Pan-Genome-Wide Association Study reveals a key role of the salmochelin receptor IroN in the biofilm formation of Salmonella Typhimurium and its monophasic variant 4,[5],12:i:.

Salmonella enterica subsp. enterica serovar Typhimurium variant 4,[5],12:i:- (so called S. 4,[5],12:i:-) has rapidly become one of the most prevalent serovars in humans in Europe, with clinical cases associated with foodborne from pork products. The mechanisms, genetic basis and biofilms relevance by which S. 4,[5],12:i:- maintains and spreads its presence in pigs remain unclear. In this study, we examined the genetic basis of biofilm production in 78 strains of S. 4,[5],12:i:- (n = 57) and S. Typhimurium (n = 21), from human gastroenteritis, food products and asymptomatic pigs. The former showed a lower Specific Biofilm Formation index (SBF) and distant phylogenetic clades, suggesting that the ability to form biofilms is not a crucial adaptation for the S. 4,[5],12:i:- emerging success in pigs. However, using a pan-Genome-Wide Association Study (pan-GWAS) we identified genetic determinants of biofilm formation, revealing 167 common orthologous groups and genes associated with the SBF. The analysis of annotated sequences highlighted specific genetic deletions in three chromosomal regions of S. 4,[5],12:i:- correlating with SBF values: i) the complete fimbrial operon stbABCDE widely recognized as the most critical factor involved in Salmonella adherence; ii) the hxlA, hlxB, and pgiA genes, which expression in S. Typhimurium is induced in the tonsils during swine infection, and iii) the entire iroA locus related to the characteristic deletion of the second-phase flagellar genomic region in S. 4,[5],12:i:-. Consequently, we further investigated the role of the iro-genes on biofilm by constructing S. Typhimurium deletion mutants in iroBCDE and iroN. While iroBCDE showed no significant impact, iroN clearly contributed to S. Typhimurium biofilm formation. In conclusion, the pan-GWAS approach allowed us to uncover complex interactions between genetic and phenotypic factors influencing biofilm formation in S. 4,[5],12:i:- and S. Typhimurium.

Multidrug resistance in Salmonella isolates of swine origin: mobile genetic elements and plasmids associated with cephalosporin resistance with potential transmission to humans.

The emergence of foodborne Salmonella strains carrying antimicrobial resistance (AMR) in mobile genetic elements (MGE) is a significant public health threat in a One Health context requiring continuous surveillance. Resistance to ciprofloxacin and cephalosporins is of particular concern. Since pigs are a relevant source of foodborne Salmonella for human beings, we studied transmissible AMR genes and MGE in a collection of 83 strains showing 9 different serovars and 15 patterns of multidrug resistant (MDR) previously isolated from pigs raised in the conventional breeding system of Northern Spain. All isolates were susceptible to ciprofloxacin and three isolates carried blaCMY-2 or blaCTX-M-9 genes responsible for cefotaxime resistance. Filter mating experiments showed that the two plasmids carrying blaCTX-M-9 were conjugative while that carrying blaCMY-2 was self-transmissible by transformation. Whole-genome sequencing and comparative analyses were performed on the isolates and plasmids. The IncC plasmid pSB109, carrying blaCMY-2, was similar to one found in S. Reading from cattle, indicating potential horizontal transfer between serovars and animal sources. The IncHI2 plasmids pSH102 in S. Heidelberg and pSTM45 in S. Typhimurium ST34, carrying blaCTX-M-9, shared similar backbones and two novel "complex class 1 integrons" containing different AMR and heavy metal genes. Our findings emphasize the importance of sequencing techniques to identify emerging AMR regions in conjugative and stable plasmids from livestock production. The presence of MGE carrying clinically relevant AMR genes raises public health concerns, requiring monitoring to mitigate the emergence of bacteria carrying AMR genes and subsequent spread through animals and food.IMPORTANCEThe emergence of foodborne Salmonella strains carrying antimicrobial resistance (AMR) in mobile genetic elements (MGE) is a significant public health threat in a One Health context. Since pigs are a relevant source of foodborne Salmonella for humans, in this study, we investigate different aspects of AMR in a collection of 83 Salmonella showing nine different serovars and 15 patterns of multidrug resistant (MDR) isolated from pigs raised in the conventional breeding system. Our findings emphasize the importance of sequencing techniques to identify emerging AMR regions in conjugative and stable plasmids from livestock production. The presence of MGE carrying clinically relevant AMR genes raises public health concerns, requiring monitoring to mitigate the emergence of bacteria carrying AMR genes and subsequent spread through animals and food.

