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López-Jaramillo P, Nieto-Martínez RE, Aure-Fariñez G, Mendivil CO, Lahsen RA, Silva-Filho RL, Andreotti LA, Manrique ME, Pasquel-Andrade MA, Rangel I, Vidrio M, Castañeda R, Restrepo M, Pinto ME. Identification and management of prediabetes: results of the Latin America Strategic Prediabetes Meeting. Rev Panam Salud Publica 2017; 41:e172. [PMID: 31410086 PMCID: PMC6664235 DOI: 10.26633/rpsp.2017.172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 05/31/2017] [Indexed: 12/14/2022] Open
Abstract
To understand the status of prediabetes diagnosis and treatment in Latin America and to evaluate the use of metformin for diabetes prevention in this context. A panel of 15 diabetes experts from seven countries in Latin America met on 14 – 15 August 2014 in Lima, Peru, to review the available literature, discuss the role of prediabetes in type 2 diabetes mellitus and cardiovascular disease, analyze collected information, and make conclusions for prediabetes diagnosis and treatment in Latin America. Prediabetes diagnosis, screening, and treatment, including lifestyle changes, pharmacological treatment, and cost-effectiveness were discussed. Five resulting statements were issued for Latin America: prediabetes is a clinical and public health problem; health care systems do not currently diagnose/treat prediabetes; use of prediabetes risk detection tools are needed region-wide; treatment includes lifestyle changes, multidisciplinary education, and metformin; and registries of patient records and further studies should be supported. The expert panel concluded that in Latin America, preventive treatment through lifestyle changes and metformin are cost-effective interventions. It is important to improve prediabetes identification and management at the primary care level.
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Affiliation(s)
- Patricio López-Jaramillo
- Metabolic Syndrome and Diabetes Clinic Fundación Oftalmológica de Santander Bucaramanga Colombia Metabolic Syndrome and Diabetes Clinic, Fundación Oftalmológica de Santander, Bucaramanga, Santander, Colombia
| | - Ramfis E Nieto-Martínez
- Human Physiology Universidad Centro-Occidental Lisandro Alvarado Barquisimeto Venezuela Human Physiology, Universidad Centro-Occidental Lisandro Alvarado, Barquisimeto, Venezuela
| | - Gestne Aure-Fariñez
- Centro Medico Docente la Trinidad Centro Medico Docente la Trinidad Caracas Venezuela Centro Medico Docente la Trinidad, Caracas, Venezuela
| | - Carlos O Mendivil
- Universidad de los Andes Universidad de los Andes Bogotá Colombia Universidad de los Andes, Bogotá, Colombia
| | - Rodolfo A Lahsen
- Clínica Las Condes Clínica Las Condes Santiago Chile Clínica Las Condes, Santiago, Chile
| | - Ruy L Silva-Filho
- Federal University of Pernambuco Federal University of Pernambuco Recife Brazil Federal University of Pernambuco, Recife, Brazil
| | - Luiz A Andreotti
- Diabetes Unit Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil Diabetes Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Mónica E Manrique
- Nutrition and Diabetes Unit Clínica Alemana Santiago Chile Nutrition and Diabetes Unit, Clínica Alemana, Santiago, Chile
| | | | - Ignacio Rangel
- Medical School Monterrey Technological Institute Monterrey Mexico Medical School, Monterrey Technological Institute, Monterrey, Mexico
| | - Maricela Vidrio
- Research Cardiometabolic Unit Occidente SC Guadalajara Mexico Research Cardiometabolic Unit, Occidente SC, Guadalajara, Mexico
| | - Rutila Castañeda
- Center for Clinical Research Center for Clinical Research Mexico City Mexico Center for Clinical Research, Mexico City, Mexico
| | - Manuela Restrepo
- Merck Colombia Merck Colombia Bogotá Colombia Merck Colombia, Bogotá, Colombia
| | - Miguel E Pinto
- School of Medicine Alberto Hurtado Cayetano Heredia University Lima Perú School of Medicine Alberto Hurtado, Cayetano Heredia University, Lima, Perú
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Stewart T, Caffrey DG, Gilman RH, Mathai SC, Lerner A, Hernandez A, Pinto ME, Huaylinos Y, Cabrera L, Wise RA, Miranda JJ, Checkley W. Can a simple test of functional capacity add to the clinical assessment of diabetes? Diabet Med 2016; 33:1133-9. [PMID: 26599981 PMCID: PMC4955604 DOI: 10.1111/dme.13032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 01/06/2023]
Abstract
AIM To identify impairment in functional capacity associated with complicated and non-complicated diabetes using the 6-min walk distance test. METHODS We enrolled 111 adults, aged ≥40 years, with Type 2 diabetes from a hospital facility and 150 healthy control subjects of similar age and sex from a community site in Lima, Peru. All participants completed a 6-min walk test. RESULTS The mean age of the 261 participants was 58.3 years, and 43.3% were male. Among those with diabetes, 67 (60%) had non-complicated diabetes and 44 (40%) had complications such as peripheral neuropathy, retinopathy or nephropathy. The mean unadjusted 6-min walk distances were 376 m and 394 m in adults with and without diabetes complications, respectively, vs 469 m in control subjects (P<0.001). In multivariable regression, the subjects with diabetes complications walked 84 m less far (95% CI -104 to -63 m) and those without complications walked 60 m less far (-77 to -42 m) than did control subjects. When using HbA1c level as a covariate in multivariable regression, participants walked 13 m less far (-16.9 to -9.9 m) for each % increase in HbA1c . CONCLUSIONS The subjects with diabetes had lower functional capacity compared with healthy control subjects with similar characteristics. Differences in 6-min walk distance were even apparent in the subjects without diabetes complications. Potential mechanisms that could explain this finding are early cardiovascular disease or deconditioning.
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Affiliation(s)
- T Stewart
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - D G Caffrey
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - R H Gilman
- Program in Disease Control and Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- A.B. PRISMA, Lima, Peru
| | - S C Mathai
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - A Lerner
- Program in Disease Control and Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - A Hernandez
- Division of Endocrinology, Department of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - M E Pinto
- Division of Endocrinology, Department of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Y Huaylinos
- Division of Endocrinology, Department of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | | | - R A Wise
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - J J Miranda
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - W Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Program in Disease Control and Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Lerner AG, Bernabé-Ortiz A, Ticse R, Hernandez A, Huaylinos Y, Pinto ME, Málaga G, Checkley W, Gilman RH, Miranda JJ. Type 2 diabetes and cardiac autonomic neuropathy screening using dynamic pupillometry. Diabet Med 2015; 32:1470-8. [PMID: 25761508 PMCID: PMC4567976 DOI: 10.1111/dme.12752] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 01/03/2023]
Abstract
AIM To determine if changes in pupillary response are useful as a screening tool for diabetes and to assess whether pupillometry is associated with cardiac autonomic neuropathy. METHODS We conducted a cross-sectional study with participants drawn from two settings: a hospital and a community site. At the community site, individuals with newly diagnosed diabetes as well as a random sample of control individuals without diabetes, confirmed by oral glucose tolerance test, were selected. Participants underwent an LED light stimulus test and eight pupillometry variables were measured. Outcomes were diabetes, defined by oral glucose tolerance test, and cardiac autonomic dysfunction, determined by a positive readout on two of four diagnostic tests: heart rate response to the Valsalva manoeuvre; orthostatic hypotension; 30:15 ratio; and expiration-to-inspiration ratio. The area under the curve, best threshold, sensitivity and specificity of each pupillometry variable was calculated. RESULTS Data from 384 people, 213 with diabetes, were analysed. The mean (±sd) age of the people with diabetes was 58.6 (±8.2) years and in the control subjects it was 56.1 (±8.6) years. When comparing individuals with and without diabetes, the amplitude of the pupil reaction had the highest area under the curve [0.69 (sensitivity: 78%; specificity: 55%)]. Cardiac autonomic neuropathy was present in 51 of the 138 people evaluated (37.0%; 95% CI 28.8-45.1). To diagnose cardiac autonomic neuropathy, two pupillometry variables had the highest area under the curve: baseline pupil radius [area under the curve: 0.71 (sensitivity: 51%; specificity: 84%)], and amplitude of the pupil reaction [area under the curve: 0.70 (sensitivity: 82%; specificity: 55%)]. CONCLUSIONS Pupillometry is an inexpensive technique to screen for diabetes and cardiac autonomic neuropathy, but it does not have sufficient accuracy for clinical use as a screening tool.
