Étude pangénomique de la variabilité dans le nombre de copies liée à l’hypertension artérielle et ses anomalies métaboliques associées

L’hypertension artérielle essentielle (HTA) est une pathologie complexe, multifactorielle et à forte composante génétique. L’impact de la variabilité dans le nombre de copies sur l’HTA est encore peu connu. Nous envisagions que des variants dans le nombre de copies (CNVs) communs pourraient augmenter ou diminuer le risque pour l’HTA. Nous avons exploré cette hypothèse en réalisant des associations pangénomiques de CNVs avec l’HTA et avec l’HTA et le diabète de type 2 (DT2), chez 21 familles du Saguenay-Lac-St-Jean (SLSJ) caractérisées par un développement précoce de l’HTA et de la dyslipidémie. Pour la réplication, nous disposions, d’une part, de 3349 sujets diabétiques de la cohorte ADVANCE sélectionnés pour des complications vasculaires. D’autre part, de 187 sujets de la cohorte Tchèque Post-MONICA (CTPM), choisis selon la présence/absence d’albuminurie et/ou de syndrome métabolique. Finalement, 134 sujets de la cohorte CARTaGENE ont été analysés pour la validation fonctionnelle. Nous avons détecté deux nouveaux loci, régions de CNVs (CNVRs) à effets quantitatifs sur 17q21.31, associés à l’hypertension et au DT2 chez les sujets SLSJ et associés à l’hypertension chez les diabétiques ADVANCE. Un modèle statistique incluant les deux variants a permis de souligner le rôle essentiel du locus CNVR1 sur l’insulino-résistance, la précocité et la durée du diabète, ainsi que sur le risque cardiovasculaire. CNVR1 régule l’expression du pseudogène LOC644172 dont le dosage est associé à la prévalence de l’HTA, du DT2 et plus particulièrement au risque cardiovasculaire et à l’âge vasculaire (P<2×10-16). Nos résultats suggèrent que les porteurs de la duplication au locus CNVR1 développent précocement une anomalie de la fonction bêta pancréatique et de l’insulino-résistance, dues à un dosage élevé de LOC644172 qui perturberait, en retour, la régulation du gène paralogue fonctionnel, MAPK8IP1. Nous avons également avons identifié six CNVRs hautement hérités et associés à l'HTA chez les sujets SLSJ. Le score des effets combinés de ces CNVRs est apparu positivement et étroitement relié à la prévalence de l’HTA (P=2×10-10) et à l’âge de diagnostic de l’HTA. Dans la population SLSJ, le score des effets combinés présente une statistique C, pour l’HTA, de 0.71 et apparaît aussi performant que le score de risque Framingham pour la prédiction de l’HTA chez les moins de 25 ans. Un seul nouveau locus de CNVR sur 19q13.12, où la délétion est associée à un risque pour l’HTA, a été confirmé chez les Caucasiens CTPM. Ce CNVR englobe le gène FFAR3. Chez la souris, il a été démontré que l’action hypotensive du propionate est en partie médiée par Ffar3, à travers une interférence entre la flore intestinale et les systèmes cardiovasculaire et rénal. Les CNVRs identifiées dans cette étude, affectent des gènes ou sont localisées dans des QTLs reliés majoritairement aux réponses inflammatoires et immunitaires, au système rénal ainsi qu’aux lésions/réparations rénales ou à la spéciation. Cette étude suggère que l’étiologie de l’HTA ou de l’HTA associée au DT2 est affectée par des effets additifs ou interactifs de CNVRs.

Influence du microbiote intestinal sur le métabolisme et la virulence des Escherichia coli entérohémorragiques

