Emergence of MDR invasive Neisseria meningitidis in El Salvador, 2017-19.

BACKGROUND: Invasive meningococcal disease (IMD) is an acute, highly transmissible and potentially fatal disease caused by Neisseria meningitidis. Prompt antimicrobial therapy and prophylaxis are recommended, where penicillin or ciprofloxacin are the available choices. However, the emergence of resistant isolates of N. meningitidis poses a challenge for antimicrobial therapy. OBJECTIVES: To describe the clinical, epidemiological and biological characteristics of six penicillin- and ciprofloxacin-resistant, culture-confirmed IMD cases reported in El Salvador, Central America, between 2017 and 2019. METHODS: Following the detection of six patients presenting with IMD in El Salvador, clinical data were collected and epidemiological action plans conducted. Isolates were subjected to antimicrobial susceptibility testing by broth microdilution and WGS for genotyping and molecular characterization analysis, including phylogeny comparison with global sequences available from public databases. RESULTS: A total of six IMD cases caused by N. meningitidis serogroup Y, resistant to both penicillin (MIC >8.0 mg/L) and ciprofloxacin (MIC 0.125 mg/L), were detected from 2017 to 2019. Genomic analysis showed that penicillin resistance was mediated by the production of ß-lactamase ROB-1. Ciprofloxacin resistance was attributed to an amino acid substitution in DNA gyrase (T91I). All isolates were classified as ST3587, clonal complex 23, and were genetically highly similar, based on core-genome SNP analysis. CONCLUSIONS: To the best of our knowledge, we report the first cases of MDR N. meningitidis causing IMD in Latin America. Our findings highlight the emergence of this potential public health threat, with a profound impact on the efficacy of IMD treatment and prophylaxis protocols.

Sedative effect of midazolam in different vehicles for oral administration.

Context: Oral administration of midazolam is one of the most important protocols for producing adequate conscious sedation; however, it has an unpleasant taste and is poorly tolerated by pediatric patients. Aim: The aim of this study was to evaluate the sedative effect of diluted midazolam in different vehicles used to mask its unpleasant taste. Methods and Material: A total of 30 male mice (BALB-c) were randomly distributed in five groups. They were administered diluted midazolam in different vehicles (saline solution, paracetamol syrup, diclofenac suspension, multi-vitamin syrup, and boxed juice). All suspensions were administered orally (0.6 mg/Kg). The pH variation was evaluated with a digital pH meter, and the quality of sedation was evaluated in three tests: hole board test, grip strength test, and forced swimming test. Results: The paracetamol syrup vehicle was found to be the only vehicle which did not change its pH over time after dilution of midazolam. When evaluating the perforated platform, the greatest sedative effect was observed in the midazolam group with the paracetamol syrup (P > 0.05). Regarding grip strength, a difference was evident in all study groups at 45 minutes (P = 0.006); the midazolam group with the multi-vitamin syrup was less effective. Regarding the response time to forced swimming, the midazolam group with the paracetamol syrup presented the longest time at 15 and 30 minutes (5.39 ± 0.93 and 6.29 ± 0.83, respectively). Conclusion: The suspension of midazolam diluted in the paracetamol syrup is the most suitable for performing conscious sedation efficiently.

Cáncer de vagina: reporte de un caso / Vaginal cancer: A case report

Vaginal cancer has a low incidence in the female population. We present the case of a 77-year-old woman who was admitted to the hospital due to postmenopausal vaginal bleeding and initial diagnosis of cancer of the uterine cervix. Vaginal biopsy was performed from an ulcerated exophytic 3 x 2 cm lesion in the superior third of the posterior vaginal wall. Pathology reported a poorly differentiated squamous cell carcinoma of the vagina. The surgical specimen showed an infiltrating, nonkeratinizing, moderately differentiated squamous cell carcinoma of the vagina. We present a case where similarity of symptomatology with cancer of the cervix may have led to a wrong diagnosis or management, due to the anatomical proximity of both tissues.

El cáncer de vagina tiene una baja incidencia en la población femenina. Una mujer de 77 años acudió al hospital con antecedentes de sangrado vaginal posmenopáusico y diagnóstico inicial de cáncer de cérvix. Se le realizó biopsia vaginal por lesión ulcerada exofítica de 3 x 2 cm en el tercio superior de la pared vaginal posterior, cuyo resultado patológico fue cáncer escamoso pobremente diferenciado de la vagina. La patología de la pieza operatoria mostró carcinoma de células escamosas, infiltrante, no queratinizante, medianamente diferenciado de vagina. Presentamos el caso, en el que pudo haber confusión en el diagnóstico y/o manejo por la similitud de la sintomatología con el cáncer de cuello uterino, debido a la localización anatómica y la proximidad de ambos tejidos.

Inteligencia emocional y niveles de estrés académico en estudiantes de medicina de la Universidad de San Martin de Porres, Chiclayo-Perú / Emotional intelligence and levels of academic stress in medical students of the Universidad de San Martin de Porres, Chiclayo-Peru

Objetivo: Evaluar si existe asociación entre Inteligencia Emocional y niveles de estrés académico en los estudiantes de la Facultad de Medicina Humana de la Universidad de San Martín de Porres -Filial Norte. Material y Método: Descriptivo transversal, se estudiaron a los 271 alumnos regulares matriculados en la Escuela Profesional de Medicina Humana, durante el semestre académico aplicándoseles el inventario de inteligencia emociona Bar-on y el inventario para estrés académico. (SISCO). Resultados: entre los más frecuentes en la Inteligencia Interpersonal, fue promedio con 47,6%; en la Inteligencia Intrapersonal, fue Muy Bajo con 47,6%; en la adaptabilidad, fue Muy Bajo 37,1%; el manejo del estrés se presentó con mayor frecuencia el nivel Bajo con 51,2%, y en estado de ánimo general fue Promedio con 34,7%. Con relación a la frecuencia con que más se presentó el estrés académico en los estudiantes fue de algunas veces con 64,1%, seguido de casi siempre con 28,8%. No se encontró asociación entre la inteligencia emocional y stress académico (p<0,05). Conclusiones: Se concluye que no existe relación de la inteligencia emocional y niveles de estrés académico en los estudiantes de medicina de la Universidad de San Martín de Porres Filial Norte.

Objetive: To assess the association between emotional intelligence and academic stress levels in students of the Faculty of Human Medicine at the University of San Martin de Porres subsidiary Norte. Material and Methods: Descriptive cross, to 271 regular students enrolled studied at the Professional School of Human Medicine during the academic semester inventory applying to them Bar-on emotional intelligence and academic stress inventory. (SISCO). Results: among the most frequent in the Interpersonal Intelligence, was average with 47.6%; in intrapersonal intelligence, it was very low with 47.6%; in adaptability, it was very low 37.1%; stress management occurred more frequently with 51.2% Low level, and overall mood was average with 34.7%. With regard to the frequency with which more academic stress was presented in students it was sometimes with 64.1%,followed by 28.8% almost always .No se encontró association between emotional intelligenceandacademicstress(p<0,05). Conclusions: We conclude that there is no relationship of emotional intelligence and academic stress levels in medical students at the Universidad de San Martin de Porres-Filial Norte.