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Affiliation(s)
- Alana G. Lerner
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ray Ticse
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Endocrinology, Department of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Arturo Hernandez
- Division of Ophtalmology, Department of Surgery, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Yvonne Huaylinos
- Division of Endocrinology, Department of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Miguel E. Pinto
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Endocrinology, Department of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Germán Málaga
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Internal Medicine, Department of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - William Checkley
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Robert H. Gilman
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Área de Investigación y Desarrollo, A.B. PRISMA, Lima, Peru
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Lazo MDLA, Bernabé-Ortiz A, Pinto ME, Ticse R, Malaga G, Sacksteder K, Miranda JJ, Gilman RH. Diabetic peripheral neuropathy in ambulatory patients with type 2 diabetes in a general hospital in a middle income country: a cross-sectional study. PLoS One 2014; 9:e95403. [PMID: 24789071 PMCID: PMC4006783 DOI: 10.1371/journal.pone.0095403] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/25/2014] [Indexed: 01/12/2023] Open
Abstract
Aim We aimed to estimate the morbidity rate and associated factors for diabetic peripheral neuropathy (DPN) in a low-middle income country setting. Methods Cross-sectional study, data was gathered at Peru's Ministry of Health national specialized hospital for endocrinological conditions through standardized interviews, anthropometric measurements and blood tests for glycated haemoglobin (HbA1c). DPN was evaluated using two techniques: the Semmes-Weinstein monofilament test and the diabetic neuropathy symptom score. Overall prevalence and 95% confidence intervals (95% CI) were calculated. Potential factors related to DPN explored included body mass index, years with disease (<10 vs. ≥10 years), glycaemic control (HbA1c <7% vs. ≥7%), microalbuminuria, retinopathy, and current pharmacological treatment. Multivariable analysis was performed using Poisson analysis to calculate prevalence ratios. Results DPN was observed in 73/129 (56.6%) patients. In multivariable analysis adjusted by age and sex, the prevalence ratio of neuropathy was 1.4 times higher (95% CI 1.07–1.88) in patients who took insulin plus metformin compared to patients who used one treatment alone, and 1.4 higher (95% CI 1.02–1.93) in patients with ≥10 years of disease compared to those with a shorter duration of disease. Also we found some characteristics in foot evaluation associated to neuropathy such as deformities (p<0.001), onychomycosis (p = 0.012), abnormal Achilles reflex (p<0.001), pain perception (p<0.001) and vibration perception (p<0.001). Conclusion DPN is highly frequent among patients with diabetes in a national specialized facility from Peru. Associated factors to DPN included being a diabetic patient for over ten years, and receiving insulin plus metformin
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Affiliation(s)
- María de los Angeles Lazo
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabé-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Miguel E. Pinto
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Servicio de Endocrinología, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Ray Ticse
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Servicio de Endocrinología, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - German Malaga
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Katherine Sacksteder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- * E-mail:
| | - Robert H. Gilman
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Pinto ME. A propósito de casos de fraude en la industria farmacéutica. Rev Peru Med Exp Salud Publica 2014. [DOI: 10.17843/rpmesp.2013.301.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Pinto ME, Banda C, Seas C. Aspergiloma pulmonar secundaria a neutropenia inducida por metimazol: reporte de un caso. Rev Peru Med Exp Salud Publica 2014. [DOI: 10.17843/rpmesp.2012.292.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
A 48-year old woman with a recent diagnosis of Graves' disease arrived at the emergency room with fever, palpitations, and a sore throat. Her regular treatment included methimazole. On admission, laboratory results showed suppressed TSH, elevated free thyroxine, and neutropenia. She was admitted and started on antibiotics and granulocyte-macrophage colony stimulating factor (gm-csf). After ten days, the patient developed leukocytosis, fever, and hemoptysis. Chest CT scan showed a lung cavity with multiple nodules in the upper right lobe. Cultures from a lung biopsy were positive for Aspergillus Fumigatus and Aspergillus Flavus. Amphotericin B was started but then switched to voriconazole, with both treatments failing to result in clinical improvement. The patient died of multi-organ failure.
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Affiliation(s)
- Miguel E Pinto
- Servicio de Endocrinología, Hospital Nacional Cayetano Heredia, Lima, Perú.
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Abstract
A 43 year old man presented with asymptomatic elevation of alanine aminotransferase (ALT) and no relevant past history. The patient denied being a chronic alcohol drinker. Work-up revealed an active hepatitis C, and liver biopsy showed active inflammation. Treatment was started with interferon-alfa and ribavirin. During the 48 weeks of treatment, the patient developed positive thyroid antibodies with varying level of thyrotropin (TSH) and thyroid hormones. At follow-up after treatment, the patient continued with hyperthyroidism due to Graves' disease. Autoimmune thyroiditis is a common complication of using interferon in patients with hepatitis C. In some cases, it is presented as hyperthyroidism because of Graves' disease. Thyroid function and thyroid antibodies should be evaluated before and during treatment with interferon.
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Affiliation(s)
- José L Pinto
- Servicio de Gastroenterología, Hospital Nacional Cayetano Heredia, Lima, Perú
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Pinto ME, Ortiz M, Villena JE. Visual vignette. Pituitary apoplexy. Endocr Pract 2011; 17:963. [PMID: 21803712 DOI: 10.4158/ep11156.vv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Miguel E Pinto
- Endocrine Service, Cayetano Heredia Hospital and School of Medicine, Cayetano Heredia University, Lima, Peru
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Abstract
Diabetic ketoacidosis is an infrequent complication of gestational diabetes but results in fetal loss. It usually occurs in the later stages of pregnancy. We report two young pregnant women who were admitted because of newly diagnosed diabetes with ketoacidosis. One patient presented with intrauterine fetal demise.
