Predictors of mortality and clinical characteristics among carbapenem-resistant or carbapenemase-producing Enterobacteriaceae bloodstream infections in Spanish children.

BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) are an emerging problem in the paediatric population worldwide with high mortality rates in bloodstream infection (BSI). OBJECTIVES: To evaluate predictors of 30 day mortality in CRE BSI in a paediatric cohort. METHODS: A retrospective observational single-centre study (December 2005-August 2018) was conducted. Cases of CRE BSI in children 0 to 16 years were included. Microbiological identification (MALDI Biotyper) and antimicrobial susceptibility testing (Vitek2® and MicroScan panel NBC44) according to EUCAST breakpoints were performed. PCR OXVIKP® was used to confirm carbapenemase genes (OXA-48, VIM, KPC, NDM). Demographic characteristics, underlying diseases, source of bacteraemia, antimicrobial therapy and outcomes were collected from medical records. Survival analysis to establish predictors of 30 day mortality was performed. RESULTS: Thirty-eight cases were included; 76.3% were hospital-acquired infections and 23.7% related to healthcare. All patients had at least one underlying comorbidity and 52.6% were recipients of an organ transplant. VIM carbapenemase was the predominant mechanism (92.1%). Previous CRE colonization or infection rate was 52.6%. Intestinal tract (26.3%) and vascular catheter (21.1%) were the most common sources of infection. Crude mortality within 30 days was 18.4% (7/38); directly related 30 day mortality was 10.5%. Conditions associated with an increment in 30 day mortality were intensive care admission and inadequate empirical therapy (P < 0.05). Combination-antibiotic targeted treatment and a low meropenem MIC were not related to improved survival. CONCLUSIONS: CRE BSI mortality rate is high. The most important factor related to 30 day survival in our CRE BSI cohort in children was empirical treatment that included at least one active antibiotic.

Gastrointestinal stromal tumors (GISTs): SEAP-SEOM consensus on pathologic and molecular diagnosis.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the digestive tract, with an incidence of 1.1 cases/100,000 inhabitants/year. A group of experts from the Spanish Society of Pathology and the Spanish Society of Oncology met to discuss a brief update on GISTs and agree on aspects relating to the pathological and molecular diagnosis of these tumors. GISTs are generally solitary, well-circumscribed lesions of variable size (<10 mm-35 cm) that may present with intra- or extra-luminal parietal growth or a mixed-type (hourglass) growth pattern. Histologically, they are unencapsulated neoplasms displaying expansive growth and spindle-shaped (70%), epithelioid (20%), or mixed cellularity (10%). Mitotic activity is generally moderate or low and should be evaluated only in areas with high cellularity or higher mitotic frequency. The great majority of GISTs harbour mutually exclusive activating mutations in genes coding for the type III receptor tyrosine kinases KIT and PDGFRA; less commonly, GISTs have also been reported to display mutations elsewhere, including BRAF and NF1 and SDH-complex genes. The method most widely used to detect KIT and PDGFRA mutations is amplification of the exons involved by polymerase chain reaction followed by direct sequencing (Sanger method) of these amplification products. Molecular analyses should always specify the type of analysis performed, the region or mutations evaluated, and the sensitivity of the detection method employed.

Biological synthesis of fluorescent nanoparticles by cadmium and tellurite resistant Antarctic bacteria: exploring novel natural nanofactories.

BACKGROUND: Fluorescent nanoparticles or quantum dots (QDs) have been intensely studied for basic and applied research due to their unique size-dependent properties. There is an increasing interest in developing ecofriendly methods to synthesize these nanoparticles since they improve biocompatibility and avoid the generation of toxic byproducts. The use of biological systems, particularly prokaryotes, has emerged as a promising alternative. Recent studies indicate that QDs biosynthesis is related to factors such as cellular redox status and antioxidant defenses. Based on this, the mixture of extreme conditions of Antarctica would allow the development of natural QDs producing bacteria. RESULTS: In this study we isolated and characterized cadmium and tellurite resistant Antarctic bacteria capable of synthesizing CdS and CdTe QDs when exposed to these oxidizing heavy metals. A time dependent change in fluorescence emission color, moving from green to red, was determined on bacterial cells exposed to metals. Biosynthesis was observed in cells grown at different temperatures and high metal concentrations. Electron microscopy analysis of treated cells revealed nanometric electron-dense elements and structures resembling membrane vesicles mostly associated to periplasmic space. Purified biosynthesized QDs displayed broad absorption and emission spectra characteristic of biogenic Cd nanoparticles. CONCLUSIONS: Our work presents a novel and simple biological approach to produce QDs at room temperature by using heavy metal resistant Antarctic bacteria, highlighting the unique properties of these microorganisms as potent natural producers of nano-scale materials and promising candidates for bioremediation purposes.

