Notes

Diagnosis of Ehrlichia sp. in Amblyomma sculptum parasitizing mounts coming from Brazil Pantanal wetland.
cess and controlled oxidative damages by the maintenance of ROS homeostasis to achieve a high survival rate after cryopreservation. This study is the first to systematically describe the role of carbon nanomaterial in the regulation of plant oxidative stress response, and provided a novel insight into the application of nanomaterials in the field of cryobiology.
The plant cuticle represents one of the major adaptations of vascular plants to terrestrial life. Cuticular permeability and chemical composition differ among species.
is a widely used model for biochemical and molecular genetic studies in plants. However, attempts to isolate the intact cuticle from fresh leaves of Arabidopsis have failed so far. The goal of this study was to optimise an enzymatic method for cuticle isolation of species with a thin cuticle and to test it on several
wild types and mutants.

We developed a method for isolation of thin cuticles that allows reducing the isolation time, the separation of abaxial and adaxial cuticles, and avoids formation of wrinkles. Optical microscopy was used for studying cuticle intactness and scanning electron microscopy for visualisation of external and internal cuticle structures after isolation. Wax extracts were analysed by GC-MS. Isolation of intact cuticle was successful for all tested plants. The wax compositions (very-long-chained fatty acids, alcohols and alkanes) of intact leaves and isolated cuticles of wild type Col-0 were compared.

We conclude that the optimised enzymatic method is suitable for the isolation of
adaxial and abaxial cuticles. The isolated cuticles are suitable for microscopic observation. Analysis of wax composition revealed some discrepancies between isolated cuticles and intact leaves with a higher yield of wax in isolated cuticles.
We conclude that the optimised enzymatic method is suitable for the isolation of A. thaliana adaxial and abaxial cuticles. The isolated cuticles are suitable for microscopic observation. Analysis of wax composition revealed some discrepancies between isolated cuticles and intact leaves with a higher yield of wax in isolated cuticles.
Stalk lodging (breaking of agricultural plant stalks prior to harvest) is a multi-billion dollar a year problem. Stalk lodging occurs when bending moments induced by a combination of external loading (e.g. wind) and self-loading (e.g. the plant's own weight) exceed the stalk bending strength of plant stems. Previous studies have investigated external loading and self-loading of plants as separate and independent phenomena. However, these two types of loading are highly interconnected and mutually dependent. The purpose of this paper is twofold (1) to investigate the combined effect of external loads and plant weight on the flexural response of plant stems, and (2) to provide a generalized framework for accounting for self-weight during mechanical phenotyping experiments used to predict stalk lodging resistance.

A mathematical methodology for properly accounting for the interconnected relationship between self-loading and external loading of plants stems is presented. The method was compared to numerous fik lodging resistance.
Properly accounting for self-weight can be critical to determining the structural response of plant stems. Equations and tools provided herein enable researchers to properly account for the plant's weight during mechanical phenotyping experiments used to determine stalk lodging resistance.
Early seedling vigor is an essential trait of direct-seeded rice. It helps the seedlings to compete with weeds for water and nutrient availability, and contributes to better seedling establishment during the initial phase of crop growth. Seedling vigor is a complex trait, and phenotyping by a destructive method limits the improvement of this trait through traditional breeding. Hence, a non-invasive, rapid, and precise image-based phenotyping technique is developed to increase the possibility to improve early seedling vigor through breeding in rice and other field crops.

To establish and assess the methodology using free-source software, early seedling vigor was estimated from images captured with a digital SLR camera in a non-destructive way. Here, the legitimacy and strength of the method have been proved through screening seven diverse rice cultivars varying for early seedling vigor. In the regression analysis, whole-plant area (WPA) estimated by destructive-flatbed scanner (WPAs) and non-destructive imm for direct-seeded rice.
The method demonstrated here is affordable and easy to establish as a phenotypic platform. It is suitable for most glasshouses/net houses for characterizing genotypes to understand the plasticity of shoots under a given environment at the seedling stage. The methodology explained in this experiment has been proven to be practical and suggested as a technique for researchers involved in direct-seeded rice. Consequently, it will help in the simultaneous screening of genotypes in large numbers, the identification of donors, and in gaining information on the genetic basis of the trait to design a breeding program for direct-seeded rice.
Epidemiological studies have suggested that adiponectin is associated with the development of insulin resistance and type 2 diabetes. This study first examined the effect of purified anthocyanins, a group of dietary flavonoids, on serum adiponectin in patients with prediabetes and newly diagnosed diabetes.

A total of 160 patients with prediabetes (n = 90) or newly diagnosed diabetes (n = 70) were randomly assigned to either the anthocyanins group or the placebo group for 12weeks of intervention. Serum adiponectin, a set of biomarkers related to glucolipid metabolism, anthropometric parameters, dietary intake and physical activity were measured before and after intervention.

Anthocyanins increased serum adiponectin compared with placebo (net change 0.46µg/mL, 95% CI [0.03, 0.90],
 = 0.038) in the subjects with newly diagnosed diabetes. No significant difference in the change in adiponectin was observed between the two groups either in the overall subjects (0.02µg/mL [- 0.32, 0.36],
 = 0.906) or in prediabetes (- 0.35µg/mL [- 0.85, 0.16],
 = 0.174). Anthocyanins also decreased fasting glucose (- 0.5mmol/L [- 1, - 0.04],
 = 0.035) in the subjects with newly diagnosed diabetes, but no such change was observed in those with prediabetes.

