The Molecular Genetic Epidemiology and Antimicrobial Resistance of Neisseria gonorrhoeae Strains Obtained from Clinical Isolates in Central Panama.

We aim to analyze Neisseria gonorrhoeae isolates in central Panama, characterize the associated gonococcal antimicrobial resistance (AMR) and conduct molecular epidemiology and genetic typing. We conducted a retrospective study based on N. gonorrhoeae hospital isolates collected between 2013 and 2018. AMR was determined using dilution agar and Etest®. Molecular typing was conducted using the Multilocus Sequence Typing (ST) scheme. The isolates analyzed (n = 30) showed resistance to penicillin (38%), tetracycline (40%), and ciprofloxacin (30%), and sensitivity to extended-spectrum cephalosporins and azithromycin. We identified 11 STs, the most frequent of which was ST1901 among the strains with decreased sensitivity and resistance to three types of antibiotics. We identified eight variations for the penA gene, all non-mosaic, with type II LVG as the most frequent (50%). To the best of our knowledge, we conducted the first Central American genomic study that analyzes a collection of gonococcal isolates, which represents a benchmark for future epidemiological and molecular genetic studies. The high prevalence of ciprofloxacin, tetracycline, and penicillin resistance, in addition to the identification of the worldwide spread of multidrug-resistant clone ST1901, should prompt the continuous and reinforced surveillance of AMR, including the molecular epidemiology of N. gonorrhoeae in Panama.

Vaccination and mortality from COVID-19: a comparative study between hemodialysis, peritoneal dialysis, and non-dialysis adult population in Panama.

PURPOSE: Dialysis patients have a different response than the non-dialysis population to infection with COVID-19. This study evaluates the prevalence of infection and lethality in patients receiving hemodialysis or peritoneal dialysis in Panama, compared to non-dialysis adult population, and reports of adverse events of vaccination. METHODS: This is a prospective, multi-center cohort study of spatients aged 18 years or older and receiving in-center hemodialysis or ambulatory peritoneal dialysis in 13 centers in Panama from March 2021 to 2022. For comparison with general population, the study used an extended period of two years. RESULTS: A total of 1531 patients receiving dialysis treatment accepted to participate. PD patients represented an 18% of study patients. Lethality was higher in peritoneal dialysis patients with COVID-19 infection than in hemodialysis in the study group (p 0.02). Total deaths in dialysis patients for 2020 were 156 patients, before vaccination; 79 in 2021; and 25 for the first trimester of 2022. Lethality for the period of 2020-2022 was 9.3% for dialysis patients and 0.2% for non-dialysis population. There was no difference in symptoms in first dose, but with second dose, hemodialysis patients reported fewer symptoms than peritoneal dialysis patients (p < 0.0001). CONCLUSION: Ninety one percent of people in the country received BNT162b2 Pfizer BionTech vaccine. Lethality decreased from 30 to 5% once vaccination was available. There were no severe adverse effects and symptoms reported were less frequent than in general population, probably due to low reactogenicity in dialysis patients, or better tolerance to pain.

Molecular Genetic Epidemiology of an Emerging Antimicrobial-Resistant Klebsiella pneumoniae Clone (ST307) Obtained from Clinical Isolates in Central Panama.

Klebsiella pneumoniae has been among the main pathogens contributing to the burden of antimicrobial resistance (AMR) in the last decade, and K. pneumoniae AMR strains predominantly cluster in the ST258 clonal complex. However, ST307 is emerging as an important high-risk clone. In Central America, there have been few studies on the molecular epidemiology of the K. pneumoniae strains involved in infections. MATERIALS AND METHODS: We conducted an epidemiological study in three reference hospitals in the central region of Panama, using isolates of K. pneumoniae involved in infections, and identifying their AMR profile, associated clinical risk factors, and molecular typing using a multilocus sequence typing (ST) scheme. RESULTS: Six STs were detected: 307 (55%), 152, 18, 29, 405, and 207. CTX-M-15- and TEM-type beta-lactamases were identified in 100% of ESBL-producing strains; substitutions in gyrA Ser83Ile and parC Ser80Ile were identified in all ST307s; and in ST152 gyrA Ser83Phe, Asp87Ala, and parC Ser80Ile, the qnrB gene was detected in all strains resistant to ciprofloxacin. CONCLUSIONS: We present the first report on ST307 in three reference hospitals in the central region of Panama, which is a high-risk emerging clone and represents a public health alert for potential difficulties in managing K. pneumoniae infections in Panama, and which may extend to other Central American countries.

