Natural disaster management: experience of an academic institution after a 7.8 magnitude earthquake in Ecuador.

OBJECTIVES: This case study describes the implementation of an academic institution's disaster management plan. STUDY DESIGN: Case study. METHODS: USFQ's Medical School developed a six-phase disaster relief plan consisting of: induction, establishing a base camp, crisis management and mental health aid, creation of multidisciplinary teams and multi-agency teams, and reconstruction. Each phase uses a community-oriented approach to foster survivor autonomy and recovery. RESULTS: Our methodology facilitated the successful implementation of multidisciplinary interventions to manage the earthquake's aftermath on the personal, community and regional levels, treated and prevented psychological and physical morbidity among survivors and promoted healthy living conditions and independence. CONCLUSIONS: A multidisciplinary response team that addresses medical needs, mental health, education, food, nutrition and sanitation is highly effective in contributing to timely, effective relief efforts. The short- and long-term solutions we describe could be applicable to other academic centres' interventions in future disaster scenarios around the world.

Salmonella Typhimurium exhibits fluoroquinolone resistance mediated by the accumulation of the antioxidant molecule H2S in a CysK-dependent manner.

OBJECTIVES: To evaluate the contribution of cysK and cysM to the fluoroquinolone (ofloxacin) antibiotic resistance in Salmonella Typhimurium, and their impact on H2S and cysteine production through targeted mutagenesis. METHODS: Salmonella Typhimurium 14028s and its cysK and cysM mutants were tested for their susceptibility to ofloxacin, as determined by a broth microdilution test (to determine the MIC) and survival curves. H2S levels were measured by the Pb(AC)2 method and cysteine levels were determined using 5,5-dithio-bis-2-nitrobenzoic acid. DNA damage induced by antibiotic treatment was determined by PFGE. Finally, expression of cysK and cysM genes under antibiotic treatment was determined by real-time reverse transcription PCR. RESULTS: As determined by MIC, the ΔcysK strain was more resistant to ofloxacin, a reactive oxygen species (ROS)-producing fluoroquinolone, than the WT and ΔcysM strains, which correlates with survival curves. Moreover, the ΔcysK strain exhibited higher H2S levels and lower cysteine levels than the WT strain. Finally, the ΔcysK strain exhibited lower DNA damage upon challenge with ofloxacin than the WT and ΔcysM strains. These results are in accordance with lower expression of cysK under ofloxacin treatment in the WT strain. CONCLUSIONS: This work demonstrated that cysteine metabolism in Salmonella Typhimurium modulated H2S levels, conferring resistance to second-generation fluoroquinolones.

Clinical correlates and determinants of airway inflammation in pediatric asthma.

BACKGROUND: Airway inflammation is a key component in the pathophysiology of asthma. However, neither its role in the clinical features of asthma nor the factors affecting the degree of inflammation have been fully defined. METHODS: We determined the fractional exhaled nitric oxide concentration (FE(NO)) using a portable device (NIOX-MINO, Aerocrine, Solna, Sweden) in a consecutive sample of 149 asthmatic children aged 6 to 14 years. In order to establish an association with FE(NO), we analyzed symptoms, spirometric parameters before and after a bronchodilator test, and the impact of asthma on quality of life during the previous 4 weeks. We also investigated how clinical variables that regulate inflammation affected FE(NO). RESULTS: In patients not treated with inhaled corticosteroids (ICs), FE(NO) was higher when specific symptoms (wheeze and cough) had been present during the previous 4 weeks; however, we were unable to establish a relationship with symptom frequency, bronchodilator use, asthma crises, hospital admissions, limitation of daily activities, or spirometry results. In patients treated with ICs, FE(NO) was not related to the clinical expression of asthma, except for a reduced ratio of forced expiratory volume in 1 second to forced vital capacity, both before and after bronchodilation. The main determinant of FE level in untreated patients was sensitization to house dust mite. In patients treated with ICs, FE(NO) was only associated with adherence to therapy. CONCLUSION: Airway inflammation, as determined by FE(NO), is only weakly associated with the clinical expression of asthma and spirometry results. Adherence to treatment is the main determinant of the degree of inflammation in patients taking ICs.

[Feasibility of FeNO measurement in asthmatic children in the primary care setting. CANON Study]. / Factibilidad de la medición en atención primaria de la fracción exhalada de óxido nítrico en niños con asma. Estudio CANON.

AIM: Asses the feasibility of exhaled nitric oxide (FeNO) measurement in asthmatic children using a hand-held device in the primary care setting. METHODS: Multicentre study performed in the paediatric clinics in seven Spanish primary health care centres. Each centre consecutively included 6-14 year-old children with doctor-diagnosed asthma. Children were asked to obtain two valid measurements of FeNO with the hand-held device NIOX MINO (Aerocrine AB, Solna, Sweden). Feasibility analysis included: (a) percentage of children able to perform the manoeuvre, (b) time required to obtain a successful determination, (c) number of attempts needed, and (d) acceptability of the technical procedure by clinical personnel involved in their guidance. RESULTS: The Study enrolled 151 children. A total of 149 (98.7%) were able to perform the FeNO manoeuvre. The majority (55%) of children had previous experience of using the hand-held device. The Overall median (and Interquartile Range, IQR) of attempts needed to reach a first valid measurement was 2 (1-3) and median (IQR) of time taken was 4 min (3-5). Nurses considered the overall procedure was very easy or easy in 87.8% (teaching) and 86.5% (performing) of children. Children with previous experience performed the manoeuvre in less attempts, less time and more easily than children without experience. CONCLUSIONS: Measurement of FeNO using NIOX MINO device is technically feasible and acceptable for children and staff in the clinical context of asthma management in primary health care. Previous experience had a positive, learning effect, in teaching and performing the FeNO manoeuvre.