Anthocyanins supplementation for 12weeks improved serum adiponectin and fasting glucose in patients with newly diagnosed diabetes, but not in patients with prediabetes.

ClinicalTrials.gov, NCT02689765. Registered on 6 February 2016, https//clinicaltrials.gov/ct2/show/NCT02689765.
ClinicalTrials.gov, NCT02689765. Registered on 6 February 2016, https//clinicaltrials.gov/ct2/show/NCT02689765.
Understanding how wild species respond to novel situations with associated risk can provide valuable insights for inter-specific behavioral variation and associations with pace-of-life (POL). Rodents, a globally distributed and diverse taxonomic group, have been the subjects of countless studies emulating risky situations. Controlled laboratory experiments with a focus on wild-caught species provide the opportunity to test fine-scale behavioral responses to contexts of risk with ecological implications. For example, assessing the importance of predator cues eliciting antipredator responses, as well as whether wild rodents embody behavioral plasticity and repertoires, illustrated by habituation and variation in behavioral traits, respectively.

In this comparative study, we examined multiple behavioral responses of four rodent species in eastern Taiwan (three native species
,
, and one invasive,
) exposed to an unfamiliar microenvironment and novel cue from an allopatric predator, the leopard cat (
)y demonstrated habituation to the microenvironment, indicating they possess adaptive capacity.
Our results suggest that these four species do largely follow a behavioral fast-slow continuum with the two smaller mice species demonstrating increased boldness in a novel context compared to the larger rat species. Also, the wild populations of rodents in eastern Taiwan may be naïve to leopard cats. Finally, the rodents in our study demonstrated habituation to the microenvironment, indicating they possess adaptive capacity.
Eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) exhibits a poorer outcome compared with non-eosinophilic chronic rhinosinusitis with nasal polyps (nonECRSwNP), so it is significant to identify effective markers to differentiate ECRSwNP in guiding the treatment strategies of these patients. Although arachidonate 15-lipoxygenase (ALOX15) is positioned as a marker of eosinophilic inflammation, its study in differentiating ECRSwNP has not been reported. The aim of this study is to assess the potential of ALOX15 in distinguishing and predicting ECRSwNP.

Forty-eight patients with chronic rhinosinusitis with nasal polyps (CRSwNP), including 30 ECRSwNP and 18 nonECRSwNP patients, were enrolled. ALOX15 mRNA level was determined in polyps by real-time polymerase chain reaction (RT-PCR). The patients' baseline characteristics were evaluated and analyzed for correlations with ALOX15. Receiver operating characteristic (ROC) curve was used to assess the predictive significance of the potential predictorP.
The relative ALOX15 mRNA level alone or in combination with blood eosinophils might be a reliable biomarker for predicting a diagnosis of ECRSwNP.
To examine published antimicrobial stewardship (AMS) initiatives in hospitals in Latin America and the Caribbean (LAC) in order to characterize AMS terminology usage, geotemporality, and elements of structure (human resources), process (interventions), and outcomes, and to set priority areas for improving AMS reporting.

This was a scoping review that searched PubMed, LILACS, EMBASE, and 12 other databases, along with a manual search for academic and grey literature to identify documents on AMS initiatives in hospitals in 33 countries of LAC, up to August 2019. Keywords included 'antibiotic' or 'antimicrobial' AND 'stewardship, policy, strategies, management, control, rational use, appropriate use, surveillance, or interventions' and 33 country names.

Selected articles totalled 147 studies published in 1985 - 2019; of those, 22% used 'antimicrobial stewardship' in the title. Eighteen countries published AMS hospital initiatives, one-half of which were implemented in capital cities. Brazil, Argentina, Colombia, Cuba, Mexico, and Chile, in descending frequency, made up > 59% of published initiatives. Educational interventions were the most frequently reported, followed by persuasive and restrictive strategies. Antimicrobial consumption was the most common outcome measure reported. About one-third of the studies (35%) referred to baseline measures-only in preparation for AMS interventions. Fifty-nine studies from 6 countries reported AMS comprehensively, using structure, process, and outcome (SPO) elements.

Published hospital AMS initiatives have increased over time and have expanded across LAC. However, more programs need to be developed. Complete reporting of SPO elements is imperative to evaluating and replicating AMS actions.
Published hospital AMS initiatives have increased over time and have expanded across LAC. However, more programs need to be developed. Complete reporting of SPO elements is imperative to evaluating and replicating AMS actions.
To describe the genotypes of the carbapenemases reported from microbiological isolates of patients in Peru.

A systematic search of the biomedical literature about carbapenemases with genotypic confirmation was carried out. It included literature published from 1 January 2000 through 15 September 2019 in the PubMed, SCOPUS, Virtual Health Library, CONCYTEC Virtual Library, and Google Scholar databases, and other sources for the publication of abstracts or posters from national or international meetings. Two reviewers carried out the data selection and extraction.

Fourteen studies, which carried out the genotypic characterization of 313 carbapenemases, were included. Of the total 313 reports, 103 analyzed enterobacteria 74 were of
, 11 of
, 7 of
and 11 of other enterobacteria; and 61 corresponded to

, 39 to

and 3 to


According to their molecular structure, 64 were metallo-ß-lactamases and 39 were serine-ß-lactamases. Of the total reports, 84 analyzed
79 corresponded to

, 4 to

, and 1 to

Of the total reports, 126 analyzed
55 corresponded to

, 66 to

, 3 to

and 2 to

.