Escorbuto una Enfermedad del Pasado en Nuestros Tiempos. A Propósito de un Caso / Scurvy a Disease of the Past in Our Times. About a case

El término escorbuto procede de una palabra del antiguo escandinavo, scorbruck, que significa "hinchazones ulceradas". Es una entidad infrecuente en pediatría, causada por deficiencia nutricional exógena de ácido ascórbico. Los seres humanos, a diferencia de otros seres vivos, no pueden sintetizar la vitamina C y, en consecuencia, dependen estrictamente de su aporte exógeno. El escorbuto puede simular varios desórdenes reumatológicos. Aunque es poco común, puede presentarse como pseudovasculitis o artritis crónica. Para el diagnóstico en pacientes que presentan síntomas músculo esqueléticos se requiere un alto índice de sospecha. Se reporta el caso de un paciente masculino de 9 años que desarrolló la enfermedad por un hábito alimentario selectivo de larga evolución, sin ingesta de frutas ni verduras. El objetivo del presente reporte es alertar al pediatra acerca del desarrollo de escorbuto como potencial consecuencia de las dietas restrictivas, y la importancia de realizar una anamnesis alimentaria completa ante la sospecha diagnóstica

The term scurvy comes from a word from the old Scandinavian, scorbruck, which means ulcerated swellings. Scurvy is an infrequent entity in pediatrics caused by exogenous nutritional deficiency of ascorbic acid. Human beings, unlike other living beings, can not synthesize vitamin C and, consequently, they depend strictly on their exogenous contribution. Scurvy can simulate several rheumatological disorders. Although it is uncommon, it can present as pseudovasculitis or chronic arthritis. A high index of suspicion is required to diagnose patients with musculoskeletal symptoms. We report a case of a 9-year-old male patient who developed the disease due to a long-term selective eating habit, without fruits or vegetables intake. The objective of this report is to alert the pediatrician about the development of scurvy as a potential consequence of restrictive diets, and the importance of performing a complete dietary history to suspect diagnosis

Extensively drug-resistant Pseudomonas Aeruginosa outbreak in a burn unit: management and solutions.

Infections are still the main cause of mortality in burn patients. Multidrug resistant bacteria can cause outbreaks in critical care and burn units. We describe an outbreak of infection by extensively drug-resistant Pseudomonas aeruginosa in the Burn Unit of a University Hospital in Barcelona (Spain) between April and July 2016. A descriptive study of all cases, a bacterial colonization screening of all admitted patients and a microbiological environmental study were performed in order to detect a possible common focus. Contact isolation and cohortization of healthcare workers of all infected or colonized patients were applied. Environmental control measures were instituted for possible sources of infection. The outbreak was caused by a strain of P. aeruginosa only sensitive to colistin. Ten patients were infected or colonized and two of them died. The same strain was detected in several taps and drains in different rooms of the Unit. After applying control measures, changing faucets and drains, carrying out thermal disinfection of the hot water installation of the unit, disinfecting the rooms with ultraviolet radiation and placing antibacterial filtration devices in all the taps among other measures, an effective control of the outbreak was achieved.

Les infections sont toujours une cause majeure de mortalité chez les brûlés. Des épidémies à bactéries multirésistantes (BMR) dans les CTB sont régulièrement rapportées. Nous décrivons une épidémie due à Pseudomonas æruginosa BMR, sensible uniquement à la colimycine, survenue dans le CTB d'un hôpital universitaire de Barcelone entre avril et juillet 2016. Elle a touché 10 patients dont 2 sont morts. Une étude de chaque cas, un dépistage chez tous les entrants et une étude environnementale ont été réalisées, afin de trouver d'éventuelles similitudes. Un isolement contact et un cohorting ont été mis en place. Des mesures de contrôle de l'environnement ont été implémentées. La souche incriminée a été retrouvée dans plusieurs robinets et siphons du service. Cette épidémie a été résolue après, outre les mesures précitées, changement des robinets et des siphons (avec mise en place d'ultrafiltres sur les robinets), choc thermique du réseau d'adduction d'eau, désinfection terminale UV des chambres.

