Relación genética, formación de biopelículas, movilidad y virulencia de Escherichia coli aislada de mastitis bovina

Escherichia coli es una de las bacterias ambientales que frecuentemente se ha visto implicada en infecciones de la glándula mamaria bovina. Aunque se desconocen los factores de virulencia específicos involucrados en dicho proceso, se ha observado que las bacterias formadoras de biopelículas se asocian con infecciones persistentes. De igual forma se ha planteado que las bacterias móviles pueden ser más patógenas. El propósito del presente trabajo fue analizar la relación genética, capacidad de formación de biopelículas y movilidad de E. coli aislada de casos de mastitis bovina, así como la virulencia in vivo de aislados representativos. De acuerdo a los datos obtenidos en este trabajo el 67.7% de las bacterias pertenece al grupo filogenético A, el 17.6% al grupo B1 y el 14.7% al D. El estudio de la relación genética mediante (GTG)5 reveló que solo dos bacterias son idénticas genéticamente, el resto de las bacterias se organizaron en siete grupos distintos con 70% de similitud. Por otro lado, el 76.5% de las bacterias estudiadas fue capaz de formar biopelículas de forma fuerte, moderada o débil. Además, los genes csgA y fimA se detectaron en el 52.9% de las bacterias formadoras de biopelículas. Por su parte, el análisis de movilidad arrojó que el 70.6% fue móvil. Mientras que, el análisis de patogenicidad en larvas de Galleria mellonella reveló que aquellas bacterias formadoras de películas y móviles fueron capaces de matar un mayor número de larvas a las 24 h que las no formadoras. Los datos presentados en este trabajo indican que las E. coli causantes de mastitis bovina son muy diversas y pertenecen principalmente al grupo filogenético A y que las formadoras de biopelículas y móviles son más patógenas.Escherichia coli es una de las bacterias ambientales que frecuentemente se ha visto implicada en infecciones de la glándula mamaria bovina. Aunque se desconocen los factores de virulencia específicos involucrados en dicho proceso, se ha observado que las bacterias formadoras de biopelículas se asocian con infecciones persistentes. De igual forma se ha planteado que las bacterias móviles pueden ser más patógenas. El propósito del presente trabajo fue analizar la relación genética, capacidad de formación de biopelículas y movilidad de E. coli aislada de casos de mastitis bovina, así como la virulencia in vivo de aislados representativos. De acuerdo a los datos obtenidos en este trabajo el 67.7% de las bacterias pertenece al grupo filogenético A, el 17.6% al grupo B1 y el 14.7% al D. El estudio de la relación genética mediante (GTG)5 reveló que solo dos bacterias son idénticas genéticamente, el resto de las bacterias se organizaron en siete grupos distintos con 70% de similitud. Por otro lado, el 76.5% de las bacterias estudiadas fue capaz de formar biopelículas de forma fuerte, moderada o débil. Además, los genes csgA y fimA se detectaron en el 52.9% de las bacterias formadoras de biopelículas. Por su parte, el análisis de movilidad arrojó que el 70.6% fue móvil. Mientras que, el análisis de patogenicidad en larvas de Galleria mellonella reveló que aquellas bacterias formadoras de películas y móviles fueron capaces de matar un mayor número de larvas a las 24 h que las no formadoras. Los datos presentados en este trabajo indican que las E. coli causantes de mastitis bovina son muy diversas y pertenecen principalmente al grupo filogenético A y que las formadoras de biopelículas y móviles son más patógenas

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Identificación de bacterias endofitas aisladas de Teocintle y Maíz con potencial para promover el crecimiento vegetal.

Tesis (Maestría en Ciencias en Producción Agrícola Sustentable), Instituto Politécnico Nacional, CIIDIR, Unidad Michoacán, 2015, 1 archivo PDF, (83 páginas). tesis.ipn.m

Quitosanos y compósito quitosano-octanoato de sodio reducen la pudrición de fresa en poscosecha

