Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review.

Reconstruction of the auricular concha poses a challenge due to its difficult access and limited tissue flexibility; however, there are no recommendations in the literature on which reconstructive technique should be favored for this anatomical site. This systematic review intends to describe and compare the reconstructive techniques used in conchal bowl reconstruction following cutaneous oncologic surgery of this region, with regard to their complications and aesthetic results. In doing so, we aim to identify the best suited reconstructive procedure(s) for the conchal bowl. The six databases searched (PubMed, Scopus, Web of Science, Ovid, SciELO, and CENTRAL) yielded twelve eligible studies that explored the revolving door flap, split-thickness skin grafts (STSG), full-thickness skin grafts (FTSG), second intention healing, the preauricular translocation flap, subcutaneous pedicle grafts, and other local flaps. Qualitative synthesis of the results concluded that the revolving door flap could be the reconstructive procedure of choice for the auricular concha, following skin cancer excision. It has a low risk of necrosis, infection, and postoperative hemorrhage, as well as excellent aesthetic outcomes. STSG may be used as an alternative. Nonetheless, due to the low sample size and the high risk of bias in some studies, further investigations must be conducted on this subject.

Longitudinal patterns of breastfeeding and its association with adiposity and subjective indicators of satiety/appetite in the first 2 years of life.

Evidence about the association between breastfeeding and its duration with growth, appetite and satiety indicators, and adiposity in low and middle-income countries facing nutritional transition is scarce. The aim of this study was to evaluate the association between longitudinal patterns of breastfeeding (exclusive [EBF] and continued [CBF]) with adiposity and growth, and the mediating role of appetite and satiety indicators in these associations in Mexican children during the first 2 years of life. Information from 378 mother-child pairs from the MAS-Lactancia birth cohort was analysed. Information was collected at birth and at months 1, 3, 6, 9, 12, 18 and 24 of life. Duration of EBF and CBF was computed. Linear mixed models were used to assess the association of EBF and CBF with growth and adiposity. Path analysis was used for mediation analysis. Compared with the reference group (EBF duration <1 month), males with >3 to ≤6 months of EBF had less abdominal circumference (ß = -0.66, p = 0.05), Z-score weight-for-length (ß = -0.17, p = 0.19) and length-for-age (ß = -0.49, p < 0.01). Participants without CBF beyond 6 months had higher BMI Z-score (ß = 0.19, p < 0.01), abdominal circumference (ß = 0.62, p < 0.01) and skinfold sum (ß = 0.80, p = 0.09), and o difference in length-for-age. For EBF, mediation was confirmed for satiety responsiveness on the association with BMI Z-Score, for food fussiness for the association with abdominal circumference and length-for-age Z-score, and enjoyment of food on the association with length-for-age Z-score. For CBF, mediation was confirmed for food fussiness in the association with length-for-age. This study suggests that a longer exposure to EBF and CBF is associated with lower adiposity in children under 2 years of age, and that this association could be partially mediated by appetite and satiety indicators.

Escudos sociales y balas mágicas para el control de la epidemia por Covid-19 en México.

La pandemia por Covid-19 llegó a México en febrero de 2020. Las autoridades sanitarias promovieron medidas de prevención no farmacológicas para contrarrestar el avance de la epidemia y a finales del año se anunció la aplicación de las primeras vacunas. A nivel global y local, las vacunas marcaron un hito al erigirse como "balas mágicas", sin em-bargo, enfrentaron diversas dificultades como la producción masiva, la logística de distribución, la efectividad, su aplicación escalonada que priorizó a grupos vulnerables, el rechazo y la baja percepción de riesgo por parte de algunos grupos de la población; por tanto, el énfasis sobre las medidas preventivas o "escudos sociales" se diluyó con el avance de la estrategia de vacunación. Este ensayo resalta la importancia de man-tener "los escudos sociales" como medidas fundamentales y complementarias a la aplicación de vacunas, puesto que, por sí solas, las "balas mágicas" presentan retos que podrían comprometer su eficacia.

