The role of specialist nurses in detecting spasticity and related symptoms in multiple sclerosis.

BACKGROUND: Spasticity is a frequent symptom of multiple sclerosis (MS), which may negatively influence daily living activities (ADL). OBJECTIVES: To (1) explore the feasibility to conduct a structured interview by specialist nurses about limitations in ADL; (2) determine the percentage of people with MS (PwMS) with limitations in ADL related to spasticity; (3) to assess the knowledge about spasticity and describe its clinical features. DESIGN: Observational, cross-sectional, multicentre study in 16 MS units of Catalonia (Spain). Participants were recruited from the outpatient facility and day-care hospital between July 2018 and June 2019 and met the following criteria: (1) age 18 or older, (2) diagnosis of MS according to McDonald criteria 2010 and (3) no clinical relapse in previous 30 days. METHODS: Specialist nurses conducted a structured interview divided in two parts: the assessment of (1) limitations in the ADL and (2) the presence of spasticity and associated symptoms. The usefulness of this intervention was requested. This study met the STROBE reporting guidelines checklist for observational studies. RESULTS: Three hundred sixty eight pwMS (244 women) with a mean age of 46 years and a median Expanded Disability Status Scale score of 2.5 (range, 0-8.5) were included. 262 (71%) pwMS had limitations in the ADL, and spasticity was reported as the most limiting symptom in 59 (23%). As a result of the interview, spasticity was observed in 199 (76%) participants; 47 (24%) of them were unaware that they had spasticity and 102 (51%) would not have reported it spontaneously. The level of the interview satisfaction was high (90%). CONCLUSIONS: Spasticity is a complex and limiting symptom in MS. The structured interview conducted by specialist nurses is feasible and has good acceptance. PATIENT CONTRIBUTION: Specialist nurses can be proactive in MS clinical assessment, which may help to detect symptoms with negative impact on quality of life.

Imágenes digitales del cerebro en la década de 1970: la construcción de una tecnología híbrida / Digital brain imaging in the 1970s building a hybrid technology

La tomografía computarizada (TC), una tecnología basada en la combinación de radiología y computación, fue utilizada para la exploración de un tumor cerebral en una paciente de un hospital de Londres en 1971. La cabeza de la persona se introdujo en un escáner, fabricado por la empresa discográfica británica EMI, para medir la cantidad de radiación absorbida por los diferentes puntos del cerebro. La imagen confeccionada constaba de una matriz tonal digital que se materializó en papel prensa, en tubo de rayos catódicos y en una fotografía Polaroid. En este artículo se mostrará el proceso de producción de la imagen TC, una representación visual que se convertiría, a partir de la década de 1970, en una tecnología habitual para las neurociencias contemporáneas, además de paradigma de representación visual en el tránsito de lo analógico a lo digital. Para ello analizaremos las implicaciones de la imagen radiográfica, inventada en un momento de auge de la imagen-movimiento, donde se enmarcan las cronofotografías, las secuencias de imágenes y la cinematografía. En este análisis haremos hincapié en los diferentes regímenes escópicos donde se encuentran cada una de las imágenes. El conocimiento, que llevó a la construcción del dispositivo, circuló entre la clínica, la industria y el laboratorio. En la construcción de las TC participaron una diversidad de agentes, incluida la computadora, la radiación por rayos X, un equipo de ingenieros electrónicos, un grupo de neurorradiólogos del Hospital Atkinson Marley y el escáner de rayos X, entre otros. Además, veremos la repercusión de varios factores vinculados a la epistemología de la imagen TC, como lo concerniente al reforzamiento clínico en el diagnóstico clínico, la vinculación de lo morfológico a lo psíquico en relación al cerebro y el tránsito de la imagen-movimiento a la imagen-tiempo. (AU)

