[MLVA analysis and virulence profile of community-acquired methicillin-resistant Staphylococcus aureus causing infections in Paraguayan children]. / Análisis MLVA y perfil de virulencia de aislamientos de Staphylococcus aureus resistentes a la meticilina adquiridos en la comunidad causantes de infecciones pediátricas en Paraguay.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is one of the first causes of skin and soft tissue infections, and can also produce severe diseases such as osteomyelitis and pneumonia. The aim of this descriptive study was to determine the SCCmec type and virulence profile and to study the genetic diversity by MLVA analysis of 21 CA-MRSA isolates that infected Paraguayan children in 2010. The SCCmec type and virulence factors were performed by PCR and genetic diversity by MLVA (multiple locus variable analysis). All the isolates carried SCCmec cassette iv. hla, hlb and sea genes were detected in 28,6%, 9,5% and 4,8% respectively. The MLVA analysis showed high genetic diversity with congruent antibiotic resistance and virulence profiles. This study revealed the presence of CA-MRSA harbouring SCCmeciv with high genetic diversity, providing information not available in our country.

Frequency and Associated Factors of Suicidal Ideation in Patients with Chronic Obstructive Pulmonary Disease.

We aimed to examine the prevalence of suicidal ideation in patients with chronic obstructive pulmonary disease (COPD) and the association between demographic and clinical variables and the occurrence of suicidal thoughts. This was a cross-sectional study. Sociodemographic and clinical data were recorded, and questionnaires were used to assess depressive symptoms (Beck Depression Inventory), comorbidities (Charlson Index), cognitive performance (Mini Mental State Examination), and quality of life (EuroQoL-5 dimensions and CAT). Specific questions about suicide-related behavior were included. Multivariate logistic regression analysis identified the significant factors associated with previous suicidal ideation and suicide attempts. The analysis included 1190 subjects. The prevalence of suicidal ideation and suicide attempts were 12.1% and 2.5%, respectively. Severely depressed patients had the highest prevalence of suicide-related behavior. The adjusted logistic model identified factors significantly associated with suicidal ideation: sex (odds ratio (OR) for women vs. men = 2.722 (95% confidence interval (CI) = 1.771-4.183)), depression score (OR = 1.163 (95% IC = 1.127-1.200)), and Charlson Index (OR 1.228 (95% IC 1.082-1.394)). Suicidal ideation is common in COPD patients, especially in women. While addressing suicidal ideation and suicide prevention, clinicians should first consider the management of depressive symptomatology and the improvement of coping strategies.

Coupling Between Subregional Oscillators Within the Suprachiasmatic Nucleus Determines Free-Running Period in the Rat.

Rats housed in a 22-h light-dark cycle (11:11, T22) exhibit 2 distinct circadian locomotor activity (LMA) bouts simultaneously: one is entrained to the LD cycle and a second dissociated bout maintains a period greater than 24 h. These 2 activity bouts are associated with independent clock gene oscillations in the ventrolateral (vl-) and dorsomedial (dm-) suprachiasmatic nucleus (SCN), respectively. Previous results in our laboratory have shown that the vl- and dm-SCN oscillators are weakly coupled under T22 and that the period of the dissociated bout depends on coupling between the 2 subdivisions. Here, we sought to study the behavior of the T22 SCN pacemaker upon release into free-running conditions and compare it to the behavior of the system upon release from typical 24-h (12:12, T24) entrainment. T22-desynchronized rats or T24-entrained rats were released into constant darkness (DD). Activity rhythms in T22 rats rapidly resynchronized upon release into DD, and the free-running period (FRP) of the fused rhythm was longer than the FRP of T24 rats. We then asked whether the in vivo period changes were also present in the ex vivo SCN. Per1-luc rats were desynchronized in T22 for assessment of SCN Per1-luc ex vivo. Similar to behavioral FRP, the period of ex vivo SCN explanted from T22 rats was longer than that for T24 animals. Mathematical models supported the observed behavior of the dual oscillator system as the result of mutual coupling between the vl- and dm-SCN oscillators. This bidirectionally coupled model predicted both the FRP of the T22 system and its phase-shifting response to light. Together, these data support a model of pacemaker organization in which a light-sensitive vl-SCN oscillator is mutually coupled with a light-insensitive dm-SCN oscillator, and together they determine the period of the coupled system as a whole and its response to light pulses.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) clones from Paraguayan children.

