The impact of the COVID-19 pandemic on heart failure management: Global experience of the OPTIMIZE Heart Failure Care network.

During the COVID-19 pandemic, reductions in heart failure (HF) hospitalizations have been widely reported, and there is an urgent need to understand how HF care has been reorganized in countries with different infection levels, vaccination rates and healthcare services. The OPTIMIZE Heart Failure Care program has a global network of investigators in 42 countries, with first-hand experience of the impact of the pandemic on HF management in different care settings. The national coordinators were surveyed to assess: 1) the challenges of the COVID-19 pandemic for continuity of HF care, from both a hospital and patient perspective; 2) the organizational changes enacted to ensure continued HF care; and 3) lessons learned for the future of HF care. Contributions were obtained from 37 national coordinators in 29 countries. We summarize their input, highlighting the issues raised and using the example of three very different settings (Italy, Brazil, and Taiwan) to illustrate the similarities and differences across the OPTIMIZE program.

Consensus Recommendations by the Asian Pacific Society of Cardiology: Optimising Cardiovascular Outcomes in Patients with Type 2 Diabetes.

The Asian Pacific Society of Cardiology convened a consensus statement panel for optimising cardiovascular (CV) outcomes in type 2 diabetes, and reviewed the current literature. Relevant articles were appraised using the Grading of Recommendations, Assessment, Development and Evaluation system, and consensus statements were developed in two meetings and were confirmed through online voting. The consensus statements indicated that lifestyle interventions must be emphasised for patients with prediabetes, and optimal glucose control should be encouraged when possible. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are recommended for patients with chronic kidney disease with adequate renal function, and for patients with heart failure with reduced ejection fraction. In addition to SGLT2i, glucagon-like peptide-1 receptor agonists are recommended for patients at high risk of CV events. A blood pressure target below 140/90 mmHg is generally recommended for patients with type 2 diabetes. Antiplatelet therapy is recommended for secondary prevention in patients with atherosclerotic CV disease.

Impact of diabetes and sex in heart failure with reduced ejection fraction patients from the ASIAN-HF registry.

AIMS: To examine sex differences in clinical characteristics, echocardiographic features, quality of life and 1-year death or heart failure (HF) hospitalization outcomes in patients with/without diabetes mellitus (DM). METHODS AND RESULTS: Utilizing the Asian Sudden Cardiac Death in HF (ASIAN-HF) registry, 5255 patients (mean age 59.6 ± 13.1, 78% men) with symptomatic HF with reduced ejection fraction (HFrEF) were stratified by DM status to address the research aims. Despite similar prevalence of DM between Asian men (43%) and women (42%), the odds of DM increased at lower body mass index in women vs. men (≥ 23 vs. ≥ 27.5 kg/m2 , Pinteraction = 0.014). DM was more strongly related to chronic kidney disease in women vs. men [adjusted odds ratio (OR) 1.85, 95% confidence interval (CI) 1.33-2.57 vs. OR 1.32, 95% CI 1.11-1.56, Pinteraction = 0.009]. Sex also modified the relationship between DM and left ventricular geometry (Pinteraction = 0.003), whereby DM was associated with a more concentric left ventricular geometry in women than men. Women had lower quality of life than men (P < 0.001), in both DM and non-DM groups. DM was associated with worse composite outcomes at 1 year in women vs. men [hazard ratio (HR) 1.79, 95% CI 1.24-2.60 vs. HR 1.32, 95% CI 1.12-1.56; Pinteraction = 0.005). CONCLUSIONS: Asian women with HFrEF were more likely to have DM despite a lean body mass index, a greater burden of chronic kidney disease and more concentric left ventricular geometry, compared to men. Furthermore, DM confers worse quality of life, irrespective of sex, and a greater risk of adverse outcomes in women than men. These data underscore the need for sex-specific approaches to diabetes in patients with HF.

Prevalence, clinical correlates, and outcomes of anaemia in multi-ethnic Asian patients with heart failure with reduced ejection fraction.

