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Abstract Background Infection prevention and control (IPC) programs are essential to prevent and control the spread of multidrug-resistant organisms in healthcare facilities (HCFs). The current implementation of these programs in Latin America remains largely unknown. Methods We conducted a mixed-methods evaluation of IPC program implementation in HCFs from Guatemala, Panama, Ecuador, and Argentina, March-July 2022. We used the World Health Organization (WHO) IPC Assessment Framework (IPCAF) survey, a previously validated structured questionnaire with an associated scoring system that evaluates the eight core components of IPC (IPC program; IPC guidelines; IPC education and training; healthcare-associated infection [HAI] surveillance; multimodal strategies; monitoring and audit of IPC practices and feedback; workload, staffing, and bed occupancy; and the built environment and materials and equipment for IPC). Each section generates a score 0–100. According to the final score, the HCF IPC program implementation is categorized into four levels: inadequate (0–200), basic (201–400), intermediate (401–600), or advanced (601–800). Additionally, we conducted semi-structured interviews among IPC personnel and microbiologists using the Systems Engineering Initiative for Patient Safety model to evaluate barriers and facilitators for IPC program implementation. We performed directed content analysis of interview transcripts to identify themes that focused on barriers and facilitators of IPC program implementation which are summarized descriptively. Results Thirty-seven HCFs (15 for-profit and 22 non-profit) completed the IPCAF survey. The overall median score was 614 (IQR 569, 693) which corresponded to an “advanced” level of IPC implementation (32% [7/22] non-profit vs. 93% [14/15] for-profit HCFs in this category). The lowest scores were in workload, staffing and bed occupancy followed by IPC training and multimodal strategies. Forty individuals from 16 HCFs were interviewed. They perceived inadequate staffing and technical resources, limited leadership support, and cultural determinants as major barriers to effective IPC guideline implementation, while external accreditation and technical support from public health authorities were perceived as facilitators. Conclusions Efforts to strengthen IPC activities in Latin American HCFs should focus on improving support from hospital leadership and public health authorities to ensure better resource allocation, promoting safety culture, and improving training in quality improvement.

Background: Tuberculosis (TB) is one of the leading causes of death worldwide. However, an accurate diagnosis contributes to timely treatment, reducing its adverse consequences. The aim of this research was to determine the diagnostic accuracy of the molecular test Xpert MTB/RIF and Xpert MTB/RIF Ultra (Xpert Ultra) for the diagnosis of pulmonary and extrapulmonary TB compared to Löwenstein-Jensen culture. Methods: We conducted a cross-sectional study of diagnostic accuracy. We included samples from patients who attended a Peruvian laboratory between 2011 and 2022. The index test was the Xpert MTB/RIF and Xpert Ultra and the reference standard was Löwenstein-Jensen solid culture for Mycobacterium tuberculosis. We calculated sensitivity, specificity, and positive and negative likelihood ratios. Results: We evaluated 1023 samples, of which 737 were pulmonary samples, 197 tested positive for the Xpert MTB/RIF and Xpert Ultra tests; and 151 tested positive for culture. The Xpert (MTB/RIF and Ultra) showed a joint sensitivity and specificity of: 97 % (95%CI: 93–99) and 93 % (95%CI: 91–95) in pulmonary samples, 100 % (95%CI: 29.2–100) and 98.3 % (95%CI: 94.1–99.8) in cerebrospinal fluid, 66.7 % (95%CI: 22.3–95.7) and 96.8 % (95%CI: 91–99.3) in pleural fluid, 100 % (95%CI: 15.8–100) and 94.3 % (95%CI: 80.8–99.3) in urine. For the detection of pulmonary TB, the Xpert MTB/RIF had a sensitivity and specificity of 97.1 % (95%CI: 89.9–99.6) and 95.6 % (95%CI: 92.9–97.5) and the Xpert Ultra of 97 % (95%CI: 88.5–99.6) 89.5 % (95%CI: 84.9–93.1) respectively. Conclusion: Our results suggest that the Xpert MTB/RIF and the Xpert Ultra are tests with high diagnostic performance for the detection of pulmonary TB and adequate specificity in pulmonary, cerebrospinal fluid, pleural, and urine samples. However, the results for other samples were imprecise.

