Molecular epidemiology of pneumococcal carriage in children from Seville, following implementation of the PCV13 immunization program in Andalusia, Spain.

INTRODUCTION: The 13-valent pneumococcal conjugate vaccine (PCV13) universal vaccination programme was introduced in December 2016 in Andalusia. METHODS: A cross-sectional study was conducted on the molecular epidemiology of pneumococcal nasopharyngeal colonization. A total of 397 healthy children were recruited from primary healthcare centres in Seville for the periods 1/4/2018 to 28/2/2020 and 1/11/2021 to 28/2/2022 (PCV13 period). Data from a previous carriage study conducted among healthy and sick children from 1/01/2006 to 30/06/2008 (PCV7 period), were used for comparison of serotype/genotype distributions and antibiotic resistance rates. RESULTS: Overall, 76 (19%) children were colonized with S. pneumoniae during the PCV13 period and there were information available from 154 isolates collected during the PCV7 period. Colonization with PCV13 serotypes declined significantly in the PCV13 period compared with historical controls (11% vs 38%, p = 0.0001), being serotypes 19F (8%), 3 (1%) and 6B (1%) the only circulating vaccine types. Serotypes 15B/C and 11A were the most frequently identified non-PCV13 serotypes during the PCV13 period (14% and 11%, respectively); the later one increased significantly between time periods (p = 0.04). Serotype 11A was exclusively associated in the PCV13 period with ampicillin-resistant variants of the Spain9V-ST156 clone (ST6521 and genetically related ST14698), not detected in the preceding period. CONCLUSIONS: There was a residual circulation of vaccine types following PCV13 introduction, apart from serotype 19F. Serotype 11A increased between PCV13 and PCV7 periods due to emergence and clonal expansion of ampicillin-resistant genotype ST6521.

Significance of hepatitis B surface antigen, IgM/IgG core antibody and hepatitis B virus DNA in blood donors.

INTRODUCTION: Identification of hepatitis B virus carriers in blood donors is imperative in order to avoid transmission of the disease via blood transfusion. OBJECTIVE: To determine if blood donors with positive results for serological markers HBsAg and anti-HBc were hepatitis B virus DNA carriers. METHODS: 12,745 samples were collected from six Ecuadorian blood banks and analyzed for HBsAg, anti-HBc and anti-HBs infectious markers by automated ELISA. All samples that tested positive for one, two or all three markers were analyzed with molecular techniques to determine the presence of viral DNA. RESULTS: 27.5 % of the samples that were reactive for anti-HBc alone and 100 % of those with positive results for HbsAg and IgM/IgG anti-HBc were identified to contain hepatitis B virus DNA (p = 0.001). CONCLUSIONS: The selection of infection markers, as well as the detection methods define the results. Performing two serological and one molecular test is important in order to identify hepatitis B virus carriers and prevent its transmission.

INTRODUCCIÓN: La identificación de portadores del virus de la hepatitis B en donantes de sangre es imperativo para evitar la transmisión de la enfermedad a través de transfusiones sanguíneas. OBJETIVO: Determinar si los donantes de sangre con resultados positivos en los marcadores serológicos HbsAg y anti-HBc eran portadores del ADN del virus de la hepatitis B. MÉTODOS: Se recolectaron 12 745 muestras de seis bancos de sangre ecuatorianos, las cuales fueron analizadas con pruebas serológicas para identificar marcadores infecciosos de HBsAg, anti-HBc, anti-HBs mediante ELISA automatizada. Todas las muestras positivas para uno, dos o los tres marcadores fueron analizadas con técnica molecular para determinar la presencia del ADN viral. RESULTADOS: Se identificó que 27.5 % de las muestras reactivas solo a anti-HBc y 100 % de las muestras con resultados positivos de HBsAg/anti-HBc-IgM/IgG presentaron ADN del virus de la hepatitis B (p = 0.001). CONCLUSIONES: La elección de los marcadores de infección y los métodos de detección definen los resultados. Es importante la realización de dos pruebas serológicas y una molecular para identificar a los portadores del virus de la hepatitis B y evitar su transmisión.

Significación de los marcadores infecciosos para identificar portadores de hepatitis B en donantes de sangre / Significance of hepatitis B surface antigen, IgM/IgG core antibody and hepatitis B virus DNA in blood donors

Resumen Introducción: La identificación de portadores del virus de la hepatitis B en donantes de sangre es imperativo para evitar la transmisión de la enfermedad a través de transfusiones sanguíneas. Objetivo: Determinar si los donantes de sangre con resultados positivos de los marcadores serológicos HbsAg y anti-HBc eran portadores de ADN del virus de la hepatitis B. Métodos: Se recolectaron 12 745 muestras de seis bancos de sangre ecuatorianos, las cuales fueron analizadas con pruebas serológicas para identificar los marcadores infecciosos HBsAg, anti-HBc, anti-HBs mediante prueba ELISA automatizada. Todas las muestras positivas para uno, dos o los tres marcadores fueron analizadas con técnica molecular para determinar la presencia de ADN viral. Resultados: Se identificó que 27.5 % de las muestras reactivas solo a anti-HBc y 100 % de las muestras con resultados positivos de HBsAg/anti-HBc-IgM/IgG presentaron ADN del virus de la hepatitis B (p = 0.001). Conclusiones: La elección de los marcadores de infección y los métodos de detección definen los resultados. Es importante la realización de dos pruebas serológicas y una molecular para identificar a los portadores del virus de la hepatitis B y evitar su transmisión.