Chronic kidney disease of nontraditional causes in central Panama.

BACKGROUND: Over the last three decades, the mesoamerican region has seen an increase in the frequency of patients diagnosed with Chronic Kidney Disease of nontraditional causes (CKDnt) also known as Meso-American Nephropathy (MeN). A region with an increased frequency of patients with Chronic Kidney Disease (CKD) has been identified in central Panama. The present study aims to characterize the clinical presentation of patients with CKDnt in an understudied population of the central region of Panama and to compare them with patients with traditional chronic kidney disease (CKDt). METHODS: A retrospective descriptive study was conducted in a nephrology reference hospital in the central provinces of Herrera and Los Santos, comparing a group of 15 patients with CKDnt to 91 patients with CKDt. Sociodemographic variables, personal history, laboratory parameters, and of renal ultrasound were compared. RESULTS: Patients with CKDnt had a median age of 58 years (IQR: 52-61), significantly lower (P < 0.001) than patients with CKDt with a median age of 71 years (IQR: 64-78). Patients with CKDnt had a history of being agricultural (60%) and transportation (20%) workers, significantly higher than patients with CKDt (15%, P < 0.001 and 0%, P < 0.01 respectively). Renal atrophy and hyperuricemia are significant clinical markers of CKDnt (P < 0.001 and P < 0.05 respectively). CONCLUSION: To our knowledge, this is the first study in Panama to investigate the clinical presentation of patients with CKDnt and one of the few in Central America and the world that compares them with patients with CKDt. In central Panama the typical CKDnt patient is a male in his 50 s who is primarily engaged in agriculture or as a public transport driver. Renal atrophy and hyperuricemia are significant clinical markers of CKDnt. Further studies are needed to help understand the common determinants and risk factors for CKDnt development in Panama and Mesoamerica.

Diagnostic evaluation and assessment of anemia in a patient with chronic kidney disease and gastrointestinal angioectasias undergoing hemodialysis.

Anemia in patients with chronic kidney disease may have underlying causes that require a broad approach. Here, we present a clinical case of anemia in a patient with chronic kidney disease and gastrointestinal angioectasias undergoing hemodialysis.

Ataxia with Ocular Apraxia Type 1 (AOA1) (APTX, W279* Mutation): Neurological, Neuropsychological, and Molecular Outlining of a Heterogenous Phenotype in Four Colombian Siblings.

Hereditary ataxias are a group of devastating neurological disorders that affect coordination of gait and are often associated with poor coordination of hands, speech, and eye movements. Ataxia with ocular apraxia type 1 (AOA1) (OMIM: 606,350.0006) is characterized by slowly progressive symptoms of childhood-onset and pathogenic mutations in APTX; the only known cause underpinning AOA1. APTX encodes the protein aprataxin, composed of three domains sharing homology with proteins involved in DNA damage, signaling, and repair. We present four siblings from an endogamic family in a rural, isolated town of Colombia with ataxia and ocular apraxia of childhood-onset and confirmed molecular diagnosis of AOA1, homozygous for the W279* p.Trp279Ter mutation. We predicted the mutated APTX with AlphaFold to demonstrate the effects of this stop-gain mutation that deletes three beta helices encoded by amino acid 270 to 339 rescinding the C2H2-type zinc fingers (Znf) (C2H2 Znf) DNA-binding, the DNA-repair domain, and the whole 3D structure of APTX. All siblings exhibited different ages of onset (4, 6, 8, and 11 years old) and heterogeneous patterns of dysarthria (ranging from absence to mild-moderate dysarthria). Neuropsychological evaluation showed no neurocognitive impairment in three siblings, but one sibling showed temporospatial disorientation, semantic and phonologic fluency impairment, episodic memory affection, constructional apraxia, moderate anomia, low executive function, and symptoms of depression. To our knowledge, this report represents the most extensive series of siblings affected with AOA1 in Latin America, and the genetic analysis completed adds important knowledge to outline this family's disease and general complex phenotype of hereditary ataxias.

