Experience of the use of lock therapy in pediatric patients with central venous catheter. / Experiencia del uso de terapia de sello en pacientes pediátricos con catéter venoso central.

Lock therapy is useful for preserving indwelling catheters. Few lock therapy studies have been published in Latin America. OBJECTIVE: To describe the clinical characteristics of pediatric patients using therapeutic and prophylactic lock therapy for six years in a high-complexity hospital in Colombia. PATIENTS AND METHOD: Cross-sectional descriptive study of patients aged < 18 years who received lock therapy. Collected variables included demographic data, clinical characteristics, blood test results, therapeutic interventions, frequency of admission to the pediatric critical care unit, and mortality. Descriptive analysis was performed. RESULTS: 54 patients were included in the study, most of them males, with 67 episodes of therapeutic lock therapy use. The most frequent diagnosis was hematological neoplasm (61%). Among these patients, 88% presented neutropenia while receiving lock therapy. Catheter preservation was achieved in 75% of the cases. Aminoglycosides were the most commonly used antibiotics (38%). Mortality due to catheter-related bacteremia was 6%. Catheter preservation using ethanol solution 70% was achieved in 62% of the patients with prophylactic lock therapy, all of whom had chronic gastrointestinal pathology. CONCLUSION: Catheter preservation rates were 75% and 62% in patients with therapeutic and prophylactic lock therapy, respectively, with a higher rate achieved among cancer patients with neutropenia (80%). Aminoglycosides and vancomycin were the most commonly used antibiotics.

Developing Vaccine Literacy for Urban Health Science Students, the Future Health Workforce.

The 2019 coronavirus disease pandemic underlined a shift in attitudes against vaccines and a rise in hesitancy among some members of the population, despite the overwhelming evidence that vaccinations are one of the most successful and safe health interventions. Research has shown that vaccine hesitancy is complex and can result from an intersectionality of multiple factors. Research has also shown that to tackle vaccine hesitancy in the community, health care workers play a pivotal role, as they are trusted sources who can provide reliable information and can address vaccination concerns for the public. Unfortunately, health care workers are also susceptible to vaccine hesitancy. Thus, to curb these negative attitudes and doubts against vaccinations, we propose to improve vaccine competency among health science students, who are the future health workforce. Here, we propose a comprehensive pedagogical approach that aims to improve the vaccine literacy in this student population in two urban community colleges. The approach includes the use of high-impact pedagogical interventions to achieve three main objectives: (i) to teach students the nature and process of science to have them become "competent outsiders"; (ii) to enhance students' knowledge of the complex science behind emerging infectious diseases and vaccine action, adopting a learner-centered and concept-focused instructional design, and (iii) to address the social, cultural, and historical aspects of vaccine development and the historical and present inequities that characterize this health intervention.

Wastewater surveillance of SARS-CoV-2 genomic populations on a country-wide scale through targeted sequencing.

SARS-CoV-2 surveillance of viral populations in wastewater samples is recognized as a useful tool for monitoring epidemic waves and boosting health preparedness. Next generation sequencing of viral RNA isolated from wastewater is a convenient and cost-effective strategy to understand the molecular epidemiology of SARS-CoV-2 and provide insights on the population dynamics of viral variants at the community level. However, in low- and middle-income countries, isolated groups have performed wastewater monitoring and data has not been extensively shared in the scientific community. Here we report the results of monitoring the co-circulation and abundance of variants of concern (VOCs) of SARS-CoV-2 in Uruguay, a small country in Latin America, between November 2020-July 2021 using wastewater surveillance. RNA isolated from wastewater was characterized by targeted sequencing of the Receptor Binding Domain region within the spike gene. Two computational approaches were used to track the viral variants. The results of the wastewater analysis showed the transition in the overall predominance of viral variants in wastewater from No-VOCs to successive VOCs, in agreement with clinical surveillance from sequencing of nasal swabs. The mutations K417T, E484K and N501Y, that characterize the Gamma VOC, were detected as early as December 2020, several weeks before the first clinical case was reported. Interestingly, a non-synonymous mutation described in the Delta VOC, L452R, was detected at a very low frequency since April 2021 when using a recently described sequence analysis tool (SAM Refiner). Wastewater NGS-based surveillance of SARS-CoV-2 is a reliable and complementary tool for monitoring the introduction and prevalence of VOCs at a community level allowing early public health decisions. This approach allows the tracking of symptomatic and asymptomatic individuals, who are generally under-reported in countries with limited clinical testing capacity. Our results suggests that wastewater-based epidemiology can contribute to improving public health responses in low- and middle-income countries.

