Caracterización de infecciones por bacterias productoras de BLEE en un hospital de referencia nacional / Characterization of ESBL-producing bacteria infections on a national referral hospital

La resistencia mediante la producción de betalactamasa de espectro extendido (BLEE) es la resistencia microbiana más común y de importancia en salud pública. Objetivos: Describir las características de las infecciones por bacterias productoras de BLEE en un hospital de referencia nacional. Diseño: Estudio transversal descriptivo. Lugar: Hospital Nacional Daniel Alcides Carrión, Callao, Perú. Materiales: Registros de los cultivos de secreciones realizados en el Laboratorio de Microbiología del HNDAC en el año 2012. Métodos: Se analizó datos del paciente (edad, sexo y servicio del cual se recibió la muestra) y datos de la muestra (fecha de obtención, el tipo de muestra, el microrganismo encontrado, el antibiograma detallado y su calificación como bacteria productora de BLEE). Principales medidas de resultados: Características de las infecciones por bacterias productoras de BLEE. Resultados: Se recolectó 3 149 muestras, 70,9 por ciento (2 235) fueron de mujeres; 29,4 por ciento fueron cultivos positivos para bacterias productoras de BLEE. Los servicios críticos obtuvieron la mayor prevalencia, y los meses donde se encontró mayor presencia fueron abril (34,7 por ciento) y julio (34,7 por ciento). Tanto E. coli (72,4 por ciento) como Klebsiella sp. (20 por ciento) fueron las prevalentes. No se encontró resistencia para imipinem, tanto para E. coli como para Klebsiella sp. Conclusiones: La prevalencia fue similar a la de América Latina (34,6 por ciento). Se presenta más evidencias de una alta presencia en consulta externa y en mayores de 46 años; siendo así un problema de salud pública...

Resistance by extended-spectrum beta-lactamase (ESBL) is the most common antimicrobial resistance and of public health importance. Objectives: To describe ESBL producing bacteria characteristics in a national reference hospital. Design: Cross sectional, descriptive study. Setting: Hospital Nacional Daniel Alcides Carrión, Callao, Peru. Materials: Records of secretion cultures done in the hospital Laboratory of Microbiology during 2012. Methods: Patient data (age, sex and service from which the sample was received) and sample data (date of collection, sample type, microorganism found, sensitivity and detailed classification as ESBLproducing bacteria) were analyzed. Main outcome measures: Characteristics of infections by ESBL-producing bacterias. Results: Study included 3 149 samples, 70.9 per cent (2 235) from female patients; 29.4 per cent were cultures positive for ESBL-producing bacteria. Critical services had the highest prevalence, and months with highest occurrence were April (34.7 per cent) and July (34.7 per cent). Both, E. coli (72.4 per cent) and Klebsiella sp. (20.0 per cent) were the most prevalent. No imipinem resistance was found for E. coli or Klebsiella sp. Conclusions: The prevalence was similar to that of Latin America (34.6 per cent). More evidence of high prevalence in outpatients and patients over 46 year-old is presented, considering it a public health problem...

Functions of nonmuscle myosin II in assembly of the cellular contractile system.

The contractile system of nonmuscle cells consists of interconnected actomyosin networks and bundles anchored to focal adhesions. The initiation of the contractile system assembly is poorly understood structurally and mechanistically, whereas system's maturation heavily depends on nonmuscle myosin II (NMII). Using platinum replica electron microscopy in combination with fluorescence microscopy, we characterized the structural mechanisms of the contractile system assembly and roles of NMII at early stages of this process. We show that inhibition of NMII by a specific inhibitor, blebbistatin, in addition to known effects, such as disassembly of stress fibers and mature focal adhesions, also causes transformation of lamellipodia into unattached ruffles, loss of immature focal complexes, loss of cytoskeleton-associated NMII filaments and peripheral accumulation of activated, but unpolymerized NMII. After blebbistatin washout, assembly of the contractile system begins with quick and coordinated recovery of lamellipodia and focal complexes that occurs before reappearance of NMII bipolar filaments. The initial formation of focal complexes and subsequent assembly of NMII filaments preferentially occurred in association with filopodial bundles and concave actin bundles formed by filopodial roots at the lamellipodial base. Over time, accumulating NMII filaments help to transform the precursor structures, focal complexes and associated thin bundles, into stress fibers and mature focal adhesions. However, semi-sarcomeric organization of stress fibers develops at much slower rate. Together, our data suggest that activation of NMII motor activity by light chain phosphorylation occurs at the cell edge and is uncoupled from NMII assembly into bipolar filaments. We propose that activated, but unpolymerized NMII initiates focal complexes, thus providing traction for lamellipodial protrusion. Subsequently, the mechanical resistance of focal complexes activates a load-dependent mechanism of NMII polymerization in association with attached bundles, leading to assembly of stress fibers and maturation of focal adhesions.

