Spatial distribution of soil organic carbon quality descriptors determining factors that affect its sequestration in Northeast Algeria.

Increasing soil organic carbon (SOC) content is crucial for soil fertility, conservation, and combating climate-related issues by sequestering CO2. While existing studies explore the total content of SOC, few of them investigate the factors that favor its sequestration and the impact of land use type and management. This research aims to study the spatial variation of the total content and the quality or maturity (in terms of aromaticity) of the humic acid (HA) fraction, along with the factors that enhance its formation and conservation for a longer time in the soil. In addition, the study tries to evaluate the performance of the Regression Kriging (RK) method in producing interpolation maps that describe the natural variation of the SOC and its quality with the aim of defining and preventing soil degradation. Finally, the study aims to evaluate the impact of the land use type and the importance of dense vegetation in the sequestration of the organic carbon (OC) in the soil. The analysis of the SOC was performed in northeast Algeria's semi-arid climate, examining content, quality, and chemical composition. Using geostatistical methods (RK), SOC is correlated with most related factors, producing detailed interpolation maps. The results showed that the SOC and its HA fraction (both its total content and its degree of transformation or maturity (measured in terms of aromaticity and structural condensation) are highly correlated to the topography of the area (P < 0.05). Results reveal variations in HAs' composition across land covers. Notably, areas subjected to burning exhibited a 21% increase in HA aromaticity compared to forested regions and a 29% increase relative to cultivated areas. The study highlights that soil cover has a substantial influence on the performance of SOC sequestration, the forested areas have a positive impact on the storage of SOC in the form of HA with a more complex chemical composition that suggests increased aromaticity and resilience. As a whole, the results indicate the potential of geostatistical methods to provide valuable information about the factors that influence the current status and evolution of SOC in the study area.

Design and characterisation of a cell exposure system with high magnetic field homogeneity: RILZ coils.

In vitro studies requiring controlled exposure to low-frequency electromagnetic fields employ exposure systems with different geometries and configurations, the Helmholtz configuration being one of the most widely used. This configuration has limitations in the homogeneity of the spatial distribution of the magnetic field intensity values. We present the design, manufacturing, and characterisation of a new coil system, called RILZ configuration, which improves the distribution of magnetic field intensity values in the three dimensions of space for three different heights in comparison with the traditional circular coils in Helmholtz configuration. In addition, a comparative study of the cellular response in CT2A cultures exposed to a magnetic field of 50 Hz and 100 µT for 48 hrs is performed with both exposure systems. The results of the study show reduced values of deviation from the central value of magnetic field intensity using the RILZ coil system. These differences are statistically significant compared to the Helmholtz configuration for the three Cartesian directions: x (p < 0.01), y (p < 0.01), z (p < 0.01). In addition, the intensity values for three different heights are statistically significantly correlated using the RILZ coil system (p < 0.01). The differences in cell behaviour are also statistically significant between the two systems (p < 0.01) and may be directly related to the differences found in the distribution of intensity values between the two systems. This study highlights the importance of the homogeneity of the magnetic field intensity generated by the exposure systems used and offers an effective solution to control the magnetic field exposure parameters in vitro assays.

Evidence Implicating Blood-Brain Barrier Impairment in the Pathogenesis of Acquired Epilepsy following Acute Organophosphate Intoxication.

Organophosphate (OP) poisoning can trigger cholinergic crisis, a life-threatening toxidrome that includes seizures and status epilepticus. These acute toxic responses are associated with persistent neuroinflammation and spontaneous recurrent seizures (SRS), also known as acquired epilepsy. Blood-brain barrier (BBB) impairment has recently been proposed as a pathogenic mechanism linking acute OP intoxication to chronic adverse neurologic outcomes. In this review, we briefly describe the cellular and molecular components of the BBB, review evidence of altered BBB integrity following acute OP intoxication, and discuss potential mechanisms by which acute OP intoxication may promote BBB dysfunction. We highlight the complex interplay between neuroinflammation and BBB dysfunction that suggests a positive feedforward interaction. Lastly, we examine research from diverse models and disease states that suggest mechanisms by which loss of BBB integrity may contribute to epileptogenic processes. Collectively, the literature identifies BBB impairment as a convergent mechanism of neurologic disease and justifies further mechanistic research into how acute OP intoxication causes BBB impairment and its role in the pathogenesis of SRS and potentially other long-term neurologic sequelae. Such research is critical for evaluating BBB stabilization as a neuroprotective strategy for mitigating OP-induced epilepsy and possibly seizure disorders of other etiologies. SIGNIFICANCE STATEMENT: Clinical and preclinical studies support a link between blood-brain barrier (BBB) dysfunction and epileptogenesis; however, a causal relationship has been difficult to prove. Mechanistic studies to delineate relationships between BBB dysfunction and epilepsy may provide novel insights into BBB stabilization as a neuroprotective strategy for mitigating epilepsy resulting from acute organophosphate (OP) intoxication and non-OP causes and potentially other adverse neurological conditions associated with acute OP intoxication, such as cognitive impairment.

