Allostasis, health, and development in Latin America.

The lifespan is influenced by adverse childhood experiences that create predispositions to poor health outcomes. Here we propose an allostatic framework of childhood experiences and their impact on health across the lifespan, focusing on Latin American and Caribbean countries. This region is marked by significant social and health inequalities nested in environmental and social stressors, such as exposure to pollution, violence, and nutritional deficiencies, which critically influence current and later-life health outcomes. We review several manifestations across cognition, behavior, and the body, observed at the psychological (e.g., cognitive, socioemotional, and behavioral dysfunctions), brain (e.g., alteration of the development, structure, and function of the brain), and physiological levels (e.g., dysregulation of the body systems and damage to organs). To address the complexity of the interactions between environmental and health-related factors, we present an allostatic framework regarding the cumulative burden of environmental stressors on physiological systems (e.g., cardiovascular, metabolic, immune, and neuroendocrine) related to health across the life course. Lastly, we explore the relevance of this allostatic integrative approach in informing regional interventions and public policy recommendations. We also propose a research agenda, potentially providing detailed profiling and personalized care by assessing the social and environmental conditions. This framework could facilitate the delivery of evidence-based interventions and informed childhood-centered policy-making.

Trombosis séptica portal secundaria a diverticulitis / Portal septic thrombophlebitis secondary to diverticulitis

Resumen La trombosis séptica de la vena porta es una complicación infrecuente de la diverticulitis, la apendicitis y de otras infecciones intraabdominales. Se asocia a elevadas tasas de complicaciones, como isquemia mesentérica, absceso hepático, hipertensión portal o muerte. Se presenta el caso de un paciente de 67 años quien consultó por fiebre, dolor abdominal e ictericia, y en quien se documentó bacteriemia por Escherichia coli y Streptococcus dysgalactiae. En las imágenes se identificó trombosis de la porta hepática secundaria a enfermedad diverticular aguda, lo que configura un diagnóstico de pileflebitis séptica. El paciente recibió terapia antibiótica dirigida, sin anticoagulación, obteniéndose adecuada respuesta clínica. Se realiza una discusión sobre el diagnóstico, etiología y tratamiento de la trombosis séptica portal.

Abstract Septic thrombosis of the portal vein is a rare complication of diverticulitis, appendicitis and other intra-abdominal infections; it is associated with high rates of complications, such as mesenteric ischemia, liver abscess, portal hypertension or death. We present the case of a 67-year-old patient who consulted for fever, abdominal pain and jaundice, and in whom Escherichia coli and Streptococcus dysgalactiae bacteremia was documented; images showed hepatic portal thrombosis secondary to acute diverticular disease, which configures a diagnosis of septic pylephlebitis. The patient received targeted antibiotic therapy without anticoagulation, with adequate clinical response. The diagnosis, etiology, and treatment of portal septic thrombosis are discussed.

Infección por listeria monocytogenes en el embarazo, asociado a desprendimiento de placenta y complicaciones perinatales: reporte de un caso / Listeria monocytogenes infection in pregnancy, associated with placental abruption and perinatal complications: case report

INTRODUCCIÓN la listeriosis, aunque es una infección infrecuente, debe ser considerada en pacientes inmunocomprometidos y gestantes, especialmente en aquellos que consumen alimentos crudos o productos lácteos no pasteurizados, lo que pone en riesgo a un gran número de mujeres embarazadas en países de habla hispana. Es importante que el médico considere su inclusión en los posibles diagnósticos diferenciales cuando la sospecha clínica lo amerite, lo que permitirá hacer un diagnóstico temprano y por lo tanto un tratamiento oportuno, evitando así las posibles complicaciones en el binomio madre-hijo. CASO CLÍNICO clínico multigestante, con embarazo de 33 + 5 semanas, que ingresó a una institución de alto nivel de complejidad en la ciudad de Medellín, Colombia, por síndrome febril asociado a sepsis obstétrica debido a infección intraamniótica por Listeria monocytogenes, que requirió cesárea de urgencia, en donde se evidenció un desprendimiento placentario del 100 % secundario al proceso infeccioso y asociado a complicaciones neonatales. CONCLUSIONES: el diagnóstico de listeriosis gestacional supone un reto clínico por su presentación inespecífica y baja incidencia. Sin embargo, las consecuencias obstétricas arrastran una gran morbilidad de la madre y morbi-mortalidad neonatal, lo que hace de suma importancia que el clínico lo tenga presente en su arsenal diagnóstico, ya que una vez diagnosticado, el tratamiento oportuno tiene desenlaces clínicos favorables.

