (3.5%). The time spent in therapeutic range (INR 2-3) was 53.5% in the warfarin group. Conclusion: This study is consistent with international literature in suggesting that the selection and monitoring of anticoagulation therapy could reduce the frequency of adverse effects (bleeding and thrombosis). The anticoagulation clinic also allows to optimise the time in the therapeutic range of the patients treated with warfarin.

Usage analysis of the Nursing Activities Score in two Spanish ICUS / Análise da utilização da escala Nursing Activities Score em duas UCIS Espanholas / Análisis de la utilización de la escala Nursing Activities Score en dos UCIS Españolas

The aim of this study was to analyze the discourse of health managers on aspects related to delay in tuberculosis diagnosis. This was a qualitative research study, conducted with 16 Family Health Unit managers. The empirical data were obtained through semi-structured interviews. The analysis was based on the theoretical framework of the French school of discourse analysis. According to the managers’ statements, the delay in tuberculosis diagnosis is related to patient and health service aspects. As for patient aspects, managers report fear, prejudice and lack of information as factors that may promote a delayed diagnosis. Regarding health service aspects, structural problems and lack of professional skills were reported. The discourse of managers should be considered to qualify tuberculosis control actions and to prevent delays in diagnosis. .

Estudo prospetivo cujo objetivo foi analisar as diferenças no preenchimento da escala Nursing Activities Score (NAS) em duas UTI polivalentes de dois hospitais espanhóis. Dados relativos internados nas unidades durante o período de outubro a novembro de 2011. Os dados recolhidos de 103 pacientes produziram 941 medições na escala NAS. Diferenças significativas foram encontradas nos itens: monitoramento, procedimentos de higiene, mobilização e posicionamento, atividades administrativas e monitoramento auricular à esquerda (p < 0,001). Conclui-se que o uso de instrumentos padronizados é essencial quando se compara a carga de trabalho em unidades diferentes. A escala apresenta itens com uma componente de avaliação subjetiva, sendo por isso importante a unificação de critérios para a comparação de resultados entre diferentes unidades.

Estudio prospectivo cuyo objetivo fue analizar las diferencias en el llenado de la escala Nursing Activities Score (NAS) en dos UCIs polivalentes de dos hospitales españoles. Datos relacionados a la carga de trabajo se recogieron diariamente, mediante la escala para los pacientes internados en las unidades durante el periodo de octubre a noviembre del 2011. Se recogieron datos de 103 pacientes obteniéndose un total de 941 medidas de la escala NAS. Diferencias significativas se encontraron en los ítems: monitorización, procedimientos de higiene, movilización y posición, tareas administrativas y monitorización de la aurícula izquierda (p < 0.001). Se concluyó que el empleo de instrumentos estandarizados es fundamental para poder comparar la carga de trabajo en diferentes unidades. La escala presenta ítems con un componente de valoración subjetiva, siendo importante la unificación de criterios para poder comparar los resultados entre las distintas unidades.

Diseminación de blaIMP-8 en enterobacterias aisladas en un hospital de Buenos Aires / [Dissemination of blaIMP-8 among Enterobacteriaceae isolates from a Buenos Aires Hospital].

From August 2008 to December 2011, six metallo-ß-lactamase-producing isolates, four Enterobacter cloacae, one Klebsiella oxytoca and one Citrobacter freundii, were detected at Hospital Interzonal General de Agudos "Evita" in Lanús. All six isolates showed multiresistant profiles and the presence of the blaIMP-8 gene. Five isolates also expressed PER-2 extended spectrum ß-lactamase. The blaIMP-8 gene was found as the first cassette in a class 1 integron. However, the 3´ conserved sequence could not be detected in three isolates. In all cases, blaIMP-8 was transferred by conjugation to azide-resistant Escherichia coli J53. PFGE analysis revealed that the four E. cloacae isolates were not genetically related. These are the first metallo-ß-lactamases detected in this institution and our results suggest a possible intra- and inter-species horizontal dissemination of blaIMP-8.