Lower respiratory tract microbiome composition and community interactions in smokers.

The lung microbiome impacts on lung function, making any smoking-induced changes in the lung microbiome potentially significant. The complex co-occurrence and co-avoidance patterns between the bacterial taxa in the lower respiratory tract (LRT) microbiome were explored for a cohort of active (AS), former (FS) and never (NS) smokers. Bronchoalveolar lavages (BALs) were collected from 55 volunteer subjects (9 NS, 24 FS and 22 AS). The LRT microbiome composition was assessed using 16S rRNA amplicon sequencing. Identification of differentially abundant taxa and co-occurrence patterns, discriminant analysis and biomarker inferences were performed. The data show that smoking results in a loss in the diversity of the LRT microbiome, change in the co-occurrence patterns and a weakening of the tight community structure present in healthy microbiomes. The increased abundance of the genus Ralstonia in the lung microbiomes of both former and active smokers is significant. Partial least square discriminant and DESeq2 analyses suggested a compositional difference between the cohorts in the LRT microbiome. The groups were sufficiently distinct from each other to suggest that cessation of smoking may not be sufficient for the lung microbiota to return to a similar composition to that of NS. The linear discriminant analysis effect size (LEfSe) analyses identified several bacterial taxa as potential biomarkers of smoking status. Network-based clustering analysis highlighted different co-occurring and co-avoiding microbial taxa in the three groups. The analysis found a cluster of bacterial taxa that co-occur in smokers and non-smokers alike. The clusters exhibited tighter and more significant associations in NS compared to FS and AS. Higher degree of rivalry between clusters was observed in the AS. The groups were sufficiently distinct from each other to suggest that cessation of smoking may not be sufficient for the lung microbiota to return to a similar composition to that of NS.

Validation of the Spanish Acute Cystitis Symptoms Score (ACSS) in native Spanish-speaking women of Europe and Latin America.

INTRODUCTION AND OBJECTIVES: The Acute Cystitis Symptom Score (ACSS) is a patient self-reporting questionnaire for clinical diagnostics and patient-reported outcome (PRO), which may assess the symptoms and the effect on the quality of life in women with acute cystitis (AC). The current study aimed to create a validated Spanish version of the ACSS questionnaire. MATERIAL AND METHODS: The process of linguistic validation of the Spanish version of the ACSS consisted of the independent forward and backward translations, revision and reconciliation, and cognitive assessment. Clinical evaluation of the study version of the ACSS was carried out in clinics in Spain and Latin America. Statistical tests included the calculation of Cronbach's α, split-half reliability, specificity, sensitivity, diagnostic odds ratio, positive and negative likelihood ratio, and area under the receiver-operating characteristic curve (AUC). RESULTS: The study was performed on 132 patients [age (mean;SD) 45.0;17.8 years] with AC and 55 controls (44.5;12.2 years). Cronbach's α of the ACSS was 0.86, and the split-half reliability was 0.82. The summary scores of the ACSS domains were significantly higher in patients than in controls, 16.0 and 2.0 (p < 0.001), respectively. The predefined cut-off point of ≥6 for a summary score of the "Typical" domain resulted in a specificity of 83.6% and a sensitivity of 99.2% for the Spanish version of the ACSS. AUC was 0.91 [0.85; 0.97]. CONCLUSIONS: The validated Spanish ACSS questionnaire evaluates the symptoms and clinical outcomes of patients with AC. It can be used as a patient's self-diagnosis of AC, as a PRO measure tool, and help to rule out other pathologies in patients with voiding syndrome.

Morphological and molecular characterization of the parasite Dipylidium caninum infecting an infant in Colombia: a case report.

BACKGROUND: Dipylidium caninum is the causal agent of dipylidiasis affecting mainly cats and dogs worldwide. Human cases of dipylidiasis are rare, and the diagnosis is prevalently based on morphological features of the parasite. Here we report the diagnosis of dipylidiasis through morphological and molecular characterization of D. caninum infecting an 11-month-old boy in Cajicá, Colombia. METHODS: Fresh faecal samples were obtained from the infant, and morphological identification of the parasite was performed through faecal smears. DNA was extracted from proglottids and used in PCR analyses for amplification of a 653-bp fragment of the nuclear ribosomal RNA (rRNA) encoding the 28S rRNA gene. A phylogeny study to better characterize the obtained DNA sequence was inferred using the maximum likelihood method and the Tamura-Nei model. RESULTS: After morphological and molecular analyses, D. caninum was identified as the etiological agent causing the infection in the infant. Results of phylogenetical analyses showed that the obtained sequence clusters within the feline genotype clade. After the diagnosis of the parasite, effective treatment with praziquantel was administered to the infant. CONCLUSIONS: This is the third human case of dipylidiasis reported in Colombia, and the first study in South America to provide a molecular identification of D. caninum.