Les Escherichia coli entérohémorragiques (EHEC) représentent un problème majeur de santé publique dans les pays développés. Les EHEC sont régulièrement responsables de toxi-infections alimentaires graves chez l’humain et causent des colites hémorragiques et le symptôme hémolytique et urémique, mortel chez les enfants en bas âge. Les EHEC les plus virulents appartiennent au sérotype O157:H7 et le bovin constitue leur réservoir naturel. À ce jour il n’existe aucun traitement pour éviter l’apparition des symptômes liés à une infection à EHEC. Par conséquent, il est important d’augmenter nos connaissances sur les mécanismes employés par le pathogène pour réguler sa virulence et coloniser efficacement la niche intestinale. Dans un premier temps, l’adaptation de la souche EHEC O157:H7 EDL933 à l’activité métabolique du microbiote intestinal a été étudiée au niveau transcriptionnel. Pour se faire, EDL933 a été cultivée dans les contenus caecaux de rats axéniques (milieu GFC) et dans ceux provenant de rats colonisés par le microbiote intestinal humain (milieu HMC). Le HMC est un milieu cécal conditionné in vivo par le microbiote. Dans le HMC par rapport au GFC, EDL933 change drastiquement de profile métabolique en réponse à l’activité du microbiote et cela se traduit par une diminution de l’expression des voies de la glycolyse et une activation des voies de l’anaplérose (voies métaboliques dont le rôle est d’approvisionner le cycle TCA en intermédiaires métaboliques). Ces résultats, couplés avec une analyse métabolomique ciblée sur plusieurs composés, ont révélé la carence en nutriments rencontrée par le pathogène dans le HMC et les stratégies métaboliques utilisées pour s’adapter au microbiote intestinal. De plus, l’expression des gènes de virulence incluant les gènes du locus d’effacement des entérocytes (LEE) codant pour le système de sécrétion de type III sont réprimés dans le HMC par rapport au GFC indiquant la capacité du microbiote intestinal à réprimer la virulence des EHEC. L’influence de plusieurs composés intestinaux présents dans les contenus caecaux de rats sur l’expression des gènes de virulence d’EDL933 a ensuite été étudiée. Ces résultats ont démontré que deux composés, l’acide N-acétylneuraminique (Neu5Ac) et le N-acétylglucosamine (GlcNAc) répriment l’expression des gènes du LEE. La répression induite par ces composés s’effectue via NagC, le senseur du GlcNAc-6-P intracellulaire et le régulateur du catabolisme du GlcNAc et du galactose chez E. coli. NagC est un régulateur transcriptionnel inactivé en présence de GlcNAc-6-P qui dérive du catabolisme du Neu5Ac et du transport GlcNAc. Ce travail nous a permis d’identifier NagC comme un activateur des gènes du LEE et de mettre à jour un nouveau mécanisme qui permet la synchronisation de la virulence avec le métabolisme chez les EHEC O157:H7. La concentration du Neu5Ac et du GlcNAc est augmentée in vivo chez le rat par le symbiote humain Bacteroides thetaiotaomicron, indiquant la capacité de certaines espèces du microbiote intestinal à relâcher les composés répresseurs de la virulence des pathogènes. Ce travail a permis l’identification des adaptations métaboliques des EHEC O157:H7 en réponse au microbiote intestinal ainsi que la découverte d’un nouveau mécanisme de régulation de la virulence en réponse au métabolisme. Ces données peuvent contribuer à l’élaboration de nouvelles approches visant à limiter les infections à EHEC.

Analyse de la distribution d'Escherichia coli, utilisée comme un marqueur microbiologique, dans un réseau de production porcin.

La présence d’Escherichia coli pathogènes en élevages porcins entraine des retards de croissance et la mortalité. La transmission des E. coli pathogènes entre les élevages et l'abattoir d’un même réseau de production n'est pas bien décrite. La détection des gènes de virulence des E. coli pathogènes pourrait permettre d’identifier un marqueur de contamination dans le réseau. L’objectif de cette étude a été d’identifier un marqueur de contamination E. coli dans un réseau de production porcine défini afin de décrire certains modes de transmission des E. coli pathogènes. Pour ce faire, une région géographique comprenant 10 fermes d’engraissement, un abattoir et un réseau de transport a été sélectionnée. Trois lots de production consécutifs par ferme ont été suivis pendant 12 mois. Des échantillons environnementaux ont été prélevés à l’intérieur et à l’extérieur des fermes (3 visites d’élevage), dans la cour de l’abattoir (2 visites lors de sorties de lot) et sur le camion de transport. La détection des gènes de virulence (eltB, estA, estB, faeG, stxA, stx2A, eae, cnf, papC, iucD, tsh, fedA) dans les échantillons a été réalisée par PCR multiplexe conventionnelle. La distribution temporelle et spatiale des gènes de virulence a permis d’identifier le marqueur de contamination ETEC/F4 défini par la détection d’au moins un gène d’entérotoxine ETEC (estB, estA et eltB) en combinaison avec le gène de l’adhésine fimbriaire (faeG). La distribution des échantillons positifs ETEC/F4 qualifie la cour de l’abattoir comme un réservoir de contamination fréquenté par les transporteurs, vecteurs de contamination entre les élevages. Ceci suggère le lien microbiologique entre l’élevage, les transporteurs et l’abattoir jouant chacun un rôle dans la dissémination des microorganismes pathogènes et potentiellement zoonotiques en production porcine.