Lose to win: marT pseudogenization in Salmonella enterica serovar Typhi contributed to the surV-dependent survival to H2O2, and inside human macrophage-like cells.

The difference in host range between Salmonella enterica serovar Typhimurium (S. Typhimurium) and Salmonella enterica serovar Typhi (S. Typhi) can be partially attributed to the gain of functions, to the loss of functions (i.e. pseudogenization), or to a combination of both processes. As previously reported, the loss of functions by pseudogenization may play a role in bacterial evolution, especially in host-restricted pathogens such as S. Typhi. The marT-fidL operon, located at the SPI-3, encodes the MarT transcriptional regulator and a hypothetical protein (i.e. FidL) with no significant similarities to known proteins, respectively. Even though predicted S. Typhimurium FidL exhibit 99.4% identity with S. Typhi FidL, marT has been annotated as a pseudogene in S. Typhi. In this work, we found that S. Typhi expressing S. Typhimurium marT-fidL exhibited an increased accumulation of reactive oxygen species (ROS), leading to a decreased survival in presence of H2O2. Moreover, we found that that the presence of a functional copy of S. Typhimurium marT-fidL in S. Typhi resulted in a repression of surV (STY4039), an ORF found in the S. Typhi SPI-3 but absent from S. Typhimurium SPI-3, that contribute to the resistance to H2O2 by decreasing the accumulation of ROS. Finally, we observed that the presence of S. Typhimurium marT-fidL in S. Typhi negatively affected the survival inside macrophage-like cells, but not in epithelial cells, after 24h post infection. Therefore, this work provides evidence arguing that marT pseudogenization in Salmonella Typhi contributed to the surV-dependent survival against H2O2, and inside human macrophage-like cells. This is a good example of how the loss of functions (marT pseudogenization) and the gain of functions (presence of surV) might contribute to phenotypic changes improving virulence.

[Interactions using the Internet among parents and pediatric societies in Spain and the Latin American Pediatric Association]. / Interacción con los padres a través de internet de las sociedades pediátricas españolas y las integradas en la ALAPE.

BACKGROUND: The Internet has revolutionized access to biomedical information among health professionals and the general public. There is demand for pediatric societies to develop quality contents directed at both pediatricians and parents. OBJECTIVE: To evaluate interaction through the Internet among parents and the pediatric societies in Spain and member organizations of the Latin American Pediatric Association. MATERIAL AND METHODS: All the official Spanish pediatric societies (n = 45) and the national organizations belonging to the Latin American Pediatric Association (25) were examined. Societies with their own websites (26 in Spain and 13 in Latin America) were identified. For each website, the following data were collected: size, access to contents, adherence to an ethical code, terms of use, division of contents for pediatricians and those for parents, and means of contact for parents. RESULTS: All the websites provided free access to biomedical information. Only 35 % of websites from Spain and 15.4 % of those from the Latin American Pediatric Association subscribed to an ethical code while 54 % and 84.6 % respectively had no terms of use section. Overall, 46 % had a specific area for parents. The most common means of contact between parents and websites was through electronic mail and 5 % of the sites explicitly accepted online consultations. Only six out of 39 websites fulfilled all the criteria evaluated. CONCLUSIONS: The presence of pediatric societies on the Internet is acceptable, without noteworthy differences between Spanish organizations and member organizations of the Latin American Pediatric Association. In general, interaction with parents is of poor quality.

Características anatómicas del tendón extensor accesorio del dedo anular, procedente del músculo extensor del dedo mínimo / Anatomical characteristics of the accessory extensor tendon of the ring finger, originating from the extensor digiti minimi muscle

El músculo extensor del dedo mínimo es una larga y estrecha lámina muscular que se origina en el epicóndilo lateral del húmero, en el tendón extensor común, insertándose, generalmente, a través de dos cintillas tendinosas, en la expansión extensora del dedo mínimo. A veces, emite un tendón accesorio para el dedo anular.El objetivo del presente estudio fue conocer la incidencia, disposición y trayecto de este tendón accesorio. Se estudiaron 60 piezas de miembros superiores, fijadas en formaldehído al 10 por ciento, correspondientes a cadáveres de individuos brasileños, adultos, de ambos sexos. El tendón accesorio fue encontrado en 7 manos (11,7 por ciento de los casos). La presencia de ese tendón tiene importancia funcional y clínico-quirúrgica, pues en casos de lesiones en el dorso de la mano que afecten a los tendones del músculo extensor de los dedos, este tendón accesorio podría establecerse como una forma alternativa en la recuperación del movimiento de la extensión del dedo anular. Los resultados complementarán el conocimiento anatómico del conjunto de tendones que constituyen el dorso de la mano.

The extensor digiti minimi muscle originates from the posterior aspect of the lateral epicondyle of the humerus from a common tendon for the epicondilar muscles. The muscular belly is long and narrow and runs distally until it joins the ulnar side of a tendon over the radiocarpal articulation. Over the dorsum of the hand, this muscle is represented by a double tendon that insert in the extensor apparatus. Sometimes, these tendons give off an accessory tendon for the ring finger. The objective of this present study was to know the incidence, disposition and course of this accessory tendon. We are study 60 upper limbs from Brazilian adult cadavers of both sexs, fixed in formaldehyde 10%. The accessory tendon of the ring finger was found in 7 hands (11,7% of the cases). The presence of this tendon have functional and surgical importance; in extensor digitorum tendons injuries, this accessory tendon could be an alternative for recuperate the extension movement of the ring finger. Our results will complete the anatomic knowledge over the dorsal tendons of the hand.