Strawberry(Fragariax ananassa)is an exquisite food, which provides health benefits, making it theberrywith the highest production and export in Mexico. However, it is highly perishable, susceptible to postharvest damage, mainly by Botrytis cinereaand Rhizopus stolonifer,amongothers. The use of pesticides in preharvestis the control strategy of these pathogens; however, pesticides are documented to harm human health and the ecosystem, showing the need to explore friendly alternatives. Reagent grade chitosan (QGR) is an innocuous polymer with widely reported antifungalactivity, while sodium octanoate (8:0) (OS) also has this property; however, so far it is unknown whether commercial grade chitosan (QGC) (the most suitable candidateto conduct a larger commercial study, due to its cost), available in Mexico, has the same effect. Therefore, the objective of this research was to evaluate the effectiveness of QGR and the QGR-OS composite in the protection of strawberry in postharvest and compare it with that of QGC and that of the QGC-OScomposite. The compounds were sprayed on the fruits and incubated simulating export conditions. The results showed significant reduction in the severity and incidence ofpostharvest strawberry fungal diseasesafter the application of QGR, QGC and QGR-OS, QGC-OS, but not that of OS applied alone. QGC and the QGC-OS composite are excellent candidates for use in a larger commercial study.La fresa (Fragaria x ananassa) es un alimento exquisito, que proporciona beneficios a la salud, por lo que es la frutilla de mayor producción y exportación en México. Sin embargo, es altamente perecedera, susceptible de sufrir daños en poscosecha, por Botrytis cinerea y Rhizopus stolonifer, entre otros. El uso de plaguicidas en precosecha es la estrategia de control de estos patógenos; no obstante, está documentado que los plaguicidas dañan la salud humana y al ecosistema, lo que muestra la necesidad de estudiar alternativas amigables. El quitosano grado reactivo (QGR) es un polímero inocuo con actividad antifúngica ampliamente reportada, mientras que el octanoato de sodio (8:0) (OS) también tiene esta propiedad; sin embargo, hasta el momento se desconoce si el quitosano grado comercial (QGC) disponible en México, tiene el mismo efecto. Por lo tanto, el objetivo de esta investigación fue evaluar la efectividad de QGR y el compósito QGR-OS en la protección de fresa en poscosecha y compararla con la de QGC y el compósito QGC-OS. Los compuestos se asperjaron sobre los frutos y se incubaron simulando las condiciones de exportación. Los resultados mostraron reducción significativa de la severidad y la incidencia de las enfermedades fúngicas de fresa en poscosecha luego de la aplicación de QGR, QGC y QGR-OS, QGC-OS, no así del OS aplicado solo. El QGC y el compósito QGC-OS son excelentes candidatos para ser utilizados en un estudio comercial de mayor alcance

Effect of SGLT2 Inhibitors on Stroke and Atrial Fibrillation in Diabetic Kidney Disease: Results From the CREDENCE Trial and Meta-Analysis

BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus.METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-analysis.RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (<45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]).CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02065791

Kidney and Cardiovascular Effects of Canagliflozin According to Age and Sex: A Post Hoc Analysis of the CREDENCE Randomized Clinical Trial

Rationale & Objective: It is unclear whether the effect of canagliflozin on adverse kidney and cardiovascular events in those with diabetic kid-ney disease varies by age and sex. We assessed the effects of canagliflozin among age group categories and between sexes in the Canagli-flozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) study.Study Design: Secondary analysis of a random-ized controlled trial. Setting & Participants: Participants in the CREDENCE trial. Intervention: Participants were randomly assigned to receive canagliflozin 100 mg/d or placebo.Outcomes: Primary composite outcome of kid-ney failure, doubling of serum creatinine con-centration, or death due to kidney or cardiovascular disease. Prespecified secondary and safety outcomes were also analyzed. Out-comes were evaluated by age at baseline (<60, 60-69, and >_70 years) and sex in the intention-to-treat population using Cox regression models.Results: The mean age of the cohort was 63.0 & PLUSMN; 9.2 years, and 34% were female. Older age and female sex were independently associ-ated with a lower risk of the composite of adverse kidney outcomes. There was no evidence that the effect of canagliflozin on the primary outcome (acomposite of kidney failure, a doubling of serum creatinine concentration, or death from kidney or cardiovascular causes) differed between age groups (HRs, 0.67 [95% CI, 0.52-0.87], 0.63 [0.4 8-0.82], and 0.89 [0.61-1.29] for ages <60, 60-69, and >_70 years, respectively; P = 0.3 for interaction) or sexes (HRs, 0.71 [95% CI, 0.5 4-0.95] and 0.69 [0.56-0.8 4] in women and men, respectively; P = 0.8 for interaction). No differences in safety outcomes by age group or sex were observed.Limitations: This was a post hoc analysis with multiple comparisons.Conclusions: Canagliflozin consistently reduced the relative risk of kidney events in people with diabetic kidney disease in both sexes and across age subgroups. As a result of greater background risk, the absolute reduction in adverse kidney outcomes was greater in younger participants.Funding: This post hoc analysis of the CREDENCE trial was not funded. The CREDENCE study was sponsored by Janssen Research and Development and was conducted collaboratively by the sponsor, an academic-led steering committee, and an academic research organization, George Clinical.Trial Registration: The original CREDENCE trial was registered at ClinicalTrials.gov with study number NCT02065791

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)