A Trypanosoma cruzi strain from southern Mexico is more virulent for male mice in part by blocking the immune response

Introduction: Chagas disease is a neglected disease in the American continent. The southern Mexican state of Chiapas has the highest incidence rate of Chagas disease in the country. The disease, mainly caused by Tripanosoma cruzi in Mexico, is more prevalent in males than in females but the scientific basis for the sex-related tropism is not completely understood. The objective of this study was to evaluate the pathogenicity of a T. cruzi strain in mice of both sexes and to assess certain elements of the immune response in the infected animals. Methodology: Triatomines bugs were searched at Los Mezcales, Chiapas, Mexico and T. cruzi was identified by PCR and sequencing. A T. cruzi strain was isolated from the feces of triatomines bugs. Mice were infected with the strain and the virulence of the T. cruzi strain as well as the immune response against the infection was compared in male versus female mice. Results: T. dimidiata was identified in all dwellings. 42.9% of the bugs were infected with T. cruzi lineage TcI. Male mice exhibited higher parasitemia than females, and developed leukopenia and lower levels of anti-T. cruzi antibodies compared to female mice. Conclusions: The identification of the T. cruzi strain in this endemic region of Mexico revealed that male mice are prone to this infectious protozoo, in addition to manifesting a deficient immune response against infection. These findings may explain the greater number of cases of Chagas disease among men in this endemic region of Latin America.

Cephalic tetanus manifesting as isolated facial nerve palsy- a case report from rural Armenia

Cephalic tetanus is a rare clinical form of tetanus, clinically characterized by trismus and cranial nerve palsy involving one or more cranial nerves, facial nerve being the most common. We report a case of cephalic tetanus with left-sided lower motor facial nerve palsy in a 66-year-old non-immunized patient after an untreated laceration injury. The patient had dysphagia, spasm of the muscles of mastication, asymmetry of the left side of the face, cough, shortness of breath, and stiffness of neck muscles. The presentation was unique given that the facial nerve palsy appeared prior to the occurrence of trismus, which misled the initial diagnosis towards Bell's palsy. He was successfully treated with tetanus antitoxin without any adverse events. Although widespread use of tetanus vaccine has led to a dramatic decline in this fatal disease, sporadic disease occurrence is still possible, particularly in individuals without up-to-date vaccinations. In this case report we illustrate the importance of early recognition of cephalic tetanus prior to the development of the full clinical picture. The early initiation of therapy is the key to recovery from this deadly disease. Physicians are encouraged to include cephalic tetanus as a cause of facial nerve palsy in their differential. In particular, paying attention to cases manifesting early after head or neck injury.

Risk factors associated with drug-resistant tuberculosis in prisons in Sāo Paulo State, Brazil (2006-2016)

Introduction: Prisons are high-risk settings for drug-resistant tuberculosis because the prevalence of the tuberculosis (TB) is much higher than in the general population. This study to investigated the factors associated with drug-resistant tuberculosis in prisons in the state of São Paulo, Brazil. Methodology: Retrospective cohort of drug-resistant TB cases for incarcerated people in São Paulo state, reported in the Tuberculosis Patient Control System between 2006 and 2016. To analyze the factors associated with drug-resistant TB, the backward method (likelihood ratio) was used, determining the adjusted odds ratio and respective 95%CI coefficients. Multiple models were proposed to adjust for potential confusion and interaction. The best fit model was selected based on the lowest Akaike information criterion coefficient. Results: In total, 473 drug-resistant tuberculosis cases were reported in the prison population of Sāo Paulo state, the majority were male. The cases that presented negative results for sputum smear and sputum culture had, respectively, an aOR=0.6 and aOR=0.16 for drug-resistant tuberculosis in relation to the cases with positive results. The cases where the patient had AIDS and reported alcoholism, respectively, an aOR=1.47 and aOR=1.60 for drug-resistant TB. Individuals with a background treatment history for TB presented a stronger association with drug-resistant tuberculosis, aOR=35.08. Conclusions: Sputum spear, sputum culture, chest X-ray, AIDS, alcoholism and background treatment history for TB were factors associated with resistance to antituberculosis drugs among prisoners. This is useful for the implementation of disease control measures related to the detection and monitoring of cases in the prison system.