Genetic Diversity and New Sequence Types of Escherichia coli Coharboring ß-Lactamases and PMQR Genes Isolated from Domestic Dogs in Central Panama.

Background: ß-lactamase-producing Escherichia coli are a widely distributed source of antimicrobial resistance for animals and humans. Little is known about the susceptibility profile and genetic characteristics of E. coli strains isolated from domestic dogs in Latin America. Methods: We report on a cross-sectional study that evaluated E. coli strains isolated from fecal samples of domestic dogs in central Panama. The extended-spectrum ß-lactamase (ESBL), AmpC genes, and plasmid-mediated quinolone resistance were investigated. Molecular typing using Pasteur's multilocus sequence typing (MLST) was conducted. Results: A total of 40 E. coli isolates were obtained, of which 80% (32/40) were resistant to at least one of the antibiotics tested, while 20% (8/40) were sensitive to all antibiotics analyzed in this study (p < 0.001). Forty percent of the strains were resistant to three or more antibiotics. The most common resistance was to tetracycline (45%) and ampicillin (30%) while 2.5% showed an ESBL phenotype. Antibiotic resistance genes were detected for one ß-lactamase (blaTEM-1) and two plasmid-mediated quinolone resistance (PMQR) enzymes (qnrS and qnrB). In addition, mutations in the chromosomal AmpC gene were observed at positions −35, −28, −18, −1, and +58. Fourteen different sequence types (STs) were identified; the most frequent were ST399 and ST425 (12% each). ST3 and ST88, which have been previously identified in human clinical isolates, were also evidenced. Three new STs were found for the first time: ST1015, ST1016 (carrier of the blaTEM-1 gene), and ST1017 (carrier of the blaTEM-1, qnrS, and qnrB genes). Conclusions: In the intestinal strains of E. coli isolated from domestic dogs, there was a high frequency of resistance to antibiotics. The presence of genes from plasmids and chromosomal mutations that conferred antibiotic resistance, the identification of isolates previously reported in humans, and the genetic diversity of STs (including three that were newly identified) confirmed the determinants of resistance to antibiotics in the domestic dogs from central Panama.

Dynamics of Mask Use as a Prevention Strategy against SARS-CoV-2 in Panama.

Early in the SARS-CoV-2 pandemic, many national public health authorities implemented non-pharmaceutical interventions to mitigate disease outbreaks. Panamá established mandatory mask use two months after its first documented case. Initial compliance was high, but diverse masks were used in public areas. We studied behavioral dynamics of mask use through the first two COVID-19 waves in Panama, to improve the implementation of effective, low-cost public health containment measures when populations are exposed to novel air-borne pathogens. Mask use behavior was recorded from pedestrians in four Panamanian populations (August to December 2020). We recorded facial coverings and if used, the type of mask, and gender and estimated age of the wearer. Our results showed that people were highly compliant (>95%) with mask mandates and demonstrated important population-level behaviors: (1) decreasing use of cloth masks over time, and increasing use of surgical masks; (2) mask use was 3-fold lower in suburban neighborhoods than other public areas and (3) young people were least likely to wear masks. Results help focus on highly effective, low-cost, public health interventions for managing and controlling a pandemic. Considerations of behavioral preferences for different masks, relative to pricing and availability, are essential for optimizing public health policies. Policies to increase the availability of effective masks, and behavioral nudges to increase acceptance, and to facilitate mask usage, during the ongoing SARS-CoV-2 pandemic, and for future pandemics of respiratory pathogens, are key tools, especially for nations lagging in access to expensive vaccines and pharmacological approaches.