Abstract Introduction: Identification of hepatitis B virus carriers in blood donors is imperative in order to avoid transmission of the disease via blood transfusion. Objective: To determine if blood donors with positive results for serological markers HBsAg and anti-HBc were hepatitis B virus DNA carriers. Methods: 12,745 samples were collected from six Ecuadorian blood banks and analyzed for HBsAg, anti-HBc and anti-HBs infectious markers by automated ELISA. All samples that tested positive for one, two or all three markers were analyzed with molecular techniques to determine the presence of viral DNA. Results: 27.5 % of the samples that were reactive for anti-HBc alone and 100 % of those with positive results for HbsAg and IgM/IgG anti-HBc were identified to contain hepatitis B virus DNA (p = 0.001). Conclusions: The selection of infection markers, as well as the detection methods define the results. Performing two serological and one molecular test is important in order to identify hepatitis B virus carriers and prevent its transmission.

Medicamento como doença e biografia sorológica em comunidades virtuais de portadores de hepatite C / Medication as disease and serological biography in virtual communities of patients with hepatitis C

Resumo A hepatite C (HC) é uma doença que se agrava insidiosamente por décadas e com altas taxas de recidiva e cronificação. Seu tratamento com coquetel viricida origina reações colaterais violentas que comprometem o bem-estar dos portadores, sobretudo por não saberem como lidar com esses efeitos. Estudamos as postagens de uma comunidade virtual (CV) por meio de técnicas de análise de conteúdo orientadas por nuvens de palavras (NP). A partir do destaque nas postagens dos termos MEDICAMENTO e TRATAMENTO apontadas pelas NP, a leitura e análise do material mostrou o TRATAMENTO como ameaça, risco e agressão a reduzir qualidade de sobrevida; o "imperativo sorológico" como determinante categórico e inexorável de decisões clínicas; angústia e resignação no decorrer do acompanhamento entre as recidivas e marcação do tempo constituindo "biografias sorológicas". Concluímos que pacientes fisicamente distantes se apropriam da Web de modo gregário em CVs deixando uma rica narrativa terapêutica cuja análise representa um relevante recurso suplementar para a identificação de demandas subestimadas pelas práticas assistenciais.

Abstract Hepatitis C (HC) is a disease that worsens insidiously for decades and with high recurrence and chronicity rates. Its treatment with viricidal cocktail causes violent side reactions that compromise the well-being of patients, mainly because they do not know how to deal with these effects. We study the posts of a virtual community (VC) using content analysis techniques guided by word clouds (WC). The terms MEDICINE and TREATMENT was pointed out by the WC and the reading and analysis of the material showed TREATMENT as a threat, risk and aggression to reduce quality of survival; the "serological imperative" as a categorical and inexorable determinant of clinical decisions; anguish and resignation during the follow-up between relapses; and time pacing constituting "serological biographies". We conclude that distant patients appropriate the Web in a gregarious way in VCs, leaving a rich therapeutic narrative whose analysis represents a relevant supplementary resource for the identification of underestimated demands for care practices.

Costo-efectividad de la prueba de secuenciación del gen CFTR para portadores asintomáticos en la población colombiana / Cost-effectiveness of the CFTR gene-sequencing test for asymptomatic carriers in the Colombian population

Introducción. La fibrosis quística es una enfermedad genética de carácter autosómico recesivo clasificada como enfermedad huérfana de alto costo. Objetivo. Determinar la razón de costo-efectividad de la prueba diagnóstica de secuenciación del gen CFTR para los portadores asintomáticos familiares en primer, segundo y tercer grados de consanguinidad. Materiales y métodos. Se hizo una búsqueda sistemática sobre la evaluación de las características operativas de la prueba diagnóstica y los modelos de árbol de decisiones en estudios de costo-efectividad. Se elaboró un modelo de árbol de decisiones tomando como unidad de análisis la prevención de futuras concepciones. Los costos de la enfermedad se obtuvieron del reporte de alto costo del Ministerio de Salud de Colombia. Los costos de la prueba se obtuvieron de laboratorios nacionales. Se hizo un análisis de sensibilidad, determinístico y probabilístico, con la perspectiva del tercer pagador y horizonte a un año. Resultados. Se obtuvo una razón incremental de costo-efectividad (RICE) de USD$ 5.051,10 por obtener 10,89 % más de probabilidades de evitar el nacimiento de un niño enfermo con fibrosis quística por pareja. Para los familiares de segundo y tercer grados, se encontró una RICE de USD$ 19.380,94 y USD$ 55.913,53, respectivamente, al aplicar el PIB per cápita. Esta tecnología fue costo-efectiva en 39 %, 61,18 % y 74,36 % para 1, 2 y 3 PIB per cápita en familiares de primer grado de consanguinidad. Conclusiones. La prueba genética de detección de portadores del gen CFTR resultó costo-efectiva dependiendo del umbral de la disponibilidad de pagar, y de los supuestos y limitaciones establecidas en el modelo.

