[Impact of the vancomycin and amikacin therapeutic monitoring in the optimization of antimicrobial dose in pediatric patients]. / Impacto del monitoreo terapéutico de vancomicina y amikacina en la optimización de dosis de antimicrobianos en pacientes pediátricos.

BACKGROUND: The monitoring of antimicrobial therapy through plasma levels makes it possible to determine the optimal dosage of antimicrobials, an essential approach in pediatrics. AIM: To describe the monitoring of plasma antimicrobial levels and dose adjustment in the pediatric population to determine if the doses used reach therapeutic ranges. METHODS: Retrospective, descriptive study using a database with measurement of plasma levels of amikacin and vancomycin in pediatric patients at San Borja Arriarán Hospital between 2015-2018. The number of patients who reached the therapeutic range with the initial dose, how many required adjustment and their characteristics were determined. RESULTS: 104 total levels were monitored. For vancomycin 65 plasmatic levels were baseline, being outside the therapeutic range 56.5%; 25% of those requiring adjustment were neonates with a higher probability of being out of range versus others (p = 0.022). For amikacin, Cpeak was in range in 60% of measurements; 15.4% required adjustment, including patients with cystic fibrosis and cancer, without adjustments in patients without comorbidity. CONCLUSION: Measurement of plasma levels is necessary to individually adjust the dose, especially in pediatric patients with cystic fibrosis, oncology and in neonatology where it is more likely not to reach a therapeutic range with initial doses.

Impacto del monitoreo terapéutico de vancomicina y amikacina en la optimización de dosis de antimicrobianos en pacientes pediátricos / Impact of the vancomycin and amikacin therapeutic monitoring in the optimization of antimicrobial dose in pediatric patients

INTRODUCCIÓN: La monitorización de antimicrobianos mediante sus concentraciones plasmáticas permite determinar la posología óptima de éstos, conducta esencial en pediatría. OBJETIVOS: Describir la monitorización de concentraciones plasmáticas de antimicrobianos y el ajuste de dosis en población pediátrica para determinar si las dosis utilizadas alcanzan rangos terapéuticos. PACIENTES Y MÉTODOS: Estudio descriptivo, retrospectivo, utilizando una base de datos con medición de concentraciones plasmáticas de amikacina y vancomicina en pacientes pediátricos del Hospital San Borja Arriarán, entre 2015-2018. Se determinó el número de pacientes que alcanzó rango terapéutico con dosis inicial, cuántos requirieron ajuste y sus características. RESULTADOS: Se monitorizó 104 concentraciones totales. Para vancomicina 65 concentraciones plasmáticas eran basales encontrándose fuera de rango terapéutico 56,5%; de los que requirieron ajuste, 25% fueron neonatos con mayor probabilidad de estar fuera de rango versus otros (p = 0,022). Para amikacina la Cpeak estuvo en rango en 60% de mediciones; 15,4% requirió ajuste incluyendo pacientes con fibrosis quística y oncológicos. No fue necesario efectuar ajustes en pacientes sin co-morbilidad. CONCLUSIÓN: La medición de concentraciones plasmáticas es necesaria para ajustar de forma individualizada la dosis, especialmente en pacientes pediátricos con fibrosis quística, oncológicos y en neonatología, donde es más probable no alcanzar rango terapéutico con las dosis iniciales.

BACKGROUND: The monitoring of antimicrobial therapy through plasma levels makes it possible to determine the optimal dosage of antimicrobials, an essential approach in pediatrics. AIM: To describe the monitoring of plasma antimicrobial levels and dose adjustment in the pediatric population to determine if the doses used reach therapeutic ranges. METHODS: Retrospective, descriptive study using a database with measurement of plasma levels of amikacin and vancomycin in pediatric patients at San Borja Arriarán Hospital between 2015-2018. The number of patients who reached the therapeutic range with the initial dose, how many required adjustment and their characteristics were determined. RESULTS: 104 total levels were monitored. For vancomycin 65 plasmatic levels were baseline, being outside the therapeutic range 56.5%; 25% of those requiring adjustment were neonates with a higher probability of being out of range versus others (p = 0.022). For amikacin, Cpeak was in range in 60% of measurements; 15.4% required adjustment, including patients with cystic fibrosis and cancer, without adjustments in patients without comorbidity. CONCLUSION: Measurement of plasma levels is necessary to individually adjust the dose, especially in pediatric patients with cystic fibrosis, oncology and in neonatology where it is more likely not to reach a therapeutic range with initial doses.

