Recent Advances in the Understanding of Stress Resistance Mechanisms in Probiotics: Relevance for the Design of Functional Food Systems.

In recent years, more and more scientific community, food producers, and food industry show increased interest in functional foods containing probiotics, which is a big challenge. The consumption of probiotics in the context of a balanced diet through the consumption of functional foods or through the intake of pharmaceutical preparations has proven to contribute to the improvement of human health, even contributing to the prevention of diseases. In order for probiotics to be considered suitable for consumption, they must contain a minimum concentration of viable cells, namely, at least 107 colony forming units of beneficial microbes per gram. Ensuring the viability of bacterial cells until the moment of consumption is the overriding priority of functional probiotic food manufacturers. Probiotic bacteria are subject to stress conditions not only during food manufacturing but also during gastrointestinal passage, which limit or even compromise their functionality. This paper first examines all the stressful conditions faced by probiotic cells in their production stages and related to the conditions present in the bioreactor fermentation and drying processes as well as factors related to the food matrix and storage. The stress situations faced by probiotic microorganisms during the gastrointestinal transit especially during stomach and intestinal residence are also analyzed. In order to understand the adaptation mechanisms of probiotic bacteria to gastrointestinal stress, intrinsic and adaptive mechanisms identified in probiotic strains in response to acid stress and to bile and bile acid stress are analyzed. In addition, improvement strategies for multiple stress tolerance of lactic acid bacteria through directions dealing with stress, accumulation of metabolites, use of protectants, and regulation of technological parameters are examined. Finally, the definition of postbiotics, inanimate microorganisms and/or their components conferring health benefits, is also introduced. Postbiotics include cell lysates, enzymes, and cell wall fragments derived from probiotic bacteria and may represent an alternative to the use of probiotics, when they do not tolerate stressful conditions.

Esporotricosis linfocutánea en un paciente pediátrico, a propósito de un caso / Lymphocutaneous sporotrichosis in a pediatric patient, a case report

Resumen La esporotricosis es una infección fúngica de evolución subagudacrónica causada por hongos dimórficos del Complejo Sporothrix schenckii. Es más frecuente en zonas tropicales. La prevalencia en Argentina se estima entre 0,01 y 0,02%. En la mitad de los pacientes se manifiesta como una esporotricosis linfocutánea, la cual se produce tras la inoculación del hongo en la piel luego de un trauma menor. La lesión inicial es una pápula o nódulo que se sucede con la aparición de una cadena ascendente de nódulos subcutáneos móviles, indoloros y eritematosos. El diagnóstico se realiza a partir del cultivo micológico. El antifúngico de elección es itraconazol y el pronóstico es usualmente favorable. Se presenta el caso de una niña de 4 años, previamente sana, que consultó por adenopatías axilares de evolución subaguda sin respuesta a múltiples esquemas antimicrobianos, confirmándose el diagnóstico de una esporotricosis linfocutánea por el cultivo de una biopsia ganglionar.

Abstract Sporotrichosis is a subacute-chronic fungal infection caused by dimorphic fungi of the Sporothrix schenckii Complex. It is more common in tropical areas. The prevalence in Argentina is estimated between 0.01 and 0.02%. In half of the patients it manifests as lymphocutaneous sporotrichosis, which occurs after inoculation of the fungus into the skin after minor trauma. The initial lesion is a papule or nodule that occurs with the appearance of an ascending chain of mobile, painless and erythematous subcutaneous nodules. The diagnosis is made from mycological culture. The antifungal of choice is itraconazole and the prognosis is usually favorable. We present the case of a healthy 4-year-old girl who consulted for subacute axillary lymphadenopathy without response to multiple antimicrobial regimens, arriving at the diagnosis of lymphocutaneous sporotrichosis from the culture of a lymph node biopsy sample.

Characterization of substrate specificity and inhibitory mechanism of bile salt hydrolase from Lactobacillus reuteri CRL 1098 using molecular docking analysis.

