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The emergence of hypervirulent Klebsiella pneumoniae (hvKP) strains poses a significant threat to public health due to high mortality rates and propensity to cause severe community-acquired infections in healthy individuals. The ability to form biofilms and produce a protective capsule contributes to its enhanced virulence and is a significant challenge to effective antibiotic treatment. Polyphosphate kinase 1 (PPK1) is an enzyme responsible for inorganic polyphosphate synthesis and plays a vital role in regulating various physiological processes in bacteria. In this study, we investigated the impact of polyP metabolism on the biofilm and capsule formation and virulence traits in hvKP using Dictyostelium discoideum amoeba as a model host. We found that the PPK1 null mutant was impaired in biofilm and capsule formation and showed attenuated virulence in D. discoideum compared to the wild-type strain. We performed a proteomic analysis to gain further insights into the underlying molecular mechanism. The results revealed that the PPK1 mutant had a differential expression of proteins involved in capsule synthesis (Wzi-Ugd), biofilm formation (MrkC-D-H), synthesis of the colibactin genotoxin precursor (ClbB), as well as proteins associated with the synthesis and modification of lipid A (ArnB-LpxC-PagP). These proteomic findings corroborate the phenotypic observations and indicate that the PPK1 mutation is associated with impaired biofilm and capsule formation and attenuated virulence in hvKP. Overall, our study highlights the importance of polyP synthesis in regulating extracellular biomolecules and virulence in K. pneumoniae and provides insights into potential therapeutic targets for treating K. pneumoniae infections.
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Dictyostelium , Klebsiella pneumoniae , Humanos , Virulência , Klebsiella pneumoniae/genética , Polifosfatos , Proteômica , BiofilmesRESUMO
Actualmente, en Chile se ha evidenciado un aumento de la población vegetariana, sin embargo, existen escasos datos sociodemográficos, por lo cual, el objetivo del presente estudio es caracterizar, según antecedentes sociodemográficos y alimentarios a personas vegetarianas chilenas en el año 2022. Se utilizó el paradigma cuantitativo y el diseño metodológico fue no experimental, descriptivo, exploratorio de corte transversal. Se aplicó una encuesta de caracterización mediante Google Forms a 504 personas y para el análisis de la información se utilizó el programa SPSS v. 24. El 85,7% declaró ser de género femenino, la edad promedio fue 26,3 ± 5,7 años, 45,5% de los encuestados se declararon ovolactovegetarianos, seguido por vegetarianos estrictos (38,7%) y la principal motivación fue principios animalistas (68,7%). El 87,8% cursó educación superior y el 36,5% correspondió al área de salud. El principal motivo de asistencia al nutricionista fue el asesoramiento con un 80%. Se destacó que la población vegetariana consideró que es fundamental la asistencia a un profesional nutricionista para practicar este estilo de vida de forma óptima, por lo que es fundamental que los profesionales de salud se involucren en conocer a esta población, con el objetivo de otorgar una atención más cercana e integral. Finalmente, la presente investigación corresponde al primer estudio que permite caracterizar a la población vegetariana en Chile.
Currently, in Chile there has been an increase in the vegetarian population; however, there are few sociodemographic data, therefore, the objective of this study is to characterise, according to sociodemographic and dietary background, Chilean vegetarians in the year 2022. The quantitative paradigm was used and the methodological design was non-experimental, descriptive, exploratory cross-section. A characterisation survey was applied using Google Forms to 504 people and SPSS v. 24. 85.7% declared to be female, the average age was 26.3 ± 5.7 years, 45.5% of those surveyed declared themselves lacto-ovo vegetarians, followed by strict vegetarians (38.7%) and the main motivation was animalistic principles (68.7%). 87.8% attended higher education and 36.5% corresponded to the health area. The main reason for helping the nutritionist was the advice with 80%. It was highlighted that the vegetarian population considered that it is essential to assist a professional nutritionist in practising this lifestyle optimally, so it is essential that health professionals get involved in getting to know this population, with the aim of providing closer and more comprehensive care. Finally, this research corresponds to the first study that allows characterising the vegetarian population in Chile.
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RESUMEN Las dietas vegetarianas pueden proveer beneficios para la salud, prevención y tratamiento de enfermedades, siendo adecuadas en todas las etapas del ciclo vital cuando es correctamente asesorada por un profesional especialista en nutrición, entre los que se encuentran las nutricionistas, a fin de prevenir déficits en nutrientes críticos. Debido a esto, resulta relevante identificar la percepción que elaboran sobre el rol del nutricionista las personas vegetarianas que no han contado con asesoría y planificación nutricional profesional. Se realizó un estudio cualitativo centrado en los relatos de vida, donde participaron 10 personas vegetarianas residentes de Coquimbo y La Serena durante el año 2019, seleccionados mediante un muestreo bola de nieve, lo que implicó producir información cualitativa a través de una entrevista semi estructurada. Posteriormente se utilizó análisis cualitativo de contenido, producto de este análisis surgen dos grandes categorías. Como primera categoría el rol biopsicosocial del profesional nutricionista y segunda categoría sugerencias desde los vegetarianos para la atención. Del análisis se destaca la importancia del profesional nutricionista en el abordaje de personas vegetarianas o veganas, quienes esperan de los profesionales un vínculo efectivo con su comunidad mediante instancias de educación alimentaria, asesorías a bajo costo, el desarrollo de competencias técnicas y personales tales como, la actualización continua y la atención empática. Los hallazgos de este estudio pueden ser tomados como guía para la formación y actualización de profesionales, además de proponer medidas nutricionales en el campo de la salud pública y atención contextualizada a personas vegetarianas.
