Production of poly-3-hydroxybutyrate (PHB) nanoparticles using grape residues as the sole carbon source.

The production of poly-3-hydroxybutyrate (PHB) on an industrial scale remains a major challenge due to its higher production cost compared to petroleum-based plastics. As a result, it is necessary to develop efficient fermentative processes using low-cost substrates and identify high-value-added applications where biodegradability and biocompatibility properties are of fundamental importance. In this study, grape residues, mainly grape skins, were used as the sole carbon source in Azotobacter vinelandii OP cultures for PHB production and subsequent nanoparticle synthesis based on the extracted polymer. The grape residue pretreatment showed a high rate of conversion into reducing sugars (fructose and glucose), achieving up to 43.3 % w w-1 without the use of acid or external heat. The cultures were grown in shake flasks, obtaining a biomass concentration of 2.9 g L-1 and a PHB accumulation of up to 37.7 % w w-1. PHB was characterized using techniques such as Fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), and differential scanning calorimetry (DSC). The formation of emulsified PHB nanoparticles showed high stability, with a particle size between 210 and 240 nm and a zeta potential between -12 and - 15 mV over 72 h. Owing to these properties, the produced PHB nanoparticles hold significant potential for applications in drug delivery.

Global Survey of the Roles, Satisfaction, and Barriers of Home Health Care Nurses on the Provision of Palliative Care.

Background: The World Health Assembly urges members to build palliative care (PC) capacity as an ethical imperative. Nurses provide PC services in a variety of settings, including the home and may be the only health care professional able to access some disparate populations. Identifying current nursing services, resources, and satisfaction and barriers to nursing practice are essential to build global PC capacity. Objective: To globally examine home health care nurses' practice, satisfaction, and barriers, regarding existing palliative home care provision. Design: Needs assessment survey. Setting/Subjects: Five hundred thirty-two home health care nurses in 29 countries. Measurements: A needs assessment, developed through literature review and cognitive interviewing. Results: Nurses from developing countries performed more duties compared with those from high-income countries, suggesting a lack of resources in developing countries. Significant barriers to providing home care exist: personnel shortages, lack of funding and policies, poor access to end-of-life or hospice services, and decreased community awareness of services provided. Respondents identified lack of time, funding, and coverages as primary educational barriers. In-person local meetings and online courses were suggested as strategies to promote learning. Conclusions: It is imperative that home health care nurses have adequate resources to build PC capacity globally, which is so desperately needed. Nurses must be up to date on current evidence and practice within an evidence-based PC framework. Health care policy to increase necessary resources and the development of a multifaceted intervention to facilitate education about PC is indicated to build global capacity.

Structural and molecular study of the supraspinatus muscle of modern humans (Homo sapiens) and common chimpanzees (Pan troglodytes).

OBJECTIVES: To analyze the muscle architecture and the expression pattern of the myosin heavy chain (MyHC) isoforms in the supraspinatus of Pan troglodytes and Homo sapiens in order to identify differences related to their different types of locomotion. MATERIALS AND METHODS: We have analyzed nine supraspinatus muscles of Pan troglodytes and ten of Homo sapiens. For each sample, we have recorded the muscle fascicle length (MFL), the pennation angle, and the physiological cross-sectional area (PCSA). In the same samples, by real-time quantitative polymerase chain reaction, we have assessed the percentages of expression of the MyHC-I, MyHC-IIa, and MyHC-IIx isoforms. RESULTS: The mean MFL of the supraspinatus was longer (p = 0.001) and the PCSA was lower (p < 0.001) in Homo sapiens than in Pan troglodytes. Although the percentage of expression of MyHC-IIa was lower in Homo sapiens than in Pan troglodytes (p = 0.035), the combination of MyHC-IIa and MyHC-IIx was expressed at a similar percentage in the two species. DISCUSSION: The longer MFL in the human supraspinatus is associated with a faster contractile velocity, which reflects the primary function of the upper limbs in Homo sapiens-the precise manipulation of objects-an adaptation to bipedal locomotion. In contrast, the larger PCSA in Pan troglodytes is related to the important role of the supraspinatus in stabilizing the glenohumeral joint during the support phase of knuckle-walking. These functional differences of the supraspinatus in the two species are not reflected in differences in the expression of the MyHC isoforms.

