Patient from India with fever and uncommon findings

A 28-years-old male patient from India that had not travelled to his country in the last nine months presented to the emergency room with general discomfort, dysthermia feeling, sweating, chills, and shivering. In the physical examination, temperature was quantified in 40.5 °C. No neurological deficit or peripheral lymphadenopathy was found. Blood was taken and sent to the local laboratory for examination and then sent to our hospital in order to confirm the diagnosis. This sample was stored for almost 3 days at room temperature

Evaluation of a Loop-Mediated Isothermal Amplification Assay to Detect Carbapenemases Directly from Bronchoalveolar Lavage Fluid Spiked with Acinetobacter spp

Carbapenem-resistant Acinetobacter spp. mainly Acinetobacter baumannii are frequently causing nosocomial infections with high mortality. In this study, the efficacy of the Eazyplex® SuperBug Complete A system, based on loop-mediated isothermal amplification (LAMP), to detect the presence of carbapenemases in Acinetobacter spp. directly from bronchoalveolar lavage (BAL) samples was assessed. A total of 22 Acinetobacter spp. strains producing OXA-23, OXA-40, OXA-58, NDM, and IMP were selected. Eazyplex SuperBug Complete A kit, used with the Genie II device, is a molecular diagnostics kit that detects a selection of genes that express carbapenemases (bla KPC , bla NDM , bla VIM , bla OXA-48 , bla OXA-23 , bla OXA-40 , and bla OXA-58 ). Negative BAL samples were identified, McFarland solutions were prepared from each of the 22 Acinetobacter strains and serial dilutions in saline solution were made to finally spike BAL samples to a concentration of 102 and 103 CFU/ml. Fifteen concentrations out of the 44 tested out did not provide detection of the carbapenemase-producing gene, all but one being at the lowest concentration tested at 102 CFU/ml; therefore, the limit of sensitivity is 103 CFU/ml. This assay represents the kind of advantages that investing in molecular diagnostics brings to the clinical practice, allowing the identification of carbapenemases in less than 30 min with a sensitivity of 103 CFU/ml

Oficina de resolução de problemas não rotineiros para alunos de 8 a 9 anos: um estudo de caso

[Objective] This article describes heuristics used by 8 and 9 year-old students to solve four non-routine problems that promote the development of arithmetic thinking from two perspectives: number distribution under a graphical representation, and use of arithmetic operations in the positional decimal system. [Methodology] The analysis included the formulation of categories that made it possible to characterize a priori the heuristics that could arise when solving each problem. These categories were used in the implementation of a mixed methodological approach with an exploratory and descriptive orientation. Qualitative analysis was carried out through a case study that helped to identify key actions based on written results provided by students. Quantitative analysis was carried out using implicative analysis, which includes a similarity tree and identification of significant classes. [Results] The results point to the importance of using simple heuristics in finding solutions to non-routine arithmetic problems, and confirm the presence of some characteristics of heuristic reasoning, such as attention, reduction, and change of assumptions. Likewise, implicative relationships were identified among some heuristics that share common characteristics, depending on the type of problem. [Conclusions] The results of this study show that, even in incorrect or incomplete answers, it is possible to recognize logical processes for the elaboration of partial answers and intuitive approaches, which are consistent with the action of simplifying or facilitating the search for a solution.[Objetivo] Caracterizar las heurísticas utilizadas por estudiantes de entre 8 y 9 años, al enfrentar cuatro problemas no rutinarios que promueven el desarrollo del pensamiento aritmético desde dos perspectivas: la distribución de números bajo una condición gráfica y el uso de operaciones aritméticas en el sistema decimal posicional. [Metodología] El análisis incluyó la elaboración de categorías que permitieron caracterizar a priori las heurísticas que podrían surgir en la resolución de los distintos problemas. Estas categorías fueron utilizadas para implementar un enfoque metodológico mixto, con un alcance exploratorio y descriptivo. El análisis cualitativo se realiza través de un estudio de caso que permite identificar desempeños claves a partir de las producciones escritas de los estudiantes. El análisis cuantitativo se realiza a través de un análisis implicativo, que incluye un árbol de similaridad y la identificación de clases significativas. [Resultados] Se evidencia que el uso de heurísticas simples en la resolución de problemas aritméticos no rutinarios favorece la búsqueda de soluciones parciales y se confirma la presencia persistente de algunas características del razonamiento heurístico, como la atención, la reducción y el cambio de supuestos. Además, se identifican relaciones implicativas entre algunas heurísticas que comparten características comunes, según el tipo de problema. [Conclusiones] Los alcances de este estudio ponen de manifiesto que, incluso en respuestas erróneas o incompletas, es posible reconocer procesos lógicos de elaboración de respuestas parciales y acercamientos intuitivos, que resultan consistentes con la acción de simplificar o facilitar la búsqueda de una solución.[Objetivo] Caracterizar as heurísticas utilizadas por estudantes entre 8 e 9 anos, frente a quatro problemas não rotineiros que promovem o desenvolvimento do pensamento aritmético a partir de duas perspectivas: a distribuição de números sob uma condição gráfica e o uso de operações aritméticas no sistema decimal posicional. [Metodologia] A análise incluiu a elaboração de categorias que permitiram caracterizar a priori as heurísticas que poderiam surgir na resolução dos diferentes problemas. Essas categorias foram utilizadas para implementar uma abordagem metodológica mista, com escopo exploratório e descritivo. A análise qualitativa é realizada por meio de um estudo de caso que permite identificar desempenhos-chave a partir das produções escritas dos alunos. A análise quantitativa é realizada por meio de uma análise implicativa, que inclui uma árvore de similaridade e a identificação de classes significativas. [Resultados] É evidente que o uso de heurísticas simples na resolução de problemas aritméticos não rotineiros favorece a busca de soluções parciais e confirma a presença persistente de algumas características do raciocínio heurístico, como atenção,  redução e mudança de pressupostos. Além disso, são identificadas relações implicativas entre algumas heurísticas que compartilham características comuns, dependendo do tipo de problema. [Conclusões] O escopo deste estudo mostra que, mesmo em respostas errôneas ou incompletas, é possível reconhecer processos lógicos de elaboração de respostas parciais e abordagens intuitivas, que são consistentes com a ação de simplificar ou facilitar a busca de uma solução