Abstract Vegetarian diets can provide benefits for health, prevention, and treatment of diseases and are appropriate at all stages of the life, when properly advised by specialists in nutrition, to prevent deficits in critical nutrients. Because of this, it is relevant to identify the perception of the role of the nutritionist among vegetarians who have not received professional nutritional advice and planning. A qualitative study focused on life stories was conducted, where 10 vegetarians living in Coquimbo and La Serena participated during 2019, selected through snowball sampling, which involved producing qualitative information through a semi-structured interview. Subsequently, qualitative content analysis was used, and two main categories emerged from this analysis. The first category was the biopsychosocial role of the professional nutritionist, and the second category was suggestions from vegetarians for care. The analysis highlights the importance of the professional nutritionist in the approach to vegetarians or vegans, who expect from professionals an effective link with their community through instances of food education, low-cost advice, the development of technical and personal skills such as continuous updating and empathetic care. The findings of this study can be taken as a guide for the training and updating of professionals, in addition to proposing nutritional measures in the field of public health and contextualized care for vegetarians.
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The prevalence of chronic and acute wounds, as well as the complexity of their treatment represent a great challenge for health systems around the world. In this context, the development of bioactive wound dressings that release active agents to prevent infections and promote wound healing, appears as the most promising solution. In this work, we develop an antibacterial and biocompatible wound dressing material made from coaxial electrospun fibers of poly(styrene-co-maleic anhydride) and poly(vinyl alcohol) (PSMA@PVA). The coaxial configuration of the fibers consists of a shell of poly (styrene-co-maleic anhydride) containing a variable concentration of silver nanoparticles (AgNPs) 0.1-0.6 wt% as antibacterial agent, and a core of PVA containing 1 wt% allantoin as healing agent. The fibers present diameters between 0.72 and 1.7 µm. The release of Ag+ in a physiological medium was studied for 72 h, observing a burst release during the first 14 h and then a sustained and controlled release during the remaining 58 h. Allantoin release curves showed significant release only after 14 h. The meshes showed an antibacterial activity against Pseudomonas aeruginosa and Bacillus subtilis that correlates with the amount of AgNPs incorporated and the release rate of Ag+. Indeed, meshes containing 0.3 and 0.6 wt% of AgNPs showed a 99.99% inhibition against both bacteria. The adherence and cell viability of the meshes were evaluated in mouse embryonic fibroblasts NIH/3T3, observing a significant increase in cell viability after 72 h of incubation accompanied by a reduced adhesion of fibroblasts that decreased in the presence of the active agents. These results show that the material prepared here is capable of significantly promoting fibroblast cell proliferation but without strong adherence, which makes it an ideal material for wound dressings with non-adherent characteristics and with potential for wound healing.
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Nanopartículas Metálicas , Álcool de Polivinil , Animais , Bandagens , Proliferação de Células , Fibroblastos , Maleatos , Anidridos Maleicos , Camundongos , Poliestirenos , Prata , EstirenoRESUMO
INTRODUCCIÓN: La endometriosis intestinal afecta en gran medida la calidad de vida de una mujer joven y habitualmente requiere un tratamiento quirúrgico con resección intestinal. Esta cirugía es técnicamente compleja por las adherencias firmes del intestino a la vagina, el útero y los ovarios. OBJETIVO: Describir y analizar los resultados quirúrgicos e histopatológicos de las resecciones intestinales por endometriosis grave durante los últimos 18 años en el Hospital Clínico de la Universidad de Chile, en relación con la introducción de la unidad multidisciplinaria de endometriosis, a partir del año 2011, y las experiencias publicadas en la literatura chilena y extranjera. MÉTODO: Trabajo retrospectivo realizado en un hospital terciario desde el año 2001 hasta el año 2019. Las pacientes se asignaron a dos grupos según el período de cirugía: grupo 2001-2010 y grupo 2011-2019, luego de la introducción de la unidad de endometriosis. Se recopilaron todas las pacientes a las que se realizó una resección intestinal (discoidal o segmentaria) por endometriosis, por laparotomía o laparoscopía. Los datos distribuidos normalmente se presentan como promedio ± DE y los datos no paramétricos como mediana (rango). Las comparaciones demográficas de variables continuas se hicieron con la prueba t de Student y las de las variables categóricas con las