Disparities in the prevalence of screened depression at different altitudes in Peru: A retrospective analysis of the ENDES 2019.

INTRODUCTION: Depression is a public health concern, nearing 1.5 million cases and accounting for 9.7% of years lost due to disability. Several factors, including altitude, contribute to its development. Altitude has become a topic for recent research, but its association with depressive symptoms has not been fully clarified. Therefore, this study aimed to determine the association between altitude and depressive symptoms in the Peruvian population. METHODS: A retrospective, cross-sectional study of the 2019 Demographic and Family Health Survey (ENDES in Spanish) was conducted. The dependent variable, depressive symptoms, was measured using the Patient Health Questionnaire (PHQ-9) and the independent variable, altitude, was categorized into: <1500 meters above sea level (masl), 1500-2499 masl and ≥2500 masl. To evaluate the association between altitude and depressive symptoms, we used Poisson regression model, constructing crude and multiple models. RESULTS: Of those living at 1500 to 2499 masl and ≥2500 masl, 7.23% and 7.12% had depressive symptoms, respectively. After adjusting for confounding variables, high altitude was found to be associated with depressive symptoms (prevalence ratio adjusted (aPR): 1.38, 95% confidence interval: 1.04-1.84; aPR 1.41, 95% CI: 1.20-1.66). CONCLUSIONS: A statistically significant association was found between high altitude and depressive symptoms. This may be attributable to hypobaric hypoxia that occurs at high altitudes and its effects on brain function. This study's findings should be considered to identify the population at risk and expand the coverage of preventive and therapeutic measures in high-altitude areas of Peru with poor access to health services.

Aislamiento microbiológico de superficies inanimadas en contacto con pacientes en un hospital peruano / Microbiological isolation of inanimate surfaces in contact with patients in a peruvian hospital

Resumen Objetivo: describir el perfil microbiológico de las superficies inanimadas en contacto con el paciente en un hospital nivel III de la seguridad social de Chiclayo, Perú. Material y métodos: Se realizó un estudio transversal, con los datos de los informes del Control microbiológico cualitativo de ambientes físicos de 5 servicios de un Hospital de Chiclayo nivel III del Perú. El método para la identificación de microorganismos fue el sistema automatizado VITEK MS. Se presentan análisis des criptivos como frecuencias y porcentajes. Resultados: Se reportaron un total de 177 aislamientos, de los cuales 97,74% (173) fueron positivos, de estos, el 50,87% (88) estuvo conformado por bacilos gram negativos, siendo el microorganismo más aislado Acinetobacter baumannii (17 muestras) seguido de Rhizobium radiobacter (16) y Sphingomonas paucimobilis 13. Conclusiones: El ambiente hospitalario se encuentra altamente contaminado, siendo la mayoría microorganismos patógenos. Estos resultados guardarían relación con el prolongado tiempo de vida de los microorganismos en las superficies inertes y el proceso de limpieza y desinfección del ambiente hospitalario, por lo que la evaluación de su eficacia y el posible desarrollo de nuevas y mejores técnicas de limpieza deben ser motivo de investigación.

Abstract Objective: to describe the microbiological profile of inanimate surfaces in contact with the patient in a social security level III hospital in Chiclayo, Peru. Material and methods: An observational, descriptive, transversal study was carried out with the data from the reports of the Microbiological Qualitative Control of Physical Environments of 5 services of a Chiclayo Hospital level III in Peru. The method for the identification of microorganisms was the automated system VITEK MS. Descriptive analyses such as frequencies and percentages are presented. Results: A total of 177 isolations were reported, from which 97.74% (173) were positive, of these, 50.87% (88) were composed by gram-negative bacilli, being the most isolated microorganism Acinetobacter baumannii (17 samples) followed by Rhizobium radiobacter (16) and Sphingomonas paucimobilis 13. Conclusions: The hospital environment is highly contaminated, being most of them pathogenic microorganisms. These results would be related to the long life of microorganisms on inert surfaces and the process of cleaning and disinfection of the hospital environment, so the evaluation of its effectiveness and the possible development of new and better cleaning techniques should be investigated.

Clinical characteristics of older patients with COVID-19: a systematic review of case reports.