Bacterias resistente a los antibióticos en aguas mineromedicinales “Santagua Chachimbiro”, Ecuador / Antibiotic resistant bacteria in mineral medicinal waters “Santagua Chachimbiro”, Ecuador

La biodiversidad bacteriana en las aguas mineromedicinales y sus perfiles de resistencia a los antibióticos es un tema en desarrollo en Ecuador. El objetivo del trabajo fue conocer la microbiota bacteriana y la resistencia a los antibióticos en aguas del balneario “Termas de Santagua Chachimbiro”, Provincia de Imbabura-Ecuador. Se recolectaron 16 muestras de agua. El aislamiento de las colonias bacterianas se obtuvo por la técnica de filtración en membrana, utilizando diferentes medios de cultivos. La identificación se realizó de acuerdo con los esquemas propuestos por MacFaddin (2003), complementados con las pruebas de las galerías Microgen. El perfil de resistencia a los antibióticos se determinó por el método de difusión en placas de Kirby y Bauer (1966). Se aislaron e identificaron 85 cepas bacterianas de las cuales el 61 % resultaron Gram negativas y 39 % Gram positivas. Las especies identificadas fueron Aeromonas caviae, Aeromonas eucrenophila, Aeromonas hydróphila, Aeromonas media, Aeromonas salmonicida, Aeromonas schubertii, Bacillus subtilis, Bacillus mycoides, Bacillus spp, Burkholderia cepacia, Citrobacter freundii, Comamonas spp, Pseudomonas aeruginosa, Pseudomonas fluorescens, Pseudomonas putida, Pseudomonas stutzeri, Ralstonia pickettii, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus lugdenensis, Staphylococcus saprophyticus, Staphylococcus spp, Staphylococcus warneri y Staphylococcus xylosus. En cuanto a la resistencia antimicrobiana la mayoría de las Gram negativas fueron resistentes a las penicilinas y cefalosporinas. Las Gram positivas a la oxacilina y penicilinas. El 66,67 % resultaron multirresistentes a más de tres antibióticos. El balneario “Termas de Santagua de Chachimbiro” presenta diversidad de especies bacteriana y la presencia de resistomas ambientales.(AU)

Bacterial biodiversity in mineral medicinal waters and the antibiotic resistance profiles, is a developing topic in Ecuador. The objective of the work was to know the bacterial microbiota and its resistance profiles to antibiotics of the mineral medicinal waters of the Santagua Chachimbiro spa, located in the Province of Imbabura-Ecuador. 16 water samples were collected. The isolation of the bacterial species was carried out by the membrane filtration technique, using different types of culture media. The identification was carried out according to the schemes proposed by MacFaddin (2003), complemented with the tests of the Microgen galleries. The antibiotic resistance profile was determined by the Kirby and Bauer (1966) plate diffusion method. 85 strains were isolate of which 61% were Gram negative and 39% Gram positive. The main species identified were Aeromonas caviae, Aeromonas eucrenophila, Aeromonas hydrophila, Aeromonas media, Aeromonas salmonicida, Aeromonas schubertii, Bacillus subtilis, Bacillus mycoides, Bacillus spp, Burkholderia cepacia, Citrobacter freundii, Comamonas spp, Pseudomonas aeruginosa, Pseudomonas fluorescenscens, Pseudomonas putida, Pseudomonas stutzeri, Ralstonia pickettii, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus lugdenensis, Staphylococcus saprophyticus, Staphylococcus spp, Staphylococcus warneri and Staphylococcus xylosus. Regarding antimicrobial resistance, most of the Gram negative strains were resistant to penicillin and cephalosporins. Gram positive to oxacillin and penicillin 66,67% were multiresistant to more than three antibiotics. The “Termas de Santagua de Chachimbiro” spa presents a diversity of bacterial species and the presence of environmental resistomes.(AU)

Utility of human epididymis protein 4 in the differential diagnosis of ascites.