In vitro activity of 12 antimicrobial peptides against Mycobacterium tuberculosis and Mycobacterium avium clinical isolates

Tuberculosis (TB) remains a major threat to human health worldwide. The increasing incidence of non-tuberculous mycobacterial infections and particularly those produced by Mycobacterium avium has emphasized the need to develop new drugs. Additionally, high levels of natural drug resistance in non-tuberculous mycobacteria (NTM) and the emergence of multidrug-resistant (MDR) TB is of great concern. Antimicrobial peptides (AMPs) are antibiotics with broad-spectrum antimicrobial activity. The objective was to assess the activity of AMPs against Mycobacterium tuberculosis and M. avium clinical isolates. MICs were determined using microtitre plates and the resazurin assay. Mastoparan and melittin showed the greatest activity against M. tuberculosis, while indolicidin had the lowest MIC against M. avium. In conclusion, AMPs could be alternatives for the treatment of mycobacterial infections. Further investigation of AMPs' activity in combination and associated with conventional antibiotics and their loading into drug-delivery systems could lead to their use in clinical practice

Diseño de un prototipo Port Community Systems para su implementación en un puerto de Barranquilla

El objetivo del presente proyecto es diseñar y elaborar un prototipo de una herramienta de comunicación que se ajuste a las necesidades de comercio exterior del puerto de estudio, en donde se mejoren la coordinación de los procesos de importación y exportación, con el fin de reducir los tiempos, y brindar un mejor servicio a los clientes. Para esto se diseñó y se construyó un prototipo de Port Community Systems enfocado principalmente en los trámites presentados en la documentación física que se incurre en los procesos de comercio exterior del puerto. Para el desarrollo del presente proyecto, se hizo revisión sobre investigaciones realizadas, visitas de campo a las diferentes áreas del puerto, y se elaboró una ruta crítica teniendo en cuenta la diagramación suministrada en lenguaje EPC de las actividades presentadas en el proceso de importación. Para la elaboración del prototipo se empleó la metodología de Business Process Management (BPM), el cual está encaminado en conocer los procesos de negocio de la organización para poder mejorarlos y automatizarlos. Se estandarizo la información de los diagramas EPC utilizando el Business Process Modeling and Notation (BPMN), que es un estándar vigente a nivel internacional para la modelación de procesos de negocio (BPM). Se utilizó como herramienta la Suite Bizagi que está compuesta por Bizagi Modeler y Bizagi Studio para poder crear el sistema de información del prototipo. Las limitaciones del proyecto correspondieron principalmente a: el acceso parcial e incompleto a los eslabones de la cadena en el proceso de comercio exterior, debido a que el estudio se enfocó principalmente en las actividades y trámites correspondientes al puerto. Las visitas en campo y el desplazamiento hacia el puerto, debido a la planificación, tiempo y costo que se requirió. Las limitantes de acceso a todas las herramientas ofrecidas por Bizagi exigido por la licencia.PregradoIngeniero Industria