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Affiliation(s)
- Miguel E Pinto
- Endocrine Service, Cayetano Heredia Hospital, Lima, Peru; Faculty of Medicine, Cayetano Heredia University, Lima, Peru.
| | - Jaime E Villena
- Endocrine Service, Cayetano Heredia Hospital, Lima, Peru; Faculty of Medicine, Cayetano Heredia University, Lima, Peru
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Pinto JL, Pinto ME. Tiroiditis autoinmune inducida por interferón en pacientes con infección por virus de la hepatitis C. Rev Peru Med Exp Salud Publica 2011. [DOI: 10.17843/rpmesp.2011.282.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Rafacho A, Abrantes JLF, Ribeiro DL, Paula FM, Pinto ME, Boschero AC, Bosqueiro JR. Morphofunctional alterations in endocrine pancreas of short- and long-term dexamethasone-treated rats. Horm Metab Res 2011; 43:275-81. [PMID: 21225543 DOI: 10.1055/s-0030-1269896] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Long-term dexamethasone therapy may induce peripheral insulin resistance (IR), which in turn elicits increased beta-cell function and proliferation. However, whether such adaptive compensations occur during short-term treatment with dexamethasone is unclear. Here, we compared morphofunctional parameters in endocrine pancreas after short- and long-term dexamethasone administration. Groups of rats received daily i. p. injection of 1 mg/kg b. w. dexamethasone for 1 (DEX-1), 3 (DEX-3), or 5 consecutive days (DEX-5), whilst control rats were saline-treated (CTL). Despite the absence of apparent IR in DEX-1 rats, this group exhibited increased circulating insulin levels and glucose-stimulated insulin secretion (GSIS), compared to the CTL group (p<0.05). Evident IR as well as marked hyperinsulinemia and GSIS, as judged by the static and dynamic insulin secretion values, were observed in DEX-3 and DEX-5 rats (p<0.05). GSIS in islets cultured with 1 μM dexamethasone was lower compared to the control (p<0.05). Marked increases in beta-cell proliferation were observed in DEX-3 and DEX-5 rats, compared to CTL and DEX-1 rats (p<0.05). The alterations observed in DEX-3 rats were more pronounced in DEX-5 rats, which also exhibited a higher content of islet Cdk4 and Cd2 proteins, compared to the CTL group (p<0.05). We conclude that short-term dexamethasone treatment (DEX-1) induces an increase in beta-cell function that does not require the presence of discernible IR. As the treatment continues, the IR develops rapidly, and increased insulin secretion as well as beta-cell hyperplasia is demanded for the appropriate maintenance of glucose homeostasis.
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Affiliation(s)
- A Rafacho
- Department of Physical Education, School of Sciences, UNESP - Universidade Estadual Paulista, Bauru, SP, Brazil.
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Pinto ME, Manrique HA, Guevara X, Acosta M, Villena JE, Solís J. Hyperglycemic hyperosmolar state and rhino-orbital mucormycosis. Diabetes Res Clin Pract 2011; 91:e37-9. [PMID: 21106269 DOI: 10.1016/j.diabres.2010.09.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 09/30/2010] [Indexed: 11/16/2022]
Abstract
Rhino-orbital mucormycosis is a fatal infection. Decompensated diabetes is the most common predisposing factor. Two male adults were admitted because of newly diagnosed diabetes with hyperglycemic hyperosmolar state and CT scan showed extensive pansinusitis and orbital inflammation. Treatment included surgical debridement and antifungal therapy. One patient died from a severe sepsis.
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Affiliation(s)
- Miguel E Pinto
- Endocrine Service, Cayetano Heredia Hospital, Lima, Peru.
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Pinto ME, Manrique HA. Retiro de sibutramina por riesgo de enfermedad cardiovascular. Rev Peru Med Exp Salud Publica 2010. [DOI: 10.17843/rpmesp.2010.273.1517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Pinto ME, Manrique HA. Retiro de sibutramina por riesgo de enfermedad cardiovascular. Rev Peru Med Exp Salud Publica 2010; 27:489-90. [DOI: 10.1590/s1726-46342010000300032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
OBJECTIVE To describe the clinical and laboratory characteristics of diabetic ketoacidosis (DKA) in adult Peruvian patients with type 2 diabetes mellitus. METHODS In this cross-sectional analysis, we reviewed clinical charts of type 2 diabetic patients with DKA admitted to Cayetano Heredia Hospital between 2001 and 2005 for data on demographics, previous treatment, previous hospital admissions for DKA, family history of diabetes, precipitating factors, hospital course, mortality, and insulin use 3 and 6 months after the index DKA episode. Patients older than 18 years who had confirmed DKA were included. Patients with type 1 diabetes mellitus were excluded. RESULTS We report on 53 patients with DKA for whom complete clinical and laboratory data were available. Of the 53 patients, 39 (74%) were men; mean age (+/- SD) was 45 +/- 12 years; and 22 (42%) had no previous diagnosis of type 2 diabetes. The following mean (+/- SD) laboratory values were obtained at DKA diagnosis: glucose, 457 +/- 170 mg/dL; pH, 7.15 +/- 0.14; bicarbonate, 7.73 +/- 6 mEq/L; and anion gap, 24.45 +/- 7.44 mEq/L. Of the 53 DKA episodes, 35 (66%) were severe (arterial pH <7.0 and/or serum bicarbonate <10 mEq/L). The following precipitating factors were discerned: discontinuation of treatment in 21 (40%), infections in 16 (30%), intercurrent illness in 3 (6%), and no identifiable cause in 13 (25%). Mortality rate was 0%. Three and 6 months after the index DKA episode, insulin was used by 65% and 56% of patients, respectively. CONCLUSION In countries with a low incidence of type 1 diabetes, DKA is frequently reported in patients with type 2 diabetes. In this study, 42% of patients had new-onset disease. Most DKA episodes were severe and were related to infection or noncompliance with treatment.
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Affiliation(s)
- Miguel E Pinto
- Endocrine Service, Cayetano Heredia Hospital, Lima, Peru.
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Abstract
In spite of the remarkable diversity of HIV-1 env genes, several amino acids are extremely conserved, probably due to functional constraints. One example is the proline found at the second position of the GPGR motif. Several viruses, however, bear substitutions at this site, for instance, GWGR subtype B variant. GWGR viruses are described in Brazil since the beginning of the epidemics, but the extent of their dispersion or the geographical origin of the variant remains unknown. In the present study, phylogenetic trees were constructed in order to study the origin and spread of this variant. All GWGR sequences as well as a subset of subtype B sequences available were included in the analyses. Analyses of differential selection were also performed on GWGR and non-GWGR sequences in order to unveil evolutionary novelties due to the action of positive selection. Although the GWGR variant was found at least in 23 countries, its expansion probably has a single origin, and Brazil is the epicenter.