OBJECTIVES: To elucidate the molecular mechanisms involved in the substrate interaction of the bile salt hydrolase of Lactobacillus reuteri CRL 1098 (LrBSH) with bile acids (BAs) and to evaluate potential enzyme inhibitors based on computer and in vitro modeling assays. RESULTS: Asp19, Asn79, and Asn171 participated in the LrBSH interaction with all BAs tested while Leu56 and Glu 222 played an important role in the interaction with glyco- and tauro-conjugated BAs, respectively. A great percentage of hydrophobic and polar interactions were responsible for the binding of LrBSH with glyco- and tauro-conjugated BAs, respectively. Remarkably, the four binding pocket loops participated in the substrate binding site of LrBSH unlike most of the reported BSHs. Inhibition assays showed that ascorbic acid, citric acid, penicillin G, and ciprofloxacin decreased LrBSH activity by 47.1%, 40.14%, 28.8%, and 9%, respectively. Docking analysis revealed that tetracycline and caffeic acid phenethyl ester had the low binding energy (-7.32 and -7.19 kcal/mol, respectively) and resembled the interaction pattern of GDCA (-6.88 kcal/mol) while penicillin (-6.25 kcal/mol) and ascorbic acid (-5.98 kcal/mol) interacted at a longer distance. CONCLUSION: This study helps to delve into the molecular mechanisms involved in the recognition of substrates and potential inhibitors of LrBSH.

[Lymphocutaneous sporotrichosis in a pediatric patient, a case report]. / Esporotricosis linfocutánea en un paciente pediátrico, a propósito de un caso.

Sporotrichosis is a subacute-chronic fungal infection caused by dimorphic fungi of the Sporothrix schenckii Complex. It is more common in tropical areas. The prevalence in Argentina is estimated between 0.01 and 0.02%. In half of the patients it manifests as lymphocutaneous sporotrichosis, which occurs after inoculation of the fungus into the skin after minor trauma. The initial lesion is a papule or nodule that occurs with the appearance of an ascending chain of mobile, painless and erythematous subcutaneous nodules. The diagnosis is made from mycological culture. The antifungal of choice is itraconazole and the prognosis is usually favorable. We present the case of a healthy 4-year-old girl who consulted for subacute axillary lymphadenopathy without response to multiple antimicrobial regimens, arriving at the diagnosis of lymphocutaneous sporotrichosis from the culture of a lymph node biopsy sample.

Tuberculosis y síndrome inflamatorio de reconstitución inmunológica. Caso pediátrico / Tuberculosis and immune reconstitution inflammatory syndrome. Pediatric case

La tuberculosis es una enfermedad muy frecuente en nuestro medio. A pesar de que la detección precoz y el tratamiento adecuado logran la curación en la mayoría de los pacientes, la dificultad en el diagnóstico, el abandono del tratamiento y la aparición de resistencia a los fármacos tradicionales generan que, en la actualidad, continúe siendo un importante problema de salud pública. En la Argentina, la tasa de morbilidad es de 25/100 000 habitantes, con un leve aumento en la mortalidad.Se presenta el caso de una paciente pediátrica con tuberculosis, que tuvo múltiples complicaciones asociadas a la enfermedad y a su tratamiento, entre las cuales se incluye el síndrome in-flamatorio de reconstitución inmunológica, también conocido como reacción paradojal al tratamiento antituberculoso. Este representa una consecuencia clínica adversa al restablecimien-to de la inmunidad en el paciente que padece una infección sistémica grave, como la tuberculosis miliar.

Tuberculosis is a very frequent disease in our environment. Although early detection and adequate treatment achieve cure in most patients, the difficulty in diagnosis, the abandonment of treatment and the appearance of resistance to traditional drugs generate that at present it continues to represent an im-portant public health problem. In Argentina, the morbidity rate is 25/100,000 inhabitants, with a slight increase in mortality.We present the case of a pediatric patient with tuberculosis and multiple complications associated with the disease and its treatment. One of these complications was the immune re-constitution inflammatory syndrome or paradoxical reaction to antituberculosis treatment. It represents an adverse clinical con-sequence of the restoration of immunity in the patient suffering from a serious systemic infection such as miliary tuberculosis.

[Tuberculosis and immune reconstitution inflammatory syndrome. Pediatric case]. / Tuberculosis y síndrome inflamatorio de reconstitución inmunológica. Caso pediátrico.

Tuberculosis is a very frequent disease in our environment. Although early detection and adequate treatment achieve cure in most patients, the difficulty in diagnosis, the abandonment of treatment and the appearance of resistance to traditional drugs generate that at present it continues to represent an important public health problem. In Argentina, the morbidity rate is 25/100,000 inhabitants, with a slight increase in mortality. We present the case of a pediatric patient with tuberculosis and multiple complications associated with the disease and its treatment. One of these complications was the immune reconstitution inflammatory syndrome or paradoxical reaction to antituberculosis treatment. It represents an adverse clinical consequence of the restoration of immunity in the patient suffering from a serious systemic infection such as miliary tuberculosis.

