Recurrences of multidrug-resistant tuberculosis: Strains involved, within-host diversity, and fine-tuned allocation of reinfections.

Recurrent tuberculosis occurs due to exogenous reinfection or reactivation/persistence. We analysed 90 sequential MDR Mtb isolates obtained in Argentina from 27 patients with previously diagnosed MDR-TB that recurred in 2018 (1-10 years, 2-10 isolates per patient). Three long-term predominant strains were responsible for 63% of all MDR-TB recurrences. Most of the remaining patients were infected by strains different from each other. Reactivation/persistence of the same strain caused all but one recurrence, which was due to a reinfection with a predominant strain. One of the prevalent strains showed marked stability in the recurrences, while in another strain higher SNP-based diversity was observed. Comparisons of intra- versus inter-patient SNP distances identified two possible reinfections with closely related variants circulating in the community. Our results show a complex scenario of MDR-TB infections in settings with predominant MDR Mtb strains.

Indicación de antibacterianos de reserva en el Hospital Docente Pediátrico Provincial Eliseo Noel Caamaño. Matanzas, 2015 / Indication of reserve antibacterials in the Provincial Pediatric Hospital Eliseo Noel Caamaño. Matanzas, 2015

Introducción: la resistencia de las bacterias a las drogas antimicrobianas es un fenómeno natural que se ha convertido en un problema mundial emergente. La Organización Mundial de la Salud ha declarado la resistencia a los antimicrobianos como una enfermedad. En la categoría de antibacterianos existe un tercer grupo, los agentes antibacterianos de reserva, los medicamentos de este grupo no tienen alternativas terapéuticas y su uso se limita a reducir el riesgo de aparición de resistencia. Objetivo: se realizó un estudio descriptivo, transversal sobre el uso de antibacterianos de reserva y la resistencia. Materiales y Métodos: se realizó un estudio descriptivo, transversal, durante el período enero a diciembre de 2015 a partir de los criterios normados en el Manual de Políticas de Antibióticos de la institución. La población de estudio estuvo constituida por todas las historias clínicas obtenidas del registro de uso de antibacterianos de reserva. Se incluyó en el estudio los microorganismos aislados en el periodo de estudio y la susceptibilidad /resistencia de los mismos a los antimicrobianos de reserva. Resultados: se puso en evidencia que los microorganismos con más frecuencia aislados fueron el estafilococo aureus y la echerichia coli. Conclusiones: se encontró en la amoxicilina+sulbactam los mayores patrones de resistencia, siendo más llamativo frente a la echerichia coli y en menor medida frente al estafilococo aureus. El cefepime mostró alta resistencia a ambos microorganismos. El uso de antibióticos de reserva puede ser considerado adecuado en la institución donde se realizó el trabajo (AU).

Introduction: bacteria resistance toward antimicrobial drugs is a natural phenomenon that has become an emergent problem around the world. The World Health Organization has declared the resistance toward antimicrobials a disease. There is a third group in the category of antibacterials: the reserve antibacterial agents. The medicines of this group do not have therapeutic alternatives and their usage is limited to reducing the risk of resistance emergence. Objective: to carry out a cross-sectional, descriptive study on the usage of reserve antibacterials and resistance. Materials and Methods: a cross-sectional, descriptive study was carried out in the period from January to December 2015, taking into account the criteria standardized in the Handbook of Antibiotics Policy of the institution. The studied population was formed by all the clinical records obtained from the reports of the reserve antibacterials usage. The microorganisms isolated in the studied period and their susceptibility/resistance toward the reserve antimicrobials was also included. Results: it was evidenced that the most frequently isolated microorganisms were Staphylococcus aureus and Escherichia coli. Conclusions: the higher resistance patterns were found in the amoxicillin + sulbactam, being more suggestive toward the Escherichia coli and less important toward the Staphylococcus aureus. Recepime showed high resistance toward both microorganisms. The reserve antibiotics use may be considered satisfactory in the institution where the study was carried out (AU).

Indicación de antibacterianos de reserva en el Hospital Docente Pediátrico Provincial Eliseo Noel Caamaño. Matanzas, 2015 / Indication of reserve antibacterials in the Provincial Pediatric Hospital Eliseo Noel Caamaño. Matanzas, 2015