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Affiliation(s)
- M E Pinto
- Departamento de Genética, Laboratório de Biodiversidade Molecular, Instituto de Biologia, UFRJ, Rio de Janeiro, RJ, Brasil
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Abstract
Single high doses of estrogen (35 mg/kg body weight) were administered to young rats aiming to exacerbate its effects on germ cell populations. The short-term (1 week) and medium-term (7 weeks) consequences of this estrogenic treatment (ET) on the testis were evaluated using light and electron microscopies, quantitative methods and TUNEL reaction. Short-term ET led to 50% atrophy of the testis, however, in the medium term the gonado-somatic index was recovered. No histopathological alterations were found at seminiferous epithelium except for short-term severe degeneration of elongated spermatids (EL) and low frequency of these cells in both time intervals. Two morphologically distinct patterns of degeneration were observed: (1) clusters of EL which were TUNEL-negative and exhibited bizarre appearance and nuclear fragmentation, (2) isolated apoptotic EL within the cytoplasm of Sertoli cells (SC). Both degenerative phenomena were more frequent in stages III-VIII of seminiferous cycle, whereas at stages I and II only coiling of flagellum was observed. One week after ET, small amounts of EL were detected in stages IX-XII, suggesting spermiation failure. Signs of functional SC damage such as an accumulation of myelin-like inclusions in their cytoplasm were observed in the short but not medium-term. However, the apoptotic rates still remained five times higher and the number of elongated spermatids was three-fold lower. Our data indicate that exposure to a high dose of estrogen around puberty has stage-specific effects on the testis and causes massive degeneration of elongated spermatids.
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Affiliation(s)
- M E Pinto
- Department of Cell Biology, Institute of Biology, State University of Campinas, 13083-863, Campinas, SP, Brazil
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20
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Fraser PD, Pinto ME, Holloway DE, Bramley PM. Technical advance: application of high-performance liquid chromatography with photodiode array detection to the metabolic profiling of plant isoprenoids. Plant J 2000. [PMID: 11115136 DOI: 10.1111/j.1365-313x.2000.00896.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The application of high-performance liquid chromatography (HPLC) using a C30 reverse-phase stationary matrix has enabled the simultaneous separation of carotenes, xanthophylls, ubiquinones, tocopherols and plastoquinones in a single chromatogram. Continuous photodiode array (PDA) detection ensured identification and quantification of compounds upon elution. Applications of the method to the characterization of transgenic and mutant tomato varieties with altered isoprenoid content, biochemical screening of Arabidopsis thaliana, and elucidation of the modes of action of bleaching herbicides are described to illustrate the versatility of the procedure.
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Affiliation(s)
- P D Fraser
- School of Biological Sciences, Royal Holloway, University of London, Egham, Surrey TW20 0EX, UK
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21
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Fraser PD, Pinto ME, Holloway DE, Bramley PM. Technical advance: application of high-performance liquid chromatography with photodiode array detection to the metabolic profiling of plant isoprenoids. Plant J 2000; 24:551-8. [PMID: 11115136 DOI: 10.1046/j.1365-313x.2000.00896.x] [Citation(s) in RCA: 256] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The application of high-performance liquid chromatography (HPLC) using a C30 reverse-phase stationary matrix has enabled the simultaneous separation of carotenes, xanthophylls, ubiquinones, tocopherols and plastoquinones in a single chromatogram. Continuous photodiode array (PDA) detection ensured identification and quantification of compounds upon elution. Applications of the method to the characterization of transgenic and mutant tomato varieties with altered isoprenoid content, biochemical screening of Arabidopsis thaliana, and elucidation of the modes of action of bleaching herbicides are described to illustrate the versatility of the procedure.
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Affiliation(s)
- P D Fraser
- School of Biological Sciences, Royal Holloway, University of London, Egham, Surrey TW20 0EX, UK
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22
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Carfagno ML, Hoskins LA, Pinto ME, Yeh JC, Raffa RB. Indirect modulation of dopamine D2 receptors as potential pharmacotherapy for schizophrenia: II. Glutamate (Ant)agonists. Ann Pharmacother 2000; 34:788-97. [PMID: 10860140 DOI: 10.1345/aph.19146] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To summarize the published preclinical and clinical data that suggest the possible use of glutamate receptor agonists or antagonists as novel antipsychotic agents. DATA SOURCES Primary and review articles were identified by MEDLINE search (from 1966 to December 1999) and through secondary sources. STUDY SELECTION AND DATA EXTRACTION All of the articles identified from the data sources were evaluated and all information deemed relevant was included. DATA SYNTHESIS The standard antipsychotic drugs, whose clinical activity correlates with affinity for dopamine D2 receptors, alleviate some of the positive symptoms of schizophrenia, but have limited impact on negative symptoms. Several lines of evidence implicate glutamate-receptor system dysfunction(s) in schizophrenia, either as causative or contributory factors. In addition, several standard antipsychotic drugs modulate glutamate or glutamate receptor activity, suggesting an alternative view of their mechanism of antipsychotic action. Preliminary studies have shown that drugs which modulate glutamate brain concentrations have positive effects in animal models of schizophrenia. CONCLUSIONS A role for glutamate in the pathogenesis or pharmacotherapy of schizophrenia is suggested from anatomic (interactions between glutamatergic and dopaminergic systems in relevant brain regions), physiologic (implication of glutamate-receptor dysfunction), and pharmacologic (modulation of glutamate or glutamate receptors) evidence. Therefore, compounds that function at glutamate receptors might represent a novel approach to the treatment of the disease or to the amelioration of symptoms, either as monotherapy or as an adjunct to dopamine D2 receptor antagonists.
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Affiliation(s)
- M L Carfagno
- School of Pharmacy, Temple University, Philadelphia, PA 19140, USA
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23
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Abstract
The subject of 'drug addiction' is multifaceted and many aspects of it (even some of the definitions) are controversial. Collateral medical problems include the spread of HIV and hepatitis C virus secondary to i.v. drug abuse and effects on prenatal brain development (1). Progress in the understanding of the causes of addictions and its treatment has been impeded by the lack of a unifying biochemical theory. However, recent evidence suggests that some common mechanism might underlie addictions to otherwise apparently unrelated drugs. A major hypothesis has emerged suggesting that the neurotransmitter dopamine (DA) might play a central role in the molecular mechanisms of at least some addictions. If so, it would represent an important target for discovery of effective pharmacotherapy and revolutionize the pharmacist's role in treating addictions. This short overview outlines the status of the theory of a common biochemical mechanism of drug addiction.
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Affiliation(s)
- C Betz
- Temple University School of Pharmacy, Philadelphia, PA 19140, USA
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24
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Ulloa MT, Giglio MS, Porte L, Santa Cruz A, McNab P, Fica A, Pinto ME, Kawaguchi K, Carmi A. [Detection of pyrogenic exotoxin SpeA, SpeB and SpeC genes in Chilean streptococci isolates and their association with clinical manifestations]. Rev Med Chil 2000; 128:27-34. [PMID: 10883519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND The virulence of Streptococcus pyogenes is determined by a variety of structural molecules, toxins and complex enzymes. Pyrogenic exotoxins cause fever, erythematous reactions, cytotoxic and immunological effects. AIM To assess the frequency of speA, SpeB and SpeC genes in Chilean Streptococcus pyogenes strains and their association with the invasiveness of infections. MATERIAL AND METHODS The genes for pyrogenic exotoxins SpeA, SpeB and SpeC were determined by polymerase chain reactions in 114 strains of group A Streptococcus pyogenes isolated from Chilean patients with invasive or non invasive infections. RESULTS The gene for SpeA was present in 30.7% of isolates, the gene for SpeB was present in 69.3% and the gen for SpeC in 44.7% of isolates. The gene for SpeA was present in 20 of 33 invasive infections and in 15 of 81 non invasive infections (p < 0.0001). On the contrary, the gene for SpeC was present in 11 of 33 invasive infections and in 41 of 81 non invasive infections (p < 0.05). The frequency of speB was similar in invasive and non invasive infections. CONCLUSIONS There is a clear relationship between the presence of SpeA genes and the severity of infections caused by Streptococcus pyogenes.