Introduction: Cystic fibrosis is an autosomal recessive genetic disease classified as a high- cost orphan disease. Objective: To determine the cost-effectiveness ratio of the diagnostic test for the CFTR gene-sequencing in asymptomatic family carriers in the first, second, and third degree of consanguinity. Materials and methods: We conducted a systematic search evaluating operative characteristics of the diagnostic test and decision-tree models in cost-effectiveness studies. A decision-tree model was elaborated taking prevention of future conceptions as a unit of analysis. We obtained the costs of the disease from the high-cost report of the Ministerio de Salud y Protección Social. The costs of the test were referenced by national laboratories. We carried out a deterministic and probabilistic sensitivity analysis with a third-payer perspective and a one-year horizon. Results: An ICER of USD$ 5051.10 was obtained as the incremental cost for obtaining 10.89% more probability of avoiding the birth of a child with cystic fibrosis per screened couple. For family members in second and third degrees, the ICER was USD$ 19,380.94 and USD$ 55,913.53, respectively, evidenced when applying the GDP per capita. This technology was cost-effective in 39%, 61.18%, and 74.36% for 1, 2, and 3 GDP per capita in first degree of consanguinity relatives. Conclusions: The genetic test for the detection of CFTR gene carriers was cost-effective depending on the threshold of availability to pay and the assumptions and limitations established in the model.

Differences by Resistotyping Between C. albicans Strains Isolated from the Oral Cavity of HIV+ and Seronegative Patients / Diferencias por resistotipificación entre cepas de C. albicans aisladas de la cavidad oral de pacientes VIH+ y seronegativos

Abstract Candida albicans is the etiological agent most frequently associated with oral candidiasis in human immunodeficiency virus (HIV) carriers. Strain typification is important to disease epidemiology, particularly with simple, low-cost methodologies such as resistotyping. The present study was designed to use resistotyping to identify possible phenotypic differences between C. albicans strains isolated from the oral cavity of HIV+ and HIV-seronegative patients. Analyses were run using resistotyping (boric acid, cetrimide, sodium periodate, sodium selenite and silver nitrate) to identify phenotypical differences between C. albicans. Descriptive statistics was performed. Of the 149 clones isolated from HIV+ patients the most frequent (47.0%) resistotype was ABCDE. The most frequent resistotype (64.8%) in the 74 clones from HIV-seronegative patients was --CDE. Phenotypic differences were identified between the strains isolated from each group. HIV+ patients exhibited greater strain diversity. Although it has limitations, resistotyping effectively identified differences between C. albicans strains.

Resumen Candida albicans es el agente etiológico más frecuentemente asociado con la candidiasis oral en portadores del virus de la inmunodeficiencia humana (VIH). La tipificación de la cepas es importante para conocer la epidemiología de la enfermedad, particularmente con metodologías simples y de bajo costo, como la resistotipificación. El presente estudio fue diseñado para identificar posibles diferencias fenotípicas por el método de resistotipificación entre cepas de C. albicans aisladas de la cavidad oral de pacientes VIH+ y seronegativos. Se realizó estadística descriptiva. Los análisis se realizaron utilizando resistotipificación (ácido bórico, cetrimida, peryodato de sodio, selenito de sodio y nitrato de plata) para identificar diferencias fenotípicas entre C. albicans. De las 149 clonas aisladas de pacientes VIH+, el resistotipo más frecuente (47.0%) fue ABCDE. El resistotipo más frecuente (64.8%) en las 74 clonas de pacientes seronegativos al VIH fue --CDE. Se identificaron diferencias fenotípicas entre las cepas aisladas de cada grupo. Los pacientes VIH + exhibieron una mayor diversidad de cepas. Aunque tiene limitaciones, la resistotipificación identificó de manera efectiva las diferencias entre las cepas de C. albicans.

Risk factors for colonization by carbapenemase-producing enterobacteria at admission to a Surgical ICU: A retrospective study.

INTRODUCTION: In 2011, a hospital-wide outbreak of OXA-48 producing Klebsiella pneumoniae occurred in our hospital, an epidemiological setting of high ESBL-producing K. pneumoniae rates. This study identifies risk factors for colonization with carbapenemase-producing enterobacteria (CPE) at Surgical Intensive Care Unit (SICU) admission. METHODS: A 2-year retrospective study was performed in all patients admitted to the SICU that following routine had a rectal swab collected upon admission. RESULTS: Of 254 patients admitted, 41 (16.1%) harbored CPE (five showing two carbapenemase-producing isolates). Most frequent carbapenemase-producing isolates and carbapenemases were K. pneumoniae (39/46, 84.8%) and OXA-48 (31/46; 76.1%), respectively. Carriers significantly had higher rates of chronic renal disease, previous digestive/biliary endoscopy, hospitalization, ICU/SICU admission, intraabdominal surgery, and antibiotic intake, as well as higher median values of clinical scores (SOFA, SAPS II and APACHE II). In the multivariate analysis (R2=0.309, p<0.001), CPE carriage was associated with prior administration of 3rd-4th generation cephalosporins (OR=27.96, 95%CI=6.88, 113.58, p<0.001), ß-lactam/ß-lactamase inhibitor (OR=11.71, 95%CI=4.51, 30.43, p<0.001), abdominal surgery (OR=6.33, 95%CI=2.12, 18.89, p=0.001), and prior digestive/biliary endoscopy (OR=3.88, 95%CI=1.56, 9.67, p=0.004). CONCLUSIONS: A strong association between production of ESBLs and carriage of CPE (mainly OXA-48 producing K. pneumoniae) was found. According to the model, the co-selection of ß-lactamases by previous exposure to broad-spectrum cephalosporins and ß-lactam/ß-lactamase inhibitors (with lower relative risk), abdominal surgery and prior digestive/biliary endoscopy were factors associated with CPE carriage.

