Group B Streptococcus colonization in pregnancy: prevalence and prevention strategies of neonatal sepsis

Early onset neonatal sepsis due to Group B streptococci (GBS) is responsible for severe morbidity and mortality of newborns. While different preventive strategies to identify women at risk are being recommended, the optimal strategy depends on the incidence of GBS-sepsis and on the prevalence of anogenital GBS colonization. We therefore aimed to assess the Group B streptococci prevalence and its consequences on different prevention strategies. We analyzed 1316 pregnant women between March 2005 and September 2006 at our institution. The prevalence of GBS colonization was determined by selective cultures of anogenital smears. The presence of risk factors was analyzed. In addition, the direct costs of screening and intrapartum antibiotic prophylaxis were estimated for different preventive strategies. The prevalence of GBS colonization was 21%. Any maternal intrapartum risk factor was present in 37%. The direct costs of different prevention strategies have been estimated as follows: risk-based: 18,500 CHF/1000 live births, screening-based: 50,110 CHF/1000 live births, combined screening- and risk-based: 43,495/1000 live births. Strategies to prevent GBS-sepsis in newborn are necessary. With our colonization prevalence of 21%, and the intrapartum risk profile of women, the screening-based approach seems to be superior as compared to a risk-based approac

TRATAMENTO MEDICAMENTOSO ORAL DA HIPERGLICEMIA NO DIABETE MELITO TIPO 2

Diet, exercise and weight reduction are the cornerstone of type 2 diabetes mellitus (DM) treatment, since most of these patients are obese. However, the majority of the individuals is not able to achieve and mantain a satisfactory glycemic control employing only these strategies, and the prescription of complementary pharmacological treatment is often necessary. The available oral agents for type 2 diabetes treatment are divided in 5 main classes: sulfonylureas, biguanides, thiazolidinediones, alfa-glucosidase inhibitors and glinides. Phase II studies are presently in course, evaluating the safety and efficacy of new drugs. Metformin belongs to biguanides’ class, and is the drug with the best profile, since not only it lowers glycemia, but it also reduces appetite and weight, and , most of all, it is the only drug that diminishes mortality rates. Data regarding indications, mechanisms of action and adverse effects of the above mentioned drugs are describe in the present review.Dieta, exercício e redução de peso são a base do tratamento do diabete melito (DM) tipo 2, uma vez que a maioria desses pacientes são obesos. No entanto, a maior parte dos indivíduos não consegue atingir e manter um controle glicêmico adequado apenas com estas medidas, sendo freqüentemente necessária a prescrição de tratamento farmacológico complementar. As drogas orais para o tratamento do DM tipo 2 são divididas em 5 classes principais: as sulfoniluréias, as biguanidas, as tiazolidinedionas, os inibidores da alfa-glicosidase e as glinidas. Estudos de fase II estão atualmente em curso, avaliando a eficácia e a segurançade novas drogas. A Metformina, representante das biguanidas, é a droga com o melhor perfil de ação, uma vez que além de controlar a glicemia, também diminui o apetite, causa diminuição do peso (ou evita seu aumento) e, sobretudo, é a única droga que promove redução de  mortalidade. Dados principais sobre as indicações, mecanismos de ação e efeitos colaterais das drogas mencionadas estão descritos por categoria nesta revisão

Tratamento medicamentoso oral da hiperglicemia no diabete melito tipo 2

Dieta, exercício e redução de peso são a base do tratamento do diabete melito (DM) tipo 2, uma vez que a maioria desses pacientes são obesos. No entanto, a maior parte dos indivíduos não consegue atingir e manter um controle glicêmico adequado apenas com estas medidas, sendo freqüentemente necessária a prescrição de tratamento farmacológico complementar. As drogas orais para o tratamento do DM tipo 2 são divididas em 5 classes principais: as sulfoniluréias, as biguanidas, as tiazolidinedionas, os inibidores da alfa-glicosidase e as glinidas. Estudos de fase II estão atualmente em curso, avaliando a eficácia e a segurança de novas drogas. A Metformina, representante das biguanidas, é a droga com o melhor perfil de ação, uma vez que além de controlar a glicemia, também diminui o apetite, causa diminuição do peso (ou evita seu aumento) e, sobretudo, é a única droga que promove redução de mortalidade. Dados principais sobre as indicações, mecanismos de ação e efeitos colaterais das drogas mencionadas estão descritos por categoria nesta revisão.Diet, exercise and weight reduction are the cornerstone of type 2 diabetes mellitus (DM) treatment, since most of these patients are obese. However, the majority of the individuals is not able to achieve and mantain a satisfactory glycemic control employing only these strategies, and the prescription of complementary pharmacological treatment is often necessary. The available oral agents for type 2 diabetes treatment are divided in 5 main classes: sulfonylureas, biguanides, thiazolidinediones, alfa-glucosidase inhibitors and glinides. Phase II studies are presently in course, evaluating the safety and efficacy of new drugs. Metformin belongs to biguanides’ class, and is the drug with the best profile, since not only it lowers glycemia, but it also reduces appetite and weight, and , most of all, it is the only drug that diminishes mortality rates. Data regarding indications, mechanisms of action and adverse effects of the above mentioned drugs are describe in the present review

Group B Streptococcus colonization in pregnancy: prevalence and prevention strategies of neonatal sepsis