[An immunological approach to acute myeloid leukaemia]. / Aspectos inmunológicos de la leucemia mieloblástica aguda.

INTRODUCTION: Acute myeloid leukaemia (AML) is the second haematological malignancy in the paediatric population, and one of the leading causes of childhood cancer mortality. Survival is currently around 60%, with no improvement in last decades, suggesting that new therapeutic approaches are needed. The anti-leukaemia effect mediated by the lymphocytes and natural killer (NK) cells of the immune system has been established in haematopoietic stem cell transplantation, and also as adoptive immunotherapy after consolidation chemotherapy schemes. PATIENTS AND METHODS: A retrospective study was conducted on the clinical characteristics of patients diagnosed and treated for AML in our centre during 1996-2014. The mean fluorescence intensities of HLA-I, MICA/B and ULBP1-4, ligands for NK cell receptors, were also analysed in ten new diagnosed leukaemia cases, five myeloid and five lymphoid. RESULTS: A total of 67 patients were used in this analysis. With a median follow up of 25 months, the event-free survival was 62% (95% CI: 55-67). Secondary AML, non-M3 phenotype, and the absence of favourable cytogenetic markers had a lower survival. The probability of relapse was 38% (95% CI: 31-45). The expression of HLA-I and ULBP-4 was significantly lower in myeloid than in lymphoid blast cells. CONCLUSIONS: Our clinical results are similar to those described in the literature. Survival did not significantly change in recent decades, and the likelihood of relapse remains high. Myeloid blasts might be more susceptible to the cytotoxicity of NK cells through their lower expression of HLA-I. NK therapy strategies in minimal disease situation could be effective, as reported by other groups.

First report of Trypanosoma evansi in a canine in Argentina.

An Argentinian Dogo which suffered from anorexia, lymphadenopathy, cachexia and paresis of the hind limbs was diagnosed with trypanosomiasis in Argentina in 2013. In this study, we describe the clinical profile and its evolution as well as the molecular method employed to identify and quantify Trypanosoma evansi.

Low-temperature biosynthesis of fluorescent semiconductor nanoparticles (CdS) by oxidative stress resistant Antarctic bacteria.

Bacterial biosynthesis of nanoparticles represents a green alternative for the production of nanostructures with novel properties. Recently, the importance of antioxidant molecules on the biosynthesis of semiconductor fluorescent nanoparticles (quantum dots, QDs) by mesophilic bacteria was reported. The objective of this work was the isolation of psychrotolerant, oxidative stress-resistant bacteria from Antarctica to determine their ability for biosynthesizing CdS QDs at low temperatures. QDs biosynthesis at 15 °C was evaluated by determining their spectroscopic properties after exposing oxidative-stress resistant isolates identified as Pseudomonas spp. to Cd(2+) salts. To characterize the QDs biosynthetic process, the effect of metal exposure on bacterial fluorescence was determined at different times. Time-dependent changes in fluorescence color (green to red), characteristic of QDs, were observed. Electron microscopy analysis of fluorescent cells revealed that biosynthesized nanometric structures localize at the cell periphery. QDs were purified from the bacterial isolates and their fluorescence properties were characterized. Emission spectra displayed classical CdS peaks when excited with UV light. Thiol content, peroxidase activity, lipopolysaccharide synthesis, metabolic profiles and sulfide generation were determined in QDs-producing isolates. No relationship between QDs production and cellular thiol content or peroxidase activity was found. However, sulfide production enhanced CdS QDs biosynthesis. In this work, the use of Antarctic psychrotolerant Pseudomonas spp. for QDs biosynthesis at low temperature is reported for the first time.

[Dual energy CT angiography of the carotid arteries: quality, bone subtraction, and radiation dosage using tube voltage 80/140 kV versus 100/140 kV]. / Energía dual y angioTC de carótidas: calidad, eliminación de hueso y dosis de radiación de 80/140 kV frente a 100/140 kV.

OBJECTIVE: To study the differences in vascular image quality, bone subtraction, and dose of radiation of dual energy CT angiography of the supraaortic trunks using different tube voltages. MATERIAL AND METHODS: We reviewed the CT angiograms of the supraaortic trunks in 46 patients acquired with a 128-slice dual source CT scanner using two voltage protocols (80/140 kV and 100/140 kV). The "head bone removal" tool was used for postprocessing. We divided the arteries into 15 segments. In each segment, we evaluated the image quality of the vessels and the effectiveness of bone removal in multiplanar reconstructions (MPR) and in maximum intensity projections (MIP) with each protocol, analyzing the trabecular and cortical bones separately. We also evaluated the dose of radiation received. RESULTS: Of the 46 patients, 13 were studied using 80/140 kV and 33 with 100/140 kV. There were no significant differences between the two groups in age or sex. Image quality in four segments was better in the group examined with 100/140 kV. Cortical bone removal in MPR and MIP and trabecular bone removal in MIP were also better in the group examined with 100/140 kV. The dose of radiation received was significantly higher in the group examined with 100/140 kV (1.16 mSv with 80/140 kV vs. 1.59 mSv with 100/140 kV). CONCLUSION: Using 100/140 kV increases the dose of radiation but improves the quality of the study of arterial segments and bone subtraction.