Considerando que la eimeriosis en alpacas es una enfermedad mortal, se plantea el objetivo de brindar una alternativa profiláctica en alpacas destetadas. Se evaluaron 30 alpacas del CICAS “La Raya” Cusco en Agosto 2022, distribuidas en 3 grupos de 10 alpacas, grupo1 (G1) 15 mg/kpv, grupo2 (G2) 22,5 mg/kpv de Toltrazuril y grupo3 (G3) control. Se realizó análisis coproparasitológico cualitativo de concentración por flotación y cuantitativo mediante método de McMaster modificado pre y post tratamiento; un posible daño hepático se evidenció mediante niveles séricos de alanina aminotransferasa (ALT) y aspartato aminotransferasa (AST). Como resultados, se identificaron eimerias en el 93,33% de alpacas destetadas, siendo más prevalente E. macusaniensis (63,33%). Así mismo, Toltrazuril a 22,5 mg/kpv controla parcialmente E. macusaniensis, mientras que a 15 y 22,5 mg/kpv controlan efectivamente a E. lamae a los 14 días post tratamiento; los niveles de AST y ALT en alpacas con 22,5 mg/kpv de Toltrazuril fueron 5,7 UI/L y 195,8 UI/L, respectivamente. En conclusión, Toltrazuril logra controlar a eimerias patógenas en alpacas, de manera parcial a E. macusaniensis, pero de forma efectiva a eimerias pequeñas como E. lamae sin alterar la función hepática en alpacas destetadas.

Abstract Background The burden of antimicrobial resistance (AMR) in Latin America is high. Little is known about healthcare workers’ (HCWs) knowledge, attitudes, and perceptions of antimicrobial stewardship (AS), AMR, and antibiotic use (AU) in the region. Methods HCWs from 42 hospitals from 5 Latin American countries were invited to take an electronic, voluntary, anonymous survey regarding knowledge, attitudes, and perceptions of AS, AMR, and AU between March–April 2023. Findings Overall, 996 HCWs completed the survey (52% physicians, 32% nurses, 11% pharmacists, 3% microbiologists, and 2% “other”). More than 90% of respondents indicated optimizing AU was a priority at their healthcare facility (HCF), 69% stated the importance of AS was communicated at their HCF, and 23% were unfamiliar with the term “antibiotic stewardship”. Most (> 95%) respondents acknowledged that appropriate AU can reduce AMR; however, few thought AU (

La investigación se titula “Tecnoestrés y rendimiento académico en estudiantes de primer ciclo de estudios de la Universidad Andina del Cusco, 2021”, siendo su objetivo general establecer la relación existente entre el nivel de tecnoestrés y el rendimiento académico de los estudiantes de primer ciclo de estudios semestre académico 2021-II de la Universidad Andina del Cusco, la interpretación de la variable rendimiento académico se realiza considerando el modelo académico de la institución de educación superior donde se ejecutó el estudio, utilizándose para la mediana de tecnoestrés un instrumento con adecuados criterios psicométricos. El estudio se desarrolló desde un enfoque cuantitativo, de tipo aplicado, pues depende de los conocimientos y aportes de la investigación básica, además, al relacionar las variables se considera de alcance correlacional y con un diseño no experimental transversal, al encuestar a una muestra de 847 estudiantes. Entre los resultados más relevantes se encuentra la relación existente entre el tecnoestrés y rendimiento académico; y en entre todas las dimensiones del tecnoestrés con el rendimiento académico, la conclusión fue que mientras mayor sea el nivel de tecnoestrés, menor será el rendimiento académico de los estudiantes.