Escudos sociales y balas mágicas para el control de la epidemia por Covid-19 en México / Social shields and magic bullets for the control of the Covid-19 epidemic in Mexico

Resumen: La pandemia por Covid-19 llegó a México en febrero de 2020. Las autoridades sanitarias promovieron medidas de prevención no farmacológicas para contrarrestar el avance de la epidemia y a finales del año se anunció la aplicación de las primeras vacunas. A nivel global y local, las vacunas marcaron un hito al erigirse como "balas mágicas", sin embargo, enfrentaron diversas dificultades como la producción masiva, la logística de distribución, la efectividad, su aplicación escalonada que priorizó a grupos vulnerables, el rechazo y la baja percepción de riesgo por parte de algunos grupos de la población; por tanto, el énfasis sobre las medidas preventivas o "escudos sociales" se diluyó con el avance de la estrategia de vacunación. Este ensayo resalta la importancia de mantener "los escudos sociales" como medidas fundamentales y complementarias a la aplicación de vacunas, puesto que, por sí solas, las "balas mágicas" presentan retos que podrían comprometer su eficacia.

Abstract: The first Covid-19 case was identified in Mexico in February 2020. Health authorities promoted non-pharmacological prevention measures to counteract the progress of the epidemic and, at the end of the year, they announced the application of the first vaccines in the country. Globally and locally, vaccines marked a milestone, positioning themselves as "magic bullets"; nevertheless, they faced several difficulties such as mass production, distribution logistics, variable effectiveness, phased implementation that prioritized vulnerable groups, rejection and low risk perception by certain groups in the population. The emphasis on population-based preventive measures or "social shields" was eventually diluted with the arrival of new vaccines. This essay highlights the importance of maintaining "social shields" as key preventive measures complementary to vaccines, since "magic bullets", on their own, present challenges that could compromise their effectiveness.

Nanoengineered Shear-Thinning Hydrogel Barrier for Preventing Postoperative Abdominal Adhesions.

More than 90% of surgical patients develop postoperative adhesions, and the incidence of hospital re-admissions can be as high as 20%. Current adhesion barriers present limited efficacy due to difficulties in application and incompatibility with minimally invasive interventions. To solve this clinical limitation, we developed an injectable and sprayable shear-thinning hydrogel barrier (STHB) composed of silicate nanoplatelets and poly(ethylene oxide). We optimized this technology to recover mechanical integrity after stress, enabling its delivery though injectable and sprayable methods. We also demonstrated limited cell adhesion and cytotoxicity to STHB compositions in vitro. The STHB was then tested in a rodent model of peritoneal injury to determine its efficacy preventing the formation of postoperative adhesions. After two weeks, the peritoneal adhesion index was used as a scoring method to determine the formation of postoperative adhesions, and STHB formulations presented superior efficacy compared to a commercially available adhesion barrier. Histological and immunohistochemical examination showed reduced adhesion formation and minimal immune infiltration in STHB formulations. Our technology demonstrated increased efficacy, ease of use in complex anatomies, and compatibility with different delivery methods, providing a robust universal platform to prevent postoperative adhesions in a wide range of surgical interventions.

Características clínicas y microbiológicas de infecciones del torrente sanguíneo en pacientes adultos neutropénicos / Clinical and microbiological characteristics of bloodstream infections in adult neutropenic patients