Which Antibiotic for Urinary Tract Infections in Pregnancy? A Literature Review of International Guidelines.

Urinary tract infection (UTI) is considered to be a major problem in pregnant women. It is also one of the most prevalent infections during pregnancy, being diagnosed in as many as 50-60% of all gestations. Therefore, UTI treatment during pregnancy is extremely important and management guidelines have been published worldwide to assist physicians in selecting the right antibiotic for each patient, taking into account the maternal and fetal safety profile. A review of the literature was carried out and all international guidelines giving recommendations about antibiotic treatments for pregnancy-related UTI were selected. The search came back with 13 guidelines from 4 different continents (8 from Europe, 3 from South America, 1 from North America and 1 from Oceania). Our review demonstrated concordance between guidelines with regard to several aspects in the antibiotic treatment of UTI during pregnancy and in the follow-up after treatment. Nonetheless, there are some areas of discordance, as in the case of antenatal screening for bacteriuria and the use of fluoroquinolones in lower or upper UTI. Given the current evidence that we have from international guidelines, they all agree on several key points about antibiotic use.

Toward Cleaner Transport Alternatives: Reduction in Exposure to Air Pollutants in a Mass Public Transport.

Commuters are often exposed to higher concentrations of air pollutants due to its proximity to mobile sources. Despite recent trends in urban transport toward zero- and low-tailpipe emission alternatives, the assessments of the impact of these transformations on commuter exposure are limited by the low frequency of such studies. In this work, we use a unique data set of personal exposure concentration measurements collected over the span of 5 years to analyze changes due to the introduction of a new fleet for Bogotá's Bus Rapid Transit System. In that system, over a thousand Euro-II and -III diesel-powered buses were replaced with Euro-VI compressed natural gas and filter-equipped Euro-V diesel buses. We measured personal exposure concentrations of equivalent black carbon (eBC), fine particulate (PM2.5), and ultra fine particles (UFP) during and after the retirement of old buses and the introduction of new ones. Observations collected prior to the fleet renewal were used as baseline and later compared to data collected over two follow-up campaigns in 2019 and 2020. Significant reductions in the concentration of PM2.5 and eBC were observed during the 2019 campaign, with a 48% decrease for mean in-bus eBC (89.9 to 46.4 µg m-3) and PM2.5 (180.7 to 95.4 µg m-3) concentrations. Further reductions were observed during the 2020 follow-up, when the fleet renovation was completed, with mean in-bus eBC decreasing to 17.7 µg m-3 and PM2.5 to 42.3 µg m-3. These observations imply nearly a 5-fold reduction in eBC exposure and a 4-fold decrease in PM2.5. There was a much smaller reduction of in-bus UFP concentration between 2019 and 2020, indicating a persistent presence of high particle number concentrations in the near-road environment despite the fleet renovation process. In-bus UFP concentrations ranged between 65 000 and 104 500 cm-3 during the follow-up campaigns. The results in this work illustrate the immediate benefits of reducing personal exposure through the adoption of vehicles with more stringent emission standards.

[Ibero-latinamerican clinical practical guidelines on pediatric caustic esophagitis: Physiopathology and clinical-endoscopic diagnosis (1st Part)]. / Guía de práctica clínica Ibero-Latinoamericana sobre la esofagitis cáustica en Pediatría: Fisiopatología y diagnóstico clínico-endoscópico (1a Parte).

Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) successive papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.

[Ibero-Latinamerican Clinical Practical Guidelines on pediatric caustic esophagitis: Therapeutical aspects (Part 2)]. / Guía de práctica clínica Ibero-Latinoamericana sobre la esofagitis cáustica en Pediatría: Aspectos terapéuticos (2a. Parte).

Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) separate papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.

Critical-sized mandibular defect reconstruction using human dental pulp stem cells in a xenograft model-clinical, radiological, and histological evaluation.