Small communities in the Arequipa region of Peru are susceptible to rockfall hazards, which impact their lives and livelihoods. To mitigate rockfall hazards, it is first necessary to understand their locations and characteristics, which can be compiled into an inventory used in the creation of rockfall hazard rating maps. However, the only rockfall inventory available for Arequipa contains limited data of large, discrete events, which is insufficient for characterizing rockfall hazards at the community scale. A more comprehensive inventory would result in a more accurate rockfall hazard rating map—a significant resource for hazard mitigation and development planning. This study addresses this need through a remote method for rockfall hazard characterization at a community scale. Three communities located in geographically diverse areas of Arequipa were chosen for hazard inventory and characterization, with a fourth being used for validation of the method. Rockfall inventories of source zones and rockfall locations were developed using high-resolution aerial imagery, followed by field confirmation, and then predictions of runout distances using empirical models. These models closely matched the actual runout distance distribution, with all three sites having an R2 value of 0.98 or above. A semi-automated method using a GIS-based model was developed that characterizes the generation and transport of rockfall. The generation component criteria consisted of source zone height, slope angle, and rockmass structural condition. Transport was characterized by rockfall runout distance, estimated rockfall trajectory paths, and hazard ratings of corresponding source zones. The representative runout distance inventory model of the validation site matched that of a nearby site with an R2 of 0.98, despite inventorying less than a third of the number of rockfalls. This methodology improves upon current approaches and could be tested in other regions with similar climatic and geomorphic settings. These maps and methodology could be used by local and regional government agencies to warn residents of rockfall hazards, inform zoning regulations, and prioritize mitigation efforts.

The acquisition of ECG signals offers physicians and specialists a very important tool in the diagnosis of cardiovascular diseases. However, very often these signals are affected by noise from various sources, including noise generated by movement during physical activity. This type of noise is known as Motion Artifact (MA) which changes the waveform of the signal, leading to erroneous readings. The elimination of this noise is performed by different filtering techniques, where the adaptive filtering using the LMS (least mean squares) algorithm stands out. The objective of this article is to determine which algorithms best deal with motion artifacts, taking into account the use of instruments or wearable equipment, in different conditions of physical activity. A comparison between different algorithms derived from LMS (NLMS, PNLMS and IPNLM) used in adaptive filtering is carried out using indicators such as: Pearson's Correlation Coefficient, Signal to Noise Ratio (SNR) and Mean Squared Error (MSE) as metrics to evaluate them. For this purpose, the mHealth database was used, which contains ECG signals taken during moderate to medium intensity physical activities. The results show that filtering by IPNLMS as well as PNLMS offers an improvement both visually and in terms of SNR, Pearson, and MSE indicators.

Oesophagostomum venulosum es un nematodo gastrointestinal (NGI) que tiene como hospedadores principalmente a los ovinos y caprinos. En Argentina la presencia de este parásito está informada en todas las regiones del país, principalmente en la especie ovina. En el Noroeste Argentino (NOA) está reportado en bovinos y camélidos. El objetivo de este trabajo fue describir por primera vez la presencia de O. venulosum en caprinos de la región del NOA. En marzo de 2023, el Servicio de Diagnóstico Veterinario Especializado INTA Salta, realizó una visita diagnóstica a un establecimiento de cría caprino de raza Criolla, ubicado en las cercanías de la ciudad capital de Salta, Argentina. El motivo de la visita fue por la muerte de una cabra que, según el relato del propietario, previo a su muerte presentó un cuadro de cólico y disnea, con pérdida progresiva de la condición corporal. Ante la sospecha de un cuadro parasitario, se decidió recolectar el tracto digestivo para la determinación de especímenes adultos. Se pudo observar la presencia de Haemonchus contortus en el abomaso, de Trichostrongylus colubriformis en el intestino delgado, y de O. venulosum en el colon. El hallazgo de O. venulosum en caprinos se suma a los informes de dicho NGI en otras especies de animales de interés zootécnico del NOA, y es, hasta nuestros conocimientos, la primera descripción en caprinos a nivel nacional.