There is a limited number of publications about carbapenemases among patients in Peru. The genotype reports come primarily from hospitals in the country's capital. This is the first review that aims to identify the types of carbapenemases reported in enterobacteria,
, and
.
There is a limited number of publications about carbapenemases among patients in Peru. The genotype reports come primarily from hospitals in the country's capital. This is the first review that aims to identify the types of carbapenemases reported in enterobacteria, P. aeruginosa, and A. baummani.
To detect the presence of the
gene associated with macrolide resistance in
strains isolated from chickens marketed in Lima, Peru.

120 samples of chicken skin from three markets in the districts of San Martin de Porres (n = 30), Santa Anita (n = 20), and Independencia (n = 70), located in the Province of Lima, Peru, were analyzed. Microbiological analysis of the samples was carried out according to ISO standard 10272-12017. For the polymerase chain reaction (PCR) confirmation of genus and species, 16-rRNA and GlyA and hipO primers, respectively, were used. For the evaluation of antibiotic sensitivity, the Müller-Hinton agar with 5% blood, with sensi-discs for azithromycin (15 µg) and erythromycin (15 µg), was used. For detection of the
gene in strains with resistant phenotypes, conventional PCR was used.

A total of 117 positive samples (97.5%) were obtained; of these, 100% were compatible with
(negative hippurate test) and confirmed by PCR. The plate-based assessment of antibiotic resistance to azithromycin and erythromycin resulted in 100% of strains with a phenotype that is resistant to these macrolides, while the PCR to detect the
gene indicated a total of 62 positives (53%), which were confirmed through sequencing.

These results demonstrate that the chicken carcasses sold in markets in Lima present contamination by
with high resistance to macrolides, which can be attributed to the presence of the
gene.
These results demonstrate that the chicken carcasses sold in markets in Lima present contamination by C. coli with high resistance to macrolides, which can be attributed to the presence of the ermB gene.
To measure the impact generated by the implementation of the pharmacy-driven antimicrobial stewardship program of the Clínica Bíblica Hospital.

This is a retrospective observational study that evaluates the consumption of antibiotics for the periods before and during implementation of the Clínica Bíblica Hospital antimicrobial stewardship program, calculated by means of defined daily dose per 1 000 patient-days and days of therapy per 1 000 patient-days. In addition, bacterial resistance patterns for the periods 2014-2015 and 2016-2017 were compared.

Consumption of most-used antibiotics was calculated, looking for trends that might be associated with the activities implemented by the Clínica Bíblica Hospital antimicrobial stewardship program. Comparing some of the antibiotics with the highest consumption in periods I and II, use of levofloxacin and ceftriaxone showed a decrease of 54.0% (p < 0.001) and 14.6% (p = 0.003), respectively, whereas there was an increase in the use of cefazolin of 4 539.3% between the periods studied, which suggests that either the antimicrobial stewardship program may have prevented an increase in bacterial resistance since its implementation, or that it is too soon to see impact on bacterial resistance.
To describe the resistance profile and the genetic characteristics of Escherichia coli isolates that harbor the mobilizable colistin resistance gene mcr-1 in Argentina.

This was a retrospective study of 192 E. coli isolates positive for mcr-1 obtained from 69 hospitals of Buenos Aires City and 14 Argentinean provinces in 2012 - 2018. The antimicrobial susceptibility was performed by agar diffusion, broth macrodilution, and/or agar dilution. Standard polymerase chain reaction (PCR) was performed to detect resistance genes and incompatibility groups; specific PCR was applied to discriminate between blaCTX-M allelic groups and mcr-1.5 variant. The genetic relatedness among isolates was evaluated by XbaI-pulsed field gel electrophoresis and multilocus sequence typing in a subset of isolates.

All E. coli isolates showed minimal inhibitory concentrations to colistin ≥ 4μg/mL; nearly 50% were resistant to third-generation cephalosporins, with CTX-M-2 being the main extended-spectrum β-lactamase detected. Five E. coli were carbapenemase-producers (3 NDM, 2 KPC). The mcr-1.5 variant was detected in 13.5% of the isolates. No genetic relationship was observed among the mcr-1-positive E. coli clinical isolates, but a high proportion (164/192; 85.4%) of IncI2 plasmids was detected.

The presence of IncI2 plasmids among highly diverse E. coli clones suggests that the mcr-1 gene's wide distribution in Argentina may be driven by the horizontal transmission of IncI2 plasmids.
The presence of IncI2 plasmids among highly diverse E. coli clones suggests that the mcr-1 gene's wide distribution in Argentina may be driven by the horizontal transmission of IncI2 plasmids.
Evaluate the level of adherence to guidelines on surgical prophylaxis in health facilities in Argentina and the determinants of non-adherence.

Cross-sectional multicenter study in 35 centers in Argentina. The level of adherence to guidelines and the forms of non-adherence were determined and these were compared based on the characteristics of the indicated antibiotic, anesthesiologist, surgery, and facility, as well as patient age. An adjusted logistic regression model was used.