Evaluation of the MagicplexTM sepsis real-time test for the rapid diagnosis of bloodstream infections in adults

Sepsis is a serious health condition worldwide, affecting more than 30 million people globally each year. Blood culture (BC) is generally used to diagnose sepsis because of the low quantity of microbes occurring in the blood during such infections. However, ~50% of bloodstream infections (BSI) give negative BC, this figure being higher for sepsis, which delays the start of appropriate antimicrobial therapy. This prospective study evaluated a multiplex real-time polymerase chain reaction, the MagicplexTM Sepsis test (MP), for the detection of pathogens from whole blood, comparing it to routine BC. We analyzed 809 blood samples from 636 adult patients, with 132/809 (16.3%) of the samples positive for one or more relevant microorganism according to BC and/or MP. The sensitivity and specificity of MP were 29 and 95%, respectively, while the level of agreement between BC and MP was 87%. The rate of contaminated samples was higher for BC (10%) than MP (4.8%) (P < 0.001). Patients with only MP-positive samples were more likely to be on antimicrobial treatment (47%) than those with only BC-positive samples (18%) (P = 0.002). In summary, the MP test could be useful in some clinical setting, such as among patients on antibiotic therapy. Nevertheless, a low sensitivity demonstrated impairs its use as a part of a routine diagnostic algorithm

Time-to-positivity, type of culture media and oxidase test performed on positive blood culture vials to predict Pseudomonas aeruginosa in patients with Gram-negative bacilli bacteraemia

OBJECTIVE: The aim of this study was to determine the usefulness of oxidase test and time-to-positivity (TTP) in aerobic and anaerobic blood culture vials to detect the presence of Pseudomonas aeruginosa in patients with Gram-negative bacilli (GNB) bacteraemia. METHODS: TTP was recorded for each aerobic and anaerobic blood culture vial of monomicrobial bacteraemia due to GNB. Oxidase test was performed in a pellet of the centrifuged content of the positive blood culture. An algorithm was developed in order to perform the oxidase test efficiently taking into account TTP and type of vial. RESULTS: A total of 341 episodes of GNB bacteraemia were analysed. Sensitivity, specificity, positive predictive value and negative predictive value of the oxidase test performed on positive vials with GNB to predict P. aeruginosa were 95%, 99%, 91%, and 99%, respectively. When growth was first or exclusively detected in anaerobic vials, P. aeruginosa was never identified hence the performance of the oxidase test could be avoided. When growth was only or first detected in aerobic vials, a TTP≥8h predicted P. aeruginosa in 37% or cases (63 of 169), therefore oxidase test is highly recommended. CONCLUSIONS: Oxidase test performed onto positive blood culture vials previously selected by TTP and type of vials is an easy and inexpensive way to predict P. aeruginosa. In most cases, this can lead to optimization of treatment in less than 24 hours

The role of Xpert MTB/RIF in diagnosing pulmonary tuberculosis in post-mortem tissues

The extent to which the Xpert MTB/RIF (Gene Xpert) contributes to tuberculosis (TB) diagnosis in samples other than sputum and cerebrospinal fluid remains uncertain. We aimed to assess the role of Xpert MTB/RIF for detecting M. tuberculosis in post-mortem tissues. We conducted a study among 30 complete diagnostic autopsies (CDA) performed at the Maputo Central Hospital (Mozambique). Lung tissues were screened for TB in all cases. In addition other tissues were tested when compatible lesions were identified in the histological exam. We used in-house real time PCR and LAMP assays to confirm the presence of M. tuberculosis DNA. The diagnosis of tuberculosis at death was established based on microbiological and histopathological results. Eight out of 30 cases (26.7%) were diagnosed of tuberculosis. Xpert had a sensitivity to detect TB in lung tissue of 87.5% (95% CI 47.3-99.7) and a specificity of 95.7% (95% CI: 78.1-99.9). In-house DNA amplification methods and Xpert showed 93.6% concordance for lung tissue and 100% concordance for brain and liver tissues. The final cause of death was attributable to tuberculosis in four cases. Xpert MTB/RIF may represent a valuable, easy-to perform technique for post-mortem TB diagnosis

Evaluación de una laguna algal de alta tasa - LATAL, en condiciones tropicales, para la eliminación de compuestos farmacéuticos presentes en el efluente de una planta de tratamiento de aguas residuales.