INTRODUCTION: Staphylococcus aureus is considered one of the most important human pathogens, and its levels of resistance to methicillin have increased even in strains isolated from people without nosocomial risk factors. Molecular analysis is essential for understanding the patterns of dissemination. The objective of this study was to identify community-acquired methicillin-resistant S. aureus (CA-MRSA) clones that infected Paraguayan children patients in two periods of time. METHODOLOGY: An observational, descriptive study was designed to determine the genetic variability of 115 isolates of CA-MRSA recovered from children who attended four reference centers in Paraguay between 2009-2010 and 2012-2013. RESULTS: The combined use of Pulsed Field Gel Electrophoresis (PFGE), Multi-Locus Sequencing Typing, Multi-Locus Variable Analysis (MLVA) and Spa typing techniques allowed the identification of two dominant clones: ST30-IV-t019 (77%) and ST5-IV-t311 (10%), and the establishment of the former as the leading cause of CA-MRSA infections in children during the study period. CONCLUSIONS: This is the first study that provides epidemiological information as well as microbiological and molecular characteristics of CA-MRSA isolates recovered from children from Asunción and the Central Department of Paraguay.

Physicochemical and nutritional characteristics of banana flour during ripening.

Banana flour has been recognized as functional ingredient, owing to its healthy nutritional pattern. Nevertheless, unripe and ripe banana flours show different characteristics and scarce information is available about changes undergone during banana ripening. This study evaluates the changes on physiochemical (chemical composition, hydration properties, rheological properties and structural characteristic) and nutritional (resistant starch content, phenolic compound and antioxidant activity) characteristics of banana flour at the initial four ripening stages. The significant increase in protein content and decrease in carbohydrate and apparent amylose content, besides the reduction in pasting properties, between 2nd and 3rd stages suggested a climacteric peak during ripening. Between those stages, a significant decrease in total and resistant starch was produced together with an increase in total phenolic content and antioxidant activity. Therefore, the knowledge of the physicochemical and nutritional characteristics of banana flour at each ripening stage allows better selection depending on the industrial application.

Cognitive status among patients with chronic obstructive pulmonary disease.

PURPOSE: We investigated the association between cognitive impairment and chronic obstructive pulmonary disease (COPD), taking into account demographic and clinical variables evaluated during routine practice. PATIENTS AND METHODS: We performed a post hoc analysis of a cross-sectional study that included subjects with stable COPD. Sociodemographic and clinical information was recorded using the Body mass index, airflow Obstruction, Dyspnea and Exacerbations index and the Charlson comorbidity index. Cognitive performance was studied by the mini-mental state examination, with a score less than 27 indicating clinical impairment. Depressive symptoms, physical activity, and quality of life (EuroQoL-5 dimensions and COPD Assessment Test) were also evaluated. RESULTS: The analysis included 940 subjects. The prevalence of cognitive impairment was 39.4%. Multivariate logistic regression models revealed that cognitive impairment was associated with educational level (odds ratio [OR] =0.096, 95% confidence interval [CI] =0.011-0.447) and poorer quality of life measured by the EuroQoL-5 dimensions social tariff (OR =0.967, 95% CI =0.950-0.983). When questionnaires were not included in the analysis, cognitive impairment was associated with educational level (OR =0.063, 95% CI =0.010-0.934), number of exacerbations (OR =11.070, 95% CI =1.450-84.534), Body mass index, airflow Obstruction, Dyspnea and Exacerbations index score (OR =1.261, 95% CI =1.049-1.515), and the Charlson comorbidity index (OR =1.412, 95% CI =1.118-1.783). CONCLUSION: Cognitive impairment is common in COPD and is associated with low educational level, higher disease severity, and increased comorbidity. This could have therapeutic implications for this population.