Diagnóstico accidental de hepatitis B crónica. a propósito de dos casos / Incidental diagnosis of chronic hepatitis B. report of two cases

Se reporta el diagnóstico accidental de dos casos de hepatitis B crónica por probable transmisión vertical. El primer caso es una gestante de 32 años que es derivada al hospital para monitoreo fetal por oligoamnios; durante su internación entra en trabajo de parto, y es asistida por una profesional sin usar guantes y se produce un importante contacto con sangre. Se realiza a la paciente un control serológico revelando ser portadora de HBsAg pero negativa para HBeAg; positiva para anti-HBe Ac y HBcIgG, negativa para anti HBs y HBc Ac IgM. El segundo caso es un paciente portador de Lupus Eritematoso Sistémico bajo tratamiento inmunosupresor, con antecedentes de tener una madre fallecida y dos hermanos portadores de VHB. La serología reveló: HBsAg (+) con carga viral de 113 copias, HBeAg (-), anti-HBe (+), HBcIgG (+), HBcIgM (-), hepatitis C (-). El paciente recibió tratamiento con tenofovir. Ambos pacientes fueron diagnosticados en forma accidental y considerados ser portadores de hepatitis B crónica inactiva por probable trasmisión vertical por los antecedentes familiares. Estos dos casos constituyen una llamada de atención sobre la transmisión vertical del virus y la importancia de realizar el despistaje en la embarazada en el primer control prenatal.

Two cases of incidentally diagnosed chronic hepatitis B of probable vertical transmissionare reported. The first case is a 32 year-old pregnant patient referred to our center for fetalmonitoring due to oligohydramnios; during her hospitalization the patient went into labor,the professional assisted her without gloves and there was an important contact with blood.Serological tests were performed to the patientrevealing to be a HBsAg carrier, but negativefor HBeAg, positive for anti-HBe Ac and HBcIgG, negative for anti HBs and HBc Ac IgM. Thesecond case is a patient with Systemic Lupus Erythematosus under immunosuppressivetreatment, with a history of having a deceased mother and two siblings with HBV infection.Serology revealedHBsAg (+) with viral load of 113 copies, HBeAg (-),hepatitis C (-), HBcIgG(+), HBcIgM (-), anti-HBe (+). The patient received treatment with ten of ovir. Bothpatients were incidentally diagnosed and considered to be chronic inactive hepatitis Bcarriers due to probable vertical transmission based on their family history. These two casesconstitute a wake-up call about the vertical transmission of the virus and the importance ofperforming the screening in all pregnant women in the first prenatal care.

Influencia de la aparatología ortodóntica sobre la ocurrencia de Candida spp. en la cavidad oral / Influence of orthodontic appliances on the occurrence of Candida spp. in the oral cavity

Introducción: El uso de aparatología ortodóntica crea condiciones favorables para el incremento de la placa bacteriana. Objetivo: Evaluar si el uso de aparatología ortodóntica influye en la presencia de especies de Candida en la cavidad oral, en un grupo de pacientes pediátricos. Material y Métodos: Se estudiaron 60 pacientes entre 4 y 10 años de edad, que requirieron tratamiento con aparatología ortodóntica. Se tomaron muestras de la cavidad oral al inicio del tratamiento ortodóntico y a los seis meses de uso. Las muestras fueron sembradas en Agar Dextrosa Sabouraud y CHROMagar® Candida. Las especies de Candida se confirmaron por RPC múltiple. Los resultados se analizaron con la prueba estadística de chi cuadrada. Resultados: La presencia de Candida fue mayor en las muestras tomadas a los seis meses de iniciado el tratamiento (p < 0,001). La especie más frecuente antes del tratamiento fue C. albicans (8,3%) y después del tratamiento fue C. tropicalis (20,0%). Conclusiones: El uso de aparatología ortodóntica influye en la presencia de especies de Candida, por lo que deben tomarse medidas preventivas para evitar su conversión en candidiasis oral, en especial, en pacientes inmunodeprimidos.

Introduction: Use of orthodontic appliances creates favorable conditions for growth of dental bacterial plaque. Aim: To establish if use of orthodontic appliance affects the presence of Candida species in the oral cavity in a group of pediatric patients. Materials and Methods: We studied 60 patients between 4 and 10 years old, requiring treatment with orthodontic appliances. Samples were taken of the oral cavity before orthodontic treatment and six months after use began. Samples were inoculated in Sabouraud Dextrose Agar and Candida CHROMagar®. Candida species confirmation and identification was done by multiple PCR, and results analyzed with a chi-squared test. Results: Candida presence was greater (p < 0,001) in the samples taken six months after use began than in the initial samples. Before treatment, the most frequently found species (percentage of studied patients) was C. albicans (8.3%), while after treatment it was C. tropicalis (20.0%). Conclusions: Use of orthodontic appliances in children increases Candida species presence in the oral cavity. Preventative measures should be taken to avoid oral candidiasis, particularly in immunosuppressed patients.