Computed tomography (CT), a technology based on the combination of radiology and computation, was used to scan a patient’s brain tumor in a London hospital in 1972. The patient’s head was introduced into a scanner, manufactured by the British record company EMI, to measure the amount of radiation absorbed by different points in the brain. The resulting image consisted of a digital tonal matrix that was materialized on newsprint, a cathode ray tube, and a Polaroid photograph. This article describes the production process of the CT image, a visual representation that would become, from the 1970s onwards, a common technology for contemporary neurosciences and a paradigm of visual representation in the transition from analog to digital. To this end, we analyze the implications of the radiographic image, invented at a time of the rise of theimage-movement in which chronophotographs, image sequences, and cinematography are framed. In this analysis, we focus on the scopic regime in which each image is found. The knowledge that led to construction of the device circulated between the clinic, industry, and laboratory. A variety of agents were involved in the construction of CT scans, including the computer, X-ray radiation, a team of electronic engineers, a group of neuroradiologists from Atkinson Marley Hospital, and the X-ray scanner, among others. We also report on the impact of several factors associated with the epistemology of CT imaging, such as the reinforcement of clinical diagnoses, the linking of the morphological to the psychic in relation to the brain, and the transition from image-motion to image-time. (AU)

A comprehensive analysis on nanostructured materials in a thermoelectric micro-system based on geometric shape, segmentation structure and load resistance.

In this study, we report the novel energy behavior of high-performance nanostructured materials in a segmented thermoelectric micro-generator (TEG). Several physical elements of the materials must be considered to determine their behavior in the thermoelectric energy conversion: temperature dependence of material properties, geometric structure, segmentation, and the symmetry of each or both p-type and n-type nanostructure semiconductor thermoelements. Recently, many efforts have reported effects independent on the thermoelectric performance of semiconductor materials. In this work, exhaustive research on the performance of high-performance nanostructured materials in a segmented thermoelectric micro-generator (TEG) was carried out. Our results show the efficiency and output power of the TEG using the temperature-dependent model, i.e., a variable internal resistance for a load resistance of the system. Our approach allows us to analyze symmetrical and asymmetric geometries, showing maximum and minimum peaks values in the performance of the TEG for specific [Formula: see text] values. The performance of the TEG is improved by about [Formula: see text] and [Formula: see text], for efficiency, and output power, respectively, considering a trapezoidal geometric shape in the 2p-3n segmented system, compared with the conventional rectangular shape.

Efectividad de la movilización articular y laser de baja potencia frente a la movilización articular en personas con trastornos temporomandibulares en un hospital de Lima-Perú / Effectiveness Of Joint Mobilization And Low-Power Laser Against Joint Mobilization In People With Temporomandibular Disorders In A Hospital From Lima-Peru

Introducción: Los trastornos temporomandibulares (TTM) constituyen un problema de salud importanteen el Perú. Objetivo: Determinar la efectividad de la movilización articular y láser de baja potencia frentea la movilización articular en personas con TTM, atendidos en un hospital de Lima-Perú. Métodos: Estudiocuantitativo longitudinal, con una muestra no probabilística de 197 participantes diagnosticados contrastornos temporomandibulares, comprendidos entre 18 y 72 años (mediana: 54, RI: 45-60), de ambos sexos, atendidos en el hospital de la Fuerza Área del Perú. Se tuvo en consideración dos grupos de tratamiento: movilización articular más láser de baja potencia (LBPMA) y solo movilización articular (MA), los desenlacesfueron: la apertura bucal máxima no asistida (ABMNA), el dolor a la ABMNA y aspectos psicosociales (síntomasdepresivos, ansiosos y de somatización), evaluados a las 2, 4 y 8 semanas, se usó estadística no paramétrica. Resultados: Se encontró mejoría en todos los desenlaces medidos en ambos grupos (p<0,05), a excepciónde la depresión. LBPMA fue mejor que MA en dolor a la ABMNA, en ABMNA solo a las 2 semanas, ansiedad alas 4 y 8 semanas y somatización solo a las 8 semanas. Conclusión: Se encontró mejoras en la disminucióndel dolor a la ABMNA, la ABMNA y en los índices de los aspectos psicosociales en ambos grupos. El LBPMAfue mejor que sólo MA en el dolor a la ABMNA, la ABMNA sólo a las 2 semanas, ansiedad a las 4 y 8 semanasy somatización a las 8 semanas.