Inter- and Intraspecific Variations in the Pectoral Muscles of Common Chimpanzees (Pan troglodytes), Bonobos (Pan paniscus), and Humans (Homo sapiens).

We have analyzed anatomic variations in the pectoralis major and pectoralis minor muscles of common chimpanzees (Pan troglodytes) and bonobos (Pan paniscus) and compared them to anatomic variations in these muscles in humans (Homo sapiens). We have macroscopically dissected these muscles in six adult Pan troglodytes, five Pan paniscus of ages ranging from fetus to adult, and five adult Homo sapiens. Although Pan troglodytes are thought to lack a separate pectoralis abdominis muscle, we have identified this muscle in three of the Pan troglodytes; none of the Pan paniscus, however, had this muscle. We have also found deep supernumerary fascicles in the pectoralis major of two Pan troglodytes and all five Pan paniscus. In all six Pan troglodytes, the pectoralis minor was inserted at the supraspinatus tendon, while, in Pan paniscus and Homo sapiens, it was inserted at the coracoid process of the scapula. Some of the anatomic features and variations of these muscles in common chimpanzees and bonobos are similar to those found in humans, therefore enhancing our knowledge of primate comparative anatomy and evolution and also shedding light on several clinical issues.

Ultrastructure of Lingual Papillae in Common Chimpanzee (Pan troglodytes) Foetus, Newborn and Adult Specimens.

Among primates, the two recognized species of chimpanzees (common chimpanzee, Pan troglodytes; pygmy chimpanzee, Pan paniscus) are considered to be the most similar to humans. Importantly, in mammals, the food intake behaviour largely determines the tongue morphology, including the type, proportion and distribution of gustatory and non-gustatory tongue papillae. The lingual papillae form during its development and mature in post-natal life depending on the different feeding. In this study, we have used scanning electron microscopy to analyse the age-related changes in the lingual papillae of foetal, newborn and adult P. troglodytes. Four main types of lingual papillae, denominated filiform, fungiform, foliate and vallate, and one subtype of filiform papillae called conical papillae, were found. The main age-related changes observed in all kinds of papillae were a progressive keratinization and morphological complexity along the lifespan. During the foetal period, there was scarce keratinization, which progressively increases in young animals to adulthood. The number of filiform increased with ageing, and both filiform and fungiform papillae in adult tongues are divided into pseudopapillae. On the other hand, the vallate papillae vary from smooth simple surfaces in foetal tongues to irregular surfaces with grooves and pseudopapillae (microscopic papilla-shaped formations within the papilla itself) in adults. These results describe for the first time the age-related variations in the three-dimensional aspect of lingual papillae of the chimpanzee tongue and provide new data to characterize more precisely these structures in the human closest specie.

Use of antibiotics and the prevalence of antibiotic-associated diarrhoea in patients with spinal cord injuries: an international, multi-centre study.

BACKGROUND: Little is known about the use of antibiotics and the extent of antibiotic-associated diarrhoea (AAD) in patients with spinal cord injuries (SCIs). AIMS: To record the use of antibiotics, establish the prevalence of AAD and Clostridium difficile infection (CDI), and assess if there was any seasonal variation in antibiotic use and incidence of AAD in patients with SCIs. METHODS: A retrospective study was conducted in six European SCI centres between October 2014 and June 2015. AAD was defined as two or more watery stools (Bristol Stool Scale type 5, 6 or 7) over 24 h. FINDINGS: In total, 1267 adults (median age 54 years, 30.7% female) with SCIs (52.7% tetraplegia, 59% complete SCI) were included in this study. Among the 215 (17%) patients on antibiotics, the top three indications for antibiotics were urinary tract infections (UTIs), infected pressure ulcers and other skin infections. Thirty-two of these 215 (14.9%) patients developed AAD and two patients out of the total study population (2/1267; 0.16%) developed CDI. AAD was more common in summer than in spring, autumn or winter (30.3% vs 3.8%, 7.4% and 16.9%, respectively; P<0.01). AAD was associated with age ≥65 years, tetraplegia, higher body mass index, hypoalbuminaemia, polypharmacy, multiple antibiotic use and high-risk antibiotic use. Summer and winter seasons and male sex were identified as independent predictors for the development of AAD. CONCLUSION: This survey found that AAD is common in patients with SCIs, and UTI is the most common cause of infection. Summer and winter seasons and male sex are unique predictors for AAD. Both AAD and UTIs are potentially preventable; therefore, further work should focus on preventing the over-use of antibiotics, and developing strategies to improve hospital infection control measures.

