Marcos, martial law and memory: The past in our future in the Philippines: Adrian E. Cristobal Lecture

I was a martial law baby. My generation grew up watching the unending spectacle of Ferdinand and Imelda Marcos. Remember this was the 20th Century, long before YouTube and Netflix. I would have preferred to watch  Zombie Apocalypse but that wasn’t an option. There were only five TV channels and three newspapers, all owned by Marcos cronies.  We didn’t call it 'fake news' then but it was vintage 1970s propaganda—obvious and crude. I was in first grade when Marcos was first elected president. I studied across the street from Malacañang, in a school for girls run by the Sisters of the Holy Ghost. I remember that in the 1960s,  the streets around the presidential mansion were busy, filled with traffic and commerce. On Thursdays, hundreds  flocked to the church nearby to pray to St. Jude, patron of hopeless causes. I was barely in my teens when martial law was declared. Suddenly the streets were silenced. The palace gates were shuttered. Barbed wire barricades kept people away. The neighborhood—the entire country—was hushed. Marcos was still president when I finished high school. He continued to issue decrees from his barricaded palace while I went off to college, graduated, and got my first job. My generation had reached adulthood with no memory of any other president.&nbsp

Empire

There is a long tradition of imperial denial in the United States. After all, Americans fought the British Empire and have always thought of themselves as different from European colonialists. They are Empire Slayers — why else would “Star Wars” and its fight against the Galactic Empire have such a hold on the popular imagination? In this episode, two scholars explain how, from the nation’s birth, imperial expansion — first westward into Indian Country and later, overseas —was a defining character of the United States. The echoes of empire can be heard in today’s news. It’s impossible to talk about immigration, drone strikes, the attacks on Asian Americans, the US withdrawal from Afghanistan, etc., without understanding the history and projection of American power. What would journalism informed by the history of empire look like

Data Mining Electronic Health Records to Support Evidence-Based Clinical Decisions

This study investigated the extent of use of data mining on electronic health records to support evidence-based clinical decisions, reasons why only few healthcare institutions integrate it in the clinical workflow, and resolutions to increase its utilization in actual clinical practice. A literature review was conducted to get examples of studies where data mining applications were used, particularly in radiation oncology, critical care, in-hospital mortality prediction, pharmaceutically treated depression, visualizing clinical event patterns, and diabetes research. For each literature reviewed, the objectives, data mining methodology, procedure for the integration of the clinical decision support system (CDSS) in the clinical workflow, and various issues and resolutions were analyzed and documented. A brief description of the required infrastructure including policies and procedures to ensure smooth integration and deployment of data mining applications in healthcare were also documented whenever available. Clinical data mining is used mostly to gain new insights, do predictions, risk assessments, and recommendations. Many studies find CDSSs a good learning environment. Issues on data preprocessing, class imbalance, feature engineering, and performance evaluation were mentioned. Other issues include the need for a more active collaboration with stakeholders, access to anonymized clinical data, formulation of interoperability standards, reevaluation of results using data from other institutions, and finally addressing ethical and legal issues. Although still in its infancy, experience of early adopters have been promising thus should encourage more research

EXPENDIO Y FACTORES ASOCIADOS QUE AFECTAN LA VENTA DE ANTIBIÓTICOS SIN RECETA MÉDICA EN EL TRATAMIENTO DEL COVID 19 EN OFICINAS FARMACÉUTICAS DEL DISTRITO DE SAN BORJA

Objetivo: Evaluar expendio y factores asociados que afectan la venta de antibióticos sin receta médica en el tratamiento del COVID 19 en oficinas farmacéuticas del distrito de San Borja. Métodos: Se realizó un estudio descriptivo y transversal en oficinas farmacéutica del distrito de San Borja. Dos pacientes simulados visitaron las oficinas farmacéuticas presentando un escenario de sintomatología por COVID 19. Los datos sobre la interacción entre el personal y el paciente simulado se registraron utilizando una hoja de recolección de datos inmediatamente después de cada visita. Todos los análisis estadísticos se realizaron utilizando el SPSS 21.0. Se consideró estadísticamente significativo un valor de p <0.05. Resultados: El personal de las oficinas farmacéuticas expendió antibióticos en 76.5% sin la presentación de la receta de un prescriptor. Se obtuvó los antibióticos principalmente en el primer nivel (63.6%) y segundo nivel (31.8%). Los antibióticos más frecuentemente expendido fueron claritromicina (29.5%), ciprofloxacino (18.2%) e ivermectina (11.4%). La azitromicina (9.1%) y levofloxacino (4.5%) se obtuvieron con menor frecuencia. El 13.7%, no recomendó antibióticos debido a los serios efectos adversos y se evitó la venta de antibióticos. Se encontró que la formación profesional del personal de las oficinas farmacéuticas influyó en el expendio de antibióticos sin receta médica. Conclusiones: Este estudio muestra que las oficinas farmacéuticas aún realizan expendio de antibióticos sin receta médica ante la insistencia de un cliente y ha identificado la formación profesional como factor de riesgo