pruebas de ji al cuadrado o de Fisher. La significación estadística se estableció en p < 0,05. RESULTADOS: Se recopilaron 52 casos. El 94,2% de las cirugías fueron electivas. El 5,8% fueron de urgencia por obstrucción intestinal (todas entre 2001 y 2010). Un 75% de las cirugías fueron laparoscópicas. Se realizó resección segmentaria en el 67,3%, resección discoidal simple en el 28,8%, resección discoidal doble en el 1,9% y resección segmentaria y una discoidal en el 1,9%. La histopatología demostró compromiso de la lesión hasta la mucosa intestinal en un 7,7%. Hubo franca disminución del dolor en el seguimiento de las pacientes. El 24% de las pacientes con deseo de embarazo y endometriosis intestinal lograron un parto de término mediante fecundación in vitro o espontáneamente. Hubo cuatro complicaciones posoperatorias, tres de ellas de categoría II según la clasificación de Clavien-Dindo y una de categoría IV A con reintervención a las 72 horas. Al comparar ambos periodos, en 2001-2010 los exámenes diagnósticos utilizados fueron ecografía transvaginal (0%), enema baritado (60%), tomografía computarizada de abdomen y pelvis (45%) y resonancia magnética pelviana (20%), mientras que en 2011-2019 fueron ecografía transvaginal (100%), enema baritado (3%), tomografía computarizada (3%) y resonancia magnética pelviana (66%). En 2001-2010, las lesiones fueron más más infiltrativas (mayor compromiso mucoso y submucoso) (75 vs. 16% de las resecciones intestinales; p < 0,05), estenóticas (cirugías de urgencia por obstrucción), con mayor porcentaje de resecciones segmentarias (100 vs. 46,9%; p < 0,05) y más días de hospitalización (5,8 ± 2,3 vs. 4,1 ± 0,9 días) que en 2011-2019. CONCLUSIONES: A nuestro entender, esta es la serie más grande publicada en Chile de resecciones intestinales por endometriosis. Estos hallazgos demuestran cómo la introducción de la unidad multidisciplinaria de endometriosis permite un diagnóstico precoz y un tratamiento quirúrgico eficaz y oportuno, tal como se decribe en la literatura.
INTRODUCTION: Bowel endometriosis severely affects a young woman's quality of life and often requires surgical treatment with bowel resection. This surgery is technically complex due to the tight adhesions of the intestine to the vagina, uterus, and ovaries. The objective of this work is to describe and analyze the surgical and histopathological results of intestinal resections for severe endometriosis during the last 18 years at the Clinical Hospital University of Chile, in relation to the implementation of the multidisciplinary endometriosis unit, based on the year 2011 and the experiences published in Chilean and foreign literature. METHOD: Retrospective work carried out in a tertiary hospital from 2001 to 2019. The patients were assigned to two groups according to the surgery period: group 2001-2010 and group 2011-2019, after endometriosis unit formation. All patients who underwent bowel resection (discoidal or segmental) for endometriosis by laparotomy or laparoscopy were collected. Normally distributed data are presented as mean ± SD and nonparametric data as median (range). Demographic comparisons of continuous variables are compared using Student's t test and categorical variables using chi squared or Fisher's test. Statistical significance was established at p < 0.05. RESULTS: 52 cases were collected. 94.2% of the surgeries were elective. 5.8% were urgent due to intestinal obstruction (all between 2001 and 2010). 75% of the surgeries were laparoscopic. Segmental resection 67.3%, simple discoidal resection 28.8%, double discoidal resection 1.9% and segmental resection and a discoidal resection 1.9%. Histopathology showed involvement of the lesion up to the intestinal mucosa in 7.7%. A marked decrease in pain in the follow-up of the patients. 24% of the patients with a desire for pregnancy and intestinal endometriosis achieved a full-term delivery by IVF or spontaneously. There were four postoperative complications, three of them category II according to the Clavien-Dindo classification, and one category IV A complication with reoperation at 72 h. When comparing both periods, between 2001-2010 the diagnostic tests used were: transvaginal ultrasound (ECO TV) (0%), barium enema (BE) (60%), abdomen pelvis CT (45%) and pelvic resonance (MRI) (20%). Between 2011 and 2019 ECO TV (100%), EB (3%), TAC (3%) RM (66%). In the period 2001 to 2010, the lesions were more infiltrative (greater mucosal and submucosal involvement) (75% vs 16% of intestinal resections (P <0.05)), stenotic (urgent surgery for obstruction), with a higher percentage of resections segmental (100% vs 46.9% (P <0.05) and more days of hospitalization (5.8 ± 2.3 SD vs 4.1 ± 0.9 SD) than in the period from 2011 to 2019. CONCLUSIONS: To our knowledge, this is the largest series published in Chile of intestinal resections for endometriosis. These findings demonstrate how the introduction of the multidisciplinary endometriosis unit allows early diagnosis and effective and timely surgical treatment as described in the literature.