AIMS: Recent international heart failure (HF) guidelines recognize anaemia as an important comorbidity contributing to poor outcomes in HF, based on data mainly from Western populations. We sought to determine the prevalence, clinical correlates, and prognostic impact of anaemia in patients with HF with reduced ejection fraction across Asia. METHODS AND RESULTS: We prospectively studied 3886 Asian patients (60 ± 13 years, 21% women) with HF (ejection fraction ≤40%) from 11 regions in the Asian Sudden Cardiac Death in Heart Failure study. Anaemia was defined as haemoglobin <13 g/dL (men) and <12 g/dL (women). Ethnic groups included Chinese (33.0%), Indian (26.2%), Malay (15.1%), Japanese/Korean (20.2%), and others (5.6%). Overall, anaemia was present in 41%, with a wide range across ethnicities (33-54%). Indian ethnicity, older age, diabetes, and chronic kidney disease were independently associated with higher odds of anaemia (all P < 0.001). Ethnicity modified the association of chronic kidney disease with anaemia (Pinteraction  = 0.045), with the highest adjusted odds among Japanese/Koreans [2.86; 95% confidence interval (CI) 1.96-4.20]. Anaemic patients had lower Kansas City Cardiomyopathy Questionnaire scores (P < 0.001) and higher risk of all-cause mortality and HF hospitalization at 1 year (hazard ratio = 1.28, 95% CI 1.08-1.50) compared with non-anaemic patients. The prognostic impact of anaemia was modified by ethnicity (Pinteraction  = 0.02), with the greatest hazard ratio in Japanese/Koreans (1.82; 95% CI 1.14-2.91). CONCLUSIONS: Anaemia is present in a third to more than half of Asian patients with HF and adversely impacts quality of life and survival. Ethnic differences exist wherein prevalence is highest among Indians, and survival is most severely impacted by anaemia in Japanese/Koreans.

Chronic Heart Failure Clinical Practice Guidelines' Class 1-A Pharmacologic Recommendations: Start-to-End Synergistic Drug Therapy?

BACKGROUND: Chronic heart failure (HF) disease as an emerging epidemic has a high economic-psycho-social burden, hospitalization, readmission, morbidity and mortality rates despite many clinical practice guidelines' evidenced-based and consensus driven recommendations that include trials' initial-baseline data. OBJECTIVE: To show that the survival and hospitalization-free event rates in the reviewed chronic HF clinical practice guidelines' class I-A recommendations as initial HF drug therapy (IDT) is possibly a combination and 'start-to-end' synergistic effect of the add-on ('end') HF drug therapy (ADT) to the baseline ('start') HF drug therapy (BDT). METHODOLOGY: The references cited in the chronic HF clinical practice guidelines of the 2005, 2009, and 2013 American Heart Association/American College of Cardiology (AHA/ACC), the 2006 Heart Failure Society of America (HFSA), and the 2005, 2008, and 2012 European Society of Cardiology (ESC) were reviewed and compared with the respective guidelines' and other countries' recommendations. RESULTS: The BDT using glycosides and diuretics is 79%-100% in the cited HF trials. The survival rates attributed to the BDT ('start') is 46%-89% and IDT ('end') 61%-92.8%, respectively. The hospitalization-free event rate of the BDT group: 47.1% to 85.3% and IDT group 61.8%-90%, respectively. Thus, the survival and hospitalization-free event rates of the ADT is 0.4%-15% and 4.6% to 14.7%, respectively. The extrapolated BDT survival is 8%-51% based on a 38% estimated natural HF survival rate for the time period109. CONCLUSION: The contribution of baseline HF drug therapy (BDT) is relevant in terms of survival and hospitalization-free event rates compared to the HF class 1-A guidelines initial drug therapy recommendations (IDT). Further, the proposed initial HF drug ('end') therapy (IDT) has possible synergistic effects with the baseline HF drug ('start') therapy (BDT) and is essentially the add on HF drug therapy (ADT) in our analysis. The polypharmacy HF treatment is a synergistic effect due to BDT and ADT.

Heart failure across Asia: Same healthcare burden but differences in organization of care.

A gap in the knowledge on the status of heart failure (HF) in Asia versus other regions led to the creation of a working group of Asian experts from 9 countries or regions (Hong Kong, Indonesia, Malaysia, Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam). Each expert sought the best available data from local publications, registries, or clinical practice. The prevalence of HF in Asia was generally similar to global values (1% to 3%), but with some outliers. There were substantial variations in healthcare spending, and the average cost of HF hospitalization varied from 813 US$ in Indonesia to nearly 9000 US$ in South Korea. Comorbidities were frequent, particularly hypertension, diabetes mellitus, and dyslipidemia. Modifiable risk factors such as smoking were alarmingly common in some countries. Asian HF patients spent between 5 and 12.5days in hospital, and 3% to 15% were readmitted for HF by 30days. The pharmacological treatment of Asian patients generally followed international guidelines, including renin-angiotensin-aldosterone system inhibitors (61% to 90%), diuretics (76% to 99%), beta-blockers (32% to 78%), and digoxin (19% to 53%), with some room for improvement in terms of life-saving therapies. Our review supports implementation of a more comprehensive and organized approach to HF care in Asia.