Teniendo en cuenta la evidencia de la presencia de micro contaminantes en el agua en la ciudad de Cali, se planteó el presente proyecto cuyo objetivo fue el de evaluar el desempeño de una laguna algal de alta tasa (LATAL), a escala piloto, en condiciones del trópico americano, para la eliminación de compuestos farmacéuticos de los grupos analgésicos, antiinflamatorios, hipolipemiantes, antiepilépticos y tranquilizantes. La LATAL fue operada como un tratamiento secundario, por lo que fue ubicada a la salida de PTAR-C. Se diseñó para tratar un caudal de 0.2 m3 d-1, tres (03) días de tiempo de retención hidráulico (TRH) y se le instaló una rueda de paletas a la entrada con una velocidad de 5 RPM. Se tomaron 16 muestras a la entrada y salida de la LATAL (una semanal) para la determinación de compuestos farmacéuticos a través de HPLC/MS-MS y se midieron parámetros in situ como pH, temperatura, oxígeno disuelto (OD), potencial REDOX (ORP), radiación solar y conductividad, además de clorofila-a y DQO. Adicionalmente, se realizaron bio-ensayos a escala de laboratorio con el fin de evaluar la acción de las microalgas en la eliminación de ibuprofeno. En la LATAL se encontraron eficiencias de eliminación altas (>70%) para los compuestos ácido fenofíbrico, ibuprofeno y paracetamol, medias (30-70%) para gabapentina, lamotrigina, fenofibrato, gemfibrozilo, diclofenaco, ketoprofeno, naproxeno y pentoxifilina y bajas ( 50%) para la mayoría de los compuestos estudiados. Adicionalmente, se realizaron ensayos a escala de laboratorio usando la cepa pura de P. Kessleri, con el objetivo de determinar la capacidad de remoción, respuesta de crecimiento y clorofila a una exposición de 1000 μg/L y 16000 μg/L de ibuprofeno, en tres tiempos de exposición (12, 48, 96h). Los resultados mostraron inhibición del crecimiento de P. Kessleri, como una respuesta inmediata a la exposición de ibuprofeno (12 h). A 48 h, la recuperación tanto del crecimiento como de la clorofila a indicaron la tolerancia de la microalga al ibuprofeno, en la dosis más baja. En 96 h, se presentó inhibición parcial y disminución de clorofila a con la dosis de 16000 μg/L, debido a que con concentraciones más altas en tiempos prolongados se genera mayor estrés. Además, se encontró que la mejor remoción de ibuprofeno (46.4%) fue con la dosis más baja y a 12 h de exposición

Factors Associated With Short-Term Eradication of Rectal Colonization by KPC-2 Producing Klebsiella pneumoniae in an Outbreak Setting

Background: KPC-producing Klebsiella pneumoniae (KPCKP) is a threat for patients admitted to healthcare institutions. Objectives: To assess the efficacy of several decolonization strategies for KPCKP rectal carriage. Methods: Observational study performed in a 750-bed university center from July to October 2018 on the efficacy of a 10-day non-absorbable oral antibiotic (NAA) regimen (colistin 10 mg/ml, amikacin 8 mg/ml, and nystatin 30 mg/ml, 10 ml/6 h) vs. the same regimen followed by a probiotic (Vivomixx®) for 20 days in adult patients with KPCKP rectal colonization acquired during an outbreak. Results: Seventy-three patients colonized by KPCKP were included, of which 21 (29%) did not receive any treatment and 52 (71.2%) received NAA either alone (n = 26, 35.6%) or followed by a probiotic (n = 26, 35.6%). Eradication was observed in 56 (76.7%) patients and the only variable significantly associated with it was not receiving systemic antibiotics after diagnosis of rectal carriage [22/24 (91.6%) vs. 34/49 (69.3%), p = 0.04]. Eradication in patients receiving NAA plus probiotic was numerically but not significantly higher than that of controls [23/26 (88.4%) vs. 15/21 (71.4%), p = 0.14] and of those receiving only NAA (OR = 3.4, 95% CI = 0.78-14.7, p = 0.09). Conclusion: In an outbreak setting, rectal carriage of KPCKP persisted after a mean of 36 days in about one quarter of patients. The only factor associated with eradication was not receiving systemic antibiotic after diagnosis. A 10-day course of NAA had no impact on eradication. Probiotics after NAA may increase the decolonization rate, hence deserving further study