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Humanos , Feminino , Adulto , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Endometriose/cirurgia , Enteropatias/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Estudos Retrospectivos , Seguimentos , Resultado do Tratamento , Endometriose/diagnóstico , Endometriose/patologia , Hospitais Universitários , Tempo de InternaçãoRESUMO
Acidithiobacillus species are fundamental players in biofilm formation by acidophile bioleaching communities. It has been previously reported that Acidithiobacillus ferrooxidans possesses a functional quorum sensing mediated by acyl-homoserine lactones (AHL), involved in biofilm formation, and AHLs naturally produced by Acidithiobacillus species also induce biofilm formation in Acidithiobacillus thiooxidans. A c-di-GMP pathway has been characterized in Acidithiobacillus species but it has been pointed out that the c-di-GMP effector PelD and pel-like operon are only present in the sulfur oxidizers such as A. thiooxidans. PEL exopolysaccharide has been recently involved in biofilm formation in this Acidithiobacillus species. Here, by comparing wild type and ΔpelD strains through mechanical analysis of biofilm-cells detachment, fluorescence microscopy and qPCR experiments, the structural role of PEL exopolysaccharide and the molecular network involved for its biosynthesis by A. thiooxidans were tackled. Besides, the effect of AHLs on PEL exopolysaccharide production was assessed. Mechanical resistance experiments indicated that the loss of PEL exopolysaccharide produces fragile A. thiooxidans biofilms. qRT-PCR analysis established that AHLs induce the transcription of pelA and pelD genes while epifluorescence microscopy studies revealed that PEL exopolysaccharide was required for the development of AHL-induced biofilms. Altogether these results reveal for the first time that AHLs positively regulate pel genes and participate in the molecular network for PEL exopolysaccharide biosynthesis by A. thiooxidans.
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Acidithiobacillus thiooxidans/genética , Acil-Butirolactonas/metabolismo , Extremófilos/genética , Regulação Bacteriana da Expressão Gênica , Polissacarídeo-Liases/genética , Acidithiobacillus thiooxidans/metabolismo , Biofilmes/crescimento & desenvolvimento , Vias Biossintéticas/genética , GMP Cíclico/análogos & derivados , GMP Cíclico/metabolismo , Extremófilos/metabolismo , Óperon , Polissacarídeo-Liases/metabolismo , Polissacarídeos Bacterianos/biossíntese , Percepção de QuorumRESUMO
Cyclic and linear nucleotides are key elements of the signal transduction networks linking perception of the environment to specific cellular behavior of prokaryotes. These molecular mechanisms are particularly important in bacteria exposed to different, and frequently simultaneous, types of extreme conditions. This is the case in acidithiobacilli, a group of extremophilic bacteria thriving in highly acidic biotopes, that must also cope with significant variations in temperature, osmotic potentials and concentrations of various transition metals and metalloids. Environmental cues sensed by bacteria are transduced into differential levels of nucleotides acting as intracellular second messengers, promoting the activation or inhibition of target components and eliciting different output phenotypes. Cyclic (c) di-GMP, one of the most common bacterial second messengers, plays a key role in lifestyle changes in many bacteria, including acidithiobacilli. The presence of functional c-di-GMP-dependent signal transduction pathways in representative strains of the best-known linages of this species complex has been reported. However, a comprehensive panorama of the c-di-GMP modulated networks, the cognate input signals and output responses, are still missing for this group of extremophiles. Moreover, little fundamental understanding has been gathered for other nucleotides acting as second messengers. Taking advantage of the increasing number of sequenced genomes of the taxon, here we address the challenge of disentangling the nucleotide-driven signal transduction pathways in this group of polyextremophiles using comparative genomic tools and strategies. Results indicate that the acidithiobacilli possess all the genetic elements required to establish functional transduction pathways based in three different nucleotide-second messengers: (p)ppGpp, cyclic AMP (cAMP), and c-di-GMP. The elements related with the metabolism and transduction of (p)ppGpp and cAMP appear highly conserved, integrating signals related with nutrient starvation and polyphosphate metabolism, respectively. In contrast, c-di-GMP networks appear diverse and complex, differing both at the species and strain levels. Molecular elements of c-di-GMP metabolism and transduction were mostly found scattered along the flexible genome of the acidithiobacilli, allowing the identification of probable control modules that could be critical for substrate colonization, biofilm development and intercellular interactions. These may ultimately convey increased endurance to environmental stress and increased potential for gene sharing and adaptation to changing conditions.
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Bax-inhibitor 1 (BI-1) is a cell death suppressor conserved in all eukaryotes that modulates cell death in response to abiotic stress and pathogen attack in plants. However, little is known about its role in the establishment of symbiotic interactions. Here, we demonstrate the functional relevance of an Arabidopsis thaliana BI-1 homolog (PvBI-1a) to symbiosis between the common bean (Phaseolus vulgaris) and Rhizobium tropici. We show that the changes in expression of PvBI-1a observed during early symbiosis resemble those of some defence response-related proteins. By using gain- and loss-of-function approaches, we demonstrate that the overexpression of PvBI-1a in the roots of common bean increases the number of rhizobial infection events (and therefore the final number of nodules per root), but induces the premature death of nodule cells, affecting their nitrogen fixation efficiency. Nodule morphological alterations are known to be associated with changes in the expression of genes tied to defence, autophagy, and vesicular trafficking. Results obtained in the present work suggest that BI-1 has a dual role in the regulation of programmed cell death during symbiosis, extending our understanding of its critical function in the modulation of host immunity while responding to beneficial microbes.
