Clinical, microbiological and genomic characterization of Gram-negative bacteria with dual carbapenemases as identified by rapid molecular testing.

Objective: Dual carbapenemase-producing organisms (DCPOs) are an emerging threat that expands the spectrum of antimicrobial resistance. There is limited literature on the clinical and genetic epidemiology of DCPOs. Methods: DCPO isolates were identified by Xpert® Carba-R PCR testing of routine diagnostic cultures performed from 2018 to 2021 at a New York City health system. WGS was performed by Illumina and/or PacBio. Medical records of patients were reviewed for clinical and epidemiological data. Results: Twenty-six DCPO isolates were obtained from 13 patients. Klebsiella pneumoniae (n = 22) was most frequent, followed by Pseudomonas aeruginosa (n = 2), Escherichia coli (n = 1) and Enterobacter cloacae (n = 1). The most common DCPO combination was blaNDM/blaOXA-48-like (n = 16). Notably, 1.05% (24/2290) of carbapenem-resistant Enterobacterales isolates were identified as DCPOs. The susceptibility profiles matched the identified resistance genes, except for a K. pneumoniae (blaKPC/blaOXA-48-like) isolate that was phenotypically susceptible to meropenem. Eleven patients were hospitalized within the year prior to admission, and received antibiotic(s) 1 month prior. Seven patients were originally from outside the USA. Hypertension, kidney disease and diabetes were frequent comorbidities. Death in two cases was attributed to DCPO infection. WGS of eight isolates showed that carbapenemases were located on distinct plasmids, except for one K. pneumoniae isolate where NDM and KPC carbapenemases were located on a single IncC-type plasmid backbone. Conclusions: Here we characterized a series of DCPOs from New York City. Foreign travel, prior hospitalization, antibiotic usage and comorbidities were common among DCPO cases. All carbapenemases were encoded on plasmids, which may facilitate horizontal transfer.

Sequential intrahost evolution and onward transmission of SARS-CoV-2 variants.

Persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have been reported in immune-compromised individuals and people undergoing immune-modulatory treatments. Although intrahost evolution has been documented, direct evidence of subsequent transmission and continued stepwise adaptation is lacking. Here we describe sequential persistent SARS-CoV-2 infections in three individuals that led to the emergence, forward transmission, and continued evolution of a new Omicron sublineage, BA.1.23, over an eight-month period. The initially transmitted BA.1.23 variant encoded seven additional amino acid substitutions within the spike protein (E96D, R346T, L455W, K458M, A484V, H681R, A688V), and displayed substantial resistance to neutralization by sera from boosted and/or Omicron BA.1-infected study participants. Subsequent continued BA.1.23 replication resulted in additional substitutions in the spike protein (S254F, N448S, F456L, M458K, F981L, S982L) as well as in five other virus proteins. Our findings demonstrate not only that the Omicron BA.1 lineage can diverge further from its already exceptionally mutated genome but also that patients with persistent infections can transmit these viral variants. Thus, there is, an urgent need to implement strategies to prevent prolonged SARS-CoV-2 replication and to limit the spread of newly emerging, neutralization-resistant variants in vulnerable patients.

The Covid-19 impacts on the European Union aquaculture sector.

There have been a number of indications of strong negative impacts of Covid-19 and the preventive measures associated with the pandemic for all food sectors. However, there is increasing evidence that the picture is quite nuanced where the Covid related measures are creating challenges for some and opportunities for others. In this paper we investigate the impacts of Covid-19 on the aquaculture sector in the European Union using two approaches; a survey where industry representatives and experts assess the impacts on key economic indicators allowing for positive as well as negative impacts, and recently published aquaculture production data for Denmark and Spain. Our findings show that surveys' results indicate that, on average, the impact of Covid-19 is negative on the income side, increasing cost and therefore negative with respect to profit. However, in every category the average covers both positive and negative answers suggesting that what was a challenge for some was a window of an opportunity for others. The production data for Denmark and Spain also indicate moderate to no impacts of the Covid-19. The strongest impacts appear on the turbot prices, a species where highly dependent on higher end restaurants. The lower price is a clear indication that there was a significant opportunity cost associated with getting access to other supply chains, particularly as the quantity was also moderately down.