BACKGROUND AND AIMS: Human epididymal protein 4 (HE4) may be a useful tool in the differential diagnosis of malignant ascites. The aim of this study was to evaluate the diagnostic utility of HE4 for detecting malignant ascites, taking into account the possible false positives identified with adenosine deaminase (ADA), C-reactive protein (CRP), % polynuclear cells (%PMN) and glomerular filtration rate (eGFR). METHODS: Concentrations of HE4, ADA, %PMN and CRP were determined in 114 samples of peritoneal fluid and creatinine in serum in order to calculate eGFR. RESULTS: Concentrations of HE4 presented significant differences (P = 0.028) in benign [median (interquartile range)] [582(372)] pmol/L) and malignant ascites ([8241(367)] pmol/L. Sensitivity was 21.2% and specificity 100%. Significant differences were also observed for HE4 between tumors of gynecological origin ([3165(8769)] pmol/L) and others ([665(663)] pmol/L), with a sensitivity of 67% and a specificity of 100%. Classifying according to possible false positives (ADA > 45U/L, CRP > 50 mg/L, %PMN > 90 and eGFR < 30 mL/min/1.73 m2) at maximum specificity, a sensitivity of 33.3% was obtained for HE4, with a cut-off point of 2660 pmol/L. Without possible false positives (ADA < 45U/L, CRP < 50 mg/L, %PMN < 90 and eGFR ≥ 30 mL/min/1.73 m2), a sensitivity of 37.7% was obtained at 100% specificity for a cut-off point of 1041 pmol/L. Applying these criteria to the entire group, a sensitivity of 36.4% was obtained at maximum specificity. CONCLUSIONS: HE4 allows the identification of malignant ascites with moderate sensitivity at maximum specificity. HE4 levels can differentiate between tumors of gynecological origin and others. Classification according to possible false positives increases sensitivity without losing specificity.

Can we predict ambident regioselectivity using the chemical hardness?

The hard/soft acid/base (HSAB) principle is a cornerstone in our understanding of chemical reactivity preferences. Motivated by the success of the original ("global") version of this rule, a "local" counterpart was readily proposed to account for regioselectivity preferences, in particular, in ambident reactions. However, ample experimental evidence indicates that the local HSAB principle often fails to provide meaningful predictions. Here we examine the assumptions behind the standard proof of the local HSAB rule, showing that it is based on a flawed premise. By solving this issue, we show that it is critical to consider not only the charge transferred between the different reacting centers but also the charge reorganization within the non-reacting parts of the molecule. We propose different reorganization models and derive the corresponding regioselectivity rules for each.

Selective Neuronal Knockout of STAT3 Function Inhibits Epilepsy Progression, Improves Cognition, and Restores Dysregulated Gene Networks in a Temporal Lobe Epilepsy Model.

OBJECTIVE: Temporal lobe epilepsy (TLE) is a progressive disorder mediated by pathological changes in molecular cascades and hippocampal neural circuit remodeling that results in spontaneous seizures and cognitive dysfunction. Targeting these cascades may provide disease-modifying treatments for TLE patients. Janus Kinase/Signal Transducer and Activator of Transcription (JAK/STAT) inhibitors have emerged as potential disease-modifying therapies; a more detailed understanding of JAK/STAT participation in epileptogenic responses is required, however, to increase the therapeutic efficacy and reduce adverse effects associated with global inhibition. METHODS: We developed a mouse line in which tamoxifen treatment conditionally abolishes STAT3 signaling from forebrain excitatory neurons (nSTAT3KO). Seizure frequency (continuous in vivo electroencephalography) and memory (contextual fear conditioning and motor learning) were analyzed in wild-type and nSTAT3KO mice after intrahippocampal kainate (IHKA) injection as a model of TLE. Hippocampal RNA was obtained 24 h after IHKA and subjected to deep sequencing. RESULTS: Selective STAT3 knock-out in excitatory neurons reduced seizure progression and hippocampal memory deficits without reducing the extent of cell death or mossy fiber sprouting induced by IHKA injection. Gene expression was rescued in major networks associated with response to brain injury, neuronal plasticity, and learning and memory. We also provide the first evidence that neuronal STAT3 may directly influence brain inflammation. INTERPRETATION: Inhibiting neuronal STAT3 signaling improved outcomes in an animal model of TLE, prevented progression of seizures and cognitive co-morbidities while rescuing pathogenic changes in gene expression of major networks associated with epileptogenesis. Specifically targeting neuronal STAT3 may be an effective disease-modifying strategy for TLE. ANN NEUROL 2023;94:106-122.