RESUMEN Las infecciones del torrente sanguíneo (IS) en pacientes oncológicos neutropénicos constituyen una patología de relevancia y se asocian a un aumento de la morbimortalidad. El objetivo de este estudio fue determinar las características epidemiológicas y microbiológicas de los episodios de IS en pacientes adultos neutropénicos con neoplasias hematológicas (NH) y neoplasias sólidas (NS). Se realizó un estudio retrospectivo en dos hospitales de tercer nivel entre 2009 y 2016. Se incluyeron todos los pacientes neutropénicos mayores de 18años con NH y NS que presentaron episodios de IS. Se excluyeron aquellos con neoplasias dermatológicas no melanoma. Se identificaron 143 episodios de IS, de los cuales el 80,4% fueron en personas con NH. El 97,9% de los pacientes tuvieron neutropenia de alto riesgo, sin diferencia entre los grupos NH y NS. Los orígenes más frecuentes de IS fueron bacteriemia primaria (46,9%) e infección asociada a catéter (21%), sin diferencias significativas entre grupos. El 74,1% de los aislamientos fueron bacilos gram negativos yEscherichiacolifue el microorganismo más frecuente (32,1%). El coco gram positivo más frecuentemente aislado fueStaphylococcusaureus(28,1%), seguido del grupo de los estafilococos coagulasa negativos (ECN), sin diferencias entre ambos tipos de neoplasias. El 67,5% de los ECN fueron multirresistentes; solo el 11,1% de los aislamientos deS. aureusfue resistente a la meticilina. El 17,6% de los aislamientos deE. coliy el 27,6% de los deKlebsiellapneumoniaefueron multirresistentes. No hubo diferencias en la frecuencia de aislamientos multirresistentes al comparar entre ambos tipos de neoplasia. Como conclusión, las IS en pacientes neutropénicos fueron más frecuentes en pacientes con NH y las causaron, principalmente, bacilos gram negativos. Se observó una elevada mortalidad en los pacientes neutropénicos con IS.

ABSTRACT Bloodstream infections (BI) are relevant in neutropenic patients because they are associated with an increased number of complications and death. The objective was determinate the epidemiologic and microbiologic features of the BI in neutropenic patients with solid neoplasm (SN) and hematologic neoplasm (HN). Retrospective study in two third level hospitals between 2009 and 2016. They were included all the patients older than 18 years-old with active oncologic disease and neutropenia, who had BI. Patients with dermatologic cancer other than melanoma where excluded. A total of 143 BI in neutropenic were observed, of which 80.4% occurred in HN. Around 97.9% of the patients had a high-risk neutropenia without differences between both groups. The most frequent site of BI was primary bacteremia (46.9%) and catheter-associated infection (21%), without significant differences between the two groups. The gram negatives bacilli (GNB) predominated over the gram positive cocci (GPC) and they represented 74.1% of the isolated bacteria, beingEscherichia colithe most frequent (32.8%). Among the gram positive cocci,Staphylococcus aureus(28.1%) was the most frequent isolated, followed by coagulase-negativeStaphylococci(CNS). There were no differences in microbiological isolates between both groups. With regard to the antimicrobial susceptibility 67.5% of the CNS, 17.6% of theE. coliand 27.6% of theKlebsiella pneumoniaewere multiresistant with no differences between both groups. Only 11.1% of S. aureus isolates were methicillin resistant. In conclusion BI of the neutropenic patients where most frequents within patients with HN, GNB were the main microbiological isolates. High mortality was observed in neutropenic patients with BI.

[Clinical and microbiological characteristics of bloodstream infections in adult neutropenic patients]. / Características clínicas y microbiológicas de infecciones del torrente sanguíneo en pacientes adultos neutropénicos.

Bloodstream infections (BI) are relevant in neutropenic patients because they are associated with an increased number of complications and death. The objective was determinate the epidemiologic and microbiologic features of the BI in neutropenic patients with solid neoplasm (SN) and hematologic neoplasm (HN). Retrospective study in two third level hospitals between 2009 and 2016. They were included all the patients older than 18 years-old with active oncologic disease and neutropenia, who had BI. Patients with dermatologic cancer other than melanoma where excluded. A total of 143 BI in neutropenic were observed, of which 80.4% occurred in HN. Around 97.9% of the patients had a high-risk neutropenia without differences between both groups. The most frequent site of BI was primary bacteremia (46.9%) and catheter-associated infection (21%), without significant differences between the two groups. The gram negatives bacilli (GNB) predominated over the gram positive cocci (GPC) and they represented 74.1% of the isolated bacteria, being Escherichia coli the most frequent (32.8%). Among the gram positive cocci, Staphylococcus aureus (28.1%) was the most frequent isolated, followed by coagulase-negative Staphylococci (CNS). There were no differences in microbiological isolates between both groups. With regard to the antimicrobial susceptibility 67.5% of the CNS, 17.6% of the E. coli and 27.6% of the Klebsiella pneumoniae were multiresistant with no differences between both groups. Only 11.1% of S. aureus isolates were methicillin resistant. In conclusion BI of the neutropenic patients where most frequents within patients with HN, GNB were the main microbiological isolates. High mortality was observed in neutropenic patients with BI.