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Affiliation(s)
- M T Ulloa
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
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25
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Giglio MS, Farías O, Lafourcade M, Pinto ME. [Surveillance of gram positive cocci susceptibility to betalactams, glycopeptides, and other antimicrobials]. Rev Med Chil 1999; 127:919-25. [PMID: 10752252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND During the last decade, there has been a progressive increase in the resistance of gram (+) cocci to betalactamics and other antimicrobials. Therefore, vancomycin and teicoplanin have incorporated as alternative antimicrobial drugs. AIM To assess the susceptibility of gram (+) cocci to different antimicrobials including vancomycin and teicoplanin. MATERIAL AND METHODS We studied 447 strains of gram (+) cocci coming from ambulatory and hospitalized patients. These included 308 Enterococcus sp strains, 99 Staphylococcus aureus strains and 40 coagulase negative Staphylococci strains. Enterococci susceptibility was measured using minimal inhibitory concentrations in agar and that of Staphylococci, through diffusion. Susceptibility to vancomycin and teicoplanin was measured using minimal inhibitory concentrations in all strains. RESULTS Enterococcus faecalis was 100% susceptible to ampicillin, penicillin, vancomycin and teicoplanin, 23% susceptible to tetracyclin and 47% to chloramphenicol. Susceptibility of E faecium was 61% to penicillin, 49% to chloramphenicol, 41% to tetracyclin, 100% to vancomycin and teicoplanin. Of 19 Enterococcus spp strains, 90% were susceptible to ampicillin, 80% to penicillin, 55% to chloramphenicol and 45% to tetracyclin. Only one E casseiflavus strain had a low level resistance to vancomycin and was susceptible to teicoplanin. No Staphylococcus aureus strain was resistant to vancomycin or teicoplanin. CONCLUSIONS A permanent surveillance of gram (+) cocci antimicrobial susceptibility is required to update therapeutic schemes.
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Affiliation(s)
- M S Giglio
- Unidad de Microbiología Occidente, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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26
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Abstract
We used microimmunofluorescence to survey the prevalence of antibodies to Chlamydia pneumoniae in 403 serum samples from asymptomatic subjects aged 6 months to 89 y in Santiago, Chile. The results suggest that Chlamydia pneumoniae infection is endemic in Chile, with a seroprevalence of 60% which does not differ by gender.
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Affiliation(s)
- M A Martínez
- Universidad de Chile, Facultad de Medicina, Instituto de Ciencias Biomédicas, Programa de Microbiologia, Santiago
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27
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Pinto ME, Casati P, Hsu TP, Ku MS, Edwards GE. Effects of UV-B radiation on growth, photosynthesis, UV-B-absorbing compounds and NADP-malic enzyme in bean (Phaseolus vulgaris L.) grown under different nitrogen conditions. J Photochem Photobiol B 1999; 48:200-9. [PMID: 10343405 DOI: 10.1016/s1011-1344(99)00031-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The effects of UV-B radiation on growth, photosynthesis, UV-B-absorbing compounds and NADP-malic enzyme have been examined in different cultivars of Phaseolous vulgaris L. grown under 1 and 12 mM nitrogen. Low nitrogen nutrition reduces chlorophyll and soluble protein contents in the leaves and thus the photosynthesis rate and dry-matter accumulation. Chlorophyll, soluble protein and Rubisco contents and photosynthesis rate are not significantly altered by ambient levels of UV-B radiation (17 microW m-2, 290-320 nm, 4 h/day for one week). Comparative studies show that under high nitrogen, UV-B radiation slightly enhances leaf expansion and dry-matter accumulation in cultivar Pinto, but inhibits these parameters in Vilmorin. These results suggest that the UV-B effect on growth is mediated through leaf expansion, which is particularly sensitive to UV-B, and that Pinto is more tolerant than Vilmorin. The effect of UV-B radiation on UV-B-absorbing compounds and on NADP-malic enzyme (NADP-ME) activity is also examined. Both UV-B radiation and low-nitrogen nutrition enhance the content of UV-B-absorbing compounds, and among the three cultivars used, Pinto exhibits the highest increases and Arroz the lowest. The same trend is observed for the specific activity and content of NADP-ME. On a leaf-area basis, the amount of UV-B-absorbing compounds is highly correlated with the enzyme activity (r2 = 0.83), suggesting that NADP-ME plays a key role in biosynthesis of these compounds. Furthermore, the higher sensitivity of Vilmorin than Pinto to UV-B radiation appears to be related to the activity of NADP-ME and the capacity of the plants to accumulate UV-B-absorbing compounds.
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Affiliation(s)
- M E Pinto
- Facultad de Ciencias Agrarias y Forestales, Universidad de Chile, Santiago, Chile.
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28
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Sepulveda M, Ruiz M, Bello H, Dominguez M, Martínez MA, Pinto ME, Gonzalez G, Mella S, Zemelman R. Adherence of Acinetobacter baumannii to rat bladder tissue. Microbios 1999; 95:45-53. [PMID: 9881463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Acinetobacter baumannii, an important nosocomial pathogen, causes severe infections in patients of intensive care units, but its pathogenic attributes are unknown. Previously, the adherence of A. baumannii to cell lines has been negative in the authors' laboratory. In this work, the adherence of strains of A. baumannii of various biotypes to small pieces of rat bladder tissue was investigated. Tissue pieces were submerged into cultures of A. baumannii and sessile cells were counted after removing planktonic bacteria. Fimbriae and sessile cells were examined by transmission and scanning electron microscopy, respectively. In contrast to a uropathogenic strain of Escherichia coli, all cultures exhibited a mannose- and galactose-resistant agglutination of human group O red blood cells as well as mannose- and galactose-resistant adherence to the bladder tissue. Inhibition of exopolysaccharide synthesis did not modify adherence. Indeed, adherence, apparently unrelated to these fimbriae or to the exopolysaccharide, may be a factor contributing to the pathogenicity of A. baumannii in the urinary tract or in other tissues.