Phenotypic and genotypic characteristics of carbapenemase- and extended spectrum ß-lactamase-producing Klebsiella pneumoniae ozaenae clinical isolates within a hospital in Panama City.

Klebsiella pneumoniae spp ozaenae is a versatile bacterial species able to acquire antimicrobial resistance; the species presents a higher antimicrobial resistance profile compared to Klebsiella pneumoniae spp pneumoniae. Carbapenemase and extended spectrum ß-lactamase (ESBL)-producing bacteria commonly arise in clinical settings where antimicrobial stewardship is limited. Our study aims to report the phenotypical and genetic characteristics of nosocomial Klebsiella pneumoniae spp ozaenae isolates associated with mortality collected from a tertiary-level hospital in Panama City. In October 2020, 11 consecutive multidrug-resistant Gram-negative isolates were recovered from secretions and blood cultures from hospitalized patients. Nearly 90% (10/11) of these patients died, and bacteria was obtained from six patients for investigation. Biochemical evaluation of the six isolates revealed the presence of multidrug-resistant Klebsiella pneumoniae spp ozaenae. Phenotypic evaluation indicated resistance to carbapenemase and EBSL. In contrast, genetic evaluation by PCR showed that only 30% (2/6) were resistant to CTX-M-1 (CTX-M group 1), whereas 60.7% (4/6) presented carbapenemase resistance genes, and 33.3% (2/6) presented New Delhi metallo-ß-lactamase (NDM) resistance genes. Klebsiella pneumoniae ST258 was identified in 83.3% (5/6) of the isolates. Phylogenetic analysis using 16S revealed low homology among the six isolates. These results suggest that antibiotic resistance genes may have been incorporated into these Klebsiella pneumoniae spp ozaenae isolates within the hospital environment. We recommend strengthening the antimicrobial stewardship program and antibiotic control policy, as well as heightened infection control and prevention measures, such as ward sanitation and increased hand washing frequency.

Molecular Epidemiology of Escherichia coli Clinical Isolates from Central Panama.

Escherichia coli represents one of the most common causes of community-onset and nosocomial infections. Strains carrying extended spectrum ß-lactamases (ESBL) are a serious public health problem. In Central America we have not found studies reporting the molecular epidemiology of E. coli strains implicated in local infections, so we conducted this study to fill that gap. Materials and Methods: We report on an epidemiological study in two reference hospitals from central Panama, identifying the susceptibility profile, associated risk factors, and molecular typing of E. coli strains isolated between November 2018 and November 2019 using Pasteur's Multilocus Sequence Typing (MLST) scheme. Results: A total of 30 E. coli isolates with antimicrobial resistance were analyzed, 70% of which came from inpatients and 30% from outpatients (p < 0.001). Two-thirds of the samples came from urine cultures. Forty-three percent of the strains were ESBL producers and 77% were resistant to ciprofloxacin. We identified 10 different sequence types (STs) with 30% of the ESBL strains identified as ST43, which corresponds to ST131 of the Achtman MLST scheme-the E. coli pandemic clone. Thirty-eight percent of the E. coli strains with the ESBL phenotype carried CTX-M-15. Conclusions: To the best of our knowledge, this is the first report confirming the presence of the pandemic E. coli clone ST43/ST131 harboring CTX-M-15 in Central American inpatients and outpatients. This E. coli strain is an important antimicrobial-resistant organism of public health concern, with potential challenges to treat infections in Panama and, perhaps, the rest of Central America.

Dengue and hantavirus coinfection with good outcomes: a clinical case from Panama.

Dengue and hantavirus are endemic in central Panama. We present a case report of a patient coinfected with dengue and hantavirus who presented overlapping clinical manifestations of both infections. The patient did not require intensive care-as it is commonplace during hantavirus pulmonary syndrome-and he had a good outcome. Patient's care was positively impacted due to correct diagnosis of coinfection. This case highlights that in endemic areas, coinfection with dengue virus and hantavirus should be suspected. To the best of our knowledge, this case is the first documented case of coinfection with dengue virus and hantavirus in Central America.