Urinary tract infections in hospitalized patients.

INTRODUCTION: Urinary Tract Infections (UTI) are an important cause of morbidity in the community, constituting one of the main reasons for hospitalization, and the fourth cause of healthcare-associated infection. The objectives of this study were to determine the frequency of community-acquired UTI (CA-UTI) with need of hospitalization and healthcare-associated UTI (HA-UTI), their risk factors, etiologic agents and their antimicrobial susceptibility spectrum. METHODS: A prospective and analytic study was conducted, in which all admissions regarding CA-UTI with need of hospitalization and HA-UTI were evaluated during the period between 2016 and 2017 in two university hospitals. RESULTS: A total of 279 episodes of UTI in hospitalized patients were identified and, among those, 178 episodes corresponded to CA-UTI and 101 to HA-UTI. On average, patients were 60 years old in both groups. HA-UTI were more frequently associated with kidney transplant, recurrent UTI and chronic kidney disease compared with CA-UTI. The instrumentation of urinary tract within the previous month was more frequent in HA-UTI (75.2% vs 32.6%, p<0.001). Escherichia coli was the most frequent isolated microorganism (62.9% in CA-UTI and 56.4% in HA-UTI), followed by Klebsiella pneumoniae and Pseudomonas aeruginosa. A total of 101 multidrug resistant microorganisms were isolated, of which 53.5% were CA-UTI, and were associated with male patients, use of antimicrobials within the previous three months, chronic kidney disease and recurrent UTI. CONCLUSION: It is of great importance for the institutions to identify the local antimicrobial susceptibility spectrum of UTI in order to stablish adequate empiric treatments.

Pro-Inflammatory Diet Is Associated with Adiposity during Childhood and with Adipokines and Inflammatory Markers at 11 Years in Mexican Children.

There is limited evidence about the inflammatory potential of diet in children. The aim of this study was to evaluate the association between the Children's Dietary Inflammatory Index (C-DII) from 5 to 11 years with adiposity and inflammatory biomarkers in Mexican children. We analyzed 726 children from a birth cohort study with complete dietary information and measurements to evaluate adiposity at 5, 7 and 11 y and 286 children with IL-6, hsCRP, leptin and adiponectin information at 11 y. C-DII trajectories were estimated using latent class linear mixed models. We used linear mixed models for adiposity and logistic and multinomial regression for biomarkers. In girls, each one-point increase in C-DII score was associated with greater adiposity (abdominal-circumference 0.41%, p = 0.03; skinfold-sum 1.76%, p = 0.01; and BMI Z-score 0.05, p = 0.01). At 11 y the C-DII was associated with greater leptin (34% ≥ 13.0 ng/mL, p = 0.03) and hsCRP concentrations (29% ≥ 3.00 mg/L, p = 0.06) and lower adiponectin/leptin ratio (75% < 2.45, p = 0.02). C-DII trajectory 3 in boys was associated with a 75.2% (p < 0.01) increase in leptin concentrations and a 37.9% decrease (p = 0.02) in the adiponectin/leptin ratio. This study suggests that the inflammatory potential of diet may influence adiposity in girls and the homeostasis of adipose tissue and chronic subclinical inflammation in 11-year-old children.

Depresión en el anciano, síntomas psicológicos y conductuales asociados a la demencia y síndrome paraneoplásico: dificultades diagnósticas. A propósito de un caso / Depression in the elderly, psychological and behavioral symptoms associated with dementia and paraneoplastic syndrome: diagnostic difficulties. A case report

El síndrome depresivo del anciano tiene unas características específicas, como un mayor predominio de la clínica motora y una menor sensación subjetiva de tristeza. El diagnóstico conlleva una dificultad añadida por la frecuente polimedicación, comorbilidades médicas y el deterioro funcional y cognitivo propios de este grupo etario. Se presenta el caso de un paciente de 83 años en el que se plantea un diagnóstico diferencial entre los síntomas psicológicos y conductuales asociados a la demencia y el síndrome depresivo del anciano, en un caso en el que la positividad a un anticuerpo onconeuronal actuó como factor distractor