Heart Failure Clinical Trials in East and Southeast Asia: Understanding the Importance and Defining the Next Steps.

Heart failure (HF) is a major and increasing global public health problem. In Asia, aging populations and recent increases in cardiovascular risk factors have contributed to a particularly high burden of HF, with outcomes that are poorer than those in the rest of the world. Representation of Asians in landmark HF trials has been variable. In addition, HF patients from Asia demonstrate clinical differences from patients in other geographic regions. Thus, the generalizability of some clinical trial results to the Asian population remains uncertain. In this article, we review differences in HF phenotype, HF management, and outcomes in patients from East and Southeast Asia. We describe lessons learned in Asia from recent HF registries and clinical trial databases and outline strategies to improve the potential for success in future trials. This review is based on discussions among scientists, clinical trialists, industry representatives, and regulatory representatives at the CardioVascular Clinical Trialist Asia Forum in Singapore on July 4, 2014.

Combination therapy in hypertension: an Asia-Pacific consensus viewpoint.

Hypertension incurs a significant healthcare burden in Asia-Pacific countries, which have suboptimal rates of blood pressure (BP) treatment and control. A consensus meeting of hypertension experts from the Asia-Pacific region convened in Hanoi, Vietnam, in April 2013. The principal objectives were to discuss the growing problem of hypertension in the Asia-Pacific region, and to develop consensus recommendations to promote standards of care across the region. A particular focus was recommendations for combination therapy, since it is known that most patients with hypertension will require two or more antihypertensive drugs to achieve BP control, and also that combinations of drugs with complementary mechanisms of action achieve BP targets more effectively than monotherapy. The expert panel reviewed guidelines for hypertension management from the USA and Europe, as well as individual Asia-Pacific countries, and devised a treatment matrix/guide, in which they propose the preferred combination therapy regimens for patients with hypertension, both with and without compelling indications. This report summarizes key recommendations from the group, including recommended antihypertensive combinations for specific patient populations. These strategies generally entail initiating therapy with free drug combinations, starting with the lowest available dosage, followed by treatment with single-pill combinations once the BP target has been achieved. A single reference for the whole Asia-Pacific region may contribute to increased consistency of treatment and greater proportions of patients achieving BP control, and hence reducing hypertension-related morbidity and mortality.

The use of medications in the secondary prevention of coronary artery disease in the Asian region.

BACKGROUND: Cardiovascular diseases, to which coronary artery disease (CAD) is a significant contributor, are a leading cause of long-term morbidity and mortality worldwide. In the years ahead, it is estimated that approximately half of the world's cardiovascular burden will occur in the Asian region. Currently there is a large gap in secondary prevention, with unrealized health gains resulting from underuse of evidence-based medications, including beta-blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), aspirin and other antiplatelet agents, and lipid-lowering drugs. Despite the almost universal recommendation for these drugs in unstable CAD, their under-prescription is well documented for patients with acute heart failure, non-obstructive CAD, and for secondary prevention of CAD. OBJECTIVE: This article reviews the burden of CAD in Asian countries together with guidelines supporting evidence-based medication use from a secondary prevention perspective. METHODS: The MEDLINE database was searched from 2000 to 2013, inclusive, for country-specific data related to CAD and supplemented with unpublished registry data. RESULTS: In the post-discharge setting following hospital admission for acute coronary syndromes, medication prescription rates were low. Beta-blocker prescription rates ranged from 49% in China to 99% in Singapore, ACE-inhibitor/ARB prescription rates ranged from 28% in China to 96% in Singapore, and lipid-lowering therapy rates ranged from 47% in China to 97% in Singapore. Aspirin/antiplatelet drug prescription rates ranged from 86% in Indonesia to 99.5% in Singapore. Recommendations are provided to improve patient outcomes and reduce the disease burden in Asia. CONCLUSIONS: Despite recommendations issued in international and national guidelines, use of CAD medications in Asia remains suboptimal. In the absence of clear contraindications, all patients with unstable CAD should receive these agents as secondary prevention. This averts the need to target drug use according to risk, with high-risk features paradoxically associated with under-prescribing of such drugs.