Disseminated fusariosis in children: Report of two cases in girls with leukemia.

Background and Purpose: Disseminated fusariosis is an opportunistic infection caused by the hyaline fungus Fusarium spp. and occurs mainly in patients with leukemia. Case report: Two cases of disseminated fusariosis in pediatric patients are presented. Profound and prolonged neutropenia, fever, myalgia, and skin lesions in the legs were present in two girls with leukemia undergoing chemotherapy. In the first case, infection by Fusarium spp. was confirmed by anatomopathological findings, pathogen isolation, and polymerase chain reaction. In the second case, Fusarium solani infection was confirmed by mass spectrometry using blood cultures and skin lesion samples. Conclusion: It is important to consider disseminated fusariosis in high-risk patients who present with profound and prolonged neutropenia and persistent fever that does not resolve after broad-spectrum antibiotics to initiate antifungal therapy in a timely manner.

Genetic diversity and evolutionary convergence of cryptic SARS- CoV-2 lineages detected via wastewater sequencing.

Wastewater-based epidemiology (WBE) is an effective way of tracking the appearance and spread of SARS-COV-2 lineages through communities. Beginning in early 2021, we implemented a targeted approach to amplify and sequence the receptor binding domain (RBD) of SARS-COV-2 to characterize viral lineages present in sewersheds. Over the course of 2021, we reproducibly detected multiple SARS-COV-2 RBD lineages that have never been observed in patient samples in 9 sewersheds located in 3 states in the USA. These cryptic lineages contained between 4 to 24 amino acid substitutions in the RBD and were observed intermittently in the sewersheds in which they were found for as long as 14 months. Many of the amino acid substitutions in these lineages occurred at residues also mutated in the Omicron variant of concern (VOC), often with the same substitutions. One of the sewersheds contained a lineage that appeared to be derived from the Alpha VOC, but the majority of the lineages appeared to be derived from pre-VOC SARS-COV-2 lineages. Specifically, several of the cryptic lineages from New York City appeared to be derived from a common ancestor that most likely diverged in early 2020. While the source of these cryptic lineages has not been resolved, it seems increasingly likely that they were derived from long-term patient infections or animal reservoirs. Our findings demonstrate that SARS-COV-2 genetic diversity is greater than what is commonly observed through routine SARS-CoV-2 surveillance. Wastewater sampling may more fully capture SARS-CoV-2 genetic diversity than patient sampling and could reveal new VOCs before they emerge in the wider human population.

Changes in the incidence of acute bacterial meningitis caused by Streptococcus pneumoniae and the implications of serotype replacement in children in Colombia after mass vaccination with PCV10.

Introduction: Acute bacterial meningitis (ABM) is a public health problem. The disease has reemerged after the introduction of pneumococcal conjugate vaccines (PCVs) due to an increase in serotypes that are not covered. The objective was to determine the changes in the disease incidence before and after the introduction of the 10-valent vaccine (PCV10) in Colombia. Methods: This multicenter study was conducted in 17 hospitals in Colombia. Data were collected from January 2008 to December 2019 in 10 hospitals in Bogotá and from January 2017 to December 2019 in seven hospitals in Cali, Medellín and Cartagena. The data were grouped into three periods: 2008-2011, 2012-2015, and 2016-2019. Results: Of the 706 cases of invasive pneumococcal disease, 81 (11.4%) corresponded to meningitis. The relative incidence in Bogotá in the first period was 0.6 per 100,000 patients ≤ 5 years, decreased to 0.4 per 100,000 patients ≤ 5 years in the second period and increased in the third period to 0.7 per 100,000 patients ≤ 5 years. Serotypes covered by PCV10 decreased from 75 to 9.1%, with Spn19A (31.8%) and Spn34 (13.6%) emerging in the third period. Increased resistance to penicillin (13 to 37%) and to ceftriaxone (5.9 to 16%) was due to the emergence of multidrug-resistant Spn19A. The total mortality rate was 23.5% and increased from 12 to 33%. Conclusions: ABM due to pneumococcus has high morbidity and mortality rates. Reemergence of the disease has been observed due to the inclusion of polymerase chain reaction (PCR) for diagnosis and replacement of circulating serotypes after the introduction of PCV10, with an increase in Spn19A, which causes death and exhibits antimicrobial resistance. Continued surveillance is needed.