West Indian Ocean variability and East African fish catch.

We describe marine climate variability off the east coast of Africa in the context of fish catch statistics for Tanzania and Kenya. The time series exhibits quasi-decadal cycles over the period 1964-2007. Fish catch is up when sea surface temperature (SST) and atmospheric humidity are below normal in the tropical West Indian Ocean. This pattern relates to an ocean Rossby wave in one phase of its east-west oscillation. Coastal-scale analyses indicate that northward currents and uplift on the shelf edge enhance productivity of East African shelf waters. Some of the changes are regulated by the south equatorial current that swings northward from Madagascar. The weather is drier and a salty layer develops in high catch years. While the large-scale West Indian Ocean has some impact on East African fish catch, coastal dynamics play a more significant role. Climatic changes are reviewed using 200 years of past and projected data. The observed warming trend continues to increase such that predicted SST may reach 30 degrees C by 2100 while SW monsoon winds gradually increase, according to a coupled general circulation model simulation with a gradual doubling of CO(2).

Rearrangements of the actin cytoskeleton and E-cadherin-based adherens junctions caused by neoplasic transformation change cell-cell interactions.

E-cadherin-mediated cell-cell adhesion, which is essential for the maintenance of the architecture and integrity of epithelial tissues, is often lost during carcinoma progression. To better understand the nature of alterations of cell-cell interactions at the early stages of neoplastic evolution of epithelial cells, we examined the line of nontransformed IAR-2 epithelial cells and their descendants, lines of IAR-6-1 epithelial cells transformed with dimethylnitrosamine and IAR1170 cells transformed with N-RasG12D. IAR-6-1 and IAR1170 cells retained E-cadherin, displayed discoid or polygonal morphology, and formed monolayers similar to IAR-2 monolayer. Fluorescence staining, however, showed that in IAR1170 and IAR-6-1 cells the marginal actin bundle, which is typical of nontransformed IAR-2 cells, disappeared, and the continuous adhesion belt (tangential adherens junctions (AJs)) was replaced by radially oriented E-cadherin-based AJs. Time-lapse imaging of IAR-6-1 cells stably transfected with GFP-E-cadherin revealed that AJs in transformed cells are very dynamic and unstable. The regulation of AJ assembly by Rho family small GTPases was different in nontransformed and in transformed IAR epithelial cells. As our experiments with the ROCK inhibitor Y-27632 and the myosin II inhibitor blebbistatin have shown, the formation and maintenance of radial AJs critically depend on myosin II-mediated contractility. Using the RNAi technique for the depletion of mDia1 and loading cells with N17Rac, we established that mDia1 and Rac are involved in the assembly of tangential AJs in nontransformed epithelial cells but not in radial AJs in transformed cells. Neoplastic transformation changed cell-cell interactions, preventing contact paralysis after the establishment of cell-cell contact and promoting dynamic cell-cell adhesion and motile behavior of cells. It is suggested that the disappearance of the marginal actin bundle and rearrangements of AJs may change the adhesive function of E-cadherin and play an active role in migratory activity of carcinoma cells.

Comparative dynamics of retrograde actin flow and focal adhesions: formation of nascent adhesions triggers transition from fast to slow flow.