INTRODUCTION: although listeriosis is a rare infection, it should be considered in immunocompromised patients and pregnancy, especially in those who consume raw food or unpasteurized dairy, which puts a large number of pregnant women in Hispanic countries at risk. It is of special importance for physicians to include listeriosis among possible diagnoses when clinical suspicion arises in order to timely treat it and thus avoid the complications that may occur in the mother-child binomial. CLINICAL CASE: a pregnant woman (33 + 5 weeks) with multiple gestations, was admitted to a high level of complexity institution in the city of Medellín, Colombia, presenting a febrile syndrome associated with obstetric sepsis due to intra-amniotic infection by Listeria monocytogenes, which required emergency cesarean section where a 100 % placental abruption was evidenced secondary to the infectious process and associated with neonatal complications. CONCLUSIONS: The diagnosis of gestational listeriosis is a clinical challenge due to its nonspecific presentation and low incidence. However, the obstetric consequences drag a great maternal morbidity and neonatal morbidity and mortality, which is why it is important for physicians to consider this in the diagnostic arsenal because once diagnosed, the appropriate treatment has favorable clinical outcomes.

Whole Genome Sequencing Applied to Pathogen Source Tracking in Food Industry: Key Considerations for Robust Bioinformatics Data Analysis and Reliable Results Interpretation.

Whole genome sequencing (WGS) has arisen as a powerful tool to perform pathogen source tracking in the food industry thanks to several developments in recent years. However, the cost associated to this technology and the degree of expertise required to accurately process and understand the data has limited its adoption at a wider scale. Additionally, the time needed to obtain actionable information is often seen as an impairment for the application and use of the information generated via WGS. Ongoing work towards standardization of wet lab including sequencing protocols, following guidelines from the regulatory authorities and international standardization efforts make the technology more and more accessible. However, data analysis and results interpretation guidelines are still subject to initiatives coming from distinct groups and institutions. There are multiple bioinformatics software and pipelines developed to handle such information. Nevertheless, little consensus exists on a standard way to process the data and interpret the results. Here, we want to present the constraints we face in an industrial setting and the steps we consider necessary to obtain high quality data, reproducible results and a robust interpretation of the obtained information. All of this, in a time frame allowing for data-driven actions supporting factories and their needs.

Hierarchical spatial sampling reveals factors influencing arbuscular mycorrhizal fungus diversity in Côte d'Ivoire cocoa plantations.

While many molecular studies have documented arbuscular mycorrhizal fungi (AMF) communities in temperate ecosystems, very few studies exist in which molecular techniques have been used to study tropical AMF communities. Understanding the composition of AMF communities in tropical areas gains special relevance as crop productivity in typically low fertility tropical soils can be improved with the use of AMF. We used a hierarchical sampling approach in which we sampled soil from cocoa (Theobroma cacao L.) plantations nested in localities, and in which localities were nested within each of three regions of Côte d'Ivoire. This sampling strategy, combined with 18S rRNA gene sequencing and a dedicated de novo OTU-picking model, allowed us to study AMF community composition and how it is influenced at different geographical scales and across environmental gradients. Several factors, including pH, influenced overall AMF alpha diversity and differential abundance of specific taxa and families of the Glomeromycotina. Assemblages and diversity metrics at the local scale did not reliably predict those at regional scales. The amount of variation explained by soil, climate, and geography variables left a large proportion of the variance to be explained by other processes, likely happening at smaller scales than the ones considered in this study. Gaining a better understanding of processes involved in shaping tropical AMF community composition and AMF establishment are much needed and could allow for the development of sustainable, productive tropical agroecosystems.

Hemolytic uremic syndrome due to gemcitabine in a young woman with cholangiocarcinoma. / Síndrome hemolítico-urêmica causada por gencitabina em uma paciente jovem com colangiocarcinoma.

Gemcitabine is a medication used to treat various types of malignant neoplasms. Its association with hemolytic uremic syndrome (HUS) has been described in few cases, although these cases have resulted in mortality rates of at least 50%. We report on the case of a 25-year-old patient with cholangiocarcinoma in remission who developed microangiopathic hemolytic anemia with acute anuric renal failure after receiving 5 cycles of gemcitabine chemotherapy; this condition was consistent with HUS caused by the side effects of this drug. The administration of gemcitabine was stopped, and hemodialysis, blood transfusions, plasma exchanges, steroids, doxycycline, and rituximab were used to treat the patient. A favorable outcome was achieved; in particular, hemolysis was controlled, and renal function was completely recovered.

