Phylogenetic variations in a novel family of hyperstable apple snail egg proteins: insights into structural stability and functional trends.

The relationship between protein stability and functional evolution is little explored in proteins purified from natural sources. Here, we investigated a novel family of egg proteins (Perivitellin-1, PV1) from Pomacea snails. Their remarkable stability and clade-related functions in most derived clades (Canaliculata and Bridgesii) make them excellent candidates for exploring this issue. To that aim, we studied PV1 (PpaPV1) from the most basal lineage, Flagellata. PpaPV1 displays unparalleled structural and kinetic stability, surpassing PV1s from derived clades, ranking among the most hyperstable proteins documented in nature. Its spectral features contribute to a pale egg coloration, exhibiting a milder glycan binding lectin activity with a narrower specificity than PV1s from the closely related Bridgesii clade. These findings provide evidence for substantial structural and functional changes throughout the genus' PV1 evolution. We observed that structural and kinetic stability decreased in a clade-related fashion and was associated with large variations in defensive traits. For instance, pale PpaPV1 lectin turns potent in the Bridgesii clade, adversely affecting gut morphology, while giving rise to brightly colored PV1s providing eggs with a conspicuous, probably warning signal in the Canaliculata clade. This work provides a comprehensive comparative analysis of PV1s from various apple snail species within a phylogenetic framework, offering insights into the interplay among their structural features, stability profiles and functional roles. More broadly, our work provides one of the first examples from natural evolution showing the crucial link among protein structure, stability and evolution of new functions.

A Case-Control Study of Real-Life Experience with Ceftolozane-Tazobactam in Patients with Hematologic Malignancy and Pseudomonas aeruginosa Infection.

We present our experience in patients with hematologic malignancy and Pseudomonas aeruginosa infection treated with ceftolozane-tazobactam. We performed a single-center case-control study comparing patients with hematologic malignancy and P. aeruginosa infection treated with ceftolozane-tazobactam (study group) with similar patients not treated with ceftolozane-tazobactam (control group) to assess safety and efficacy. Nineteen cases and 38 controls were analyzed. Cases were younger (45.6 years versus 57.6 years; P = 0.012) and less frequently had bacteremia (52.6% versus 86.8%; P = 0.008). They also had worse Multinational Association for Supportive Care in Cancer (MASCC) scores (10.2 versus 16.1; P = 0.0001), more hospital-acquired infections (78.9% versus 47.4%; P = 0.013), and more extremely drug-resistant (XDR) P. aeruginosa infections (47.4% versus 21.1%; P = 0.015). Cases received a median of 14 days (7 to 18 days) of ceftolozane-tazobactam (monotherapy in 11 cases [57.9.6%]). Ceftolozane-tazobactam was mostly used as targeted therapy (16 cases; 84.2%) because of resistance (9 cases; 47.4%), failure (4 cases; 21.1%), and toxicity (3 cases; 15.8%). Ten cases had bacteremia (52.6%). The sources were pneumonia (26.3%), catheter-related bacteremia (21.1%), primary bacteremia (21.1%), and perianal/genital (15.7%), urinary (10.5%), and skin/soft tissue (5.3%) infection. No toxicity was attributed to ceftolozane-tazobactam. More than 60% had neutropenia, and 15.8% fulfilled the criteria for sepsis. There were no significant differences in clinical cure at day 14 (89.5% versus 71.1%; P = 0.183) or recurrence (15.8% versus 10.5%; P = 0.675). Thirty-day mortality was lower among cases (5.3% versus 28.9%; P = 0.045). Ceftolozane-tazobactam was well tolerated and at least as effective as other alternatives for P. aeruginosa infection in patients with hematologic malignancy, including neutropenic patients with sepsis caused by XDR strains.

Chemical Isotope Labeling Exposome (CIL-EXPOSOME): One High-Throughput Platform for Human Urinary Global Exposome Characterization.

Human exposure to hundreds of chemicals, a primary component of the exposome, has been associated with many diseases. Urinary biomarkers of these chemicals are commonly monitored to quantify their exposure. However, because of low concentrations and the great variability in physicochemical properties of exposure biomarkers, exposome research has been limited by low-throughput and costly methods. Here, we developed a sensitive and high-throughput exposome analytical platform (CIL-EXPOSOME) by isotopically labeling urinary biomarkers with common functional groups (phenolic hydroxyl/carboxyl/primary amine). After a simple cleanup, we used mass spectrometry to perform a screening for both targeted and untargeted biomarkers, which was further processed by an automatic computational pipeline method for qualification and quantification. This platform has effectively introduced an isotope tag for the absolute quantification of biomarkers and has improved sensitivity of 2-1184 fold compared to existing methods. For putative identification, we built a database of 818 urinary biomarkers with MS/MS fragmentation information from either standards or in silico predictions. Using this platform, we have found 671 urinary exposure biomarker candidates from a 2 mL pooled urine sample. The exposome data acquisition and analysis time has also been greatly shortened. The results showed that CIL-EXPOSOME is a useful tool for global exposome analysis of complex samples.