Effects of a Short-Term Heat Acclimation Protocol in Elite Amateur Boxers.

ABSTRACT: Stone, BL, Ashley, JD, Skinner, RM, Polanco, JP, Walters, MT, Schilling, BK, and Kellawan, JM. Effects of a short-term heat acclimation protocol in elite amateur boxers. J Strength Cond Res 36(7): 1966-1971, 2022-Boxing requires proficient technical and tactical skills coupled with high levels of physiological capacity. Although heat and humidity negatively affect acute exercise performance, short-term exercise training in hot and humid environments can lead to physiological adaptations that enhance exercise performance in both hot and thermoneutral conditions. In highly trained endurance athletes, exercise-induced acclimation can occur in as little as 5 days (known as short-term heat acclimation [STHA]). However, the impact of a 5-day heat acclimation (5-DayHA) in combat athletes, such as elite amateur boxers, is unknown. The aim of the present investigation was to determine whether a 5-DayHA improves aerobic performance in a thermoneutral environment and causes positive physiological adaptations in elite boxers. Seven elite amateur boxers underwent a 5-DayHA protocol, consisting of 60-minute exercise sessions in an environmental chamber at 32 °C and 70% relative humidity. Repeat sprint test (RST) evaluated aerobic performance in a thermoneutral environment 24 hours before and after the 5-DayHA. Presession and postsession hydration status (urine specific gravity) and body mass were assessed. After a 5-DayHA period, boxers significantly improved RST performance (13 ± 7 to 19 ± 7 sprints, d = 0.92, p = 0.03) but not pre-exercise hydration status (1.02 ± 0.01 to 1.01 ± 0.01, d = 0.82, p = 0.07). Therefore, these findings suggest 5-DayHA enhances aerobic performance in elite-level amateur boxers and may provide a viable training option for elite combat athletes.

Everybody nose: molecular and clinical characteristics of nasal colonization during active methicillin-resistant Staphylococcus aureus bloodstream infection.

BACKGROUND: Healthcare-associated infections pose a potentially fatal threat to patients worldwide and Staphylococcus aureus is one of the most common causes of healthcare-associated infections. S. aureus is a common commensal pathogen and a frequent cause of bacteremia, with studies demonstrating that nasal and blood isolates from single patients match more than 80% of the time. Here we report on a contemporary collection of colonizing isolates from those with methicillin-resistant S. aureus (MRSA) bloodstream infections to evaluate the diversity within hosts, and detail the clinical features associated with concomitant nasal colonization. METHODS: Swabs of the bilateral anterior nares were obtained from patients diagnosed with MRSA bacteremia. A single colony culture from the blood and an average of 6 colonies from the nares were evaluated for MRSA growth. For the nares cultures, we typed multiple isolates for staphylococcal protein A (spa) and derived the clonal complexes. Demographic and clinical data were obtained retrospectively from the electronic medical record system and analysed using univariate and multivariable regression models. RESULTS: Over an 11-month period, 68 patients were diagnosed with MRSA bloodstream infection, 53 were swabbed, and 37 (70%) were colonized with MRSA in the anterior nares. We performed molecular typing on 213 nasal colonies. Spa types and clonal complexes found in the blood were also detected in the nares in 95% of the cases. We also found that 11% of patients carried more than one clone of MRSA in the nares. Male sex and history of prior hospitalization within the past 90 days increased odds for MRSA colonization. CONCLUSION: The molecular epidemiological landscape of colonization in the setting of invasive disease is diverse and defining the interplay between colonization and invasive disease is critical to combating invasive MRSA disease.

Modified methicillin-resistant Staphylococcus aureus detected in neonatal intensive care patients.