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Proteínas de Membrana/genética , Phaseolus/genética , Proteínas de Plantas/genética , Rhizobium tropici/fisiologia , Apoptose/genética , Regulação da Expressão Gênica de Plantas , Proteínas de Membrana/metabolismo , Phaseolus/microbiologia , Imunidade Vegetal/genética , Proteínas de Plantas/metabolismo , Raízes de Plantas/microbiologia , Raízes de Plantas/fisiologia , Simbiose/genéticaRESUMO
En el mundo hay unos 47 millones de personas que padecen demencia, y cada año se registran cerca de 10 millones de nuevos casos. La demencia es una de las principales causas de discapacidad y dependencia entre las personas mayores de 65 años. La demencia vascular constituye la segunda causa de demencia en adultos mayores y en ocasiones su diagnóstico es poco asertivo por la variedad y similitud de síntomas entre las diferentes enfermedades que originan demencia vascular, incluyendo CADASIL (acrónimo inglés de Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy); particularmente el déficit cognitivo es de los síntomas más complejos de diagnóstico, teniendo en cuenta que su manifestación clínica depende de la magnitud y localización de la lesión. La enfermedad de CADASIL, aunque se constituye como una infrecuente causa de demencia vascular de naturaleza hereditaria a nivel mundial, representa una patología de gran importancia en el ámbito nacional, dado que en familias colombianas se ha reportado mutaciones que conllevan a dicha patología. Por lo tanto, su diagnóstico y tratamiento constituyen un reto para el personal clínico, sabiendo que la identificación temprana y precisa es la mejor estrategia para evitar la progresión precoz de la enfermedad y el mejoramiento de la calidad de vida del paciente. De acuerdo con lo anterior, se realizó una revisión de la diferenciación clínica del déficit cognitivo del CADASIL con respecto a las demás demencias vasculares, con el fin de generar una herramienta que apoye la diferenciación clínica de dicha patología.
In the world, there are approximately 47 million people who have dementia, and every year they register near 10 million new cases. The dementia is one of the principal reasons for disability and dependence between people older than 65 years old. Vascular dementia constitutes the second reason of dementia in the elders, and sometimes the diagnosis is slightly assertive because of the variety and similarity of symptoms between the different diseases that originate vascular dementia, including CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy). Particularly, the cognitive deficit is one of the most complex symptoms of diagnosis, bearing in mind that its clinical manifestation depends on the magnitude and location of the injury. CADASIL disease, though it constituted as an infrequent reason of vascular dementia of hereditary nature worldwide, represents a pathology of great importance in the national area, because, in Colombian families, there have been reported mutations that carry to the above-mentioned pathology. Therefore, its diagnosis and treatment constitute a challenge for the clinical personnel, knowing that the early and precise identification is the best strategy to avoid the rapid progression of the disease and the improvement of the quality of life of the patient. In agreement with the previous information, there was made a review of the clinical differentiation of the cognitive deficit of CADASIL regarding other vascular dementias, to generate a tool that supports the clinical differentiation of the pathology mentioned above.
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Humanos , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/fisiopatologia , CADASIL/diagnóstico , CADASIL/fisiopatologia , Demência Vascular/diagnóstico , Demência Vascular/fisiopatologiaRESUMO
Abstract Background: Post-operative delirium is a serious complication in patients undergoing major abdominal surgery. It remains unclear whether peri-operative hemodynamic and perfusion variables affect the risk for postoperative delirium. The objective of this pilot study was to evaluate the association between perfusion and hemodynamics peri-operative with the appearance of post-operative delirium. Methods: Prospective cohort study of adults 60 years or older undergoing elective open colon surgery. Multimodal hemodynamic and perfusion variables were monitored, including central venous oxygenation (ScvO2), lactate levels, and non-invasive cerebral oxygenation (rSO2), according to a standard anesthesia protocol. Fisher's exact test or Student's t-test were used to compare patients who developed post-operative delirium with those who did not (p < 0.05). Results: We studied 28 patients, age 73 ± 7 years, 60.7% female. Two patients developed post-operative delirium (7.1%). These two patients had fewer years of education than those without delirium (p = 0.031). None of the peri-operative blood pressure variables were associated with incidence of post-operative delirium. In terms of perfusion parameters, postoperative ScvO2 was lower in the delirium than the non-delirium group, without reaching statistical significance (65 ± 10% vs. 74 ± 5%; p = 0.08), but the delta-ScvO2 (the difference between means post-operative and intra-operative) was associated with post-operative delirium (p = 0.043). Post-operative lactate and rSO2 variables were not associated with delirium. Conclusions: Our pilot study suggests an association between delta ScvO2 and post-operative delirium, and a tendency to lower post-operative ScvO2 in patients who developed delirium. Further studies are necessary to elucidate this association.