Resistência bacteriana em gram positivos de interesse em saúde animal e pública

Among multiresistant Gram-positive microorganisms, stands out methicillin-resistant Staphylococcus (MRS), an opportunistic pathogen associated with hospital acquired and community infections reported in medicine and large increase in reports of veterinary medicine. In veterinary medicine, numerous reports regarding several species of animals have been described. MRS is intrinsically resistant to all ?-lactam drugs. In veterinary medicine, numerous reports regarding several species of animals have been described, but Staphylococcus aureus with intermediate resistance and resistant to vancomycin (VISA/VRSA) has not yet been reported in veterinary medicine, still need further study. Staphylococcus spp. are also related to antimicrobial resistance of macrolides, lincosamides, and streptogramin B (MLSB) group, that has the same mechanism of action, although the drugs belong to different classes. In veterinary medicine, clindamycin (lincosamide class) is widely used for skin infections, wounds, bone infections, pneumonia, infections of the oral cavity, and infections caused by anaerobic bacteria, besides being used for treatments of MRS infections. Enterococcus is another resistant Gram-positive microorganism, from which vancomycin-resistant enterococci (VREs) are the most important strains. There are several reports of VREs in veterinary medicine due the use of a similar antimicrobial (avoparcin) in livestock; therefore this group of microorganisms has now acquired great prominence since vancomycin is considered as the last resort for the treatment of MRS and Enterococcus associated with nosocomial infections in humans. The biggest problem these microorganisms and their resistance mechanisms cause is related to its huge impact on public health due to the increasing close contact between animals and humans. The objective of this review was to identify the main Gram-positive microorganisms associated with animals, describing their mechanisms of action that lead to antimicrobial resistance, as well as their impact on public health through their zoonotic and anthropozoonotic potential.Dentre os micro-organismos gram positivos multirresistentes destacam-se, principalmente os Staphylococcus spp. meticilina resistente (MRS), patógenos considerados oportunistas e relacionados tanto a infecções hospitalares como infecções comunitárias, tendo inúmeros relatos na medicina e um grande aumento de relatos na medicina veterinária, em diversas espécies de animais. MRS são intrinsicamente resistentes a todas as drogas beta-lactâmicas. Os Staphylococcus aureus com resistência intermediária e os resistentes à vancomicina (VISA/VRSA) ainda não foram reportados em animais, porém são necessários estudos mais aprofundados. Os Staphylococcus spp. também estão relacionados com resistência aos antimicrobianos do grupo dos Macrolídeos, Lincosamidas e Streptogramineas B (MLSb), que apesar de serem de classes diferentes, possuem o mesmo mecanismo de ação. Na medicina veterinária, a clindamicina (antimicrobiano da classe da Lincosamida) é amplamente utilizada para tratamentos de infecções de pele, feridas, infecções ósseas, pneumonia, infecção da cavidade oral e infecções causadas por bactérias anaeróbicas, além de ser utilizada em infecções causadas por MRS. Outro gênero de micro-organismos gram positivos resistente é o Enterococcus, sendo os Enterococcus vancomicina resistente (VRE) os de maior importância. Após vários relatos de VRE na medicina veterinária, devido ao grande uso de um antimicrobiano análogo (avoparcina) na produção animal, esse grupo de micro-organismo passou a ter grande destaque, uma vez que a vancomicina é considerada o último recurso para o tratamento de MRS e de Enterococcus associados a infecções hospitalares em humanos, as quais já foram também isoladas cepas resistentes. O maior problema destes microorganismos e seus mecanismos de resistência na medicina veterinária está relacionado ao seu impacto na saúde publica, devido ao contato cada vez mais próximo entre animais e o homem. Com isso, o objetivo dessa revisão foi apontar os principais micro-organismos gram positivos encontrados na medicina veterinária descrevendo seus mecanismos de ação que levam a resistência aos antimicrobianos, assim como o impacto na saúde publica através do seu potencial zoonótico e também antropozoonótico