HIV/AIDS infection in critical care: epidemiological profile and risk factors for mortality in a Colombian cohort.

INTRODUCTION: Outcomes of human immunodeficiency virus (HIV) infected patients admitted to intensive care units (ICU) have improved with antiretroviral therapy (ART). However, whether the outcomes have improved in low- and middle-income countries, paralleling those of high-income countries is unknown. The objective of this study was to describe a cohort of HIV-infected patients admitted to ICU in a middle-income country and identify the risk factors associated with mortality. METHODOLOGY: A cohort study of HIV-infected patients admitted to five ICUs in Medellín, Colombia, between 2009 and 2014 was done. The association of demographic, clinical and laboratory variables with mortality was analyzed using a Poisson regression model with random effects. RESULTS: During this time period, 472 admissions of 453 HIV-infected patients were included. Indications for ICU admission were: respiratory failure (57%), sepsis/septic shock (30%) and central nervous system (CNS) compromise (27%). Opportunistic infections (OI) explained 80% of ICU admissions. Mortality rate was 49%. Factors associated with mortality included hematological malignancies, CNS compromise, respiratory failure, and APACHE II score ≥ 20. CONCLUSIONS: Despite advances in HIV care in the ART era, half of HIV-infected patients admitted to the ICU died. This elevated mortality was associated to underlying disease severity (respiratory failure and APACHE II score ≥ 20), and host conditions (hematological malignancies, admission for CNS compromise). Despite the high prevalence of OIs in this cohort, mortality was not directly associated to OIs.

Vaccination with Formulation of Nanoparticles Loaded with Leishmania amazonensis Antigens Confers Protection against Experimental Visceral Leishmaniasis in Hamster

Visceral leishmaniasis (VL) is a fatal disease caused by the protozoa Leishmania infantum for which dogs are the main reservoirs. A vaccine against canine visceral leishmaniasis (CVL) could be an important tool in the control of human and CVL by reducing the infection pressure of L. infantum. Despite the CVL vaccine available on the market, the Brazilian Ministry of Health did not implement the use of it in their control programs. In this sense, there is an urgent need to develop more efficient vaccines. In this study, the association between two polymeric nanoformulations, (poly (D, L-lactic) acid (PLA) polymer) loading Leishmania amazonensis antigens, was evaluated as a potential immunobiological agent against VL using golden hamsters as an experimental model. The results indicated that no significant adverse reactions were observed in animals vaccinated with LAPSmP. LAPSmP presented similar levels of total anti-Leishmania IgG as compared to LAPSmG. The LAPSmP and LAPSmG groups showed an intense reduction in liver and spleen parasitic load by qPCR. The LAPSmP and LAPSmG vaccines showed exceptional results, indicating that they may be promising candidates as a VL vaccine.

1,3 Dipolar Cycloaddition of Münchnones: Factors behind the Regioselectivity.

The 1,3 dipolar cycloaddition reactions of münchnones and alkenes provide an expedite synthetic way to substituted pyrroles, an exceedingly important structural motif in the pharmaceutical and material science fields of research. The factors governing their regioselectivity rationalization are not well understood. Using several approaches, we investigate a set of 14 reactions (featuring two münchnones, 12 different alkenes, and two alkynes). The Natural Bond Theory and the Non-Covalent Interaction Index analyses of the noncovalent interaction energies fail to predict the experimental major regioisomer. Employing global cDFT descriptors or local ones such as the Fukui function and dual descriptor yields similarly inaccurate predictions. Only the local softness pairing, within Pearson's Hard and Soft Acids and Bases principle, constitutes a reliable predictor for the major reaction product. By taking into account an estimator for the steric effects, the correct regioisomer is predicted. Steric effects play a major role in driving the regioselectivity, as was corroborated by energy decomposition analysis of the transition states.

Underwater versus conventional EMR of large nonpedunculated colorectal lesions: a multicenter randomized controlled trial.

