Design of a low-cost force insoles to estimate ground reaction forces during human gait.

This paper proposes a low-cost electronic system for estimating ground reaction forces (GRF) during human gait. The device consists of one master node and two slave nodes. The master node sends instructions to slave nodes that sample and store data from two force insoles located at the participant's feet. These insoles are equipped with 14 piezo-resistive FlexiForce A301 sensors (FSR). The slave nodes are attached to the ankles and feet of each participant. Subsequently, the start command is transmitted through the master node, which is connected to the USB port of a personal computer (PC). Once the walking session is completed, the information obtained by the slave nodes can be downloaded by accessing the access point generated by these devices through Wi-Fi communication. The GRF estimation system was validated with force platforms (BTS Bioengineering P6000, Italy), giving on average a fit measure equal to 68 . 71 % ± 4 . 80 % in dynamic situations. Future versions of this device are expected to increase this fit by using machine learning models.

Method to determine instantaneous transient responses in pressurized pipes from transfer functions and state space for evaluation of leak signals.

This article addresses the impact of transient pressure anomalies in hydraulic systems, triggered by the opening or closing of valves or pumps, instantly disturbing the line of hydraulic gradient (LGH). This variation in pressure has significant consequences both in hydraulic and structural terms for water networks. Most of the existing techniques to detect transients in water distribution systems use asynchronous methods, generating timeless information that limits the response capacity in critical situations. Therefore, an automatic transient detection system based on the Internet of Things (IoT) is proposed, capable of identifying overpressure or underpressure pulses in soft real-time, activating alarms to facilitate decision-making. This approach helps maintain the safety of the water distribution system and prevent leaks in the network. Furthermore, a model of the transient behavior of pressure and flow is presented by linearizing the water hammer equations from the Laplace transform, thus generating a transfer function that describes the algebraic relationship between the outlet and inlet of the hydraulic system.•The transient analysis of the hydraulic system prototype underscores its high sensitivity to initial conditions, attributed to turbulence. This observation suggests the possible presence of a dynamic strange attractor related to water hammer phenomena in pressure pipes.•The methodology involving transfer functions and state-space models enables the assessment of how leaks impact the transient responses of the system, including the magnitude, duration, and frequency of disturbances generated by them.•The proposed method introduces a dynamic transfer function capable of identifying instantaneous changes over time in terms of flow and pressure.

Low-Power Long-Term Ambulatory Electrocardiography Monitor of Three Leads with Beat-to-Beat Heart Rate Measurement in Real Time.

A low-power long-term ambulatory ECG monitor was developed for the acquisition, storage and processing of three simultaneous leads DI, aVF and V2 with a beat-to-beat heart rate measurement in real time. It provides long-term continuous ECG recordings until 84 h. The monitor uses a QRS complex detection algorithm based on the continuous wavelet transform with splines, which automatically selects the scale for the analysis of ECG records with different sampling frequencies. It includes a lead-off detection to continuously monitor the electrode connections and a real-time system of visual and acoustic alarms to alert users of abnormal conditions in its operation. The monitor presented is based in an ADS1294 analogue front end with four channels, 24-bit analog-to-digital converters and programmable gain amplifiers, a low-power dual-core ESP32 microcontroller, a microSD memory for data storage in a range of 4 GB to 32 GB and a 1.4 in thin-film transistor liquid crystal display (LCD) variant with a resolution of 128 × 128 pixels. It has programmable sampling rates of 250, 500 and 1000 Hz; a bandwidth of 0 Hz to 50% of the selected sampling rate; a CMRR of -105 dB; an input margin of ±2.4 V; a resolution of 286 nV; and a current consumption of 50 mA for an average battery life of 84 h. The ambulatory ECG monitor was evaluated with the commercial data-acquisition system BIOPAC MP36 and its module for ECG LABEL SS2LB, simultaneously comparing the morphologies of two ECG records and obtaining a correlation of 91.78%. For the QRS detection in real time, the implemented algorithm had an error less than 5%. The developed ambulatory ECG monitor can be used for the analysis of the dynamics of the heart rate variability in long-term ECG records and for the development of one's own databases of ECG recordings of normal subjects and patients with cardiovascular and noncardiovascular diseases.

Development a Low-Cost Wireless Smart Meter with Power Quality Measurement for Smart Grid Applications.