[Silicosis: computed tomography findings]. / Silicosis pulmonar: hallazgos radiológicos en la tomografía computarizada.

Silicosis is an occupational lung disease, which is caused by the inhalation of silica and affects a wide range of jobs. There are many clinical forms of silicosis: acute silicosis, results from exposure to very large amounts of silica dust over a period of less than 2 years. Simple chronic silicosis, the most common type that we see today, results from exposure to low amounts of silica between 2 and 10 years. Chronic silicosis complicated, with silicotic conglomerates. In many cases the diagnosis of silicosis is made according to epidemiological and radiological data, without a histological confirmation. It is important to know the various radiological manifestations of silicosis to differentiate it from other lung diseases and to recognize their complications. The objective of this work is to describe typical and atypical radiological findings of silicosis and their complications in helical and high resolution (HRCT) thorax CT.

An experimental approach to studying the effectiveness and safety of meglumine antimoniate formulations.

Among the problems associated to leishmaniasis, the two most outstanding ones are the lack of a vaccine and the adverse effects caused by drugs use for its control. Meglumine antimoniate compounds are the first-line drugs in the treatment for cutaneous leishmaniasis (the most prevalent form of the disease in Colombia); nevertheless, they are far from being ideal drugs due to their toxicity (not to mention the emergence of drug-resistant parasites), all of which has prompted current search for new strategies to improve their safety. This work assesses the effectiveness and safety (toxicity including new aspects related with immunotoxicity not reported previously) of two different meglumine antimoniate formulations using an in vitro and in vivo murine model. The results evidence that although both injectable formulations induce an equally efficient (clearance of intracellular parasites), both give rise to adverse effects, including a preferential immunomodulation on Balb/c mice and in a lesser proportion on ICR mice. These results are comparable to human trials reporting variable reactions when following the same treatment regimen. The model presented herein is proposed as a tool for evaluating the effectiveness and safety of meglumine antimoniate-based antileishmanial formulations.

[Renal oncocytoma. Review of our 22 patients]. / Oncocitoma renal. Revisión de nuestra serie de 22 pacientes.

UNLABELLED: Renal oncocytoma (OR) is a benign tumor. It may represent up to 3-7% of solid kidney masses, and shows specifics cellular and evolutive characteristics. Metacronicity, multifocality and bilateralism has been reported. MATERIALS AND METHODS: Between 1986 and 2005, 478 kidney tumors have been surgically treated at our institution. We report the frequency and characteristics of OR in our patients, compared with renal cell carcinomas (RCC). We try to find out the rate of multifocality, bilateralism and other tumor association, and the number of neoplasms originally diagnosed as OR before surgery. Mean and median follow up: 36.86 and 13 months (1-193). Specific survival rate 100%. RESULTS: We found 24 OR in 10 men and 12 women with a mean age of 59 years (34-84). 12 in the left kidney and 12 in the right one, one patient presenting oncocytomatosis. Tumor mean size was 4.64 cm (1-12.5 cm). Tumors were discovered incidentally in 17 cases. Presentation symptoms in the rest of patients were gross hematuria. CONCLUSIONS: The rate of OR found in our sample population of renal tumors undergoing surgery matches other series already published. Two synchronic OR, but not metacronous, bilateral or metastatic tumors were found. All cases presented a benign evolution.

[Computer-based system for monitoring the course of intraocular inflammation]. / Computergestütztes System zur Verlaufskontrolle intraokularer Entzündungen.

BACKGROUND: Until now, there has been no consistent rating system for changes of intraocular inflammation. We present such a computer-based system. METHODS: This program is based on a FileMaker database. It is made of anterior and posterior uveitis scores on the basis of published evaluation guidelines of the International Ocular Inflammation Society (IOIS). An anterior uveitis score consisting of anterior chamber cells, flare, and perilimbal injection on the one hand and a posterior uveitis score consisting of vitreous haze, macula, and optic nerve head edema on the other hand are calculated. After adding visual acuity, intraocular pressure, and systemic dose of corticosteroids, all parameters can be visualized by a radar graph. RESULTS: This system of documentation is easy to handle and presents a simplified version of the disease course. The abstract visualization enables the patient to better understand the therapeutic management. CONCLUSIONS: The program presented here offers good opportunities for standardized monitoring of the disease course.