A total of 1,083 surgical procedures were reviewed. Adherence to guidelines was 67%. The most frequent forms of non-adherence were incorrect antibiotic (28.9%), unnecessary prophylaxis (25.5%), and prolonged prophylaxis (24.4%). Adherence to guidelines was higher in persons under 18 years of age (84.9% compared to 65.5%, p < 0.001). According to the type of health coverage (social welfare, private insurance, public coverage, or community coverage), adherence was 33.3%, 64.4%, 78.8%, and 83.3%, respectively; p < 0.001. Accod use of antibiotics were the most frequent forms of non-adherence. Adherence was higher with younger patients, where programs exist to optimize the use of antimicrobial drugs, where there is private or public health coverage, with the pediatric population, for specific pathologies, in emergency surgery, and in certain specialties.
Adherence to guidelines was 67%. Incorrect, unnecessary, and prolonged use of antibiotics were the most frequent forms of non-adherence. Adherence was higher with younger patients, where programs exist to optimize the use of antimicrobial drugs, where there is private or public health coverage, with the pediatric population, for specific pathologies, in emergency surgery, and in certain specialties.
To characterize carbapenemase-producing
isolated from patients treated at a hospital in Cumaná, Sucre, Venezuela.

This was a retrospective study conducted at the general hospital in Cumaná where 58
strains were analyzed for resistance to antimicrobials, specifically carbapenems, in January - June 2015. Production of metallo-β-lactamases and serine carbapenemases was determined by the double-disc synergy test, using EDTA-sodium mercaptoacetic acid and 3-aminophenyl boronic acid discs, respectively. Multiplex-PCR was used to detect genes coding for carbapenemases. Molecular typing using ERIC-PCR determined the presence of clones.

Four strains of
resistant to carbapenems were identified. Phenotypic methods for detection of metallo-β-lactamases and serine carbapenemases were positive, and PCR demonstrated the co-presence of

and

genes in all four strains. ERIC-PCR identified two clones circulating in the hospital.

Infection control strategies are needed at the central hospital in Cumaná and its surrounding areas to prevent the spread of these pathogens, especially given the high levels of migration from Venezuela to other countries in South America.
Infection control strategies are needed at the central hospital in Cumaná and its surrounding areas to prevent the spread of these pathogens, especially given the high levels of migration from Venezuela to other countries in South America.
Measure social inequalities in antimicrobial resistance in
in Colombia.

Ecological study using a multi-panel of data, disaggregated at the subnational level, and using isolations of
as a proxy for antimicrobial resistance (AMR) between 2009 and 2018. A sociodemographic characterization, an analysis of the antimicrobial sensitivity of isolations of
, and a measurement of inequalities in AMR in
were conducted using the slope index of inequality, the relative inequality index, and the concentration index.

The findings indicate antimicrobial resistance to penicillin (50.7%) and tetracycline (67.3%) in isolations of
, and the existence of absolute and relative inequalities during the study period. Access barriers to health services, not having received information on the prevention of sexually transmitted infections, basic unmet needs, and illiteracy explained the inequalities in AMR in
.

Six recommendations emerged with a view to largely containing AMR in
i) increase awareness of safe sexual and reproductive health; ii) rethink how to deliver key messages with an equity approach; iii) improve information, prescription, and drug chain systems; iv) form coalitions to improve response and share objectives with the private sector; v) improve the availability and disaggregation of data; and vi) support research on inequalities in AMR.
Six recommendations emerged with a view to largely containing AMR in N. gonorrhoeae i) increase awareness of safe sexual and reproductive health; ii) rethink how to deliver key messages with an equity approach; iii) improve information, prescription, and drug chain systems; iv) form coalitions to improve response and share objectives with the private sector; v) improve the availability and disaggregation of data; and vi) support research on inequalities in AMR.
To determine the prevalence of methicillin-resistant
(MRSA) in animals used to produce foods in the Americas.

A systematic literature review was performed in the following databases Scopus, Web of Science, MEDLINE, EMBASE, and Virtual Health Library. Articles published in the past 10 years, without language limits, were selected. The outcome of interest was the prevalence of MRSA in food-producing animals. Prevalence rates were meta-analyzed in grouped random effects models using the DerSimonian and Laird method. The geographic distribution of MRSA and the time trend of resistance were also analyzed.

Of 19 studies included, 11 were performed in the United States and 11 analyzed pig samples. Five studies were performed in South America. The samples analyzed in the studies were collected in farming, processing, and retail sites. MRSA prevalence in the Americas was 7.6% (95%CI 5.6-9.5%), and was higher in pigs [12.6% (95%CI 7.0-18.2%)] followed by bovine cattle [2.4% (95%CI 1.2-3.7%)] and poultry [1.8% (95CI% 0.3-3.4%)]. MRSA prevalence was higher in pigs in North America and bovine cattle in Latin America. There was no significant variation in MRSH prevalence along the 10-year period analyzed.

MRSA prevalence in food-producing animals in the Americas was higher in pigs, without significant changes across time.
MRSA prevalence in food-producing animals in the Americas was higher in pigs, without significant changes across time.Acinetobacter baumannii is considered to be a worldwide threat to public health due to its high antimicrobial resistance rates and the severe infections it can cause. Little is known about this pathogen's resistance in Central America. This report aims to describe the antimicrobial resistance profile of A. baumannii at a tertiary hospital in Honduras. The cross-sectional analysis was conducted at the tertiary care laboratory hospital in San Pedro Sula in 2015 - 2017. A total of 113 consecutive microbiological reports were analyzed, comprising 100 individuals from whom A. baumannii was isolated. Epidemiological and microbiological data, including the isolation setting and patient information, were recorded. Prevalence of multi-drug and extensive-drug resistance was assessed according to international standards. The median age of individuals was 22 years (2 - 35 years); female was the predominant gender (53%). The hospital's pediatric wards had the highest number of isolates (n = 48). The most frequent specimen from which A. baumannii was isolated was skin and soft tissue (n = 39). Resistance to carbapenems was reported to be 40.7% among the isolates (n = 46); multi-drug resistant, 35.4% (n = 40); and extensively-drug resistant, 7.1% (n = 8). This report reveals the threat of this pathogen to public health in Honduras and appeals for antibiotic stewardship programs throughout Central America.
Describe the results of the Program for the Rational Use of Antimicrobials at Mexico's Juárez Hospital.