[Community-acquired Staphylococcus aureus isolated from Paraguayan children: clinical, phenotypic and genotypic characterization]. / Staphylococcus aureus adquiridos en la comunidad: caracterización clínica, fenotípica y genotípica de aislados en niños paraguayos.

INTRODUCTION: The prevalence of Staphylococcus aureus in the community has increased, being the pediatric population the most affected. This fact highlights the need for epidemiological surveillance. AIM: To characterize clinical, phenotypic and genotypic isolates of S. aureus children's samples with community-acquired infections, collected in hospitals of Asuncion and the Central Department, between November 2009 and December 2010. MATERIALS AND METHODS: Descriptive and transverse analysis with analytical component. Clinical data collected by medical records, antibiotic susceptibility according to CLSI criteria and detection of mecA (encoding methicillin resistance) and luk-PV genes (encoding Panton Valentine leucocidin) by PCR using specific oligonucleotides. RESULTS: 123 isolates of S. aureus, 76% came from skin and soft tissue infections and 20% from sepsis. 18.7% (n = 23) were resistant to methicillin (MRSA). The presence of the mecA gene, a variant there and the PVL was detected in 12.2 and 48 isolates respectively. 43% of MRSA (n = 10) was carrying luk-PV. The clinical and demographic differences between patients infected with MRSA or MSSA were not statistically significant. DISCUSSION: This study constitutes the first phenotypic and genotypic characterization of S. aureus associated with pediatric patients in Paraguay.

Análisis MLVA y perfil de virulencia de aislamientos de Staphylococcus aureus resistentes a la meticilina adquiridos en la comunidad causantes de infecciones pediátricas en Paraguay

Staphylococcus aureus resistente a la meticilina adquirido en la comunidad (SARM-AC) es uno de los principales patógenos causantes de infecciones de piel y partes blandas, aunque también se lo implica en infecciones graves, como osteomielitis y neumonía. El objetivo de este estudio descriptivo fue determinar el tipo de cassette SCCmec, el perfil de virulencia y la variabilidad genética de 21 aislamientos de SARM-AC que infectaron a niños paraguayos en el año 2010. Se determinó por PCR el tipo de cassette SCCmec y los factores de virulencia, en tanto que la variabilidad genética se determinó por la técnica multiple locus variable analysis (MLVA). Todos los aislamientos (100%) presentaron cassette SCCmec IV; algunos portaron factores de virulencia como hla, hlb y sea (el 28,6, el 9,5 y el 4,8%, respectivamente). El análisis MLVA mostró gran variabilidad genética, con datos de antibiotipo y perfil de virulencia congruentes. Este trabajo pone de manifiesto por primera vez en Paraguay la presencia de SARM-AC portador del cassette SCCmec IV con elevada diversidad genética.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is one of the first causes of skin and soft tissue infections, and can also produce severe diseases such as osteomyelitis and pneumonia. The aim of this descriptive study was to determine the SCCmec type and virulence profile and to study the genetic diversity by MLVA analysis of 21 CA-MRSA isolates that infected Paraguayan children in 2010. The SCCmec type and virulence factors were performed by PCR and genetic diversity by MLVA (multiple locus variable analysis). All the isolates carried SCCmec cassette IV. hla, hlb and sea genes were detected in 28,6%, 9,5% and 4,8% respectively. The MLVA analysis showed high genetic diversity with congruent antibiotic resistance and virulence profiles. This study revealed the presence of CA-MRSA harbouring SCCmec IV with high genetic diversity, providing information not available in our country.