Dynamic actin network at the leading edge of the cell is linked to the extracellular matrix through focal adhesions (FAs), and at the same time it undergoes retrograde flow with different dynamics in two distinct zones: the lamellipodium (peripheral zone of fast flow), and the lamellum (zone of slow flow located between the lamellipodium and the cell body). Cell migration involves expansion of both the lamellipodium and the lamellum, as well as formation of new FAs, but it is largely unknown how the position of the boundary between the two flow zones is defined, and how FAs and actin flow mutually influence each other. We investigated dynamic relationship between focal adhesions and the boundary between the two flow zones in spreading cells. Nascent FAs first appeared in the lamellipodium. Within seconds after the formation of new FAs, the rate of actin flow decreased locally, and the lamellipodium/lamellum boundary advanced towards the new FAs. Blocking fast actin flow with cytochalasin D resulted in rapid dissolution of nascent FAs. In the absence of FAs (spreading on poly-L-lysine-coated surfaces) retrograde flow was uniform and the velocity transition was not observed. We conclude that formation of FAs depends on actin dynamics, and in its turn, affects the dynamics of actin flow by triggering transition from fast to slow flow. Extension of the cell edge thus proceeds through a cycle of lamellipodium protrusion, formation of new FAs, advance of the lamellum, and protrusion of the lamellipodium from the new base.

Controlling cell length.

Control of cell dimensions is an important but poorly understood aspect of morphogenesis. In this review, our primary focus is on control of cell length in different types of cells and cytoskeletal regulation of this parameter. Cell length is not a constant characteristic of certain cell type but of cells of fibroblastic morphology. Since cytoskeleton organization can change during different processes of morphogenesis changes in length control during cell spreading, epithelio-mesenchymal transformation and also in neoplastic transformation are discussed.

Regulation of polarity in cells devoid of actin bundle system after treatment with inhibitors of myosin II activity.

Interplay of two cytoskeletal systems--microfilaments and microtubules is essential for directional cell movement. To better understand the role of those cytoskeletal systems in polarization of cells, rat fibroblasts were incubated with drugs inhibiting activity of myosin II: blebbistatin and Y-27632. Both drugs led to disappearance of actin-myosin bundles and mature focal cell-matrix adhesions but did not affect polarization and directional motility. The rate of motility even increased after inhibitor treatment. The characteristic feature of inhibitor-treated fibroblasts was collapse of the cytoplasm accompanied by bundling of microtubules that led to transformation of lamellae into long immobile tails. The only exception was the leading anterior lamella which was not transformed into the tail and supported directional movement of the cell. The tail at the cell rear determined the position of anterior lamella and direction of locomotion. Depolymerization of microtubules by colcemid stopped directional locomotion of inhibitor-treated cells. These data show that integrity of the microtubular system provides the basic mechanism of polarization and orientation which is only modified by interactions with actin-myosin system and cell-substrate adhesions. We suggest that the position of bundled tail microtubules and dispersed microtubules in leading lamella determine polarization in cells lacking stress fibers and focal adhesions. Thus, polarization is based on microtubule-dependent mechanisms both in non-contractile and contractile cells. These mechanisms could switch dependent on circumstances as fibroblasts may acquire non-contractile phenotype, not only after direct inhibition of myosin II but also in certain conditions of microenvironment.

Correlations of geographic distribution and temperature of embryonic development with the nuclear DNA content in the Salamandridae (Urodela, Amphibia).

We used flow cytometry to measure the nuclear DNA content in erythrocytes of 27 salamandrid species. Across these species, diploid genome size varied more than 2 fold (51.3-104.4 pg). According to genome size and geographic distribution, 3 groups of newt species were recognized: West Palearctics with smaller amounts of nuclear DNA; Nearctic, with intermediate values; and East Asiatic, with higher genome sizes. Viviparous West Palearctic salamanders differed from most of the oviparous West Palearctic newts in possessing larger genome sizes. The nuclear DNA content strongly correlates with species range limits. At the same temperature, embryos of salamandrid species with larger genome sizes have a markedly longer developmental time than those with smaller genomes. We present an analysis of the relationships between the amount of nuclear DNA and water temperature at the breeding sites.

Transformation by RAS oncogene decreases the width of substrate-spread fibroblasts but not their length.

We compared morphometric parameters of the contours of cells in four pairs of non-transformed mouse and rat lines and of the same lines transformed by oncogenes of the RAS family. As expected, the mean areas of all RAS-transformed lines were much smaller than those of their non-transformed counterparts. At the same time the average length of cell projection did not regularly decrease after transformation. These results show that transformation induced by expression of RAS oncogene selectively affect only one component of spreading, namely transversal spreading and not longitudinal spreading; these changes result in an increase of antero-posterior polarity of transformed fibroblasts.

ROS up-regulation mediates Ras-induced changes of cell morphology and motility.