Introduction: Temporomandibular Disorders (TMD) are a major health problemin Peru. Objective: To determine the effectiveness of joint mobilization andlow-power laser against joint mobilization in people with TMD, treated in ahospital located in Lima-Peru. Methods: Longitudinal study with a quantitativeapproach, with a non-probabilistic sampling of 197 participants diagnosed withtemporomandibular disorders of both sexes, between 18 and 72 years old(median: 54, IR: 45-60), treated at the Hospital of the Hospital Central de lasFuerzas Aéreas del Perú. We took two groups of treatment into consideration:joint mobilization plus low-power laser (JMLPL) and only joint mobilization (JM).The outcomes were maximal unassisted mouth opening capacity (MUMO), painat MUMO, and psychosocial aspects (depressive, anxious and somaticsymptoms), evaluated at 2, 4 and 8 weeks, where nonparametric statistics wasused. Results: Improvement was found in all outcomes measured in bothgroups (p<0.05) with the exception of depression. JMLPL was better than JMregarding pain at MUMO, MUMO only at 2 weeks, anxiety at 4 and 8 weeks andsomatization only at 8 weeks. Conclusion: Improvements were found inreduction of pain at MUMO, MUMO and in the indexes of psychosocial aspectsin both groups. JMLPL was better than only JM regarding pain at MUMO,MUMO only at 2 weeks, anxiety at 4 and 8 weeks, and somatization at 8 weeks.

The early drawings and prints of Santiago Ramón y Cajal: a visual epistemology of the neurosciences

Santiago Ramón y Cajal created histological images using a variety of artistic techniques and methods. In order to contextualise his practice, I have selected a set of drawings and prints of cartilage cells that were used in Cajal's reference handbooks. I then introduce a lithograph representing an inflamed cartilage included in Cajal's first publication. This technique enabled the publishing of graphic information in colour. By reviewing images included in the material that Cajal consulted during his pre-graduate years, I show that he participated in the transnational production of drawing and made use of the printing techniques available to present his research. By analysing a set of original drawings included in Cajal's notebook, Diario de Observaciones, and his first published lithographs of cartilage cells and neurons, I reveal the graphic specificities of his transition from handmade drawings to print representations. Cajal's drawing and lithographing relate directly to artistic interests developed in his youth (López Piñero, 1985), and these skills facilitated the technical transit between notebook and published images, enabling him to formalise his knowledge by including histological results in printed material. A determining factor in Cajal's graphic production relating to the nervous system was his expertise in using chemical silver nitrate, resulting from his interest in photography. Finally, his colour selection is discussed, in order to demonstrate that, even when Cajal drew black lines, he was using black as a specific colour, one he observed through the microscope after staining histological samples

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Design of Nano-Structured Micro-Thermoelectric Generator: Load Resistance and Inflections in the Efficiency.

In recent years the interest for the harvest of energy with micro thermoelectric generators ( µ TEG) has increased, due to its advantages compared to technologies that use fossil fuels. There are three ways to improve the performance of the device, by modifying its structure, type of material and operation control. In this study, the role of the load resistance R L on the performance of a µ TEG with nanostructured materials is investigated. The interaction of the load resistance with the thermoelements exhibits interesting features, arising from the coupling of the temperature-dependent electrical and thermal transport properties at different temperature ranges and the architecture of nanostructured thermoelectric materials. This coupling results in inflections on the efficiency, i.e., maximum and minimum values of the efficiency at higher temperatures, 600-900 K. We show the explicit dependence of the performance of the µ TEG in terms of the load resistance and discuss the underlying physics. The unusual features of the efficiency of nanostructured thermoelectric materials are a result of the behavior of the power factor and the nonequilibrium properties of the system. We also analyze the effect of the geometric shape of the thermoelements on the device. We determine the performance of the µ TEG, evaluating the generation power and its efficiency. The results show that the efficiency of the device can decrease or increase depending on the value of R L , while the power decreases with an increase of the load resistance.

Peltier Supercooling in Transient Thermoelectrics: Spatial Temperature Profile and Characteristic Cooling Length.

Thermoelectric coolers (TECs) can reach temperatures below that obtained with a steady-state current by applying an electrical current pulse which enables a transitory state in a Peltier device. This effect is known as supercooling. In this paper, we study characteristics parameters, such as the minimum cooling temperature and spatial temperature profile, in a TEC operated under current pulses and a cooling load ( Q c ) . Numerical analysis for a one-dimensional thermoelectric model of the cooling system is developed, and a novel MATLAB programming code is proposed for the transient state based on finite element analysis. We also investigate the influence of the thermoelement's length upon the cooling mechanism. A new parameter called the "characteristic cooling length" is proposed to describe the length in which the minimum cooling temperature occurs along the elements of a TEM. Results show the transient temperature profiles along the elements of the semiconductor P-type element, and a "characteristic cooling length" is characterized. We also propose a general principle, and the lowest cooling temperature values are obtained for a semiconductor's small length and variable pulse cooling load under current pulse operation. The present study will serve as guidance for the geometric design of TECs under current pulse operations.