In the context of the current COVID-19 pandemic, higher morbidity and mortality have been reported in older adults. This age group presents physiological changes and its own clinical conditions such as frailty, dementia, among others. OBJECTIVE: To describe the characteristics of COVID-19 patients, both over and under 80 years old, by conducting a systematic review of the literature describing case reports, and to summarize and critically assess these characteristics. METHODS: Systematic review. The study was registered on the Registry of Health Research Projects (PRISA) of the Peruvian National Institute of Health (code EI00000631). Five electronic databases (Scopus, PubMed, PubMed Central, LILACS, and SCIELO) were systematically searched during the period between December 31, 2019 and April 16, 2020. The search focused on case reports, case studies, and case series of older people with COVID-19 infection aged over or under 80 years. When selecting the cases, priority was given to clinical and epidemiological profile, laboratory and imaging patterns, and comprehensive geriatric evaluation. RESULTS: 1,149 articles were identified; after applying the filters, a total of 15 publications of case reports and complete records of 27 older adults were obtained. The most frequent age group was between 60 to 69 years old. There is little literature regarding case reports of older adults aged over 80 years. The most frequent parameters were hypertension, fever, cough, respiratory distress, ground-glass opacification in chest radiography and tomography. Furthermore, decrease in PaO2/FiO2 ratio and lymphocytes, and increase in C-reactive protein and Interleukin 6 were observed. CONCLUSIONS: This systematic review found little available information of patients under 80 years old, and far less for those over 80 years old, and an absence of comprehensive geriatric assessment.

No contexto da atual pandemia de covid-19, maior morbidade e mortalidade têm sido relatadas em idosos. Sabe-se que essa faixa etária apresenta alterações fisiológicas e condições clínicas próprias, como fragilidade, demência, entre outras. OBJETIVO: Descrever as características de pacientes com covid-19, maiores e menores de 80 anos, por meio de uma revisão sistemática da literatura que descreve relatos de casos, e resumir e avaliar criticamente essas características. MÉTODO: Revisão sistemática. O estudo foi registrado no Registro de Projetos de Pesquisa em Saúde (PRISA) do Instituto Nacional de Saúde do Peru (código EI00000631). Local: cinco bases de dados eletrônicas (Scopus, PubMed, PubMed Central, LILACS e SCIELO) foram sistematicamente pesquisadas entre 31 de dezembro de 2019 e 16 de abril de 2020. A busca se concentrou em relatos de caso, estudos de caso e séries de casos mais antigos pessoas com infecção por SARS-CoV-2 com mais e menos de 80 anos. Na seleção dos casos, a prioridade foi dada ao perfil clínico e epidemiológico, padrões laboratoriais e de imagem, e avaliação geriátrica abrangente. RESULTADOS: Foram identificados 1.149 artigos. Após a aplicação dos filtros, obteve-se um total de 15 publicações de relatos de caso e registros completos de 27 idosos. A faixa etária mais frequente foi de 60 a 69 anos. Há pouca literatura sobre relatos de casos de adultos com mais de 80 anos. Os parâmetros mais frequentes foram hipertensão, febre, tosse, dificuldade respiratória, vidro fosco na radiografia e tomografia de tórax. Também foram observados diminuição da PaO2 / FiO2 e linfócitos, e aumento da proteína C reativa e Interleucina 6. CONCLUSÕES: Esta revisão sistemática encontrou poucas informações disponíveis sobre pacientes com menos de 80 anos, em quantidade ainda menor para aqueles com mais de 80 anos, além de uma ausência de avaliação geriátrica abrangente.

Clinical characteristics of older patients with COVID-19: a systematic review of case reports / Características clínicas de pacientes idosos com covid-19: uma revisão sistemática de relatos de casos

ABSTRACT. In the context of the current COVID-19 pandemic, higher morbidity and mortality have been reported in older adults. This age group presents physiological changes and its own clinical conditions such as frailty, dementia, among others. Objective: To describe the characteristics of COVID-19 patients, both over and under 80 years old, by conducting a systematic review of the literature describing case reports, and to summarize and critically assess these characteristics. Methods: Systematic review. The study was registered on the Registry of Health Research Projects (PRISA) of the Peruvian National Institute of Health (code EI00000631). Five electronic databases (Scopus, PubMed, PubMed Central, LILACS, and SCIELO) were systematically searched during the period between December 31, 2019 and April 16, 2020. The search focused on case reports, case studies, and case series of older people with COVID-19 infection aged over or under 80 years. When selecting the cases, priority was given to clinical and epidemiological profile, laboratory and imaging patterns, and comprehensive geriatric evaluation. Results: 1,149 articles were identified; after applying the filters, a total of 15 publications of case reports and complete records of 27 older adults were obtained. The most frequent age group was between 60 to 69 years old. There is little literature regarding case reports of older adults aged over 80 years. The most frequent parameters were hypertension, fever, cough, respiratory distress, ground-glass opacification in chest radiography and tomography. Furthermore, decrease in PaO2/FiO2 ratio and lymphocytes, and increase in C-reactive protein and Interleukin 6 were observed. Conclusions: This systematic review found little available information of patients under 80 years old, and far less for those over 80 years old, and an absence of comprehensive geriatric assessment.