El objetivo del presente estudio fue determinar la relación entre la actividad física con el deterioro cognitivo en adultos mayores;esta investigación tiene un enfoque cuantitativo, de diseño no experimental, transversal, de tipo descriptivo y causal que llegó a evaluar a un total de 203 sujetos mediante el cuestionario de Pfeiffer (SPMSQ) y el cuestionario internacional de actividad física IPAQ. Con respecto a los resultados se encontró que, en la actividad física un 33.99% de los evaluados tienen actividad moderada, un 33% tiene actividad alta y un 21.67% tiene actividad baja;en el deterioro cognitivo un 71.43% no cuenta con deterioro, un 16.26% tiene un deterioro leve y un 12.32% tiene un deterioro moderado; en el análisis de regresión se determinó, a un nivel de confianza del 95%, que la actividad física se relaciona con el deterioro cognitivo (p=0.02, p

The present study assessed the impact of using irrigation water contaminated with Azithromycin (AZM) residues on the biomass and antioxidant compounds of purple corn; for this purpose, the plants were cultivated under ambient conditions, and the substrate used consisted of soil free from AZM residues, mixed with compost in a ratio of 1:1 (v/v). The experiment was completely randomized with four replications, with treatments of 0, 1, 10, and 100 μg/L of AZM. The results indicate that the presence of AZM in irrigation water at doses of 1 and 10 μg/L increases the weight of dry aboveground biomass, while at an amount of 100 μg/L, it decreases. Likewise, this study reveals that by increasing the concentration of AZM from 1 to 10 μg/L, total polyphenols and monomeric anthocyanins double, in contrast, with an increase to 100 μg/L, these decrease by 44 and 53%, respectively. It has been demonstrated that purple corn exposed to the antibiotic AZM at low doses has a notable antioxidant function in terms of DPPH and ORAC. The content of flavonols, phenolic acids, and flavanols increases by 57, 28, and 83%, respectively, when the AZM concentration is from 1 to 10 μg/L. However, with an increase to 100 μg/L, these compounds decrease by 17, 40, and 42%, respectively. On the other hand, stem length, root length, and dry weight of root biomass are not significantly affected by the presence of AZM in irrigation water.

BackgroundDengue has emerged as an unprecedented epidemic in Peru, and it is anticipated that this issue will escalate further owing to climate change. This study aimed to determine the risk factors associated with death from dengue in patients treated at Hospital II in Pucallpa, Peru.MethodologyThis retrospective cohort study collected information from the medical records of patients with a diagnosis of dengue treated at Hospital II Pucallpa-Peru between January 2019 and March 2023. The primary outcome was death, and the secondary outcome was death, development of severe dengue, or Intensive Care Unit (ICU) admission. Cox regression models were used to determine risk factors.FindingsThe clinical records of 152 patients were evaluated, with a median age of 27.5 years (interquartile range, 11-45). Among all patients, 29 (19.1%) developed severe dengue, 31 (20.4%) were admitted to the ICU, and 13 (8.6%) died during follow-up. In the survival analysis, bilirubin >1.2 mg/dL was associated with a higher risk of death aHR: 11.38 (95% CI: 1.2 106.8). Additionally, factors associated with poor prognosis included having 1 to 3 comorbidities aRR: 1.92 (1.2 to 3.2), AST ≥251 U/L aRR: 6.79 (2.2 to 21.4), history of previous dengue aRR: 1.84 (1.0 to 3.3), and fibrinogen ≥400 mg/dL aRR: 2.23 (1.2 to 4.1).SignificanceElevated bilirubin was associated with death from dengue, whereas an increase in comorbidities and a history of previous dengue were related to a poor prognosis of the disease. Early identification of severe dengue would be more feasible with improved access to laboratory testing, particularly in tropical areas with a high dengue incidence.