Intra-amoebic localization of Arcobacter butzleri as an endocytobiont of Acanthamoeba castellanii.

Acanthamoeba castellanii is a free-living amoeba found mainly in humid environments and Arcobacter butzleri is an emerging zoonotic pathogen, both can establish in vitro endosymbiotic relationships in the absence of bacterial replication. We analyzed the localization of A. butzleri within A. castellanii establishing their association with endoplasmic reticulum vesicles and mitochondria. Through confocal microscopy, we observed that during the early stages of endosymbiosis, there is not colocalization between amoebic vacuoles containing A. butzleri and mitochondria or ER vesicles of A. castellanii. Considering that energy production of this bacterium occurs via metabolism of amino acids or the tricarboxylic acid cycle, these results contribute to explain the absence of bacterial replication, since A. butzleri would not have access to the nutrients found in endoplasmic reticulum vesicles and mitochondria. In addition, we observe that A. butzleri induces significantly the actin polymerization of A. castellanii during the early stages of endosymbiosis.

Comparison of media and growth conditions for culturing enterohepatic Helicobacter species.

This research aims to compare the culturing conditions for enterohepatic Helicobacter, evaluating culture media, incubation atmosphere and susceptibility to antimicrobials used to generate selective conditions. Four common media for the closely related genus Campylobacter (Columbia, Bolton, Brucella and CCDA agar), as well as the need for hydrogen in the microaerobic incubation atmosphere, were evaluated. Serial dilutions of 13 strains belonging to six species (H. apodemus, H. bilis, H. canicola, H. canis, H. equorum and Helicobacter sp.) were inoculated in each media and incubated at 37°C for 48 to 96 h using CampyGen (OXOID) and gaseous exchange (including hydrogen) in parallel. Columbia or Brucella agars were the most appropriate for culturing EHH (P < 0·05). However, there was no significant difference between the atmospheres evaluated (P = 0·13). In addition, minimal inhibitory concentration for six antibiotics showed that all isolates were resistant to trimethoprim, whereas for the rest of the antibiotics (cephalothin, cefoperazone, cefsulodin, teicoplanin and vancomycin) the inhibition range was between 8 and 64 µg ml- 1 . Our findings suggest that Columbia or Brucella media, regardless of the use of hydrogen, can be used for the EHH isolation. In addition, the concentration of antibiotics included in commercial campylobacteria supplements is suitable for EHH species recovery. SIGNIFICANCE AND IMPACT OF THE STUDY: Enterohepatic Helicobacter (EHH) infections have been associated with several diseases in humans such as acute gastroenteritis, inflammatory bowel disease and hepatobiliary diseases. Although they are frequently detected in clinical samples by molecular methods, only occasionally they are isolated using culture conditions described for the taxonomic related pathogen Campylobacter sp. This is because the optimal conditions for the isolation of EHH have not yet been described, which results in an underestimation of the prevalence and clinical importance of these emerging pathogens. Therefore, this study provides insight for culturing EHH species.

Development of an electrochemical biosensor for the determination of triglycerides in serum samples based on a lipase/magnetite-chitosan/copper oxide nanoparticles/multiwalled carbon nanotubes/pectin composite.

A very sensitive electrochemical biosensor to determine totals triglycerides (TGs) in serum samples has been developed. It is based on the electrochemical oxidation of glycerol at glassy carbon electrodes modified with magnetic nanoparticles bonded to lipase enzyme and copper oxide nanoparticles, both supported on a multiwalled carbon nanotubes/pectin dispersion. Glycerol is produced by enzymatic reaction between the TGs present in samples and the lipase immobilized. The quantification of triglycerides was performed by amperometric measurements. The proposed electrochemical biosensor improves the performance of others methods developed for the TGs quantification. The determination of TGs does not need a pretreatment of serum samples. The PLS-1 algorithm was used for the quantification of TGs. According to this algorithm, the of detection and quantification limits were from 3.2 × 10-3 g L-1 to 3.6 × 10-3 g L-1, and from 9.6 × 10-3 to 1.1 × 10-2 g L-1, respectively. The sensitivity was 1.64 × 10-6 A L g-1. The proposed electrochemical biosensor exhibited a very good performance, a stability of 20 days, very good reproducibility and repeatability, and it is presented as a very good alternative for the determination of TGs in human serum clinical samples.