Resumo Justificativa: O delírio pós-operatório é uma complicação séria em pacientes submetidos à cirurgia abdominal de grande porte. Ainda não está claro se as variáveis hemodinâmicas e de perfusão no período perioperatório afetam o risco de delírio pós-operatório. O objetivo deste estudo piloto foi avaliar a associação entre perfusão e hemodinâmica no perioperatório com o surgimento de delírio pós-operatório. Métodos: Estudo prospectivo de coorte de adultos com 60 anos ou mais, submetidos à cirurgia eletiva aberta do cólon. As variáveis multimodais de hemodinâmica e perfusão foram monitoradas, inclusive oxigenação venosa central (ScvO2), níveis de lactato e oxigenação cerebral não invasiva (rSO2), de acordo com um protocolo-padrão de anestesia. O teste exato de Fisher ou o teste t de Student foram usados para comparar os pacientes que desenvolveram delírio pós-operatório com aqueles que não desenvolveram p < 0,05. Resultados: Avaliamos 28 pacientes, 73 ± 7 anos, 60,7% do sexo feminino. Dois pacientes desenvolveram delírio pós-operatório (7,1%). Esses dois pacientes tinham menos anos de escolaridade do que aqueles sem delírio pós-operatório (p = 0,031). Nenhuma das variáveis de pressão arterial no perioperatório foi associada à incidência de delírio. Quanto aos parâmetros de perfusão, ScvO2 foi menor no grupo que apresentou delírio pós-operatório do que no grupo que não apresentou delírio, sem atingir significância estatística (65 ± 10% vs. 74 ± 5%; p = 0,08), mas o delta-ScvO2 (a diferença entre as médias no pós-operatório e intraoperatório) foi associado ao delírio (p = 0,043). As variáveis de lactato e rSO2 no pós-operatório não foram associadas ao delírio. Conclusões: Nosso estudo piloto sugere uma associação entre delta-ScvO2 e delírio e uma tendência à diminuição da ScvO2 no pós-operatório de pacientes com delírio. Estudos adicionais são necessários para elucidar essa associação.
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Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Complicações Pós-Operatórias/epidemiologia , Doenças do Colo/cirurgia , Delírio/epidemiologia , Complicações Pós-Operatórias/etiologia , Fluxo Sanguíneo Regional , Procedimentos Cirúrgicos do Sistema Digestório , Projetos Piloto , Estudos Prospectivos , Doenças do Colo , Doenças do Colo/complicações , Delírio/etiologia , Hipotensão/complicaçõesRESUMO
Acidophile bacteria belonging to the Acidithiobacillus genus are pivotal players for the bioleaching of metallic values such as copper. Cell adherence to ores and biofilm formation, mediated by the production of extracellular polymeric substances, strongly favors bioleaching activity. In recent years, the second messenger cyclic diguanylate (c-di-GMP) has emerged as a central regulator for biofilm formation in bacteria. C-di-GMP pathways have been reported in different Acidithiobacillus species; however, c-di-GMP effectors and signal transduction networks are still largely uncharacterized in these extremophile species. Here we investigated Pel exopolysaccharide and its role in biofilm formation by sulfur-oxidizing species Acidithiobacillusthiooxidans. We identified 39 open reading frames (ORFs) encoding proteins involved in c-di-GMP metabolism and signal transduction, including the c-di-GMP effector protein PelD, a structural component of the biosynthesis apparatus for Pel exopolysaccharide production. We found that intracellular c-di-GMP concentrations and transcription levels of pel genes were higher in At. thiooxidans biofilm cells compared to planktonic ones. By developing an At. thiooxidans ΔpelD null-mutant strain we revealed that Pel exopolysaccharide is involved in biofilm structure and development. Further studies are still necessary to understand how Pel biosynthesis is regulated in Acidithiobacillus species, nevertheless these results represent the first characterization of a c-di-GMP effector protein involved in biofilm formation by acidophile species.
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BACKGROUND: Cardiogenic shock secondary to coronary involvement in large vessel vasculitis (LVV) is an unsuspected finding, even more, when no other vascular territories are compromised and when it constitutes the initial clinical manifestation. This case report illustrates a case in which a complete diagnostic study uncovered this aetiology. CASE SUMMARY: A 33-year-old woman with cough and chest pain who was diagnosed with acute bronchitis returned with worsening dyspnoea, chest pain, and developed cardiogenic shock. The initial differential diagnoses included myocarditis and takotsubo cardiomyopathy (TCM) owing to a positive troponin I, and echocardiogram with left ventricular dilation, dyskinesia in mid-ventricular and apical segments, systolic dysfunction, and functional mitral regurgitation. A cardiac magnetic resonance showed contractility abnormalities resembling the pattern of TCM but lacked the characteristic myocardial oedema. Subsequently, a coronary angiography expected to result without obstructions showed a critical narrowing of the left main coronary artery. Surgical management consisted of a pericardium patch grafted in the stenotic ostium to restore adequate perfusion. The surgical specimens were sent to the pathology laboratory that reported findings compatible with LVV. Four days after the surgical intervention the patient was discharged alive with a complete recovery of left ventricular systolic function. DISCUSSION: Chest pain symptoms in a young woman, could be caused by multiple entities, and an ischaemic aetiology from a non-atherosclerotic origin should be kept in mind. A complete study with coronary angiography is crucial to rule out an ischaemic cause even in low-risk groups for atherosclerotic coronary heart disease.