ObjectiveTo assess quality of life and explore its associated factors in a group of patients with chronic kidney disease (CKD) undergoing hemodialysis in Peru.MethodologyWe conducted a cross-sectional analysis of patients with CKD treated at two medical centers in Tacna, Peru; between July and September 2023. We conducted a survey via telephone interviews with eligible patients using the Short Form 36 (SF 36) to assess their quality of life.ResultsOf 257 patients with CKD undergoing hemodialysis, we successfully interviewed 207 (59.9% males, median age: 62 years, median time on hemodialysis: 3.5 years). In the context of the SF-36 assessment, the dimensions with the lowest scores were physical role (mean: 13.9), emotional role (32.2), and physical function (32.4). Regarding the SF-36 summary scores, the average scores were 42.2 in the mental health domain and 32.0 in the physical health domain. In the adjusted model, the physical health domain score was higher in males (β = 2.7) and those with economic self-sufficiency (β = 3.0) and lower in older adults (β = -2.5). The score in the mental health domain was higher in those with a higher level of education (β = 4.1), in those with economic self-sufficiency (β = 3.8), and in those receiving care at one of the centers included (β: 4.2).ConclusionQuality of life was affected, particularly in the realms of physical and emotional well-being. Furthermore, both the physical and mental health domains tend to show lower scores among women, older individuals, those lacking economic self-sufficiency, individuals with lower educational levels, and those with comorbidities.

La llegada de la globalización ha sido caracterizada, sin lugar a dudas, por la creciente invasión de la tecnología y con ello una mayor exigencia a todo nivel de las sociedades, grupos e individuos, a ello es importante añadir la necesidad extrínseca de ciertas habilidades que hoy en día son indispensables en el desarrollo de cualquier sujeto para mantenerse competitivo, ya no solamente a nivel individual, sino también en un ámbito colectivo y una de esas habilidades es saber leer de manera comprensiva. Es en esa dirección que el presente artículo analiza la situación real respecto al desarrollo de la lectura comprensiva de estudiantes de tercero de primaria de la Unidad Educativa “Abraham Flores Velásquez” de la comunidad de Alalay quienes mostraron en el apartado del diagnóstico limitaciones en la comprensión de diferentes textos, donde presentan una lectura deletreada, que difícilmente pueden comprender lo que leen.

Pascalia glauca es una de las plantas tóxicas más importantes de Argentina. A pesar de que se sabe que las cabras son susceptibles a la intoxicación por P. glauca, los informes sobre esta especie son escasos. El objetivo de este trabajo fue caracterizar la intoxicación experimental en cabras con P. glauca. Se dividieron 12 cabras adultas de raza Saanen en 4 grupos en función de la cantidad de planta administrada. Los grupos 1 a 3 ingirieron 4 g/kg, 6 g/kg y 8 g/kg de planta seca respectivamente. El cuarto grupo fue el grupo control y se le ofreció solo heno de alfalfa. Los animales intoxicados fueron inspeccionados cada dos horas y se les tomaron muestras de sangre 6, 12, 24 y 48 horas después de la intoxicación para medir los niveles de enzimas hepáticas. Clínicamente, los grupos 2 y 3 mostraron anorexia, depresión, decúbito, mioclonía, convulsiones y muerte entre 9 y 24 horas después de la intoxicación. Los hallazgos patológicos incluyeron necrosis centrolobulillar con y sin hemorragias. Ambos grupos mostraron una actividad elevada de la aspartato aminotransferasa sérica entre 6 y 24 horas después de la ingestión de P. glauca. El grupo control y el grupo 1 no mostraron signos clínicos ni elevación de enzimas hepáticas a pesar de que fueron controlados durante 15 días después de la intoxicación. Este trabajo permitió obtener más información sobre los aspectos clínicos y patológicos de la intoxicación por P. glauca en cabras.