Síndrome hemolítico-urêmica causada por gencitabina em uma paciente jovem com colangiocarcinoma / Hemolytic uremic syndrome due to gemcitabine in a young woman with cholangiocarcinoma

Resumo A gencitabina é um fármaco utilizado no tratamento de vários tipos de neoplasias malignas. Há poucas descrições de associação entre a droga e a síndrome hemolítico-urêmica (SHU), apesar de os pacientes em questão terem ido a óbito em pelo menos 50% dos casos. O presente artigo relata o caso de uma paciente com 25 anos de idade em remissão diagnosticada com colangiocarcinoma que apresentou anemia hemolítica microangiopática acompanhada de insuficiência renal aguda anúrica após cinco ciclos de quimioterapia com gencitabina; as manifestações eram condizentes com SHU causada pelos efeitos colaterais do medicamento. A administração de gencitabina foi interrompida, e a paciente foi tratada com hemodiálise, transfusões de sangue, trocas de plasma, corticosteroides, doxiciclina e rituximabe. Foi atingido um desfecho favorável; mais especificamente, a hemólise foi controlada e a função renal foi plenamente restabelecida.

Abstract Gemcitabine is a medication used to treat various types of malignant neoplasms. Its association with hemolytic uremic syndrome (HUS) has been described in few cases, although these cases have resulted in mortality rates of at least 50%. We report on the case of a 25-year-old patient with cholangiocarcinoma in remission who developed microangiopathic hemolytic anemia with acute anuric renal failure after receiving 5 cycles of gemcitabine chemotherapy; this condition was consistent with HUS caused by the side effects of this drug. The administration of gemcitabine was stopped, and hemodialysis, blood transfusions, plasma exchanges, steroids, doxycycline, and rituximab were used to treat the patient. A favorable outcome was achieved; in particular, hemolysis was controlled, and renal function was completely recovered.

Endocarditis infecciosa deválvula aórtica por pseudomonasaeruginosa: reporte de caso / Infectious endocarditis aortic valve Pseudomonas aeruginosa: a case report

La endocarditis infecciosa (EI) es generada por microorganismos de la superficie endocárdiaca, llevando posteriormente a la formación de vegetaciones. Es más comúnmente causada por organismos gram positivos, tales como Staphylococcus yStreptococcus; los gram negativos son culpables de alrededor del 10% de todos los casos de endocarditis. Menos del 2% de las endocarditis infecciosas son causadas por gérmenes gram negativos no HACEK (Hemophilus, Actinobacillus, Cardiobacterium,Eikenella, y Kingella), incluyendo Pseudomonas aeruginosa; esta última afecta principalmente a pacientes inmunocomprometidos, conduciendo a infecciones nosocomiales severas, con altas tasas de morbi-mortalidad, y se asocia con usuariosde drogas intravenosas, infecciones por catéter y enfermedad valvular protésica.Los orígenes comunes han sido los tractos respiratorio, urinario o infecciones del torrente sanguíneo. Nosotros describimos el caso de un paciente masculino, de73 años de edad, inmunocompetente, quien presentó endocarditis infecciosa en laválvula aórtica protésica.

Síndrome hemofagocítico secundario a histoplasmosis diseminada: reporte de caso / Hemophagocytic syndrome secondary to disseminated histoplasmosis: a case report

La histoplasmosis es una micosis causada por el hongo dimorfo Histoplasma capsulatum. El síndrome hemofagocítico es una enfermedad potencialmente mortal causada por la activación inapropiada de linfocitos y macrófagos, que conduce a daño celular en múltiples órganos y sistemas. Describimos el caso de un paciente masculino de 46 años de edad, con infección VIH/SIDA, con fiebre, disnea, pérdida de peso y pancitopenia, quien presenta un síndrome hemofagocítico secundario a una histoplasmosis diseminada, diagnóstico este realizado por estudios de médula ósea.

Histoplasmosis is a mycosis caused by the dimorphic fungus Histoplasma capsulatum. Hemophagocytic syndrome is a potentially lethal condition caused by inappropriate activation of lymphocytes and macrophages, leading to cellular damage in multiple organs and systems. We describe the case of a male patient 46 years old with HIV Infection/AIDS, with fever, dyspnea, diarrhea, weight loss and pancytopenia, who presents a disseminated histoplasmosis with a secondary HFS, this diagnosis made by bone marrow studies.