[Weight control behaviors in dieting adolescent girls and their relation to body dissatisfaction and obsession with thinness]. / Conductas de control de peso en mujeres adolescentes dietantes y su relación con insatisfacción corporal y obsesión por la delgadez.

INTRODUCTION: Obsession with thinness and body dissatisfaction can lead adolescents to follow unsupervised diets, which could result in risky weight control behaviors such as fasting, vomiting, use of diuretics and laxatives. The aim of the current study is to examine weight control behaviors in dieting adolescents and relate them to body dissatisfaction (BD) and obsession with thinness (OT). METHODS: A cross-sectional study was conducted on 439 adolescents from Valparaiso public schools to investigate risky weight control behaviors due to BD and OT scales from the Eating Disorders Inventory-2 (EDI-2), comparing restrained eaters and non-restrained eaters. RESULTS: A total of 43% adolescents had followed a weight loss diet without medical supervision. The dieters had higher BD and OT values. Moderate to severe food restriction, based on expert judgment, was observed in 29.6%, and differences in the presence and severity of purging behaviors were found between the 2 groups. CONCLUSIONS: One third of the adolescents studied followed diets without professional supervision and had higher BD and OT values, as well as risky weight control behaviors. Overweight and obese adolescents followed more restrictive diets and developed riskier weight control behaviors.

Questionnaire-based study to assess the association between management practices and mastitis within tie-stall and free-stall dairy housing systems in Switzerland.

BACKGROUND: Prophylactic measures are key components of dairy herd mastitis control programs, but some are only relevant in specific housing systems. To assess the association between management practices and mastitis incidence, data collected in 2011 by a survey among 979 randomly selected Swiss dairy farms, and information from the regular test day recordings from 680 of these farms was analyzed. RESULTS: The median incidence of farmer-reported clinical mastitis (ICM) was 11.6 (mean 14.7) cases per 100 cows per year. The median annual proportion of milk samples with a composite somatic cell count (PSCC) above 200,000 cells/ml was 16.1 (mean 17.3) %. A multivariable negative binomial regression model was fitted for each of the mastitis indicators for farms with tie-stall and free-stall housing systems separately to study the effect of other (than housing system) management practices on the ICM and PSCC events (above 200,000 cells/ml). The results differed substantially by housing system and outcome. In tie-stall systems, clinical mastitis incidence was mainly affected by region (mountainous production zone; incidence rate ratio (IRR) = 0.73), the dairy herd replacement system (1.27) and farmers age (0.81). The proportion of high SCC was mainly associated with dry cow udder controls (IRR = 0.67), clean bedding material at calving (IRR = 1.72), using total merit values to select bulls (IRR = 1.57) and body condition scoring (IRR = 0.74). In free-stall systems, the IRR for clinical mastitis was mainly associated with stall climate/temperature (IRR = 1.65), comfort mats as resting surface (IRR = 0.75) and when no feed analysis was carried out (IRR = 1.18). The proportion of high SSC was only associated with hand and arm cleaning after calving (IRR = 0.81) and beef producing value to select bulls (IRR = 0.66). CONCLUSIONS: There were substantial differences in identified risk factors in the four models. Some of the factors were in agreement with the reported literature while others were not. This highlights the multifactorial nature of the disease and the differences in the risks for both mastitis manifestations. Attempting to understand these multifactorial associations for mastitis within larger management groups continues to play an important role in mastitis control programs.

Highly emissive Zn-Ln metal-organic frameworks with an unusual 3D inorganic subnetwork.

Mixed zinc-lanthanide (Zn-Ln) metal-organic frameworks (MOFs) based on the 3,5-pyrazoledicarboxylate ligand exhibit an unusual three-dimensional (3D) inorganic subnetwork and display highly efficient photoluminescence.

