ABSTRACT
OBJECTIVE: Despite its use was abandoned several decades ago, the polycationic peptide colistin has become the last hope to treat severe infections caused by multidrug-resistant Gram-negative bacteria. Thus, the development of colistin resistance may seriously compromise the efficacy of treatment. Moreover, colistin has high toxicity being dose dependent. A potentially effective strategy to avoid resistance may be to combine colistin with other antimicrobials. This may help in the rescue of old antimicrobials and in reducing toxic undesired effects. METHODS: Antimicrobial susceptibility determination, efflux machinery function measurements in different conditions and measurement of inhibition of the extrusion by colistin were performed. Moreover, modifications of anisotropy of the membranes by using fluorescent dyes was accomplished. RESULTS: Sub-inhibitory concentrations of colistin have a synergistic effect with several antimicrobials that act intracellularly (targeting protein synthesis and DNA replication). This effect was demonstrated through the uptake increases of acridine orange. in Pseudomonas aeruginosa, Escherichia coli and Acinetobacter baumanii but also in an intrinsically colistin-resistant species as Serratia marcescens. Measurements of the anisotropy of bacterial membranes, as a measure of membrane fluidity, showed significant changes indicative of colistin activity. CONCLUSION: The alterations in the cellular efflux machinery that resulted in higher intracellular concentrations of acridine orange, and likely of other antimicrobials combined with data of membrane fluidity and measured synergism in vitro allow us to envisage the use of these combinations to fight infections caused by multidrug-resistant bacteria.
ABSTRACT
La diabetes mellitus tipo 1 es una enfermedad crónica que requiere un tratamientocomplejo y que genera cambios en el estilo de vida personal y familiar.El paciente/familia debe adquirir una serie de conocimientos, habilidades yconductas saludables que le permitan comprender su enfermedad y autogestionarla.Para ayudar a conseguir estos objetivos, es necesario disponer de programaseducativos estructurados que faciliten el aprendizaje. Cuando estosprogramas están diseñados para aplicarse en la edad pediátrica, los objetivos,el material y las actividades deben adecuarse a la edad del paciente y a lascaracterísticas propias de la infancia. Para conseguir que el niño llegue a laetapa adulta sabiendo autogestionar correctamente su diabetes, es muy importantela actitud y formación de los padres/tutores, así como la habilidad enel traspaso progresivo de responsabilidades(AU)
Type 1 diabetes mellitus is a chronic disease that requires a complex treatmentand that generates changes in the patients personal and family lifestyle. In orderto understand and self-manage the disease, the patient/family needs toacquire certain knowledge, skills and healthy habits. Structured educationalprograms must be available to facilitate the learning process and help patientsachieving these objectives. When those programs are designed for pediatricpatients objectives, material and activities must be adapted to patients age aswell as the distinctive characteristics of childhood. To make sure that childrenare able to adequately self-manage their diabetes by the time they reach adulthood,parents/tutors attitude and training are of fundamental importance, aswell as providing progressive transfer of responsibilities to them(AU)
Subject(s)
Humans , Child, Preschool , Child , Adolescent , Patient Education as Topic , Patient Education as Topic/methods , Diabetes Mellitus, Type 1/psychology , Models, Educational , Psychology, Child/education , Psychology, Child/instrumentation , Child Guidance/instrumentation , Child Guidance , Child Guidance/methodsABSTRACT
We present DIRAS, an application to support physicians in determining the risk of complications for individual diabetic patients. The risk pattern of each diabetic patient is obtained using a Case-based Reasoning method called LID. Case-based Reasoning is an Artificial Intelligence technique based on solving new situations according to past experiences. For each patient, the LID method determines the risk of each diabetic complication according to the risk of already diagnosed patients. In addition, LID builds a description that can be viewed as an explanation of the obtained risk.