Assessment of the main pathogens associated with clinical and subclinical endometritis in cows by culture and MALDI-TOF mass spectrometry identification.

Clinical endometritis (CE) and subclinical endometritis (SCE) are diseases that affect dairy cows during the puerperium, causing negative effects on the animals' milk production and fertility. The objective of this study was to assess the main bacteria related to cases of CE and SCE from uterine samples of dairy cows in Brazilian herds. Selective and differential media were used for isolation of aerobic and anaerobic bacteria and further MALDI-TOF mass spectrometry (MS) identification. A total of 279 lactating dairy cows with 28 to 33 d in milk from 6 commercial farms were evaluated. Initially, cows were classified in 3 groups: cytologic healthy cows (n = 161), cows with CE (n = 83), and cows with SCE (n = 35). Healthy animals presented 97 species, followed by the CE group with 53 identified species, and SCE cows presented only 21 bacterial species. We found a significantly higher isolation rate of Trueperella pyogenes in CE (26.5%) cows compared with healthy and SCE cows. Some anaerobic species were exclusively isolated from the CE group, even though they presented lower frequency. Interestingly, 18.1% of samples from CE cows and 40% of SCE cows were negative to bacterial isolation. Despite the use of culture-dependent methods instead of molecular methods, the present study enabled the identification of a complex community of 127 different species from 48 genera, composed of aerobic and anaerobic bacterial species among the 3 different animal groups. The method of sample collection, culture, and identification by MALDI-TOF MS were essential for the success of the analyses.

Virulence and antimicrobial resistance of Klebsiella pneumoniae isolated from passerine and psittacine birds.

Klebsiella pneumoniae is considered one of the most important Gram-negative opportunistic pathogens. The contact between humans and birds poses health risks to both. The aim of this study was to investigate the resistance and virulence of K. pneumoniae isolates from psittacines and passerines, seized from illegal trade in Brazil. We analysed 32 strains isolated from birds of the orders Psittaciformes and Passeriformes by polymerase chain reaction (PCR) for virulence factor genes. Antibiotic resistance was assessed by disk diffusion assay and PCR. The results indicated that fimH (100%), uge (96.8%), kfu (81.2%) and irp-2 (68.7%) were the most common virulence genes, followed by kpn (46.8%), K2 (43.7%), mrkD (34.3%) and iroN (15.6%). The combination of virulence genes resulted in a great diversity of genotypes and the heterogeneity of the strains is also confirmed in the analysis by amplified fragment length polymorphism. The susceptibility profiles of the K. pneumoniae showed 25% of multiple antibiotic resistance strains. We identified seven strains that presented non-extended spectrum beta lactamase blaSHV variants SHV-1 and SHV-11 and one strain positive to the blaTEM-1 gene. Plasmid-mediated quinolone resistance was present in 10 strains (10/32). The data obtained in this study reveal the pathogenic potential of this pathogen and highlight the need for surveillance and monitoring.

[Gynecological abnormalities in patients with rectovestibular fistula]. / Malformaciones ginecológicas en pacientes con fístula recto vestibular.

Patients with recto vestibular fistula may have gynecological malformations that could be unnoticed at the initial examination. The aim of this paper is to demonstrate the incidence of these malformations and propose a study method to help diagnose these malformations, avoiding unnecessary surgeries. We reviewed the records of patients treated with rectovaginal fistula (RVF) in the last 18 years and studied their gynecological malformations, time at diagnosis and treatment received. Of the 39 patients treated, 5 of them (13.1%) demonstrated 9 gynecological malformations: Hemivaginas (2), hemiuteros (2), uterine agenesis (2), vaginal agenesis (2) and vaginal septum (1). The diagnosis was made after the posterior sagittal approach (PSA) in two patients (acute abdomen and hydrometrocolpos), during the PSA in 2 patients and only one of them was diagnosed before the PSA. The 2 patients with hemivaginas and hemiuterus underwent a hemihysterosalpinguectomy and a vaginoplasty later in adolescence. The patient with vaginal and uterine agenesis diagnosed prior to PSA underwent a posterior sagittal anorectoplasty and a vaginoplasty with colon in the same procedure. The patient with vaginal and uterine agenesis (age 13 months) is waiting for vaginal replacement. The patient with vaginal septum (intraoperative finding) underwent a septum resection during the PSA. Gynecological defects are part of RVF spectrum. Girls with RVF require a complete gynecological examination prior to the definitive repair. Preoperative examinations assist in the timing and type of repair, and ultimately avoids complications and unnecessary interventions.