BACKGROUND AND AIMS: Underwater EMR (UEMR) is an alternative procedure to conventional EMR (CEMR) to treat large, nonpedunculated colorectal lesions (LNPCLs). In this multicenter, randomized controlled clinical trial, we aimed to compare the efficacy and safety of UEMR versus CEMR on LNPCLs. METHODS: We conducted a multicenter, randomized controlled clinical trial from February 2018 to February 2020 in 11 hospitals in Spain. A total of 298 patients (311 lesions) were randomized to the UEMR (n = 149) and CEMR (n = 162) groups. The main outcome was the lesion recurrence rate in at least 1 follow-up colonoscopy. Secondary outcomes included technical aspects, en bloc resection rate, R0 resection rates, and adverse events, among others. RESULTS: There were no differences in the overall recurrence rate (9.5% UEMR vs 11.7% CEMR; absolute risk difference, -2.2%; 95% CI, -9.4 to 4.9). However, considering polyp sizes between 20 and 30 mm, the recurrence rate was lower for UEMR (3.4% UEMR vs 13.1% CEMR; absolute risk difference, -9.7%; 95% CI, -19.4 to 0). The R0 resection showed the same tendency, with significant differences favoring UEMR only for polyps between 20 and 30 mm. Overall, UEMR was faster and easier to perform than CEMR. Importantly, the techniques were equally safe. CONCLUSIONS: UEMR is a valid alternative to CEMR for treating LNPCLs and could be considered the first option of treatment for lesions between 20 and 30 mm due to its higher en bloc and R0 resection rates. (Clinical trial registration number: NCT03567746.).

Tendon injections - upper extremity.

Imaging-guided tendon procedures aim to reduce pain and increase function by controlling inflammation and stimulating healing. Ultrasound is the preferable guiding modality due to its high resolution and real-time demonstration of the tendinous anatomy and needle positioning. The technique includes appropriate patient positioning, which varies depending on the targeted tendon, as well as sterile and proper draping. For most procedures, we prefer the "in-plane" approach, which demonstrates the entire needle as it advances through different tissue layers. Upper limb injections commonly use corticosteroids and anesthetics with different reported short- and long-term results depending on the tendon treated; better results are obtained in the treatment of tenosynovitis (sliding tendons such as trigger finger and De Quervain's tenosynovitis). Shoulder and elbow tendinopathies (anchor tendons) may also benefit from injections containing irritants or healing stimulants such as dextrose (prolotherapy) and platelet-rich plasma or by the stimulation of healing via tendon perforations (fenestration). The hyaluronic acid injection has also been used in the treatment of both tenosynovitis and tendinopathies. For tendons passing through osteofibrous tunnels, an additional release may be performed, and the techniques are discussed in this review. Therefore, this article provides practicing musculoskeletal radiologists and trainees with a comprehensive review of tendon injection musculoskeletal image-guided procedures.

Diversidad y perfiles de resistencia a los antibióticos en especies de Aeromonas aisladas de ecosistema acuático del ecuador / Diversity and profiles of resistance to antibiotics in species of Aeromonas isolated from the aquatic ecosystem of ecuador

Introducción: En Ecuador se desconoce la diversidad de especies de Aeromonas y sus perfiles de resistencia a los antibióticos en la mayoría de ecosistemas acuáticos. Objetivo: Conocer la diversidad de especies del género Aeromonas y sus perfiles de resistencia a los antibióticos presentes en el balneario de aguas mineromedicinales “Santagua de Chachimbiro” y en el agua del lago volcánico cratérico Cuicocha. Metodología: Se analizaron muestras de agua del balneario “Santagua de Chachimbiro” y del lago volcánico cratérico Cuicocha, ubicados en la provincia de Imbabura-Ecuador. El aislamiento de las especies de Aeromonas se realizó por la técnica de siembra en profundidad y por filtración en membrana utilizando como medio de cultivo el agar R2A y el agar almidón ampicilina. Las bacterias se identificaron siguiendo el esquema propuesto Longa et al., (1997), complementadas con pruebas de las galerías Microgen. El perfil de resistencia a los antibióticos se determinó por el método de difusión en placas de Kirby y Bauer (1966) interpretándose según el CLSI (2019). Resultados: Se lograron identificar un total de 19 cepas del género Aeromonas pertenecientes a 6 especies. Los perfiles de resistencia a los antibióticos muestran diferentes patrones para cada una de las especies, aunque prevalecen las especies multiresistentes a los antibióticos amoxicilina, amoxicilina/ácido clavulánico, aztreonam, eritromicina y tetraciclina. Conclusiones: Se demuestra la presencia de diversas especies de Aeromonas en ambientes acuáticos del Ecuador con variados perfiles de resistencias y multiresistencia a los antibióticos. (AU)

