Fiebre reumática. Estudio de 16 años en el Hospital Pediátrico Docente “Pedro Agustín Pérez” de Guantánamo

The cases treated by rheumatic fever were studied in the Pediatric Teaching Hospital "Pedro Agustín Pérez" of Guantánamo, from January 1996 to December 2011. It was investigate the incidence of the disease, origin, way of coexistence of children, antecedents Of tonsillitis, treatment compliance, symptoms and signs at admission, complementary outcome, hospital stay and valve sequelae. The results show that there was a higher incidence of the disease in 2006 and less in 2000 and 2002. The majority of the patients came from the rural area, those with overcrowding predominated, and the history of tonsillitis and noncompliance were frequent. Fever and tachycardia predominated among the symptoms and a third of the children had valve sequelae, mainly mitral insufficiency. The positivity of the hemogram and erythrocyte sedimentation occurred.Se estudian los casos atendidos por fiebre reumática en el Hospital Pediátrico Docente “Pedro Agustín Pérez” de Guantánamo, en el período enero de 1996 - diciembre de 2011. Se investiga la incidencia de la enfermedad, procedencia, modo de convivencia de los niños, antecedentes de amigdalitis, cumplimiento del tratamiento, síntomas y signos al ingreso, resultado de complementarios, estadía hospitalaria y secuelas valvulares. Los resultados muestran que hubo mayor incidencia de la enfermedad en 2006 y menos en 2000 y 2002. La mayoría de los pacientes procedía de área rural, predominaron los que tenían hacinamiento y fue frecuente el antecedente de amigdalitis y el incumplimiento del tratamiento. La fiebre y la taquicardia predominaron entre los síntomas y la tercera parte de los niños tuvo secuelas valvulares, sobre todo Insuficiencia mitral. La positividad del hemograma y eritrosedimentación, sobresalieron.

Inter-Observer Agreement on Subjects' Race and Race-Informative Characteristics

Health and socioeconomic disparities tend to be experienced along racial and ethnic lines, but investigators are not sure how individuals are assigned to groups, or how consistent this process is. To address these issues, 1,919 orthodontic patient records were examined by at least two observers who estimated each individual's race and the characteristics that influenced each estimate. Agreement regarding race is high for African and European Americans, but not as high for Asian, Hispanic, and Native Americans. The indicator observers most often agreed upon as important in estimating group membership is name, especially for Asian and Hispanic Americans. The observers, who were almost all European American, most often agreed that skin color is an important indicator of race only when they also agreed the subject was European American. This suggests that in a diverse community, light skin color is associated with a particular group, while a range of darker shades can be associated with members of any other group. This research supports comparable studies showing that race estimations in medical records are likely reliable for African and European Americans, but are less so for other groups. Further, these results show that skin color is not consistently the primary indicator of an individual's race, but that other characteristics such as facial features add significant information

Transition to the new race/ethnicity data collection standards in the Department of Veterans Affairs

BACKGROUND: Patient race in the Department of Veterans Affairs (VA) information system was previously recorded based on an administrative or clinical employee's observation. Since 2003, the VA started to collect self-reported race in compliance with a new federal guideline. We investigated the implications of this transition for using race/ethnicity data in multi-year trends in the VA and in other healthcare data systems that make the transition. METHODS: All unique users of VA healthcare services with self-reported race/ethnicity data in 2004 were compared with their prior observer-recorded race/ethnicity data from 1997 – 2002 (N = 988,277). RESULTS: In 2004, only about 39% of all VA healthcare users reported race/ethnicity values other than "unknown" or "declined." Females reported race/ethnicity at a lower rate than males (27% vs. 40%; p < 0.001). Over 95% of observer-recorded data agreed with self-reported data. Compared with the patient self-reported data, the observer-recorded White and African American races were accurate for 98% (kappa = 0.89) and 94% (kappa = 0.93) individuals, respectively. Accuracy of observer-recorded races was much worse for other minority groups with kappa coefficients ranging between 0.38 for American Indian or Alaskan Natives and 0.79 for Hispanic Whites. When observer-recorded race/ethnicity values were reclassified into non-African American groups, they agreed with the self-reported data for 98% of all individuals (kappa = 0.93). CONCLUSION: For overall VA healthcare users, the agreement between observer-recorded and self-reported race/ethnicity was excellent and observer-recorded and self-reported data can be used together for multi-year trends without creating serious bias. However, this study also showed that observation was not a reliable method of race/ethnicity data collection for non-African American minorities and racial disparity might be underestimated if observer-recorded data are used due to systematic patterns of inaccurate race/ethnicity assignments