Early onset neonatal sepsis due to Group B streptococci (GBS) is responsible for severe morbidity and mortality of newborns. While different preventive strategies to identify women at risk are being recommended, the optimal strategy depends on the incidence of GBS-sepsis and on the prevalence of anogenital GBS colonization. We therefore aimed to assess the Group B streptococci prevalence and its consequences on different prevention strategies. We analyzed 1316 pregnant women between March 2005 and September 2006 at our institution. The prevalence of GBS colonization was determined by selective cultures of anogenital smears. The presence of risk factors was analyzed. In addition, the direct costs of screening and intrapartum antibiotic prophylaxis were estimated for different preventive strategies. The prevalence of GBS colonization was 21%. Any maternal intrapartum risk factor was present in 37%. The direct costs of different prevention strategies have been estimated as follows: risk-based: 18,500 CHF/1000 live births, screening-based: 50,110 CHF/1000 live births, combined screening- and risk-based: 43,495/1000 live births. Strategies to prevent GBS-sepsis in newborn are necessary. With our colonization prevalence of 21%, and the intrapartum risk profile of women, the screening-based approach seems to be superior as compared to a risk-based approach

Curso evolutivo da microalbuminúria em pacientes com diabete melito tipo 2 (DM2)

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O polimorfismo K121Q do gene da PCI está associado ao desenvolvimento de hipertensão arterial em pacientes DM 2

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The surfactin-like lipopeptides from Bacillus spp.: natural biodiversity and synthetic biology for a broader application range

International audienceSurfactin is a lipoheptapeptide produced by several Bacillus species and identified for the first time in 1969. At first, the biosynthesis of this remarkable biosurfactant was described in this review. The peptide moiety of the surfactin is synthesized using huge multienzymatic proteins called NonRibosomal Peptide Synthetases. This mechanism is responsible for the peptide biodiversity of the members of the surfactin family. In addition, on the fatty acid side, fifteen different isoforms (from C12 to C17) can be incorporated so increasing the number of the surfactin-like biomolecules. The review also highlights the last development in metabolic modelling and engineering and in synthetic biology to direct surfactin biosynthesis but also to generate novel derivatives. This large set of different biomolecules leads to a broad spectrum of physico-chemical properties and biological activities. The last parts of the review summarized the numerous studies related to the production processes optimization as well as the approaches developed to increase the surfactin productivity of Bacillus cells taking into account the different steps of its biosynthesis from gene transcription to surfactin degradation in the culture medium

The German National Registry of Primary Immunodeficiencies (2012-2017)

Introduction: The German PID-NET registry was founded in 2009, serving as the first national registry of patients with primary immunodeficiencies (PID) in Germany. It is part of the European Society for Immunodeficiencies (ESID) registry. The primary purpose of the registry is to gather data on the epidemiology, diagnostic delay, diagnosis, and treatment of PIDs. Methods: Clinical and laboratory data was collected from 2,453 patients from 36 German PID centres in an online registry. Data was analysed with the software Stata® and Excel. Results: The minimum prevalence of PID in Germany is 2.72 per 100,000 inhabitants. Among patients aged 1–25, there was a clear predominance of males. The median age of living patients ranged between 7 and 40 years, depending on the respective PID. Predominantly antibody disorders were the most prevalent group with 57% of all 2,453 PID patients (including 728 CVID patients). A gene defect was identified in 36% of patients. Familial cases were observed in 21% of patients. The age of onset for presenting symptoms ranged from birth to late adulthood (range 0–88 years). Presenting symptoms comprised infections (74%) and immune dysregulation (22%). Ninety-three patients were diagnosed without prior clinical symptoms. Regarding the general and clinical diagnostic delay, no PID had undergone a slight decrease within the last decade. However, both, SCID and hyper IgE- syndrome showed a substantial improvement in shortening the time between onset of symptoms and genetic diagnosis. Regarding treatment, 49% of all patients received immunoglobulin G (IgG) substitution (70%—subcutaneous; 29%—intravenous; 1%—unknown). Three-hundred patients underwent at least one hematopoietic stem cell transplantation (HSCT). Five patients had gene therapy. Conclusion: The German PID-NET registry is a precious tool for physicians, researchers, the pharmaceutical industry, politicians, and ultimately the patients, for whom the outcomes will eventually lead to a more timely diagnosis and better treatment

Comprehensive molecular characterization of gastric adenocarcinoma

Gastric cancer is a leading cause of cancer deaths, but analysis of its molecular and clinical characteristics has been complicated by histological and aetiological heterogeneity. Here we describe a comprehensive molecular evaluation of 295 primary gastric adenocarcinomas as part of The Cancer Genome Atlas (TCGA) project. We propose a molecular classification dividing gastric cancer into four subtypes: tumours positive for Epstein–Barr virus, which display recurrent PIK3CA mutations, extreme DNA hypermethylation, and amplification of JAK2, CD274 (also known as PD-L1) and PDCD1LG2 (also knownasPD-L2); microsatellite unstable tumours, which show elevated mutation rates, including mutations of genes encoding targetable oncogenic signalling proteins; genomically stable tumours, which are enriched for the diffuse histological variant and mutations of RHOA or fusions involving RHO-family GTPase-activating proteins; and tumours with chromosomal instability, which show marked aneuploidy and focal amplification of receptor tyrosine kinases. Identification of these subtypes provides a roadmap for patient stratification and trials of targeted therapies