La fístula recto-vestibular se puede asociar a anomalías ginecológicas que, en numerosas ocasiones, pasan inadvertidas en la exploración inicial. Su reconocimiento en el momento adecuado puede cambiar el plan terapéutico y el pronóstico. Se revisan las historias de las pacientes con fístula recto-vestibular de los últimos 18 años y se describen las malformaciones ginecológicas asociadas, el momento del diagnóstico, el tratamiento y resultado postoperatorio. De 39 pacientes, en 5 (12,8%) se observaron 12 malformaciones ginecológicas: hemivaginas (2), hemiúteros (2), agenesia uterina (2), agenesia vaginal (2) y tabique vaginal (3). En dos pacientes el diagnóstico se realizó durante la anorrectoplastia, en otras dos después de la anorrectoplastia sagital posterior a causa de hidrometrocolpos y solo en una de ellas, antes de la intervención. En las pacientes con hemivagina y hemiútero se realizó, en una, la extirpación del hemiútero y la trompa y, en la otra, plastia vaginal transformándola en una única vagina. Cuando el diagnóstico se hizo antes de la intervención se pudo planificar la plastia adecuadamente. En la paciente con tabique vaginal y hallazgo intraoperatorio la anomalía genital fue tratada durante la anorrectoplastia. La paciente con agenesia vaginal y uterina aún no ha sido intervenida. Las malformaciones ginecológicas se asocian con relativa frecuencia a la fístula recto-vestibular. Por ello se requiere una exploración ginecológica adecuada antes de la anorrectoplastia para poder planificar de manera correcta el momento de la reparación, evitando complicaciones e intervenciones innecesarias. intraútero, la invaginación intestinal postnatal en el prematuro y la invaginación intestinal postnatal en el neonato a término.

[Negative pressure system in the treatment of enterocutaneous fistulas in the pediatric population]. / Sistema de presión negativa en el tratamiento de fístulas enterocutáneas en la población pediátrica.

AIM OF THE STUDY: The management of children with enterocutaneous fistulas (EF) along with large abdominal wall defects secondary to multiple surgical interventions can be difficult and sometimes lead to intestinal failure (IF). The aim of this study is to present the results of negative pressure systems and their properties (edema reduction angiogenesis promotion and granulation tissue formation) in children with enterocutaneous fistulas (EF) and their prognosis. MATERIALS AND METHODS: A retrospective analysis of children with refractory, high output EF treated with NPS between 2008-2014. Outcome variables were duration and effectiveness of treatment as well as complications associated with NPS. RESULTS: Eight patients met inclusion criteria and were treated with NPS during a median of 25 days (range 5-50). The aetiologies were volvulus (2), necrotizing enterocolitis (2), gastroschisis (2), Blue Rubber Bleb Nevus (1) and duodenopancreatic anastomosis fistula following hepatopancreatic transplantation (1). Most patients (n=7) had large abdominal wall defects that closed during treatment, though two patients required further laparotomies due to evisceration. Two patients developed a second EF that was also successfully treated with NPS. No complications were identified arising from the use of NPS. After a 5-yr follow up 3 patients had a multivisceral transplantation and survive, and 4 died due to encephalopathy (1), hemolytic anemia (1), catheter-related sepsis (1) and one while waiting for a multivisceral graft for transplantation. CONCLUSIONS: Despite of a limited series of patients we recommend NPS as a useful tool in the management of EF and/ or abdominal wall defects.