Challenges and solutions in medically managed ACS in the Asia-Pacific region: expert recommendations from the Asia-Pacific ACS Medical Management Working Group.

Acute coronary syndromes (ACS) remain a leading cause of mortality and morbidity in the Asia-Pacific (APAC) region. International guidelines advocate invasive procedures in all but low-risk ACS patients; however, a high proportion of ACS patients in the APAC region receive solely medical management due to a combination of unique geographical, socioeconomic, and population-specific barriers. The APAC ACS Medical Management Working Group recently convened to discuss the ACS medical management landscape in the APAC region. Local and international ACS guidelines and the global and APAC clinical evidence-base for medical management of ACS were reviewed. Challenges in the provision of optimal care for these patients were identified and broadly categorized into issues related to (1) accessibility/systems of care, (2) risk stratification, (3) education, (4) optimization of pharmacotherapy, and (5) cost/affordability. While ACS guidelines clearly represent a valuable standard of care, the group concluded that these challenges can be best met by establishing cardiac networks and individual hospital models/clinical pathways taking into account local risk factors (including socioeconomic status), affordability and availability of pharmacotherapies/invasive facilities, and the nature of local healthcare systems. Potential solutions central to the optimization of ACS medical management in the APAC region are outlined with specific recommendations.

Genetic polymorphism of clinical and environmental strains of Pichia anomala.

In this work 20 clinical and 3 environmental yeast isolates were characterized by classical morphological and physiological methods, as well as molecular methods based on PCR of the ITS1-5.8S rDNA-ITS2 region. The characteristic morphology and biochemical profiles observed in these samples correspond to those described for the Pichia genera, more specifically to P. anomala. The profiles of susceptibility to five antifungal drugs were determined by two broth dilution methods. The results obtained by both methods were comparable and showed that clinical isolates presented more resistance to azoles, amphotericin B, and 5-fluorocytosine, than environmental ones did. By amplification and sequencing of internal transcribed spacers (ITS1 and ITS2) and the ribosomal 5.8S DNA, the yeast samples were divided into four groups, where the strains within each group had the same sequence. Of the analyzed yeast isolates, 78% were identified as Pichia anomnala. Using RAPD analysis with seven different Operon primers, polymorphism was observed within the four groups. Our study highlights the growing importance of P. anornala in fungemic episodes in premature neonates. Furthermore, the methodologies used provide a powerful tool to identify and determine differences in similar strains of this yeast.

Caracterización molecular de cepas de candida albicans aisladas de candidiasis oral en personas VIH positivo / Molecular characterization of candida albicans cepas isolated from oral candidiasis in VIH positive persons

Los aislados de Candida albicans de pacientes VIH positivo presentan características especiales, como su patrón atípico de sensibilidad frente a los antifúngicos, rasgo fenotípico que es producto de una variación genómica dentro de la especie, de ahí la importancia de estudiarla y caracterizarla genotípicamente. No se encuentran en Chile estudios publicados sobre la variabilidad genética en Candida albicans aislada de pacientes VIH positivo. En este trabajo se optimizó la técnica de amplificación aleatoria RAPD-PCR para estudiar variabilidad genética, se probaron 20 partidores de secuencias inespecíficas, concentraciones MgCl2 de 2,5 a 3,5 mM, KCl 25 a 75 mm, DNA de Candida albicans entre 300 a 3 ng en el medio de amplificación. El método permitió diferenciar 7 cluster genéticos distintos entre las 32 cepas del estudio, observándose un genotipo dominante en el 76 por ciento de los pacientes; describimos que un mismo paciente puede estar infectado por 2 o 3 cepas genéticamente distintas de Candida albicans.

Estandarización de una técnica para la detección de salmonella spp. util para manipuladores de alimentos mediante técnica de amplificación molecular / Standardization of a technique for the detection of salmonella spp. useful for food handlers by molecular amplification technique

El problema de las toxoinfecciones alimentarias es un problema de salud a nivel mundial, entre las que se encuentran las producidas por Salmonella spp.; la prevalencia de sus especies ha cambiado en los últimos años, además del bajo nivel de sensibilidad de los métodos tradicionales de aislamiento como es el caso del coprocultivo. Debido a esto el objetivo de este trabajo fue estandarizar una metodología molecular (PCR) para este patógeno a partir de muestras fecales; los resultados mostraron gran sensibilidad y especificidad, haciendo factible su utilización en manipuladores de alimentos.