Fatty acids as Biomarkers in the Mangrove sediments of Cochin

The biogeochemistry of mangroves are the least understood ecological properties because of their sediment complexicity due to the tidal influx of allochthonous organic matter and the autochthonous inputs.In order to understand the relative importance of biogeochemical processes,it is necessary not only to characterise and qualify the organic matter but also to identify its major sources .The present study is a preliminary investigation to identify the sources of organic matter in three mangrove systems of Cochin Estuary using fatty acid biomarkers,δ13 C of total organic matter,elemental composition and biochemical composition.

Studies on isolation and molecular characterization of plasmids from Vibrios

While the seriousness of the problem of antibiotic resistance is now recognized, the complex web of resistance linking humans, animals, and the environment is getting realized. More often, antibiotics are used as a preventive measure against diseases. Antibiotic use for agriculture leads to the increased resistance in the environment since antibiotics are inevitable element during agriculture/aquaculture and antibiotic residues are excreted as waste that is frequently spread onto farmland as organic fertilizer. Fecal bacteria survive long periods in the environment and spread through runoff into groundwater, rivers, and marine ecosystems.However, horizontal gene transfer occurs in the animals and guts of humans and in a variety of ecosystems, creating a pool of resistance in the rice fields and open waters. Even if people are not in direct contact with resistant disease through food animals, there are chances of contact with resistant fecal pathogens from the environment. Additionally, pathogens that are autochthonous to the environment can acquire resistance genes from the environment. Our study revealed that autochthonous , bacteria Vibrio spp gained antibiotic resistance in the environment. Further, it was evident that horizontal gene transfer occurs in Vibrio by means of plasmids, which further augments the gravity of the problem. Non-pathogenic bacteria may also acquire resistance genes and serve as a continuing source of resistance for other bacteria, both in the environment, and in the human gut. As the effectiveness of antibiotics for medical applications decline, the indiscriminate use of in aquaculture and in humans can have disastrous conditions in future due to horizontal gene transfer and the spread of resistant organisms: We must recognize and deal with the threat posed by overuse of antibiotics.

Spatial and Temporal Variation of Microbial Community Structure In Surficial Sediments of Cochin Estuary

This thesis entitled spatial and temporal variarion of microbial community structure in surficial sediments of cochin estuary.In the estuarine and coastal systems, organic matter (OM) is derived not only from autochthonous primary production, but also from allochthonous (terrestrial) organic matter (OM) delivered by river discharge and runoff. A significant portion of the OM sinks through the water column and is ultimately stored in carbon pool in the sediments.Analysis of spatial and temporal variation in benthic microbial community of a tropical estuary was conducted for the first time using non selective measures that affirms that PLFA approach is a sensitive and reliable method in determining microbial community structures of surficial sediments of estuary.The close relationship between the concentrations of the microbial fatty acids and total biomass indicates that bacteria could account for the largest proportion of the biomass in the sediments.This is first study that has documented the changes in microbial community composition linkage to biotic and abiotic variables in benthic estuarine ecosystem. This contemporaneous community will be the backdrop for understanding the response of autochthonous community to increasing anthropogenic stress.

