High sporulation and overexpression of virulence factors in biofilms and reduced susceptibility to vancomycin and linezolid in recurrent Clostridium [Clostridioides] difficile infection isolates

Clostridium [Clostridioides] difficile infection (CDI) is one of the leading causes of diarrhea associated with medical care worldwide, and up to 60% of patients with CDI can develop a recurrent infection (R-CDI). A multi-species microbiota biofilm model of C. difficile was designed to evaluate the differences in the production of biofilms, sporulation, susceptibility to drugs, expression of sporulating (sigH, spo0A), quorum sensing (agrD1, and luxS), and adhesion-associated (slpA and cwp84) pathway genes between selected C. difficile isolates from R-CDI and non-recurrent patients (NR-CDI). We obtained 102 C. difficile isolates from 254 patients with confirmed CDI (66 from NR-CDI and 36 from R-CDI). Most of the isolates were biofilm producers, and most of the strains were ribotype 027 (81.374%, 83/102). Most C. difficile isolates were producers of biofilm (100/102), and most were strongly adherent. Sporulation was higher in the R-CDI than in the NR-CDI isolates (p = 0.015). The isolates from R-CDI patients more frequently demonstrated reduced susceptibility to vancomycin than isolates of NR-CDI patients (27.78% [10/36] and 9.09% [6/66], respectively, p = 0.013). The minimum inhibitory concentrations for vancomycin and linezolid against biofilms (BMIC) were up to 100 times and 20 times higher, respectively, than the corresponding planktonic MICs. Expression of sigH, spo0A, cwp84, and agrD1 was higher in R-CDI than in NR-CDI isolates. Most of the C. difficile isolates were producers of biofilms with no correlation with the ribotype. Sporulation was greater in R-CDI than in NR-CDI isolates in the biofilm model of C. difficile. The R-CDI isolates more frequently demonstrated reduced susceptibility to vancomycin and linezolid than the NR-CDI isolates in both planktonic cells and biofilm isolates. A higher expression of sporulating pathway (sigH, spo0A), quorum sensing (agrD1), and adhesion-associated (cwp84) genes was found in R-CDI than in NR-CDI isolates. All of these factors can have effect on the recurrence of the infection.Peer reviewe

Circulation of Highly Drug-Resistant Clostridium difficile Ribotypes 027 and 001 in Two Tertiary-Care Hospitals in Mexico

© 2018, Mary Ann Liebert, Inc.OBJECTIVE: To assess drug susceptibility and characterize Clostridium difficile ribotypes in isolates from two tertiary-care hospitals in Mexico. METHODS: Isolates were evaluated for genotyping, antimicrobial susceptibility testing and detection of mutations associated with drug resistance. PCR ribotyping was performed using a combination of gel-based and capillary electrophoresis-based approaches. RESULTS: MIC50 and MIC90 were ≥128 mg/L for ciprofloxacin, erythromycin, clindamycin, and rifampicin. There was no reduced susceptibility to metronidazole or tetracycline; however, reduced susceptibility to vancomycin (≥4 mg/L) and fidaxomicin (≥2 mg/L) was detected in 50 (40.3%) and 4 (3.2%) isolates, respectively. Furthermore, the rpoB Arg505Lys mutation was more frequently detected in isolates with high minimum inhibitory concentration (MIC) to rifampicin (≥32 mg/L) (OR = 52.5; 95% CI = 5.17-532.6; p < 0.000). Of the 124 C. difficile isolates recovered, 84 (66.7%) were of ribotype 027, 18 (14.5%) of ribotype 001, and the remainder were other ribotypes (353, 255, 220, 208, 176, 106, 076, 020, 019, 017, 014, 012, 003, and 002). CONCLUSION: Ribotypes 027 and 001 were the most frequent C. difficile isolates recovered in this study, and demonstrated higher MICs. Furthermore, we found four isolates with reduced susceptibility to fidaxomicin, raising a concern since this drug is currently unavailable in Mexican Hospitals.Peer reviewedFinal Accepted Versio

Review: The Journal of Dramaturgy, volume 22, issue 2

Contents include: Editor\u27s Note; Elliott Hayes Award Acceptance Speech From Denver to Gulu, With Thanks to Lynn Nottage; Learning to Speak American: A Writer\u27s Journey, Keynote Remarks Delivered at the Annual Conference of the Literary Managers and Dramturgs of the Americas, Alliance Theatre, Atlanta, GA June 28, 2012; Michael Mark Chemers\u27 Ghost Light: An Introductory Handbook for Dramaturgy; Creative Process in Theatrical Translation: An Interview with Adam Versenyi; Croisades in Quebec: On the Semiotics of Contemporary French Dramaturgie. Issue editors: Sydney Cheek-O\u27Donnell, Debra Cardona, Janine Sobeckhttps://soundideas.pugetsound.edu/lmdareview/1044/thumbnail.jp

Early-stage intestinal-type gastric adenocarcinoma as an incidental finding: case report and review of literature

Gastric cancer is the malignant neoplasm in which gastric resection is the only viable strategy for long-term survival. Gastric carcinoma typically does not produce symptoms, therefore presenting as either advance or metastatic disease at the time of diagnosis. The most common early symptoms tend to be abdominal pain and weight loss. Adequate surgical resection is the only curative therapeutic option in patients with resectable gastric cancer.  We present the case of a 66-year-old male patient who initially presented with abdominal pain and one episode of gastrointestinal bleeding, for which an endoscopic biopsy was conducted which reported intestinal-type gastric adenocarcinoma. Subtotal gastrectomy with Billroth II anastomosis was then performed without reported complications. Patient remains asymptomatic 3 months following the surgical intervention in surveillance with ambulatory care