PURPOSE: This research evaluated clinical, histological, and radiological osseous regeneration in a critical-sized bilateral cortico-medullary osseous defect in model rabbits from New Zealand after receiving a hydroxyapatite matrix and polylactic polyglycolic acid (HA/PLGA) implanted with human dental pulp stem cells (DPSCs). METHODS: Eight New Zealand rabbits with bilateral mandibular critical-sized defects were performed where one side was treated with an HA/PLGA/DPSC matrix and the other side only with an HA/PLGA matrix for 4 weeks. RESULTS: An osseointegration was clinically observed as well as a reduction of 70% of the surgical lumen on one side and a 35% on the other. Histologically, there was neo-bone formation in HA/PLGA/DPSC scaffold and angiogenesis. A bone radiodensity (RD) of 80% was radiologically observed achieving density levels similar to mandibular bone, while the treatment with HA/PLGA matrix achieves RD levels of 40% on its highest peaks. CONCLUSIONS: HA/PLGA/DPSC scaffold was an effective in vivo method for mandibular bone regeneration in critical-sized defects induced on rabbit models.

Guía de práctica clínica Ibero-Latinoamericana sobre la esofagitis cáustica en Pediatría: aspectos terapéuticos (2a. Parte) / Ibero-Latinamerican Clinical Practical Guidelines on pediatric caustic esophagitis: therapeutical aspects (Part 2)

Resumen: La ingestión de cáusticos representa un grave problema médico-social por las consecuencias devastadoras e irreversibles que puede producir en el tracto digestivo superior. En Iberoamérica no se han publicado datos fidedignos sobre la incidencia o la prevalencia de lesiones inducidas por cáusticos. La información disponible sobre la presentación clínica, diagnóstico, tratamiento y pronóstico se basa en series retrospectivas de casos y, de hecho, su manejo clínico se sustenta en muchos casos fundamentalmente en la opinión de expertos. Recientemente como una iniciativa de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (SLAGHNP) y con la co laboración de colegas de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediá trica (SEGHNP), hemos diseñado una Guía de Práctica Clínica (GPC) la cual incluye una serie de enunciados y recomendaciones dirigidos a optimizar la atención a los pacientes y que se basan en la revisión sistemática de la evidencia. En dos (2) manuscritos sucesivos nos hemos enfocado primero, en los aspectos fisiopatológicos y de diagnóstico clínico-endoscópico de la esofagitis cáustica en niños (1a. Parte) y en segundo lugar, en los aspectos más relevantes del tratamiento (2a. Parte). Esperamos esta guía se convierta en una herramienta útil para el clínico en el difícil proceso de toma de decisio nes a la hora de evaluar un paciente posterior a la ingesta de una sustancia cáustica.

Abstract: Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) separate papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.

Guía de práctica clínica Ibero-Latinoamericana sobre la esofagitis cáustica en Pediatría: fisiopatología y diagnóstico clínico-endoscópico (1a Parte) / Ibero-latinamerican clinical practical guidelines on pediatric caustic esophagitis: physiopathology and clinical-endoscopic diagnosis (1st Part)

Resumen: La ingestión de cáusticos representa un grave problema médico-social por las consecuencias devastadoras e irreversibles que puede producir en el tracto digestivo superior. En Iberoamérica no se han publicado datos fidedignos sobre la incidencia o la prevalencia de lesiones inducidas por cáusticos. La información disponible sobre la presentación clínica, diagnóstico, tratamiento y pronóstico se basa en series retrospectivas de casos y, de hecho, su manejo clínico se sustenta en muchos casos fundamentalmente en la opinión de expertos. Recientemente como una iniciativa de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (SLAGHNP) y con la co laboración de colegas de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediá trica (SEGHNP), hemos diseñado una Guía de Práctica Clínica (GPC) la cual incluye una serie de enunciados y recomendaciones dirigidos a optimizar la atención a los pacientes y que se basan en la revisión sistemática de la evidencia. En dos (2) manuscritos sucesivos nos hemos enfocado primero, en los aspectos fisiopatológicos y de diagnóstico clínico-endoscópico de la esofagitis cáustica en niños (1a. Parte) y en segundo lugar, en los aspectos más relevantes del tratamiento (2a. Parte). Esperamos esta guía se convierta en una herramienta útil para el clínico en el difícil proceso de toma de decisio nes a la hora de evaluar un paciente posterior a la ingesta de una sustancia cáustica.

Abstract: Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) successive papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.

Attitudes and misconceptions towards sharks and shark meat consumption along the Peruvian coast.