Teleocichla preta, a new species of cichlid from the Rio Xingu Basin in Brazil (Teleostei: Cichlidae).

Teleocichla preta nov. sp. inhabits the rapids along the Rio Xingu and lower portion of the Rio Iriri. It is the largest species in the genus, reaching 121·3 mm standard length (LS ) while others do not reach more than 87·8 mm LS . Teleocichla preta is distinguished from all other species of Teleocichla by the unique blackish (in live specimens) or dark brown (preserved specimens) overall colouration of the body, which masks the faint vertical bars or zig-zag pattern of blotches on the flanks. Teleocichla preta also has a deeper body and a deep laterally compressed caudal peduncle, unlike any other congener, as well as a stout lower pharyngeal tooth plate bearing molariform teeth on its median area.

Euphorbia dioeca Kunth as a novel source for alpha-glucosidase inhibitors / Euphorbia dioeca Kunth como una nueva fuente de inhibidores de alfa-glucosidasa

Euphorbia dioeca Kunth belongs to the Wanderer’s herb complex that is traditionally used for skin diseases and recently as antidiabetic. The methanol and aqueous extracts were evaluated for their in vitro alpha-glucosidase inhibitory activity and an oral starch tolerance test. These extracts showed an IC50 of 0.55 and 0.85 mg/mL, respectively. In diabetic Long Evans rats, the methanol and aqueous extracts reduced significantly the postprandial hyperglycemia peak in 15.2 percent and 12.8 percent, respectively. The alpha-glucosidase inhibitory activity is related with the presence of glycosides, phenolic compounds and flavonoids. Additionally, the safety parameters of both extracts were assessed by means of an acute toxicity test, being classified as innocuous. The traditional use of E. dioeca to control type 2 diabetes was confirmed, being an important source of alfa-glucosidase inhibitors.

Euphorbia dioeca Kunth, pertenece al complejo de plantas medicinales denominado Hierba de la Golondrina; el cual se utiliza para diversos padecimientos, destacando su uso como antidiabético. En dicho marco, se evaluó tanto la actividad inhibitoria de alfa-glucosidasa in vitro, como su desempeño en una prueba de tolerancia a una carga de almidón postprandial. Los extractos inhibieron la actividad de la alfa-glucosidasa con una CI50 de 0.55 y 0.85 mg/mL, respectivamente. Los extractos metanólico y acuoso disminuyeron significativamente el pico hiperglucémico postprandial en un 15.2 por ciento y un 12.8 por ciento, respectivamente, cuando se evaluó en ratas diabéticas. La actividad inhibitoria de alfa-glucosidasa, reflejada en ambas pruebas, está relacionada con la presencia de glicósidos, compuestos fenólicos y flavonoides. De manera adicional, ambos extractos fueron evaluados en una prueba de toxicidad aguda, siendo clasificados como inocuos. Se corroboró el uso tradicional de E. dioeca para el control de la diabetes tipo 2, siendo una importante fuente de compuestos inhibidores de alfa-glucosidasa.

Economic analysis of the single-dose immunization strategy against hepatitis A in Argentina.