[Hospital emergency health service care as a risk factor for methicillin-resistant Staphylococcus aureus in residents of long-term care facilities]. / El servicio de urgencias hospitalario como factor de riesgo de colonización por Staphylococcus aureus resistente a meticilina de los residentes en centros de larga estancia.

OBJECTIVES: Residents of long-term care facilities (LTCFs) are at risk for methicillin-resistant Staphylococcus aureus (MRSA) colonization because of age-related illnesses and high rates of hospital use, in particular, of visits to the emergency department (ED). We aimed to determine the prevalence of and risk factors for MRSA colonization in LTCF residents. MATERIAL AND METHODS: A descriptive cross-sectional study was carried out in 2014 (April­June). LTCF residents in the northern part of the island of Tenerife were eligible for enrollment. We collected clinical and epidemiologic data and took nasal swabs for culture (chromID MRSA agar) to screen for MRSA colonization. Molecular typing was established by pulsedfield gel electrophoresis. MRSA colonization was the dependent variable in logistic regression analysis. RESULTS: A total of 624 residents were enrolled. MRSA was detected in 25.8%. Sixty-four of the residents had received care in a hospital ED in the 3 months prior to enrollment. Multivariant regression analysis detected 2 risk factors for MRSA colonization: hospital ED care in the last 3 months (odds ratio [OR], 2.05; 95% CI, 1.29­3.26; P=.002) and the presence of skin lesions (OR, 1.65; 95% CI, 1.11­2.44); P=.013). The health-care-associated, ST5 MRSA-IVa, was the most prevalent (75.8%). CONCLUSION: LTCF residents in our area are a significant reservoir of MRSA colonization. Hospital ED care was a predictor of MRSA colonization. We believe that stronger measures to prevent cross-contamination of multidrug resistant microorganisms must be implemented, along with active vigilance systems to detect MRSA in hospitals.

OBJETIVO: Los residentes de centros de larga estancia (CLE) son población de riesgo para la colonización por Staphylococcus aureus resistente a meticilina (SARM) debido a la morbilidad asociada a la edad y la alta tasa de contactos hospitalarios, especialmente en el servicio de urgencias hospitalario (SUH). El objetivo del estudio fue determinar la prevalencia y los factores asociados a la colonización por SARM en los residentes de CLE. METODO: Se realizó un estudio descriptivo transversal entre abril y junio de 2014. Como criterio de inclusión se consideró ser residente de un CLE del área norte de la isla de Tenerife. Se recogieron variables clínico-epidemiológicas y muestras nasales que se sembraron en agar chromID®MRSA, que discrimina entre colonizados por SARM o no. El tipado molecular se realizó mediante electroforesis en campo pulsante. Se realizó un análisis de regresión logística sobre la variable SARM como dependiente. RESULTADOS: Se incluyeron 624 residentes. La prevalencia de SARM fue del 25,8%. Un total de 64 residentes necesitaron ser atendidos en el SUH en los tres meses previos al estudio. En el análisis multivariante se observó que ser atendido en el SUH en los tres meses previos [odss ratio (OR): 2,05 IC 95%: 1,29-3,26, p = 0,002] y la presencia de lesiones en la piel [OR: 1,65; IC 95% (1,11-2,44), p = 0,013] fueron las variables relacionadas con la colonización por SARM. El clon predominante fue ST­5 SARM-IVa (75,8%), estrechamente relacionado con la asistencia sanitaria. CONCLUSIONES: Los CLE de nuestra área constituyen un importante reservorio de SARM. Haber sido atendido en el SUH se comportó como factor predictor de colonización por SARM, por lo que es necesario de reforzar las medidas preventivas de transmisión cruzada de microorganismos multirresistentes e implantar sistemas vigilancia activa de SARM en el SUH

High prevalence of asymptomatic carriers of Tropheryma whipplei in different populations from the North of Spain.

INTRODUCTION: Tropheryma whipplei is the causative agent of Whipple disease. T. whipplei has also been detected in asymptomatic carriers with a very different prevalence. To date, in Spain, there are no data regarding the prevalence of T. whipplei in a healthy population or in HIV-positive patients, or in chronic fatigue syndrome (CFS). Therefore, the aim of this work was to assess the prevalence of T. whipplei in stools in those populations. METHODS: Stools from 21 HIV-negative subjects, 65 HIV-infected, and 12 CFS patients were analysed using real time-PCR. HIV-negative and positive subjects were divided into two groups, depending on the presence/absence of metabolic syndrome (MS). Positive samples were sequenced. RESULTS: The prevalence of T. whipplei was 25.51% in 98 stool samples analysed. Prevalence in HIV-positive patients was significantly higher than in HIV-negative (33.8% vs. 9.09%, p=0.008). Prevalence in the control group with no associated diseases was 20%, whereas no positive samples were observed in HIV-negative patients with MS, or in those diagnosed with CFS. The prevalence observed in HIV-positive patients without MS was 30.35%, and with MS it was 55.5%. The number of positive samples varies depending on the primers used, although no statistically significant differences were observed. CONCLUSIONS: There is a high prevalence of asymptomatic carriers of T. whipplei among healthy and in HIV-infected people from Spain. The role of T. whipplei in HIV patients with MS is unclear, but the prevalence is higher than in other populations.