Examining relationships between psychotic experiences and suicidal ideation in adolescents using a network approach.

BACKGROUND: Suicide is one of the leading causes of death in young individuals. Timely and adequate identification of individuals with suicidal ideation could prevent from suicidal behavior. Psychotic experiences (PE) have been shown to increase levels of suicidal ideation (SI) in the general population. Therefore, detailed investigation of the relationship of PE and SI is relevant. However, the exact nature of the relationship between these two phenomena remains unclear. Understanding psychopathology as a complex network of interacting symptoms could be helpful to elucidate specific associations existing between PE and SI. METHOD: A specific type of network analysis, the Ising model, was used to examine connections between dichotomized questions on psychotic experiences and suicidal ideation in a cross-sectional study with 1685 adolescents from the general population aged 13-18 years. RESULTS: SI was mostly connected to the PE domains perceptual anomalies (PA) and bizarre experiences (BE), which have higher strength values in the network. Central nodes within these domains, as indexed by higher centrality measures (strength and betweenness) were: auditory experiences (PA1: hearing voices when you are alone), persecutory ideation (BE1: feelings of being persecuted; BE2: conspiracy against you), and social anxiety (SANX) (SANX1: I cannot get close to people). CONCLUSIONS: Suicidal ideation is differentially connected to specific psychotic experiences. Auditory PE, persecutory ideation, and social anxiety symptoms could play a central role in the interconnectedness of the two constructs.

Relationship between Salmonella infection, shedding and serology in fattening pigs in low-moderate prevalence areas.

Salmonella is a major foodborne pathogen causing important zoonosis worldwide. Pigs asymptomatically infected in mesenteric lymph nodes (MLN) can be intermittent shedders of the pathogen through faeces, being considered a major source of human infections. European baseline studies of fattening pig salmonellosis are based on Salmonella detection in MLN. This work studies the relationship between Salmonella infection in MLN and intestinal content (IC) shedding at slaughter and the relationship between the presence of the pathogen and the serologic status at farm level. Mean Salmonella prevalence in the selected pigs (vertically integrated production system of Navarra, Spain) was 7.2% in MLN, 8.4% in IC and 9.6% in serum samples. In this low-moderate prevalence context, poor concordance was found between MLN infection and shedding at slaughter and between bacteriology and serology. In fact, most of shedders were found uninfected in MLN (83%) or carrying different Salmonella strains in MLN and in IC (90%). The most prevalent Salmonellae were Typhimurium resistant to ACSSuT ± Nx or ASSuT antibiotic families, more frequently found invading the MLN (70%) than in IC (33.9%). Multivariable analysis revealed that risk factors associated with the presence of Salmonella in MLN or in IC were different, mainly related either to good hygiene practices or to water and feed control, respectively. Overall, in this prevalence context, detection of Salmonella in MLN is an unreliable predictor of faecal shedding at abattoir, indicating that subclinical infections in fattening pigs MLN could have limited relevance in the IC shedding.

Lagrangian coherent structure assisted path planning for transoceanic autonomous underwater vehicle missions.

Transoceanic Gliders are Autonomous Underwater Vehicles (AUVs) for which there is a developing and expanding range of applications in open-seas research, technology and underwater clean transport. Mature glider autonomy, operating depth (0-1000 meters) and low energy consumption without a CO2 footprint enable evolutionary access across ocean basins. Pursuant to the first successful transatlantic glider crossing in December 2009, the Challenger Mission has opened the door to long-term, long-distance routine transoceanic AUV missions. These vehicles, which glide through the water column between 0 and 1000 meters depth, are highly sensitive to the ocean current field. Consequently, it is essential to exploit the complex space-time structure of the ocean current field in order to plan a path that optimizes scientific payoff and navigation efficiency. This letter demonstrates the capability of dynamical system theory for achieving this goal by realizing the real-time navigation strategy for the transoceanic AUV named Silbo, which is a Slocum deep-glider (0-1000 m), that crossed the North Atlantic from April 2016 to March 2017. Path planning in real time based on this approach has facilitated an impressive speed up of the AUV to unprecedented velocities resulting in major battery savings on the mission, offering the potential for routine transoceanic long duration missions.