Developing a low-cost wireless energy meter with power quality measurements for smart grid applications represents a significant advance in efficient and accurate electric energy monitoring. In increasingly complex and interconnected electric systems, this device will be essential for a wide range of applications, such as smart grids, by introducing a real-time energy monitoring system. In light of this, smart meters can offer greater opportunities for sustainable and efficient energy use and improve the utilization of energy sources, especially those that are nonrenewable. According to the 2020 International Energy Agency (IEA) report, nonrenewable energy sources represent 65% of the global supply chain. The smart meter developed in this work is based on the ESP32 microcontroller and easily accessible components since it includes a user-friendly development platform that offers a cost-effective solution while ensuring reliable performance. The main objective of developing the smart meters was to enhance the software and simplify the hardware. Unlike traditional meters that calculate electrical parameters by means of complex circuits in hardware, this project performed the calculations directly on the microcontroller. This procedure reduced the complexity of the hardware by simplifying the meter design. Owing to the high-performance processing capability of the microcontroller, efficient and accurate calculations of electrical parameters could be achieved without the need for additional circuits. This software-driven approach with simplified hardware led to benefits, such as reduced production costs, lower energy consumption, and a meter with improved accuracy, as well as updates on flexibility. Furthermore, the integrated wireless connectivity in the microcontroller enables the collected data to be transmitted to remote monitoring systems for later analysis. The innovative feature of this smart meter lies in the fact that it has readily available components, along with the ESP32 chip, which results in a low-cost smart meter with performance that is comparable to other meters available on the market. Moreover, it is has the capacity to incorporate IoT and artificial intelligence applications. The developed smart meter is cost effective and energy efficient, and offers benefits with regard to flexibility, and thus represents an innovative, efficient, and versatile solution for smart grid applications.

TLS Protocol Analysis Using IoTST-An IoT Benchmark Based on Scheduler Traces.

The Internet of Things (IoT) envisions billions of everyday objects sharing information. As new devices, applications and communication protocols are proposed for the IoT context, their evaluation, comparison, tuning and optimization become crucial and raise the need for a proper benchmark. While edge computing aims to provide network efficiency by distributed computing, this article moves towards sensor nodes in order to explore efficiency in the local processing performed by IoT devices. We present IoTST, a benchmark based on per-processor synchronized stack traces with the isolation and precise determination of the introduced overhead. It produces comparable detailed results and assists in determining the configuration that has the best processing operating point so that energy efficiency can also be considered. On benchmarking applications which involve network communication, the results can be influenced by the constant changes that occur in the state of the network. In order to circumvent such problems, different considerations or assumptions were used in the generalization experiments and the comparison to similar studies. To present IoTST usage on a real problem, we implemented it on a commercial off the-shelf (COTS) device and benchmarked a communication protocol, producing comparable results that are unaffected by the current network state. We evaluated different Transport-Layer Security (TLS) 1.3 handshake cipher suites at different frequencies and with various numbers of cores. Among other results, we could determine that the selection of a specific suite (Curve25519 and RSA) can improve the computation latency by up to four times over the worst suite candidate (P-256 and ECDSA), while both providing the same security level (128 bits).

Sensor for Real-Time Glucose Measurement in Aqueous Media based on Nanomaterials Incorporating an Artificial Neural Network Algorithm on a System-On-Chip / Sensor para Medición de Glucosa en Tiempo Real para Medios Acuosos basado en Nanomateriales Incorporando un Algoritmo de Red Neuronal Artificial en un Sistema en Chip

Abstract The aim of this paper is to present the development of a real-time measurement system for glucose in aqueous media. The proposed system incorporates two lines of research: i) design, synthesis, and implementation of a non-enzymatic electrochemical sensor of Multi-Walled Carbon Nanotubes with Copper nanoparticles (MWCNT-Cu) and ii) design and implementation of a machine learning algorithm based on an Artificial Neural Network Multilayer Perceptron (ANN-MLP), which is embedded in an ESP32 SoC (System on Chip). From the current data that is extracted in real-time during the oxidation-reduction process to which an aqueous medium is subjected, it feeds the algorithm embedded in the ESP32 SoC to estimate the glucose value. The experimental results show that the nanostructured sensor improves the resolution in the amperometric response by identifying an ideal place for data collection. For its part, the incorporation of the algorithm based on an ANN embedded in a SoC provides a level of 97.8 % accuracy in the measurements. It is concluded that incorporating machine learning algorithms embedded in low-cost SoC in complex experimental processes improves data manipulation, increases the reliability of results, and adds portability.