OBJETIVOS: Las fístulas enterocutáneas (FE) de evolución tórpida y los defectos de pared abdominal (DPA) en niños multioperados son difíciles de manejar y pueden ser causa de fallo intestinal. El objetivo de este estudio fue analizar si el sistema de presión negativa (SPN) que disminuye el edema, favorece la vascularización y la aparición del tejido de granulación, mejora la cicatrización y el pronóstico de las FE. METODOS: Se realizó un estudio retrospectivo de niños multioperados con fístulas enterocutáneas recalcitrantes y de alto débito con o sin defectos de pared abdominal, entre 2008-2014 tratados con SPN. Las variables analizadas fueron el cierre de la fístula y/o defecto abdominal, el tiempo transcurrido y las complicaciones del tratamiento. RESULTADOS: Ocho pacientes cumplieron criterios de inclusión y fueron tratados con SPN con una mediana de 25 días (5-50). La etiología fue vólvulo intestinal (2), enterocolitis necrosante (2), gastrosquisis (2), Blue Rubber Bled Nevus (1) y fístula de anastomosis duodenopancreática en un trasplante hepatopancreático (1). Siete pacientes asociaron defectos de pared abdominal. Dos pacientes se reintervinieron posteriormente por evisceración y ninguno desarrolló nuevas fístulas. Dos pacientes presentaron nueva FE en otra localización y también fue tratada con SPN, resolviéndose. No se identificaron complicaciones derivadas del empleo de la presión negativa. Tras un seguimiento de 5 años, 3 niños recibieron posteriormente un trasplante multivisceral y 4 fallecieron [candidato a trasplante (1), encefalopatía (1), anemia hemolítica (1), sepsis de catéter (1)]. CONCLUSION: A pesar de nuestra serie limitada de pacientes proponemos este sistema como una herramienta útil en el manejo de FE y/o DPA.

Leptin gene therapy attenuates neuronal damages evoked by amyloid-ß and rescues memory deficits in APP/PS1 mice.

There is growing evidence that leptin is able to ameliorate Alzheimer's disease (AD)-like pathologies, including brain amyloid-ß (Aß) burden. In order to improve the therapeutic potential for AD, we generated a lentivirus vector expressing leptin protein in a self-inactivating HIV-1 vector (HIV-leptin), and delivered this by intra-cerebroventricular administration to APP/PS1 transgenic model of AD. Three months after intra-cerebroventricular administration of HIV-leptin, brain Aß accumulation was reduced. By electron microscopy, we found that APP/PS1 mice exhibited deficits in synaptic density, which were partially rescued by HIV-leptin treatment. Synaptic deficits in APP/PS1 mice correlated with an enhancement of caspase-3 expression, and a reduction in synaptophysin levels in synaptosome preparations. Notably, HIV-leptin therapy reverted these dysfunctions. Moreover, leptin modulated neurite outgrowth in primary neuronal cultures, and rescued them from Aß42-induced toxicity. All the above changes suggest that leptin may affect multiple aspects of the synaptic status, and correlate with behavioral improvements. Our data suggest that leptin gene delivery has a therapeutic potential for Aß-targeted treatment of mouse model of AD.

[Functional evaluation in patient with critical SARS-CoV-2 disease: Cohort study in a third level hospital rehabilitation unit]. / Evaluación funcional tras SARS-CoV-2 crítico. Estudio de cohortes de la unidad de rehabilitación en un hospital de tercer nivel.

INTRODUCTION: SARS-COV-2 pneumonia is a highly contagious respiratory disease that causes respiratory, physical and psychological dysfunctions. We present the results of patient assessment when they were discharged from the ICU. MATERIAL AND METHOD: Cohort study of patients affected by SARS-COV-2 pneumonia admitted to the intensive care unit from 01/10/2020 to 31/07/2021. We collect sociodemographic data, personal history, ICU and hospital stay, Barthel, FAC and mMRC (pre-admission/initial assessment/discharge), development of osteomuscular and/or neurological pathology and need for rehabilitation treatment. RESULTS: A total of 341 patients were evaluated, of which 224 met criteria. The average age was 63 years (68.75% men). Mean ICU/hospital stay were 27/44 days. They were assessed by physiatry, after that, we provide a guide developed by physiatry, solving doubts about the disease and setting exercises of intensity and progressive difficulty, to be carried out during the admission and at home. Neurological pathology was present at 42.86% patients, of whom a 83.33% were peripheral nervous system disease. The total of the sample needed respiratory physiotherapy and a 72.32% motor physiotherapy. CONCLUSIONS: In our study, a high number of patients have needed rehabilitation treatment in order to get functional recovery, highlighting the development of post-COVID neurological pathology. SARS-COV-2 generates other complications, not only respiratory, subsidiary to be assessed and treated by rehabilitation services for a comprehensive recovery that minimizes sequelae.