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Affiliation(s)
- M Sepulveda
- Departamento de Microbiologia, Facultad de Ciencias Biologicas, Universidad de Concepcion, Casilla, Chile
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29
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Labarca JA, McDonald LC, Pinto ME, Palavecino E, González P, Cona E, Fernández A, Giglio MS, Jarvis WR. Proficiency in detecting vancomycin resistance in enterococci among clinical laboratories in Santiago, Chile. Emerg Infect Dis 1999; 5:839-40. [PMID: 10603228 PMCID: PMC2640812 DOI: 10.3201/eid0506.990623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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30
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Pinto ME, Tanuri A, Schechter M. Molecular and epidemiologic evidence for the discontinuous introduction of subtypes B and F into Rio de Janeiro, Brazil. J Acquir Immune Defic Syndr Hum Retrovirol 1998; 19:310-2. [PMID: 9803977 DOI: 10.1097/00042560-199811010-00017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Ruiz M, Bello H, Sepúlveda M, Domínguez M, Martínez MA, Pinto ME, González G, Mella S, Zemelman R. [Adherence of Acinetobacter baumannii to rat tracheal tissue]. Rev Med Chil 1998; 126:1183-8. [PMID: 10030089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Acinetobacter baumannii is an important nosocomial pathogen whose virulence factors have not been fully elucidated. AIM To study the adherence and hemagglutinating capacity of several biotypes of Acinetobacter baumannii. MATERIAL AND METHODS Thirty nine strains of Acinetobacter baumannii isolated from hospitalized patients were studied. The adherence of these strains to small pieces of rat tracheal tissue was studied. Additionally, their ability to hemagglutinate human erythrocytes and the effect of D-mannose and D-galactose on the adherence and hemagglutinating capacity was assessed. Transmission electron microscopy of strains was performed looking for the presence of fimbriae. RESULTS All strains exhibited adherence to tissues. All strains had also D-mannose and D-galactose resistant hemagglutinating ability. Fimbriae were found in Acinetobacter baumannii and E coil cells. CONCLUSIONS Adherence of Acinetobacter baumannii to rat tracheal tissue, apparently not related to the presence of fimbriae, may be a virulence mechanism of this bacterium.
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Affiliation(s)
- M Ruiz
- Departamento de Microbiología Facultad de Ciencias Biológicas, Universidad de Concepción, Chile
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32
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Martínez MA, Pinto ME, Zemelman R, Cifras LA, Lira G, Ramírez C. [Surface characteristics and antimicrobial sensitivity of clinical strains of Acinetobacter spp]. Rev Med Chil 1998; 126:1079-84. [PMID: 9922511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND The treatment of nosocomial infections caused by Acinetobacter baumannii has been hindered by the easiness of this species to acquire antimicrobial resistance. AIM To study surface hydrophobicity, the presence of capsule and antimicrobial susceptibility of nosocomial Acinetobacter spp strains. MATERIAL AND METHODS Ninety four Acinetobacter spp strains isolated from a public hospital of Santiago, between July 1995 and April 1996, were studied. RESULTS Compared to Acinetobacter genospecies 3 isolates, A baumannii isolates exhibited greater antimicrobial resistance, was uniformly susceptible to imipenem and highly resistant to other antimicrobials of clinical use. Most strains of biotypes 8 and 9 were hydrophilic and encapsulated, whereas those of infrequent biotypes and of Acinetobacter genospecies 3 were, with few exceptions, hydrophobic and not encapsulated. CONCLUSIONS Capsule production might confer a greater virulence to Acinetobacter baumannii biotypes 8 and 9, and explain their higher prevalence in the studied hospital.
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Affiliation(s)
- M A Martínez
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile
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33
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Levine MM, Lagos R, Levine OS, Heitmann I, Enriquez N, Pinto ME, Alvarez AM, Wu E, Mayorga C, Reyes A. Epidemiology of invasive pneumococcal infections in infants and young children in Metropolitan Santiago, Chile, a newly industrializing country. Pediatr Infect Dis J 1998; 17:287-93. [PMID: 9576382 DOI: 10.1097/00006454-199804000-00005] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM To study the epidemiology of invasive pneumococcal infections in infants and young children in Santiago, Chile, as a representative pediatric population in a newly industrializing country where pneumococcal conjugate vaccines may be used in the future. METHODS A 5-year retrospective laboratory-based review (1989 to 1993) was followed by a 3-year prospective laboratory and hospital surveillance study in two of the six health administrative areas of Santiago to detect all hospitalized cases of invasive pneumococcal disease (defined as Streptococcus pneumoniae isolated from blood, cerebrospinal fluid or another normally sterile site) among infants and children (0 to 23 months of age in the retrospective and 0 to 59 months of age in the prospective study). RESULTS During the 5-year retrospective survey the incidence of invasive pneumococcal disease was 90.6 cases per 10(5) infants 0 to 11 months old and 18.5 cases per 10(5) toddlers 12 to 23 months old. Similar rates (60.2 per 10(5) infants and 18.1 per 10(5) toddlers) were recorded during the 3 years of prospective surveillance. Among the 110 cases in children 0 to 59 months of age detected during the 3-year prospective surveillance, 2 clinical forms, pneumonia and meningitis, accounted for 87.2% of all cases; 13 of the 49 pneumonia patients (26%) had empyema as a complication. Notably 40 of the 110 cases (36.4%) occurred before 6 months of age (63.4% of the 63 infant cases). Serotypes 1, 14, 5 and 6B were the most prevalent. Overall 76 and 69%, respectively, of S. pneumoniae isolates were antigenic types that would be covered by the 11- or 9-valent conjugate vaccines under development. CONCLUSIONS Invasive pneumococcal infections in Santiago, Chile, exhibit an epidemiologic pattern intermediate between that of developing and industrialized countries. The high burden of disease in early infancy dictates that an accelerated immunization schedule (beginning in the perinatal period) or maternal immunization with pneumococcal vaccines should be explored.
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Affiliation(s)
- M M Levine
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore 21201, USA
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34
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Abstract
BACKGROUND Infantile chronic recurrent parotitis (ICRP) is characterized by episodes of recurrent swelling of the parotid gland with decreased salivary flow and purulent secretion. The etiology of this little unknown clinical condition has been attributed to multiple causes such as canalicular system malformations, ascending bacterial infection, hyposialia, parotitis sequelae, viral infections and immunologic disorders, among others. METHODS We studied the types (with counts) of microorganisms involved in ICRP. Saliva samples were obtained from 56 patients and 20 controls, inoculated onto enriched media and incubated under aerobic and anaerobic conditions. Antimicrobial susceptibility and serotyping of the isolated organisms isolated were performed. RESULTS Of 57 saliva samples from ICRP patients, 52 (91%) were culture-positive. The most frequently isolated microorganisms were Streptococcus pneumoniae and Haemophilus influenzae. Thirteen of twenty (65%) samples were also culture-positive, mostly for viridans streptococci. However, colony counts were lower than in clinical samples (P < 0.004). Approximately one-third of S. pneumoniae strains resistant or moderately resistant to penicillin, and all H. influenzae strains were susceptible to all of the antimicrobials tested. CONCLUSIONS S. pneumoniae or H. influenzae were isolated in high concentrations in IRCP cases but not in controls, suggesting that these microorganisms may have a role in the development of this clinical entity. Quantitative cultures are very important in assessment of the pathogenic role of these microorganisms in patients but not in controls.
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Affiliation(s)
- M S Giglio
- Department of Microbiology, Faculty of Medicine, University of Chile, Santiago, Chile.