An observational, cross-sectional, retrospective, descriptive study was designed. For the consumption of antimicrobial agents, data from January 2013 to December 2018 were analyzed by calculating the defined daily dose (DDD). For the cost analysis, a traditional costing calculation was used.

For the group of carbapenem agents, there was a sizeable reduction in the consumption of imipenem / cilastatin the DDD declined from 2.3 in 2013 to 0.7 in 2018, a decrease of 70%. By contrast, for the other two agents, increases were observed. The consumption of meropenem increased by 2% (from 2.4 in 2013 to 2.5 in 2018); the consumption of ertapenem increased by 75% (from 1 in 2013 to 1.8 in 2018). The total expenditure on antimicrobial agents was USD 930 556.46 during 2013, compared to USD 856 079.10 during 2018, representing a difference of 8% or USD 74 905.61 of the total expenditure.

Programs for the rational use of antimicrobials need to be evaluated continuously, by monitoring both consumption of agents by patients and related institutional expenditures.
Programs for the rational use of antimicrobials need to be evaluated continuously, by monitoring both consumption of agents by patients and related institutional expenditures.Antimicrobial resistance (AMR) in pathogens has been associated mainly with excessive use of antibiotics. Most studies of resistance have focused on clinical pathogens; however, microorganisms are exposed to numerous anthropogenic substances. Few studies have sought to determine the effects of chemical substances on microorganisms. Exposure to these substances may contribute to increased rates of AMR. Understanding microorganism communities in natural environments and AMR mechanisms under the effects of anthropogenic substances, such as pesticides, is important to addressing the current crisis of antimicrobial resistance. This report draws attention to molecules, rather than antibiotics, that are commonly used in agrochemicals and may be involved in developing AMR in non-clinical environments, such as soil. This report examines pesticides as mediators for the appearance of AMR, and as a route for antibiotic resistance genes and antimicrobial resistant bacteria to the anthropic environment. Available evidence suggests that the natural environment may be a key dissemination route for antibiotic-resistant genes. Understanding the interrelationship of soil, water, and pesticides is fundamental to raising awareness of the need for environmental monitoring programs and overcoming the current crisis of AMR.
The objective is to present the results of the Latin American Program for Quality Assurance in Bacteriology and Antimicrobial Resistance (LA-EQAS) between 2000 and 2018 and the evolution of the detection of resistance mechanisms with clinical impact.

The participating National Reference Laboratories (NRLs) received 25 surveys with 10 strains in each one, representing a total of 86 bacterial species and 40 resistance mechanisms. To evaluate the performance of the NRLs, five indicators were analyzed bacterial identification, interpretation of susceptibility testing, acceptable ranges for zones of inhibition, inferred resistance mechanism, and delay time for the response.

The average concordance was 82.6% (range 74-95%) for bacterial identification, 93.3% (85-98%) for the interpretation of susceptibility testing, 84.6% (70-94%) for the zones of inhibition, and 82.5% (73-96%) for the inferred resistance mechanisms. The average delay time for the response was 34 days. Improvements in the detection of mechanisms of clinical importance, such as resistance to methicillin, macrolides and glycopeptides in Gram-positive cocci, and extended-spectrum, AmpC plasmid and carbapenemase beta-lactamases in Gram-negative bacilli, were observed.

The LA-EQAS is an excellent tool for continuous quality improvement in the diagnosis of infections due to multiresistant microorganisms in NRLs in Latin America.
The LA-EQAS is an excellent tool for continuous quality improvement in the diagnosis of infections due to multiresistant microorganisms in NRLs in Latin America.
To define the antimicrobial resistance profiles of the microorganisms most commonly isolated from hospitalized adult patients in Dominican Republic (DR).

A retrospective, cross-sectional study of phenotypic antimicrobial susceptibility patterns was conducted using data from 3 802 clinical microbiology reports specifying positive bacterial cultures in samples collected from patients admitted to the clinical, surgery, and intensive care units (ICU) at three tertiary-level care hospitals in the city of Santiago de los Caballeros from 1 January 2016 - 31 December 2017. Descriptive statistics and chi-square test (
≤ 0.05) were used to analyze the qualitative variables.

At the three hospitals, there were 932, 1 090, and 1 780 microbiology reports analyzed. Of the total, 1274 were from the ICU, 1 042 from the surgery unit, and 1 486 from the clinical unit. Methicillin resistance was found in 57.3% of the
isolates and 75.3% of the coagulase-negative staphylococci. Third-generation cephalosporin resistance was detected in 54.4% of isolates identified as members of the
family, 67.3% of the
spp., and 91.7% of the
, while carbapenem resistance was shown by 8.0%, 23.8%, and 51.0% of these, respectively. Most of the resistant
spp. isolates were found in just one hospital and the prevalence of
resistant to carbapenems was highest in the ICU.

Antimicrobial resistance levels are high among hospitalized patients in Dominican Republic and may cause enhanced risk factors that impact clinical outcomes. Urgent measures are needed to address antimicrobial resistance in DR.
Antimicrobial resistance levels are high among hospitalized patients in Dominican Republic and may cause enhanced risk factors that impact clinical outcomes. Urgent measures are needed to address antimicrobial resistance in DR.
To identify effective interventions to manage antimicrobial resistance in hospital settings and potential barriers to their implementation.