Misconceptions, lack of knowledge, and negative attitudes towards sharks act as barriers preventing actions required to tackle threats to shark populations, limiting the success of global shark conservation initiatives. Peru, a major player for the international trade of shark products, recently approved the 'National Action Plan for the Conservation and Management of Sharks, Rays and Chimaeras' (PAN-Tib); a guiding document for conservation initiatives aimed at these fishes. Within PAN-Tib, the assessment of Peruvians' current knowledge and attitudes towards sharks is listed as a research priority. Between June and October 2016, 2004 Peruvians were surveyed along the coast to characterize their (i) shark meat consumption patterns, and (ii) knowledge and attitudes towards sharks. Results suggest that shark meat consumption is extended, but not necessarily frequent, and higher in the northern regions of the country. However, 77.5% of shark meat consumers were unaware that they had eaten sharks. Although 57.6% of the participants recognized that sharks are present in Peruvian waters, only 19.4% of the surveyed population was capable of naming at least one local shark species. Moreover, Peruvians have very negative attitudes towards sharks. They fear them and view them as man-eaters, despite this, no shark attacks have ever been reported in the country. These results highlight the need to: (i) encourage sustainable shark meat consumption, and (ii) promote communication campaigns aimed at increasing knowledge about sharks, and their importance as a source of employment and food for coastal communities, as for the national economy.

Microbial "social networks".

BACKGROUND: It is well understood that distinct communities of bacteria are present at different sites of the body, and that changes in the structure of these communities have strong implications for human health. Yet, challenges remain in understanding the complex interconnections between the bacterial taxa within these microbial communities and how they change during the progression of diseases. Many recent studies attempt to analyze the human microbiome using traditional ecological measures and cataloging differences in bacterial community membership. In this paper, we show how to push metagenomic analyses beyond mundane questions related to the bacterial taxonomic profiles that differentiate one sample from another. METHODS: We develop tools and techniques that help us to investigate the nature of social interactions in microbial communities, and demonstrate ways of compactly capturing extensive information about these networks and visually conveying them in an effective manner. We define the concept of bacterial "social clubs", which are groups of taxa that tend to appear together in many samples. More importantly, we define the concept of "rival clubs", entire groups that tend to avoid occurring together in many samples. We show how to efficiently compute social clubs and rival clubs and demonstrate their utility with the help of examples including a smokers' dataset and a dataset from the Human Microbiome Project (HMP). RESULTS: The tools developed provide a framework for analyzing relationships between bacterial taxa modeled as bacterial co-occurrence networks. The computational techniques also provide a framework for identifying clubs and rival clubs and for studying differences in the microbiomes (and their interactions) of two or more collections of samples. CONCLUSIONS: Microbial relationships are similar to those found in social networks. In this work, we assume that strong (positive or negative) tendencies to co-occur or co-infect is likely to have biological, physiological, or ecological significance, possibly as a result of cooperation or competition. As a consequence of the analysis, a variety of biological interpretations are conjectured. In the human microbiome context, the pattern of strength of interactions between bacterial taxa is unique to body site.

Identifying areas of deforestation risk for REDD+ using a species modeling tool.

BACKGROUND: To implement the REDD+ mechanism (Reducing Emissions for Deforestation and Forest Degradation, countries need to prioritize areas to combat future deforestation CO2 emissions, identify the drivers of deforestation around which to develop mitigation actions, and quantify and value carbon for financial mechanisms. Each comes with its own methodological challenges, and existing approaches and tools to do so can be costly to implement or require considerable technical knowledge and skill. Here, we present an approach utilizing a machine learning technique known as Maximum Entropy Modeling (Maxent) to identify areas at high deforestation risk in the study area in Madre de Dios, Peru under a business-as-usual scenario in which historic deforestation rates continue. We link deforestation risk area to carbon density values to estimate future carbon emissions. We quantified area deforested and carbon emissions between 2000 and 2009 as the basis of the scenario. RESULTS: We observed over 80,000 ha of forest cover lost from 2000-2009 (0.21% annual loss), representing over 39 million Mg CO2. The rate increased rapidly following the enhancement of the Inter Oceanic Highway in 2005. Accessibility and distance to previous deforestation were strong predictors of deforestation risk, while land use designation was less important. The model performed consistently well (AUC > 0.9), significantly better than random when we compared predicted deforestation risk to observed. If past deforestation rates continue, we estimate that 132,865 ha of forest could be lost by the year 2020, representing over 55 million Mg CO2. CONCLUSIONS: Maxent provided a reliable method for identifying areas at high risk of deforestation and the major explanatory variables that could draw attention for mitigation action planning under REDD+. The tool is accessible, replicable and easy to use; all necessary for producing good risk estimates and adapt models after potential landscape change. We propose this approach for developing countries planning to meet requirements under REDD+.