Competência e comportamento em informação: uma análise social / Competencia y comportamiento de la información: un análisis social / Information competence and behavior: a social analysis

Reflexão crítica sobre a interferência do ambiente social na conformação do comportamento em informação dos pacientes portadores de Diabetes Mellitus, do Centro Médico Senador José Ermírio de Moraes (CMSJEM), Pernambuco, Brasil, tendo como horizonte o desenvolvimento da sua autonomia. As análises foram referenciadas na perspectiva sociocognitiva da Ciência da Informação e se fundamentaram em concepções teóricas, relacionando os conceitos de comportamento em informação e competência em informação. As análises acentuaram as observações de Chatman de que as pessoas que vivem fora de um contexto social considerado especializado em informações (outsiders, neste estudo, os portadores de Diabetes Mellitus), de forma geral escamoteiam e ignoram informações sobre o seu mundo real, as quais poderiam ser de ajuda para lidar com o seu cotidiano e problemas diários, porque seguem padrões sociais, compartilhados coletivamente. E aqueles que vivem dentro desse contexto social (os insiders, neste estudo, os profissionais de saúde e os especialistas em informação) veem nisso uma disfunção, porque os mesmos não examinam o efeito das normas culturais e sociais, e como elas afetam os modos sob os quais as pessoas (outsiders) escolhem e respondem à busca e ao uso de informação.

Reflexión crítica sobre las interferencias del ambiente social en la formación del comportamiento informacional en pacientes portadores de Diabetes Mellitus, del Centro Médico Senador José Ermírio de Moraes (CMSJEM), Pernambuco, Brasil, teniendo como objetivo el desarrollo de su autonomía. Los análisis tienen como marco de referencia la perspectiva sociocognitiva de la Ciencia de la Información y se fundamentan en concepciones teóricas, relacionando los conceptos de comportamiento informacional y competencia informacional. Los análisis destacaron las observaciones de Chatman de que las personas que viven fuera de un contexto social que se considera especializado en informaciones (outsiders, en este estudio, los portadores de Diabetes mellitus), de forma general escamotean e ignoran informaciones sobre su mundo real, que podrían ayudarles a lidiar con su cotidianidad y problemas diarios, porque siguen patrones sociales, compartidos colectivamente. Aquellos que viven dentro de ese contexto social (insiders, en este estudio, los profesionales de salud y los profesionales de la información) ven en eso una disfunción porque no examinan el efecto de las normas culturales y sociales, y cómo ellas influyen sobre los modos en que las personas (outsiders) escogen y responden a la búsqueda y uso de la información.

Critical reflection about the interference of the social environment in shaping the information behavior of patients with Diabetes Mellitus (DM), of Senador José Ermírio de Moraes Medical Center (CMSJEM), Pernambuco, Brasil, having as horizon the development of their autonomy. Analyzes were referenced in the socio-cognitive perspective of the Information Science (IS) and were based on theoretical conceptions, relating the concepts of information behavior and information literacy. The analyzes emphasized Chatman's observations that people who live outside a social context (outsiders, in this study, patients with DM) which is considered specialized in information, generally conceal and ignore information about the real world, which could be helpful to cope with their everyday and daily problems, because they follow social standards, collectively shared. And those who live within this social context (the insiders, in this study, health professionals and information specialists) see this as a dysfunction, because they do not examine the effect of cultural and social norms, and how these affect the ways in which people (outsiders) choose and respond to search and use of information.

Detección de Neisseria meningitidis en portadores asintomáticos en un hospital universitario de Brasil / Detectio of Neisseria meningitidis in asymptomatic carriers in a university hospital from Brazil

Los portadores asintomáticos de meningococos en hospitales son un factor de riesgo (FR) para adquirir la enfermedad meningocócica. La frecuencia de portadores de meningococos fue determinada a través de colecta orofaríngea en personal de un hospital de Brasil (n = 200). La prevalencia de portadores fue del 9% (IC del 95%, 5-13%). Los FR asociados al estado de portador fueron los siguientes: edad promedio 26,5 años, sexo masculino, hábito de frecuentar bares y número de personas/casa. Entre las 18 cepas de meningococos aisladas, 14 eran no agrupables (NG), 3 correspondieron al serogrupo B y una al 29E. La frecuencia de los serotipos y serosubtipos fue heterogénea, con un ligero predominio de los serotipos 4 y 7 y de los serosubtipos P1.7 y P1.5. La mayoría de las cepas (n=13) fueron sensibles a los antimicrobianos estudiados. El gen ctrA fue identificado por PCR en 9 (64,3%) de las 14 cepas NG, lo que sugiere virulencia en la mayoría de las cepas NG aisladas. Por lo tanto, se requiere una vigilancia constante de estos portadores asintomáticos

Asymptomatic meningococcus carriers in hospitals is a risk factor for acquiring meningococcal disease. Meningococcal carrier (MC) frequency was investigated in oropharyngeal swab samples collected from 200 staff members at a teaching hospital from Brazil. MC prevalence was 9% (95% CI 5­13%). Risk factors associated with MC were: mean age of 26.5 years, male gender, bar attendance frequency and number of persons/house. Of 18 isolated meningococcal strains, 14 were non-groupable (NG), 3 corrresponded to serogroup B and 1 to serogroup 29E. The frequency of serotypes and serosubtypes was heterogenous, with a slight predominance of serotypes 4 and 7 and serosubtypes P1.7 and P1.5. Most strains (n=13) were susceptible to the antimicrobials tested. The ctrA gene (PCR) was identified in 9 (64.3%) of the 14 NG strains, suggesting virulence in most of the NG isolated strains. Therefore, a constant surveillance of these asymptomatic carriers is required