Efecto de una intervención educativa sobre la técnica de autoadministración de insulina para prevenir lipohipertrofias / Effect of an educational intervention on insulin self-administration technique to prevent lipohypertrophy / Efeito de uma intervenção educativa sobre a técnica de auto-aplicação de insulina para prevenção de lipohipertrofia

Introducción: Ante las complicaciones que presentan los pacientes diabéticos surge la necesidad de desarrollar estrategias educativas de autocuidado que mejoren la calidad de vida. Objetivo:determinar el efecto de una intervención educativa sobre la técnica correcta de la autoadministración de insulina en personas insulinorrequirientes para la prevención de lipohipertrofias en el municipio de San Gil. Metodología:estudio epidemiológico cuasiexperimental; se utilizó un instrumento de medición con prueba antes y después, con una muestra conformada por 86 personas diabéticas insulinorrequirientes con diabetes mellitus tipo 1 y 2.Resultados:en el pretest, el nivel de conocimiento sobre la administración de insulina presenta nivel bajo en el 19,5 %, nivel medio en el 5,2 % y nivel alto en el 75,3 %; en el postest el 100 % presentó nivel de conocimiento alto.Conclusión: La intervención educativa sobre la técnica correcta de la autoadministración de insulina en personas insulinorrequirientes para la prevención de lipohipertrofias tuvo un efecto positivo ya que los pacientes lograron alcanzar un nivel alto en sus conocimientos que mejoraron la técnica de administración de insulina para un tratamiento eficaz.

Introduction: Given the complications experienced by diabetic patients, there is a need to develop educational strategies for self-care to improve their quality of life.Objective: To determine the effect of an educational intervention on the correct technique for self-administration of insulin in insulin-requiring diabetic patients to prevent lipohypertrophy in the municipality of San Gil.Methods: This was a quasi-experimental epidemiological study; a measurement instrument with pre- and posttest evaluation was used in a sample of 86 insulin-requiring diabetic patients with type 1 and 2 diabetes mellitus.Results: In the pretest, the level of knowledge of insulin administration was low in 19.5% of the participants, middle in 5.2%, and high in 75.3%; in the posttest, 100% showed a high level of knowledge.Conclusion: The educational intervention on the correct technique of insulin self-administration in insulin-requiring diabetic patients to prevent lipohypertrophy had a positive effect as patients could reach a high level of knowledge and improved the insulin administration technique for effective treatment

ntrodução: Diante das complicações apresentadas pelos pacientes diabéticos, surge a necessidade de desenvolver estratégias educativas de autocuidado que melhorem a qualidade de vida.Objetivo: determinar o efeito de uma intervenção educativa sobre a técnica correta de auto-aplicação de insulina em pessoas que necessitam de insulina para prevenção de lipohipertrofia no município de San Gil.Metodologia: estudo epidemiológico quase experimental. Utilizou-se um instrumento de medida com teste antes e depois, com amostra composta por 86 diabéticos insulino-requerentes com diabetes mellitus tipo 1 e 2.Resultados: no pré-teste, o nível de conhecimento sobre administração de insulina apresenta baixo nível em 19 ,5%, nível médio em 5,2% e nível alto em 75,3%; no pós-teste, 100% apresentaram alto nível de conhecimento.Conclusão: A intervenção educativa sobre a técnica correta de autoadministração de insulina em pessoas insulino-requerentes para prevenção de lipohipertrofia teve um efeito positivo, pois os pacientes conseguiram atingir um alto nível de conhecimento que melhorou a técnica de administração de insulina para um tratamento efetivo

Genetic Diversity and Evolutionary Convergence of Cryptic SARS-CoV-2 Lineages Detected Via Wastewater Sequencing.