La tuberculosis es una enfermedad muy frecuente en nuestro medio. A pesar de que la detección precoz y el tratamiento adecuado logran la curación en la mayoría de los pacientes, la dificultad en el diagnóstico, el abandono del tratamiento y la aparición de resistencia a los fármacos tradicionales generan que, en la actualidad, continúe siendo un importante problema de salud pública. En la Argentina, la tasa de morbilidad es de 25/100 000 habitantes, con un leve aumento en la mortalidad. Se presenta el caso de una paciente pediátrica con tuberculosis, que tuvo múltiples complicaciones asociadas a la enfermedad y a su tratamiento, entre las cuales se incluye el síndrome inflamatorio de reconstitución inmunológica, también conocido como reacción paradojal al tratamiento antituberculoso. Este representa una consecuencia clínica adversa al restablecimiento de la inmunidad en el paciente que padece una infección sistémica grave, como la tuberculosis miliar.

Efecto antifúngico y antimicotoxigénico de Lactobacillus plantarum CRL 778 a diferentes valores de actividad de agua / Antifungal and antimycotoxigenic effect of Lactobacillus plantarum CRL 778 at different water activity values

Ochratoxin A (OTA) is a mycotoxin produced by filamentous fungi with high impact Lactic acid bacteria; in food safety due to its toxicity. In the last decade, the presence of OTA was widely reported in different foods. In this study, the ability of Lactobacillus (L.) plantarum CRL 778 to control growth and OTA production by Aspergillus (A.) niger 13D strain, at different water activity (a w) values (0.955, 0.964, 0.971, 0.982, and 0.995) was determined in vitro. Both parame ters were significantly (p<0.05) reduced by the lactobacilli and the effect depended on a w. Greatest growth rate inhibition (46.9%) was obtained at a w = 0.995, which is the most suitable value for growth and production of antifungal metabolites (lactic acid, acetic acid, phenyllac-tic and hydroxyl-phenyllactic acids) by L. plantarum CRL 778. Besides, morphological changes and inhibition of melanin synthesis were observed in colonies of A. niger 13D in presence of L. plantarum CRL 778 at a w ranged between 0.971 and 0.995. In addition, maximum reduction (90%) of OTA production took place at a w = 0.971, while inhibition of fungi growth was more evident at a w =0.995. These findings suggest that L. plantarum CRL 778 could be used for control of ochratoxigenic fungal growth and OTA contamination in different fermented foods with a w values between 0.971 and 0.995.

Ocratoxina A (OTA) es una micotoxina producida por hongos filamentosos con un alto impacto en la seguridad alimentaria debido a su toxicidad. En la última década se ha reportado ampliamente a nivel mundial, la presencia de OTA en diversos alimentos. En este estudio se evaluó in vitro, la capacidad de Lactobacillus (L.) plantarum CRL 778 de controlar el crecimiento y la producción de OTA por Aspergillus (A.) niger 13D, a diferentes valores de actividad de agua (a w): 0.955, 0.964, 0.971,0.982 y 0.995). La cepa láctica redujo significativamente (p <0.05) ambos parámetros, siendo el efecto dependiente del valor de a w. La mayor inhibición del crecimiento (46.9%) se obtuvo a a w =0.995, valor más adecuado para el crecimiento y producción de metabolitos antifúngicos (ácido láctico, ácido acético, ácidos fenil-láctico e hidroxi-fenil láctico) por la cepa láctica. Además, se observaron cambios morfológicos en las colonias de A. niger 13D, crecidas en presencia de L. plantarum CRL 778 a valores de a w de 0.971 y 0.995. El porcentaje máximo de reducción en la producción de OTA (90%) por la cepa láctica se observó a un valor de a w = 0.971, mientras la inhibición del crecimiento fúngico fue mayor cuando a w = 0.995. Estos hallazgos sugieren que L. plantarum CRL 778 podría emplearse para el control de la contaminación por hongos ocratoxigénicos en alimentos con valores de aw comprendidos entre 0.971-0.995.

Antifungal and antimycotoxigenic effect of Lactobacillus plantarum CRL 778 at different water activity values.