Valores referenciales de antiestreptolisina O y portadores asintomáticos de estreptococos β-hemolíticos en adolescentes y adultos del Municipio Francisco Linares Alcántara, Venezuela / Reference valúes antistreptolysin O and asymptomatic carriers of β-hemolytic streptococci in adolescents and adults at Municipality Francisco Linares Alcántara, Venezuela

Introduction: β-hemolytic streptococci (Streptococcus pyogenes) groups A, C or G, secretes streptolysin O, toxin which causes in the infected individual an adaptive humoral immune response with production of serum antibodies called anti-streptolysin O (ASO). Objectives: To determine the reference value of ASO in a sample of 159 individuals aged 16-72 years from municipality Francisco Linares Alcántara, Aragua state, applying indirect (passive) agglutination test. By using a throat swab sample which was sown in blood agar 5% the frequency of asymptomatic carriers of β-hemolytic streptococci was also determined. Results and Discussion: As reference value for determining ASO by agglutination method a title of up to 200 IU/mL was obtained, this reference value differs from that recommended by the commercial equipment. Asymptomatic carriers frequency was 21.2% (n = 34). The distribution of β-hemolytic streptococci isolated were: group A (17.6%), group B (32.3%), group C (20.5%), group D (2.9%), group F (8.8%), group G (14.7%) and unclusterable (2.9%). Conclusions: The new ASO reference value for teens and adults of the mentioned municipality is up to 200 IU/mL. β-hemolytic Streptococcus group B was the most frequently isolated.

Introducción: Los estreptococos β-hemolíticos del grupo A (Streptococcus pyogenes), C o G, secretan estreptolisina O, toxina que causa en el individuo infectado una respuesta inmune adaptativa humoral con producción de anticuerpos séricos denominados antiestreptolisina O (ASO). Objetivos: Determinar el valor referencial de ASO en una muestra poblacional de 159 individuos con edades comprendidas entre 16 y 72 años del municipio Francisco Linares Alcántara, estado Aragua mediante aglutinación (pasiva) indirecta. También se determinó la frecuencia de portadores asintomáticos de estreptococos β-hemolíticos utilizando una muestra de exudado faríngeo que se sembró en agar sangre de cordero al 5%. Resultados y Discusión: Como valor referencial para la determinación de ASO por el método de aglutinación se obtuvo un título de hasta 200 UI/mL, valor que difiere del recomendado por el kit comercial. La frecuencia de portadores fue 21,2% (n = 34). La distribución de los estreptococos β-hemolíticos aislados fue: grupo A (17,6%), grupo B (32,3%), grupo C (20,5%), grupo D (2,9%), grupo F (8,8%), grupo G (14,7%) y no agrupable (2,9%). Conclusiones: El nuevo valor referencial de ASO para adolescentes y adultos del municipio mencionado es hasta 200 UI/mL. Streptococcus β-hemolítico del grupo B fue el grupo más frecuentemente aislado.

Detection of Neisseria meningitidis in asymptomatic carriers in a university hospital from Brazil.

Asymptomatic meningococcus carriers in hospitals is a risk factor for acquiring meningococcal disease. Meningococcal carrier (MC) frequency was investigated in oropharyngeal swab samples collected from 200 staff members at a teaching hospital from Brazil. MC prevalence was 9% (95% CI 5-13%). Risk factors associated with MC were: mean age of 26.5 years, male gender, bar attendance frequency and number of persons/house. Of 18 isolated meningococcal strains, 14 were non-group able (NG), 3 corresponded to serogroup B and 1 to serogroup 29E. The frequency of serotypes and serosubtypes was heterogenous, with a slight predominance of serotypes 4 and 7 and serosubtypes P1.7 and P1.5. Most strains (n=13) were susceptible to the antimicrobials tested. The ctrA gene (PCR) was identified in 9 (64.3%) of the 14 NG strains, suggesting virulence in most of the NG isolated strains. Therefore, a constant surveillance of these asymptomatic carriers is required.

Pacientes portadores de necessidades especiais: abordagem odontológica e anestesia geral / Patients with special needs: dental approach and general anesthesia

Os indivíduos portadores de necessidades especiais são mencionados na história há muitos séculos. Atualmente, no Brasil, existem grupos isolados que prestam atendimento odontológico a estes pacientes. Baseado na literatura, o objetivo deste trabalho é possibilitar ao cirurgião-dentista um maior conhecimento sobre o atendimento odontológico a pacientes com necessidades especiais - principalmente, aos portadores de síndrome de Down, paralisia cerebral e deficiências audiovisuais - e a necessidade de anestesia geral. Como conclusão, foi possível constatar que, antes de iniciar o atendimento odontológico a essa população, é essencial ter uma visão ampla e completa do paciente especial, reconhecer a etiologia das deficiências e proporcionar, além de níveis elevados de saúde bucal, dignidade e melhor qualidade de vida.