Síndrome de Alport: una actualización en fisiopatología, genética, diagnóstico y tratamiento / Alportsyndrome: anupdate in pathophysiology, genetics, diagnosis, and treatment

RESUMEN El síndrome de Alport es una enfermedad renal hereditaria de curso progresivo, que ocurre por defectos genéticos en los genes responsables de la constitución de la membrana basal glomerular. Las mutacionespatogénicas en los genes para el colágeno tipo IV (COL 4A3/4/5) producen una alteración en el arreglo correcto de la membrana basal a nivel glomerular.La presentación clínica puede variar dependiendo de la mutación que presente el paciente. Luego de confirmar el diagnóstico,con estudios genéticoso mediante biopsia, se hace necesaria la correlación genotipo-fenotipo para determinar pronóstico y tratamiento. La reducción de la proteinuria, según sugieren las guías de manejo, ha resultado en un retraso en la progresión a enfermedad renal crónica, mientras se concluyen los estudios con medicamentos innovadores dirigidos a receptores específicos.

ABSTRACT Alportsyndromeis a renal hereditarydisease of progressivecourse, causedby geneticdefects in the genes responsible for the constitution of the glomerular basementmembrane. Mutation in genes fortype IV collagen occurs at COL 4A3/4/5, whichproducesinterference in thecorrectmembranearrangement. Clinicalpresentationmayvarydependingonmutationtype. Afterconfirming diagnosis, withgenetic studiesorbiopsies, managementincludesidentification of risk and treatment. Reduction of proteinuria, as managementguidelinessuggest, has resulted in delay in progressiontochronickidneydisease. In themeantime, studiesfor new treatmentdevelopments are in progress, directedtospecificreceptors.

Epidemiology of viral respiratory infections in a pediatric reference hospital in Central Panama.

BACKGROUND: Acute respiratory infections (ARIs) are a worldwide public health problem. It is estimated that up to 80% of cases of ARIs are caused by viruses. In Central America, however, we identified few epidemiologic studies on the main ARI-related viruses in hospitalized children. METHODS: This study retrospectively analyzed the clinical charts of patients ages 29 days to 14 years admitted with diagnoses of ARIs in a pediatric reference hospital in central Panama during 2016. The variables analyzed were age, sex, signs, symptoms, and diagnosis at admission. Samples of patients to whom a viral panel was indicated were analyzed via quantitative polymerase chain reaction, qPCR. RESULTS: The most common virus was respiratory syncytial virus (RSV; 25.9%), followed by influenza A virus (10.6%), rhinovirus (10.6%), parainfluenza type 3 (PIV-3; 8.2%) and adenovirus (5.9%). However, virus detection varied with patient age and season. RSV and Influenza virus were respectively identified mainly during July-November and May-July. All cases of viral co-infection occurred in children < 5-years-old. Both influenza A (H1N1) pdm09 and rhinovirus were detected in all pediatric ages analyzed in this study, unlike RSV and PIV-3, which were only present in children < 5-years-old. CONCLUSIONS: This study analyzed the epidemiological patterns of different respiratory viruses in pediatric patients with ARI from central Panama and found that the prevalence of the specific respiratory viruses identified varied with season and age. The most common viruses were RSV, influenza A, and rhinovirus. There were no reports of human metapneumovirus associated with ARI, which may be explained by the time and geographic location of the study. Knowledge of the local epidemiology of respiratory viruses in tropical countries is helpful in forecasting the peaks of hospitalizations due to ARIs and may help improve prevention efforts aiming at respiratory disease control in these settings.

Epidemiological Characteristics of Road Traffic Injuries Involving Children in Three Central American Countries, 2012-2015.