Expression of activated Ras causes an increase in intracellular content of reactive oxygen species (ROS). To determine the role of ROS up-regulation in mediation of Ras-induced morphological transformation and increased cell motility, we studied the effects of hydrogen peroxide and antioxidant NAC on morphology of REF52 rat fibroblasts and their ability to migrate into the wound in vitro. Treatment with low dosages of hydrogen peroxide leading to 1.5- to 2-fold increase in intracellular ROS levels induced changes of cell shape, actin cytoskeleton organization, cell adhesions and migration resembling those in Ras-transformed cells. On the other hand, treatment with NAC attenuating ROS up-regulation in cells with conditional or constitutive expression of activated Ras led to partial reversion of morphological transformation and decreased cell motility. The effect of ROS on cell morphology and motility probably results from modulation of activity of Rac1, Rho, and cofilin proteins playing a key role in regulation of actin dynamics. The obtained data are consistent with the idea that ROS up-regulation mediates two key events in Ras-induced morphological transformation and cell motility: it is responsible for Rac1 activation and is necessary (though insufficient) for realization of Ras-induced cofilin dephosphorylation.

Cytoskeletal mechanisms responsible for invasive migration of neoplastic cells.

Cytoskeletal reorganizations, especially alterations of contractile tension generated by the actin-myosin cortex, are of central importance in the development of the phenotype of morphologically transformed neoplastic cells with invasive behavior. These reorganizations can be regarded as genetically determined aberrations of the physiological reactions of normal cells which are responsible for their ability to undergo exploratory migrations, including epithelio-mesenchymal transformations, invasion of matrix by epithelial tubules etc. It is suggested that these physiological and neoplastic transformations are based on Rho-dependent alterations in contractility. A decrease or an increase in contractility may result in the development of distinct types of invasive phenotypes. These contractility-dependent phenotype alterations may be modified by alterations in the expression of other genes, especially of those coding for components of adhesive structures.

Length control is determined by the pattern of cytoskeleton.

In our previous experiments with linear strips of adhesive substrate, we found that elongated cultured fibroblasts preserve their length regardless of cell width and the number of cytoplasmic processes. This constancy of length was called 'length control'. In contrast to fibroblasts, single cultured epitheliocytes have nearly discoid shape on the plane substrata and have no length-controlling mechanism: their length on the narrow strips of adhesive substrate increased significantly in comparison with the diameter on the plane substrate. These results suggested that control of length is cell specific. An alternative suggestion is that length control is associated not with the cell type but with the cell cytoskeletal pattern (namely, with epithelioid circular actin bundles or straight actin bundles). Experiments described in this paper were made to choose between these two suggestions. Mouse embryo fibroblasts spreading on the planar substrate first acquire discoid epithelioid shape with a circular actin bundle. Only later did they acquire a polarized shape with straight actin bundles. Polarized, fully spread fibroblasts temporarily acquire discoid epithelioid shape when treated with the Taxol, disorganizing microtubules. However, epithelial discoid cells can be transformed into elongated fibroblast-like cells by scatter factor (HGF/SF; a cytokine) and by agents inhibiting Rho kinase. These reversible transitions from fibroblastic to epithelioid shape and vice versa were accompanied by a corresponding disappearance and appearance of length control. Fibroblasts with stress fibers destroyed by the Rho-kinase inhibitor Y27632 became considerable longer on the adhesive strips than on the plane while retaining a near-polarized shape. Thus, length control is typical not of the cell origin but of the cell phenotype (i.e. for polarized cells with microtubules and intact actin cytoskeleton).

Thread-grain transition of mitochondrial reticulum as a step of mitoptosis and apoptosis.