[Transcultural validation in Spanish of the Actionable Bladder Symptoms Screening Tool]. / Validacion transcultural al castellano del Actionable Bladder Symptoms Screening Tool.

INTRODUCTION: Disorders of the lower urinary tract are frequent in patients with multiple sclerosis throughout the course of the disease and reach variable prevalences close to 75%. It is essential to obtain an early diagnosis in the initial phases and to implement an optimal therapeutic management. Burks et al developed the Actionable Bladder Symptoms Screening Tool (ABSST) as a useful screening test in such disorders. Later, Bates et al developed a short version of the ABSST with the objective of minimising the time required to complete it and making it easier to use. AIMS: To carry out the transcultural validation into Spanish of the short version of the ABSST. PATIENTS AND METHODS: The ABSST was translated into Spanish and then back-translated into English, which confirmed the semantic equivalence. A field test was conducted on 40 patients with multiple sclerosis, with two extra questions being included at the end in order to check the comprehension and acceptability of the tool, together with a final item that asked for the time spent on completing it. RESULTS: Forty patients were selected In accordance with the eligibility and exclusion criteria; 67.5% of them were females and the overall mean age was 46.2 years. The rate of comprehension of the test was 100%, and that of acceptability was 97.5%. Results showed that 57.5% obtained scores >= 3, and an average of 5.33 minutes were spent on completing it. CONCLUSIONS: As a brief screening questionnaire for urinary disorders in multiple sclerosis, the ABSST is a useful tool for detecting them at an early stage and has now been validated for use in Spanish.

TITLE: Validacion transcultural al castellano del Actionable Bladder Symptoms Screening Tool.Introduccion. Los trastornos del tracto urinario inferior son frecuentes en pacientes con esclerosis multiple a lo largo del transcurso de la enfermedad y alcanzan prevalencias variables cercanas al 75%. Es primordial realizar un diagnostico precoz en fases tempranas y un abordaje terapeutico optimo. Burks et al elaboraron el Actionable Bladder Symptoms Screening Tool (ABSST) como herramienta de cribado util de dichos trastornos. Posteriormente, Bates et al desarrollaron una version corta del ABSST con el objetivo de minimizar el tiempo de realizacion y facilitar su manejo. Objetivo. Realizar la validacion transcultural al castellano de la version breve del ABSST. Pacientes y metodos. Se realizo la traduccion al castellano del ABSST y una posterior retrotraduccion al ingles que confirmaba su equivalencia semantica. Se llevo a cabo una prueba de campo en 40 pacientes con esclerosis multiple, incluyendo dos preguntas finales para comprobar la comprension y aceptabilidad de la herramienta y un ultimo item que recogia el tiempo empleado para su realizacion. Resultados. Se seleccionaron 40 pacientes conforme a los criterios de inclusion y exclusion; el 67,5% eran mujeres y la media global de edad era de 46,2 años. La comprension del test fue del 100%, y la aceptabilidad, del 97,5%. El 57,5% obtuvo puntuaciones >= 3, y se emplearon 5,33 minutos de media. Conclusiones. El ABSST como cuestionario de cribado breve de trastornos urinarios en la esclerosis multiple es una herramienta util para su deteccion temprana y queda validado para su uso en castellano.

Teaching the basics of echocardiography in the undergraduate: Students as mentors. / Enseñanza de las bases de la ecocardioscopia en el pregrado: los estudiantes como mentores.