Long-term evaluation of phrenic nerve pacing for respiratory failure due to high cervical spinal cord injury.

OBJECTIVES: Phrenic nerve pacing is a method of respiratory support that can replace mechanical ventilation in high-level cervical spinal cord injury patients with diaphragmatic paralysis. Our objective was to evaluate survival and long-term quality of life in patients with external respiratory support by PNP vs volumetric respirator in patients with severe respiratory insufficiency due to a high-level spinal cord injury. DESIGN: This is a retrospective review study of a prospectively collected database for evaluate the survival and a questionnaire for quality of life has been collected face-to-face or by telephone at present. PATIENTS: Cervical SCI patients with permanent respiratory support (PNP or MV). METHODS: Long-term evaluation of a cohort of PNP-supported patients. We performed a comparison between these patients and volumetric respirator-supported patients. For survival analysis, we used the Kaplan-Meier method and Cox proportional hazards model. The health-related quality of life was assessed with SF-36 questionnaire, a general HRQL evaluation. RESULTS: One hundred twenty six patients on permanent respiratory support were evaluated during the study period. Of these, 38 were on PNP and 88 were mechanically ventilated. Paced patients were younger and had a longer survival, but in a multivariate analysis adjusted for age using a multiple logistic correlation we found that length of survival was greater for PNP patients. In terms of HRQL, the PNP-supported patients showed better results in terms of social functioning. CONCLUSIONS: PNP is a stable and effective method of long-term respiratory support in this type of patients (SCI patients dependent on external respiratory support). In these patients it improves the length of survival and some social issues by quality of life when compared with patients under MV.

Functional and comparative study of lingual papillae in four species of bear (Ursidae) by scanning electron microscopy.

The eight current species of bear (Ursidae) are widely distributed throughout Europe, Asia, and America. They are mainly encountered in the northern hemisphere, except for the spectacled bear and the sun bear, which are also found in the south of the equator. Adaptations of the masticatory apparatus (teeth, tongue, and musculature) to diet are one of the factors that imply the greatest structural changes in the cranium. This diet may be carnivorous, herbivorous, melliferous, or insectivorous, with one type of food predominating according to the time of year. The way in which food is eaten determines the morphology of the lingual surface; generally speaking, all bears put their mouth to the food, which, initially, they lick or they let the food stick to their tongue, as occurs when insects are eaten. As in all mammals, a distinction can be made between mechanical and gustatory papillae and the development and distribution of which depend on the species and their eating habits. In this study of the complete tongues of four species of adult bears, we describe the morphology of the lingual surfaces, the different types of papillae, their characteristics, and topographic distribution. It was seen that there were five main types of lingual papillae: filiform, conical, fungiform, foliate, and vallate. Morphology of the microgrooves and pores was similar to that observed in other mammals. In general, there were no great differences among the four species of bears studied, perhaps due to the similarity in the kind of food they consume in captivity.

Hyperglycemia after intratympanic dexamethasone treatment in a diabetic patient.

The treatment of patients with idiopathic sudden sensorineural hearing loss must be performed as an emergency measure in order to prevent long term hearing deficit. Steroids in monotherapy provide the best outcome. There is some controversy regarding the most efficient route but in order to prevent side effects, intratympanic treatment is the preferred choice, especially in diabetic patients. We here present the case of a patient that developed hyperglycemia after systemic and intratympanic dexamethasone treatment for sudden hearing loss. We conclude that after intratympanic treatment great caution must be taken.

Human neuroblastoma cultures for biorobotics.

This paper introduces a new biorobotic system using human neuroblastoma cultures and centre of area learning for basic robotic guidance. Multielectrode Arrays Setups have been designed for direct culturing neural cells over silicon or glass substrates, providing the capability to stimulate and record simultaneously populations of neural cells. The main objective of this work will be to control a robot using this biological neuroprocessor and a new simple centre of area learning scheme. The final system could be applied for testing how chemicals affect the behaviour of the robot or to establish the basis for new hybrid optogenetic neuroprostheses based on stimulating optically genetic-modified neurons.