Although motor vehicle collisions (MVCs) are a worldwide public health concern due to their high injury, mortality, and fatality rates, few studies have addressed the epidemiologic behavior of MVCs in Latin American youth. Thus, this study was aimed at describing and comparing the characteristics of MVCs involving 0 to 14-year-olds in Costa Rica, Guatemala, and Panama. A secondary aim was to estimate the crude MVC-related injury, fatality, and mortality rates and their trends over time. We conducted a descriptive, retrospective study using publicly available data for Costa Rica, Panama, and Guatemala between 2012 and 2015. We examined the reported MVC cases and calculated the crude injury, fatality, and mortality rates and their trends over time (α = 0.05). Publicly available data reported 12,020 MVC-related injuries and 431 MVC-related deaths involving 0 to 14-year-olds. The most frequent mechanisms involved 0 to 14-year-olds as passengers or pedestrians in MVCs (>85% of all cases). The highest crude MVC-related injury and mortality rates were reported for Panama (119.35 and 2.14 per 100,000 population, respectively, in 0 to 14-years-olds), while Guatemala had the highest median MVC-related fatality rate (8.84 per 100,000 events; χ2 [2] = 377.8; p < 0.001) with a statistically significant trend increasing over time (r = 0.947; p = 0.027). Although several factors play a role in the prevention of MVCs among 0 to 14-year-olds, we found that Costa Rica was the only country that implemented a policy on child restraint systems resulting in the lowest rates of MVC-related injury, mortality, and fatality. These results could be used by decision makers from the aforementioned Central American countries to develop adequate policies addressing MVC preventative strategies to protect Central American infants and children.

Epidemiologic Characteristics of Suicide in Panama, 2007-2016.

Background and objectives: We aim to describe the demographic characteristics associated with suicide in Panama, to estimate the suicide mortality rate and years of potential life lost (YPLL) to suicide, and to explore the correlation of suicide rates with the Multidimensional Poverty Index (MPI). We present a descriptive retrospective epidemiological report of suicide-related mortality (Panama, 2007-2016). Materials and Methods: Data were matched-merged to calculate unadjusted suicide mortality rates (overall, and by sex, age groups, and administrative region), YPLL, and coefficients (r) for the correlation of MPI and suicide rates. Results: There were 1475 deaths by suicide (86% among men, 47% between 20 and 39 years). The average mortality rate was estimated at 3.91 per 100,000 population with an average YPLL rate of 3.79 per 1000 population. There was a statistically significant trend to reduce YPLL over time (r = -0.93; p< 0.001). Exploratory analyses did not show a significant correlation between the MPI and suicide rates. Our study showed a 6:1 male-to-female ratio of suicide, mostly affecting the age groups of 20-29 and over 80 years. Conclusions: Exploratory analyses on the correlation of the MPI and the suicide rates did not achieve statistical significance, and alternative explanations, such as access to pesticides and alcohol, were further explored to inform potential interventions.

Políticas públicas basadas en evidencia científica: el caso de la seguridad vial infantil / Public policies based on scientific evidence: child road safety

Los accidentes de tránsito son un problema de salud pública global. En América Latina, la tasa de mortalidad por accidentes de tránsito en niños es casi el doble que el promedio mundial. Se presenta nuestra experiencia en la formulación de una política pública de seguridad vial infantil en Panamá, basada en la evidencia científica generada por nuestro grupo de investigación. Además, se propone un modelo para la formulación de políticas públicas que podría usarse en otros países latinoamericanos. Se trata de un vector de formulación que es parte del ciclo de las políticas públicas e incluye la identificación de un problema público, la ejecución de la investigación científica, la publicación y la socialización de los productos científicos para la formulación de la política pública con la participación incluyente de los científicos, la sociedad civil y los tomadores de decisiones cuando estos comparten espacios de diálogo.

Road traffic accidents are a global public health problem. In Latin America, the mortality rate among children due to road traffic accidents almost doubles the global average. We describe our experience formulating a public policy on child road safety in Panama, based on the scientific evidence produced by our research group. Moreover, we propose a model for public policy-making that may be used in other Latin American countries. It is a formulation vector that is part of the public policy-making cycle and entails identifying a public problem, conducting scientific research, publishing and disseminating scientific products for public policy-making with the participation of scientists, the civil society, and decision-makers by sharing spaces for dialog.