A synthesis of evidence for health policy was performed using SUPPORT tools. Literature searches were performed in November and December 2018 in 14 databases. A face-to-face deliberative dialogue workshop to identify implementation barriers was performed with 23 participants (manager, researchers, and health care professionals) and 14 listeners divided into three groups. Researchers with experience in deliberative dialogue acted as facilitators.

Twenty-seven systematic reviews focusing on antimicrobial stewardship using combined or individual strategies were identified. The interventions included education, electronic systems, use of biomarkers, and several strategies of antimicrobial management. The main barriers to the implementation of interventions, identified in the literature and deliberative dialogue workshop, were poor infrastructure and insufficient human resources, patient complaints regarding the treatment received, cultural differences within the multidisciplinary team, work overload, and lack of financing/planning.

Most of the strategies identified were effective for antimicrobial stewardship in hospital settings. The reliability of results may be strengthened with the performance of additional research of higher methodological quality.
Most of the strategies identified were effective for antimicrobial stewardship in hospital settings. The reliability of results may be strengthened with the performance of additional research of higher methodological quality.
To report the species identified in candidemia isolated in hospitals in Paraguay, their distribution by age groups, and their susceptibility to fluconazole, voriconazole, and amphotericin B.

Retrospective study of candidemia reported to the Central Health Public Laboratory by seven hospitals between 2010 and 2018. Identification and susceptibility testing were performed using the automated Vitek 2
system.

520 cases of candidiasis were reported. The prevalent species were
(34.4%),
(30.4%),
(25.4%
(4.8%), and
(2.1%). Less frequent species were
(1.2%),
(1%),
(0.3%),
(0.2%), and
(0.2%). Candidiasis was most prevalent in the elderly (48.5%) and adults (29.9%).
was most frequent in newborns and infants, and
in pediatric patients; 2.8% and 0.6% of
and 4.4% and 2.5% of
were resistant, respectively, to fluconazole and voriconazole; 8% of
were resistant to fluconazole and two isolations showed a minimum inhibitory concentration for voriconazole greater than 0.25 mg/L.

This is the first report on candidemias in hospitals of Paraguay. Together with other studies, it will improve knowledge about this infection in the country.
This is the first report on candidemias in hospitals of Paraguay. Together with other studies, it will improve knowledge about this infection in the country.
To identify socioeconomic factors associated with antimicrobial resistance of
and
in Chilean hospitals (2008-2017).

We reviewed the scientific literature on socioeconomic factors associated with the emergence and dissemination of antimicrobial resistance. Using multivariate regression, we tested findings from the literature drawing from a longitudinal dataset on antimicrobial resistance from 41 major private and public hospitals and a nationally representative household survey in Chile (2008-2017). We estimated resistance rates for three priority antibiotic-bacterium pairs, as defined by the Organisation for Economic Co-operation and Development; i.e., imipenem and meropenem resistant
cloxacillin resistant
and cefotaxime and ciprofloxacin resistant


Evidence from the literature review suggests poverty and material deprivation are important risk factors for the emergence and transmission of antimicrobial resistance. Most studies found that worse socioeconomic indicators were associated with higher rates of antimicrobial resistance. Our analysis showed an overall antimicrobial resistance rate of 32.5%, with the highest rates for
(40.6%) and the lowest for
(25.7%). We found a small but consistent negative association between socioeconomic factors (income, education, and occupation) and overall antimicrobial resistance in univariate (p < 0.01) and multivariate analyses (p < 0.01), driven by resistant
and
.

Socioeconomic factors beyond health care and hospital settings may affect the emergence and dissemination of antimicrobial resistance. Preventing and controlling antimicrobial resistance requires efforts above and beyond reducing antibiotic consumption.
Socioeconomic factors beyond health care and hospital settings may affect the emergence and dissemination of antimicrobial resistance. Preventing and controlling antimicrobial resistance requires efforts above and beyond reducing antibiotic consumption.
Describe the clinical and epidemiological characteristics and resistance profile of cases of extensively drug-resistant tuberculosis (XDR-TB) diagnosed in Peru from 2013 to 2015.

This descriptive study included patients who met the definition of XDR-TB and were reported to the national epidemiological surveillance system of Peru's Ministry of Health. It used a descriptive analysis and, to identify spatial distribution, a heat map based on kernel density estimation.

It was estimated that XDR-TB cases diagnosed as new represented 7.3% of all multidrug-resistant tuberculosis (MDR-TB) cases reported during the study period; 74% of patients were aged 15 to 44 years old; and the male-female ratio was 1.7. Half of the country's departments reported at least one case of XDR-TB, and 42% of new cases had no history of resistance or previous treatment. In the other half of the departments, the majority had previous MDR and pre-XDR resistance. Among the cases, 57.7% presented resistance to 5 and 7 first- and second-line drugs and 41.6% presented resistance to 8 and 10 drugs.

This study offers important details of the epidemiological profile of XDR-TB in Peru, where there has been an increase in cases of primary XDR-TB; that is, cases with no prior history of disease. Furthermore, this form of tuberculosis has spread to a greater number of departments in the country.
This study offers important details of the epidemiological profile of XDR-TB in Peru, where there has been an increase in cases of primary XDR-TB; that is, cases with no prior history of disease. Furthermore, this form of tuberculosis has spread to a greater number of departments in the country.
The Amazon basin is one of the seven major geographical areas where scorpionism is recorded. In French Guiana, 90 stings per 100,000 inhabitants are registered per year. As the severity of cases is higher in children, descriptive studies are needed to have a better understanding of this pathology. The aim of the present study is to describe pediatric scorpionism in French Guiana.