A Trigger Enzyme in Mycoplasma pneumoniae: Impact of the Glycerophosphodiesterase GlpQ on Virulence and Gene Expression

Mycoplasma pneumoniae is a causative agent of atypical pneumonia. The formation of hydrogen peroxide, a product of glycerol metabolism, is essential for host cell cytotoxicity. Phosphatidylcholine is the major carbon source available on lung epithelia, and its utilization requires the cleavage of deacylated phospholipids to glycerol-3-phosphate and choline. M. pneumoniae possesses two potential glycerophosphodiesterases, MPN420 (GlpQ) and MPN566. In this work, the function of these proteins was analyzed by biochemical, genetic, and physiological studies. The results indicate that only GlpQ is an active glycerophosphodiesterase. MPN566 has no enzymatic activity as glycerophosphodiesterase and the inactivation of the gene did not result in any detectable phenotype. Inactivation of the glpQ gene resulted in reduced growth in medium with glucose as the carbon source, in loss of hydrogen peroxide production when phosphatidylcholine was present, and in a complete loss of cytotoxicity towards HeLa cells. All these phenotypes were reverted upon complementation of the mutant. Moreover, the glpQ mutant strain exhibited a reduced gliding velocity. A comparison of the proteomes of the wild type strain and the glpQ mutant revealed that this enzyme is also implicated in the control of gene expression. Several proteins were present in higher or lower amounts in the mutant. This apparent regulation by GlpQ is exerted at the level of transcription as determined by mRNA slot blot analyses. All genes subject to GlpQ-dependent control have a conserved potential cis-acting element upstream of the coding region. This element overlaps the promoter in the case of the genes that are repressed in a GlpQ-dependent manner and it is located upstream of the promoter for GlpQ-activated genes. We may suggest that GlpQ acts as a trigger enzyme that measures the availability of its product glycerol-3-phosphate and uses this information to differentially control gene expression

The EpsE Flagellar Clutch Is Bifunctional and Synergizes with EPS Biosynthesis to Promote Bacillus subtilis Biofilm Formation

Many bacteria inhibit motility concomitant with the synthesis of an extracellular polysaccharide matrix and the formation of biofilm aggregates. In Bacillus subtilis biofilms, motility is inhibited by EpsE, which acts as a clutch on the flagella rotor to inhibit motility, and which is encoded within the 15 gene eps operon required for EPS production. EpsE shows sequence similarity to the glycosyltransferase family of enzymes, and we demonstrate that the conserved active site motif is required for EPS biosynthesis. We also screen for residues specifically required for either clutch or enzymatic activity and demonstrate that the two functions are genetically separable. Finally, we show that, whereas EPS synthesis activity is dominant for biofilm formation, both functions of EpsE synergize to stabilize cell aggregates and relieve selective pressure to abolish motility by genetic mutation. Thus, the transition from motility to biofilm formation may be governed by a single bifunctional enzyme

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Components of growth in Holstein heifers fed either alfalfa or corn silage diets to produce two daily gains

Growth components were compared in an experiment with a 2 x 2 factorial design. Eight replicates of Holstein heifers were fed diets based on either alfalfa or corn silage for daily gain of either 725 or 950 g from 181 to 334 kg of body weight (BW). Mean daily gains from corn diets were greater than gains from alfalfa diets for BW, udder, empty body, fat, fat-free matter, protein, H2O, C, and energy but were less than gains from alfalfa for gut contents and ash. High daily gain produced higher mean values for all of these variables than did lower daily gain. The percentage of protein in fat-free matter was not affected by either main effect. The percentage of fat in empty body gain was increased as daily gain increased. Energy concentration of fat-free matter that was gained was not affected by either diet or daily gain. Energy concentration of empty body gain increased as daily gain increased. The percentage of gut contents in daily BW gain was higher for heifers fed the alfalfa diet than for those fed the corn diet. Energy concentration in daily BW gain was affected by diet and daily gain. Variations of:at and gut contents in daily BW gain must be considered when requirements or expected growth are described