Usefulness of Procalcitonin Levels for Predicting the Microbiological Orientation in Patients with Sepsis.

The main objective of the study was to verify whether levels of procalcitonin (PCT) could guide us toward determining the type of bacteria causing the sepsis and to identify the discriminatory cut-off point in the first urgent laboratory test. This study is a single center retrospective analysis that includes 371 patients with a mean age of 71.7 ± 15.6 years who were diagnosed with sepsis or septic shock. The yield of blood cultures in demonstrating the causative microbiological agent was 24.3% (90), and it was 57, 1% (212) when evaluating all types of cultures. Statistically significant positive differences were observed in the mean value of the PCT between the group that obtained positive cultures and the group that did not (p < 0.0001). The AUC-ROC of PCT values as a guide to the causal bacteria type was 0.68 (95%CI: 0.57-0.78, p < 0.0021). The PCT value that showed the best diagnostic characteristics for identifying Gram-negative rods (GNR) as the causative agent in blood cultures was 2.1 ng/mL. The positive predictive value (PPV) was 78, 9% (66.3-88.1%). The AUC-ROC of the PCT values for sepsis diagnosis, with any positive culture that could be assessed, was 0.67 (95%CI: 0.63-0.73, p < 0.0001). The PCT value that showed the best diagnostic characteristic for predicting sepsis was 3.6 ng/mL.

Racial and Ethnic Disparity in 4Ms among Older Adults Among Telehealth Users as Primary Care.

Telehealth has been widely accepted as an alternative to in-person primary care. This study examines whether the quality of primary care delivered via telehealth is equitable for older adults across racial and ethnic boundaries in provider-shortage urban settings. The study analyzed documentation of the 4Ms components (What Matters, Mobility, Medication, and Mentation) in relation to self-reported racial and ethnic backgrounds of 254 Medicare Advantage enrollees who used telehealth as their primary care modality in Southern Nevada from July 2021 through June 2022. Results revealed that Asian/Hawaiian/Pacific Islanders had significantly less documentation in What Matters (OR = 0.39, 95%, p = .04) and Blacks had significantly less documentation in Mobility (OR = 0.35, p < .001) compared to their White counterparts. The Hispanic ethnic group had less documentation in What Matters (OR = 0.18, p < .001) compared to non-Hispanic ethnic groups. Our study reveals equipping the geriatrics workforce merely with the 4Ms framework may not be sufficient in mitigating unconscious biases healthcare providers exhibit in the telehealth primary care setting in a provider shortage area, and, by extrapolation, in other care settings across the spectra, whether they be in-person or virtual.

Fast track SSTI management program based on a rapid molecular test (GeneXpert® MRSA/SA SSTI) and antimicrobial stewardship.

PURPOSE: This study examines the impacts of a skin and soft tissue infection (SSTI) management program involving a rapid diagnostic algorithm (Gram stain plus real-time PCR, GeneXpert® MRSA/SA SSTI) performed directly on clinical samples plus antimicrobial stewardship (AMS) counseling of the responsible physician. METHODS: Participants were 155 consecutive adult inpatients with SSTI and good quality clinical samples submitted to the microbiology laboratory from April 2016 to January 2017. Results of the rapid test and AMS recommendations were phoned through to the responsible physician. The comparison group was a historical cohort. RESULTS: Most SSTI were surgical wound infections (41.3% vs 38.1% for the intervention and comparison groups respectively) followed by diabetic foot (14.2% and 18.1%), abscesses (13.5% both) and cellulitis (12.9% both). Isolated microorganisms were mostly Gram-negative bacilli (two-thirds), followed by Staphylococcus aureus (SA). The ratio methicillin-susceptible SA (MSSA) to methicillin-resistant SA (MRSA) was 4:1. Improvements in the intervention cohort were: DOT (22.0 vs. 24.3 days, p = 0.007), treatment duration per SSTI episode (14.1 vs. 15.0 days, p = 0.072), treatment cost (433.1 vs. 533.3 €, p = 0.039), length of stay (18.6 vs 20.7 days, p = 0.031), related mortality (1 vs. 4 patients, p = 0.022) and Clostridium difficile infection (CDI) (4 vs. 8 patients, p = 0.050). In 48 cases (31.4%) in the intervention group, advice was given to improve empiric antibiotic treatment. CONCLUSION: This type of program could help adjust antibiotic treatment when inappropriate, reducing antibiotic use and costs, length of stay, CDI and related mortality.