RESUMO. No contexto da atual pandemia de covid-19, maior morbidade e mortalidade têm sido relatadas em idosos. Sabe-se que essa faixa etária apresenta alterações fisiológicas e condições clínicas próprias, como fragilidade, demência, entre outras. Objetivo: Descrever as características de pacientes com covid-19, maiores e menores de 80 anos, por meio de uma revisão sistemática da literatura que descreve relatos de casos, e resumir e avaliar criticamente essas características. Método: Revisão sistemática. O estudo foi registrado no Registro de Projetos de Pesquisa em Saúde (PRISA) do Instituto Nacional de Saúde do Peru (código EI00000631). Local: cinco bases de dados eletrônicas (Scopus, PubMed, PubMed Central, LILACS e SCIELO) foram sistematicamente pesquisadas entre 31 de dezembro de 2019 e 16 de abril de 2020. A busca se concentrou em relatos de caso, estudos de caso e séries de casos mais antigos pessoas com infecção por SARS-CoV-2 com mais e menos de 80 anos. Na seleção dos casos, a prioridade foi dada ao perfil clínico e epidemiológico, padrões laboratoriais e de imagem, e avaliação geriátrica abrangente. Resultados: Foram identificados 1.149 artigos. Após a aplicação dos filtros, obteve-se um total de 15 publicações de relatos de caso e registros completos de 27 idosos. A faixa etária mais frequente foi de 60 a 69 anos. Há pouca literatura sobre relatos de casos de adultos com mais de 80 anos. Os parâmetros mais frequentes foram hipertensão, febre, tosse, dificuldade respiratória, vidro fosco na radiografia e tomografia de tórax. Também foram observados diminuição da PaO2 / FiO2 e linfócitos, e aumento da proteína C reativa e Interleucina 6. Conclusões: Esta revisão sistemática encontrou poucas informações disponíveis sobre pacientes com menos de 80 anos, em quantidade ainda menor para aqueles com mais de 80 anos, além de uma ausência de avaliação geriátrica abrangente.

Serosurvey for dengue virus infection among pregnant women in the West Nile virus enzootic community of El Paso Texas.

All 4 dengue viruses (DENV) cause sporadic outbreaks of human disease in the Rio Grande Valley along the US-Mexico border. In addition, West Nile virus (WNV) is enzootic in most border communities, and is the only arbovirus known to cause human disease in the El Paso, Texas community. In an effort to determine if DENV were also endemic in the El Paso community, a serosurvey was conducted among mothers at the time of delivery of their babies in selected hospitals. Cord-blood plasma samples obtained from mothers were tested for DENV antibody by an enzyme-linked immuno-sorbent assay (ELISA), plaque reduction neutralization test (PRNT) and a multiplex microsphere immunoassay. All DENV antibody positive plasma samples were also tested for WNV antibody by the same assays to consider the possibility that DENV antibody positive samples reflected WNV cross reactive antibody. The results indicated that 0.74% (11/1,472) of the mothers had a previous DENV infection and that 3.3% (48/1,472) had a previous WNV infection. Of these mothers, 0.20% (3/1,472) had antibody to both DENV and WNV as evidence of infection by both viruses. The results indicated that 0.2% (3/1472) of the mothers were positive for antibody to only WNV envelope, thus suggesting an undetermined flavivirus infection. Although 6 of the 11 DENV antibody positive mothers did not have a history of travel to a DENV endemic country, the findings of this survey provided further evidence of local transmission of WNV and suggested the possibility of focal autochthonous transmission of DENV in the El Paso community.

Ameloblastic fibrosarcoma of the mandible: a case report and brief review of the literature.

Ameloblastic fibrosarcoma is an uncommon odontogenic tumor composed of a benign epithelial component and a malignant ectomesenchymal component most frequently seen in the third and fourth decades of life. It mainly presents as a painful maxillary or mandibular swelling. Radiographs show a radiolucent mass with ill-defined borders. Radical surgical excision and long-term follow-up are the suggested treatment. We report the case of a 22-year-old female with a 2-month history of an asymptomatic swelling in her left mandible. Examination revealed an exophytic growth measuring 3 × 3 cm extending from the mandibular left first premolar to the second molar. The patient underwent a left hemimandibular resection. Histopathological examination revealed a biphasic tumor composed of inconspicuous islands of benign odontogenic epithelium and an abundant malignant mesenchymal component with marked cellularity, nuclear pleomorphism, hyperchromatism, and moderate mitotic figures with clear margins; one year after the surgical procedure, the patient is clinically and radiologically disease-free.

ß-lactamases produced by amoxicillin-clavulanate-resistant enterobacteria isolated in Buenos Aires, Argentina: a new blaTEM gene.