Adrenalectomía y cirugía mayor ambulatoria. ¿Es posible? / No disponible

Objetivo: El propósito de nuestro estudio fue determinar la factibilidad y seguridad de un programa de adrenalectomía laparoscópica (AL) en régimen ambulatorio (CMA) en el Hospital General de Ciudad Real (HGCR).Material y método: Realizamos una revisión retrospectiva de las adrenalectomías realizadas en el HGCR desde enero de 2006a junio de 2008. La morbilidad y las características de las mas asadrenales extirpadas fueron evaluadas, al igual que la estancia hospitalaria y las complicaciones postoperatorias para ver si podrían haber sido incluidos en un programa de CMA según estrictoscriterios de selección. Resultados: Se realizaron 16 adrenalectomías durante esteperiodo; 12 por vía laparoscópica. Aplicando los criterios de Gill para cirugía ambulatoria, el grupo de candidatos consistiría en 6 pacientes que presentaban las siguientes características: la edad media fue de 51,67 años (44-65), 3 eran funcionantes y 3 incidentalomas. El ratio izquierdas/derechas fue 2:1. El tamaño tumoral medio fue de 3,75 cm (1-5 cm). En todos los casos se practicó AL transperitoneal lateral con tiempo operatorio medio de 83 minutos(30-150 minutos). No se registraron complicaciones postoperatorias. La estancia media fue de 2,83 días (2-3 días), con requerimientos de analgesia oral habitual durante 1-3 días. Conclusión: Nuestros resultados muestran que aplicando estrictos criterios de selección, es seguro y factible iniciar un programa ambulatorio de adrenalectomías por cirujanos expertos en técnicas laparoscópicas avanzadas, con alta satisfacción y nula morbilidad. Aún se necesitan estudios controlados que propicien criterios adecuados para unos resultados óptimos (AU)

Objective: The purpose of our study was to determine the feasibility and safety of a program for laparoscopic adrenalectomy(LA), on an ambulatory basis, at the General Hospital of Ciudad Real (HGCR).Material and method: A retrospective study was undertaken from January 2006 to June 2008. Co-morbidity and characteristics of the adrenal masses to be excised were assessed, as well as hospital length of stay and postoperative complications, to see whether they could have been included in an outpatient program according to strict selection criteria. Results: During the study period 16 adrenalectomies were performed at our institution; 12 of them by laparoscopy. Applying Gill’s criteria for outpatient surgery, the group of candidates consisted of 6 patients who met the following characteristics: mean age was 51.67 years (44-65), 3 tumours were functioning and the other 3 incidental findings. The ratio left/right was 2:1.The mean tumour size was 3.75 cm (1-5 cm). All cases underwent a lateral transperitoneal LA approach, the mean operative time was 83 minutes (30-150). No postoperative complications occurred.The average length of stay was 2.83 days (2-3), with regularoral analgesia requirements for 1-3 days.Conclusion: Our results show that, by applying strict selectioncriteria, it would be safe and feasible to under go an ambulatory program of adrenalectomy by experienced surgeons in advanced laparoscopic techniques, achieving high patients’ satisfaction and no morbidity. Controlled studies are still required to provide appropriate criteria for optimal results (AU)

Induction of tolerance in renal transplantation using splenic transplantation: experimental study in a canine model.

OBJECTIVE: To evaluate in a canine model the induction of tolerance to renal transplantation after splenectomy and splenosis. MATERIALS AND METHODS: This prospective, experimental, comparative, longitudinal study included 4 experimental groups, each comprising 4 dogs. Group 1 (control group) underwent renal transplantation only; group 2 underwent renal transplantation and splenectomy; group 3 underwent renal transplantation and splenosis; and group 4 underwent renal transplantation, splenectomy, and splenosis. Survival and degree of rejection were compared between the 4 groups. RESULTS: Splenosis improved renal function after transplantation, as indicated by increased serum creatinine concentration (group 3, 6.2 mg/dL vs group 1, 12.9 mg/dL). Comparison of weighted survival curves (corrected for degree of rejection) demonstrated a significant difference between group 2 (66.0 days) and group 4 (66.2 days) vs group 1 (52.7 days) and group 3 (41.2 days) (P = .05, Wilcoxon rank sum test). CONCLUSION: These results suggest that in this experimental model of renal transplantation, splenosis and splenectomy induce clinical tolerance, as indicated by improved renal function and prolonged recipient survival.