Resumen El objetivo de este artículo es presentar el desarrollo de un sistema de medición en tiempo real de glucosa en medios acuosos. El sistema que se implementa incorpora dos lineas de investigación: i) diseño, síntesis e implementación de un sensor electroquímico no enzimático de Nanotubos de Carbono de Pared Múltiple con nanopartículas de Cobre (NTCPM-Cu) y ii) diseño e implementación de un algoritmo de aprendizaje automático basado en una Red Neuronal Perceptrón Multicapa (RN-PM), embebido en un ESP32 SoC (Sistema en Chip). Un dato de corriente que se extrae en tiempo real durante el proceso de oxidación-reducción a la que se somete un medio acuoso, alimenta el algoritmo embebido en el ESP32 para estimar el valor de glucosa. De los resultados experimentales se demuestra que el sensor nanoestructurado mejora la resolución en la respuesta amperométrica al identificar un lugar ideal para la toma de datos. Por su parte, la incorporación del algoritmo basado en una RN embebido en SoC otorga un nivel de 97.8 % de exactitud en la mediciones. Se concluye que incorporar algoritmos de aprendizaje automático embebidos en SoC de bajo costo en procesos experimentales complejos, mejora la manipulación de datos, incrementa la confiabilidad en resultados y adiciona portabilidad.

Fuzzy Control of Pressure in a Water Supply Network Based on Neural Network System Modeling and IoT Measurements.

As hydroenergetic losses are inherent to water supply systems, they are a frequent issue which water utilities deal with every day. The control of network pressure is essential to reducing these losses, providing a quality supply to consumers, saving electricity and preserving piping from excess pressure. However, to obtain these benefits, it is necessary to overcome some difficulties such as sensing the pressure of geographically distant consumer units and developing a control logic that is capable of making use of the data from these sensors and, at the same time, a good solution in terms of cost benefit. Therefore, this work has the purpose of developing a pressure monitoring and control system for water supply networks, using the ESP8266 microcontroller to collect data from pressure sensors for the integrated ScadaLTS supervisory system via the REST API. The modeling of the plant was developed using artificial neural networks together with fuzzy pressure control, both designed using the Python language. The proposed method was tested by considering a pumping station and two reference units located in the city of João Pessoa, Brazil, in which there was an excess of pressure in the supply network and low performance from the old controls, during the night period from 12:00 a.m. to 6:00 a.m. The field results estimated 2.9% energy saving in relation to the previous form of control and a guarantee that the pressure in the network was at a healthy level.

Técnicas regionales guiadas por ultrasonido para manejo de analgesia para cesárea / Ultrasound regional analgesic technic for cesarian analgesia

One of the fundamental pillars for optimal patient recovery after a cesarean section is pain management after a surgical intervention. For years the gold standard for analgesic management the use of intrathecal morphine due to its long-lasting effect, however adverse effects related to the use of opioids are evidenced too, Currently, with the advent of multimodal analgesia, the use of opioids and the effects associated with them have been reduced, optimizing pain management, reducing hospital stay, lower risk of postpartum depression, reducing the presence of nausea and vomiting as well as pruritus and improving mother-child relationship. An essential component of the multimodal analgesia are regional blocks like the transversus abdominis plane block and the ilioinguinal / iliohypogastric block, Quadratus lumborum and erectus spinae plane block demonstrate its usefulness with better pain management compared with TAP block regardless these have a higher level of complexity due to the visceral pain control; but there is no evidence with methodologic quality enough that demonstrate better outcomes compare with intrathecal morphine.

Uno de los pilares fundamentales para la recuperación de la paciente que fue intervenida de cesárea es el manejo del dolor posoperatorio. Por años el estándar de oro ha sido el uso de la morfina intratecal considerando su larga duración como también los efectos adversos, actualmente con el advenimiento de la analgesia multimodal, se ha reducido el uso de opiodes y de los efectos asociados a estos optimizando el manejo del dolor, disminuyendo la estancia hospitalaria, menor riesgo de depresión posparto, disminuye la presencia de náusea y vómitos como también prurito y mejorando la relación madre e hijo. Un componente esencial de la analgesia multimodal son los bloqueos: transverso del abdomen, ilioinguinal/ iliohipogástrico, cuadrado lumbar, erector de la espina; que han aportado eficazmente en el abordaje del dolor posoperatorio. El bloqueo de los planos y demuestra su utilidad con un mejor manejo del dolor en comparación con el bloqueo TAP, a pesar de que estos tienen un mayor nivel de complejidad debido al control del dolor visceral; pero no hay evidencia con suficiente calidad metodológica que demuestre mejores resultados en comparación con la morfina intratecal.