Resistance to ß-lactam/ß-lactamase inhibitors in enterobacteria is a growing problem that has not been intensively studied in Argentina. In the present work, 54/843 enterobacteria collected in a teaching hospital of Buenos Aires city were ampicillin-sulbactam-resistant isolates remaining susceptible to second- and third-generation cephalosporins. The enzymatic mechanisms present in the isolates, which were also amoxicillin-clavulanic acid (AMC)-resistant (18/54) were herein analyzed. Sequencing revealed two different variants of blaTEM-1, being blaTEM-1b the most frequently detected allelle (10 Escherichia coli, 3 Klebsiella pneumoniae, 2 Proteus mirabilis and 1 Raoultella terrigena) followed by blaTEM-1a (1 K. pneumoniae). Amoxicillin-clavulanate resistance seems to be mainly associated with TEM-1 overproduction (mostly in E. coli) or co-expressed with OXA-2-like and/or SHV ß-lactamases (K. pneumoniae and P. mirabilis). A new blaTEM variant (TEM-163) was described in an E. coli strain having an AMC MIC value of 16/8µg/ml. TEM-163 contains Arg275Gln and His289Leu amino acid substitutions. On the basis of the high specific activity and low IC50 for clavulanic acid observed, the resistance pattern seems to be due to overproduction of the new variant of broad spectrum ß-lactamase rather than to an inhibitor-resistant TEM (IRT)-like behavior.

ß-lactamases produced by amoxicillin-clavulanate-resistant enterobacteria isolated in Buenos Aires, Argentina: A new blaTEMgene / ß-lactamasas producidas por enterobacterias resistentes a amoxicilina-ácido clavulánico aisladas en Buenos Aires, Argentina: un nuevo gen blaTEM

La resistencia a la combinación de ß-lactámico/inhibidor de ß-lactamasa en enterobacterias es un problema creciente que no ha sido estudiado intensamente en Argentina. En el presente trabajo, 54/843 enterobacterias recolectadas en un hospital universitario de la ciudad de Buenos Aires fueron resistentes a ampicilina-sulbactama, pero se mantuvieron sensibles a las cefalosporinas de segunda y tercera generación. Se analizaron los mecanismos enzimáticos presentes en los aislamientos que también fueron resistentes a amoxicilina-ácido clavulánico (AMC) (18/54). La secuenciación reveló dos variantes diferentes de blaTEM-1, donde blaTEM-1b es el alelo más frecuentemente detectado (10 Escherichia coli, 3 Klebsiella pneumoniae, 2 Proteus mirabilis y 1 Raoultella terrigena), seguidos por blaTEM-1a(1 K. pneumoniae). La resistencia a AMC parece estar asociada principalmente con la hiperproducción de TEM-1 (sobre todo en E. coli) o con la coexpresión con ß-lactamasas tipo OXA-2 y/o SHV (K. pneumoniae y P. mirabilis). Se describió una nueva variante de blaTEM(TEM-163) en un aislamiento de E. coli que presentó una CIM frente a AMC de 16/8 µg/ml. La enzima TEM-163 contiene dos sustituciones de aminoácidos respecto de TEM-1, Arg275Gln y His289Leu. Teniendo en cuenta la alta actividad específica observada y la baja IC50 para el ácido clavulánico, el patrón de resistencia de este aislamiento parece obedecer a la hiperproducción de la nueva variante de la ß-lactamasa de amplio espectro, en lugar de vincularse con un comportamiento similar al de una TEM resistente a inhibidores (IRT).

Resistance to ß-lactam/ß-lactamase inhibitors in enterobacteria is a growing problem that has not been intensively studied in Argentina. In the present work, 54/843 enterobacteria collected in a teaching hospital of Buenos Aires city were ampicillin-sulbactam-resistant isolates remaining susceptible to second-and third-generation cephalosporins. The enzymatic mechanisms present in the isolates, which were also amoxicillin-clavulanic acid (AMC)-resistant (18/54) were herein analyzed. Sequencing revealed two different variants of blaTEM-1, being blaTEM-1b the most frequently detected allelle (10 Escherichia coli, 3 Klebsiella pneumoniae, 2 Proteus mirabilis and 1 Raoultella terrigena) followed by blaTEM-1a(1 K. pneumoniae). Amoxicillin-clavulanate resistance seems to be mainly associated with TEM-1 overproduction (mostly in E. coli) or co-expressed with OXA-2-like and/or SHV ß-lactamases (K. pneumoniae and P. mirabilis). A new blaTEMvariant (TEM-163) was described in an E. coli strain having an AMC MIC value of 16/8 µg/ml. TEM-163 contains Arg275Gln and His289Leu amino acid substitutions. On the basis of the high specific activity and low IC50 for clavulanic acid observed, the resistance pattern seems to be due to overproduction of the new variant of broad spectrumß-lactamase rather than to an inhibitor-resistant TEM (IRT)-like behavior.