Distribución de sistemas de secreción tipo VI en plásmidos

Trabajo presentado en el II Basque Microbiology Meeting MikrobioGUNE, celebrado en Bilbao (España) el 13 de diciembre de 2022

Are Type VI Secretion System-encoding plasmids vehicles for antimicrobial resistances?

Trabajo presentado en Workshop on Plasmids as Vehicles of AMR Spread, celebrado en Trieste (Italia) del 18 al 22 de septiembre de 2023.Peer reviewe

Genomic inventory of mobile type VI secretion systems

Trabajo presentado en el International Symposium on Plasmid Biology, celebrado en Toulouse (Francia) del 18 al 23 de septiembre de 2022

Antimicrobial Resistance Phenotypic Profile of Isolates from Clinical Infections in Dogs

Background: Antimicrobial resistance is described as a condition in which a micro-organism is able to survive when exposed to an antimicrobial agent. The resistance rates to antimicrobials in companion animals have risen considerably. Studies of local antimicrobial susceptibility profiles are needed as well as education and warning about the use of tests for the identification and susceptibility of pathogenic bacterial strains. The aim of this study was to identify the main antimicrobial resistance in clinical samples of dogs, and to detect multidrug-resistant strains of importance to public health.Materials, Methods & Results: Bacterial pathogens of 77 dog infections were isolated and their sensitivity profile to antimicrobials was determined. One hundred bacterial isolates were identified. Of these, 61 were Gram-positive (55 Staphylococcus spp., 4 Enterococcus spp. and 2 Streptococcus spp.) and 39 Gram-negative (36 fermenters and 3 non-fermenters). Seventy-nine isolates were considered multiresistant following individual assessment of drugs, and 85 following the evaluation of classes. Only 3 were sensitive to all drugs. Four isolates were resistant to all classes and only sensitive to some antibiotics. Of the 55 samples of Staphylococcus spp., 36 (65.45%) were identified as phenotypically MRS. Two isolates of Enterococcus spp. were resistant to vancomycin (VRE). Also 66.67% (26/39) of the samples were positive for the presumptive test for ESBL. For the MRS-positive isolates detected in this study, chloramphenicol was the antimicrobial that showed superior sensitivity in 74.29% of the cases (27/36); therefore it is considered the most appropriate for treatment of this type of micro-organism. In case of aminoglycosides, when their resistance was checked in MRS isolates, all resistance percentages increased, implying a limited use of this class for such a type of multi-resistant micro-organism. Contrarily, in case of ESBL, a superior sensitivity was observed towards MRS isolates, thus making them a prime treatment choice for the infection caused by these micro-organisms.Discussion: Literature have reported a gradual increase in multidrug resistance towards antimicrobial agents in veterinary medicine over the past decades. In this study, 64% of multiresistant strains were considered of significant importance, notably MRS (36), VRE (2) and ESBL (26). The early identification of pathogens in animals has become an important step in order to minimize the transmission of antibacterial resistance. The increase in the number of multidrug-resistant bacteria in animals and humans demonstrates the need to develop and implement measures in order to monitor and control the spread of this resistance. It is possible that the increased drug resistance is linked to the constant exposure to these drugs and the subsequent selective pressure, causing the transfer of resistant genes between strains. Carbapenems and glycopeptides should be used with caution in veterinary medicine in order to prevent such processes of selection that develop resistance in micro-organisms to these two classes, which can result in cross-resistance between animals and humans and create obstacles in the treatment of patients, especially for the two drugs mentioned, since they are important for the treatment of nosocomial infections in humans. The resistance percentage towards fluoroquinolones was identified to be higher in Gram-positive isolates, particularly in MRS, which showed 75% resistance against this class (according to the CLSI, resistance to one fluoroquinolone antimicrobial agent provides resistance to other antimicrobials of this class). For ESBL isolates, the resistance was shown to be 50%. The resistance towards the fluoroquinolones and aminoglycosides class can be associated with the expression of the genes that produce ESBL