Continuous erector spinae plane block for pain management in laparoscopic liver resection: case report / Bloqueo continuo del elevador de la espina para el manejo del dolor en una reseccion hepática laparoscopica: reporte de caso

Abstract Pain after liver resection can be difficult to manage. Epidural anesthesia (EA) is an effective technique in pain control in this surgery. However, postoperative coagulopathy and hypotension due to autonomic nervous system block in high-risk patients, may result that the EA is an inadequate analgesic technique in according to enhanced recovery after surgery (ERAS) recommendations for liver surgery. Regional block techniques have been recommended for liver surgery in ERAS guidelines. Erector spinae plane (ESP) block is a recent block described for thoracic and abdominal surgeries and provides both somatic and visceral analgesia. We describe a high-risk patient with cardiac dysfunction and Parkinson's disease who underwent laparoscopic right liver resection for hepatocellular carcinoma. Satisfactory intra and postoperative analgesia was achieved by a combined continuous ESP block, transversus abdominis plane (TAP), and oblique subcostal TAP blocks. Surgery and postoperative period was uneventful. No opioids were administered during hospitalization. A combined of thoracic and abdominal wall blocks can be an effective approach for intra and postoperative analgesia in high-risk patients undergoing laparoscopic liver resection. Further clinical research is recommended to establish the effectiveness of the ESP block as an analgesic technique in this surgery.

Resumen El dolor posterior a una resección hepática puede ser difícil de manejar. La anestesia epidural (AE) es una técnica efectiva para el control del dolor en esta cirugía. Sin embargo, la coagulopatía y la hipotensión postoperatorias debido al bloqueo del sistema nervioso autónomo en pacientes de alto riesgo, puede hacer que la AE sea una técnica analgésica inadecuada, de acuerdo con las recomendaciones de la recuperación mejorada después de cirugía (ERAS, por las iniciales en inglés de Enhanced Recovery After Surgery) para cirugía hepática. Se han recomendado las técnicas de bloqueo regional para cirugía hepática en las guías ERAS. El bloqueo del plano erector de la espina (BEE) (ESP, por las iniciales en inglés de erector spinae plan block) es una técnica reciente, para cirugías torácicas y abdominales, que brinda analgesia tanto somática como visceral. Se describe aquí un paciente de alto riesgo con disfunción cardiaca y enfermedad de Parkinson que se sometió a resección la paroscópica del lóbulo derecho del hígado por carcinoma hepatocelular. Se logró analgesia intra y postoperatoria eficaz mediante una combinación de bloqueo continuo ESP, y bloqueos del plano transverso abdominal (PTA) y del plano transverso abdominal subcostal oblicuo. La cirugía y el periodo postoperatorio transcurrieron sin novedad y no se administraron opioides durante la hospitalización. La combinación de bloqueos combinados torácicos y de la pared abdominal pueden ser un abordaje efectivo para la analgesia intra y postoperatoria en pacientes de alto riesgo que se someten a resección hepática laparoscópica. Se recomienda continuar con la investigación clínica a finde establecer la efectividad del bloqueo ESP como técnica anestésica para esta cirugía.

[Erector spinae plane block in pediatric orthopedic surgery: two case reports]. / Bloqueio do plano eretor da espinha em cirurgia ortopédica pediátrica: dois relatos de caso.

The erector spinae plane block is a safe and effective regional anesthesia technique, which has earned new indications perioperatively since its description. We introduce two pediatric anesthesia cases in which we performed the erector spinae plane block during intermediate/major orthopedic surgeries. The first patient is a 2 year-old girl submitted to surgical treatment of developmental dysplasia of the hip. The second patient is a 14 year-old boy submitted to surgical treatment of bilateral clubfoot. This last patient is potentially the first published case in which the erector spinae plane block was performed for ankle and foot surgery. Both cases experienced excellent analgesia, avoiding opiate requirement completely.