OBJECTIVES: As part of an active MRSA surveillance programme in our neonatal ICU, we identified nares surveillance cultures from two infants that displayed heterogeneity in methicillin resistance between isolated subclones that lacked mecA and mecC. METHODS: The underlying mechanism for the modified Staphylococcus aureus (MODSA) methicillin-resistance phenotype was investigated by WGS. RESULTS: Comparison of finished-quality genomes of four MODSA and four MSSA subclones demonstrated that the resistance changes were associated with unique truncating mutations in the gene encoding the cyclic diadenosine monophosphate phosphodiesterase enzyme GdpP or a non-synonymous substitution in the gene encoding PBP2. CONCLUSIONS: These two cases highlight the difficulty in identifying non-mecA, non-mecC-mediated MRSA isolates in the clinical microbiology laboratory, which leads to difficulties in implementing appropriate therapy and infection control measures.

Rickets in a Thoroughbred-cross foal: case report and review of the literature.

Rickets is a metabolic bone disease associated with failure of endochondral ossification and impaired osteoid mineralization in growing animals. As a consequence, affected individuals can develop gross and microscopic bone malformations. The most common causes of rickets in domestic species include vitamin D and phosphorus deficiency. Rickets has been described in multiple species; however, comprehensive postmortem characterizations with confirmatory histopathology in equids have not been published. A 6-mo-old, Thoroughbred-cross foal was diagnosed with rickets based on gross autopsy findings and microscopic examination of the ribs and long bones. Grossly, all costochondral junctions of the ribs were enlarged with a "rachitic rosary" appearance, and there were multiple fracture calluses in the rib bodies. Epiphyses and metaphyses of the long bones appeared widened on sagittal section, and their physes were irregularly thickened. Histologically, there were poorly organized columns of hypertrophic chondrocytes within the physes of affected bones, islands of chondrocytes embedded within the primary and secondary spongiosa, and faintly eosinophilic seams of poorly mineralized osteoid within the bone trabeculae. Areas of focally increased osteoclastic activity were observed in some of the sections, perhaps pointing to a more complex metabolic bone disease in a growing animal. Low serum concentrations of calcium and 25-hydroxyvitamin D were detected in an antemortem sample. The pathogenesis of these imbalances was not definitively established, but lack of sunlight exposure, low concentration of vitamin D precursors in the diet (perhaps secondary to malnutrition), or both, were suspected; a genetic basis cannot be ruled out.

Las Políticas de Salud Oral en el contexto de las enfermedades no transmisibles: Un desafío pendiente en Chile / Oral Health Policies in the context of non-communicable diseases: A pending challenge in Chile

RESUMEN: Las enfermedades no transmisibles constituyen la mayor carga de enfermedad en Chile y el mundo. La estrecha interrelación preventiva y terapéutica entre las enfermedades orales y las enfermedades sistémicas en el contexto de las enfermedades no transmisibles, pone de manifiesto la urgente necesidad de diseñar políticas públicas que permitan incorporar la salud oral en el control de estas enfermedades. A pesar de que en Chile se han implementado programas para el tratamiento de las principales enfermedades orales en grupos priorizados, a través de garantías explicitas en salud y de otros programas odontológicos, estas prestaciones no están dirigidas a personas con enfermedades cardiovasculares, diabetes u otras enfermedades no transmisibles de alto impacto en la población. Aunque, la evidencia disponible y las recomendaciones de las organizaciones científicas internacionales, fundamentan la incorporación de la salud oral en los planes y programas de salud general, lamentablemente un enfoque médico-odontológico más integrado en el control y manejo de las enfermedades no transmisibles sigue siendo un desafío pendiente en Chile.

ABSTRACT: Non-communicable diseases constitute the greatest burden of disease in Chile and the world. The close preventive and therapeutic relationship between oral diseases and systemic diseases in the context of non-communicable diseases, highlights the urgent need to design health policies that allow the incorporation of oral health in the control of these diseases. Despite the implementation of programs in Chile for the treatment of the main oral diseases in prioritized groups, through explicit guarantees in health and other dental programs, these benefits are not aimed at people with cardiovascular diseases, diabetes or other non-communicable diseases with high impact on the population. The available evidence and the recommendations of international scientific organizations support the incorporation of oral health in general health plans and programs. Unfortunately, a more integrated medical-dental approach in the control and management of non-communicable diseases remains a pending challenge in Chile.