Marcadores candidatos, estrategias de cultivo y perspectivas de las DPSCs como terapia celular en odontología / Candidate markers, culture strategies and DPSC perspectives used as cellular therapy in dentistry

La ingeniería tisular basada en las células troncales de pulpa dental se considera como un enfoque prometedor para la odontología regenerativa, con el objetivo final de reemplazar morfológica y funcionalmente los tejidos periodontales y/o los dientes perdidos a través de la síntesis in vitro de sustitutos análogos tisulares o, incluso, de un diente humano denominado biodiente. Las células troncales de la pulpa dental representan una colonia de células adultas que tienen la capacidad de autorrenovación y diferenciación en diferentes linajes. El origen exacto de las células troncales de la pulpa dental no ha sido completamente determinado y estas células troncales parecen ser la fuente de los odontoblastos que contribuyen a la formación del complejo dentinopulpar. Recientemente, los logros obtenidos a partir de la investigación de las células troncales nos han permitido contemplar las posibles aplicaciones terapéuticas de las células troncales de la pulpa dental. Algunos estudios han demostrado que las células troncales de la pulpa dental son capaces de producir tejidos dentales in vivo, incluyendo la dentina, la pulpa dental y las estructuras de la corona. Mientras que otras investigaciones han demostrado que estas células troncales se diferencian in vitro e in vivo, por ejemplo, en osteoblastos, neuroblastos, condrocitos, fibroblastos y endotelio. En teoría, un biodiente sintetizado a partir de las células troncales de la pulpa dental debe ser la mejor opción para recuperar la totalidad de la estructura y función de un diente humano. El objetivo de este artículo de revisión es hacer una breve descripción de la localización, origen, aislamiento y marcadores candidatos de células troncales de pulpa dental, para así plantear las perspectivas de aplicación en la clínica odontológica.

Tissue engineering based on dental pulp stem cells is considered as a promising approach for regenerative dentistry. It purports the final target of morphologically and functionally replacing periodontal tissues and/or lost teeth by means of the in vitro synthesis of tissue-analog substitutes, or even a human tooth (called bio-tooth). Dental pulp stem cells represent a colony of adult cells which have the ability to auto-renovate and differentiate in different lineages. Dental pulp stem cells exact origin has yet to be fully determined; these stem cells seem to be the source of odontoblasts, which contribute to the formation of the dentin-pulp complex. Recently, achievements obtained through research conducted on stem cells, have allowed us to contemplate the possible therapeutic applications of dental pulp stem cells. Some studies have shown that dental pulp stem cells are able to produce in vivo dental tissues, including dental pulp and crown structures. Other research has demonstrated that these stem cells differentiate in vivo and in vitro into osteoblasts, neuroblasts, chondrocytes fibroblasts, and endothelium. In theory, a bio-tooth synthesized from autogenic dental pulp stem cells should be the best option to recover the whole structure and function of a human tooth. The aim of the present review article was to undertake a brief description of the location, origin, isolation and candidate markers of dental pulp stem cells in order to thus present application perspectives to be used in the dental clinic.

Artritis reactiva secundaria a fiebre por mordedura de rata: reporte de un caso clínico / Reactive arthritis secondary to rat-bite fever: report on a clinical case

Caso clínico: Paciente de sexo masculino, de 69 años, sin otros antecedentes. Debuta con dolor en zona de la cadera derecha transitorio, evolucionando con cuadro de seis días de desarrollo de fiebre hasta 39,2ºC, calofríos, artralgias en tarso derecho, rodillas, hombros y astenia, por lo que fue hospitalizado. Al examen destacaba aumento de volumen doloroso en rodilla izquierda y hombro derecho. El estudio de líquido articular descartó artritis infecciosa y presencia de cristales intraarticulares. Los exámenes séricos mostraban parámetros inflamatorios alterados con leucocitosis, VHS y PCR elevados. Panel viral negativo. Sin otro foco inflamatorio evidente, se inició manejo antibiótico empírico con Ceftriaxona y Cloxacilina, con buena respuesta, mejorando su sintomatología y parámetros inflamatorios. Cultivos articulares negativos. El Gram de hemocultivos demostró la presencia de bacilos Gram negativos, aislando en los hemocultivos Streptobacillus moniliformis. El paciente evoluciona favorablemente, con regresión total de su cuadro articular. Discusión y conclusión: La Fiebre por Mordedura de Rata es una enfermedad sistémica que típicamente se presenta con fiebre, rash cutáneo y poliartralgias migratorias. Uno de sus principales agentes causales es el Streptobacillus moniliformis, que coloniza la nasofaringe de ratas y otros roedores. Casos aislados han sido reportados en Chile. En la Fiebre por Mordedura de Rata hasta un 50 por ciento de los pacientes desarrolla artritis con derrame articular o sin él. Puede afectar cualquier articulación, pero la más comúnmente comprometida es la rodilla. El dolor articular disminuye en las primeras tres semanas del uso de antibióticos, pero la articulación en ocasiones puede llegar a ser destruida. En sujetos sanos se han reportado tasas de mortalidad de 10 por ciento a 15 por ciento. Mientras todos los síntomas se resuelven puede haber recaídas con graves complicaciones, como meningitis, endocarditis...