Depression in the elderly is characterized by specific features such as a greater predominance of motor symptoms and a less subjective feeling of sadness. Diagnosis involves an added difficulty due to frequent polymedication, medical comorbidities, and functional and cognitive impairment typical of this age group. The case of an 83 year old patient is presented. Differential diagnosis is discussed between behavioural and psychological symptoms of dementia and depression in the elderly, in a case where positivity to an onconeuronal antibody acted as a distracting factor

Prevalence of inadequate intake of vitamins and minerals in the Mexican population correcting by nutrient retention factors, Ensanut 2016.

OBJECTIVE: To estimate the usual intake and the prevalence of inadequacy of selected nutrients in the Mexican population and the potential effect that the nutrient retention factors (NRF) could have on these estimates. Likewise, document the methodology used in the analysis of the 24 hours of the mid-way National Health and Nutrition Survey 2016 (Ensanut MC 2016). MATERIALS AND METHODS: Dietary information from the Ensanut MC 2016 was analyzed with and without the use of NRFs. RESULTS: Results. Most nutrients evaluated showed a relevant inadequacy prevalence above 10% in all age groups. Likewise, we documented that, when NRFs were not applied, estimated intakes and prevalence were significantly under-estimated in a range of 2% to 55.5%. CONCLUSIONS: We documented the relevance of the application of NRFs for adequate estimation of the prevalence of inadequate intake of selected nutrients in population studies.

OBJETIVO: Estimar la ingesta habitual y la prevalencia de inadecuación de nutrimentos selectos en la población mexicana y el efecto potencial de los factores de retención de nutrimentos (FRN). Asimismo, describir la metodología utilizada en el procesamiento del recordatorio de 24 horas de la Encuesta Nacional de Salud y Nutrición de Medio Camino 2016 (Ensanut MC 2016). MATERIAL Y MÉTODOS: Se analizó la información dietética de Ensanut MC 2016 con y sin utilización de FRN. RESULTADOS: En los nutrimentos evaluados, las prevalencias de inadecuación fueron superiores al 10% en todos los grupos de estudio. La no consideración de los FRN causó la subestimación en las prevalencias de inadecuación en un rango de 2% a 55.5%. CONCLUSIONES: . Se documenta la relevancia de la aplicación de FRN para la adecuada estimación de las prevalencias de inadecuación en estudios poblacionales.

Prevalence of inadequate intake of vitamins and minerals in the Mexican population correcting by nutrient retention factors, Ensanut 2016 / Prevalencia de consumo inadecuado de vitaminas y minerales en población mexicana, corrigiendo por factores de retención de nutrimentos, Ensanut 2016

Abstract Objective: To estimate the usual intake and the prevalence of inadequacy of selected nutrients in the Mexican population and the potential effect that the nutrient retention factors (NRF) could have on these estimates. Likewise, document the methodology used in the analysis of the 24 hours of the mid-way National Health and Nutrition Survey 2016 (Ensanut MC 2016). Materials and methods: Dietary information from the Ensanut MC 2016 was analyzed with and without the use of NRFs. Results: Most nutrients evaluated showed a relevant inadequacy prevalence above 10% in all age groups. Likewise, we documented that, when NRFs were not applied, estimated intakes and prevalence were significantly underestimated in a range of 2% to 55.5%. Conclusions: We documented the relevance of the application of NRFs for adequate estimation of the prevalence of inadequate intake of selected nutrients in population studies.

Resumen Objetivo: Estimar la ingesta habitual y la prevalencia de inadecuación de nutrimentos selectos en la población mexicana y el efecto potencial de los factores de retención de nutrimentos (FRN). Asimismo, describir la metodología utilizada en el procesamiento del recordatorio de 24 horas de la Encuesta Nacional de Salud y Nutrición de Medio Camino 2016 (Ensanut MC 2016). Material y métodos: Se analizó la información dietética de Ensanut MC 2016 con y sin utilización de FRN. Resultados: En los nutrimentos evaluados, las prevalencias de inadecuación fueron superiores al 10% en todos los grupos de estudio. La no consideración de los FRN causó la subestimación en las prevalencias de inadecuación en un rango de 2% a 55.5%. Conclusión: Se documenta la relevancia de la aplicación de FRN para la adecuada estimación de las prevalencias de inadecuación en estudios poblacionales.