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BACKGROUND: Post-operative delirium is a serious complication in patients undergoing major abdominal surgery. It remains unclear whether peri-operative hemodynamic and perfusion variables affect the risk for postoperative delirium. The objective of this pilot study was to evaluate the association between perfusion and hemodynamics peri-operative with the appearance of post-operative delirium. METHODS: Prospective cohort study of adults 60 years or older undergoing elective open colon surgery. Multimodal hemodynamic and perfusion variables were monitored, including central venous oxygenation (ScvO2), lactate levels, and non-invasive cerebral oxygenation (rSO2), according to a standard anesthesia protocol. Fisher's exact test or Student's t-test were used to compare patients who developed post-operative delirium with those who did not (p<0.05). RESULTS: We studied 28 patients, age 73±7 years, 60.7% female. Two patients developed post-operative delirium (7.1%). These two patients had fewer years of education than those without delirium (p=0.031). None of the peri-operative blood pressure variables were associated with incidence of post-operative delirium. In terms of perfusion parameters, postoperative ScvO2 was lower in the delirium than the non-delirium group, without reaching statistical significance (65±10% vs. 74±5%; p=0.08), but the delta-ScvO2 (the difference between means post-operative and intra-operative) was associated with post-operative delirium (p=0.043). Post-operative lactate and rSO2 variables were not associated with delirium. CONCLUSIONS: Our pilot study suggests an association between delta ScvO2 and post-operative delirium, and a tendency to lower post-operative ScvO2 in patients who developed delirium. Further studies are necessary to elucidate this association.
Assuntos
Doenças do Colo/cirurgia , Delírio/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Idoso , Doenças do Colo/complicações , Doenças do Colo/fisiopatologia , Delírio/etiologia , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Humanos , Hipotensão/complicações , Masculino , Projetos Piloto , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Fluxo Sanguíneo RegionalRESUMO
Resumen Introducción La resistencia a antibióticos es un problema mundial. En los pacientes que requieren cirugía de urgencia, los antibióticos son un apoyo importante concomitante al acto quirúrgico. Objetivo Analizar los cultivos de líquido peritoneal obtenidos de pacientes operados por patología quirúrgica abdominal de urgencia. Materiales y Métodos Se realiza una cohorte prospectiva de los pacientes operados de urgencia. Se tomó cultivo de líquido peritoneal y se procesó según técnica estandarizada. Resultados Se encontró un 39,4% de cultivos positivos. E. coli fue el germen más frecuente. Destacan 5 cultivos positivos para P. aeruginosa. Existe un 25% de resistencia a ampicilina/sulbactam y 19% a quinolonas para E. coli. Conclusión La resistencia encontrada fue menor a lo reportado en la literatura, pero aún destacable. El conocimiento del perfil de bacterias y sus resistencias a antimicrobianos son importantes para las políticas hospitalarias locales de uso racional de antibióticos.
Background Antimicrobial resistance is a worldwide problem. In patients requiring emergency surgery, antibiotics are an important assistance additional to surgical intervention. Objective Analize peritoneal fluid cultures obtaines from patients who underwent emergency surgery. Methods A prospective cohort of emergency abdominal surgical patients were enrolled. Peritoneal fluid cultures were taken and processed according to standarized technique. Results A 39.4% of positive cultures was found. E. coli was the most common bacteria identified. Five positive cultures for P. aeruginosa stand out. E. coli had 25% resistance to ampicillin/sulbactam and 19% for quinolones. Conclusion Resistance found was lower than international reports, but still noteworthy. Knowledge of local bacteria profile and antimicrobial resistance is important for local antibiotic hospital policy.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Bactérias/efeitos dos fármacos , Líquido Ascítico/microbiologia , Abdome/cirurgia , Antibacterianos/farmacologia , Pseudomonas aeruginosa/efeitos dos fármacos , Bactérias/isolamento & purificação , Testes de Sensibilidade Microbiana , Farmacorresistência Bacteriana , Emergências , Escherichia coli/efeitos dos fármacos , Klebsiella pneumoniae/efeitos dos fármacosRESUMO
Different strategies have been used to overcome the difficulties to produce antimicrobial peptides. Here we used Intein Mediated Purification with an Affinity Chitin-binding Tag (IMPACT-System, New England Biolabs) for the expression of the antimicrobial peptide cecropin to reduce its sensitivity to intracellular proteases and use its inducible self-cleaving capability to remove the carrier. Cecropin was cloned into suitable expression vector pTYB11, and expression induced by IPTG in Escherichia coli ER2566. The use of 22ºC induction allowed the expression of cecropin with its intein carrier in soluble form. Cell extracts were purified by chitin affinity chromatography and intein-mediated splicing of the target protein was achieved by thiol addition, obtaining a final yield of 2.5 mg cecropin/l. Cecropin cleaved from the intein had its proper biologically active form, showing a micromolar antimicrobial activity against Vibrio ordalii, Vibrio alginolyticus and Escherichia coli.