Introduction: In Ecuador, the diversity of Aeromonas species and their resistance profiles to antibiotics in most aquatic ecosystems are unknown. Objective: To know the diversity of species of the genus Aeromonas and their resistance profiles to antibiotics present in the mineralmedicinal water spa “Santagua de Chachimbiro” and in the water of the Cuicocha crater volcanic lake. Methodology: Water samples from the “Santagua de Chachimbiro” spa and from the volcanic crater lake Cuicocha, located in the province of Imbabura-Ecuador, were analyzed. The isolation of the Aeromonas species was carried out by the deep seeding technique and by membrane filtration using R2A agar and ampicillin starch agar as the culture medium. The bacteria were identified following the schemes proposed by Longa et al., (1997), complemented with tests of the Microgen galleries. The antibiotic resistance profile was determined by the plate diffusion method of Kirby and Bauer (1966) interpreted according to the CLSI (2019). Results: A total of 19 strains of the genus Aeromonas belonging to 6 species were identified. Antibiotic resistance profiles show different patterns for each of the species, although species multi-resistant to antibiotics amoxicillin, amoxicillin/clavulanic acid, aztreonam, erythromycin and tetracycline prevail. Conclusions: The presence of various species of Aeromonas in aquatic environments of Ecuador with varied profiles of resistance and multi-resistance to antibiotics is demonstrated. (AU)

Perfiles de susceptibilidad a los antibióticos en cepas del genero Bacillus aisladas de ambientes acuáticos extremos del Ecuador / Susceptibility profiles to antibiotics in strains of the genus Bacillus isolated from extreme aquatic environments of Ecuador

Introducción: En el agua de los ecosistemas acuáticos considerados extremos, debido a los valores de sus parámetros fisicoquímicos y químicos, tales como altas concentraciones de sales, ambientes oligotróficos, pH extremos, alta radiación y temperaturas extremas, existe una población bacteriana que se ha adaptado a esas condiciones y que pueden ser un reservorio importante de resistomas naturales.Objetivo. Conocer los perfiles de susceptibilidad a diversos antibióticos en cepas del género Bacillus aisladas de balnearios de aguas mineromedicinales y de agua de un lago cratérico volcánico del Ecuador.Materiales y métodos. Se analizaron un total de 16 muestras de agua mineromedicinal y 32 muestras de agua de lago cratérico volcánico. El aislamiento de Bacillus se realizó por la técnica de filtración en membrana, utilizando filtros Millipore de 0,45 μm de poro, un volumen de muestra de 100 mL y el agar R2A. Las cepas aisladas se identificaron siguiendo los esquemas de MacFaddin (2004), complementadas con las pruebas bioquímicas de las galerías Microgen para Bacillus. El perfil de resistencia a los antibióticos se determinó por el método de difusión en placas de Kirby y Bauer (1966) interpretándose según el CLSI (2019).Resultados. Se identificaron 19 cepas de Bacillus. La mayoría de las cepas fueron resistentes y multiresistentes a los antibióticos clindamicina, eritromicina, gentamicina, oxacilina y penicilina.Conclusiones. Los resultados señalan la presencia de especies de Bacillus y de resistomas asociados a este género en el agua de ambientes naturales extremos en el Ecuador, lo cual sugiere que estos ambientes pueden ser un reservorio importante de bacterias resistentes a los antibióticos. (AU)

Introduction: The water of aquatic ecosystems considered extreme, given the values of its physicochemical and chemical parameters, such as high concentrations of salts, oligotrophic environments, extreme pH, high radiation and extreme temperatures, there is a bacterial population that has adapted to these conditions and that they can be an important reservoir of natural resistomes.Objective. The objective of the present work was to know the profiles of susceptibility to various antibiotics in strains of the Bacillus genus isolated from mineromedicinal water spas and water from a volcanic crater lake in Ecuador.Materials and methods. A total of 16 mineromedicinal water samples and 32 samples of crater volcanic lake water were analyzed. The isolation of the Bacillus colonies was carried out by the membrane filtration technique, using Millipore filters of 0.45 μm pore, a sample volume of 100 mL and R2A agar. The isolated strains were identified following the schemes of MacFaddin (2004), complemented with the biochemical tests of the Microgen galleries for Bacillus. The antibiotic resistance profile was determined by the plate diffusion method of Kirby and Bauer (1966), interpreted according to the CLSI (2019).Results. 19 Bacillus strains were identified. Most of the strains were resistant and multi-resistant to the antibiotic clindamycin, erythromycin, gentamicin, oxacillin, and penicillin. Conclusions. The results indicate the presence of Bacillus species and resistomes associated with this genus in the water of extreme natural environments in Ecuador, which suggests that these environments may be an important reservoir of bacteria resistant to antibiotics. (AU)

Nanoformulations with Leishmania braziliensis Antigens Triggered Controlled Parasite Burden in Vaccinated Golden Hamster (Mesocricetus auratus) against Visceral Leishmaniasis.