Detection of high-risk Avian Pathogenic Escherichia coli (APEC) isolated from broilers in São Paulo, Brazil.

Some high-risk Avian Pathogenic Escherichia coli (APEC) clones have been associated with increased economic losses caused by avian colibacillosis. They may represent an additional food consumption concern due to the potential zoonotic role causing urinary tract infections mainly related to E. coli ST73 and ST95 lineages. This study aimed to characterize APEC isolated from slaughterhouse carcasses presenting lesions compatible with avian colibacillosis. We analyzed about 6500 broilers carcasses, and 48 showed lesions consistent with colibacillosis. Forty-four strains of E. coli were isolated, with 77.27% (n = 34/44) classified as APEC. The isolates belonged to the phylogenetic groups B2 (41.17%, n = 14/34), G (20.59%, n = 7/34), A (17.65%, n = 6/34), B1 (8.82%, n = 3/34), and E (5.88%, n = 2/34). Determining the phylogenetic group of 5.88% (n = 2/34) of the strains was impossible. Moreover, 20.59% (n = 7/34) were positive to the clonal groups ST117, 8.82% (n = 3/34) to ST95, and 8.82% (n = 3/34) were classified as belonging to serogroup O78 by PCR screening. Strains of APEC from O78 serogroup and ST117 are considered high-risk clones for poultry, and our data reinforced the need for surveillance of these pathogens in poultry farms and slaughterhouses.

Dealing with initial inconclusive serological results for chronic Chagas disease in clinical practice.

Most guidelines for Chagas disease recommend the performance of two serological tests in order to detect it. However, inconclusive results may arise from this strategy. The aim was to describe whether serological follow-up together with the patient's clinical characteristics could clarify the outcome of patients with initial inconclusive test results. In this retrospective case series, all results of Chagas disease serological tests and outpatient visits recorded from 2004 to 2008 were screened for inclusion. The inclusion criterion was clinical suspicion of chronic Chagas disease and the exclusion criteria were previous diagnosis of Chagas disease, suspicion of acute Chagas disease, and serological tests with no corresponding medical evaluation. A total of 1,732 patients were analyzed. Chronic Chagas disease prevalence was 21.1%. After the initial set of serological tests, 2.9% of patients had inconclusive test results. Most of these patients had definite diagnosis after clinical follow-up and the repetition of serological tests in a new blood sample. Loss to follow-up while partaking in the diagnostic investigation reached 17.7%. The prevalence of initial inconclusive serological tests for chronic Chagas disease is low. Clinical evaluations and follow-up clarify the definite diagnosis. Noncompliance to follow-up is a frequent problem. Strategies to reduce inconclusive results and noncompliance are discussed.

Cone Beam Computed Tomography evaluation of midpalatal suture maturation according to age and sex: A systematic review.

AIM: To systematically review and analyse the available evidence and assess if a correlation exists in children and young adults between the chronological age and the degree of midpalatal suture maturation as assessed according to the method proposed by Angelieri et al. [2013]. METHODS: A search was performed in Medline/Pubmed, Scopus, and Web of Science during October 2020 for published studies analysing midpalatal suture maturation through cone beam tomography according to the method proposed by Angelieri et al. [2013]. The review was performed according to the PRISMA protocol and the articles were selected according to the established inclusion and exclusion criteria. To assess the quality of reporting, the STROBE checklist was applied. CONCLUSION: The high variability of the maturational stages in the studied cohorts, highlights the poor correlation between suture maturation and chronological age in both genders, especially in young adults. According to our findings until the age of 14, the high prevalence of stages related to sutural opening does not justify CBCT assessment of the MPS and supports the use of a conventional protocol for maxillary expansion.