Clinical and radiological profile of neuromyelitis optica spectrum disorders in an Ecuadorian cohort.

BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is a complex disease characterized by a severe inflammation of the central nervous system (CNS). This disease typically manifests with recurrent optic neuritis (ON) and acute transverse myelitis (ATM). The clinical and radiological spectrum of NMOSD is little known in Latin America (LATAM) and few reports have been published in the literature so far. In Ecuador, no reports on NMOSD have been published. For this reason we aimed to assess the demographic, clinical and imaging characteristics of patients with NMOSD from third level hospitals from Ecuador. METHODS: This is a descriptive study in which we assessed medical reports of patients with inflammatory demyelinating diseases who were attended in third level hospitals from Ecuador in 2017. Then we applied the 2015 diagnostic criteria, those patients who met the new NMOSD diagnostic criteria were selected and analyzed. Additionally, exploratory sub-analyses were subsequently carried out. RESULTS: We identified 59 patients with NMOSD, the relative frequency of NMOSD was 15.9%. The multiple sclerosis (MS) /NMOSD ratio was 5.2:1. Twenty four percent of patients were newly defined as having NMOSD when 2015 criteria was applied. The median time to diagnoses was shorter by the 2015 criteria than 2006 criteria (p<0.001). NMOSD was more prevalent in women (female/male ratio 4.4:1). The disease onset was more frequent at the fourth decade of life. The most common symptoms at the disease onset were ON and the association of ON with ATM. The mean of expanded disability status scale (EDSS) was 4.8 (SD±1.8). Concomitant autoimmune diseases were infrequent in this population (11.9%). The brain magnetic resonance imaging (MRI) abnormalities were present in 25.7% of patients at disease onset. Spinal cord MRI showed longitudinally extensive transverse myelitis (LETM) in 91.5% of cases. Recurrent NMOSD was frequent in this cohort (88%). Positivity for antibodies against aquaporin-4 (AQP4-IgG) which was measured through indirect immunofluorescence assay (IIF) was identified in 81% of the patients tested. Patients with seronegative AQP4-IgG had higher grade of disability than seropositive patients (p<0.05). Ninety eight percent of patients received treatment with immunosuppressive drugs. Three patients died due to gastric cancer (1 patient) and infectious diseases (2 patients). CONCLUSIONS: This is the first descriptive study in an Ecuadorian cohort of patients with NMOSD. We show a wide epidemiological, clinical and radiological spectrum of NMOSD.

Karyotype description of Pomacea patula catemacensis (Caenogastropoda, Ampullariidae), with an assessment of the taxonomic status of Pomacea patula.

Mitotic chromosomes of the freshwater snail Pomacea patula catemacensis (Baker 1922) were analyzed on gill tissue of specimens from the type locality (Lake Catemaco, Mexico). The diploid number of chromosomes is 2n = 26, including nine metacentric and four submetacentric pairs; therefore, the fundamental number is FN = 52, No sex chromosomes could be identified. The same chromosome number and morphology were already reported for P. flagellata, i.e., the other species of the genus living in Mexico. The basic haploid number for family Ampullariidae was reported to be n = 14 in the literature; so, its reduction to n = 13 is probably an apomorphy of the Mexican Pomacea snails. Lanistes bolteni, from Egypt, also shows n = 13, but its karyotype is much more asymmetrical, and seems to have evolved independently from P. flagellata and P. patula catemacensis. The nominotypical subspecies, P. patula patula (Reeve 1856), is a poorly known taxon, whose original locality is unknown. A taxonomical account is presented here, and a Mexican origin postulated as the most parsimonious hypothesis.