Individuals with special needs are mentioned in history for many centuries. Currently in Brazil, there are isolated groups who provide dental care to these patients. Based on the literature, the objective of this work is to enable the dentist a better understanding of dental care to patients with special needs - especially to people with Down Syndrome, cerebral palsy and audiovisual disabilities - and the need for general anesthesia. It was concluded that, before starting dental care to this population, it is essential to have a comprehensive and complete view of the particular patient; recognizing the etiology of disabilities and provide high levels of oral health, dignity and quality of life.

[Eradication of Staphylococcus aureus in carrier patients undergoing joint arthroplasty]. / Resultados de una intervención de descolonización de Staphylococcus aureus en pacientes portadores a los que se indica una prótesis articular.

INTRODUCTION: Prosthetic joint infection (PJI) is a complication with serious repercussions and its main cause is Staphylococcus aureus. The purpose of this study is to determine whether decolonization of S.aureus carriers helps to reduce the incidence of PJI by S.aureus. MATERIAL AND METHODS: An S.aureus screening test was performed on nasal carriers in patients undergoing knee or hip arthroplasty between January and December 2011. Patients with a positive test were treated with intranasal mupirocin and chlorhexidine soap 5 days. The incidence of PJI was compared with patients undergoing the same surgery between January and December 2010. RESULTS: A total of 393 joint replacements were performed in 391 patients from the control group, with 416 joint replacements being performed in the intervention group. Colonization study was performed in 382 patients (91.8%), of which 102 were positive (26.7%) and treated. There was 2 PJI due S.aureus compared with 9 in the control group (0.5% vs 2.3%, odds ratio [OR]: 0.2, 95% confidence interval [CI]: 0.4 to 2.3, P=.04). CONCLUSIONS: In our study, the detection of colonization and eradication of S.aureus carriers achieved a significant decrease in PJI due to S.aureus compared to a historical group.

Aspectos bioéticos en el ejercicio actual de la genética humana / Bioethical aspects in current human genetics

En los últimos años las ciencias de la vida y la salud han conseguido hitos importantes permitiendo el surgimiento la ingeniería genética, la genética médica y la genómica, ramas que plantean la necesidad de criterios científicos y técnicos basados en la conducta y labor de sus profesionales. Es así que consideramos importante reflexionar desde el punto de vista bioético los siguientes temas: Las pruebas de paternidad, que tienen como objeto determinar el vínculo genético ascendente en primer grado entre un individuo y su progenitor masculino. El tamiz de portadores que se utiliza para determinar si una persona es portadora de una enfermedad genética, suele aplicarse a heterocigotos para un gen recesivo, en reordenamientos cromosómicos. La eugenesia, concebida como una ideología social, como ciencia es la rama de la manipulación genética que estudia el perfeccionamiento de la especie humana. La clonación humana, ha demostrado que se puede reprogramar una célula diferenciada de un individuo adulto, convirtiendo una célula altamente especializada en un embrión y hacerla volver atrás en su programa genético, obteniendo así un ser idéntico al primero. Como profesionales de la salud preservamos la vida, sin olvidar que debemos tratar de ofrecer una adecuada calidad de la misma a nuestros pacientes y dentro de condiciones éticas.

Nowdays, the life and health sciences have achieved significant milestones allowing the emergence of new branches, such as genetic engineering, molecular genetics, medical genetics and genomics, which pose scientific and technical criteria to sort and conduct their professional work. Thus, we consider important to analyze and reflect from the bioethical standpoint advances in the field of human genetics, addressing the following topics: Paternity tests, studies that are intended to determine the genetic link up (kinship) in the first degree between an individual and his male parent. The carrier screening used to determine whether a person is a carrier of a genetic disease, usually applied to individuals heterozygous fora recessive gene, or individuals heterozygous fora dominant gene that do notexpress the disease and chromosomal rearrangements. Eugenics, conceived as a social ideology, is defined as improving a species, as a science is the branch of genetic engineering that studies the improvement of the human species. Human cloning is a topic that generates more discussion not only from an ethical view, but also philosophical and religious points of view, since it has been shown that you can reprogram a differentiated cell of an adult, becoming a highly specialized cell into an embryo and make it go back in their genetic program, thus obtaining identical to the first one. As health professionals, we try to preserve life, not forgetting that we should give adequate quality of life to our patients with ethical conditions.

[Follow-up of patients with chronic hepatitis B infection with no indication for treatment. Ultrasound follow-up for carriers of the hepatitis B surface antigen]. / Seguimiento de los pacientes con infección crónica por virus B sin indicación de tratamiento. Seguimiento ecográfico en los portadores del antígeno de superficie del virus de la hepatitis B.

Ultrasonography enables us to easily study HBV liver disease progression. The presence of an irregular border in the liver, a hyperechoic pattern and an increase in the size of the caudate lobe are objective signs of cirrhosis. The slowing of the portal flow measured by Doppler echocardiography has a high specificity and sensitivity for establishing the noninvasive diagnosis of portal hypertension. For HBV carriers with no active replication data and no associated liver disease, the periodicity of ultrasound examinations for the early diagnosis of hepatocarcinoma has not been established. One of the limitations of this technique is the interobserver and intraobserver variability. Staff who are assigned to this technique need sufficient experience and dedication.