Performance of Segmented Thermoelectric Cooler Micro-Elements with Different Geometric Shapes and Temperature-Dependent Properties.

In this work, the influences of the Thomson effect and the geometry of the p-type segmented leg on the performance of a segmented thermoelectric microcooler (STEMC) were examined. The effects of geometry and the material configuration of the p-type segmented leg on the cooling power ( Q c ) and coefficient of performance ( C O P ) were investigated. The influence of the cross-sectional area ratio of the two joined segments on the device performance was also evaluated. We analyzed a one-dimensional p-type segmented leg model composed of two different semiconductor materials, B i 2 T e 3 and ( B i 0.5 S b 0.5 ) 2 T e 3 . Considering the three most common p-type leg geometries, we studied both single-material systems (using the same material for both segments) and segmented systems (using different materials for each segment). The C O P , Q c and temperature profile were evaluated for each of the modeled geometric configurations under a fixed temperature gradient of Δ T = 30 K. The performances of the STEMC were evaluated using two models, namely the constant-properties material (CPM) and temperature-dependent properties material (TDPM) models, considering the thermal conductivity ( κ ( T ) ), electrical conductivity ( σ ( T ) ) and Seebeck coefficient ( α ( T ) ). We considered the influence of the Thomson effect on C O P and Q c using the TDPM model. The results revealed the optimal material configurations for use in each segment of the p-type leg. According to the proposed geometric models, the optimal leg geometry and electrical current for maximum performance were determined. After consideration of the Thomson effect, the STEMC system was found to deliver a maximum cooling power that was 5.10 % higher than that of the single-material system. The results showed that the inverse system (where the material with a higher Seebeck coefficient is used for the first segment) delivered a higher performance than the direct system, with improvements in the C O P and Q c of 6.67 % and 29.25 % , respectively. Finally, analysis of the relationship between the areas of the STEMC segments demonstrated that increasing the cross-sectional area in the second segment led to improvements in the C O P and Q c of 16.67 % and 8.03 % , respectively.

Colorectal Cancer: From the Genetic Model to Posttranscriptional Regulation by Noncoding RNAs.

Colorectal cancer is the third most common form of cancer in developed countries and, despite the improvements achieved in its treatment options, remains as one of the main causes of cancer-related death. In this review, we first focus on colorectal carcinogenesis and on the genetic and epigenetic alterations involved. In addition, noncoding RNAs have been shown to be important regulators of gene expression. We present a general overview of what is known about these molecules and their role and dysregulation in cancer, with a special focus on the biogenesis, characteristics, and function of microRNAs. These molecules are important regulators of carcinogenesis, progression, invasion, angiogenesis, and metastases in cancer, including colorectal cancer. For this reason, miRNAs can be used as potential biomarkers for diagnosis, prognosis, and efficacy of chemotherapeutic treatments, or even as therapeutic agents, or as targets by themselves. Thus, this review highlights the importance of miRNAs in the development, progression, diagnosis, and therapy of colorectal cancer and summarizes current therapeutic approaches for the treatment of colorectal cancer.

Etiología y patrones de resistencia antimicrobiana en sepsis neonatal temprana y tardía, en una Unidad de Terapia Intensiva Neonatal / Etiology and antimicrobial resistance patterns in early and late neonatal sepsis in a Neonatal Intensive Care Unit