Karyological and electrophoretic differences between Pomacea flagellata and P. patula catemacensis: Caenogastropoda: Ampullariidae

The widespread Mexican apple snail Pomacea flagellata (Say 1827) and the strictly endemic "tegogolo" P. patula catemacensis (Baker 1922) (restricted to Lake Catemaco), are the only known American Ampullariidae that have haploid complements n=13. Pomacea patula catemacensis has suffered a critical reduction in abundance due to immoderate fishing for human consumption. Chromosome slides were obtained from colchicine-injected Pomacea snails collected from nine locations along the coastal zone of the Gulf of Mexico, including Lake Catemaco, for use in principal component analysis (PCA). Total proteins in foot homogenates were analyzed through isoelectric focusing (IEF) and native-PAGE electrophoresis on polyacrylamide gels. The chromosome number 2n=26 was confirmed for snails from all locations, with a uniform 9 m + 4 sm formula. However, P. patula catemacensis showed significantly larger chromosomes (absolute size) than any population of P. flagellata. Pomacea patula catemacensis also differed from all populations of P. flagellata in a PCA with standardized data, i.e., independently of the absolute size difference between species. Proteins with an acid isoelectric point were dominant in the foot of both species. The electrophoresis analysis showed that P. flagellata has 17 protein bands, with an upper bound at IEF=7.6, while P. patula catemacensis has only 15 bands, with an upper bound at IEF=7 and a more evenly spaced band pattern. Molecular weights ranged from 40 to approximately 130 kDa in both species. Proteins with high values (>94 kDa) were the most abundant. Pomacea patula catemacensis showed a band of 93 kDa, which was absent from all specimens of P. flagellata. Samples of P. flagellata did not cluster according to any geographical pattern in the statistical analyses, nor did they show any taxonomically useful differences in their electrophoretic patterns that merit sub-specific discrimination.

Uso del monitoreo ambulatorio de la presión arterial en la evaluación clínica de la hipertensión arterial / Ambulatory blood pressure monitoring in the clinic evaluation of arterial hypertension

La presión arterial, al igual que otros eventos de importancia biológica en nuestro organismo, sigue un ritmo circadiano normalmente, por lo que ésta fluctúa durante las 24 horas del día. Para establecer la eficacia del tratamiento antihipertensivo, se deberá demostrar que dicho tratamiento mantiene controlada la presión arterial en los diferentes momentos del día y la noche, por lo cual se ha utilizado el monitoreo ambulatorio de la presión arterial (MAPA) o “holter de presión,” como una herramienta indispensable en la evaluación clínica de la hipertensión arterial.

The arterial pressure, the same as others events of biologic importance in our organism, follow a normally circadian rhythm, and fluctuate during 24 hours of day. For establish the efficiency ofantihypertensive treatment, should be demonstrated that treatment keep under control the arterial pressure in the different moments of day and night, this is the reason why used an ambulatory blood pressure monitoring like a essential tool in the evaluation of arterial hypertension.

Hipertensión arterial: respuesta inadecuada al tratamiento médico vs. paciente / Hypertension: inadequate response to the treatment physician vs. patient

Objetivo: Determinar las causas más comunes de una respuesta inadecuada al tratamiento antihipertensivo en nuestro medio, y qué porcentaje de la población hipertensa controla su presión con el tratamiento aplicado.Diseño del estudio: El presente es un estudio retroprospectivo, analítico, llevado a cabo en el Servicio de cardiología de la Consulta Externa del hospital Luis Vernaza de Guayaquil. La muestra fue de 100 pacientes hipertensos tratados en quienes se trató de determinar la eficacia del tratamiento antihipertensivo. De estos pacientes, a 30 no controlados se les realizó una encuesta para establecer la causa de su respuesta inadecuada al tratamiento.Resultados: Aproximadamente 60% de pacientes presentó un control eficaz de su presión arterial. Dentro de los no controlados se observó que la causa principal de la respuesta inadecuada al tratamiento fue la falta de sometimiento al mismo, (53,33%), y a su vez esta se debió en su mayor porcentaje al olvido y a los costos de la medicación (44% c/u), siendo pocos los casos de abandono por intolerancia al fármaco empleado.Conclusión: Con lo observado se estableció la necesidad de reducir esta falta de colaboración al tratamiento mediante un seguimiento más persistente e integral de los pacientes hipertensos, el que incluye educación del paciente sobre la importancia y consecuencias a corto, mediano y largo plazo de su enfermedad y los beneficios de la terapia.

Objective: To determine common causes of an inadequate response to the antihypertensive treatment in our environment and how many patients can control their blood pressure with their treatment.Study Design: This is a retro prospective study made in cardiology service of Luis Vernaza Hospital – Guayaquil, where we chose 100 hypertensive patients under treatment and tried to determine its efficacy. We chose those who were not controlling their pressure and tried to establish more common causes of their inadequate response to the treatment. Results: Approximately 60% of patients had an effective control of their blood pressure. In those who were not under control we found that the outstanding cause of an inadequate response to the treatment was the lack of adherence (53.33%) and at the same time this lack of adherence to the treatment was due to forgetting as much as medication expenses (44%) and there with few cases of withdrawal for intolerance to the drugConclusion: As we observed, it is necessary to reduce this lack of adherence to the treatment by means of a more aggressive and integral following of hypertensive patients, which should include education of the patient about the importance and short-term and long-term consequences and also the benefits of the treatment.