Análisis del riesgo de precio de las acciones mediante la estimación del Coeficiente beta (β) de los bancos en México

Esta investigación se centró en la inversión en acciones y en el estudio del riesgo de mercado, al cual se refiere al riesgo de precio de las acciones y que este se analizó con más detalle porque contiene dos clasificaciones de gran importancia para una buena toma de decisiones a la hora de invertir en este tipo de instrumento y/o activo financiero llamado las acciones. Además, en esta investigación se analizaron las acciones de las instituciones de banca múltiple en México y con ayuda del principal índice de la Bolsa Mexicana de Valores, el índice S&amp;P/BMV IPC, se estimó la medida de riesgo mejor conocida como el coeficiente beta, esto con el fin de conocer el impacto significativo que trae consigo el riesgo de mercado que es el riesgo de precio de las acciones, el cual si este riesgo es analizado y considerado de manera correcta puede ser de gran beneficio y ventaja al momento de invertir en este tipo de inversión. Este estudio también se convierte en una guía para los interesados en la inversión en acciones para que puedan entender el mercado financiero al que pertenece este activo financiero llamado acciones, así como el sistema financiero mexicano de una manera general, lo cual es de gran importancia para conocer la zona a la que pertenece el sector bancario, que son las instituciones de banca múltiple, y el sector bursátil (Mercado de valores) al que pertenecen las empresas que cotizan en la Bolsa de Valores, como son las instituciones de banca múltiple, ya que estas ofrecen sus acciones, y que además, en la Bolsa Mexicana de Valores contiene el índice S&amp;P/BMV IPC, que fue un elemento esencial, junto con las acciones de las instituciones de banca múltiple, para la estimación del coeficiente beta en esta investigación

Preparation of high-quality planar FeRh thin films for in situ TEM investigations

The preparation of a planar FeRh thin film using a focused ion beam (FIB) secondary electron microscope (SEM) for the purpose of in situ transmission electron microscopy (TEM) is presented. A custom SEM stub with 45° faces allows for the transfer and milling of the sample on a TEM heating chip, whilst Fresnel imaging within the TEM revealed the presence of the magnetic domain walls, confirming the quality of the FIB-prepared sample

Enhancing appropriate statin therapy in Type 2 Diabetic patients aged between 40-75 years at Graduate Medical Education (GME) Internal Medicine clinic

Background: The prevalence of type 2 diabetes mellitus (T2DM) is significantly higher in Rio Grande Valley than the rest of the United States. T2DM patients have an elevated risk of Atherosclerotic cardiovascular disease (ASCVD), and clinical trials have demonstrated the beneficial effects of statin therapy on ASCVD. A quality-improvement project was implemented in the GME Internal Medicine (IM) Clinic at Doctors Hospital at Renaissance to improve statin therapy appropriateness. Methods: T2DM patients aged 40-75 were selected from the GME IM Clinic visits from July 2021 to October 2021 for baseline data and from January 2022 to April 2022 after implementing our interventions, which included education of the new practice guidelines of statin therapy in T2DM to the internal medicine residents, as well as development of a clinical decision support tool designed to assess the indication and intensity of statin therapy. Exclusion criteria included patients without T2DM, ages above 75/below 40 years of age, and missing information for ASCVD risk stratification. Statin appropriateness was determined according to the American Diabetes Association standards in diabetes management. Results: The number of patients in the four months after the exclusions pre-intervention and post-intervention were 153 and 207, respectively. Overall, 71.9% (n=110) of the patients pre-intervention were receiving an appropriate statin therapy; the number increased to 80% (n=166) post-intervention (p = 0.003), considered statistically significant using t-test analysis. Of the total patients (N=43) with inappropriate statin therapy, 37% (n=16) had inadequate dose, and 63% (n=27) were not receiving any statin in the pre-intervention cohort. This percentage of inadequate statin dose and no statin therapy decreased to 65% (n=27) and 35% (n=14), respectively post-intervention. Conclusion: Appropriate statin therapy has been shown to reduce all-cause mortality by 19% in T2DM. Appropriateness of statin therapy was increased by 10%, and more than 50% reduction of patients without receiving any statin therapy, after our intervention. Effective implementation of new guidelines regarding risk stratification and prevention of ASCVD in T2DM age 40-75 years of age may be challenging. Barriers such as physicians\u27 adoption and knowledge regarding new guidelines can be overcome with appropriate tools and education, such as those implemented in our project

The Effectiveness of Fiscal Policy in Mexico

Using a VAR model with quarterly information for the 1980 to 2008 period, this paper studies the dynamic effects of fiscal policy on Gross Domestic Product in the Mexican economy. We find evidence of non–Keynesian effects of government expenditure on GDP in the short run. Also, we find evidence that government revenue has a significant impact on GDP only in the fourth quarter

The Effectiveness of Fiscal Policy in Mexico

Using a VAR model with quarterly information for the 1980 to 2008 period, this paper studies the dynamic effects of fiscal policy on Gross Domestic Product in the Mexican economy. We find evidence of non–Keynesian effects of government expenditure on GDP in the short run. Also, we find evidence that government revenue has a significant impact on GDP only in the fourth quarter