Erector spinae plane block in pediatric orthopedic surgery: two case reports / Bloqueio do plano eretor da espinha em cirurgia ortopédica pediátrica: dois relatos de caso

Abstract The erector spinae plane block is a safe and effective regional anesthesia technique, which has earned new indications perioperatively since its description. We introduce two pediatric anesthesia cases in which we performed the erector spinae plane block during intermediate/major orthopedic surgeries. The first patient is a 2 year-old girl submitted to surgical treatment of developmental dysplasia of the hip. The second patient is a 14 year-old boy submitted to surgical treatment of bilateral clubfoot. This last patient is potentially the first published case in which the erector spinae plane block was performed for ankle and foot surgery. Both cases experienced excellent analgesia, avoiding opiate requirement completely.

Resumo O bloqueio do plano eretor da espinha guiado por ultrassonografia é uma técnica segura e eficaz de anestesia regional, que apresenta novas indicações no perioperatório. Apresentamos dois casos de bloqueio do plano eretor da espinha realizados para analgesia de cirurgia ortopédica pediátrica de médio/grande porte. O primeiro: menina de 2 anos submetida a tratamento cirúrgico de displasia do desenvolvimento do quadril. O segundo: menino de 14 anos submetido a correção de pé valgo bilateral. Este último, no melhor do nosso conhecimento, é o primeiro caso de bloqueio do plano eretor da espinha em cirurgia de tornozelo/pé descrito na literatura. Os casos tiveram analgesia pós-operatória adequada, sem necessidade de opioides.

[Comparison between erector spinal plane block and epidural block techniques for postoperative analgesia in open cholecystectomies: a randomized clinical trial]. / Comparação entre as técnicas de bloqueio do plano do músculo eretor da espinha e bloqueio epidural para analgesia pós­operatória em colecistectomias abertas: um ensaio clínico randomizado.

INTRODUCTION AND OBJECTIVES: Blockade of the Erector Spinal Muscle (ESP block) is a relatively new block, initially described for chronic thoracic pain analgesia, but it has already been described for anesthesia and analgesia in thoracic surgical procedures and, more recently, for high abdominal surgeries. The aim of the study was to compare two techniques, ESP Block and Epidural block with morphine and local anesthetic for postoperative analgesia of open cholecystectomy surgeries. METHODS: Controlled single-blind randomized clinical trial with 31 patients (ESP block, n = 15; Epidural, n = 16), of both genders, ages between 27 and 77 years. The ESP block was performed at the T8 level with injection of 20 mL of 0.5% ropivacaine bilaterally. The epidural block was performed at the T8-T9 space with 20 mL of 0.5% ropivacaine and 1 mg of morphine. RESULTS: The ESP block group presented higher mean Numeric Pain Scale (NPS) values for pain in the up to 2 hour (p = 0.001) and in the 24 hour (p = 0.001) assessments. The ESP block group had a three-fold increased risk (43.7% vs. 13.3%) of rescue opioid use in the 24 postoperative hours when compared to the epidural group (RR = 3.72, 95% CI: 0.91 to 15.31, p = 0.046). CONCLUSION: ESP block did not prove to be an effective technique for postoperative analgesia of open cholecystectomy, at the doses performed in this study, having required more use of rescue opioid, and without differences in NPS. More comprehensive studies are required to assess the efficacy of ESP block for the visceral and abdominal somatic component, considering the specific blockade level.

Comparison between erector spinal plane block and epidural block techniques for postoperative analgesia in open cholecystectomies: a randomized clinical trial / Comparação entre as técnicas de bloqueio do plano do músculo eretor da espinha e bloqueio epidural para analgesia pós-operatória em colecistectomias abertas: um ensaio clínico randomizado