Ochratoxin A (OTA) is a mycotoxin produced by filamentous fungi with high impact in food safety due to its toxicity. In the last decade, the presence of OTA was widely reported in different foods. In this study, the ability of Lactobacillus (L.) plantarum CRL 778 to control growth and OTA production by Aspergillus (A.) niger 13D strain, at different water activity (aw) values (0.955, 0.964, 0.971, 0.982, and 0.995) was determined in vitro. Both parameters were significantly (p<0.05) reduced by the lactobacilli and the effect depended on aw. Greatest growth rate inhibition (46.9%) was obtained at aw=0.995, which is the most suitable value for growth and production of antifungal metabolites (lactic acid, acetic acid, phenyllactic and hydroxyl-phenyllactic acids) by L. plantarum CRL 778. Besides, morphological changes and inhibition of melanin synthesis were observed in colonies of A. niger 13D in presence of L. plantarum CRL 778 at aw ranged between 0.971 and 0.995. In addition, maximum reduction (90%) of OTA production took place at aw=0.971, while inhibition of fungi growth was more evident at aw=0.995. These findings suggest that L. plantarum CRL 778 could be used for control of ochratoxigenic fungal growth and OTA contamination in different fermented foods with aw values between 0.971 and 0.995.

Metástasis mandibular: informe de un caso clínico / Mandibular metastasis: report of a clinical case

El presente trabajo tiene como objetivo describir un caso clínico de metástasis mandibular, que según la literatura actual es de baja prevalencia. Una paciente de 60 años de edad acudió a la consulta por tumefacción y dolor del lado derecho de la mandíbula. Se realizó una tomografía axial computada de maxilar inferior y se detectó una lesión osteolítica. El examen histopatológico del tejido óseo incisional informó metástasis. A partir de este resultado, la paciente fue derivada al Departamento de Oncología, donde inició el tratamiento correspondiente y falleció a los pocos meses del diagnóstico. A pesar de la baja prevalencia de metástasis maxilar, esta debe considerarse especialmente en pacientes con presencia de tumefacción, dolor y parestesia de aparición repentina y etiología desconocida (AU)

The aim of this work is to describe a clinical case of mandibular metastasis that, according to the current literature, occurs with low frequency. A 60 year old female patient showed swelling and pain on the right side of the jaw. Axial computed tomography of the lower maxilla was performed, detecting an osteolytic lesion. Histopathological diagnosis of metastatic tissue was reported after biopsy of incisional bone tissue and the patient was referred to the oncology department for treatment and died a few months after the diagnosis. Despite the infrequent appearance of maxillary metastases, they should be considered especially in patients with presence of swelling, pain and sudden onset paraesthesia of unknown etiology (AU)

Resolución integral de una fractura coronorradicular complicada por traumatismo dentoalveolar: informe de un caso / Integral resolution of a complicated crown-root fracture by dentoalveolar traumatism: report of a case

Objetivo: Mostrar una alternativa de tratamiento para las fracturas coronorradiculares complicadas, que restablece la función y la estética de las piezas traumatizadas. Caso clínico: Una paciente de 16 años se presentó en la guardia del Centro Odontológico OSEP tras haber sufrido un accidente vial que le produjo un traumatismo dentoalveolar. El diagnóstico fue fractura coronaria sin exposición pulpar de la pieza dentaria 12 y fractura coronorradicular complicada de la pieza 11. El tratamiento incluyó restauración con resina compuesta de la pieza 12 y endodoncia, extrusión ortodóntica, alargamiento coronario y rehabilitación con perno de fibra de cuarzo y corona de resina compuesta de la pieza 11. Conclusiones: El tratamiento de las fracturas coronorradiculares representa un desafío para el odontólogo. Los resultados del tratamiento, en este paciente, fueron excelentes, ya que lograron devolver estética y función (AU)

Aim: To show an alternative treatment for complicated crown-root fractures, which restores function and aesthetics of the traumatized teeth. Case report: This paper reports the case of a 16-yearold girl who attends the OSEP Dental Center, stating that she had suffered a traffic accident resulting in a dentoalveolar trauma. The diagnosis was a coronary fracture without pulp exposure of tooth 12, and complicated crown-root fracture of tooth 11. Treatment included composite resin restoration of tooth 12 and endodontic, orthodontic extrusion, crown lengthening and rehabilitation with quartz fiber post and composite resin crown of tooth 11. Conclusions: The treatment of crown-root fractures poses a challenge for the dentist. The results of the treatment in this patient were excellent, and aesthetics and function were restored (AU)

Effects of Lysozyme on the Activity of Ionic of Fluoroquinolone Species.