OBJECTIVE: To analyse the ability of medical students to incorporate the practical teaching of basic echocardiography planes using a peer mentoring design. METHODOLOGY: Thirty-six medical students previously trained in obtaining echocardiography planes (mentors) taught the other 5th-year students (n=126). The teaching methodology included three stages: theory (online course), basic training (three 15h sessions of practical experience in ultrasound and at least 20 echocardiographic studies per mentor) and objective structured clinical assessment (OSCA), which scored the appropriateness of the basic ultrasound planes and the correct identification of 16 cardiac structures. RESULTS: The students' weighted mean score in the OSCA was 8.66±1.98 points (out of 10). Only 10 students (8.4%) scored less than 5, and 15 (12.6%) scored less than 7. Fifty students (42%) scored 10 points. The most easily identified structure was the left ventricle in the short-axis parasternal plane, with 89.9% of correct answers. The most poorly identified structure was the mitral valve in the subxiphoid plane, with 69.7% of correct answers. CONCLUSIONS: Peer mentoring-based teaching achieves an appropriate level of training in obtaining basic echocardiography planes. The training period is relatively short. The peer mentoring system can facilitate the implementation of teaching on basic aspects of ultrasound to a large number of undergraduate students.

Tuberculosis extrapulmonar con compromiso peritoneal. Reporte de caso clínico y revisión de literatura / Extrapulmonary tuberculosis with peritoneal compromise. Case clinical report and literature review

Extrapulmonary tuberculosis accounts for a significant proportion of tuberculosis cases worldwide (about 20-25% of the cases). Nevertheless, the diagnosis is often delayed or even missed due to insidious clinical presentation and poor performance of diagnostic tests. Peritoneal tuberculosis is due to the infection of Mycobacterium tuberculosis in the peritoneum. It represents 0.7% of total cases of tuberculosis. This disease can mimic malignancy specially in women, because of its clinical presentation with ascites, weight loss and similar radiological sings. The phenomenon of migration, the increased use of immunosuppressive therapy and the epidemic of AIDS have contributed to a resurgence of this disease. We present the clinical case of a Haitian woman who presented ascites, abdominal pain and weight loss with radiological signs that suggested peritoneal carcinomatosis, in which further studies of ascitic fluid showed elevated adenosindeaminase, a specific and sensitive finding for tuberculosis. (AU)

A dynamical systems perspective for a real-time response to a marine oil spill.

This paper discusses the combined use of tools from dynamical systems theory and remote sensing techniques and shows how they are effective instruments which may greatly contribute to the decision making protocols of the emergency services for the real-time management of oil spills. This work presents the successful interplay of these techniques for a recent situation, the sinking of the Oleg Naydenov fishing ship that took place in Spain, close to the Canary Islands, in April 2015.

Consultas ambulatorias pediátricas atendidas en el servicio de urgencia de un hospital universitario / Pediatric outpatient consultation at the emergency department of a university hospital

Introducción: Conocer el perfil epidemiológico de las consultas pediátricas atendidas en el servicio de urgencia (SU) es esencial para planificar los procesos de atención médica y orientar los programas de educación e investigación. Objetivos: Describir las características de la población infantil y los principales motivos de consulta (MC) atendidos en un SU pediátrico. Pacientes y Método: Estudio clínico descriptivo retrospectivo de las visitas realizadas a un SU infantil en un hospital académico de Santiago durante un período de doce meses. Se analizaron los MC por grupo etario, gravedad, estacionalidad, forma de egreso y frecuencia de visitas recurrentes. Resultados: Se evaluaron 24.531 consultas pediátricas, 51,9 por ciento (n = 12.720) eran varones. La edad de los pacientes osciló entre un día y 15 años, con una mediana de 36,5 meses. El 1,5 por ciento de los pacientes (n = 362) eran recién nacidos (RN), 17,6 por ciento (n = 4.326) lactantes, 51,9 por ciento (n = 12.725) preescolares y 29 por ciento (n = 7.118) escolares. Los principales MC fueron fiebre (n = 6.643, 28,2 por ciento), síntomas gastrointestinales (n = 5.606, 23,8 por ciento) y síntomas respiratorios (n = 5.018, 21,3 por ciento), los cuales no difirieron significativamente según género. La mayoría de los pacientes (95,5 por ciento) fueron enviados a su domicilio. El riesgo de hospitalización fue más elevado en los RN y en aquellos que consultaron por ictericia (OR = 7,20; IC 95 por ciento 3,12-16,6), síntomas neurológicos (OR = 6,90; IC 95 por ciento 4,60-10,4) e intoxicaciones (OR = 6,45; IC 95 por ciento 2,82-14,7). Alrededor del 4 por ciento fueron consultas repetidas, especialmente en los RN. Conclusiones: El perfil epidemiológico de las consultas pediátricas atendidas en el SU fue similar al descrito en estudios internacionales. Sin embargo, encontramos una menor tasa de hospitalización a pesar que los pacientes presentaban un perfil de riesgo similar en la admisión al SU.