El objetivo de este trabajo fue evaluar los efectos de la suplementación con proteína y cobre en cabras lecheras naturalmente infectadas con nematodos gastrointestinales (NGI) en el Valle de Lerma, provincia de Salta, Argentina. Se analizaron tres grupos de 10 animales cada uno: GSP (grupo suplementado con 19% de proteína y cobre administrado por vía subcutánea a razón de 0,5 ml por cada 20 kg de peso al inicio del ensayo), GSPD (grupo suplementado con proteína y cobre como GSP y desparasitados mensualmente con Derquantel + Abamectina), y GC (grupo control, sin suplementación ni desparasitación). Se realizaron monitoreos cada 15 días desde principios de marzo de 2021 hasta el parto, a fines de julio de 2021. Además, los animales fueron examinados clínicamente y se determinó su condición de Famacha y corporal. Se examinó hematocrito y proteínas séricas, y se realizaron análisis coprológicos para confirmar y determinar la prevalencia de nematodos y EPG. Luego del parto, se midió la producción diaria de leche de cada animal hasta los 90 días de lactancia. Los géneros NGI prevalentes fueron Haemonchus y Trichostrongylus. En el momento del parto, CG difirió significativamente en el recuento de huevos NGI promedio de GSP y GSPD, con 4035 (±4873.8) para CG, 1225 (±1173.5) para GSP y 983 (±1854.8) para GSPD. En cuanto a los parámetros fisiológicos, el hematocrito fue de 27,7% (±4,4) en GC; 31,7% (±5,1) en GSP y 32% (±3,5) en GSPD; las proteínas séricas totales fueron 4 g/dl (±0,62) en GC, 5,8 g/dl (±0,69) en GSP y 6,2 g/dl (±0,61) en GSPD. La producción de leche en los grupos tratados (GSPD: 167,7 l ± 18,2 l; GSP: 153,3 ± 18,2 l) fue mayor que en el GC (85,7 ± 19,2 l). La suplementación proteica tuvo un efecto positivo sobre los parámetros parasitológicos, fisiológicos y productivos. Bajo las condiciones de este estudio, sería recomendable suplementar a los animales 45 días antes del parto para mejorar el control de NGI y la producción de leche.

Tachycardia-induced cardiomyopathy is an entity characterized by reversible dysfunction of the left ventricle, which can be induced by different types of arrhythmia such as atrial fibrillation, atrial flutter, incessant supraventricular tachycardia and ventricular arrhythmia (more frequent causes). Correct identification of the causative arrhythmia and normalization of the heart rate (e.g through medical treatment, electrical cardioversion, ablation) can lead to recovery of left ventricular function. Tachycardia-induced cardiomyopathy should be suspected in patients with tachycardia and left ventricular dysfunction (heart failure setting), especially when there is no history of previous heart disease. Its usual phenotype is that of non-ischaemic/non-valvular dilated cardiomyopathy and it can occur in both children (main cause: permanent junctional reciprocating tachycardia) and adults (main cause: atrial fibrillation). With proper treatment, most cases recover within a few months, though there is a risk of relapse, especially when the causal arrhythmia reappears or its control is lost. This is a narrative review that comprehensively addresses the pathophysiology, clinical manifestations, and therapeutic management of tachycardia-induced cardiomyopathy. This article is part of the Emerging concepts in heart failure management and treatment Special Issue: https://www.drugsincontext.com/special_issues/emerging-concepts-in-heart-failure-management-and-treatment

El objetivo de este estudio fue comprender como la concentración de los sólidos solubles (Cp) y la temperatura (Tp) afectaron el comportamiento reológico de la pulpa de camu-camu. Los factores de Cp (10 – 20 °Brix) y Tp (30 – 60 °C) se variaron según un diseño factorial 3 × 7 con tres repeticiones. Los frutos maduros de camu-camu mostraron características biométricas de peso (10,81 g), diámetro axial (2,55 cm) y ecuatorial (2,68 cm) antes de ser despulpados. Las características fisicoquímicas de la pulpa fueron: solidos solubles (6,26 °Brix), pH (3,46), humedad (92,56%) y ácido ascórbico (1,78 g/100 g). La concentración de la pulpa se realizó en un rotavapor y las mediciones reológicas fueron evaluadas en un viscosímetro de Brookfield. Los parámetros reológicos ayudaron a calcular el índice de consistencia (K: 11,82 a 69,29 Pa·sn) e índice de flujo (n: 0,303 a 0,347) mediante el modelo de Ley de la Potencia (R2 > 0,99), revelando la naturaleza del adelgazamiento al cizallamiento (comportamiento pseudoplástico). La energía de activación varió de 8,51 a 10,21 kJ/mol. Los resultados reológicos de las pulpas concentradas de camu-camu pueden usarse como parámetro de control de calidad y dimensionamiento de equipos, tuberías, intercambiadores de calor, filtros y bombas.