Fluoroquinolones (FQs) constitute an important class of biologically active broad-spectrum antibacterial drugs that are which are in contact with many biological fluids under different acidity conditions. We studied the reactivity of ciprofloxacin (Cpx) and levofloxacin (Lev) and their interaction with lysozyme (Lyz) at different pH values, using UV-visible absorption, fluorescence, infrared spectroscopies supported by DFT calculation and docking. In addition, by antimicrobial assays, the biological consequences of the interaction were evaluated. DFT calculation predicted that the FQ cationic species present at acid pH have lower stabilization energies, with an electric charge rearrangement because of their interactions with solvent molecules. NBO and frontier orbital calculations evidenced the role of two charged centers, NH2⁺ and COO-, for interactions by electronic delocalization effects. Both FQs bind to Lyz via a static quenching with a higher interaction in neutral medium. The interaction induces a structural rearrangement in ß-sheet content while in basic pH a protective effect against the denaturation of Lyz was inferred. The analysis of thermodynamic parameters and docking showed that hydrophobic, electrostatic forces and hydrogen bond are the responsible of Cpx-Lyz and Lev-Lyz associations. Antimicrobial assays evidenced an antagonist effect of Lyz in acid medium while in neutral medium the FQs' activities were not modified by Lyz.

Lactic Acid Fermentation Improved Textural Behaviour, Phenolic Compounds and Antioxidant Activity of Chia (Salvia hispanica L.) Dough.

In this work, autochthonous lactic acid bacteria (LAB) were isolated from chia (Salvia hispanica L.) dough and selected on the basis of the kinetics of acidification and proteolytic activity. Strain no. C8, identified as Lactobacillus plantarum C8, was selected and used as starter to obtain chia sourdough. Lactic acid fermentation increased the organic acid mass fractions (lactic, acetic and phenyl lactic acids to 12.3 g, 1.0 g and 23.8 µg per kg of dough respectively), and antioxidant activities, which increased by approx. 33-40% compared to unfermented chia flour dough. In addition, total phenolic content increased 25% and its composition was strongly modified after 24 h of fermentation by L. plantarum C8. Chlorogenic acid was only found in the fermented dough (2.5 mg/g), while ferulic acid was detected from the beginning of fermentation, being 32% higher in chia sourdough (5.6 mg/g). The use of fermented chia sourdough improved the overall characteristics of white bread, including physical (e.g. reduced hardness and chewiness of the crumb) and antioxidant properties (25% on average), compared to the white bread. These results indicate that the use of chia sourdough could be a promising alternative to improve the technological and antioxidant properties of wheat bread. In addition, this work has shown, for the first time, that lactic acid bacterium is able to ferment chia dough, improving its overall characteristics.

Comportamiento y percepción del dolor en niños colombianos sometidos a electromiografía de superficie

Introducción: La Electromiografía-EMG de superficie evalúa la función muscular. Es poco utilizada como examen de rutina para valorar los músculos periorales y masticatorios, debido a que algunos consideran que puede ser molesto para el paciente pediátrico. Objetivo: Describir la percepción de dolor y el comportamiento en niños colombianos con y sin labio y paladar fisurado durante el examen de electromiografía de superficie en músculos periorales y masticatorios. Métodos: Previa aprobación del comité de ética (acta-009 2013p) y firma de consentimiento y asentimiento informado. Se realizó el examen en 69 niños entre 5-15 años: 45 con labio y paladar hendido (23-fisura unilateral, 22-fisura bilateral) y 24 sin hendidura. Se aplicaron las escalas de Wong Baker (Dolor) y Frankl (comportamiento). Resultados: 66 niños (95,65%) presentaron comportamiento Tipo 4 y 3 niños (4,35%) mostraron comportamiento Tipo 3 al inicio del examen. Al final del procedimiento, el 100% presentó comportamiento tipo 4. La percepción del dolor con la escala Wong Baker mostro ningún dolor en 62 niños (89,86%) y solo un poco de dolor en 7 (10,14%). Conclusiones: Los menores no manifiestan cambios importantes en su comportamiento por dolor o molestias durante el procedimiento de electromiografía de superficie.