Introduction: To determine the epidemiological profile of pediatric consultations treated at the emergency department (ED) is essential for planning processes of medical care and to guide education programs and research. Objectives: To describe the characteristics of the child population and the main reasons for consultation (RFC) seen in a pediatric emergency service. Patients and Method: A retrospective, descriptive clinical study was conducted regarding the visits to the Children's Emergency Service of an academic hospital in Santiago, for a period of twelve months. RFC were analyzed by age group, severity, seasonality, disposition and frequency of recurrent visits. Results: 24,531 pediatric consultations were evaluated, 51.9 percent were male (n = 12,720). The age of the patients ranged between one day old and 15 years, with a median age of 36.5 months. 1.5 percent of patients were newborns (NB), 17.6 percent were infants (n = 4,326), 51.9 percent were preschoolers (n = 12,725) and 29 percent were school children (n = 7,118). Major RFC were fever (n = 6,643, 28.2 percent), gastrointestinal symptoms (n = 5,606, 23.8 percent) and respiratory symptoms (n = 5,018, 21.3 percent), which did not differ significantly according to gender. Most patients (95.5 percent) were sent to their homes. The risk of hospitalization was more elevated in NB and in those with jaundice (OR = 7.20, 95 percent CI 3.12 to 16.6), neurological symptoms (OR = 6.90, 95 percent CI 4.60 -10.4) and poisoning (OR = 6.45, 95 percent CI 2.82 to 14.7). About 4 percent were repeat visits, especially in the NB group. Conclusions: The epidemiological profile of pediatric consultations seen at the ED was similar to that described in previous studies. However, a lower rate of hospitalization was found even though the patients had similar risk profile.

Skin conditions in primary care: an analysis of referral demand.

INTRODUCTION: Skin conditions are among the main reasons for seeking primary health care. Primary care physicians (PCPs) must diagnose skin conditions and determine their impact, and must therefore incorporate the relevant knowledge and skills into their education. The present study analyzes the reasons for primary care referral to dermatology (referral demand) as well as diagnostic agreement between PCPs and dermatologists informed by pathology where appropriate. MATERIAL AND METHODS: Data were collected for 755 patients and 882 initial dermatology appointments from February 1, 2012 through April 30, 2012 following primary care referral. Data obtained included age, sex, occupation, reason for referral, primary care diagnosis, and dermatologic diagnosis. Statistical analysis of the data for each diagnosed condition identified frequency, reasons for referral, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the κ statistic for diagnostic agreement. RESULTS: The most common diagnoses were seborrheic keratosis, melanocytic nevus, actinic keratosis, and acne. The main reason for referral was diagnostic assessment (52.5%). For skin tumors, sensitivity of primary care diagnosis was 22.4%, specificity 94.7%, PPV 40.7%, and NPV 88.3%, with a κ of 0.211. For the more common diagnoses, primary care sensitivity was generally low and specificity high. CONCLUSIONS: According to our results, primary care physicians are better qualified to rule out a given skin condition in a patient (high specificity) than to establish an accurate clinical diagnosis (poor sensitivity). This suggests that knowledge and skills training should be organized for primary care physicians to improve management of skin conditions-especially skin cancer, because of its impact. A more responsive system would ensue, with shorter waiting lists and better health care.

Abdominal ultrasound and medical education.