Wastewater-based epidemiology (WBE) is an effective way of tracking the appearance and spread of SARS-COV-2 lineages through communities. Beginning in early 2021, we implemented a targeted approach to amplify and sequence the receptor binding domain (RBD) of SARS-COV-2 to characterize viral lineages present in sewersheds. Over the course of 2021, we reproducibly detected multiple SARS-COV-2 RBD lineages that have never been observed in patient samples in 9 sewersheds located in 3 states in the USA. These cryptic lineages contained between 4 to 24 amino acid substitutions in the RBD and were observed intermittently in the sewersheds in which they were found for as long as 14 months. Many of the amino acid substitutions in these lineages occurred at residues also mutated in the Omicron variant of concern (VOC), often with the same substitution. One of the sewersheds contained a lineage that appeared to be derived from the Alpha VOC, but the majority of the lineages appeared to be derived from pre-VOC SARS-COV-2 lineages. Specifically, several of the cryptic lineages from New York City appeared to be derived from a common ancestor that most likely diverged in early 2020. While the source of these cryptic lineages has not been resolved, it seems increasingly likely that they were derived from immunocompromised patients or animal reservoirs. Our findings demonstrate that SARS-COV-2 genetic diversity is greater than what is commonly observed through routine SARS-CoV-2 surveillance. Wastewater sampling may more fully capture SARS-CoV-2 genetic diversity than patient sampling and could reveal new VOCs before they emerge in the wider human population. Author Summary: During the COVID-19 pandemic, wastewater-based epidemiology has become an effective public health tool. Because many infected individuals shed SARS-CoV-2 in feces, wastewater has been monitored to reveal infection trends in the sewersheds from which the samples were derived. Here we report novel SARS-CoV-2 lineages in wastewater samples obtained from 3 different states in the USA. These lineages appeared in specific sewersheds intermittently over periods of up to 14 months, but generally have not been detected beyond the sewersheds in which they were initially found. Many of these lineages may have diverged in early 2020. Although these lineages share considerable overlap with each other, they have never been observed in patients anywhere in the world. While the wastewater lineages have similarities with lineages observed in long-term infections of immunocompromised patients, animal reservoirs cannot be ruled out as a potential source.

Etiology and the challenge of diagnostic testing of community-acquired pneumonia in children and adolescents.

BACKGROUND: Pneumonia is the leading cause of mortality in pediatric population. The etiology of pneumonia in this population is variable and changes according to age and disease severity and where the study is conducted. Our aim was to determine the etiology of community-acquired pneumonia (CAP) in children aged 1 month to 17 years admitted to 13 Colombian hospitals. METHODS: Prospective cohort study. Hospitalized children with radiologically confirmed CAP and ≤ 15 days of symptoms were included and followed together with a control group. Induced sputum (IS) was submitted for stains and cultures for pyogenic bacteria and Mycobacterium tuberculosis, and multiplex PCR (mPCR) for bacteria and viruses; urinary antigens for pneumococcus and Legionella pneumophila; nasopharyngeal swabs for viruses, and paired serology for atypical bacteria and viruses. Additional cultures were taken at the discretion of primary care pediatricians. RESULTS: Among 525 children with CAP, 71.6% had non-severe pneumonia; 24.8% severe and 3.6% very severe pneumonia, and no fatal cases. At least one microorganism was identified in 84% of children and 61% were of mixed etiology; 72% had at least one respiratory virus, 28% pyogenic bacteria and 21% atypical bacteria. Respiratory syncytial virus, Parainfluenza, Rhinovirus, Influenza, Mycoplasma pneumoniae, Adenovirus and Streptococcus pneumoniae were the most common etiologies of CAP. Respiratory syncytial virus was more frequent in children under 2 years and in severe pneumonia. Tuberculosis was diagnosed in 2.3% of children. IS was the most useful specimen to identify the etiology (33.6%), and blood cultures were positive in 3.6%. The concordance between all available diagnostic tests was low. A high percentage of healthy children were colonized by S. pneumoniae and Haemophilus influenzae, or were infected by Parainfluenza, Rhinovirus, Influenza and Adenovirus. CONCLUSIONS: Respiratory viruses are the most frequent etiology of CAP in children and adolescents, in particular in those under 5 years. This study shows the challenges in making an etiologic diagnosis of CAP in pediatric population because of the poor concordance between tests and the high percentage of multiple microorganisms in healthy children. IS is useful for CAP diagnosis in pediatric population.