ß-lactamases produced by amoxicillin-clavulanate-resistant enterobacteria isolated in Buenos Aires, Argentina: A new blaTEMgene / ß-lactamasas producidas por enterobacterias resistentes a amoxicilina-ácido clavulánico aisladas en Buenos Aires, Argentina: un nuevo gen blaTEM

La resistencia a la combinación de ß-lactámico/inhibidor de ß-lactamasa en enterobacterias es un problema creciente que no ha sido estudiado intensamente en Argentina. En el presente trabajo, 54/843 enterobacterias recolectadas en un hospital universitario de la ciudad de Buenos Aires fueron resistentes a ampicilina-sulbactama, pero se mantuvieron sensibles a las cefalosporinas de segunda y tercera generación. Se analizaron los mecanismos enzimáticos presentes en los aislamientos que también fueron resistentes a amoxicilina-ácido clavulánico (AMC) (18/54). La secuenciación reveló dos variantes diferentes de blaTEM-1, donde blaTEM-1b es el alelo más frecuentemente detectado (10 Escherichia coli, 3 Klebsiella pneumoniae, 2 Proteus mirabilis y 1 Raoultella terrigena), seguidos por blaTEM-1a(1 K. pneumoniae). La resistencia a AMC parece estar asociada principalmente con la hiperproducción de TEM-1 (sobre todo en E. coli) o con la coexpresión con ß-lactamasas tipo OXA-2 y/o SHV (K. pneumoniae y P. mirabilis). Se describió una nueva variante de blaTEM(TEM-163) en un aislamiento de E. coli que presentó una CIM frente a AMC de 16/8 Ag/ml. La enzima TEM-163 contiene dos sustituciones de aminoácidos respecto de TEM-1, Arg275Gln y His289Leu. Teniendo en cuenta la alta actividad específica observada y la baja IC50 para el ácido clavulánico, el patrón de resistencia de este aislamiento parece obedecer a la hiperproducción de la nueva variante de la ß-lactamasa de amplio espectro, en lugar de vincularse con un comportamiento similar al de una TEM resistente a inhibidores (IRT).(AU)

Resistance to ß-lactam/ß-lactamase inhibitors in enterobacteria is a growing problem that has not been intensively studied in Argentina. In the present work, 54/843 enterobacteria collected in a teaching hospital of Buenos Aires city were ampicillin-sulbactam-resistant isolates remaining susceptible to second-and third-generation cephalosporins. The enzymatic mechanisms present in the isolates, which were also amoxicillin-clavulanic acid (AMC)-resistant (18/54) were herein analyzed. Sequencing revealed two different variants of blaTEM-1, being blaTEM-1b the most frequently detected allelle (10 Escherichia coli, 3 Klebsiella pneumoniae, 2 Proteus mirabilis and 1 Raoultella terrigena) followed by blaTEM-1a(1 K. pneumoniae). Amoxicillin-clavulanate resistance seems to be mainly associated with TEM-1 overproduction (mostly in E. coli) or co-expressed with OXA-2-like and/or SHV ß-lactamases (K. pneumoniae and P. mirabilis). A new blaTEMvariant (TEM-163) was described in an E. coli strain having an AMC MIC value of 16/8 Ag/ml. TEM-163 contains Arg275Gln and His289Leu amino acid substitutions. On the basis of the high specific activity and low IC50 for clavulanic acid observed, the resistance pattern seems to be due to overproduction of the new variant of broad spectrumß-lactamase rather than to an inhibitor-resistant TEM (IRT)-like behavior.(AU)

Peritonitis aguda secundaria. Causas, tratamiento, pronóstico y mortalidad / Acute generalize peritonitis. Causes, treatment, prognosis and mortality