The Surface electromyography-EMG evaluates muscular function. It is seldom used as a routine examination to assess perioral and masticatory muscles as it is considered to cause the pediatric patient discomfort. Objective: Describe the perception of pain and behavior displayed by Colombian children with and without cleft lip and palate during the surface electromyography test performed on perioral and masticatory muscles. Methods: Prior approval by the ethics committee (act-009-2013p) and an informed consent and assent signature were obtained. The exam were performed on 69 children between 5 and 15 years; 45 with cleft lip and palate (23 with unilateral cleft, 22 with bilateral cleft) and 24 children without cleft. The Wong Baker (pain) and Frankl (behavior) scales were used. Results: At the beginning of the exam, 66 children (95.66 %) displayed type 4 behavior and 3 children (4.35 %) displayed type 3 behavior. At the end of the procedure, 100 % of the children displayed type 4 behavior. When using the Wong Baker scale, the perception of the pain showed that 62 patients (89.86 %) felt no pain and 7 patients (10.14 %) felt just a little pain. Conclusions: Children do not show significant changes in their behavior - or pain and discomfort during the procedure of surface electromyography.

Bacteriemia nosocomial en servicios de Cuidados Críticos y en Sala General / Nosocomial bloodstream infection in critical care units and in general wards

Introducción: las bacteriemias nosocomiales (BN) están ampliamente estudiadas en servicios de cuidados críticos, principalmente la relacionada a catéteres venosos centrales (CVC). La importancia de las BN y su impacto clínico no ha sido estudiada en salas generales de internación, en donde es cada vez mayor el uso de CVC y existe un uso extendido de catéteres venosos periféricos (CVP). Objetivo: nos propusimos comparar la BN ocurridas en salas de cuidados generales y en éreas de cuidados críticos. Métodos: estudio prospectivo descriptivo de BN desde 01/12/2008 hasta 30/06/2012, en un hospital de adultos de tercer nivel con 400 camas. Resultados: se registraron 361 bacteriemias: 50,9% nosocomiales, 16,1% relacionadas al sistema de salud y 32,9% comunitarias. De 184 BN se presentaron 52 episodios (28,3%) en servicios de cuidados críticos y 132 (71,3% en Sala General, principalmente en Clínica Médica (82,5%). El foco más frecuente de las BN fue asociado a catéteres venosos (60%) y foco desconocido (28%). Los porcentajes de multirresistencia fueron similares en ambos ámbitos. No hubo diferencias estadísticamente significativas en los Servicios de Cuidados Críticos comparado con la mortalidad por BN en Sala General (46,1% vs 46,9%; p=0,99). Conclusiones: el mayor porcentaje de BN se presentó en servicios de cuidados no críticos, su impacto es relevante si consideramos que la mortalidad intrahospitalaria resultó similar a la de servicios de cuidados críticos. Siendo la principal causa de BN en sala general, la relacionada al uso de catéter venoso central y periférico, urge la necesidad de diseñar protocolos para su colocación y manejo.

Introduction: Nosocomial Bloodstream Infections (NBI) are completely studied in critical care units, mainly those associated with central venous catheter (CVC). The significance and impact of NBI has not been analyzed in general wards, where there is an incresing use of CVC as well asan extended use of peripheral lines. Objective: we compared NBI in general wards with those occurred in critical care units. Methods: prospective, descriptive study performed from 01/12/2008 since 30/06/2012, in an adult third level 400-bed hospital. Results: we obtained 361 bloodstream infections: 50.9% nosocomial, 16.1% healthcare related and 32.9% community acquired. Out of 184 NBI episodes 52 (28.3%) were from critical care units and 132 (71,3%) from general wards, mainly internal medicine service (82.5%). The most frequent source of NBI was related to venous catheters (60%) and unknown focus (28%). Frequency of multirresistant microorganisms was similar in both areas. No statistically significant differences were found in the in-hospital mortality of NBI in critical care units and general wards (46.1% vs 46.9%; p=0.99). Conclusion: General wards presented the highest percentage of NBI. Its impact is relevant considering that the in-hospital mortality was similar tothat in critical care units. The main cause of NBI in general wards is that associated to the use of venous catheter, central and peripheral ones, therefore recommendations for catheterization and maintenance of venous catheters should be implemented.