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Humanos , Antibacterianos/metabolismo , Cecropinas/metabolismo , Escherichia coli , Western Blotting , Cromatografia de Afinidade , Cromatografia Líquida de Alta Pressão , Clonagem Molecular , Fusão Gênica , Inteínas , Peptídeos Catiônicos Antimicrobianos/metabolismo , Proteínas RecombinantesRESUMO
Childhood obesity is reaching epidemic proportions throughout the world; however, little is known on the nutritional status of children with disabilities. To address this issue, medical records of 748 children aged 18 years or younger receiving physical therapy during 2004-2005 at a privately sponsored free rehabilitation clinic in Punta Arenas, Patagonia, Chile were abstracted. Data included demographic, clinical, and anthropometric information recorded at the first visit. As a comparison, height and weight were also collected in 215 children attending local schools. Nutritional status was calculated as body mass index (above 6 years of age) or evaluated by growth curves (6 years of age or below) as undernourished, normal, overweight, obese, or morbidly obese. Logistic regression was used to determine risk factors for obesity in these children. Overall, a significant difference in nutritional status between disabled and non-disabled children was found (P<0.001). Children with disabilities had a higher prevalence of both below and above normal weight than non-disabled children. Risk factors for obesity included increasing age and living with a grandparent independent of other socioeconomic factors. Compared with normal children, risk of obesity was doubled for those with developmental delays [odds ratio (OR): 1.96; 95% confidence interval (CI): 1.16-3.34] and neurological disorders (OR: 2.58, 95% CI: 1.26-5.29), whereas individuals with cerebral palsy were less than half as likely to be obese than non-disabled children (OR: 0.46, 95% CI: 0.20-1.03). We conclude that overnutrition continues to be a problem for both disabled and non-disabled children in Patagonia. Programs to increase physical activity and improve nutrition are needed in this isolated part of the world.
Assuntos
Crianças com Deficiência/reabilitação , Estado Nutricional , Obesidade/complicações , Adolescente , Índice de Massa Corporal , Criança , Pré-Escolar , Chile/epidemiologia , Crianças com Deficiência/classificação , Crianças com Deficiência/estatística & dados numéricos , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Prontuários Médicos , Obesidade/etiologia , Obesidade/prevenção & controle , Prevalência , Fatores de Risco , Classe SocialRESUMO
Novel doublet molecules of cecropin A from Drosophila melanogaster were designed and constructed combining the regular (CECdir) with the inverted (CECret) coding sequence of the standard CEC A1 gene resulting in the following configurations: CECdir-CECret and CECret-CECdir. These two recombinant molecules were generated using a three-primer driven PCR reaction yielding composite single functional aminoacidic molecules with the coding sequences of CECdir linked in frame with the coding sequence of CECret and vice versa. In order to obtain these constructions, a retropeptide DNA-coding sequence was chemically synthesized to match the expected polarity of the newly generated CECret sequence. Both doublet antimicrobial peptides (drAMPs) were cloned in the T7 promoter driven expression plasmid pET27b+ and expressed in E. coli BL21 without any fusion protein. Only the former recombinant peptide was expressed and purified from cell extracts and its specific activity against two different bacteria showed to be higher than those displayed by their monomer parental counterparts.
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Cecropinas , Drosophila melanogaster , Cromatografia Líquida de Alta Pressão , Escherichia coliRESUMO
CECdir-CECret is a novel non-toxic doublet 8.5 kDa peptide representing the natural coding sequence of the antimicrobial peptide Cecropin A from Drosophila melanogaster fused in-frame to its own inverted version. Expression of this cloned doublet peptide in Escherichia coli, yielded peptides that were mostly packaged into inclusion bodies. The new molecule was purified, solubilized and refolded, through a standard guanidine-based procedure. The recovered refolded peptides were then characterized by HPLC chromatography, MALDI-TOF-mass spectrometry and peptide sequencing, and finally evaluated for their antimicrobial potential. The novel doublet peptide CECdir-CECret, displays an enhanced in vitro antimicrobial activity and action spectrum in comparison to the monomer Cecropin A.
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Anti-Infecciosos/química , Anti-Infecciosos/farmacologia , Peptídeos Catiônicos Antimicrobianos/química , Peptídeos Catiônicos Antimicrobianos/farmacologia , Peptídeos/química , Peptídeos/farmacologia , Proteínas Recombinantes de Fusão/química , Proteínas Recombinantes de Fusão/farmacologia , Animais , Anti-Infecciosos/metabolismo , Peptídeos Catiônicos Antimicrobianos/metabolismo , Escherichia coli/genética , Escherichia coli/metabolismo , Corpos de Inclusão/metabolismo , Peptídeos/metabolismo , Proteínas Recombinantes de Fusão/metabolismo , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por MatrizRESUMO
Se analizaron las fichas clínicas de 2552 colecistectomías entre enero de 1999 y marzo de 2001. Se encontraron 59 cánceres de la vesícula biliar, con una prevalencia del 2,31 por ciento. En el estudio anátomopatológico, fueron etapificados veintisiete en estadio I, diecisiete en estadio II, once en estadio III y cuatro pacientes en estadio IV. El 81,1 por ciento eran mujeres y el 18,9 por ciento hombres. En más del 90 por ciento de los casos no se sospecha la presencia de un cáncer de la vesícula biliar en el preoperatorio ni en el intraoperatorio. Analizada la sobrevida en los estadios I, no muestra diferencias estadísticamente significativas entre los grupos intervenidos por cirugía abierta o laparascópica, realizando la simple colecistectomía. En nuestra experiencia, se deben extremar los recursos para un diagnóstico precoz, determinando grupos de riesgo para el CVB, evitar la rotura vesicular y derramamiento de bilis y cálculos en el intraoperatorio, extraer la vesícula en bolsa, y conversión a cirugía abierta en caso de sospecha de CVB. A la vesícula biliar extraída se le debe realizar un examen macroscópico y estudio histopatológico completo