Clinical case: Male patient, 69 years old and no previous record. First episode with transitory pain in the right hip zone, going on to 6 days of fever that evolves to 39.2 ºC, shivers, articular pain in the right tarsus, knees, shoulders and asthenia, so he was hospitalized. Upon examination, painful swellings of the left knee and right shoulder stood out. A study of synovial fluid ruled out infectious arthritis and presence of intra-articular crystals. Blood tests showed altered inflammatory parameters with high leukocytes, VHS and CRP. Negative viral panel. Without another evident inflammatory focus, an empirical management was initiated by means of antibiotics with Ceftriaxone y Cloxaciline, which had a good response relieving symptoms and inflammatory panels. Negative articular culturing. The blood culture Gram showed presence of negative Gram bacilli, with the isolation of Streptobacillus moniliformis in the blood cultures. Patient evolves favorably, with full regression of his articular symptoms. Discussion and conclusion: Rat-bite fever is a systemic sickness that typically presents itself with high fever, skin rash and migratory poly-articular pain. One of its main causing agents is the Streptobacillus moniliformis that colonize the nasopharynx of rats and other rodents. Isolated cases have been reported in Chile. In Rat-bite Fever up to 50 percent of patients develop arthritis with and without joint effusion. It may affect any joint, but that most commonly compromised is the knee. Articular pain subsides in the first 3 weeks of use of antibiotics, but the joint may sometimes even be destroyed. Mortality rates in healthy individuals have been reported at 10 percent to 15 percent. While all symptoms disappear there might be relapses with serious complications such as meningitis, endocarditis, myocarditis, pneumonia and fulminant sepsis that may cause the patient to die. Timely diagnose and treatment are paramount to avoid its serious...

Linfoma testicular: incidencia, descripción epidemiológica y manejo durante el período 2005-2011 / Testicular lymphoma: incidence, epidemiologic description and management during the 2005-2011 period

El linfoma testicular es una patología infrecuente, correspondiendo al 9 por ciento de los cánceres testiculares, presentándose más frecuentemente entre los 60 a 80 años (25-50 por ciento). La presentación clínica más frecuente es el aumento de volumen unilateral e indo/oro. El tipo histológico más común es linfoma difuso de células grandes B (60-90 por ciento). La orquidectomía radical asociada a quimioterapia y radioterapia es la primera línea de tratamiento para los pacientes con enfermedad limitada. Material y método: Estudio retrospectivo descriptivo. Se revisó y filtró la lista de pacientes ingresados al SIGGES como tumor testicular entre enero 2005 a abril 2011. De los pacientes con diagnóstico histológico e inmunohistoquímico compatible, se registraron las características epidemiológicas, estudio, manejo y sobrevida. Posteriormente se realizó un análisis de la base de datos con el programa estadístico SPSS 13. 0. Resultados: De un total de 299 pacientes con el diagnóstico histológico de cáncer testicular, 8 pacientes fueron diagnosticados como linfoma testicular confirmado por histología e inmunohistoquímica. El promedio y mediana de edad fue 52 años y 63 años (18-73) respectivamente. Tres casos (37,5 por ciento) correspondieron a presentaciones secundarias. En 6 de los casos (75 por ciento) el testículo afectado fue el derecho. Histológicamente, el 63 por ciento correspondió a Linfoma difuso de células grande B. Clínicamente, el todos los casos se presentaron con aumento de volumen y con marcadores en rango normal. En 7 casos (8 7, 5 por ciento) el diagnóstico y manejo inicial fue mediante orquidectomía radical, y en un caso por biopsia testicular, con orquidectomía posterior 3 casos presentaron diseminación...