Tracking cryptic SARS-CoV-2 lineages detected in NYC wastewater.

Tracking SARS-CoV-2 genetic diversity is strongly indicated because diversifying selection may lead to the emergence of novel variants resistant to naturally acquired or vaccine-induced immunity. To monitor New York City (NYC) for the presence of novel variants, we deep sequence most of the receptor binding domain coding sequence of the S protein of SARS-CoV-2 isolated from the New York City wastewater. Here we report detecting increasing frequencies of novel cryptic SARS-CoV-2 lineages not recognized in GISAID's EpiCoV database. These lineages contain mutations that had been rarely observed in clinical samples, including Q493K, Q498Y, E484A, and T572N and share many mutations with the Omicron variant of concern. Some of these mutations expand the tropism of SARS-CoV-2 pseudoviruses by allowing infection of cells expressing the human, mouse, or rat ACE2 receptor. Finally, pseudoviruses containing the spike amino acid sequence of these lineages were resistant to different classes of receptor binding domain neutralizing monoclonal antibodies. We offer several hypotheses for the anomalous presence of these lineages, including the possibility that these lineages are derived from unsampled human COVID-19 infections or that they indicate the presence of a non-human animal reservoir.

Acute Intrathoracic Tuberculosis in Children and Adolescents with Community-Acquired Pneumonia in an Area with an Intermediate Disease Burden.

Tuberculosis (TB) in the pediatric population is a major challenge. Our objective was to describe the clinical and microbiological characteristics, radiological patterns, and treatment outcomes of children and adolescents (from 1 month to 17 years) with community-acquired pneumonia (CAP) caused by TB. We performed a prospective cohort study of a pediatric population between 1 month and 17 years of age and hospitalized in Medellín, Colombia, with the diagnosis of radiologically confirmed CAP that had ≤ 15 days of symptoms. The mycobacterial culture of induced sputum was used for the bacteriological confirmation; the history of TB contact, a tuberculin skin test, and clinical improvement with treatment were used to identify microbiologically negative TB cases. Among 499 children with CAP, TB was diagnosed in 12 (2.4%), of which 10 had less than 8 days of a cough, 10 had alveolar opacities, 9 were younger than 5 years old, and 2 had close contact with a TB patient. Among the TB cases, 50% (6) had microbiological confirmation, 8 had viral and/or bacterial confirmation, one patient had multidrug-resistant TB, and 10/12 had non-severe pneumonia. In countries with an intermediate TB burden, Mycobacterium tuberculosis should be included in the etiological differential diagnosis (as a cause or coinfection) of both pneumonia and severe CAP in the pediatric population.

Induced sputum as an adequate clinical specimen for the etiological diagnosis of community-acquired pneumonia (CAP) in children and adolescents.

OBJECTIVES: This study aimed to evaluate the utility of induced sputum (IS) for the diagnosis of community-acquired pneumonia (CAP) in pediatric population. METHODS: This cross-sectional study included pediatric population aged between 1 month and 17 years who were hospitalized with a diagnosis of CAP in 13 hospitals in Colombia, in whom an IS sample was obtained. Gram staining, aerobic bacterial and mycobacterial culture tests, and polymerase chain reaction (PCR) for 6 atypical bacteria and 15 respiratory viruses were performed. We evaluated the quality of IS samples. RESULTS: IS samples were collected in 516 of 525 children included in this study. The median age was 32 months, 38.6% were younger than 2 years, and 40.9% were between 2 and 5 years. Two patients had transient hypoxemia during the procedure. The quality of the IS obtained was good in 48.4% and intermediate in 24.5%. Identification of a respiratory pathogen was achieved with an IS sample (with Gram staining, culture test, and PCR) in 372 of 516 children with CAP. CONCLUSION: Our study shows that IS is an adequate sample for the diagnosis of CAP in pediatric population that required hospitalization. The procedure was safe, well tolerated, and with better diagnostic yields compared with the rest of the samples obtained.