Abstract Introduction and objectives: Blockade of the Erector Spinal Muscle (ESP Block) is a relatively new block, initially described for chronic thoracic pain analgesia, but it has already been described for anesthesia and analgesia in thoracic surgical procedures and, more recently, for high abdominal surgeries. The aim of the study was to compare two techniques, ESP Block and Epidural Block, with morphine and local anesthetic for postoperative analgesia of open cholecystectomy surgeries. Methods: Controlled single-blind randomized clinical trial with 31 patients (ESP Block, n = 15; Epidural, n = 16), of both genders, ages between 27 and 77 years. The ESP block was performed at the T8 level with injection of 20 mL of 0.5% ropivacaine bilaterally. The epidural block was performed at the T8-T9 space with 20 mL of 0.5% ropivacaine and 1 mg of morphine. Results: The ESP Block group presented higher mean ​​Numeric Pain Scale (NPS) values for pain in the up to 2 hour (p = 0.001) and in the 24 hour (p = 0.001) assessments. The ESP Block group had a three-fold increased risk (43.7% vs. 13.3%) of rescue opioid use in the 24 postoperative hours when compared to the epidural group (RR = 3.72, 95% CI: 0.91 to 15.31, p = 0.046). Conclusion: ESP Block did not prove to be an effective technique for postoperative analgesia of open cholecystectomy, at the doses performed in this study, having required more use of rescue opioid, and without differences in NPS. More comprehensive studies are required to assess the efficacy of ESP block for the visceral and abdominal somatic component, considering the specific blockade level.

Resumo Justificativa e objetivo: O Bloqueio do Plano do Músculo Eretor da Espinha (ESP block) é um bloqueio relativamente novo, inicialmente descrito para analgesia de dor torácica crônica, porém já descrito para anestesia e analgesia em procedimentos cirúrgicos torácicos e, mais recentemente, para cirurgias abdominais altas. O estudo objetivou comparar as técnicas de bloqueio ESP e bloqueio Epidural com morfina e anestésico local para analgesia pós-operatória de cirurgias de colecistectomia aberta. Método: Estudo clínico randomizado controlado, unicego com 31 pacientes (ESP block, n = 15; Epidural, n = 16), de ambos os sexos, idades entre 27 e 77 anos. O ESP block foi realizado no nível de T8 com injeção de 20 mL de ropivacaína 0,5% bilateral. O bloqueio Epidural foi realizado no espaço T8-T9 com 20 mL de ropivacaína 0,5% e 1 mg de morfina. Resultados: O grupo ESP block apresentou valores médios de dor pela Escala Visual Numérica (EVN) maiores nas avaliações até 2 horas (p= 0,001) e em 24 horas (p= 0,001). O grupo ESP block apresentou um risco três vezes maior - 43,7%vs.13,3% - de uso de opioide de resgate em 24 horas pós-operatórias do que o grupo epidural (RR = 3,72; 95% IC 0,91 a 15,31; p= 0,046). Conclusão: Nas doses realizadas nesse estudo, o ESP block não se mostrou uma técnica efetiva para analgesia pós-operatória de colecistectomia aberta, com mais uso de opioide de resgate e sem diferenças na escala visual numérica de dor. Necessita-se de estudos mais abrangentes avaliando a eficácia do ESP block para o componente visceral e somático abdominal, considerando o nível do bloqueio específico.

A Custom Microcontrolled and Wireless-Operated Chamber for Auditory Fear Conditioning.

Animal behavioral paradigms, such as classical conditioning and operant conditioning, are an important tool to study the neural basis of cognition and behavior. These paradigms involve manipulating sensory stimuli in a way that learning processes are induced under controlled experimental conditions. However, the majority of the commercially available equipment did not offer flexibility to manipulate stimuli. Therefore, the development of most versatile devices would allow the study of more complex cognitive functions. The purpose of this work is to present a low-cost, customized and wireless-operated chamber for animal behavior conditioning, based on the joint operation of two microcontroller modules: Arduino Due and ESP8266-12E. Our results showed that the auditory stimulation system allows setting the carrier frequency in the range of 1 Hz up to more than 100 kHz and the sound stimulus can be modulated in amplitude, also over a wide range of frequencies. Likewise, foot-shock could be precisely manipulated regarding its amplitude (from ∼200 µA to ∼1500 µA) and frequency (up to 20 pulses per second). Finally, adult rats exposed to a protocol of cued fear conditioning in our device showed consistent behavioral response and electrophysiological evoked responses in the midbrain auditory pathway. Furthermore, the device developed in the current study represents an open source alternative to develop customized protocols to study fear memory under conditions of varied sensory stimuli.

Extracellular proteases of Staphylococcus epidermidis: roles as virulence factors and their participation in biofilm.