Introducción. La sepsis neonatal es una de las principales causas de muerte en recién nacidos. El tratamiento antimicrobiano empírico se sustenta en información epidemiológica y pruebas de susceptibilidad antimicrobiana. El objetivo del estudio fue describir los agentes etiológicos y su sensibilidad antimicrobiana enreciénnacidos con sepsis temprana (SNTe) o tardía (SNTa) de una Unidad de Terapia Intensiva Neonatal. Métodos. Estudio transversal realizado en un hospital de concentración del occidente de México. Se determinó la resistencia antimicrobiana de los gérmenes aislados en sangre o líquido cefalorraquídeo de pacientes con SNTe o SNTa nosocomial. Resultados. Se aislaron bacterias o levaduras en 235 cultivos de 67 eventos de SNTe y 166 eventos de SNTa. Del total de aislamientos, las bacterias más frecuentes fueron enterobacterias (51,5%), seguidas de Streptococcus spp. en SNTe y Staphylococcus spp. en SNTa. En cuanto a las enterobacterias de adquisición nosocomial, el 40% fueron productoras de betalactamasas de espectro extendido. En especies de Staphylococcus, la resistencia a oxacilina se registró en el 65,5%. En las enterobacterias (n: 121), la frecuencia de resistencia a amikacina, piperacilina-tazobactam y meropenem fue menor del 3%. En bacterias no fermentadoras, no se observó resistencia a amikacina, ciprofloxacino y cefepime; sin embargo, el número de aislamientos fue escaso. Conclusiones. Las bacterias identificadas con mayor frecuencia en SNTe fueron enterobacterias (67,6%) y Streptococcus spp. (17,6%), mientras que, en SNTa, fueron enterobacterias (44,9%) y Staphylococcus spp. (34,7%). El 40% de las enterobacterias de adquisición nosocomial fueron productoras de betalactamasas de espectro extendido y el 65,5% de Staphylococcus spp. mostraron resistencia a oxacilina.

Introduction. Neonatal sepsis is one of the main causes of death among newborn infants. Empirical antimicrobial treatment is based on epidemiological information and antimicrobial susceptibility tests. The objective of this study was to describe etiologic agents and their antimicrobial susceptibility among newborn infants with early-onset neonatal sepsis (EONS) or late-onset neonatal sepsis (LONS) at a Neonatal Intensive Care Unit. Methods. Cross-sectional study conducted at a tertiary referral hospital in Western Mexico. Determination of antimicrobial resistance of microorganisms isolated in blood or cerebrospinal fluid of patients with EONS or nosocomial LONS. Results. Yeasts and bacteria were isolated from 235 cultures corresponding to 67 events of EONS and 166 events of LONS. Of all isolates, the most common bacteria were Enterobacteriaceae (51.5%), followed by Streptococcus spp. in EONS, and by Staphylococcus spp. in LONS. Of all nosocomial Enterobacteriaceae, 40% were extended spectrum beta-lactamase producing bacteria. Among Staphylococcus species, resistance to oxacillin was recorded in 65.5%. Among Enterobacteriaceae (n: 121), resistance to amikacin, piperacillin-tazobactam, and meropenem was below 3%. Non-fermenting bacteria did not show resistance to amikacin, ciprofloxacin or cefepime; however, the number of isolates was scarce. Conclusions.The most commonly identified bacteria in EONS were Enterobacteriaceae (67.6%) and Streptococcus spp. (17.6%), and Enterobacteriaceae (44.9%) and Staphylococcus spp. (34.7%) in LONS. Forty percent ofnosocomial Enterobacteriaceae were extended spectrum beta-lactamase producing bacteria, and 65.5% of Staphylococcus spp. showed resistance to oxacillin.

Etiología y patrones de resistencia antimicrobiana en sepsis neonatal temprana y tardía, en una Unidad de Terapia Intensiva Neonatal / Etiology and antimicrobial resistance patterns in early and late neonatal sepsis in a Neonatal Intensive Care Unit

Introducción. La sepsis neonatal es una de las principales causas de muerte en recién nacidos. El tratamiento antimicrobiano empírico se sustenta en información epidemiológica y pruebas de susceptibilidad antimicrobiana. El objetivo del estudio fue describir los agentes etiológicos y su sensibilidad antimicrobiana enreciénnacidos con sepsis temprana (SNTe) o tardía (SNTa) de una Unidad de Terapia Intensiva Neonatal. Métodos. Estudio transversal realizado en un hospital de concentración del occidente de México. Se determinó la resistencia antimicrobiana de los gérmenes aislados en sangre o líquido cefalorraquídeo de pacientes con SNTe o SNTa nosocomial. Resultados. Se aislaron bacterias o levaduras en 235 cultivos de 67 eventos de SNTe y 166 eventos de SNTa. Del total de aislamientos, las bacterias más frecuentes fueron enterobacterias (51,5%), seguidas de Streptococcus spp. en SNTe y Staphylococcus spp. en SNTa. En cuanto a las enterobacterias de adquisición nosocomial, el 40% fueron productoras de betalactamasas de espectro extendido. En especies de Staphylococcus, la resistencia a oxacilina se registró en el 65,5%. En las enterobacterias (n: 121), la frecuencia de resistencia a amikacina, piperacilina-tazobactam y meropenem fue menor del 3%. En bacterias no fermentadoras, no se observó resistencia a amikacina, ciprofloxacino y cefepime; sin embargo, el número de aislamientos fue escaso. Conclusiones. Las bacterias identificadas con mayor frecuencia en SNTe fueron enterobacterias (67,6%) y Streptococcus spp. (17,6%), mientras que, en SNTa, fueron enterobacterias (44,9%) y Staphylococcus spp. (34,7%). El 40% de las enterobacterias de adquisición nosocomial fueron productoras de betalactamasas de espectro extendido y el 65,5% de Staphylococcus spp. mostraron resistencia a oxacilina.(AU)