Aseguramiento de la calidad y biotecnología en la industria del vino / Quality assurance and biotechnology in the wine industry

En los últimos años se ha observado un fuerte aumento en la producción y comercialización del vino, tanto a nivel nacional como internacional. Diversos factores que involucran estos procesos se han desarrollado a la par de este fenómeno y, a su vez, han influenciado al mismo. Entre éstos se encuentran la investigación aplicada y el avance biotecnológico que, de la mano del apoyo gubernamental y de organizaciones internacionales, han revertido la escasa investigación de los años anteriores. Otro factor relevante es la tendencia a la estandarización de procesos y de tecnologías de gestión de calidad y medioambiental, en la cual se han involucrado diferentes organizaciones internacionales, tales como la Organización Internacional del Vino, la Organización Internacional de Estandarización (ISO) y el Codex Alimentarius (FAO-OMS). En este artículo se revisa el grado y las características de la investigación aplicada en esta Industria, la relación de ésta con el desarrollo tecnológico, con los sistemas de gestión de calidad, con la protección medioambiental y la estandarización internacional de los procesos. De igual modo, se describe el nivel de exigencia de algunos mercados importantes para el país, como es la Comunidad Europea y las posibilidades de incorporar modernos sistemas estándares de calidad e inocuidad que permitan enfrentar de mejor forma los desafíos del sector.

Caracterización de una levadura emergente / Characterization of an emerging yeast

Las infecciones fúngicas han aumentado en el último tiempo, entre ellas las causadas por hongos levaduriformes. Siendo descritas actualmente como levaduras emergentes, han sido confundidas frecuentemente con especies del género Candida, presentando diferencias sutiles en las características morfofisiológicas, además de presentar patrones de susceptibilidad diferentes al género Candida. El presente trabajo fue propuesto para caracterizar morfofisiológica y molecularmente a una de ellas.

Actividad in vitro de 5 antifúngicos contra aislados clínicos y ambientales de pichia anomala / In vitro activity of 5 antifungal against environmental and clinical isolates of pichia anomala

Las infecciones fúngicas han aumentado en el último tiempo, entre ellas, las infecciones por levaduras emergentes, cuyos patrones de sensibilidad no han sido estudiados debido a la inexistencia de patrones de temperatura y medios de cultivo apropiados para realizar test de sensibilidad. El presente trabajo, fue propuesto como un modelo experimental de Pichia anomala, aislada de pacientes con MICs superiores que los aislados ambientales, siendo la anfotericina B el antifúngico con la mejor actividad antifúngica.

Brettanomyces, un contaminante en nuestras viñas / Brettanomyces, a contaminant in our vineyards

Uno de los avances de la enología moderna es el reconocimiento de la importancia de la levadura como un agente imprescindible para la adecuada obtención de vino. El proceso de fermentación es dinámico y existe un recambio de especies de levaduras desde el principio al final de la fermentación. Sin embargo, una de ellas, Brettanomyces, puede contaminar los caldos, alterando las cualidades aromáticas y de sabor del vino, provocando en algunos casos la pérdida del producto vinificado.Además de una importante pérdida económica, cifras extraoficiales indican que hasta un 5 por ciento de la producción nacional se pierde cada año producto de este hongo; el monto en pérdidas, sólo en vino embotellado, podría llegar a los US$30.000.000. La reacción en cadena de la polimerasa (PCR, Polimerase chain reaction) puede ser utilizada para detectar diminutas cantidades de ADN de un microorganismo. Esta técnica permite detectar este contaminante en no más de 24 horas, presenta una alta sensibilidad, necesitándose una cantidad ínfima de microorganismos en la muestra (1-100) levaduras por mL. El diagnóstico oportuno de la contaminación de los vinos por esta levadura permitiría adoptar medidas que controlen la proliferación de este contaminante, reduciendo las pérdidas del producto.