Staphylococci produce a large number of extracellular proteases, some of which are considered as potential virulence factors. Staphylococcus epidermidis is a causative agent of nosocomial infections in medical devices by the formation of biofilms. It has been proposed that proteases contribute to the different stages of biofilm formation. S. epidermidis secretes a small number of extracellular proteases, such as serine protease Esp, cysteine protease EcpA, and metalloprotease SepA that have a relatively low substrate specificity. Recent findings indicate a significant contribution of extracellular proteases in biofilm formation through the proteolytic inactivation of adhesion molecules. The objective of this work is to provide an overview of the current knowledge of S. epidermidis' extracellular proteases during pathogenicity, especially in the different stages of biofilm formation.

Informe Quincenal Epidemiológico Nacional (IQEN) No. 3; Implementación del Centro de Operaciones de Emergencia en Salud pública COE-ESP del Instituto Nacional de Salud, Colombia, 2017 / Biweekly National Epidemiological Report

el Centro de Operaciones de Emergencia en Salud Pública (COE-ESP), del Instituto Nacional de Salud (INS) de Colombia, es una estrategia con los principios de la Organización Mundial de la Salud (OMS) para optimizar la planificación de acciones de preparación y respuesta en situaciones de brote o ante cualquier evento que pueda constituir un riesgo en salud pública. Una adecuada infraestructura física, un recurso humano entrenado y la gestión por procesos de una estructura de un Sistema Comando Incidente, permiten identificar, valorar y modificar una potencial situación de riesgo. El presente estudio tiene como objetivo describir los eventos gestionados como respuesta ante situaciones de riesgo en salud pública.

The Center of Emergency Operations in Public Health (COE-ESP), of the National Institute of Health (INS) of Colombia, is a strategy with the principles of the World Health Organization (WHO) to optimize the planning of preparedness actions and response in outbreak situations or to any event that may constitute a public health risk. An adequate physical infrastructure, a trained human resource and the management by processes of a structure of an Incident Command System, allow to identify, assess and modify a potential risk situation. The present study aims to describe the events managed as a response to situations of risk in public health

Polymorphism analysis and new JAG1 gene mutations of Alagille syndrome in Mexican population.

Alagille syndrome is a multisystem disorder with an autosomic dominant pattern of inheritance that affects the liver, heart, eyes, kidneys, skeletal system and presents characteristic facial features. Mutations of the JAG1 gene have been identified in 20-89% of the patients with Alagille syndrome, this gene encodes for a ligand that activates the Notch signaling pathway. In the present study we analyzed 9 Mexican patients with Alagille syndrome who presented the clinical criteria for the classical presentation of the disease. By using the denaturing high performance liquid chromatography mutation analysis we were able to identify different mutations in 7 of the patients (77.77%), importantly, we found 5 novel mutations in JAG1 gene. The allelic frequency distribution of 13 polymorphisms in Mexican population is also reported. The overall results demonstrated an expanding mutational spectrum of JAG1 gene in the Mexican population.

Virulence and antibiotic resistance of Enterococcus faecalis clinical isolates recovered from three states of Mexico. Detection of linezolid resistance.

BACKGROUND AND AIMS: The virulence of Enterococcus faecalis is associated with three proteins involved in biofilm production: Ace, Agg, and Esp. Isolates also vary with respect to drug resistance. The present study investigated four characteristics of clinical isolates of E. faecalis recovered from three hospitals in Mexico, including biofilm production, the presence of biofilm-related genes, antibiotic susceptibility, and clonal diversity. METHODS: We studied 109 clinical isolates. Biofilm formation was investigated using crystal violet and the safranin method with biofilm index correction. The presence of ace, agg, and esp genes was determined by PCR. Susceptibility to antibiotics was determined by the broth microdilution method and clonal relatedness was determined by pulsed-field gel electrophoresis (PFGE). RESULTS: Using the crystal violet method, 4.6% (5/109) of isolates were high biofilm producers, 48% (52/109) were moderate producers, 20% (39/109) were low producers, and 11% (12/109) were nonproducers. The agg gene was present in 44% (48/109), the ace gene in 39% (43/109), and the esp gene in 33% (36/109). The esp gene was associated with biofilm production (p <0.001), whereas the ace gene correlated with tetracycline resistance (p <0.01). The biofilm index was associated with the presence of both esp plus agg in glucose medium (p = 0.006). Clinical isolates showed high resistance to tetracycline and ciprofloxacin. Also, 2% of isolates were resistant to linezolid and there was no vancomycin resistance. PFGE revealed 109 different restriction patterns. CONCLUSIONS: The presence of the esp and agg gene was associated with biofilm production, whereas the presence of the ace gene correlated with tetracycline resistance. Overall, a moderate resistance to antibiotics was detected and there was no clonal relatedness among isolates.