Estudio comparativo de morbimortalidad del prematuro tardío y el recién nacido de termino. Hospital de Clínicas. Asunción, Paraguay

Introducción: Comparado con el recién nacido a término, la tasa de morbimortalidad en el prematuro tardío es mayor a causa de las características específicas limítrofes que presentan en sus diferentes órganos. Objetivos: Describir las causas, las características clínicas y determinar la incidencia y la tasa de mortalidad de prematuros tardíos en comparación con los recién nacidos de término en un Departamento de Neonatología. Materiales y Métodos: Estudio observacional analítico retrospectivo, muestreo no probabilístico de casos consecutivos de recién nacidos prematuros tardíos, así como el siguiente recién nacido de término, de las fichas clínicas para una relación 1/1. Resultados: Durante el año 2012 nacieron 2741 RN vivos, 210 fueron RN prematuros tardíos (7,6%). El 61% de los nacimientos fue por parto normal en RN de término, y por cesárea 60% en RN pretérmino tardío (p=0,003). Presentaron alguna complicación posterior al nacimiento 95/210 de los RN pretérmino tardíos (45%), y 11/210 de los RN de término (5%) con un OR de 14,9 (IC= 7-29, P < 0.0001). La complicación más frecuente fue la dificultad respiratoria en 54/210 RN pretérmino tardíos y así como en 8/210 RNT, requerimiento de luminoterapia en 41/210 RN pretérmino tardíos y en 8/210 RNT. Se encontraron diferencias significativas en la presencia de dificultad respiratoria OR 8,74, requerimiento de luminoterapia OR 6, de antibioticoterapia OR 6 y de ingreso a terapia intensiva 9,6. No se detectó diferencias significativas en cuanto al óbito de los pacientes (p=0.29). Conclusiones: Los RN pretérminos tardíos presentan mayor morbilidad que los nacidos a término. La incidencia de RN pretérmino tardíos fue similar a lo encontrado a nivel mundial. La causa más frecuentemente asociada fue el elevado número de cesáreas. En comparación con los de término, presentaron mayor número de complicaciones como dificultad respiratoria y requerimiento de luminoterapia, y mayor tiempo de hospitalización.

Introduction: Compared with term newborns, the morbidity and mortality rate in late prematurity is higher because of the specific borderline development of the different organ systems. Objectives: To describe the causes, clinical characteristics and determine the incidence and mortality rate of late preterm infants compared with term infants in a Neonatology Department. Materials and Methods: This was a retrospective analytical observational study, with non-probabilistic sampling of consecutive cases of late preterm infants, as well as the following term newborn, as obtained from clinical records for a 1/1 ratio. Results: During 2012, 2741 live births were born, 210 were premature newborns (7.6%). 61% of births were due to normal delivery in term newborns, and 60% in late preterm newborns (p = 0.003). There were 95/210 complications of late preterm infants (45%) and 11/210 of term infants (5%) with an OR of 14.9 (CI = 7-29, P <0.0001) . The most frequent complication was respiratory distress in 54/210 late preterm infants, as well as in 8/210 in term newborns; luminotherapy in 41/210 late preterm infants and 8/210 in term newborns. Significant differences were found in the presence of respiratory distress, OR 8.74, luminotherapy, OR 6, antibiotic therapy, OR 6, and admission to intensive care unit, OR 9,6. There were no significant differences in patient deaths (p = 0.29). Conclusions: Late preterm infants present higher morbidity than those born at term. The incidence of late preterm newborns was similar to that found worldwide. The most frequent associated cause was a high number of cesarean sections. Compared with term newborns, late preterm newborns developed a greater number of complications such as respiratory distress and light therapy requirements, and longer hospitalization time.

Staphylococcus aureus adquiridos en la comunidad: caracterización clínica, fenotípica y genotípica de aislados en niños paraguayos / Community-acquired Staphylococcus aureus isolated from Paraguayan children: clinical, phenotypic and genotypic characterization

Introduction: The prevalence of Staphylococcus aureus in the community has increased, being the pediatric population the most affected. This fact highlights the need for epidemiological surveillance. Aim: To characterize clinical, phenotypic and genotypic isolates of S. aureus children’s samples with community-acquired infections, collected in hospitals of Asuncion and the Central Department, between November 2009 and December 2010. Materials and Methods: Descriptive and transverse analysis with analytical component. Clinical data collected by medical records, antibiotic susceptibility according to CLSI criteria and detection of mecA (encoding methicillin resistance) and luk-PV genes (encoding Panton Valentine leucocidin) by PCR using specific oligonucleotides. Results: 123 isolates of S. aureus, 76% came from skin and soft tissue infections and 20% from sepsis. 18.7% (n = 23) were resistant to methicillin (MRSA). The presence of the mecA gene, a variant there and the PVL was detected in 12.2 and 48 isolates respectively. 43% of MRSA (n = 10) was carrying luk-PV. The clinical and demographic differences between patients infected with MRSA or MSSA were not statistically significant. Discussion: This study constitutes the first phenotypic and genotypic characterization of S. aureus associated with pediatric patients in Paraguay.