Sinopsis de la Situación de Salud Oral en Chile - Parte III: Encuestas Nacionales de Salud / Synopsis or the Oral Health Situation in Chile - Part III: National Health Surveys

RESUMEN: Este artículo realiza una revisión y síntesis de las principales encuestas poblacionales de salud en Chile. Se describen sus principales características y hallazgos con el objetivo de orientar a los profesionales odontólogos en el conocimiento de material existente para el diagnóstico odontológico objetivo, así como el impacto de la salud oral en la calidad de vida, a nivel poblacional.

ABSTRACT: This article makes a brief review and synthesis of national health surveys in Chile. The article describes the main characteristics and findings in order to guide dental professionals with the knowledge of the existing material for an objective population oral health diagnosis, as well as the impact of oral health on quality of life of the population.

A serological assay to detect SARS-CoV-2 seroconversion in humans.

SARS-Cov-2 (severe acute respiratory disease coronavirus 2), which causes Coronavirus Disease 2019 (COVID19) was first detected in China in late 2019 and has since then caused a global pandemic. While molecular assays to directly detect the viral genetic material are available for the diagnosis of acute infection, we currently lack serological assays suitable to specifically detect SARS-CoV-2 antibodies. Here we describe serological enzyme-linked immunosorbent assays (ELISA) that we developed using recombinant antigens derived from the spike protein of SARS-CoV-2. Using negative control samples representing pre-COVID 19 background immunity in the general adult population as well as samples from COVID19 patients, we demonstrate that these assays are sensitive and specific, allowing for screening and identification of COVID19 seroconverters using human plasma/serum as early as two days post COVID19 symptoms onset. Importantly, these assays do not require handling of infectious virus, can be adjusted to detect different antibody types and are amendable to scaling. Such serological assays are of critical importance to determine seroprevalence in a given population, define previous exposure and identify highly reactive human donors for the generation of convalescent serum as therapeutic. Sensitive and specific identification of coronavirus SARS-Cov-2 antibody titers may, in the future, also support screening of health care workers to identify those who are already immune and can be deployed to care for infected patients minimizing the risk of viral spread to colleagues and other patients.

Introductions and early spread of SARS-CoV-2 in the New York City area.

New York City (NYC) has emerged as one of the epicenters of the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. To identify the early transmission events underlying the rapid spread of the virus in the NYC metropolitan area, we sequenced the virus that causes coronavirus disease 2019 (COVID-19) in patients seeking care at the Mount Sinai Health System. Phylogenetic analysis of 84 distinct SARS-CoV-2 genomes indicates multiple, independent, but isolated introductions mainly from Europe and other parts of the United States. Moreover, we found evidence for community transmission of SARS-CoV-2 as suggested by clusters of related viruses found in patients living in different neighborhoods of the city.

A serological assay to detect SARS-CoV-2 seroconversion in humans.

Here, we describe a serological enzyme-linked immunosorbent assay for the screening and identification of human SARS-CoV-2 seroconverters. This assay does not require the handling of infectious virus, can be adjusted to detect different antibody types in serum and plasma and is amenable to scaling. Serological assays are of critical importance to help define previous exposure to SARS-CoV-2 in populations, identify highly reactive human donors for convalescent plasma therapy and investigate correlates of protection.

Mitochondrial 3 beta-hydroxysteroid dehydrogenase (HSD) is essential for the synthesis of progesterone by corpora lutea: an hypothesis.