Why Do Antibiotics Exist?

In the struggle with antibiotic resistance, we are losing. There is now a serious threat of moving into a postantibiotic world. High levels of resistance, in terms of both frequency and strength, have evolved against all clinically approved antibiotics worldwide. The usable life span of new clinically approved antibiotics is typically less than a decade before resistance reaches frequencies so high as to require only guarded usage. However, microbes have produced antibiotics for millennia without resistance becoming an existential issue. If resistance is the inevitable consequence of antibiotic usage, as has been the human experience, why has it not become an issue for microbes as well, especially since resistance genes are as prevalent in nature as the genes responsible for antibiotic production? Here, we ask how antibiotics can exist given the almost ubiquitous presence of resistance genes in the very microbes that have produced and used antibiotics since before humans walked the planet. We find that the context of both production and usage of antibiotics by microbes may be key to understanding how resistance is managed over time, with antibiotic synthesis and resistance existing in a paired relationship, much like a cipher and key, that impacts microbial community assembly. Finally, we put forward the cohesive, ecologically based "secret society" hypothesis to explain the longevity of antibiotics in nature.

Protocol for safe, affordable, and reproducible isolation and quantitation of SARS-CoV-2 RNA from wastewater.

The following protocol describes our workflow for processing wastewater with the goal of detecting the genetic signal of SARS-CoV-2. The steps include pasteurization, virus concentration, RNA extraction, and quantification by RT-qPCR. We include auxiliary steps that provide new users with tools and strategies that will help troubleshoot key steps in the process. This protocol is one of the safest, cheapest, and most reproducible approaches for the detection of SARS-CoV-2 RNA in wastewater. Owing to a pasteurization step, it is safe for use in a BSL2 facility. In addition to making the protocol safe for the personnel involved, pasteurization had the added benefit of increasing the SARS-CoV-2 genetic signal. Furthermore, the RNA obtained using this protocol can be sequenced using both Sanger and Illumina sequencing technologies. The protocol was adopted by the New York City Department of Environmental Protection in August 2020 to monitor SARS-CoV-2 prevalence in wastewater in all five boroughs of the city. In the future, this protocol could be used to detect a variety of other clinically relevant viruses in wastewater and serve as a foundation of a wastewater surveillance strategy for monitoring community spread of known and emerging viral pathogens.

Semiosfera de la salud en parques: estudio de caso en Quito y Madrid / Health semiosphere in parks: case study in Quito and Madrid

Introduction: The parks importance as green environments for healthy recreation is not assumed in their real dimension given their health benefits, although the World Health Organization recommends the availability of a minimum of 9 m2 of green space per person. Various international organizations recognize that the park's main essential services for communities are economic value, health and environmental benefits. Objective: To determine the health semiosphere in emblematic parks of Quito and Madrid. Methods: A mixed investigation was carried out using semiotics as the main tool. For the information gathering, the citizen survey technique of Quito and Madrid was applied, as a basis for a comparative analysis that allowed measuring the perception modes. Results: Intrinsic health activities were determined as part of the park's semiosphere, both in Quito and Madrid. In the first city, recreation was recognized as the main one, and sports in the second city; as well as cultural and recreational activities such as the relevant ones to be enhanced. Conclusions: The park's main activities are intrinsically linked to citizen's health, so their semiosphere is based on their determination with the aim of repowering them(AU)

Introducción: La importancia de los parques como entornos verdes de sano esparcimiento no es asumida en su real dimensión dados sus beneficios a la salud, a pesar de que la Organización de la Salud recomienda la disponibilidad de un mínimo de 9 m2 de espacio verde por persona. Diversos organismos internacionales reconocen que los principales servicios esenciales de los parques para las comunidades son el valor económico, la salud y los beneficios ambientales. Objetivo: Determinar la semiósfera de la salud en parques emblemáticos de Quito y Madrid. Métodos: Se realizó una investigación mixta empleándose la semiótica como herramienta principal. Para el levantamiento de información se aplicó la técnica de encuesta a ciudadanos de Quito y Madrid, como base para un análisis comparativo que permitió medir los modos de percepción. Resultados: Se determinaron las actividades intrínsecas a la salud como parte de la semiósfera de los parques, tanto en Quito como en Madrid. En la primera ciudad se reconoció a la recreación como principal, y en la segunda al deporte; así como a las actividades culturales y recreacionales como las relevantes a ser repotenciadas. Conclusiones: Las actividades principales en los parques están intrínsecamente ligadas a la salud de sus ciudadanos, por lo que su semiósfera radica en la determinación de las mismas con el afán de repotenciarlas(AU)