Abstract This study aimed to understand how adding whole-banana flour (WBF) affected the physicochemical properties of extrudates intended for the development of breakfast flakes. The parameters: WBF addition (50% to 70%, dry basis), feed moisture (27% to 33%, wet basis), and barrel temperature in the last zone of the extruder (80 ºC to 100 °C) were varied according to a 23 factorial design with augmented center points. The addition of WBF linearly affected all the physical and chemical properties evaluated and showed a synergistic effect with barrel temperature for changes in hardness and carbohydrate content. WBF additions above 64.9%, adjusted to feed moisture between 29.6% to 32.6%, and thermomechanically cooked at barrel temperatures above 87 °C, consumed 216 to 257 kJ/kg of mechanical energy, which produced flakes with a hardness between 160 and 180 N. This work could contribute to the incorporation of WBF for developing more nutritious breakfast cereals, with a fiber content greater than 7.2 g/100 g.

ABSTRACT Enterotoxigenic Escherichia coli (ETEC) is one of the leading causes of infant diarrhea in low- and middle-income countries (LMICs). Diarrheal pathogens are transmitted through environmental reservoirs; however, the bacterial clones that spread across the human-environment interface remain unexplored. We aimed to determine the relationship and clonal dissemination of ETEC between children with diarrhea and polluted water samples from a local river in La Paz, Bolivia. By using WGS and the PhenePlates phenotypic system to analyze ETEC strains, we showed that ST218 and ST410 LT+STh ETEC expressing the colonization factor (CF) CS23 were found with high frequency in both samples. The CS23 ETEC isolates were found within several STs, E. coli phylogroups, and across ETEC lineages. Comparative genomic evaluation and PhenePlate screening of globally distributed clinical ETEC strains suggest that the CS23 gene is likely carried on plasmids acquired independently of the bacterial chromosomal background. Clinical strains were more often multidrug-resistant (MDR) than environmental isolates and harbored the class 1 integron-integrase gene intI1 next to the MDR cassettes. Retrospective analysis of antibiotic resistance in ETEC revealed a high frequency of MDR in clinical isolates. The LT+STh CS23 environmental ETEC isolates, showed an increased biofilm ability at environmental temperature, equal cytotoxicity, and significantly lower adherence to human epithelial cells compared to ETEC expressing other CFs. Together, we suggest that CS23 is more prevalent in ETEC than previously estimated, and the Choqueyapu River is a reservoir for LT+STh CS23 ETEC containing strains capable of causing diarrheal cases in children. IMPORTANCE The importance of clean water cannot be overstated. It is a vital resource for maintaining health and well-being. Unfortunately, water sources contaminated with fecal discharges from animal and human origin due to a lack of wastewater management pose a significant risk to communities, as they can become a means of transmission of pathogenic bacteria like enterotoxigenic E. coli (ETEC). ETEC is frequently found in polluted water in countries with a high prevalence of diarrheal diseases, such as Bolivia. This study provides novel insights into the circulation of ETEC between diarrheal cases and polluted water sources in areas with high rates of diarrheal disease. These findings highlight the Choqueyapu River as a potential reservoir for emerging pathogens carrying antibiotic-resistance genes, making it a crucial area for monitoring and intervention. Furthermore, the results demonstrate the feasibility of a low-cost, high-throughput method for tracking bacterial pathogens in low- and middle-income countries, making it a valuable tool for One Health monitoring efforts.