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35
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Giglio MS, Pinto ME, Córdova E, Escandar P, Waman C. [Identification of Enterococcus species from clinical samples and their antimicrobial susceptibility]. Rev Med Chil 1996; 124:70-6. [PMID: 8762621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The genus enterococcus has 12 species of which, E faecalis and E faecium are most important in human infections. A progressive resistance to penicillin and ampicillin has been detected in these species. The aim of this work was to identify Enterococcus species isolated in a hospital and to study their antimicrobial susceptibility. We studied 209 Enterococcus species coming from patients admitted to a public hospital. Their susceptibility to penicillin, ampicillin, imipenem, vancomycin, tetracycline, chloramphenicol, ciprofloxacin, gentamicin and streptomycin was determined with the agar dilution technique. Eighty seven percent of species were E faecalis and 7.1% were E fecium, other isolated species were E hirae, E casseliflaws, E avium, E solitarius and E faecalis variant. Thirty eight percent of these species were isolated from the urinary tract, 22% from the skin and 14% from surgical wounds. All E faecalis species were susceptible to penicillin, ampicillin, imipenem and vancomycin; 27.3% were susceptible to tetracycline, 54.7% to chloramphenicol and 80% to ciprofloxacin. Seventy three percent of E faecium species were susceptible to penicillin, 80% to ampicillin and 60% to imipenem. Sixty two percent of E faecalis and 42.4% of E faecium were resistant to streptomycin. It is concluded that the correct identification of Enterococcus species has therapeutic implications.
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Affiliation(s)
- M S Giglio
- Departamento de Microbiología, Universidad de Chile, Santiago
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36
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Abstract
To characterize antibody binding to a panel of V3 loop peptides representing diverse HIV-1 neutralization epitopes, 149 HIV-1 infected individuals from Rio de Janeiro (RJ) were investigated. Results were analyzed with respect to risk factors for infection and other epidemiological and clinical data. Peptide reactivity was not associated with sex, clinical status, CD4 counts, antigenemia or beta 2-microglobulin serum level. A segregation of peptide reactivity according to route of infection was encountered. This finding suggests that more then one viral strain may be circulating in RJ, in subjects with different risk factors for HIV-1 infection. An investigation of prevalent HIV-1 genotypes, serotypes and immunotypes may be of importance for the design and selection of potential vaccines to be used in Brazil as well as for the selection of populations to be included in future vaccine efficacy trials.
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Affiliation(s)
- M E Pinto
- Serviço de Doenças Infecciosas e Parasitárias, Universidade Federal do Rio de Janeiro, Brasil
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37
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da Costa SM, Schechter M, Shindo N, Vicente AC, Oliveira EF, Pinto ME, Tanuri A. Sequence and phylogenetic analysis of glycoprotein 120 of an HIV type 1 variant (GWGR) prevalent in Brazil. AIDS Res Hum Retroviruses 1995; 11:1143-5. [PMID: 8554914 DOI: 10.1089/aid.1995.11.1143] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- S M da Costa
- Departamento de Genética, Universidade Federal do Rio de Janeiro, Brazil
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38
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Dominguez M, Gonzalez G, Bello H, Garcia A, Mella S, Pinto ME, Martinez MA, Zemelman R. Identification and biotyping of Acinetobacter spp. isolated in Chilean hospitals. J Hosp Infect 1995; 30:267-71. [PMID: 7499807 DOI: 10.1016/0195-6701(95)90261-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Two hundred and eighty-one isolates of Acinetobacter spp. obtained from clinical specimens in hospitals from five Chilean cities were identified to species level and biotyped. Respiratory tract and wound secretions were the main sources of the isolates. Acinetobacter baumannii was the most frequent species (96.8%), followed by Acinetobacter genospecies 3 (2.8%). Twelve different biotypes of A. baumannii strains were found of which biotypes 9, 8 and 6 were the most frequent. Isolates of other biotypes were rare. These results differ from most other Latin American and European countries.
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Affiliation(s)
- M Dominguez
- Departamento de Microbiologia, Facultad de Ciencias Biologicas, Universidad de Concepcion, Chile
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39
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Affiliation(s)
- C B Hofer
- Programa SIDA/AIDS, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil
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40
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Casellas JM, Blanco MG, Pinto ME. The sleeping giant. Antimicrobial resistance. Infect Dis Clin North Am 1994; 8:29-45. [PMID: 8021447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Resistance to most of the antimicrobial agents in use today is present in Latin America as of this publication. Their underlying mechanisms are in place and an even more serious situation is foreseen in the years to come. Both nosocomial and common community-acquired infections have changed to require more complex ways of management. Although newer antibiotics take the place of the older ones, wiser and more restrictive usage of the currently available antibiotics is needed. This may be obtained through education and with the amplification of national and supranational networks of surveillance, which could anticipate trends in resistance.
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Affiliation(s)
- J M Casellas
- Infectious Diseases and Clinical Microbiology Department, Postgraduate School of Health Sciences, Catholic University, Buenos Aires, Argentina
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Schechter M, Zajdenverg R, Machado LL, Pinto ME, Lima LA, Perez MA. Predicting CD4 counts in HIV-infected Brazilian individuals: a model based on the World Health Organization staging system. J Acquir Immune Defic Syndr (1988) 1994; 7:163-8. [PMID: 7905525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
CD4 cell counts are one of the best available surrogate markers for disease progression; they are widely used laboratory parameters in clinical trials and commonly used indicators for the introduction of primary prophylaxis and antiretroviral therapy. However, measurement is too expensive to be done in most developing countries. The objective of this study was to derive a model for prediction of CD4 counts < 200 cells/mm3 based on the proposed World Health Organization (WHO) staging system for HIV infection and widely available laboratory parameters. One hundred and six consecutive patients enrolled in a prospective cohort study who were not taking anti-HIV drugs or prophylaxis for opportunistic infections were included. Blood tests were performed within 72 h of the outpatient visit. Lymphocyte phenotyping was done by flow cytometry. Two models based on the WHO staging system, hematocrit and total lymphocyte counts, were developed. The two models had sensitivity > 90% and specificity > 83%. These results indicate that the combined use of simple clinical and laboratory parameters can predict CD4 counts < 200 cells/mm3 with high sensitivity and specificity. Similar studies should be conducted in other countries. Should our findings be confirmed, intervention strategies based on this model of potential universal applicability should be devised and validated.
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Affiliation(s)
- M Schechter
- AIDS Program, Hospital Universitario Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil
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Martínez MA, Pinto ME. [Molecular characterization of the transferable resistance to amikacin in Enterobacteriaceae strains isolated from hospital infections]. Rev Med Chil 1993; 121:969-74. [PMID: 8191162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Sixty-three amikacin resistant strains of Enterobacteriaceae isolated in three hospitals from Santiago, between 1988 and 1990 were included in this study. The strains were multiresistant and harbored 1-5 plasmids. Fifty six isolates (88.9%) transferred amikacin resistance to E coli C600 receptor strain by conjugation. The transconjugants acquired a 11 kilobase-pair or a larger plasmid. The plasmids also encoded resistance to kanamycin, tobramycin, streptomycin and ampicillin. A DNA probe from the gene AAC (6')-I encoding an aminoglycoside 6'-N-acetyltransferase, AAC (6')-I hybridized in Southern blot with plasmid DNA of the 10 Enterobacteriaceae strains tested, but not with the plasmid DNA of 8 amikacin resistant clinical strains of A baumannii. The results indicate that amikacin resistance in Enterobacteriaceae is due mainly to conjugative plasmids encoding an AAC (6')-I.