Antecedentes: La peritonitis aguda secundaria (PAS) es una emergencia común y su tratamiento fundamental es la intervención quirúrgica. Sin embargo a pesar de los avances en las técnicas quirúrgicas; la antibiótico-terapia y el soporte de los cuidados intensivos conlleva una alta morbilidad y mortalidad, siendo su manejo difícil y complejo. PACIENTES Y MÉTODO: 99 casos de PAS sometidos a laparotomía en el período 2006-2010 (56 varones y 43 mujeres) son analizados de manera retrospectiva en un estudio descriptivo que tiene como objetivo identificar las causas más frecuentes, establecer el porcentaje de certeza diagnóstica preoperatoria, investigar las complicaciones postoperatorias, evaluar factores pronósticos de mortalidad según el índice de Mannheim y determinar la mortalidad. RESULTADOS: La principal causa de peritonitis secundaria fue la apendicular (19%), seguida de peritonitis postoperatoria (17%), en tercer lugar, la perforación de úlcera gastroduodenal, y de asas delgadas (16% cada una), luego, la peritonitis de origen ginecológico (12%), seguidas por las de origen colónico (10%). El tratamiento más frecuente fue el control del foco de contaminación, lavado y secado, con cierre de la cavidad peritoneal (93%). El abdomen abierto, contenido con bolsa de Bogotá se utilizó en 7% de los casos. La mortalidad asociada con la peritonitis secundaria fue de 16%. CONCLUSIONES: Las causas más frecuentes de peritonitis secundaria, fueron, la apendicular, seguidas de las peritonitis postoperatorias. El porcentaje de certeza diagnóstica preoperatoria encontrado en esta serie fue del 27%. Las complicaciones más frecuentes del foco operatorio fueron las dehiscencias de suturas, seguidas de las colecciones a nivel del lecho operatorio

Background: Acute secondary peritonitis (ASP) is a common emergency, its fundamental treatment is surgical intervention, whoever despite the advances on surgical techniques, antibiotic-therapy and intensive care support; mortality and morbidity stay high, while its management remain difficult and complex. PATIENTS AND METHOD: 99 patients with ASP, that underwent laparotomy at the First Department of Surgical Clinics, during the 2006-2010 period (56 males and 43 females) were retrospectively studied with the purpose of identify the main causes, establish the accuracy of preoperative diagnosis, investigate postoperative complications, evaluate prognosis factors of mortality according to the Mannheim index and determinate the mortality. RESULTS: Perforated appendix, was the cause in 19%, follow by postoperative peritonitis (17%), in third place, perforation of the stomach and duodenum and small intestine (16%, each), follow by female internal genital organs (12%) and perforation of the colon (10%). The main treatment was controlling the local point of contamination, with primary close of the peritoneal cavity (93%), Open abdomen contain by Bogotá bag was used in 7% of the cases. The associated mortality was 16%. CONCLUSIONS: Main causes of secondary peritonitis were the appendix, follow by postoperative peritonitis. The preoperative diagnosis accuracy was 27%. The main complications found were suture failure, follow by intra-abdominal collections.

ß-lactamases produced by amoxicillin-clavulanate-resistant enterobacteria isolated in Buenos Aires, Argentina: a new blaTEM gene. / ß-lactamases produced by amoxicillin-clavulanate-resistant enterobacteria isolated in Buenos Aires, Argentina: a new blaTEM gene.

Resistance to ß-lactam/ß-lactamase inhibitors in enterobacteria is a growing problem that has not been intensively studied in Argentina. In the present work, 54/843 enterobacteria collected in a teaching hospital of Buenos Aires city were ampicillin-sulbactam-resistant isolates remaining susceptible to second- and third-generation cephalosporins. The enzymatic mechanisms present in the isolates, which were also amoxicillin-clavulanic acid (AMC)-resistant (18/54) were herein analyzed. Sequencing revealed two different variants of blaTEM-1, being blaTEM-1b the most frequently detected allelle (10 Escherichia coli, 3 Klebsiella pneumoniae, 2 Proteus mirabilis and 1 Raoultella terrigena) followed by blaTEM-1a (1 K. pneumoniae). Amoxicillin-clavulanate resistance seems to be mainly associated with TEM-1 overproduction (mostly in E. coli) or co-expressed with OXA-2-like and/or SHV ß-lactamases (K. pneumoniae and P. mirabilis). A new blaTEM variant (TEM-163) was described in an E. coli strain having an AMC MIC value of 16/8Ag/ml. TEM-163 contains Arg275Gln and His289Leu amino acid substitutions. On the basis of the high specific activity and low IC50 for clavulanic acid observed, the resistance pattern seems to be due to overproduction of the new variant of broad spectrum ß-lactamase rather than to an inhibitor-resistant TEM (IRT)-like behavior.

Características clínicas y patológicas de los tumores de mediastino en un hospital universitario / Clinical and pathological characteristics of tumors of the mediastinum in a university hospital