BACKGROUND: Vaccination against hepatitis A (HA) was carried out only as part of a limited outbreak control strategy in Argentina until June 2005, when universal immunization in infants was introduced into the national immunization calendar. A single-dose strategy was chosen instead of the standard two-dose schedule used elsewhere. This study aimed to estimate preventive, medical, and non-medical costs related to HA and to compare these costs in the periods before and after mass vaccination. METHODS: A retrospective analysis estimated treatment costs of HA and unspecified hepatitis cases reported to the National Health Surveillance System from 2000 to 2010. Costs related to immunization, fulminant hepatitis (FH), liver transplantation, and death were projected as well. Using a social perspective and a healthcare system perspective, costs in two 5-year periods were compared: 2000-2004 versus 2006-2010. Finally, we evaluated the impact of different discount rates, FH risk, and exclusion of unspecified hepatitis cases in the sensitivity analysis. RESULTS: Total HA and unspecified hepatitis cases decreased from 157,871 in 2000-2004 to 17,784 in 2006-2010. Medical and non-medical costs decreased from US$11,811,600 and US$30,118,222 to US$1,252,694 and US$4,995,895 in those periods, respectively. Immunization costs increased from US$6,506,711 to US$40,912,132. Total preventive, medical, and non-medical costs decreased from US$48,436,534 to US$47,160,721, representing a 2.6% reduction in total costs between the two periods. When a healthcare system perspective was considered or unspecified hepatitis cases were excluded, total costs were 130.2% and 30.8% higher in 2006-2010 than in the previous period, respectively. CONCLUSION: After implementation of the universal single-dose vaccination against HA in infants in Argentina, an impressive decline was observed in HA cases, with a decrease in medical and non-medical costs in the first 5 years. The single-dose strategy, which is simpler and less expensive than the standard two-dose scheme, can be a good alternative for future vaccination policies in other countries where HA is endemic.

Molecular epidemiology of hospital-onset methicillin-resistant Staphylococcus aureus infections in Southern Chile.

Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen of public health importance. In Chile, the Cordobes/Chilean clone was the predominant healthcare-associated MRSA (HA-MRSA) clone in 1998. Since then, the molecular epidemiological surveillance of MRSA has not been performed in Southern Chile. We aimed to investigate the molecular epidemiology of HA-MRSA infections in Southern Chile to identify the MRSA clones involved, and their evolutionary relationships with epidemic international MRSA lineages. A total of 303 single inpatient isolates of S. aureus were collected in the Valdivia County Hospital (2007-2008), revealing 33% (100 MRSA/303) prevalence for HA-MRSA infections. The SCCmec types I and IV were identified in 97% and 3% of HA-MRSA, respectively. All isolates lacked the pvl genes. A random sample (n = 29) of all MRSA was studied by pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), SCCmec subtyping, agr and spa typing, and virulence genes profiling. PFGE analysis revealed the predominance (89%, 26/29) of pulsotype A and three additional pulsotypes, designated H1, I33, and G1. Pulsotype A (ST5-SCCmecI-spa-t149) is clonally related to the Cordobes/Chilean clone. Pulsotype H1 (ST5-SCCmecIVNT-spa-t002) is genetically related to the Pediatric clone (ST5-SCCmecIV). Pulsotype I33 (ST5-SCCmecIVc-spa-t002) is clonally related by PFGE to the community-associated MRSA (CA-MRSA) clone spread in Argentina, I-ST5-IVa-PVL(+). The G1 pulsotype (ST8-SCCmecIVc-spa-t024) is clonally related to the epidemic USA300 CA-MRSA. Here, we demonstrate the stability of the Cordobes/Chilean clone over time as the major HA-MRSA clone in Southern Chile. The identification of two CA-MRSA clones might suggest that these clones have entered into the healthcare setting from the community. These results emphasize the importance of the local surveillance of MRSA infections in the community and hospital settings.

Dimethyl sulfide biofiltration using immobilized Hyphomicrobium VS and Thiobacillus thioparus TK-m in sugarcane bagasse.

Sugarcane bagasse was used as a carrier material of microorganisms in two different biofilters used to remove dimethyl sulfide (DMS) from a gas stream. The first biofilter was inoculated with Hyphomicrobium VS and the second with Thiobacillus thioparus Tk-m. During the operation of the biofilters the empty bed residence time (EBRT) was varied from 90 to 180 seconds and the inlet concentration of DMS from 12 to 50 ppmv. The inlet load was varied in the range of 0.62 to 5.2 (g DMS/m3 h). The maximum elimination capacity (EC) of the biofilter inoculated with Hyphomicrobium VS was 5 g DMS/m3 h; however, for the biofilter inoculated with T. thioparus Tk-m the maximum EC was 3.9 g DMS/m3 h. For T. thioparus TK-m the maximum removal efficiency (RE) obtained was 85.1 +/- 5.2% at 12 ppmv DMS inlet concentration, inlet load of 0.62 g DMS/m3 h and 180 s EBRT. The highest removal efficiency for Hyphomicrobium VS was 97.6 + 4.8% at 12 ppmv DMS inlet concentration, load of 0.62 g DMS/m3 h and 180 s EBRT.