Summary: Background: Cervical cytology remains widely used as the initial tool in cervical cancer screening worldwide. WHO guidelines recommend replacing cytology with primary HPV testing to reach cervical cancer elimination goals. We assessed the performance of cytology and high-risk HPV testing to detect cervical precancer, cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) among women aged 30–64 years participating in the ESTAMPA study. Methods: Women were screened with cytology and HPV across ESTAMPA study centres in Latin America. Screen-positives were referred to colposcopy with biopsy collection and treatment as needed. Those with no evident precancer were recalled at 18-months for a second HPV test to complete disease ascertainment. Performance indicators for cytology and HPV to detect CIN3+ were estimated. Findings: 30,606 participants with available cytology and HPV results were included in the analysis. A total of 440 histologically confirmed CIN3s and 30 cancers were diagnosed. Cytology sensitivity for CIN3+ was 48.5% (95% CI: 44.0–53.0), whereas HPV testing had a sensitivity of 98.1% (95% CI: 96.3–96.7). Specificity was 96.5% (95% CI: 96.3–96.7) using cytology and 88.7% (95% CI: 88.3–89.0) with HPV. Performance estimates varied substantially by study centre for cytology (ranging from 32.1% to 87.5% for sensitivity and from 89.2% to 99.5% for specificity) while for HPV results were more consistent across sites (96.7%–100% and 83.6–90.8%, respectively). Interpretation: The limited and highly variable sensitivity of cytology strongly supports transition to the more robust and reproducible HPV-based cervical screening to ensure progress towards global cervical cancer elimination targets in Latin America. Funding: IARC/WHO, UNDP, HRP/WHO, NCI and local funders.

ABSTRACT The increasing prevalence of antibiotic-resistant bacteria is an emerging threat to global health. The analysis of antibiotic-resistant enterobacteria in wastewater can indicate the prevalence and spread of certain clonal groups of multiresistant bacteria. In a previous study of Escherichia coli that were isolated from a pump station in Norway over 15 months, we found a recurring E. coli clone that was resistant to trimethoprim, ampicillin, and tetracycline in 201 of 3,123 analyzed isolates (6.1%). 11 representative isolates were subjected to whole-genome sequencing and were found to belong to the MLST ST2797 E. coli clone with plasmids carrying resistance genes, including blaTEM-1B, sul2, dfrA7, and tetB. A phenotypic comparison of the ST2797 isolates with the uropathogenic ST131 and ST648 that were repeatedly identified in the same wastewater samples revealed that the ST2797 isolates exhibited a comparable capacity for temporal survival in wastewater, greater biofilm formation, and similar potential for the colonization of mammalian epithelial cells. ST2797 has been isolated from humans and has been found to carry extended spectrum β-lactamase (ESBL) genes in other studies, suggesting that this clonal type is an emerging ESBL E. coli. Collectively, these findings show that ST2797 was more ubiquitous in the studied wastewater than were the infamous ST131 and ST648 and that ST2797 may have similar abilities to survive in the environment and cause infections in humans. IMPORTANCE The incidence of drug-resistant bacteria found in the environment is increasing together with the levels of antibiotic-resistant bacteria that cause infections. The COVID-19 pandemic has shed new light on the importance of monitoring emerging threats and finding early warning systems. Therefore, to mitigate the antimicrobial resistance burden, the monitoring and early identification of antibiotic-resistant bacteria in hot spots, such as wastewater treatment plants, are required to combat the occurrence and spread of antibiotic-resistant bacteria. Here, we applied a PhenePlate system as a phenotypic screening method for genomic surveillance and discovered a dominant and persistent E. coli clone ST2797 with a multidrug resistance pattern and equivalent phenotypic characteristics to those of the major pandemic lineages, namely, ST131 and ST648, which frequently carry ESBL genes. This study highlights the continuous surveillance and report of multidrug resistant bacteria with the potential to spread in One Health settings.