Isolation of potential zoonotic Mycobacterium spp. from diseased freshwater angelfish (Pterophyllum scalare) from an aquarium.

Nontuberculous mycobacteria infection is one of the most common chronic bacterial diseases in ornamental aquarium fish and appears to be directly related to stressful husbandry practices. Furthermore, it also represents zoonotic potential. Here we present the isolation and characterization of non-tuberculous mycobacteria from diseased freshwater angelfish (Pterophyllum scalare) in São Paulo, Brazil. Nine discarded breeding females with signs of disease were evaluated. The fish exhibited lethargy, loss of appetite, cachexia, skin ulcers, and exophthalmia. At necropsy, four fishes presented macroscopic granulomas in the spleen. Mycobacterium chelonae, M. fortuitum, M. gordonae, M. intracellulare and M. peregrinum were isolated and identified by hsp65 PCR restriction analysis. Histopathological analysis revealed microscopic lesions compatible with mycobacteriosis, and Mycobacterium bacillus were observed by Ziehl-Neelsen stain. Notably, all Mycobacterium species identified in this study have already been reported in human patients; therefore, diseased animals may be a source of infection for people who handle fish and aquariums.

Association between anticholinergic activity and xerostomia and/ or xerophthalmia in the elderly: systematic review.

PURPOSE: The aim of this work was to investigate the association between anticholinergic burden or anticholinergic drug use and xerostomia and/or xerophtalmia in elderly through a systematic review of the published literature. METHODS: A search was carried out in 3 databases (CINAHL, Embase and Pubmed). Studies conducted in people ≥65 years of age, who took anticholinergic medications, and measured the association between the anticholinergic burden or the use of these medications with the prevalence of xerostomia and / or xerophthalmia, published up to August 2022, were selected. Studies published in languages other than Spanish and/or English were excluded. RESULTS: One thousand two hundred eleven articles were identified, 10 were selected for this review: six cross-sectional studies, two cohorts, one case-control and one randomized controlled clinical trial. A total of 3535 patients included in the different studies were studied. The most used scales were the Anticholinergic Drug Scale (ADS) and the Anticholinergic Risk Scale (ARS). Four articles studied the relationship between the use of anticholinergic medication and the prevalence of xerostomia and / or xerophthalmia, finding a positive relationship with xerostomia in all of them. Another 6 measured the relationship between anticholinergic burden and xerostomia and / or xerophthalmia. Four found a positive relationship between anticholinergic burden and xerostomia and/or xerophthalmia. CONCLUSIONS: Our findings suggest a clear relationship between the use of anticholinergic drugs or anticholinergic burden and the presence of xerostomia. This relationship was less conclusive in the case of xerophthalmia.

The cadherin-catenin complex in nasopharyngeal carcinoma.

Abnormal Wnt signaling and impaired cell-cell adhesion due to abnormal E-cadherin and ß-catenin function have been implicated in many cancers, but have not been fully explored in nasopharyngeal carcinoma. The aim of this study was to analyze ß-Catenin cellular location and E-cadherin expression levels in nasopharyngeal carcinoma. E-cadherin expression levels were also correlated with clinical data and underlying pathology. ß-Catenin and E-cadherin expression were examined in 18 nasopharyngeal carcinoma and 7 non-tumoral inflammatory pharynx tissues using immunohistochemical methods. Patient clinical data were collected, and histological evaluation was performed by hematoxylin/eosin staining. ß-catenin was detected in membrane and cytoplasm in all cases of nasopharyngeal carcinoma, regardless of histological type; in non-tumoral tissues, however, ß-catenin was observed only in the membrane. As for E-cadherin expression levels, strong staining was observed in most non-tumoral tissues, but staining was only moderate in nasopharyngeal carcinoma tissues. E-cadherin expression was associated with ß-catenin localization, study group, metastatic disease, and patient outcomes. Reduced levels of E-cadherin protein observed in nasopharyngeal carinoma may play an important role in invasion and metastasis. Cytoplasmic ß-catenin in nasopharyngeal carcinoma may impair cell-cell adhesion, promoting invasive behavior and a metastatic tumor phenotype.