[Prosthetic radial head for type III Masson fractures]. / Prótesis de cabeza de radio en fracturas Mason tipo III.

INTRODUCTION: The treatment of type III Masson radius head fractures is variable; there is not a clear solution. MATERIAL AND METHODS: This study addresses the course of patients treated with radius head replacement for type III Masson fractures at ISSEMYM Medical Center, Ecatepec, Mexico. RESULTS: Four male patients were included; mean age was 34.5 years (range 28-41). The mechanism of injury was direct contusion; 3 of the elbows were left (75%) and one was right (25%). A bipolar uncemented prosthesis was used. According to Broberg and Morrey functional assessment criteria, patients had an excellent course. The mean time elapsed after surgery is 13 months. CONCLUSION: We concluded that the radius head prosthesis for type III Masson fractures is a good alternative. Patients may start rehabilitation right away, unlike what occurs with other surgical techniques.

Equine sperm nuclei with different ploidy levels: relationship between the nuclear DNA content and the nuclear area.

The aims of this study were to estimate the ability of the Feulgen reaction to identify equine sperm nuclei with different ploidy levels, to determine the frequency of haploid, diploid and polyploid sperm nuclei in the semen of fertile equines and to evaluate the relationship between the nuclear DNA content and the nuclear area. Determination of the ploidy level of Feulgen-stained spermatozoa using a scanning microspectrophotometer was very similar to the subjective estimations made with a light microscope. This indicates that the Feulgen reaction is a simple, inexpensive and reliable technique to recognise the ploidy level of equine spermatozoa. The incidence of diploid and polyploid spermatozoa, determined with a light microscope in 11 fertile equines, was 0.17 ± 0.08% and 0.027 ± 0.027% respectively. DNA content values obtained by microspectrophotometry in the only equine that presented polyploid spermatozoa allowed us to discriminate between haploid, diploid and polyploid subpopulations. Measurement of the nuclear area discriminated only two subpopulations: one including the haploid and diploid subpopulations and the other including the polyploid one. The similarity between the area of the haploid and diploid sperm nuclei suggests that the increase in DNA content is anisotropic, with a privileged direction of growth perpendicular to the nuclear flattening plane.

Pneumoperitoneum in association with perforated appendicitis in a Brazilian Amazon woman. Case report.

Radiographic findings of free air in the peritoneal cavity secondary to perforation of a acutely inflamed appendix are extremely rare. It accounts for about 0-7% of all patients with pneumoperitoneum. We report on a 58-years-old Brazilian Amazon woman presenting a 1- week history of abdominal pain, tenderness and distension associated with asthenia and without passage of stool or gas. Abdominal percussion revealed a tympanic sound located on the right hypocondrium. Plain chest radiography revealed a large amount of free air beneath the right leaf of the diaphram. The patient was taken immediately to the operation room and, during surgery, a gangrenous appendix with an apex perforation was verified. Appendectomy was performed as routinely. The patient evolved with pneumonia and septic shock that responded well to intravenous antibiotics and vasoactive drugs. She was discharged to home on the twenty-first post-operative day in good clinical conditions. This case highlights that perforated acute appendicitis is rarely associated with pneumoperitoneum, but it must be considered in the differential diagnosis of patients presenting right abdominal pain and free intraperitoneal air.

Susceptibility of Arcobacter butzleri to human blood serum / Susceptibilidade de Arcobacter butzleri ao soro humano

A susceptibilidade de 10 amostras de Arcobacter butzleri ao soro humano foi estudada. A maior atividade bactericida foi encontrada no soro humano normal, com taxas de sobrevivência bacterianainversamente proporcionais à diluição do soro. As maiores taxas de sobrevivência foram obtidas com o soro inativado pelo calor. As taxas de sobrevivência decresceram com a adição de soro fresco ao inativado. O soro com valores reduzidos de gamaglobulinas e valores normais de complemento mostrou ativo efeito bactericida. Os resultados demonstraram que A. butzleri é altamente susceptível ao efeito bactericida do soro humano, sugerindo que pode ser capaz de ativar diretamente o complemento pela via alternativa.(AU)