We conducted a monocentric descriptive retrospective study on scorpion stings in all pediatric patients admitted to Cayenne General Hospital from January 1, 2002 to December 31, 2018.

In this survey, 132 patients were included. Of them, 63% were male. Patients with general signs of envenomation were younger and lighter (p = 0.04). The picture was "one sting" (95.3%) by a "big" (47.6%), "black" (60%) and "small pincer" (58%) scorpion on the extremity of the body (84%). Stings occurred mainly during the day, while patients changed clothes. There was no envenomation during night. The monthly evaluation highlights that the number oere envenomation presented most of the time with cardiac, pulmonary, and gastrointestinal symptoms.As a co-transcriptional process, RNA processing, including alternative splicing and alternative polyadenylation, is crucial for the generation of multiple mRNA isoforms. RNA processing mechanisms are widespread across all higher eukaryotes and play critical roles in cell differentiation, organ development and disease response. Recently, significant progresses have been made in understanding the mechanism of RNA processing. RNA processing is regulated by trans-acting factors such as splicing factors, RNA-binding proteins and cis-sequences in pre-mRNA, and increasing evidence suggests that epigenetic mechanisms, which are important for the dynamic regulation and state of specific chromatic regions, are also involved in co-transcriptional RNA processing. In contrast, recent studies also suggest that alternative RNA processing also has a feedback regulation on epigenetic mechanisms. In this review, we discuss recent studies and summarize the current knowledge on the epigenetic regulation of alternative RNA processing. In addition, a feedback regulation of RNA processing on epigenetic regulators is also discussed.In this study, we compared the molecular, clinical, and pathological characteristics, as well as pedigrees, between patients with Lynch-like syndrome (LLS) and confirmed Lynch syndrome (LS) to develop appropriate management strategies for patients with LLS and their affected family members. Between June 2008 and September 2018, 81 patients with LLS and 47 patients with LS who developed colorectal cancer (CRC) were enrolled in this study. Multigene panel testing included 139 genes and was performed for all patients. The variants identified in each group were described, and clinicopathological characteristics and pedigrees were compared between the two groups. In the LLS group, a total of 52 variants were detected in 44 (54.3%) patients. Among the 52 variants, 17 were variants of unknown significance in mismatch repair genes, and the other most frequently mutated genes were MUYTH, POLE, BRCA2, and GJB2. The proportion of early-onset patients was significantly higher among the LS probands than among the LLS prob on the presence of confirmed pathogenic/likely pathogenic germline variant(s) and family history.Esophageal cancer (EC) is a serious malignant tumor, both in terms of mortality and prognosis, and immune-related genes (IRGs) are key contributors to its development. In recent years, immunotherapy for tumors has been widely studied, but a practical prognostic model based on immune-related genes (IRGs) in EC has not been established and reported. This study aimed to develop an immunogenomic risk score for predicting survival outcomes among EC patients. In this study, we downloaded the transcriptome profiling data and matched clinical data of EC patients from The Cancer Genome Atlas (TCGA) database and found 4,094 differentially expressed genes (DEGs) between EC and normal esophageal tissue (p 2). Then, the intersection of DEGs and the immune genes in the "ImmPort" database resulted in 303 differentially expressed immune-related genes (DEIRGs). Next, through univariate Cox regression analysis of DEIRGs, we obtained 17 immune genes related to prognosis. We detected nine optimal survival-associated IRGs (HSPA6, CACYBP, DKK1, EGF, FGF19, GAST, OSM, ANGPTL3, NR2F2) by using Lasso regression and multivariate Cox regression analyses. Finally, we used those survival-associated IRGs to construct a risk model to predict the prognosis of EC patients. This model could accurately predict overall survival in EC and could be used as a classifier for the evaluation of low-risk and high-risk groups. In conclusion, we identified a practical and robust nine-gene prognostic model based on immune gene dataset. These genes may provide valuable biomarkers and prognostic predictors for EC patients and could be further studied to help understand the mechanism of EC occurrence and development.Conventionally, patients with combined rare diseases are often difficult to diagnose. This is because some clinicians tend to consider the multiple disease symptoms as the presentation of a complicated "syndrome." This pattern of thinking also confines their way of filtering pathogenic mutations. Some real pathogenic mutations might be ignored due to not covering all disease presentations. Here we report the case of a girl who was suffering from spherocytosis and Antley-Bixler syndrome with genital anomalies and disordered steroidogenesis. She remained undiagnosed even after targeted gene detection before. However, after performing next-generation sequencing and analyzing the sequencing data, we identified two mutations c.2978T > A in ANK1 and c.1370G > A in POR. Our findings and experiences in diagnosing these mutations could contribute to the existing knowledge on the clinical and genetic diagnosis of patients with disease presentations in multiple systems.Ancestry informative markers (AIMs) are used in forensic genetics to infer biogeographical ancestry (BGA) of individuals and may also have a prominent role in future police and identification investigations. In the last few years, many studies have been published reporting new AIM sets. These sets include markers (usually around 100 or less) selected with different purposes and different population resolutions. Regardless of the ability of these sets to separate populations from different continents or regions, the uncertainty associated with the estimates provided by these panels and their capacity to accurately report the different ancestral contributions in individuals of admixed populations has rarely been investigated. This issue is addressed in this study by evaluating different AIM sets. Ancestry