[Epidemiological and microbiological characteristics of uncomplicated urinary infections]. / Características epidemiológicas y microbiológicas de las infecciones urinarias no complicadas.

Introduction: Uncomplicated urinary tract infections(UC-UTI) represent a frequent reason for consultation. Most cases are empirically treated, but the antimicrobial susceptibility of the causative microorganisms has changed over the past years. The objectives of this study where to determine UC-UTI causative microorganism and their antimicrobial susceptibility profiles in adult women. Methods: A prospective analytic study was conducted in two hospital in Córdoba, Argentina, between November/2016 and October/2017. From the identification of positive urine cultures, urinary tract infections (UTI) in women ≥18 years without risk factors for complicated UTIs were included, excluding asymptomatic bacteriurias. Results: A total of 610 UC-UTI were identified and 62.6% of them in patients younger than 50 years; 73.3% of cases were cystitis, being more frequent in older women. Escherichia coli was isolated in 89.2% of UTI and negative coagulase Staphylococcus in 4.2%. As regards Escherichia coli, its resistance against ciprofloxacin was 18.8%; 4.4% against ceftriaxone and 1.8% against nitrofurantoin. There was an elevated resistance against ampicillin, trimethoprim­sulfamethoxazole and ampicillin­sulbactam. Main conclusion: The most frequent isolated microorganism was Escherichia coli, consistent with global epidemiology. This microorganism showed less than 20% total resistance against ciprofloxacin, ceftriaxone and nitrofurantoin.

Introducción: Las infecciones del tracto urinario no complicadas (ITU-NoC) representan un motivo frecuente de consulta ambulatorio, siendo la mayoría tratadas empíricamente. Han existido cambios en susceptibilidad antimicrobiana en los últimos años. Nuestros objetivos fueron determinar los microorganismos de las ITU-NoC y su perfil de susceptibilidad antimicrobiana en mujeres adultas. Métodos: Estudio analítico prospectivo en dos hospitales de Córdoba, Argentina, entre noviembre/2016 y octubre/2017. A partir de la identificación de urocultivos positivos, se incluyeron las infecciones urinarias(ITUs) en mujeres ≥18 años, sin factores de riesgo para ITUs complicada, excluyéndose las bacteriurias asintomáticas. Resultados: Se identificaron 610 episodios de ITU-NoC, 382(63%) en <50 años. El 73.3% de las ITU-noC correspondieron a cistitis, siendo más frecuentes en las mujeres mayores 50 años.  En el 89.2% de las ITUs se aisló Escherichia coli y 4.2% Staphylococcus coagulasa negativo. Respecto a E. coli, su resistencia a ciprofloxacina fue de 18.8%, ceftriaxona 4.4% y nitrofurantoína 1.8%. Se observó una resistencia elevada a ampicilina, trimetoprima-sulfametoxazol y ampicilina-sulbactam. Conclusiones: En conclusión, el microorganismo más frecuentemente aislado fue E. coli, concordando con la epidemiología global, presentando una resistencia menor al 20% a ciprofloxacina, ceftriaxona y nitrofurantoína.

[Bloodstream infections in cancer patients]. / Infecciones del torrente sanguíneo en pacientes oncológicos.