Susceptibility of Arcobacter butzleri to human blood serum / Susceptibilidade de Arcobacter butzleri ao soro humano

A susceptibilidade de 10 amostras de Arcobacter butzleri ao soro humano foi estudada. A maior atividade bactericida foi encontrada no soro humano normal, com taxas de sobrevivência bacterianainversamente proporcionais à diluição do soro. As maiores taxas de sobrevivência foram obtidas com o soro inativado pelo calor. As taxas de sobrevivência decresceram com a adição de soro fresco ao inativado. O soro com valores reduzidos de gamaglobulinas e valores normais de complemento mostrou ativo efeito bactericida. Os resultados demonstraram que A. butzleri é altamente susceptível ao efeito bactericida do soro humano, sugerindo que pode ser capaz de ativar diretamente o complemento pela via alternativa.

Dermis acelular porcina (sus scrofa) cargada con antioxidantes de larrea divaricata / Porcine (sus scrofa) acellular dermis load with antioxidants from larrea divaricata

Con el objeto de cargar con antioxidantes de Larrea divaricata una dermis acelular porcina para propósitos terapéuticos, se determinó el contenido de polifenoles y antocianinas de extractos puros, aislados y absorbidos en una dermis acelular porcina. Los valores para polifenoles totales y antocianinas fueron: a) Larrea divaricata: 58,77 + 1,55 mg ácido gálico / 100 g peso fresco, 400,00 + 9,55 mg cianidina 3-glucósido / 100 g peso fresco, repectivamente, b) dermis acelular porcina: 8,86 + 0,55 mg ac. gállico / 100 g peso fresco y 0,10+ 0,00 mg cianidina 3-glucósido / 100 g peso fresco; respectivamente, c) Larrea divaricata absorbida en dermis acelular porcina 45,92 + 0,90 mg ácido gálico / 100 g peso fresco y 155,92 + 5,90 mg cianidina 3-glucósido / 100 g peso fresco, respectivamente. Nosotros concluimos que es posible tener una dermis acelular porcina cargada con antioxidantes de Larrea divaricata para propósitos médicos.

The aim of the study was to evaluate loading with antioxidants from Larrea divaricata a porcine acellular dermis for therapeutic purposes, poliphenols and anthocianins of pure extracts, isolated and absorbed in pig acellular dermis was evaluated. The following values (total polyphenols and anthocianins) were obtained: a) Larrea divaricata: 58,77 + 1,55 mg gallic acid / 100 g fresh weight; 400,95 + 9,55 mg cianydin 3- glucosyde / 100 g fresh weight; respectively; b) porcine acellular dermis: 8,86 + 0,55 mg gallic acid / 100 g fresh weight and 0,10+ 0,00 mg cianydin 3-glucosyde / 100 g fresh weight; respectively, c) L. divaricata absorbed in porcine acellular dermis: 45,92 + 0,90 mg gallic acid / 100 g fresh weight and 155,92 + 5,90 mg cianydin 3-glucosyde / 100 g fresh weight, respectively. We concluded that it is possible to get a porcine acellular dermis loaded with antioxidants from Larrea divaricata for medical purposes.

Displasia tanatoforica: reporte de un caso / Thanatophoric dysplasia: a case report

Este caso concierne a paciente de 15 años quien fue referida del medio rural por presentar en su control pre-natal hallazgo ecográfico de malformación congénita: Polihidramnios severo, edema fetal generalizado (anasarca) hidrops no inmune con antecedente de hermano con malformación esuquelética congénita acondroplasia. Fue estudiada en el Servicio de ARO, observándose durante su hospitalización ausencia de frecuencia cardiaca fetal razón por la cual, se realiza inducción de trabajo de parto con obtención de producto con signos de maceración además de malformaciones esqueléticas en miembros superiores e inferiores, edema generalizado, desprendimiento de placenta 20 por ciento. Posteriormente se realiza curetaje uterino para verificar presencia o no de restos placentarios, después de 2 días de hospitalización la paciente se egresa debido a buena evolución clínica.