Neumonías neonatales / Neonatal pneumonia

El pulmón constituye el lugar más común de asentamiento de los microorganismos causales de sepsis del recién nacido. Este origen corresponde tanto a la vida prenatal y al parto como a la vida posnatal. Es por ello por lo que deben observarse estrechamente los signos sugerentes de dificultad respiratoria en el neonato, con el fin de llevar a cabo un diagnóstico y un tratamiento precoces. Estos cuadros se asocian a una gran morbilidad, pues se estima en unas 800.000 las muertes neonatales al año debidas a infecciones respiratorias en países en vías de desarrollo. En nuestro medio se estima que la incidencia es menor del 1%, pero sería cercana al 10% en niños con comorbilidad si se englobasen tanto los recién nacidos con peso adecuado para la edad gestacional como los de bajo peso. Además, en la práctica clínica se observa que casi en la totalidad de los cuadros sépticos existe afectación neumónica más o menos significativa tanto clínica como radiológica. En este artículo revisamos los diversos aspectos y retos que plantean las neumonías neonatales (en especial los gérmenes más habituales), y su enfoque terapéutico(AU)

The lung is the most common site of entry of the microorganisms causing sepsis in the newborn infant. This invasion can occur during the prenatal period and labor, as well as during the postnatal period. Thus, we must closely monitor signs suggestive of respiratory distress in the newborn infant in order to establish an early diagnosis and initiate treatment. These conditions are associated with a high rate of morbidity, and it is estimated that, in developing countries, approximately 800,000 neonatal deaths a year are due to respiratory infections. In our population, the incidence is calculated to be less than 1%, but it would be nearly10% in children with co-morbidity if the population includes those with a birth weight adequate for their gestational age and full term and premature infants. In addition, in clinical practice, it is observed that in nearly every case of sepsis, there is more or less significant evidence of pulmonary involvement in both the clinical and radiological examinations. In this article, we review the different aspects and challenges associated with neonatal pneumonia, focusing especially on the most common microorganisms and the therapeutic approach (AU)

Prevalence of mutations in TSHR, GNAS, PRKAR1A and RAS genes in a large series of toxic thyroid adenomas from Galicia, an iodine-deficient area in NW Spain.

OBJECTIVE: Toxic thyroid adenoma (TA) is a common cause of hyperthyroidism. Mutations in the TSH receptor (TSHR) gene, and less frequently in the adenylate cyclase-stimulating G alpha protein (GNAS) gene, are well established causes of TA in Europe. However, genetic causes of TA remain unknown in a small percentage of cases. We report the first study to investigate mutations in TSHR, GNAS, protein kinase, cAMP-dependent, regulatory, type I alpha (PRKAR1A) and RAS genes, in a large series of TA from Galicia, an iodine-deficient region in NW Spain. DESIGN AND METHODS: Eighty-five TA samples were obtained surgically from 77 hyperthyroid patients, operated on for treatment of non-autoimmune toxic nodular goitre. After DNA extraction, all coding exons of TSHR, GNAS and PRKAR1A genes, and exons 2 and 3 of HRAS, KRAS and NRAS were amplified by PCR and sequenced. Previously unreported mutants were cloned in expression vectors and their basal constitutive activities were determined by quantification of cAMP response element (CRE)-luciferase activity in CO7 cells transfected with wild-type and mutant plasmids. RESULTS: TSHR gene mutations were found in 52 (61.2%) samples, GNAS gene mutations in 4 (4.71%) samples and no PRKAR1A or RAS mutations were found. Only three previously unreported mutations were found, two affecting the TSHR, A623F and I635V, and one affecting the G-protein alpha-subunit (Gsalpha), L203P. All mutant proteins showed higher CRE-luciferase activity than their wild-type counterparts. CONCLUSIONS: TA in a hyperthyroid population living in Galicia, a Spanish iodine-deficient region, harbours elevated frequencies of TSHR and GNAS mutations activating the cAMP pathway. However, the genetic cause of TA was undetermined in 34% of the TA samples.