Draft genome sequence of first Vibrio diabolicus in Mexico strain InDRE-D1-M1, an emergent threat

Introduction: The complete genome of the marine environmental bacterium Vibrio diabolicus isolated from raw shrimp in the city of Guadalajara in the state of Jalisco in Mexico is reported here. Methodology: Vibrio spp. it was isolated and identified using standard microbiological and molecular techniques. Whole genome sequencing was performed using the Miseq system (Illumina, USA). Results: The Multi Locus Sequence Typing profile of the isolated Vibrio bacteria coincided only with 4 specific loci (atpA, gyrB, pyrH and recA) and with a total coverage of the species belonging to Vibrio spp. Analysis of the complete genome of the Vibrio isolate and other closely related species, using the genomic fingerprints of the Virtual Analysis Method for PHylogenomic fingerprint estimation (VAMPHyRe) software, revealed the clustering of this species among the clade Vibrio diabolicus. The antibiogram revealed that this strain of Vibrio diabolicus is resistant to ampicillin, which is consistent with the bioinformatic finding of the β-lactamase enzyme that hydrolyzes carbenicillin class A. Conclusions: This study demonstrated that the environmental marine bacterium Vibrio diabolicus contains carrier genes associated with pathogenicity and ecological function, which could represent a threat to public health.

Characterization of commensal Escherichia coli isolates from slaughtered sheep in Mexico

Introduction: Commensal Escherichia coli is defined as bacteria without known virulence factors that could be playing a specific role in some diseases; however, they could be responsible to disseminate antimicrobial resistance genes to other microorganisms. This study aimed to characterize the commensal E. coli isolates obtained from slaughtered sheep in the central region of Mexico. Methodology: Isolates were classified as commensal E. coli when distinctive genes related to diarrheagenic pathotypes (stx1, stx2, eae, bfp, LT, stp, ipaH, and aggR) were discarded by PCR. Identification of serotype, phylogenetic group, and antimicrobial resistance was also performed. Results: A total of 41 isolates were characterized. The phylogenetic groups found were B1 in 37 isolates (90.2%), A in 2 (4.8%), and 1 isolate (2.4%) for C and D groups. Serotypes associated with diarrhea in humans (O104:H2 and O154:NM) and hemolytic uremic syndrome (O8:NM) were detected. Thirty-three isolates (80%) were resistant to ceftazidime, 23 (56%), to tetracycline 8 (19.5%) to ampicillin, and 1 to amikacin. Six isolates (14.6%) were multidrug-resistant. Conclusions: This study provides new information about commensal E. coli in slaughtered sheep, high percentages of resistance to antibiotics, and different profiles of antimicrobial resistance were found, their dissemination constitute a risk factor towards the consuming population.

Acceptance and barriers of COVID-19 vaccination among people with chronic diseases in Saudi Arabia

Introduction: Coronavirus Disease 2019 is a life-threatening disease, especially for people suffering from chronic diseases. As the vaccine is considered an essential tool to confront pandemics, many international medical institutions have developed vaccines. Countries around the world started immunizing their citizens. This study aims to assess the acceptance and barriers of COVID-19 vaccine uptake among Saudi Arabian people who suffer from chronic diseases. Methodology: In February-March 2021, a cross-sectional study of Saudi Arabian people who have chronic diseases was undertaken. It was based on an Arabic self-administered online questionnaire and used a convenience sampling technique. 310 people were invited. The response rate was 97%. Results: 51.95% of the participants agreed to take the COVID-19 vaccine, 33.5% were unsure about being vaccinated, and 14.5% refused. The most frequent concerns between participants and receiving the vaccine were about the side effects and the perceived misconception that following preventative measures is enough to protect against the virus. Significant associations between age, education, and occupation with acceptance rate were found (p < 0.05). Conclusions: Although a higher acceptance for the targeted group was expected, the participants showed a moderate acceptance of the COVID-19 vaccine. Addressing the barriers in the current study regarding vaccine uptake and focusing on building trust in the safety and efficacy of the vaccine will aid in hesitancy and resistance toward the vaccine, specifically if these measures were undertaken by an authority such as the Saudi Ministry of Health.

On the early detecting of the COVID-19 outbreak

Introduction: This paper aims to measure the performance of early detection methods, which are usually used for infectious diseases. Methodology: By using real data of confirmed Coronavirus cases from the Kingdom of Saudi Arabia and Italy, the moving epidemic method (MEM) and the moving average cumulative sums (Mov. Avg Cusum) methods are used in our simulation study. Results: Our results suggested that the CUSUM method outperforms the MEM in detecting the start of the Coronavirus outbreak.