Leishmaniasis is a widespread vector-borne disease in Brazil, with Leishmania (Leishmania) infantum as the primary etiological agent of visceral leishmaniasis (VL). Dogs are considered the main reservoir of this parasite, whose treatment in Brazil is restricted to the use of veterinary medicines, which do not promote a parasitological cure. Therefore, efficient vaccine development is the best approach to Canine Visceral Leishmaniasis (CVL) control. With this in mind, this study used hamsters (Mesocricetus auratus) as an experimental model in an anti-Leishmania preclinical vaccine trial to evaluate the safety, antigenicity, humoral response, and effects on tissue parasite load. Two novel formulations of nanoparticles made from poly(D, L-lactic) acid (PLA) polymer loading Leishmania braziliensis crude antigen (LB) exhibiting two different particle sizes were utilized: LBPSmG (570 nm) and LBPSmP (388 nm). The results showed that the nanoparticles were safe and harmless to hamsters and were antigenic with the induction in LBSap, LBPSmG, and LBPSmG groups of total anti-Leishmania IgG antibodies 30 days after challenge, which persists 200 days in LBSap and LBPSmP. At the same time, a less pronounced hepatosplenomegaly in LBSap, LBPSmG, and LBPSmP was found when compared to control groups, as well as a less pronounced inflammatory infiltrate and granuloma formation in the spleen. Furthermore, significant reductions of 84%, 81%, and 90% were observed in spleen parasite burden accessed by qPCR in the LBSap, LBPSmG, and LBPSmP groups, respectively. In this way, LBSap, LBPSmG, and LBPSmP formulations showed better results in vaccinated and L. infantum-challenged animals in further reducing parasitic load in the spleen and attenuating lesions in liver and splenic tissues. This results in safe, harmless nanoformulation vaccines with significant immunogenic and infection control potential. In addition, animals vaccinated with LBPSmP had an overall reduction in parasite burden in the spleen, indicating that a smaller nanoparticle could be more efficient in targeting antigen-presenting cells.

Factors associated with lesion detection in colonoscopy among different indications.

BACKGROUND AND OBJECTIVE: Different factors may influence colonoscopy performance measures. We aimed to analyze procedure- and endoscopist-related factors associated with detection of colorectal lesions and whether these factors have a similar influence in the context of different colonoscopy indications: positive fecal immunochemical test (+FIT) and post-polypectomy surveillance colonoscopies. METHODS: This multicenter cross-sectional study included adults aged 40-80 years. Endoscopists (N = 96) who had performed ≥50 examinations were assessed for physician-related factors. Adenoma detection rate (ADR), adenomas per colonoscopy rate (APCR), advanced ADR, serrated polyp detection (SDR), and serrated polyps per colonoscopy rate (SPPCR) were calculated. RESULTS: We included 12,932 procedures, with 4810 carried out after a positive FIT and 1967 for surveillance. Of the 96 endoscopists evaluated, 43.8% were women, and the mean age was 41.9 years. The ADR, advanced ADR, and SDR were 39.7%, 17.7%, and 12.8%, respectively. Adenoma detection rate was higher in colonoscopies after a +FIT (50.3%) with a more than doubled advanced ADR compared to non-FIT procedures (27.6% vs. 13.0%) and similar results in serrated lesions (14.7% vs. 13.5%). Among all the detection indicators analyzed, withdrawal time was the only factor independently related to improvement (p < 0.001). Regarding FIT-positive and surveillance procedures, for both indications, withdrawal time was also the only factor associated with a higher detection of adenomas and serrated polyps (p < 0.001). Endoscopist-related factors (i.e., weekly hours dedicated to endoscopy, annual colonoscopy volume and lifetime number of colonoscopies performed) had also impact on lesion detection (APCR, advanced ADR and SPPCR). CONCLUSIONS: Withdrawal time was the factor most commonly associated with improved detection of colonic lesions globally and in endoscopies for + FIT and post-polypectomy surveillance. Physician-related factors may help to address strategies to support training and service provision. Our results can be used for establishing future benchmarking and quality improvement in different colonoscopy indications.