What is trending in paediatric dentistry? An Altmetric study on paediatric dentistry journals.

PURPOSE: To assess the online attention to research in the field of paediatric dentistry in relation to publication details and citations. METHODS: The articles were identified by a search performed through the Dimensions Free App. The search included the six journals related to paediatric dentistry listed in the SCImago Journal and Country Rank. The 200 articles with the highest AAS (Altmetric Attention Score) were collected and screened for data related to publication, authorship, and research topic. Citations were harvested from WOS (Web of Science) and Scopus. RESULTS: The 86.3% of the 200 articles belonged to only two of the journals: the International Journal of Paediatric Dentistry and the European Archives of Paediatric Dentistry. The 53.5% of the articles were published between 2014 and 2019. The mean AAS was 8.3. Cross-sectional studies were the most prevalent study design. AAS did not correlate to the number of citations as reported in WOS and Scopus. CONCLUSIONS: Online attention to research in paediatric dentistry can be improved. According to the topic, erosion studies displayed high visibility. The classic citation count in combination with the AAS offers a more comprehensive insight iinto research. The online profile of journals and their social media dissemination policies should be improved to facilitate the spread of research information in scholar and non-scholar audiences through the web.

Combined treatment of enterocutaneous fistula with laser diode and embolization. / Tratamiento de fístula enterocutánea combinando láser diodo y embolización.

INTRODUCTION: Enterocutaneous fistula treatment in patients undergoing multiple surgeries is complex and requires creative solutions. We present the case of an enterocutaneous fistula managed with laser diode and cyanoacrylates. CLINICAL CASE: 15-year-old patient, diagnosed with ulcerative colitis at 12 years of age, undergoing full colectomy with urgent ileostomy as a result of a flare-up refractory to medical treatment. Five months later, an ileoanal pull-through with pouch was carried out, leaving a protection ileostomy in place. However, postoperative evolution was poor, with pelvic infection, so two further urgent open surgeries were required for lavage and hemostasis purposes. Six months later, anastomotic stricture was noted. It was healed following various pneumatic dilations under ultrasound vision and at-home dilations using Hegar dilators. One year following this, ileostomy was closed, but one month later, abdominal distension occurred. It was associated with a fistula in the abdominal midline, which could be endoscopically guided, with its origin being located at the ileoanal anastomosis. Laser diode sessions were applied for treatment purposes, with partial improvement, but still with gas emission. One year later, embolization was performed by placing platinum coils and lipiodol-diluted cyanoacrylates, and clinical signs disappeared. 17 months following this surgery, the patient has no symptoms, with full day and night fecal continence and 3 daily stools, and the fistula is completely closed. CONCLUSION: Combined treatment with laser diode and platinum coil and cyanoacrylate embolization proves effective in the management of enterocutaneous fistula, with low morbidity.

INTRODUCCION: El tratamiento de las fístulas enterocutáneas establecidas en pacientes multioperados es complejo y requiere de soluciones creativas. Presentamos la resolución de un caso con láser diodo y con cianoacrilatos. CASO CLINICO: Paciente de 15 años, diagnosticado a los 12 de colitis ulcerosa y sometido a pancolectomía con ileostomía urgente por brote refractario al tratamiento médico. Cinco meses después se realizó un descenso ileoanal con reservorio dejando ileostomía de protección, pero presentó un posoperatorio tórpido con infección pélvica, precisando dos nuevas laparotomías urgentes, para lavado y hemostasia. Seis meses después, se evidenció una estenosis de la anastomosis que se resolvió tras varias dilataciones, neumáticas bajo visión endoscópica y domiciliarias con tallos de Hegar. Un año después se cerró la ileostomía, presentando al mes una distensión abdominal y aparición de fístula en línea media abdominal, que pudo tutorizarse endoscópicamente, observando su origen en la anastomosis ileoanal. Se trató mediante sesiones de láser diodo, con mejoría parcial, aunque persistía la salida de gases. Un año después se embolizó implantando espirales de platino y cianoacrilatos diluidos con lipiodol, resolviéndose totalmente el cuadro. Transcurridos 17 meses de esta última intervención, el paciente se encuentra asintomático, con continencia fecal total diurna y nocturna, tres deposiciones al día y la fístula está totalmente cerrada. CONCLUSION: El tratamiento con láser diodo, combinado con embolización con espirales de platino y cianoacrilatos, puede ser un tratamiento eficaz con baja morbilidad de las fístulas enterocutáneas establecidas.