Assessment of pathomorphological characteristics of the oral mucosa in patients with HBV, HCV and HIV

Introduction: Oral clinical manifestations in HBV HCV and HIV patients indicate a deterioration in general health status. The aim of the study was to assess pathomorphologic features of oral mucosa observed in patients with these diseases. Methodology: The study was conducted in N1 Dental Clinic of YSMU after M. Heratsi. The total number of patients taking part in the research was 120, including HBV (n = 40), HCV (n = 40) and HIV (n = 40). After biopsy and subsequent histological examination of the oral mucosa, statistical analysis was carried out using Excel 2013 and R software. Results: Pathomorphological examination revealed inflammatory infiltrations in all samples collected from HBV, HCV and HIV patients. These changes included microcirculatory disorders in 98.3% of samples: fibrinous-like deposits lining the surface of erosions and ulcers on the oral mucosa (1.67%), fibrosis of the mucous membrane (70%), dystrophy of squamous epithelium (93.3%) and bone sequestration (3.3%). Comparative analysis of pathomorphological characteristics revealed distinct content of infiltrates: lymphoplasmacytic infiltration in patients with HBV and HCV, while HIV patients showed neutrophils infiltration and lack of plasmocytes. Conclusions: There are common abnormal morphological changes in the oral mucosa typical of all patients with HBV, HCV and HIV, as well as liver diseases specific to each of them. Inflammation in the patients with HIV indicated impairment of the humoral immune system. Understanding the distinct characteristic of inflammation in the oral cavity could be useful for early differential diagnosis and management of patients with HIV, HBV and HCV.

The potential counter effect of COVID-19 outbreak on an antimicrobial agents prescribing educational intervention

Introduction: Educational interventions targeting health care professionals can contribute to improving knowledge and behaviors of antimicrobial agents prescribing. However, the unprecedented COVID-19 outbreak caused a disruption of the current practices and treatment guidelines. Therefore, it is highly likely that the pandemic had its disruptive effect on any educational interventions that were going on during the outbreak. This study aims to evaluate the effectiveness of an educational intervention in improving antimicrobial agents prescribing Methodology: This was a randomized controlled study that included 69 resident physicians in a teaching hospital. The intervention group received an educational intervention focusing on antimicrobial agents prescribing and resistance. Before and after the intervention, outpatient antimicrobial agents prescribing rates for the two study arms were compared for the pre- and post-intervention periods. Additionally, all participants were asked to complete an online questionnaire that measured their knowledge, attitudes and behavioral intention towards antimicrobial agents resistance and prescription. The post-intervention period included the months of February, March, and June 2020. April and May were excluded from the study period since clinics were closed due to the COVID -19 pandemic. Results: Post-intervention, the rate of antimicrobial agents prescribing by the intervention group was significantly higher than that of the control group (p < 0.001). Mean fear score for the intervention group was significantly lower than that for the control group after the intervention. Conclusions: Findings indicate failure of the educational intervention in improving antimicrobial agents prescribing. However, an unexpected counter effect of the COVID-19 outbreak is highly likely.

COVID-19 pandemic: a reminder to develop forensic radiology facility

COVID-19 outbreak has resulted in a substantial morbidity and mortality, and has put the health system under tremendous stress. A need for devising and adopting newer methods and techniques is being emphasized in the healthcare facilities to combat the effects of the SARS-CoV-2. Besides patient care, focus needs to be laid on the effective and dignified management of the deceased and medico-legal services provided by the hospitals and medical institutions during the COVID-19 pandemic. Considering the likelihood of forensic experts and autopsy personnel being exposed to SARS-CoV-2 inadvertently during the autopsy, it is recommended to resort to safer and minimally invasive techniques of postmortem examination of the dead. In this regard, employing radiological techniques for postmortem examination appears to be a promising option during the COVID-19 pandemic. An inherent advantage of postmortem radiography over conventional autopsies is the minimization of the risk of transmission of infection to the health care workers. Our correspondence highlights on the possibility of using radiological facilities as an effective replacement of high-risk conventional autopsy procedures during the COVID-19 pandemic.