Assessment of trophic change and its probable impact on tropical estuarine environment (the Kodungallur-Azhikode estuary, India)

The cumulative effects of global change, including climate change, increased population density and domestic waste disposal, effluent discharges from industrial processes, agriculture and aquaculture will likely continue and increases the process of eutrophication in estuarine environments. Eutrophication is one of the leading causes of degraded water quality, water column hypoxia/anoxia, harmful algal bloom (HAB) and loss of habitat and species diversity in the estuarine environment. The present study attempts to characterize the trophic condition of coastal estuary using a simple tool; trophic index (TRIX) based on a linear combination of the log of four state variables with supplementary index Efficiency Coefficient (Eff. Coeff.) as a discriminating tool. Numerically, the index TRIX is scaled from 0 to10, covering a wide range of trophic conditions from oligotrophic to eutrophic. Study area Kodungallur-Azhikode Estuary (KAE) was comparatively shallow in nature with average depth of 3.6±0.2 m. Dissolve oxygen regime in the water column was ranged from 4.7±1.3 mgL−1 in Station I to 5.9±1.4 mgL−1 in Station IV. The average nitrate-nitrogen (NO3-N) of KAE water was 470 mg m−3; values ranged from Av. 364.4 mg m−3 at Station II to Av. 626.6 mg m−3at Station VII. The mean ammonium-nitrogen (NH4 +-N) varied from 54.1 mg m−3 at Station VII to 101 mg m−3 at Station III. The average Chl-a for the seven stations of KAE was 6.42±3.91 mg m−3. Comparisons over different spatial and temporal scales in the KAE and study observed that, estuary experiencing high productivity by the influence of high degree of eutrophication; an annual average of 6.91 TRIX was noticed in the KAE and seasonal highest was observed during pre monsoon period (7.15) and lowest during post monsoon period (6.51). In the spatial scale station V showed high value 7.37 and comparatively low values in the station VI (6.93) and station VII (6.96) and which indicates eutrophication was predominant in land cover area with comparatively high water residence time. Eff. Coeff. values in the KAE ranges from −2.74 during monsoon period to the lowest of −1.98 in pre monsoon period. Present study revealed that trophic state of the estuary under severe stress and the restriction of autochthonous and allochthonous nutrient loading should be keystone in mitigate from eutrophication process

Geochemical characteristics of surficial sediments in a tropical estuary, southwest India

Geochemical characteristics of surficial sediments in the Panangad region of Cochin estuary, the largest brackish-water humid ecosystem in the south-west coast of India, were analysed. Temporal variations in nutrient stoichiometry, seasonal characteristics of redox elements Fe and S, and the phosphorus geochemistry were employed for the purpose. The stoichiometric analysis pointed towards autochthonous origin of organic matter, possibility of nitrogen limitation, and allochthonous modification of redox conditions. Seasonal variations were not statistically significant for all the geochemical parameters, whereas significant spatial variations were observed with lower values at sandy stations, suggesting that the texture of the sediments is the main factor influencing the sediment geochemistry. Significant inter-relations between the geochemical parameters also suggest a common control mechanism. Based on these geochemical characteristics, the study region can be effectively categorized into two distinct zones, viz. (1) erosion and transportation and (2) deposition zones

Dissolved Folin Phenol Active Substances (Tannin and Lignin) in the Seawater along the West Coast of India

Information on the distribution of dissolved Folin phenol active substances (FPAS) such as tannin and lignin in the seawater along the west coast of India is provided. Notable amounts of FPAS (surface concentrations: 80 f.1gll to 147 f.1gll and bottom concentrations: 80 f.1gll to 116 f.1gll) were detected in the seawater along the coast. The distribution pattern brings about a general depth-wise decrease. A seaward decrease was observed in the southern stations whereas reverse was the case in northern stations. A significant negative correlation was observed between FPAS concentration and dissolved oxygen in sub-surface samples. The appreciable amounts of FPAS detected in the coastal waters indicate the presence of organic matter principally originating from terrestrial (upland and coastal marsh) ecosystems in the marine environment. In this context, they may be used as tracers to determine the fate of coastalborn dissolved organic matter in the ocean and to determine directly the relationship between allochthonous and autochthonous organic matter

Distribution, extracellular virulence factors and antibiogram of motile aeromonads in fresh water ornamental fishes and immune response of Cyprinus carpio against Aeromonas hydrophila infection