Las neoplasias mediastinales son tumores poco comunes que pueden aparecer a cualquier edad, pero son más comunes entre la tercera y la quinta década de la vida. Aproximadamente 40% de las masas son asintomáticas y se descubren incidentalmente en una radiografía de tórax de rutina. El objetivo de este trabajo es establecer la frecuencia y características de este tipo de tumores en un hospital universitario general. PACIENTES Y MÉTODO: estudio observacional, retrospectivo, descriptivo de corte transversal. Fueron incluidos todos los pacientes con diagnóstico de tumor mediastinal primario, con confirmación anatomopatológica, durante el periodo 2008-2012. RESULTADOS: De los 795 pacientes adultos registrados en el Departamento de Oncología, 27 (3,4%) padecían patologías tumorales mediastinales. 19 (70%) pertenecían al sexo masculino y la edad promedio fue 41 años. La ubicación topográfica más frecuente corresponde en un 63% (17 casos) al mediastino anterior. Los tipos histológicos más frecuentes fueron: el de origen germinal con 6 casos (22%) y los linfomas (Hodgkin y no Hodgkin) se presentaron en 4 casos cada uno (24% en total). CONCLUSIONES: La frecuencia de tumores mediastinales fue de 3,4%. En su mayoría aparecen en pacientes del sexo masculino (70%), y la edad promedio de aparición es de 41 años. La ubicación topográfica más frecuente es el mediastino anterior (63%). El tipo histológico más frecuente son los linfomas y el tumor de origen germinal.

Mediastinal neoplasms are rare tumors that can occur at any age but are most common between the third and fifth decade of life. Approximately 40% of the masses are asymptomatic and are discovered incidentally on a routine chest radiograph. The aim of this work is to determine the frequency and characteristics of this type of tumors in a general university hospital. PATIENTS AND METHODS: An observational, retrospective, cross- sectional descriptive. We included all patients diagnosed with primary mediastinal tumor with pathologic confirmation, during the period 2008-2012. RESULTS: Of the 795 adult patients registered with the Department of Oncology, 27 (3.4%) had mediastinal tumor pathologies. 19 (70%) were male and the average age was 41 years. The most common topographic location corresponds to 63% (17 cases) the anterior mediastinum. The most common histological types were: the germinal source with 6 cases (22%) and lymphomas (Hodgkin and non-Hodgkin) occurred in 4 cases each (24% total). CONCLUSIONS: The frequency of mediastinal tumors was 3.4%. They mostly appear in male patients (70%), and the average age of onset is 41 years. The most common topographic location is the anterior mediastinum (63%). The most common histological type are lymphomas and germ cell tumor origin.

Causas de hemorragia digestiva alta no varicosa / Causes of non-variceal upper gastrointestinal bleeding

La hemorragia digestiva alta constituye una de lasemergencias médicas más frecuentes. Es motivo de hospitalizaciónsiempre, y a pesar de los avances terapéuticosactuales, la mortalidad de los episodios agudos siguesiendo considerableSe realizó un estudio observacional, descriptivo, retrospectivo,de corte transverso en la Primera Cátedra deClínica Quirúrgica del Hospital de Clínicas de Asuncióndesde enero 2011 a diciembre 2011. Fueron evaluados 27pacientes con diagnóstico de hemorragia digestiva alta,sometidos a endoscopía digestiva alta, con el objetivo deenumerar las causas, determinar la frecuencia de resangradoy de tratamiento quirúrgico encontradas en el servicio.Se han encontrado como causas más frecuentes dehemorragia digestiva alta a la úlcera gástrica 12 casos(44%) y úlcera duodenal 10 casos (37%), habiendo concomitanciade lesiones. Tres casos (11%) requirieron unasegunda endoscopía por resangrado. En ningún caso senecesitó de una terapéutica quirúrgica para detener el sangrado

Peritonitis aguda generalizada: presentación clínica, causasy diagnóstico preoperatorio / Acute generalized peritonitis: clinical features, etiology and preoperative diagnosis

Antecedentes: La peritonitis aguda generalizada(PAG) es un cuadro de frecuente observación; sus causasson numerosas y su diagnóstico temprano mejora notablementelos resultados del tratamiento; el conocimientode las causas comunes orienta la correcta interpretacióndel cuadro clínico y el enfoque terapéutico racional. Pacientes y método: 229 casos de PAG sometidos a laparotomíaen la Primera Cátedra de Clínica Quirúrgica enel periodo 2000-2004 (125 hombres y 104 mujeres conuna edad media de 39,8 años) son analizados de maneraretrospectiva en un estudio descriptivo que tiene comoobjetivo investigar las causas de la PAG, los resultadosde los medios de diagnóstico y la exactitud del diagnósticopreoperatorio. Resultados: El dolor abdominal fuereferido por 225 (generalizado 116). El examen físicoreveló dolor abdominal en 194 pacientes (generalizadoen la mitad); la defensa muscular en 172 y la irritaciónperitoneal en 154. La disminución de los ruidos hidroaéreosse constató en 91 pacientes y la ausencia completaen 50. El fondo de saco Douglas estaba doloroso en 114pacientes. En el 64% la cifra de Glóbulos blancos superóel rango normal y la neutrofilia fue comprobada en el90.3%. El apéndice perforado fue la causa en el 60.7%,el estómago y el duodeno en 14.4%, el intestino delgado7%, el colon y la vesícula biliar 6 % y los genitales internosfemeninos en 4 %. El diagnóstico preoperatorio fuecorrecto en la mitad de los pacientes. Conclusiones: eldolor abdominal, signo y síntoma, fue observado en casitodos los casos; la irritación peritoneal, la contractura yla disminución o ausencia de los ruidos intestinales en lamayoría; la neutrofilia fue la regla, no así la leucocitosis.El diagnóstico preoperatorio fue correcto en la mitad delos pacientes.