Comparación de la prueba tridimensional con PCR múltiple, para detección de carbapenemasas / Comparison of tridimensional test with multiplex PCR for detecction of carbapenemases

Objetivo: Comparar la prueba fenotípica para la detección de carbapenemasas (Prueba Tridimensional -THT), con la prueba de biología molecular, reacción de polimerasa en cadena (PCR múltiple), para la detección de genes de resistencia. Materiales y métodos: De un total de 118 aislamientos de cepas de bacterias Gram negativas, del programa de vigilancia de multirresistencia en un hospital de tercer nivel, fueron evaluadas para la detección de carbapenemasas por Test de Hodge tridimensional (THT) y PCR Múltiple. Se hicieron cálculos de sensibilidad, especificidad, VPP, VPN, índice de validez e índice de Youden (IY), con sus intervalos de confianza. Resultados: Se observó que la prueba THT en comparación con PCR, presentó una sensibilidad de 98,41% (IC 95% 94,53 - 100), la especificidad fue de 83,64% (IC 95% 72,95 - 94,32) y los valores predictivos positivo y negativo fueron respectivamente 87,32 (IC 95% 78,88 - 95,77) y 97,87 (IC 95% 92,68 - 100). El índice de Youden fue 0,82 (IC 95% 0,72 - 0,92) y el índice de validez 91,53% (IC 95% 86,08 - 96,97) Conclusión: La prueba tridimensional de Hodge (THT), para detección de resistencia a carbapenémicos, puede ser una prueba de rutina útil en el laboratorio para sugerir resistencia por carbapenemasas

Objective: To compare the phenotypic test for detection of carbapenemases (Three-dimensional Test - THT), with molecular biology test (Multiplex PCR), for the detection of resistance genes. Methods: A total of 118 isolates of Gram-negative bacteria strains from the multiresistant surveillance program at a third-level hospital were evaluated for the detection of carbapenemases by three-dimensional test (THT) and the molecular biology PCR Multiple method . We calculated sensitivity, specificity, PPV, NPV, validity index and Youden index (IY), with their confidence intervals. Results: THT test compared to the multiple PCR test had a sensitivity of 98.41% (95% CI 94.53 - 100), specificity was 83.64% (95% CI 72.95 - 94 , 32) and positive and negative predictive values were respectively 87.32 (95% CI 78.88 - 95.77) and 97.87 (95% CI 92.68 - 100). Conclusion: The Hodge three-dimensional test (THT), for detection of carbapenem resistance, may be a useful routine laboratory test to suggest resistance by carbapenemases.

Early-Onset Invasive Infection Due to Corynespora cassiicola Associated with Compound Heterozygous CARD9 Mutations in a Colombian Patient.

PURPOSE: CARD9 deficiency is an inborn error of immunity that predisposes otherwise healthy humans to mucocutaneous and invasive fungal infections, mostly caused by Candida, but also by dermatophytes, Aspergillus, and other fungi. Phaeohyphomycosis are an emerging group of fungal infections caused by dematiaceous fungi (phaeohyphomycetes) and are being increasingly identified in patients with CARD9 deficiency. The Corynespora genus belongs to phaeohyphomycetes and only one adult patient with CARD9 deficiency has been reported to suffer from invasive disease caused by C. cassiicola. We identified a Colombian child with an early-onset, deep, and destructive mucocutaneous infection due to C. cassiicola and we searched for mutations in CARD9. METHODS: We reviewed the medical records and immunological findings in the patient. Microbiologic tests and biopsies were performed. Whole-exome sequencing (WES) was made and Sanger sequencing was used to confirm the CARD9 mutations in the patient and her family. Finally, CARD9 protein expression was evaluated in peripheral blood mononuclear cells (PBMC) by western blotting. RESULTS: The patient was affected by a large, indurated, foul-smelling, and verrucous ulcerated lesion on the left side of the face with extensive necrosis and crusting, due to a C. cassiicola infectious disease. WES led to the identification of compound heterozygous mutations in the patient consisting of the previously reported p.Q289* nonsense (c.865C > T, exon 6) mutation, and a novel deletion (c.23_29del; p.Asp8Alafs10*) leading to a frameshift and a premature stop codon in exon 2. CARD9 protein expression was absent in peripheral blood mononuclear cells from the patient. CONCLUSION: We describe here compound heterozygous loss-of-expression mutations in CARD9 leading to severe deep and destructive mucocutaneous phaeohyphomycosis due to C. cassiicola in a Colombian child.