The thesis deals with the prevalence and distribution of motile aeromonads in selected ornamental fishes. The presence of motile aeromonads in ornamental fishes and associated carriage water is well documented. Though aeromonads are a part of autochthonous flora of natural waters, disease outbreak occurs as a result of environmental stress on the cultured species and virulence of the pathogens. While ornamental aquaculture in many parts of the world is highly organized and practiced scientifically, it is highly unorganized in India. The culture ponds/tanks are often maintained in very poor manner and the fishes are subjected to high degree of stress during transportation from the production facility to retail vendors. The situation is no better at retail outlets, where fishes are maintained in crowded condition without proper aeration or food. All these could result in high prevalence of diseases caused by motile aeromonads. No systematic study has been carried out to understand the prevalence of motile aeromonads in ornamental fishes and carriage water . It also gives an account of the production of extracellular virulence factors and the antibiogram of the different species of motile aeromonads isolated. The growth characteristics and virulence potential of a representative strain of Aeromonas hydrophila is also studied. The nucleotide sequencing of the strain was carried out and sequences deposited in Genbank. Survival and immune response of Cyprinus carpio under different stress conditions and on probiotic treatment with Bacillus NL110, when challenged with A. hydrophila is also dealt within this thesis.

Provenance, Isolation and Characterisation of Organic Matter in the Cochin Estuarine Sediment-“a Diagenetic Amino Acid Marker Scenario

Cochin estuarine system is among the most productive aquatic environment along the Southwest coast of India, exhibits unique ecological features and possess greater socioeconomic relevance. Serious investigations carried out during the past decades on the hydro biogeochemical variables pointed out variations in the health and ecological functioning of this ecosystem. Characterisation of organic matter in the estuary has been attempted in many investigations. But detailed studies covering the degradation state of organic matter using molecular level approach is not attempted. The thesis entitled Provenance, Isolation and Characterisation of Organic Matter in the Cochin Estuarine Sediment-“ A Diagenetic Amino Acid Marker Scenario” is an integrated approach to evaluate the source, quantity, quality, and degradation state of the organic matter in the surface sediments of Cochin estuarine system with the combined application of bulk and molecular level tools. Sediment and water samples from nine stations situated at Cochin estuary were collected in five seasonal sampling campaigns, for the biogeochemical assessment and their distribution pattern of sedimentary organic matter. The sampling seasons were described and abbreviated as follows: April- 2009 (pre monsoon: PRM09), August-2009 (monsoon: MON09), January-2010 (post monsoon: POM09), April-2010 (pre monsoon: PRM10) and September- 2012 (monsoon: MON12). In order to evaluate the general environmental conditions of the estuary, water samples were analysed for water quality parameters, chlorophyll pigments and nutrients by standard methods. Investigations suggested the fact that hydrographical variables and nutrients in Cochin estuary supports diverse species of flora and fauna. Moreover the sedimentary variables such as pH, Eh, texture, TOC, fractions of nitrogen and phosphorous were determined to assess the general geochemical setting as well as redox status. The periodically fluctuating oxic/ anoxic conditions and texture serve as the most significant variables controlling other variables of the aquatic environment. The organic matter in estuary comprise of a complex mixture of autochthonous as well as allochthonous materials. Autochthonous input is limited or enhanced by the nutrient elements like N and P (in their various fractions), used as a tool to evaluate their bioavailability. Bulk parameter approach like biochemical composition, stoichiometric elemental ratios and stable carbon isotope ratio was also employed to assess the quality and quantity of sedimentary organic matter in the study area. Molecular level charactersation of free sugars and amino acids were carried out by liquid chromatographic techniques. Carbohydrates are the products of primary production and their occurrence in sediments as free sugars can provide information on the estuarine productivity. Amino acid biogeochemistry provided implications on the system productivity, nature of organic matter as well as degradation status of the sedimentary organic matter in the study area. The predominance of carbohydrates over protein indicated faster mineralisation of proteinaceous organic matter in sediments and the estuary behaves as a detrital trap for the accumulation of aged organic matter. The higher lipid content and LPD/CHO ratio pointed towards the better food quality that supports benthic fauna and better accumulation of lipid compounds in the sedimentary environment. Allochthonous addition of carbohydrates via terrestrial run off was responsible for the lower PRT/CHO ratio estimated in thesediments and the lower ratios also denoted a detrital heterotrophic environment. Biopolymeric carbon and the algal contribution to BPC provided important information on the better understanding the trophic state of the estuarine system and the higher values of chlorophyll-a to phaeophytin ratio indicated deposition of phytoplankton to sediment at a rapid rate. The estimated TOC/TN ratios implied the combined input of both terrestrial and autochthonous organic matter to sedimentsAmong the free sugars, depleted levels of glucose in sediments in most of the stations and abundance of mannose at station S5 was observed during the present investigation. Among aldohexoses, concentration of galactose was found to be higher in most of the stationsRelative abundance of AAs in the estuarine sediments based on seasons followed the trend: PRM09-Leucine > Phenylalanine > Argine > Lysine, MON09-Lysine > Aspartic acid > Histidine > Tyrosine > Phenylalanine, POM09-Lysine > Histadine > Phenyalanine > Leucine > Methionine > Serine > Proline > Aspartic acid, PRM10-Valine > Aspartic acid > Histidine > Phenylalanine > Serine > Proline, MON12-Lysine > Phenylalanine > Aspartic acid > Histidine > Valine > Tyrsine > MethionineThe classification of study area into three zones based on salinity was employed in the present study for the sake of simplicity and generalized interpretations. The distribution of AAs in the three zones followed the trend: Fresh water zone (S1, S2):- Phenylalanine > Lysine > Aspartic acid > Methionine > Valine ῀ Leucine > Proline > Histidine > Glycine > Serine > Glutamic acid > Tyrosine > Arginine > Alanine > Threonine > Cysteine > Isoleucine. Estuarine zone (S3, S4, S5, S6):- Lysine > Aspartic acid > Phenylalanine > Leucine > Valine > Histidine > Methionine > Tyrosine > Serine > Glutamic acid > Proline > Glycine > Arginine > Alanine > Isoleucine > Cysteine > Threonine. Riverine /Industrial zone (S7, S8, S9):- Phenylalanine > Lysine > Aspartic acid > Histidine > Serine > Arginine > Tyrosine > Leucine > Methionine > Glutamic acid > Alanine > Glycine > Cysteine > Proline > Isoleucine > Threonine > Valine. The abundance of AAs like glutamic acid, aspartic acid, isoleucine, valine, tyrosine, and phenylalanine in sediments of the study area indicated freshly derived organic matter.