Use of MALDI-TOF for identification and surveillance of gram-negative bacteria in captive wild psittacines.

Microbiological studies of the sanitary and health status of psittacine birds that will be reintroduced is important in evaluating whether these animals act as carriers of pathogenic agents to other animals and humans. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is a faster and more accurate method to identify bacteria than conventional microbiology methods. The aim of this study was to evaluate the health status of psittacines housed in captivity, by assessment of Gram-negative bacteria from fecal microbiota through MALDI- TOF MS identification. The results indicate high frequency of Gram-negative bacteria in feces (96.5%), especially from the Enterobacteriaceae family (88.7%). The most prevalent bacteria were Escherichia coli (39.0%), Proteus vulgaris (12.2%), Klebsiella spp. (12.1%) and Raoultella ornithinolytica (8.7%). Proteus hauseri, Citrobacter spp., Morganella morgannii, Providencia rettgeri, Enterobacter spp. and Escherichia hermannii were isolated with lower frequency. . All these agents are potentially pathogenic for parrots and can cause systemic infections in other animals and humans. These findings reinforce that MALDI- TOF MS proved to be a rapid and accurate method of identification of the microorganism and evaluation of the health status of psittacines, providing relevant data to assist decision-making regarding the sanitary protocols in wildlife centers, and possible future reintroduction of wild birds.

[Intestinal transplant: in what phase are we?]. / Trasplante intestinal: ¿en qué fase estamos?

OBJECTIVE: To analyze the evolution of Small Bowel Transplantation program since the beginning of the program. MATERIAL AND METHODS: [corrected] All children who underwent intestinal transplantation between 1997 and 2009 were retrospectively reviewed: epidemiological data, status before transplant, surgical technique, immunosupression, results, survival and long.term quality of life were analysed. RESULTS: Fifty-two intestinal transplants were performed in 46 children (20 isolated bowel, 20 combined liver and intestine, and 12 multivisceral); median age was 32m (range 7m-19a); weight 12,3 kg (range 3,9-60); 31 had short gut syndrome, 8 dismotility, 5 intractable diarrhea, and two were miscellaneous. Intestinal adaptation was initially attempted in 26 patients, without success, 20 were directly listed for transplant. The modality of transplant was modified in 17 while listed. Baseline immunosupression consisted of tacrolimus and steroids, although 5 required conversion to Sirolimus later. Six died during the first month, due to sepsis/multiorganic failure (poor status at transplant); 13 died during the long-term follow-up. Acute rejection was seen in 20, chronic rejection in 3, PTLD in 8 (6 died) and GVHD in 5 patients (3 died). Overall survival after 5 years of follow-up is 65,2 % (51,7% for the graft). From 2006 to 2008, overall patient/graft survival at 6 m, 1 and 3 years after transplant is 88,7/84,1, 81,2/81,2 and 81,2/71,1%, respectively. After a median follw-up of 39 +/- 29 months, 27 patients are alive (59%), off TPN, (70% had their ostomy taken down), go to school, are scarcely hospitalized and enjoy a good quality of life. CONCLUSIONS: Intestinal transplantation has consolided itself as a good choice for irreversible intestinal failure, being feasible to achieve a normal life. Although overall survival diminishes over time, the center experience has improved the results. These patients need a very close follow-up, once transplant is over, in order to get an early diagnose of immunological complications.