Oclusión intestinal: Frecuenciay causas en un servicio de cirugía / InteIntestinal occlusion: Frequency and causes in the Department of Surgery

Introducción: La oclusión intestinal, incluida entre loscuadros del Abdomen Agudo Quirúrgico, constituye cerca del3% de los ingresos en cirugía y debe ser diagnosticada precozmentepara un tratamiento exitoso.Objetivo: Conocer la frecuencia y las causas de la OclusiónIntestinal mecánica, en un Servicio de Cirugía.material y método: Observacional, descriptivo, retrospectivo,corte transverso de pacientes hospitalizados y tratadosquirúrgicamente por Oclusión Intestinal mecánica durante elperíodo de enero del 2008 a diciembre del 2010,Resultados: La oclusión intestinal tuvo una frecuencia de2%; el mayor porcentaje en el rango de 50-59 años; entre lascausas comunes las bridas y hernias estranguladas ocupan elprimer lugar, seguidas por los tumores.Conclusión: Los resultados son similares a estudios previos;se resalta que los tumores son la 3º causa en un porcentajeimportante.

Delta opioids reduce the neurotransmitter release probability by enhancing transient (KV4) K+-currents in corticostriatal synapses as evaluated by the paired pulse protocol.

Field recordings were used to determine the influence of delta-opioid receptor activation on corticostriatal synaptic transmission. Application of the selective delta-opioid receptor agonist, [Tyr-D-Pen-Gly-Phe-D-Pen]-enkephalin (DPDPE, 1 microM), decreased the amplitude of the field-excitatory synaptic potential and at the same time increased the paired pulse ratio (PPR) suggesting a presynaptic site of action. This response reversed rapidly when DPDPE was washed and blocked by 1 nM of the selective delta-receptor antagonist naltrindole. Neither omega-conotoxin GVIA (1 microM) nor omega-agatoxin TK (400 nM), blockers of N- and P/Q-type Ca2+-channels, respectively, nor TEA (1 mM), blocker of some classes of K+-channels, occluded the effects of DPDPE. Instead, 1 mM 4-AP or 400 microM Ba2+ occluded completely the effects of DPDPE. Therefore, the results suggest that the modulation by delta opioids at corticostriatal terminals is mediated by transient (KV4) K+-conductances.

[Enzymatic resistance to beta lactam antibiotics within the genus Proteus and evaluation of Proteus mirabilis phenotypes and genotypes for resistance to third- and fourth-generation cephalosporins]. / Resistencia enzimática a betalactámicos en el género Proteus y evaluación de los fenotipos y genotipos de resistencia a cefalosporinas de tercera y cuarta generación en Proteus mirabilis.

INTRODUCTION: The aim of this study was to evaluate betalactam resistance within the genus Proteus and characterize the betalactamases responsible for this resistance. METHODS: We analyzed 99 strains (87, P. mirabilis; 10 P. vulgaris, and 2, P. penneri) isolated from patients at one University Hospital. Antibiotic susceptibility tests were performed according to NCCLS recommendations. Presence of extended spectrum betalactamases (ESBL) was inferred by both double disk diffusion tests and minimum inhibitory concentration (MIC) of third and fourth generation cephalosporins alone and in the presence of clavulanic acid. Isoelectric points (pI) of the enzymes were estimated by isoelectrofocusing and the presence of the encoding genes was confirmed by polymerase chain reaction (PCR). RESULTS: A broad spectrum betalactamase could be detected in those isolates (28%) resistant to penicillin and first generation cephalosporins while CTX-M-2 enzyme could be detected in P. mirabilis isolates resistant to third and fourth generation cephalosporins (18%). One of the P. vulgaris displayed reduced susceptibility to cefotaxime due to an enzyme of pI 7.4, while resistance to cefotaxime in one P. penneri was related to an enzyme of pI 6.8. Both enzymes were active on cefotaxime (1,000 mg/l) in the iodometric assay. CONCLUSION: The broad extended spectrum betalactamase within genus Proteus was TEM-1, while CTX-M-2 was the ESBL responsible for the third and fourth generation cephalosporins in P. mirabilis. In P. vulgaris and P. penneri this resistance was associated with the hyperproduction of the chromosomal encoded betalactamase.