Estudio de factibilidad para realizar un plan exportador entre Colombia y España (Pamplona) para productos alimenticios de fabricacion autóctona Colombiana como el arequipe, herpos, obleas y el bocadillo

This investigation was made in order to develop an exporting plan of Colombian autochthonous Products target to Navarra, Spain, and then contribute with the economy and progress of Colombia, increasing the exports and the employment in the country. Thanks to the opportunity that one of the participants of this project had, it was possible to have a direct contact with the Pamplona citizens, investigating the different aspects of exporting to another country, analyzing the target, the market access, the product portfolio, and the consumer behaviour. To begin with this project, the first step was to develop a marketing research investigation, in order to determine the possibility of having a new segment of the Colombian autochthonous products, composed of Spanish and Colombian people. This was the first step to aim into a defined segment, and to learn about all the agreements and regulations between Colombian and Spain. These regulations are about food regulations, quality standards, and to remark, production chains, and distribution channels. Alter analyzing the international distribution chain to Spain, it will be found the market size, and the different enterprises that offer the same products to this country, that further more than competence, is a source of information to find the right way to sell this kind of products.

Lessons in psychology – Colombia Nineteenth Century

Manuel Ancízar published in 1851 his Lectures on Psychology. The text has been a representative of the interests of Colombian intellectuals of the time for discipline. The treatise of the history of psychology Colombia have considered the nineteenth century as a period characterized by a poorly conceived attempt to import some emerging professional practices of psychiatric and educational type. However, the work of Ancízar showed large exhibition on the subject matter of psychology: human consciousness and the theories that support the formation of the new science. The core of the work is oriented towards the secular drama, against which Ancízar defended the supernatural origin and nature of the human soul. The author introduced an eclectic psychology in which, the secular orientation of modern ideas are integrated with the conception of the soul as a divine gift. The reading of the work has been outstanding and indispensable work for understanding ancient and autochthonous forms of access to psychological issues.