Neumonías virales / Viral pneumonia

La neumonía viral es una de las enfermedades más comunes que afecta a lactantes y niños. La OMS comunica que la infección respiratoria aguda continúa siendo una causa importante de morbimortalidad infantil; se estima que aproximadamente 2 millones de niños menores de 5 años de edad mueren por esta causa en los países del Tercer Mundo y el 40% de estas muertes son debidas a infecciones virales. El problema que plantean las neumonías virales es triple: por un lado, el descubrimiento de nuevos virus patógenos, algunos de los cuales causan graves cuadros neumónicos; por otro, las dificultades para conocer la etiología, problema de difícil solución, y un problema no menor, su coexistencia con otros patógenos, con el probable aumento de la morbimortalidad asociada. Una cuestión todavía no resuelta y que preocupa en todo el mundo es la infección por el virus de la gripe aviar, tipo H1N5, cuyo hipotético paso a humanos por infección humana (no animal-humano) no descarta la posibilidad de una pandemia. Parece razonable pensar que el enfoque futuro para un aumento del control de estas infecciones virales vendrá por bioingienería genética, lo que mejorará su identificación y el desarrollo de vacunas para los virus más agresivos causantes de neumonías virales graves(AU)

Viral pneumonia is one of the most common diseases affecting infants and children throughout the world. The WHO reports that acute respiratory infections continue to be a leading cause of morbidity and mortality in young children; they kill approximately two million children under the age of 5 years in developing countries, and about 40% of these deaths are due to viral infections. The challenge posed by the viral pneumonias is triple: on the one hand, the discovery of new pathogenic viruses, some of which cause serious pulmonary problems; on the other hand, the difficulties involved in determining the etiology, a question that is difficult to resolve; and another that is by no means minor, their coexistence with other pathogens, probably accompanied by an increase in the associated morbidity and mortality. Another problem that remains to be solved, and has become a worldwide concern, is infection by the H5N1 avian flu virus, the hypothetical transfer of which from an infected human to other humans (not animal-to-human) does not rule out the possibility of a pandemic. It seems to be reasonable to think that the future approach to controlling an increase in these viral infections will come from genetic engineering to improve their identification and the development of vaccines for the most aggressive causative viruses of serious viral pneumonias(AU)

Neumonía estafilocócica / Staphylococcus aureus pneumonia

La infección estafilocócica es una causa poco frecuente de neumonía en niños inmunocompetentes. Es casi exclusivamente una enfermedad de lactantes. La neumonía por Staphylococcus tiende a presentarse como una enfermedad aguda y grave, en especial porque muchos antibióticos usados para tratar las neumonías adquiridas en la comunidad (NAC) no proporcionan una cobertura apropiada para este agente. Los hallazgos radiológicos incluyen bronconeumonía con infiltrados alveolares, que habitualmente son unilaterales. Estos infiltrados pueden coalescer y originar grandes áreas de consolidación y cavitación. La destrucción de las paredes bronquiales puede dar lugar a la formación de neumatoceles en más del 50% de los casos y a empiemas. Aunque la aparición de los neumatoceles puede ser dramática, una vez que la infección es controlada, los neumatoceles se resuelven completamente en unos pocos meses. A pesar de su baja frecuencia, estas neumonías precisan ser tratadas conociendo el antibiótico más adecuado, pues este germen puede tener cepas meticilin resistentes, que obligan al uso de fármacos específicos como la vancomicina o la teicoplanina(AU)

Staphylococcus infection is a rare cause of pneumonia in immunocompetent children. It is almost exclusively a disease of infants. Staphylococcus aureus pneumonia tend to present as an acute and severe illness, especially because many antibiotics used to treat community acquired pneumonia (CAP) do not providec overage for this agent. Radiologic findings include bronchopneumonia with alveolar infiltrates, which is more commonly unilateral. The infiltrates may coalesce and may evolve areas of consolidation and cavitation. Destruction of bronchial walls may lead to pneumatocele formation in about more half of the cases and empyema. Although the appearance of staphylococcal pneumatoceles may be dramatic, usually once the infection has been overcome, the pneumatoceles resolve completely over a few months. In spite of its low frequency, these pneumonias are necessary to be treated knowing the most suitable antibiotic, since this germ can have meticillin-resistant strains, which force to the use of specific drugs as the vancomyc in or the teicoplanin(AU)