inference was carried out in admixed South American populations, both at population and individual levels. The results of ancestry inferences using AIM sets with different numbers of markers among admixed refeidual level and not at the population level, e.g., in association studies or the determination of a suspect's BGA, the results of this work point to the need of a more careful evaluation of the uncertainty associated with the ancestry estimates in admixed populations, when small AIM-sets are used.The sodium/hydrogen antiporter (NHX) gene family with the Na+/H+ exchange protein domain is a transporter of sodium and hydrogen ions and plays an important role in the response of plants to salt stress. Studying the response of cotton to salt stress through comprehensive identification and analysis of NHX genes in several species and their roles in salt tolerance mechanisms is of great significance. In this study, 23, 24, 12, and 12 NHX genes were identified from Gossypium hirsutum (Gh), G. barbadense, G. arboreum and G. raimondii, respectively. Phylogenetic analysis showed that these genes were mainly divided into three clades with significant subcellular localization, namely, endosome (Endo-class), plasma membrane (PM-class) and vacuole (Vac-class). By analyzing the structure of NHX genes and proteins, each branch of the NHX gene family was found to be structurally conserved, and collinearity analysis showed that NHX genes were mainly expressed through whole genome and segmental duplication. The non-synonymous (Ka)/synonymous (Ks) values showed that the NHX gene family experienced strong purifying selection during long-term evolution. Cis-acting element analysis showed that the NHX gene family may be related to the regulation of abscisic acid (ABA) and methyl jasmonate (MeJA) hormones. Additionally, transcriptomic data analysis and qRT-PCR showed that GhNHXs exhibited different expression patterns in each tissue and under different salinities. These results provide an important reference for us to further understand and analyze the molecular regulation mechanism of cotton NHX genes.The arms race between plants and viruses never ceases. Chinese cabbage, an important type of Brassica vegetable crop, is vulnerable to plant virus infection, especially to Turnip mosaic virus (TuMV). To better examine the molecular mechanisms behind the virus infection, we conducted the correlation analysis of RNA-Seq and quantitative iTRAQ-LC-MS/MS in TuMV-infected and in healthy Chinese cabbage leaves. There were 757 differentially expressed genes and 75 differentially expressed proteins that were screened in Chinese cabbage plants infected with TuMV. These genes were enriched in many pathways, and among them, the plant hormone signal transduction, plant-pathogen interaction, and protein processing in the endoplasmic reticulum pathways were suggested to be closely related pathways. The correlation analysis between RNA-Seq and quantitative iTRAQ-LC-MS/MS was then further explored. Finally, we obtained a preliminary network of several candidate genes associated with TuMV infection, and we found that they mainly belonged to calcium signaling pathways, heat shock proteins, WRKY transcription factors, and non-specific lipid transfer proteins. These results may lead to a better understanding of antiviral mechanisms and of disease-resistant breeding.Background and Objective Agranulocytosis is a rare and potentially life-threatening complication of metamizole (dipyrone) intake that is characterized by a loss of circulating neutrophil granulocytes. While the mechanism underlying this adverse drug reaction is not well understood, involvement of the immune system has been suggested. In addition, associations between genetic variants in the Human Leukocyte Antigen (HLA) region and agranulocytosis induced by other drugs have been reported. The aim of the present study was to assess whether genetic variants in classical HLA genes are associated with the susceptibility to metamizole-induced agranulocytosis (MIA) in a European population by targeted resequencing of eight HLA genes. Design A case-control cohort of Swiss patients with a history of neutropenia or agranulocytosis associated with metamizole exposure (n = 53), metamizole-tolerant (n = 39) and unexposed controls (n = 161) was recruited for this study. A high-throughput resequencing (HTS) and high-resoluConclusion Our results do not support an HLA-restricted T cell-mediated immune mechanism for MIA. However, we established an efficient high-resolution (three-field) eight-locus HTS HLA resequencing method to interrogate the HLA region and demonstrated the feasibility of its application to pharmacogenetic studies.
Classical cardiovascular risk factors (CRFs) are associated with impaired angiogenic activities of bone marrow-derived proangiogenic cells (PACs) related to peripheral artery diseases (PADs) and ischemia-induced neovascularization. MicroRNAs (miRs) are key regulators of gene expression, and they are involved in the modulation of PAC function and PAC paracrine activity. However, the effects of CRFs on the modulation of miR expression in PACs are unknown.

We used a model of hindlimb ischemia and next-generation sequencing to perform a complete profiling of miRs in PACs isolated from the bone marrow of mice subjected to three models of CRFs aging, smoking (SMK) and hypercholesterolemia (HC).

Approximately 570 miRs were detected in PACs in the different CRF models. When excluding miRs with a very low expression level (<100 RPM), 40 to 61 miRs were found to be significantly modulated by aging, SMK, or HC. In each CRF condition, we identified downregulated proangiogenic miRs and upregulated antiangiogenic ion and for the future development of novel therapies to improve neovascularization and reduce tissue damage in patients with severe PAD.
This study describes for the first time the effects of CRFs on the modulation of miR profile in PACs related to PAD and ischemia-induced neovascularization. We found that several angiogenesis-modulating miRs are similarly altered in different CRF conditions. Our findings constitute a solid framework for the identification of miRs that could be targeted in PACs in order to improve their angiogenic function and for the future development of novel therapies to improve neovascularization and reduce tissue damage in patients with severe PAD.
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