Bloodstream infections (BI) are an important cause of morbidity and mortality in cancer patients. A retrospective study was performed in two hospitals aimed to evaluate characteristics of BI episodes occurred in adult patients with hematologic (HN) and solid (SN) neoplasia other than non-melanoma skin cancers in the period 2009-2016. A total of 467 episodes of bacteremia and 16 of fungemia were identified. A total of 200 (41.4%) bacteremias occurred in patients with HN and 283 (58.6%) in patients with SN. The most frequent SN and HN were colon cancer (18.7%) and non-Hodgkin lymphoma (27%), respectively. The main risk factors for BI were a previous surgical procedure in SN and chemotherapy in the previous 30 days and use of central venous catheter in HN. Infections were mainly acquired in the hospital environment and the most frequent presentation was bacteremia without focus, mostly in HN (38% vs. 20.8%, p < 0.001). Gram negative bacilli (GNB) were isolated in 336 (69.5%) episodes and predominated over Gram positive cocci (GPC) in both groups. Escherichia coli was the most frequent GNB isolated in both SN (24.7%) and HN patients (20.5%). The most frequent GPC was Staphylococcus aureus. Multidrug-resistance was found in 15% of the isolates in SN and 18% in HN. The overall mortality was 40.5% in patients with HN and 37.5% in patients with SN, with the majority of deaths occurring in the first 30 days.

Las infecciones del torrente sanguíneo (ITS) son una importante causa de morbimortalidad en pacientes oncológicos. Los objetivos del estudio fueron evaluar las características de las ITS en pacientes con neoplasia hematológica (NH) y sólida (NS) en un estudio retrospectivo realizado en dos hospitales, entre 2009 y 2016. Fueron incluidos todos los episodios de ITS en adultos con neoplasias activas, excepto cáncer de piel no melanoma. Fueron identificados 467 episodios de bacteriemia y 16 de fungemia. Un total de 200 (41.4%) bacteriemias ocurrieron en pacientes con NH y 283 (58.6%) en pacientes con NS. Las NS y NH más frecuentes fueron cáncer de colon (18.7%) y linfoma no Hodgkin (27%), respectivamente. Los principales factores de riesgo de ITS fueron el antecedente de procedimiento quirúrgico para NS y quimioterapia en los 30 días previos y uso de catéter venoso central para NH. Las infecciones fueron adquiridas principalmente en el medio intrahospitalario y la presentación más frecuente fue la bacteriemia sin foco, fundamentalmente en NH (38.0% vs. 20.8%, p < 0.001). En un total de 336 (69.5%) aislamientos predominaron bacilos Gram negativos (BGN) sobre cocos Gram positivos (CGP) sin diferencias entre grupos. Escherichia coli fue el BGN más frecuente en NS (24.7%) y NH (20.5%). El CGP más frecuente fue Staphylococcus aureus. El 15% y el 18% de los aislamientos fue multirresistente en NS y NH, respectivamente. La mortalidad global fue 40.5% en pacientes con NH y 37.5% en pacientes con NS. La mayoría de las muertes ocurrió en los primeros 30 días.

Bloodstream infections in cancer patients / Artículo original

Resumen Las infecciones del torrente sanguíneo (ITS) son una importante causa de morbimortalidad en pacientes oncológicos. Los objetivos del estudio fueron evaluar las características de las ITS en pacientes con neoplasia hematológica (NH) y sólida (NS) en un estudio retrospectivo realizado en dos hospitales, entre 2009 y 2016. Fueron incluidos todos los episodios de ITS en adultos con neoplasias activas, excepto cáncer de piel no melanoma. Fueron identificados 467 episodios de bacteriemia y 16 de fungemia. Un total de 200 (41.4%) bacteriemias ocurrieron en pacientes con NH y 283 (58.6%) en pacientes con NS. Las NS y NH más frecuentes fueron cáncer de colon (18.7%) y linfoma no Hodgkin (27%), respectivamente. Los principales factores de riesgo de ITS fueron el antecedente de procedimiento quirúrgico para NS y quimioterapia en los 30 días previos y uso de catéter venoso central para NH. Las infecciones fueron adquiridas principalmente en el medio intrahospitalario y la presentación más frecuente fue la bacteriemia sin foco, fundamentalmente en NH (38.0% vs. 20.8%, p < 0.001). En un total de 336 (69.5%) aislamientos predominaron bacilos Gram negativos (BGN) sobre cocos Gram positivos (CGP) sin diferencias entre grupos. Escherichia coli fue el BGN más frecuente en NS (24.7%) y NH (20.5%). El CGP más frecuente fue Staphylococcus aureus. El 15% y el 18% de los aislamientos fue multirresistente en NS y NH, respectivamente. La mortalidad global fue 40.5% en pacientes con NH y 37.5% en pacientes con NS. La mayoría de las muertes ocurrió en los primeros 30 días.