Introduction. Neonatal sepsis is one of the main causes of death among newborn infants. Empirical antimicrobial treatment is based on epidemiological information and antimicrobial susceptibility tests. The objective of this study was to describe etiologic agents and their antimicrobial susceptibility among newborn infants with early-onset neonatal sepsis (EONS) or late-onset neonatal sepsis (LONS) at a Neonatal Intensive Care Unit. Methods. Cross-sectional study conducted at a tertiary referral hospital in Western Mexico. Determination of antimicrobial resistance of microorganisms isolated in blood or cerebrospinal fluid of patients with EONS or nosocomial LONS. Results. Yeasts and bacteria were isolated from 235 cultures corresponding to 67 events of EONS and 166 events of LONS. Of all isolates, the most common bacteria were Enterobacteriaceae (51.5%), followed by Streptococcus spp. in EONS, and by Staphylococcus spp. in LONS. Of all nosocomial Enterobacteriaceae, 40% were extended spectrum beta-lactamase producing bacteria. Among Staphylococcus species, resistance to oxacillin was recorded in 65.5%. Among Enterobacteriaceae (n: 121), resistance to amikacin, piperacillin-tazobactam, and meropenem was below 3%. Non-fermenting bacteria did not show resistance to amikacin, ciprofloxacin or cefepime; however, the number of isolates was scarce. Conclusions.The most commonly identified bacteria in EONS were Enterobacteriaceae (67.6%) and Streptococcus spp. (17.6%), and Enterobacteriaceae (44.9%) and Staphylococcus spp. (34.7%) in LONS. Forty percent ofnosocomial Enterobacteriaceae were extended spectrum beta-lactamase producing bacteria, and 65.5% of Staphylococcus spp. showed resistance to oxacillin.(AU)

Etiology and antimicrobial resistance patterns in early and late neonatal sepsis in a Neonatal Intensive Care Unit.

INTRODUCTION: Neonatal sepsis is one of the main causes of death among newborn infants. Empirical antimicrobial treatment is based on epidemiological information and antimicrobial susceptibility tests. The objective of this study was to describe etiologic agents and their antimicrobial susceptibility among newborn infants with early-onset neonatal sepsis (EONS) or late-onset neonatal sepsis (LONS) at a Neonatal Intensive Care Unit. METHODS: Cross-sectional study conducted at a tertiary referral hospital in Western Mexico. Determination of antimicrobial resistance of microorganisms isolated in blood or cerebrospinal fluid of patients with EONS or nosocomial LONS. RESULTS: Yeasts and bacteria were isolated from 235 cultures corresponding to 67 events of EONS and 166 events of LONS. Of all isolates, the most common bacteria were Enterobacteriaceae (51.5%), followed by Streptococcus spp. in EONS, and by Staphylococcus spp. in LONS. Of all nosocomial Enterobacteriaceae, 40% were extended spectrum beta-lactamase producing bacteria. Among Staphylococcus species, resistance to oxacillin was recorded in 65.5%. Among Enterobacteriaceae (n: 121), resistance to amikacin, piperacillin-tazobactam, and meropenem was below 3%. Non-fermenting bacteria did not show resistance to amikacin, ciprofloxacin or cefepime; however, the number of isolates was scarce. CONCLUSIONS: The most commonly identified bacteria in EONS were Enterobacteriaceae (67.6%) and Streptococcus spp. (17.6%), and Enterobacteriaceae (44.9%) and Staphylococcus spp. (34.7%) in LONS. Forty percent ofnosocomial Enterobacteriaceae were extended spectrum beta-lactamase producing bacteria, and 65.5% of Staphylococcus spp. showed resistance to oxacillin.