esticular lymphoma is a rare disease, happening in 9 percent of testicular cancers, most commonly between the ages 60 to 80 years (25 percent-50 percent). The most common presentation is unilateral indolent testicular growth. Histology shows a diffuse big B cell lymphoma in most of the cases (60 percent-90 percent). Radical orchiectomy, chemotherapy and radiation are the first line therapy for patients with limited disease. Materials and methods: Retrospective clinical study. We included and filtered the SIGGES list of patients admitted for Testicular Tumor from January 2005 to April 2011. Patients with a compatible diagnosis were analyzed, using SPSS 13.0® as statistical software. Result: Of a total number of 299 testicular cancer patients 8 presented with a histological and inmunnohistochemical testicular lymphoma. Mean age was 52 years and the median 63 years (18-73). ln three cases (37.5 percent) it was a secondary localization. ln 6 cases ( 75 percent) the affected testicle was the right one. 63 percent corresponded to a diffuse big cell B cell Lymphoma. All patients presented normal tumor markers. ln 7 (87,5 percent) cases the initial treatment was radical orchiectomy in one patient the diagnosis was don through a testicular biopsy, and the orchidectomy was differed. 3 cases presented dissemination. In 7 patients adjuvant chemotherapy was performed. Mortal/ty was 38 percent with a 1 7-month follow-up. Conclusion: Testicular lymphoma is a rare condition with bad prognosis. Histology is fundamental for treatment, an in this sense inmunohystochemcal analysis is especially helpful...

Cirugía percutánea renal bilateral simultánea en decúbito supino: experiencia inicial / Percutaneous bilateral renal surgery in supine position: initial experience

La litiasis renal bilateral voluminosa es un desafío quirúrgico para el endourólogo. La cirugía percutánea bilateral simultánea (CPRBS) es una modalidad aceptada, tanto en adultos como niños, sin embargo existe poca literatura al respecto. Presentamos nuestra experiencia de 3 pacientes (6 unidades renales) en posición de Valdivia-Galdakao. Incluimos el primer reporte mundial de un caso de CPRBS tubeless bilateral en de cúbito supino...

Simultaneous bilateral PCNL (SBPCNL) is a safe procedure and can be used effectively in adults as well as in children. In addition to being cost effective, it involves only a single anesthesia with a shorter hospital stay and faster convalescence. We present our initial experience of 3 cases (6 renal units) in supine position. We include the first report to our knowledge of a tubeless SBPCNL in supine position...

Estudio de un brote intrahospitalario por salmonella typhimurium productora de beta-lactamasa de espectro extendido SHV-5 / Study of a hospital outbreak by enlarged SHV-5 spectrum beta-lactamase producing salmonella typhimurium

Antecedentes: Presencia de un brote intrahospitalario de Salmonella typhimurium productora de beta-lactamasas de espectro extendido ocurrido en el Hospital San Bartolome, entre el 17 de febrero y el 6 de marzo del año 2001. Objetivo: Identificar los mecanismos implicados en la transmisión de Salmonella typhimurium y caracterización de los genes asociados a la resistencia en beta-lactámicos. Diseño: Estudio clínico bacteriológico retrospectivo. Lugar: Hospital Nacional Docente Madre Niño (Honadomani) San Bartolomé. Materiales biológicos: Aislamientos bacterianos provenientes de pacientes lactantes. Intervenciones: Se determinó la diversidad genética de cinco aislamientos bacterianos provenientes de pacientes lactantes hospitalizados en la Unidad pediátrica del hospital, utilizando REP-PCR y fingerprint plasmídico. Previamente, se caracterizó la resistencia antimicrobiana, determinando la presencia de beta-lactamasa de espectro extendido mediante la prueba de sinergia de doble disco; la variante fue identificada por PCR secuenciamiento del gen blashv. Principales medidas de resultados: Presencia de genotipos, plásmidos y beta-lactamasa de Salmonella typhimurium. Resultados: Se determinó la presencia de dos genotipos en los aislamientos de Salmonella typhimurium; el caso índice (sensible) presentó un genotipo diferente al de otros aislamientos resistentes pertenecientes a pacientes hospitalizados. Se determinó la presencia en S. typhimurium de un plásmido de peso molecular elevado de tamaño distinto a los de K. pneumoniae, pero probablemente relacionado con una cepa de E. coli intrahospitalaria. Se encontró la beta-lactamasa de espectro extendido SHV- 5 en los aislamientos de S. typhimurium y E. coli. Conclusiones: El estudio sugiere que la diseminación de estas bacterias en los lactantes puede haber sido favorecida por varios factores que habrían intervenido en la transferencia de elementos genéticos responsables de la resistencia antimicrobiana.