INTRODUCTION: Ultrasound is a very versatile diagnostic modality that permits real-time visualization of multiple internal organs. It is of invaluable help for the physical examination of the patients. AIM: To assess if ultrasound can be incorporated into medical education and if the students can perform a basic abdominal ultrasound examination without the necessity of a long period of training. METHODOLOGY: Twelve medical students were trained in basic abdominal ultrasound during a 15-h training program including a 5-h theoretical and practical course and supervised practice in 20 selected patients. Subsequently, we conducted an evaluation test that assessed the ability of students to obtain the ultrasound views and to detect various pathologies in five different patients. RESULTS: The students were able to correctly identify the abdominal views more than 90% of the times. This percentage was only lower (80%) in the right subcostal view to locate the gallbladder. The accuracy or global efficiency of the ultrasound for the diagnosis of relevant pathological findings of the patients was greater than 90% (91.1% gallstones, abdominal aortic aneurysm 100%; splenomegaly 98.3%, ascites 100%; dilated inferior vena cava 100%; acute urinary retention 100%). CONCLUSION: The ultrasound may be a feasible learning tool in medical education. Ultrasound can help students to improve the physical examination.

[Pediatric outpatient consultation at the emergency department of a university hospital]. / Consultas ambulatorias pediátricas atendidas en el Servicio de Urgencia de un hospital universitario.

INTRODUCTION: To determine the epidemiological profile of pediatric consultations treated at the emergency department (ED) is essential for planning processes of medical care and to guide education programs and research. OBJECTIVES: To describe the characteristics of the child population and the main reasons for consultation (RFC) seen in a pediatric emergency service. PATIENTS AND METHOD: A retrospective, descriptive clinical study was conducted regarding the visits to the Children's Emergency Service of an academic hospital in Santiago, for a period of twelve months. RFC were analyzed by age group, severity, seasonality, disposition and frequency of recurrent visits. RESULTS: 24,531 pediatric consultations were evaluated, 51.9% were male (n=12,720). The age of the patients ranged between one day old and 15 years, with a median age of 36.5 months. 1.5% of patients were newborns (NB), 17.6% were infants (n=4,326), 51.9% were preschoolers (n=12,725) and 29% were school children (n=7,118). Major RFC were fever (n=6,643, 28.2%), gastrointestinal symptoms (n=5,606, 23.8%) and respiratory symptoms (n=5,018, 21.3%), which did not differ significantly according to gender. Most patients (95.5%) were sent to their homes. The risk of hospitalization was more elevated in NB and in those with jaundice (OR=7.20, 95% CI 3.12 to 16.6), neurological symptoms (OR=6.90, 95% CI 4.60 -10.4) and poisoning (OR=6.45, 95% CI 2.82 to 14.7). About 4% were repeat visits, especially in the NB group. CONCLUSIONS: The epidemiological profile of pediatric consultations seen at the ED was similar to that described in previous studies. However, a lower rate of hospitalization was found even though the patients had similar risk profile.

Epidemiology of subclinical salmonellosis in wild birds from an area of high prevalence of pig salmonellosis: phenotypic and genetic profiles of Salmonella isolates.

The epidemiology of subclinical salmonellosis in wild birds in a region of high Salmonella prevalence in pigs was studied. Three hundred and seventy-nine faecal samples from 921 birds trapped in 31 locations nearby pig premises, and 431 samples from 581 birds of 10 natural settings far from pig farms were analysed for the presence of Salmonella spp. Positive samples were serotyped and analysed for antimicrobial resistance (AR). Phage typing and pulsed-field gel electrophoresis (PFGE) on Salmonella Typhimurium isolates were also carried out. The overall proportion of Salmonella-positive samples was 1.85% (95% CI=0.93, 2.77). Salmonella isolation was positively associated with samples collected from birds in the proximity of a pig operation (OR=16.5; 95% CI=5.17, 52.65), and from non-migratory (or short-distance migration) birds (OR=7.6; 95% CI=1.20, 48.04) and negatively related to mostly granivorous birds (OR=0.4; 95% CI=0.15, 1.13). Salmonella Typhimurium was the most prevalent serotype and four different XbaI PFGE patterns were observed that matched the four phage types identified (U310, U311, DT164 and DT56). Only 20% of the strains showed multi-AR. In three farms, a high degree of homogeneity among isolates from different birds was observed. These findings suggested that pig farms may act as amplifiers of this infection among wild birds, and the degree of bird density may have much to do on this transmission. Some of the Salmonella serotypes isolated from bird faeces were of potential zoonotic transmission and associated with AR. Monitoring salmonellosis in wild bird is advised.