Relationship between bile salt hydrolase activity, changes in the internal pH and tolerance to bile acids in lactic acid bacteria.

The effect of the conjugated bile acid (BA) on the microbial internal pH (pHin) values in lactic acid bacteria with and without ability to hydrolyze bile salts (BSH[+] and BSH[-] strains, respectively) was evaluated. BSH(+) strains showed a gradual increase in the pHin following the addition of conjugated BA; this behavior was more pronounced with GDCA than with TDCA may be due to the higher affinity of BSH for the glyco-conjugates acids. Conversely, the BSH(-) strains showed a decrease in internal pH probably as a consequence of weak acid accumulation. As expected, a decrease in the cytoplasmatic pH affected the cell survival in this last group of strains, while the BSH(+) strains were more resistant to the toxic effect of BA. PURPOSE OF WORK: To evaluate bile salt hydrolase activities, changes in the internal pH and cell survival to bile acids in lactic acid bacteria to establish the relationship between these parameters.

Efflux of bile acids in Lactobacillus reuteri is mediated by ATP.

PURPOSE OF WORK: To study whether an active bile acid (BA) efflux occurs in Lactobacillus reuteri CRL 1098 as well as the nature (ATP or proton motive force [PMF] mediated primary transport) of the BA extrusion mechanism. BAs are powerful detergents which disorganize the lipid bilayer structure of cellular membranes. Specific bile resistance mechanisms (bile efflux, bile salt hydrolysis, and intrinsic architecture and composition of cell membrane the most prevalent) have been described in intestinal bacteria. L. reuteri, showed a significant degree of resistance to the toxic action of BA and the presence of an active efflux ATP-dependent of conjugated (taurocholic [TCA]) and free (cholic [CA]) BA in the CRL 1098 strain is now reported. However, due the high pKa (5.5) of cholic acid (CA) compared with the conjugated species, a significant fraction (between 35 and 50% at pH 6.5 and 5.2, respectively) of free BA also diffused passively, even in the absence of ATP. To our knowledge, our results represent the first evidence of ATP as the energy source involved in the BA extrusion in L. reuteri.

Application of fluorescent techniques to evaluate the survival of probiotic lactobacilli to bile acid.

PURPOSE OF WORK: To apply a fluorescent dye as an alternative technique to evaluate the survival of potentially probiotic lactobacilli to bile acids (BA) as first step in the design of probiotic functional foods. The use of lactic acid bacteria (LAB) in the functional food design depends on their ability to survive in the gastrointestinal tract where bile is an important natural barrier. Bile is mainly constituted by conjugated BA, which can be hydrolyzed to free BA and taurine or glycine. Changes in the transmembrane electrical potential (ΔΨ) of probiotic LAB strains due to the effect of conjugated and free BA were measured and showed that the majority of the tested LAB strains had greater sensibility to free BA than to their respective conjugated acids. Variations in the ΔΨ of the microorganism correlated well with bacterial viability determined by standard plate count method. We therefore propose the DiSC(3)-based fluorescent technique as a rapid and effective method to evaluate the resistance of probiotic lactobacilli to bile as first step for strain selection to be included in functional foods.

[Pregnancy and tetralogy of Fallot with and without surgical correction]. / Embarazo y tetralogía de Fallot con y sin corrección quirúrgica.

BACKGROUND: Tetralogy of Fallot is the most common cyanotic congenital cardiac lesions. Although pregnancy in patients with corrected tetralogy of Fallot usually have a satisfactory outcome, there may have maternal cardiovascular complications. OBJECTIVE: To report our experience in monitoring and treatment of 16 pregnancies in 14 women with tetralogy of Fallot. PATIENTS AND METHOD: Prospective study performed in 16 pregnancies of 14 patients with tetralogy of Fallot, who attended the services of Cardiology and High Risk Pregnancy in the Hospital de Gineco-Obstetricia of the Centro Médico de Occidente (Mexico), from January 1997 to January 2010. Nine women had total surgical correction and five hadn't. All patients obtained complete study protocol and tests of fetal wellbeing. RESULTS: Hemoglobin and hematocrit were significantly higher in the group without surgical correction; this group also had lower oxygen saturation and right ventricular enlargement. Of the 16 pregnancies, five were resolved vaginally, the other by cesarean section. The cyanotic mothers had premature termination of pregnancy, lower birth weight and Apgar slightly deteriorated. There were no maternal or neonatal deaths, neither cardiac malformation in newborns. CONCLUSIONS: There are more risks for the binomial in patients with uncorrected tetralogy of Fallot and in those operated with significant residual lesions. A greater anatomical impact was significantly correlated with major hemoglobin and minor oxygen saturation, which are the most important risk factors for adverse fetal outcomes.