Introducción: La prevalencia de infecciones por Staphylococcus aureus en la comunidad ha aumentado, siendo la población pediátrica la más afectada; poniendo de relieve la necesidad de una vigilancia epidemiológica. Objetivo: Caracterizar clínica, fenotípica y genotípicamente aislados de S. aureus de muestras de niños con infecciones adquiridas en la comunidad, recolectadas en hospitales de Asunción y el Departamento Central, entre noviembre de 2009 y diciembre de 2010. Materiales y Métodos: Estudio descriptivo de corte trasverso. Datos clínicos fueron recabados de fichas, la susceptibilidad a antimicrobianos se hizo según criterio del CLSI y la detección de genes mecA y luk-PV se realizó por RPC empleando oligonucleótidos específicos. Resultados: De 123 aislados de S. aureus, 76% provenían de infecciones de piel y tejidos blandos y 20% de pacientes con bacteriemias. 18,7% (n: 23) fueron resistentes a meticilina (SARM). Se detectó la presencia de genes mecA, una variante del mismo y luk-PV en 9,8%, 1,6 y 39% de los aislados, respectivamente. El 43% de los SARM (n: 10) fue portador de luk-PV. Las diferencias clínicas y demográficas entre pacientes infectados por SARM o SASM no fueron estadísticamente significativas. Discusión: Este estudio constituye la primera caracterización clínica, fenotípica y genotípica de S. aureus asociados a la comunidad en población pediátrica realizada en Paraguay.

Prácticas sobre la lectura de libros a niños y niñas en una comunidad de Paraguay / Practice of Family Reading of Books to Children in a Community in Paraguay

Introducción: El hábito de lectura de libros a los niños y niñas es una herramienta, que estimula su desarrollo neuropsicoafectivo y social, además le permite desenvolverse en un mundo de cambios constantes con sentido crítico. Es accesible y fácil de realizar, sin embargo los lectores habituales y competentes varían de acuerdo al contexto en el que se desarrollan. Objetivos: Conocer las prácticas sobre la lectura de libros de los niños y niñas de la Comunidad 24 de junio de San Lorenzo Materiales y Métodos: Diseño observacional descriptivo, de corte trasversal. Los datos fueron obtenidos a través de una encuesta realizada a los adultos tutores de los niños y niñas de la comunidad mencionada, durante los meses de julio a setiembre del 2012, y se obtuvieron datos acerca de la práctica de lectura de libros a los niños y la persona encargada de realizar esa actividad, la base de la estructura familiar y escolaridad de los adultos tutores. Resultados: La distribución por grupo etario corresponde a 55% escolares, 26% preescolares, 18% lactantes mayores y 1% a lactantes menores. Sobre la práctica de la lectura de libros a los niños 72% respondió que no realizaban esta actividad y 28% que sí lo hacían, de los cuales 79% lo realizaba la madre, 13% el padre y 8% otra persona. La base familiar está constituida en un 71% por padre y madre biológicos, 21% solo la madre, 1% solo por el padre, 3% por madre biológica y padre no biológico y 4% por otros. La escolaridad de los adultos tutores corresponde a primaria incompleta 18%, primaria completa 18%, secundaria incompleta 23%, secundaria completa 33% y terciaria completa 8%. Conclusión: La práctica de la lectura de libros a los niños y niñas en esta comunidad no es una actividad realizada habitualmente, aunque en su mayoría se encuentran en una estructura familiar conformada por ambos progenitores con escolaridad superior a la primaria completa