Nuevos agentes de enfermedades fúngicas: sensibilidad de levaduras frente a antifúngicos / New agents of fungical diseases: sensivility of the yeast opposit to antifungicals

Se ha experimentado un aumento de infecciones particularmente en los pacientes hospitalizados y/o portadores de alguna modalidad de inmunosupresión. El uso excesivo de nuevos y más potentes antimicrobianos y de antineoplásicos que producen alteraciones de las barreras mucosas del tracto gastrointestinal con atenuación de la función inmune celular, la utilización de catéteres intravasculares que provocan quiebre de la integridad de las barreras cutáneas, el empleo de nutrición parenteral, procedimientos quirúrgicos más agresivos, hemodiálisis, entre otros, son factores que han influido para el creciente número de enfermedades fúngicas oportunistas por nuevos agentes. Entre los microorganismos emergentes cabe resaltar especialmente las levaduras entre ellas Candida no albicans, accharomyces spp., debaryomyces spp., Hansenula spp., etc. Casos de fungemia por especies de levaduras sexuadas, Hansenula han surgido en las últimas décadas, relacionadas principalmente a 2 factores: inmunodepresión y el uso de catéter. Ese hecho ha despertado la atención de los pesquisadores para un estudio más detallado sobre Hansenula spp. El análisis de 30 muestras de Hansenula anomala de origen humano (21) y ambiental (9) en cuanto a su morfología, producción de ascosporos y evaluación del perfil de sensibilidad frente a 5 antifúngicos por métodos estandarizados, (NCCLS) fue el objetivo de nuestra investigación. Los aspectos macromorfológicos y micromorfológicos fueron estudiados a temperatura ambiente, respectivamente en medios de agar sabouraud glucosado y agar fuba con tween 80...

Programa de prevención de exposiciones laborales a sangre y líquidos corporales contaminados en alumnos de escuela de enfermería-experiencia de una universidad tradicional / Program for the prevention of worker exposure to contaminated blood and body fluids, designed for students of the school of nursing - experience of a traditional university

Los profesionales del área de la salud están en constante riesgo de infecciones durante su trabajo. Objetivos: establecer un programa de control y prevención de accidentes perfuro-cortantes y determinar su epidemiología. Metodología: Un estudio de cohorte prospectivo de tipo no analítico descriptivo de 12 mesesde duración (1999 a 2000). Resultados: Fue logrado un 90 por ciento de asistencia a actividades educativas, un 97 por ciento al programa de inmunización, fueron notificados 11 accidentes. El tiempo de notificación fue en media de 60 minutos. Los tipos de accidentes fueron: cortopunzante (81,81 por ciento), contacto con sangre (81,81 por ciento), sangramiento del sitio de inoculación en un 72,72 por ciento. La aguja corresponde al material más notificado (72,72 por ciento). El 63 por ciento de los accidentes ocurrió después de realizado el procedimiento y 45 por ciento fue por problemas en la eliminación del material cortopunzante. 9 notificados fueron con paciente fuente conocido. Conclusiones: 1)La cobertura de inmunización anti-hepatitis B presentó cobertura adecuada 97 por ciento 2) el pinchazo en el dedo con aguja fue el accidente que presentó la mayor incidencia 3) el 63 por ciento de los accidentes ocurrió después de realizado el procedimiento 4) la inmunización anti-hepatitis B, logró prevenir que el accidente presentara características de riesgo vital para la alumna.

Genetic polymorphism of clinical and environmental strains of Pichia anomala

In this work 20 clinical and 3 environmental yeast isolates were characterized by classical morphological and physiological methods, as well as molecular methods based on PCR of the ITS1-5.8S rDNA-ITS2 region. The characteristic morphology and biochemical profiles observed in these samples correspond to those described for the Pichia genera, more specifically to P. anomala. The profiles of susceptibility to five antifungal drugs were determined by two broth dilution methods. The results obtained by both methods were comparable and showed that clinical isolates presented more resistance to azoles, amphotericin B, and 5-fluorocytosine, than environmental ones did. By amplification and sequencing of internal transcribed spacers (ITS1 and ITS2) and the ribosomal 5.8S DNA, the yeast samples were divided into four groups, where the strains within each group had the same sequence. Of the analyzed yeast isolates, 78 por percent were identified as Pichia anomala. Using RAPD analysis with seven different Operon primers, polymorphism was observed within the four groups. Our study highlights the growing importance of P. anomala in fungemic episodes in premature neonates. Furthermore, the methodologies used provide a powerful tool to identify and determine differences in similar strains of this yeast.