Factores asociados a la infección para Clostridium difficile en un hospital universitario de Bogotá

Introducción La infección por Clostridium difficile, es una de las causas más frecuentes de diarrea nosocomial con una alta morbimortalidad, con un aumento exponencial en su incidencia, en Estados Unidos se duplicó, de 261 casos x 100.000 en 1993 pasó a 546 x 100.000 en 2003 2, y en Canadá se encontraron datos similares con un aumento de 4.5 veces, en 1991 de 35.6 casos x 100.000 a 156.3 casos por 100.000 en 2004 3 . Se han descrito varios factores asociados Materiales y Métodos Se trata de un estudio descriptivo de tipo serie de casos en el que se evaluaron pacientes con diagnóstico de infección por C. Difficile y los factores asociados en un Hospital Universitario entre febrero de 2010 hasta septiembre de 2011 Resultados Se recolectaron 31 pacientes la edad promedio fue de 58 años con un rango entre 18 y 93 años, de los cuales 19 (61%) fueron mujeres y 12 (39%) hombres. El factor asociado a la infección por C. Difficile más frecuentemente encontrado fue el uso de inhibidores de bomba de protones con 54.84% (n=17) .No se encontraron pacientes VIH positivos o con diagnóstico de enfermedad inflamatoria intestinal. Ningún paciente presentó complicaciones asociadas a la infección ni mortalidad alguna. Conclusión El factor asociado que más se presentó fue el uso de antimicrobianos en los quince dias previos al inicio del cuadro en el 74% de los pacientes lo que coincide con lo presentado en la literatura mundial.

Factores asociados a infección de fracturas abiertas de extremidades por accidentes de tránsito. Bogotá, 2012-2013

Los traumatismos por accidentes de tránsito, constituyen un problema de salud pública, a nivel mundial. Las lesiones más frecuentes son las fracturas de extremidades (84.3%). Las fracturas tienen un elevado riesgo de presentar infecciones, secuelas e incapacidades permanentes. Objetivo : Determinar si los factores asociados con la patología (lugar de fractura, clasificación de fractura, comorbilidades del paciente) y/o los factores relacionados con la atención médica (uso de profilaxis antibiótica diferente al protocolo institucional, tiempo prolongado para remisión, demoras en manejo quirúrgico) se asocian a mayor probabilidad de presentar infección de fracturas abiertas, en población mayor a 15 años, atendidos por accidente de tránsito, en una clínica de Bogotá de tercer nivel especializada en atención de SOAT, durante el período Octubre de 2012 a Octubre de 2013. Metodología: Estudio de casos y controles no apareado, relación 1:3, conformado por 43 casos (fracturas abiertas infectadas) y 129 controles (fracturas abiertas no infectadas). Resultados: La edad media de los casos fue de 39.42 +/- 16.82 años (med=36 años) y la edad media de los controles fue de 33.15 +/- 11.78 años (med=30 años). El 83.7% de los casos y el 78.3% de los controles corresponden al sexo masculino. Predominaron los accidentes en motocicleta en el 81.4% de los casos y el 86% de los controles. En el análisis bivariado se encuentra que la edad mayor a 50 años (p=0.042), una clasificación de la fractura grado IIIB o IIIC (p=0.02), cumplimiento del protocolo antibiótico institucional según el grado de fractura (p=0.014) y un tiempo mayor a 24 horas desde el momento del accidente al centro especializado en trauma (p=0.035) se asociaron significativamente con infección de la fractura abierta. En el análisis multivariado se encuentra únicamente que la clasificación de la fractura grado IIIB o IIIC se asocia con infección de la fractura OR 2.6 IC95% (1.187 – 5.781) (p=0.017). La duración de hospitalización fue mayor en los casos (32.37+/- 22.92 días, med=26 días) que en los controles (8.81 +/- 7.52 días, med=6 días) (p<0.001). El promedio de lavados quirúrgicos fue mayor en los casos (4.85±4.1, med=4.0) que en el grupo control (1.94±1.26, med=2) (p<0.001). Conclusiones: La infección posterior a una fractura abierta, implica costos elevados de atención con hospitalizaciones prolongadas y mayor frecuencia de intervenciones quirúrgicas como se evidencia en el presente estudio. Se debe fortalecer el sistema de remisión y contra remisión para acortar los tiempos de inicio de manejo especializado de los pacientes con fracturas abiertas. Se debe incentivar dentro de las instituciones, el cumplimiento de protocolos de profilaxis antibiótica según el grado de la fractura para disminuir el riesgo de complicación infecciosa.