Abstract Bloodstream infections (BI) are an important cause of morbidity and mortality in cancer patients. A retrospective study was performed in two hospitals aimed to evaluate characteristics of BI episodes occurred in adult patients with hematologic (HN) and solid (SN) neoplasia other than non-melanoma skin cancers in the period 2009-2016. A total of 467 episodes of bacteremia and 16 of fungemia were identified. A total of 200 (41.4%) bacteremias occurred in patients with HN and 283 (58.6%) in patients with SN. The most frequent SN and HN were colon cancer (18.7%) and non-Hodgkin lymphoma (27%), respectively. The main risk factors for BI were a previous surgical procedure in SN and chemotherapy in the previous 30 days and use of central venous catheter in HN. Infections were mainly acquired in the hospital environment and the most frequent presentation was bacteremia without focus, mostly in HN (38% vs. 20.8%, p < 0.001). Gram negative bacilli (GNB) were isolated in 336 (69.5%) episodes and predominated over Gram positive cocci (GPC) in both groups. Escherichia coli was the most frequent GNB isolated in both SN (24.7%) and HN patients (20.5%). The most frequent GPC was Staphylococcus aureus. Multidrug-resistance was found in 15% of the isolates in SN and 18% in HN. The overall mortality was 40.5% in patients with HN and 37.5% in patients with SN, with the majority of deaths occurring in the first 30 days.

High-efficiency transformation of Yarrowia lipolytica using electroporation.

Yarrowia lipolytica is an industrial host organism with incredible potential for metabolic engineering. However, the genetic tools and capacities in this host lag behind those of conventional counterparts. In this study, we sought to increase the transformation efficiency of Y. lipolytica by creating a simple protocol using electroporation. Efficiency was increased by optimizing wash buffers, pre-culture growth time, OD600 of competent cells, voltage, competent cell volume, DNA concentration, and recovery time. The outcome of these optimizations led to a simple protocol with maximum linear fragment transformation efficiency of 1.6 × 104 transformants per µg DNA and 2.8 × 104 transformants per µg DNA for episomal plasmid transformation. The protocol presented here is superior to other Y. lipolytica transformation protocols as it requires no lengthy pretreatment and no required carrier DNA to achieve efficiencies on par with, or exceeding, previously reported methods.

Rewiring Yarrowia lipolytica toward triacetic acid lactone for materials generation.

Polyketides represent an extremely diverse class of secondary metabolites often explored for their bioactive traits. These molecules are also attractive building blocks for chemical catalysis and polymerization. However, the use of polyketides in larger scale chemistry applications is stymied by limited titers and yields from both microbial and chemical production. Here, we demonstrate that an oleaginous organism (specifically, Yarrowia lipolytica) can overcome such production limitations owing to a natural propensity for high flux through acetyl-CoA. By exploring three distinct metabolic engineering strategies for acetyl-CoA precursor formation, we demonstrate that a previously uncharacterized pyruvate bypass pathway supports increased production of the polyketide triacetic acid lactone (TAL). Ultimately, we establish a strain capable of producing over 35% of the theoretical conversion yield to TAL in an unoptimized tube culture. This strain also obtained an averaged maximum titer of 35.9 ± 3.9 g/L with an achieved maximum specific productivity of 0.21 ± 0.03 g/L/h in bioreactor fermentation. Additionally, we illustrate that a ß-oxidation-related overexpression (PEX10) can support high TAL production and is capable of achieving over 43% of the theoretical conversion yield under nitrogen starvation in a test tube. Next, through use of this bioproduct, we demonstrate the utility of polyketides like TAL to modify commodity materials such as poly(epichlorohydrin), resulting in an increased molecular weight and shift in glass transition temperature. Collectively, these findings establish an engineering strategy enabling unprecedented production from a type III polyketide synthase as well as establish a route through O-functionalization for converting polyketides into new materials.