Association of mitochondrial population to a mitochondrial reticulum is typical of many types of the healthy cells. This allows the cell to organize a united intracellular power-transmitting system. However, such an association can create some difficulties for the cell when a part of the reticulum is damaged or when mitochondria should migrate from one cell region to another. It is shown that in these cases decomposition of extended mitochondria to small roundish organelles takes place (the thread-grain transition). As an intermediate step of this process, formation of beads-like mitochondria occurs when several swollen parts of the mitochondrial filament are interconnected with thin thread-like mitochondrial structures. A hypothesis is put forward that the thread-grain transition is used as a mechanism to isolate a damaged part of the mitochondrial system from its intact parts. If the injury is not repaired, spherical mitochondrion originated from the damaged part of the reticulum is assumed to convert to a small ultracondensed and presumably dead mitochondrion (this process is called 'mitoptosis'). Then the dead mitochondrion is engulfed by an autophagosome. Sometimes, an ultracondensed mitoplast co-exists with a normal mitoplast, both of them being surrounded by a common outer mitochondrial membrane. During apoptosis, massive thread-grain transition is observed which, according to Youle et al. (S. Frank et al., Dev Cell 1: 515, 2002), is mediated by a dynamin-related protein and represents an obligatory step of the mitochondria-mediated apoptosis. We found that there is a lag phase between addition of an apoptogenic agent and the thread-grain transition. When started, the transition occurs very fast. It is also found that this event precedes complete de-energization of mitochondria and cytochrome c release to cytosol. When formed, small mitochondria migrate to (and in certain rare cases even into) the nucleus. It is suggested that small mitochondria may serve as a transportable form of organelles ('cargo boats' transporting some apoptotic proteins to their nuclear targets).

Mechanism of filopodia initiation by reorganization of a dendritic network.

Afilopodium protrudes by elongation of bundled actin filaments in its core. However, the mechanism of filopodia initiation remains unknown. Using live-cell imaging with GFP-tagged proteins and correlative electron microscopy, we performed a kinetic-structural analysis of filopodial initiation in B16F1 melanoma cells. Filopodial bundles arose not by a specific nucleation event, but by reorganization of the lamellipodial dendritic network analogous to fusion of established filopodia but occurring at the level of individual filaments. Subsets of independently nucleated lamellipodial filaments elongated and gradually associated with each other at their barbed ends, leading to formation of cone-shaped structures that we term Lambda-precursors. An early marker of initiation was the gradual coalescence of GFP-vasodilator-stimulated phosphoprotein (GFP-VASP) fluorescence at the leading edge into discrete foci. The GFP-VASP foci were associated with Lambda-precursors, whereas Arp2/3 was not. Subsequent recruitment of fascin to the clustered barbed ends of Lambda-precursors initiated filament bundling and completed formation of the nascent filopodium. We propose a convergent elongation model of filopodia initiation, stipulating that filaments within the lamellipodial dendritic network acquire privileged status by binding a set of molecules (including VASP) to their barbed ends, which protect them from capping and mediate association of barbed ends with each other.

Auditory and vestibular sequelae to traumatic brain injury: a pilot study.

AIM: To investigate the incidence of persisting auditory and vestibular sequelae in a group of 30 young adults recovering from Traumatic Brain Injury (TBI). METHODS: 30 participants, aged 21-45 years, with TBI suffered 19 months to 27 years previously, underwent a semi-structured interview and pure-tone hearing test in their home. Participants who failed the hearing screen then undertook a more comprehensive audiological evaluation. RESULTS: A variety of sequelae to TBI were reported. These were interpreted as tinnitus (53%), vestibular dysfunction (83%), abnormal facial sensory symptoms (27%) and intolerance to loud/sudden noises (87%). Ten (33%) participants demonstrated significant sensorineural hearing impairment in addition to speech recognition performance significantly worse than would have been predicted from their hearing impairment. CONCLUSIONS: Findings from this study will be of benefit to health professionals working in this area of rehabilitation as they seek to provide functional assessments and devise programmes to treat the often devastating auditory processing problems of people recovering from TBI.

Coastal dispersion conditions near the southwestern tip of Africa: a system for evaluation and prediction.

A system is presented to monitor the local meteorology and to predict the dispersion of effluents from a nuclear power station situated on the coast near the southwestern tip of Africa. A computerized weather station forms the basis of the system and provides spatial definition of wind profiles and dispersion indices near the coastal interface by interpolation between a sensor array. The meteorological system measures winds, temperature structure and turbulence indices at the 10-m level at five remote points and in the 10- to 80-m layer at the main coastal station. To provide a system for evaluation and prediction of effluent trajectories, a real-time three-dimensional puff dispersion model was developed. The meteorology input to the model is automatically verified and updated at 15-min intervals. Model results are presented under complex weather conditions to show how time and space changes in the local wind field are handled. To assist weather forecasters supporting the nuclear emergency plan, a simple tabular display enables a view of the dispersion climatology over 24-h (coastal) and 7-d (synoptic) cycles. These results are presented to contrast the different scales of circulation and for comparison within the nuclear industry to assist health physicists in deciding appropriate levels of meteorological support for emergency plans.