Estilos de vida y su relación con las calificaciones escolares: estudio en Ecuador / Lifestyles and their relation to school ratings: study in Ecuador

Introducción: En una sociedad que promueve hábitos de vida saludable como la práctica de actividad física, descanso nocturno y dieta saludable, el impacto que pueda tener en las calificaciones de adolescentes es interesante pero sobradamente positivo. Sin embargo, hay otros hábitos de vida bastante habituales entre los adolescentes como el consumo de alcohol y el sedentarismo, cuya relación con el rendimiento académico aporta una visión nueva sobre el fracaso escolar. Objetivo: Analizar la relación entre el tiempo dedicado a ver la televisión, el tabaquismo y el consumo de alcohol con las calificaciones escolares de adolescentes ecuatorianos. Métodos: La presente investigación tomó como referencia el trabajo realizado por Kovacs, del Real, Gestoso, López, Mufraggi, y Palou34. El presente estudio se realizó en escuelas de la sierra ecuatoriana (54), siendo del número total de participantes de 17.302, de los cuales 7.502 son alumnos y 9.800 corresponde a los padres y tutores que colaboraron. Se aplicó un cuestionario para describir las variables frecuencia semanal de práctica deportiva, consumo de alcohol, tabaco, televisión, asignaturas suspensas y nivel socioeconómico de los padres. Resultados: Del análisis multivariante las variables negativamente asociadas al rendimiento académico son el tabaco, el nivel socio económico bajo, el alcohol y ver la televisión más de dos horas al día. Por el contrario, las que tienen una relación positiva con el rendimiento académico son la práctica deportiva a nivel competición, practicar deporte con una frecuencia superior a los dos días por semana y ser mujer. Conclusiones: Se demostró que el beber, consumir tabaco, la edad, ser hombre, emplear más de dos horas al día en ver la televisión y pertenecer a un grupo socioeconómico bajo afecta de manera negativa a las calificaciones académicas. Sin embargo, el ser mujer, estudiar en un colegio privado o concertado y practicar deporte influye positivamente(AU)

Introduction: In a society that promotes healthy lifestyle habits such as physical activity, nighttime rest, and a healthy diet, the impact it may have on adolescents' grades is interesting, but it is also positive. However, there are other habits of life quite common among adolescents such as alcohol consumption and sedentary lifestyle, whose relationship with academic performance provides a new vision of school failure. Objective: To analyze the relationship between the time spent watching television, smoking and alcohol consumption with school grades of Ecuadorian adolescents. Methods: The present research took as reference the work carried out by Kovacs, del Real, Gestoso, López, Mufraggi, and Palou34. The present study was conducted in schools in the Ecuadorian highlands (54), the total number of participants being 17,302, of which 7,502 are students and 9,800 correspond to the parents and guardians who collaborated. A questionnaire was applied to describe the weekly frequency variables of sports practice, alcohol consumption, tobacco, television, suspended subjects and parents' socioeconomic status. Results: From the multivariate analysis it was obtained that the variables negatively associated with academic performance are tobacco, low socio-economic level, alcohol and watching television more than two hours a day. On the other hand, those that have a positive relationship with academic performance are sporting at the competition level, practicing sports more frequently than two days a week and being female. Conclusions: This study shows that, in Ecuadorian adolescents, drinking, smoking, age, being a man, spending more than two hours a day watching television and belonging to a low socioeconomic group negatively affects academic qualifications. However, being a woman, studying in a private or concerted school and practicing sports has a positive influence(AU)