Factores etiológicos más frecuentes de epilepsia tardía / Frequent factors etiologicos mas of epilepsy tardia

Tipo de estudio: prospectivo, observacional, analítico, con un universo de 32 pacientes quienes presentaron por primera ocasión crisis convulsiva después de los 15 años e ingresados al hospital Abel Gilbert Pontón de la ciudad de Guayaquil entre septiembre 2001 y agosto 2002.Objetivos: Establecer:a) El factor de riesgo más importante.b) El grupo etario más susceptible.c) El tipo de crisis más frecuente.d) La importancia de la TC.Resultados: Se demostró lesión en 26 pacientes (81%), en 6 (19%) no se halló la causa. La etiología más frecuente fue la ECV con 16 pacientes (50%); 5 con neuroinfección (15%).La TC encontró lesiones hipodensas en 14 pacientes, 2 hiperdensas; 3 con signos de atrofia. En 10 reporta normal. Conclusiones: La ECV es la principal causa. La TC cerebral .demostró ser útil al evidenciar lesiones. Las crisis generalizadas son las más frecuentes (84%).

Type of study: Prospectivo, observacional, analitic study; with a universe of 32 patients who presented by first time convulsive crisis after 15 years and entered the Guayaquil Hospital between September 2001 and August 2002. Objectives: Are to establish: a) The factor of more important risk. b) The more susceptible etario group. c) The type of more frequent crisis. d) The importance of the TC. Results: Injury in 26 patients (81%) in 6(19 %) was demonstrated was not the cause. The etiología but frequents was him ECV with 16 patients (50%); 5 patients with neuroinfección (15%) the TC found injuries hypodense in 14 patients, 2 hyperdense ones; 3 with atrophy signs. In 10 it reports normal. Conclusions: ECV is the main cause TC is important for demonstrating injuries The generalized crises are most frequent (84%).

Sensibilidad y especificidad de la punción por aspiración con aguja fina en la evaluación del nódulo tiroideo solitario, Hospital Regional Teodoro Maldonado Carbo Guayaquil / Sensibility and specificity of the punction by aspiration with fine needle in the evaluation of the solitary thyroid nodule, Teodoro Maldonado Carbo Regional Hospital Guayaquil

Objetivo: evaluar la eficacia de la punción por aspiración con aguja fina (PAAF) en el estudio del nódulo tiroideo solitario. Tipo de estudio: Se realizó un estudio transversal de una muestra no aleatoria de 32 pacientes quienes presentaron nódulo tiroideo solitario. Análisis estadístico: se determinó la sensibilidad, especificidad, valores predictivos positivo y negativo, tasas de falsos positivos y negativos, prevalencia y valor global del método. Resultados: sensibilidad 81 por ciento, especificidad 90 por ciento, valor predictivo positivo 81 por ciento y valor predictivo negativo 90 por ciento, prevalencia 34 por ciento tasa de falsos positivos 8,5 por ciento, tasas de falsos negativos 19 por ciento y el valor global del método fue de 86 por ciento...

Karyotype description of Pomacea patula catemacensis (Caenogastropoda, Ampullariidae), with an assessment of the taxonomic status of Pomacea patula

Mitotic chromosomes of the freshwater snail Pomacea patula catemacensis (Baker 1922) were analyzed on gill tissue of specimens from the type locality (Lake Catemaco, Mexico). The diploid number of chromosomes is 2n = 26, including nine metacentric and four submetacentric pairs, therefore, the fundamental number is FN = 52. No sex chromosomes could be identified. The same chromosome number and morphology were already reported for P. flagellata, i.e., the other species of the genus living in Mexico. The basic haploid number for family Ampullariidae was reported to be n = 14 in the literaure; so, its reduction to n = 13 is probably an apomorphy of the Mexican Pomacea snails. Lanistes bolteni, from Egypt, also shows n = 13, but its karyotype is much more asymmetrical, and seems to have evolved independently from P. flagellata and P. patula catemacencis. The nominotypical subspecies, P. patula patula (Reeve 1856), is a poorly known taxon, whose original locality is unknown. A taxonomical account is presented here, and a Mexican origin postulated as the most parsimonious hypothesis.