The intensive care unit in the postoperative period of major abdominal surgery. / La unidad de cuidados intensivos en el postoperatorio de cirugía mayor abdominal.

Despite low mortality in patients undergoing major abdominal surgery, the number of high-risk patients is increasing and has become a health problem. At present, surgery is understood as a continuous process, in which numerous guidelines added to less invasive techniques offering a lesser physiological impact upon patients with serious comorbidities are responsible for the final outcome. The prevention, identification and early treatment of complications prove as important as the preoperative or surgical technique.?The introduction of ERAS (enhanced recovery after surgery) protocols is the cornerstone for the management of these patients, and is advocated by most surgical societies for reducing mortality, length of hospital stay and hospital costs. The postoperative management of these patients in postsurgery Intensive Care Units guarantees effectiveness and efficiency in maintaining optimum patient care.

AFM probing in aqueous environment of Staphylococcus epidermidis cells naturally immobilised on glass: physico-chemistry behind the successful immobilisation.

AFM probing of microbial cells in liquid environments usually requires them to be physically or chemically attached to a solid surface. The fixation mechanisms may influence the nanomechanical characterization done by force curve mapping using an AFM. To study the response of a microbial cell surface to this kind of local measurement this study attempts to overcome the problem associated to the uncertainties introduced by the different fixation treatments by analysing the surface of Staphylococcus epidermidis cells naturally (non-artificially mediated) immobilised on a glass support surface. The particularities of this natural bacterial fixation process for AFM surface analysis are discussed in terms of theoretical predictions of the XDLVO model applied to the systems bacteria/support substratum and bacteria/AFM tip immersed in water. In this sense, in the first part of this study the conditions for adequate natural fixation of three S. epidermidis strains have been analyzed by taking into account the geometries of the bacterium, substrate and tip. In the second part, bacteria are probed without the risk of any possible artefacts due to the mechanical or chemical fixation procedures. Forces measured over the successfully adhered cells have (directly) shown that the untreated bacterial surface suffers from a combination of both reversible and non-reversible deformations during acquisition of force curves all taken under the same operational conditions. This is revealed directly through high-resolution tapping-mode imaging of the bacterial surface immediately following force curve mapping. The results agree with the two different types of force curves that were repeatedly obtained. Interestingly, one type of these force curves suggests that the AFM tip is breaking (rather than pushing) the cell surface during acquisition of the force curve. In this case, adhesive peaks were always observed, suggesting a mechanical origin of the measured pull-off forces. The other type of force curves shows no adhesive peaks and exhibits juxtaposing of approaching and retraction curves, reflecting elastic deformations.

Effect of UV irradiation on the surface Gibbs energy of Ti6Al4V and thermally oxidized Ti6Al4V.

Thermal oxidation of Ti6Al4V increases the thickness, modifies the structure, and changes the amount of alloying elements of the surface titanium dioxide layer with respect to the spontaneous passive layer of Ti6Al4V. The effects on the surface properties of Ti6Al4V and thermally oxidized Ti6Al4V after different periods of UV irradiation have been studied by measurement of water, formamide, and diiodomethane contact angles. The rate of modification of the water contact angle with the irradiation time is dependent on the surface treatment, but the water adhesion work, after an initial energetic step, follows a similar trend for both. Application of the Young equation together with the van Oss approach allowed evaluation of the surface Gibbs energy of the alloys. Similar to the water adhesion work, the surface Gibbs energy dependence on the irradiation time follows a similar trend for both samples and it is due to the change of the electron-donor parameter of the acid-base component. Also, a linear relationship common for both samples has been obtained between the cosines of the water contact angle and the formamide or diiodomethane contact angle. These facts indicate that the surface modification continuously produced by the UV irradiation is similar all along the process and similar for both samples after an energetic threshold for the thermally oxidized sample. It has been also tested that the hydrophilic-hydrophobic conversion is reversible for Ti6Al4V and Ti6Al4V thermally treated.