Background: An ESBL Salmonella typhimurium outbreak occurred at San Bartolome hospital from February 17 through March 16, 2001. Objectives: To identify the mechanism involved in Salmonella typhimurium spread and genetic characterization of beta-lactamase resistance associated genes. Design: Clinical-bacteriologic retrospective study. Setting: San Bartolomé Mother Child Teaching National Hospital. Biologic materials: Bacterial isolations from lactating patients. Interventions: The genetic diversity was characterized from five bacterial isolates from infants admitted to the pediatric units, using REP-PCR and plasmid fingerprinting. We previously characterized the antimicrobial resistance, determining the presence of ESBL by the double disc diffusion method and the variant was identified by sequencing the gen blashv. Main outcome measures: Salmonella typhimurium genotypes, plasmids and beta-lactamase presence. Results: We found two different genotypes among the Salmonella typhimurium isolates; the index case (susceptible) showed a different genotype and the other isolates coming from hospitalized children were resistant. One of the S. typhimurium plasmids had a heavier molecular weight than K. pneumoniaeÆs but as heavy as the hospital acquired E. coli isolates plasmids. We found the ESBL SHV-5 in both S. typhimurium y E. coli isolates. Conclusions: This report suggests that the bacteria spread among infants could be facilitated by many factors playing different roles in the genetic material transfer responsible of the microbial resistance.

Polymorphism in gene coding for ACE determines different development of myocardial fibrosis in rats.

In humans, the effect of angiotensin-converting enzyme (ACE) gene polymorphisms in cardiovascular disease is still controversial. In the rat, a microsatellite marker in the ACE gene allows differentiation of the ACE gene polymorphism among strains with different ACE levels. We tested the hypothesis that this ACE gene polymorphism determines the extent of cardiac fibrosis induced by isoproterenol (Iso) in the rat. We used a male F(2) generation (homozygous LL and BB ACE genotypes determined by polymerase chain reaction) derived from two rat strains [Brown-Norway (BB) and Lewis (LL)] that differ with respect to their plasma ACE activities. For induction of left ventricular (LV) hypertrophy (LVH) and cardiac fibrosis, rats were infused with Iso (5 mg x kg(-1) x day(-1)) or saline (control) for 10 days and euthanized at day 1 after the last injection. The interstitial collagen volumetric fraction (ICVF), collagen I, and fibronectin content, but not collagen III content, were significantly higher in the homozygous BB rats than in homozygous LL rats. Differences in metalloprotease (MMP)-9, but not in MMP-2 activities as well as in cardiac cell proliferation, were also detected between LL and BB rats treated with Iso. LV ACE activity was higher in BB rats than LL rats and correlated with ICVF (r = 0.61, P < 0.002). No changes were observed in plasma ACE activities, ANG II plasma or LV levels, plasma renin activity, and ACE and ANG II type 1 receptor (AT1R) mRNA levels in the LV of rats with the two different ACE polymorphisms. Iso induced a similar degree of LVH [assessed by an increase in LV weight 100 per body weight, LV-to-right ventricle (RV) ratio, and LV protein content] in LL and BB rats. We concluded that rats in the F(2) generation with high plasma ACE activity developed more fibrosis but to a similar degree of LVH compared with rats with low plasma ACE activity.

Caracterización molecular de Klebsiella pneumoniae y Enterobacter cloacae productoras de ß-lactamasas de espectro extendido tipo SHV-5 en una unidad de cuidados intensivos neonatal de Lima / Molecular characterization of extended-spectrum type SHV-5 ß-Lactamases producing Klebsiella pneumoniae and Enterobacter cloacae in a neonatal intensive care unit in Lima

Objetivo: Determinar los mecanismos implicados en la transmisión y resistencia antimicrobiana de aislamientos hospitalarios de Klebsiella pneumoniae y Enterobacter cloacae. Materiales y métodos: Se determinó la diversidad genética de 10 aislamientos bacterianos provenientes de pacientes hospitalizados y muestras ambientales procedentes de una unidad de cuidados intensivos de neonatos de un hospital de Lima utilizando el patrón de banda de ADN ribosomal y plasmídico. Posteriormente, se caracterizó la resistencia antimicrobiana y sus principales factores utilizando electroforesis de punto isoeléctrico, Southern Blotting y PCR. Finalmente se evaluó la capacidad de transferencia de la resistencia mediante ensayos de conjugación bacteriana. Resultados: Todos los aislamientos de K. pneumoniae y E. cloacae presentaron el mismo perfil plasmídico. Los aislamientos de E. cloacae presentaron un mismo patrón genético, por el contrario se encontraron cuatro genotipos distintos de K. pneumoniae altamente relacionados. Todos los aislamientos produjeron ßlactamasa de especto extendido Tipo SHV-5 transferible a otras especies. Conclusiones: El estudio sugiere que la diseminación de estas bacterias en los neonatos pudo haber sido favorecida por un inadecuado manejo asistencial, una defectuosa conservación de leche para el consumo neonatal y el indiscriminado uso de antibióticos, el cual generó una activa transmisión de genes responsables de la resistencia antimicrobiana