Weaning Outcomes in Patients with Brain Injury.

BACKGROUND: Despite the need for specific weaning strategies in neurological patients, evidence is generally insufficient or lacking. We aimed to describe the evolution over time of weaning and extubation practices in patients with acute brain injury compared with patients who are mechanically ventilated (MV) due to other reasons. METHODS: We performed a secondary analysis of three prospective, observational, multicenter international studies conducted in 2004, 2010, and 2016 in adults who had need of invasive MV for more than 12 h. We collected data on baseline characteristics, variables related to management ventilator settings, and complications while patients were ventilated or until day 28. RESULTS: Among the 20,929 patients enrolled, we included 12,618 (60%) who started the weaning from MV, of whom 1722 (14%) were patients with acute brain injury. In the acutely brain-injured cohort, 538 patients (31%) did not undergo planned extubation, defined as the need for a tracheostomy without an attempt of extubation, accidental extubation, and death. Among the 1184 planned extubated patients with acute brain injury, 202 required reintubation (17%). Patients with acute brain injury had a higher odds for unplanned extubation (odds ratio [OR] 1.35, confidence interval for 95% [CI 95%] 1.19-1.54; p < 0.001), a higher odds of failure after the first attempt of weaning (spontaneous breathing trial or gradual reduction of ventilatory support; OR 1.14 [CI 95% 1.01-1.30; p = 0.03]), and a higher odds for reintubation (OR 1.41 [CI 95% 1.20-1.66; p < 0.001]) than patients without brain injury. Patients with hemorrhagic stroke had the highest odds for unplanned extubation (OR 1.47 [CI 95% 1.22-1.77; p < 0.001]), of failed extubation after the first attempt of weaning (OR 1.28 [CI 95% 1.06-1.55; p = 0.009]), and for reintubation (OR 1.49 [CI 95% 1.17-1.88; p < 0.001]). In relation to weaning evolution over time in patients with acute brain injury, the risk for unplanned extubation showed a downward trend; the risk for reintubation was not associated to time; and there was a significant increase in the percentage of patients who underwent extubation after the first attempt of weaning from MV. CONCLUSIONS: Patients with acute brain injury, compared with patients without brain injury, present higher odds of undergoing unplanned extubated after weaning was started, lower odds of being extubated after the first attempt, and a higher risk of reintubation.

Simulation-based education improves military trainees' skill performance and self-confidence in tourniquet placement: A randomized controlled trial.

BACKGROUND: Tactical Combat Casualty Care (TCCC) is the standard of care for stabilization and treatment of military trauma patients. The Department of Defense has mandated that all service members receive role-based TCCC training and certification. Simulation education can increase procedural skills by providing opportunities for deliberate practice in safe, controlled environments. We developed and evaluated the effectiveness of a simulation-based TCCC training intervention to improve participants' skill performance and self-confidence in tourniquet placement. METHODS: This study was a single-blinded, randomized trial with waitlist controls. Army Reserve Officers Training Corp cadets from a single training battalion comprised the study population. After randomization and baseline assessment of all participants, group A alone received focused, simulation-based TCCC tourniquet application training. Three months later, all participants underwent repeat testing, and after crossover, the waitlist group B received the same intervention. Two months later, all cadets underwent a third/final assessment. The primary outcome was tourniquet placement proficiency assessed by total score achieved on a standardized eight-item skill checklist. A secondary outcome was self-confidence in tourniquet application skill as judged by participants' Likert scale ratings. RESULTS: Forty-three Army Reserve Officers Training Corp cadets completed the study protocol. Participants in both group A (n = 25) and group B (n = 18) demonstrated significantly higher performance from baseline to final assessment at 5 months and 2 months, respectively, following the intervention. Mean total checklist score of the entire study cohort increased significantly from 5.53 (SD = 2.00) at baseline to 7.56 (SD = 1.08) at time 3, a gain of 36.7% ( p < 0.001). Both groups rated their self-confidence in tourniquet placement significantly higher following the training. CONCLUSION: A simulation-based TCCC curriculum resulted in significant, consistent, and sustained improvement in participants' skill proficiency and self-confidence in tourniquet placement. Participants maintained these gains 2 months to 5 months after initial training. LEVEL OF EVIDENCE: Therapeutic/care management; Level II.