In mouse ovaries, the enzyme 3 beta-hydroxysteroid dehydrogenase (HSD) is distributed between microsomes and mitochondria. Throughout the follicular phase of the estrous cycle, the HSD activity in microsomes is predominant; whereas, after LH stimulation, HSD activity during the luteal phase is highest in the mitochondria. The current study examined whether or not LH stimulation always results in an increase in mitochondrial HSD activity. This was accomplished by measuring the HSD activity in microsomal and mitochondrial fractions from ovaries of pregnant mice. These animals have two peaks of LH during gestation, and one peak of LH after parturition. It was found that mitochondrial HSD activity was highest after each peak of LH. It is proposed that mitochondrial HSD is essential for the synthesis of high levels of progesterone. The increase in HSD activity in mitochondria after LH stimulation occurs because: 1) LH initiates the simultaneous synthesis of HSD and the cholesterol side-chain cleavage enzyme (P450scc); and, 2) HSD and P450scc bind together to form a complex, which becomes inserted into the inner membrane of the mitochondria. High levels of progesterone are synthesized by mitochondrial HSD because: 1) the requisite NAD+ cofactor for progesterone synthesis is provided directly by the mitochondria, rather than indirectly via the rate limiting malate-aspartate shuttle; and, 2) the end-product inhibition of P450scc by pregnenolone is eliminated because pregnenolone is converted to progesterone.

Ruptura prematura de membranas : incidencia, diagnóstico y manejo en un hospital maternidad / Premature rupture of amniotic fluid membranes: occurrence, diagnosis and treatment at a maternity hospital

Se realizó un estudio descriptivo-prospectivo a 2,388 embarazadas que acudieron al Centro Materno Infantil San Lorenzo de los Mina, Santo Domingo, República Dominicana, durante el período agosto-septiembre 1988, para determinar la incidencia, el diagnóstico y tratamiento de Ruptura Prematura de Membranas. Solo 288 casos (12//) presentaron Ruptura Prematura de Membranas. En 280 (97//) casos se diagnostica Ruptura Prematura de Membranas por el método clínico; 258 (89.5//) casos por interrogatorio y exámen físico. En 155 (54//) casos fue manejado conservadoramente; 133 (46//) casos de manera agresiva; el parto vaginal fue la vía de desembarazo en 74 (65.6//) casos, y la cesárea en el 99 (34//) casos. El método clínico es altamente específico para diagnosticar Ruptura Prematura de Membranas, el manejo conservador se usó más en ambarazadas a término y pretérmino, en los inmaduros y post-maduro se indicó manejo agresivo

Tipos capsulares A y D en cepas de pasteurella multocida de origen porcino / Capsular serotypes A and D in pasteurella multocida strains from swine

Se realizó la tipificación de 115 cepas de Pasteurella multocida aisladas de pulmones neumónicos de cerdos. Los tipo capsulares A y D se determinaron por las pruebas de sensibilidad a la hialuronidasa estafilocóccica y aglutinación con acriflavina, respectivamente. El tipo A fue diagnósticado en el 80,86 por ciento de las cepas y el D en el 19,13 por ciento

Estudio de la flora bacteriana aerobica del semen de cerdos / Study of the aerobic bacteria flora

371 muestras de semen recolectadas de 46 verracos provenientes de 4 granjas del Estado Aragua fueron sometidas a contaje bacteriano y a estudios bacteriológicos. Microorganismos de 12 géneros fueron aislados, siendo los más frecuentes Escherichia coli, Corynebacterium spp y Staphylococcus coagulasa negativa. El rango encontrado de bacterias por ml por muestra individual fue entre 600-321.000 colonias por ml. Sólo dos muestras no presentaron contaminación bacteriana

Flora aeróbica en abscesos de origen suino / Aerobic bacteria from abcesses in swine

44 cepas de bacterias aeróbicas fueron obtenidas de 30 abcesos de diferente localización en cerdos durante los años 81-86. En las muestras examinadas se encontraron cultivos puros (60%) o mixtos (40%). De 44 aislamientos de 30 abcesos, 17 (56,6%) correspondieron al aislamiento de Corynebacterium pyogenes, 10 (33,3%) correspondieron a Streptococcus spp todos con actividad hemolítica, 6 (11,9%) correspondieron al género Escherichia coli y los géneros Proteus, Pseudomonas, Bacillus, Klebsiella y Micrococcus. La bacteria aislada con mayor frecuencia fue el Corynebacterium pyogenes (56,6%) mayormente puro y la combinación más frecuente que el género Streptococcus (23,5%)