Introducción: la resistencia de las bacterias a las drogas antimicrobianas es un fenómeno natural que se ha convertido en un problema mundial emergente. La Organización Mundial de la Salud ha declarado la resistencia a los antimicrobianos como una enfermedad. En la categoría de antibacterianos existe un tercer grupo, los agentes antibacterianos de reserva, los medicamentos de este grupo no tienen alternativas terapéuticas y su uso se limita a reducir el riesgo de aparición de resistencia. Objetivo: se realizó un estudio descriptivo, transversal sobre el uso de antibacterianos de reserva y la resistencia. Materiales y Métodos: se realizó un estudio descriptivo, transversal, durante el período enero a diciembre de 2015 a partir de los criterios normados en el Manual de Políticas de Antibióticos de la institución. La población de estudio estuvo constituida por todas las historias clínicas obtenidas del registro de uso de antibacterianos de reserva. Se incluyó en el estudio los microorganismos aislados en el periodo de estudio y la susceptibilidad /resistencia de los mismos a los antimicrobianos de reserva. Resultados: se puso en evidencia que los microorganismos con más frecuencia aislados fueron el estafilococo aureus y la echerichia coli. Conclusiones: se encontró en la amoxicilina+sulbactam los mayores patrones de resistencia, siendo más llamativo frente a la echerichia coli y en menor medida frente al estafilococo aureus. El cefepime mostró alta resistencia a ambos microorganismos. El uso de antibióticos de reserva puede ser considerado adecuado en la institución donde se realizó el trabajo (AU).

Introduction: bacteria resistance toward antimicrobial drugs is a natural phenomenon that has become an emergent problem around the world. The World Health Organization has declared the resistance toward antimicrobials a disease. There is a third group in the category of antibacterials: the reserve antibacterial agents. The medicines of this group do not have therapeutic alternatives and their usage is limited to reducing the risk of resistance emergence. Objective: to carry out a cross-sectional, descriptive study on the usage of reserve antibacterials and resistance. Materials and Methods: a cross-sectional, descriptive study was carried out in the period from January to December 2015, taking into account the criteria standardized in the Handbook of Antibiotics Policy of the institution. The studied population was formed by all the clinical records obtained from the reports of the reserve antibacterials usage. The microorganisms isolated in the studied period and their susceptibility/resistance toward the reserve antimicrobials was also included. Results: it was evidenced that the most frequently isolated microorganisms were Staphylococcus aureus and Escherichia coli. Conclusions: the higher resistance patterns were found in the amoxicillin + sulbactam, being more suggestive toward the Escherichia coli and less important toward the Staphylococcus aureus. Recepime showed high resistance toward both microorganisms. The reserve antibiotics use may be considered satisfactory in the institution where the study was carried out (AU).

LED fluorescence microscopy in the diagnosis of tuberculosis: Fading and restaining of smears for external quality assessment.

Blinded rechecking is a method proposed for external quality assurance (EQA) of auramine-stained acid-fast bacilli (AFB) smears using fluorescence microscopy (FM), however, this procedure is not well developed and slides fading over time could compromise its implementation. Since bleaching of fluorescent molecules involves temperature-dependent chemical reactions, it is likely that low temperatures could slow down this process. We stored auramine-stained slides under different environmental conditions, including -20°C, and examined them over time. The slides stored in all the environments faded. At -20°C, fading was not reduced in relation to room temperature. Restaining and re-examining smears after five months showed that the slides containing saliva and storage at -20°C were associated with failure in AFB reappearance. In conclusion, the practice of freezing slides until they are viewed should be discouraged as it has a negative effect on blinded rechecking by reducing reading concordance after restaining. Specimen quality should be considered when interpreting FM-EQA results.

Una visión retrospectiva y prospectiva del proceso de formación en las organizaciones / A retrospective and prospective vision of the formation process in the organizations

El presente artículo forma parte de la línea de investigación "Construcción de procesos de identidad en las organizaciones", del Grupo de Investigación de Psicología del Trabajo y las Organizaciones de la Facultad de Psicología de la Universidad Santo Tomás, la cual busca construir procesos contextualizados que permitan en las organizaciones pensar sus modos de generación de identidad y sentido de pertenencia. Examina, de manera parcial, las conceptualizaciones acerca del proceso de formación en este ámbito, así como su planteamiento sistemático analizado desde diferentes autores. El objetivo principal es presentar una propuesta de este proceso basado en la educación permanente, el enfoque de competencias y la gestión del aprendizaje, partiendo de una orientación comportamental de la psicología. Para ello se expone un breve recuento sobre los procesos implicados, al igual que una muestra documental de la formación para finalizar con la propuesta.

This article comprises of the investigation line "Construction of identity processes in the organizations", of the investigation group of work and organizations psychology of the Psychology Faculty of the Santo Tomás University, which looks for the construction of contextual processes, that allow in the organizations, to think its ways of identity generation and belongs to sense. It examines in a partial way the conceptualizations about the formation process in this ambit, as well as its systematic exposition analyzed from different authors. The primary intention is to present a proposal of this process based in the permanent education, the competitions approach, the learning management, and starting off of a behavioral direction of psychology. For it a brief count of the implied processes is exposed, also a documentary sample of the formation to finalize with the proposal.