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Affiliation(s)
- M A Martínez
- Departamento de Preclínicos, Facultad de Medicina, Universidad de Chile, Campus Occidente
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Vidal A, Kramer V, Lafourcade M, Pinto ME. [Susceptibility of Neisseria gonorrhoea strains]. Rev Med Chil 1993; 121:785-8. [PMID: 8296083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The susceptibility of 45 strains of Neisseria gonorrhoea was studied measuring minimal inhibitory concentrations of five antimicrobials. Results show that 66.7% of strains are resistant to tetracycline and 11.2% to penicillin. All strains were susceptible to ciprofloxacin, ceftriaxone and cefotaxime. This results should prompt to perform surveillance in different areas of Santiago and to establish new therapeutic norms for the treatment of gonococcal infections.
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Affiliation(s)
- A Vidal
- Departamento de Preclínicos, Facultad de Medicina, Universidad de Chile, Santiago de Chile
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Martínez MA, Pinto ME, Giglio MS, Pommier J, Muñoz LM. [Identification and sensitivity of acinetobacter sp isolated from clinical specimens and hospital environment]. Rev Med Chil 1992; 120:1267-72. [PMID: 1340947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
One hundred thirty two strains of acinetobacter isolated between october 1989 and march 1991 at the San Juan de Dios Hospital, Santiago de Chile were included in this study. One hundred twelve isolates were obtained from patients and 20 from the hospital environment. Among the 112 clinical isolates, 108 (96.4%) were identified according to the new classification proposed by Bouvet and Grimont in 1986 as A. baumannii, and four as acinetobacter genospecies 3. The 20 strains obtained from the hospital environment corresponded to A baumannii. No differences in the activities of the antimicrobial agents were found between clinical and environmental strains of A baumannii. Imipenem was the most active antimicrobial drug against A baumannii followed in descending order by sulbactam ampicillin and ceftazidime. The other antimicrobials tested showed poor activity against these strains as revealed for the MICs 50 and 90 in the resistance range.
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Affiliation(s)
- M A Martínez
- Departamento de Preclínicos, Facultad de Medicina, Universidad de Chile
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Contreras R, Ferreccio C, Sotomayor V, Astroza L, Berríos G, Ortiz E, Palomino C, Prenzel I, Pinto ME, Levine M. [Typhoid fever in school children: by what measures is the modification of the clinical course due to oral vaccination?]. Rev Med Chil 1992; 120:134-41. [PMID: 1340549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The clinical course of infection by Salmonellae was compared between patients who had been vaccinated against typhoid fever using the Ty21a vaccine and those who had not. Of 2566 bacteriological confirmed cases 84% were infected with S typhi, 14% with S paratyphi B and 2% with S paratyphi A. Among patients with typhoid fever, 34% were treated in hospital, 3.5% had relapses, 5.4% developed complications and 1 patient died (0.05%). Among patients with paratyphoid fever, 18% were treated in hospital, 0.6% had relapses, 1.4% developed complications and there were no deaths. These figures were similar among vaccinated and non-vaccinated cases. A slightly greater proportion of vaccinated cases were treated in hospital (38 vs 30%). Thus, use of oral vaccination against typhoid fever does not alter the clinical course of infection with Salmonellae.
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Affiliation(s)
- R Contreras
- Programa de Control de Fiebre Tifoidea, Ministerio de Salud, Chile, Santiago
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Montiel F, Kaltwasser G, Pinto ME, Lam M. In vitro antibacterial activity of trospectomycin (U-63,366F) against anaerobic bacteria and aerobic gram-positive cocci in Chile. Diagn Microbiol Infect Dis 1991; 14:259-64. [PMID: 1832369 DOI: 10.1016/0732-8893(91)90040-m] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The in vitro activity of trospectomycin sulfate was compared with those of several antimicrobials, against 301 anaerobic bacteria and 613 aerobic Gram-positive cocci. Trospectomycin was about 4- to 32-fold more active than was spectinomycin. Trospectomycin exhibited consistently good activity against all Bacteroides fragilis group isolates, except Bacteroides vulgatus, and against all other anaerobes comparable or higher to that of clindamycin. The trospectomycin's activity was most similar to that of vancomycin, even against methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus epidermidis.
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Affiliation(s)
- F Montiel
- Laboratorio de Microbiología Clínica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago
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Saelzer E, Muñoz P, Peña A, Tellerías L, Fernández A, Giglio M, D'Ottone K, Zapata L, Alarcón T, Pinto ME. [Bacterial isolation in infants hospitalized for acute diarrhea]. Rev Chil Pediatr 1989; 60:328-33. [PMID: 2520838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Bacteria were investigated in stools of 156 children under two years of age admitted to the pediatric wards of a general hospital at the western metropolitan area of Santiago, Chile, because of acute diarrhea with only one stool sample. A known pathogenic agent was isolated from 115 cases (73.7%), this being a bacteria in 87/115 (75.6%). Most prevalent microorganisms were Enteropathogenic Escherichia coli (EPEC). (65.5%), specially serogroups 0111, 0119 and 055, Enterotoxigenic Escherichia coli (ETEC) (18.4%), Campylobacter yeyuni (13.8%), Salmonellae (9.2%) and Shigellae (6.9%). Invasive Escherichia coli (EIEC) and Aeromonas hydrophila were observed in only one case. Yersinia enterocolitica was not isolated. Age was under one year in 92% of patients and 83% were normally or slightly under nourished. Fecal leucocytes were abnormally increased (greater than 5 per high power field) in 41.4% of positive bacterial isolates, in 83% of children with Shigellae, in 50% of those with EPEC and Salmonellae and in 25% of the Campylobacter yeyuni group.
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Gutiérrez J, Bronfman L, Lorca J, Pinto ME, Torrens M, Garcia ME, Barrientos A, Palma T. [Infection in severe neutropenia: analysis of 140 episodes]. Rev Med Chil 1989; 117:1141-9. [PMID: 2519358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We analyzed infections complicating 140 episodes of severe neutropenia in 86 patients. The underlying diagnosis was acute leukemia in 64, lymphoma in 12 and isolated cases of bone marrow aplasia, agranulocytosis, dysmyelopoiesis and solid tumors. No fever developed in 35 (25%) episodes. No cause for the fever was identified in 40% of the remaining episodes. Clinical evidence of an infection was present in 20%, with positive bacteriologic findings in 27%. Respiratory infection (16%), pneumonia (11%) and sepsis (10%) were the most common infectious processes. Infectious agents isolated were gram negative bacilli (72%), gram positive cocci (19%) and fungi (9%). The association of amikacin and carbenicillin or cephalosporins proved to be superior to gentamycin-penicillin (p less than 0.01). 16 patients died for an overall mortality of 11%. Pneumonia and infection by K pneumoniae or C albicans were associated to a poorer prognosis.
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Fernández A, Pinto ME, Vidal A. [Identification of group B beta hemolytic Streptococcus in infections of adults and children]. Rev Med Chil 1989; 116:514-9. [PMID: 2664938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The frequency of isolation of group B beta-hemolytic streptococcus was investigated in samples from the skin, genitourinary tract and respiratory tract in adults and children, in 2 periods, 1977-79 and 1984-86. Hydrolysis of sodium hippurate or bile and sensitivity to bacitracin were used to identify the germ. Serologic group was confirmed by coagglutination. The incidence of isolation increased from 6.1% (n = 18) to 28.7% (n = 119) from the first to the second period, ranking second among all S groups. Isolation from blood and from spinal fluid in newborns was observed only in the second period.
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