[Modification to surgical technique of cesarean hysterectomy]. / Modificación a la técnica quirúrgica de cesárea-histerectomía.

BACKGROUND: Bleeding is a significant cause of maternal mortality in the world. Obstetric hysterectomy increases maternal morbidity and mortality. OBJECTIVES: To describe a modified technique of cesarean-hysterectomy to limit bleeding during surgery in cases of placenta accreta and placenta previa, which consist of hypogastric artery ligation before the removal of the uterus. Another objective of this study is to compare maternal outcomes of patients undergoing this technique with the usual technique. PATIENTS AND METHOD: Comparative, longitudinal, closed stydy. We analyzed the records of 86 patients undergoing cesarean-hysterectomy surgery, from July 1, 2008 to July 31, 2009, were programmed 29 patients with the modified technique and 57 with the usual. The main outcomes analyzed were: estimated bleeding during surgery, number of packed red blood cells and plasma units transfused and hospital stay in intensive care. RESULTS: Bleeding during surgery, blood transfusion and admission to intensive care demand, and hospital stay were significantly lower in patients with the modified technique. Also there were fewer trans and postoperative complications in this group. CONCLUSIONS: The results of this study show that the modified technique of cesarean-hysterectomy derives significant reduction of maternal morbidity, less massive transfusions demand to manage intensive care units.

Infección por Mycobacterium avium subsp. paratuberculosis en un rebaño criollo limonero / Mycobacterium avium subsp. paratuberculosis infection in a criollo limonero herd

El objetivo de este estudio consistió en definir, analizar y evaluar la situación de un rebaño Criollo Limonero elite en relación a la paratuberculosis bovina. La investigación se llevó a cabo utilizando las variables epidemiológicas y el análisis de muestras (leche y suero) mediante inmunoensayo enzimático (ELISA) comercial. Posteriormente, se tomaron como base estos resultados y utilizando otras herramientas diagnósticas como la exploración clínica, tinción directa, cultivos, identificación mediante ensayo de reacción en cadena de la polimerasa (PCR) y estudio histomorfológico, todas ellas dirigidas a confirmar el estado de la infección. Los resultados permiten aseverar la existencia de infección por Mycobacterium avium subsp. paratuberculosis (MAsP) en tasas de positividad variable. La técnica de ELISA mostró alta capacidad en la identificación de animales subclinicamente afectados, lo que demuestra su potencial como prueba primaria de diagnóstico en el establecimiento de futuros programas de control. La técnica de amplificación por PCR reveló la presencia de genoma de subespecies de Mycobacterium avium, lo cual apoya fuertemente la presunción de infección en estos animales por MAsP, pese a la imposibilidad de lograr claras evidencias clínicas, clinicopatológicas, microbiológicas e histopatológicas que permitieran corroborar este dictamen. La estrecha correlación entre los resultados de ELISA y PCR, ratifica no sólo la confirmación diagnóstica, sino también validan los datos obtenidos a través de la prueba serológica.

The purpose of this research was to define, analyze and evaluate the situation of an elite Criollo Limonero herd related to bovine paratuberculosis. The investigation was carried out using the epidemiological variables and samples analysis (milk and serum) through a commercial enzyme immunoassay (ELISA). The results of the above test were taken as a foundation to use other diagnostic tools, such as clinical examination, direct staining, bacterial culture, identification through polymerase chain reaction (PCR) and histopathologic studies, to find out the status of the disease. The results allowed asserting the infection by the presence of Mycobacterium avium subsp. paratuberculosis (MAsP) in positive variable rates. The ELISA technique showed high capacity in identification of the sub clinical affected animal, which proved its potential as a diagnostic primary test in the establishment of future control programs. The PCR amplification revealed Mycobacterium avium subspecie genome presence, which lead to predict these animals infection by MAsP, in spice of the impossibility to accomplish clear clinical, clinic pathologic, microbiologic and histopathologic evidences that allowed corroborating the diagnosis. The narrow relation between ELISA and PCR results ratified not only the diagnostic confirmation, but also they validated the data collected through the serological test.