Adaptación y validación del Faces-20-ESP: Re-conociendo el funcionamiento familiar enChillán, Chile / Adaptation and validation of faces 20-ESP: family functioning awareness in Chillán, Chile

En este artículo presentamos el proceso de adaptación y validación al contextolocal de la Escala Breve de Evaluación Familiar Faces 20 ESP realizada en la ciudad de Chillán,Chile. Los resultados obtenidos nos demostraron una semejanza altamente significativa frente a losencontrados en la versión original, lo que da cuenta de la fiabilidad y validez del instrumento para elestudio del funcionamiento familiar, sentando importantes precedentes académicos para posterioresinvestigaciones.Con base en el análisis comparativo, pudimos observar que en las familias estudiadas no existendiferencias estadísticamente significativas tanto en cohesión como en adaptabilidad, entre lostipos ensambladas y nucleares. Esto evidencia empíricamente que no es posible atribuir un tipo defuncionamiento determinado a una configuración familiar específica, lo que posiblemente contengaimplicancias teóricas futuras.

Virulence factors in vancomycin-resistant and vancomycin - susceptible Enterococcus faecalis from Brazil / Fatores de virulência em Enterococcus faecalis resistentes e suscetível à vancomicina isolados no Brasil

Enterococci are members of commensal flora of animals and insects, but are also important opportunistic pathogens. Our objective was to observe if there was any difference of virulence in several groups of E. faecalis, mainly between vancomycin-resistant E. faecalis (VREFS) of colonization and infection. VREFS and vancomycin-sensitive E. faecalis from Brazil were screened for the presence of virulence factor genes. Phenotypic assays were used to assess in vitro expression, to understand the pathogenic potential of these isolates and to determine whether a correlation exists between virulence and antibiotic resistance. Different virulence profiles were found suggesting that the disseminating clone may have generated several variations. However, our study showed that one constellation of traits appeared most commonly: gelatinase, aggregation substance and esp (GEA). These factors are important because they have been implicated in cell aggregation and biofilm formation. Biofilm formation may promote the conjugation of plasmids harboring resistance and virulence genes, enhancing the probability of entry of new resistance genes into species. Curiously, the profile GEA was not exclusive to VREFS, it was the second most observed in VSEFS isolates from colonization and infection in hospitalized patients and also from rectal swabs of healthy volunteers. Such strains appear to represent the entry gateway to new resistance genes into E. faecalis and may contribute to the spreading of E. faecalis mainly in hospitals.

Enterococci são membros da microbiota comensal de animais e insetos, mas também são importantes patógenos oportunistas. Nosso objetivo foi observar se há qualquer diferença na virulência nos diversos grupos de Enterococcus faecalis, principalmente nos E. faecalis resistente à vancomicina (VREFS) isolados de colonização e infecção. VREFS e E. faecalis sensíveis à vancomicina (VSEFS) do Brasil foram pesquisadas quanto a presença de fatores de virulência. Ensaios fenotípicos foram usados para obter a expressão in vivo, entender o potencial patogênico destas amostras e determinar se existe correlação entre virulência e resistência a antibióticos. Diferentes perfis de virulência foram encontrados sugerindo que o clone que está se disseminado pode ter gerado diversas variações. No entanto, nosso estudo mostrou que um conjunto de fatores parece ser mais comum entre as amostras: gelatinase, substância de agregação e esp (GEA). Estes fatores tem sido correlacionados com a agregação de células e formação de biofilmes. A formação de biofilme pode promover a conjugação de plasmídeos contendo genes de resistência entre as espécies. Curiosamente, o perfil GAE não foi exclusivo para VREFS, foi o segundo mais observado em amostras VSEFS provenientes de colonização e infecção em pacientes hospitalizados e também de swabs retais de voluntários saudáveis. Tais linhagens pacerem representar a "porta de entrada" para novos genes de resistência em E. faecalis e podem contribuir para a disseminação de E. faecalis principalmente nos hospitais.