A preliminary report on critical antimicrobial resistance in Escherichia coli, Enterococcus faecalis, and Enterococcus faecium strains isolated from healthy dogs in Chile during 2021-2022.

Antimicrobial Resistance (AMR) represents one of the main current threats to global public health; where production animals, companion animals, humans, and the environment play a significant role in its dissemination. However, little attention has been given to companion animals as reservoirs and disseminators of relevant antimicrobial resistant bacteria, especially in South American countries such as Chile. For this reason, this research aimed to estimate the prevalence of AMR to different critical antibiotics at a screening level in commensal bacteria such as E. coli and Enterococcus spp., isolated from healthy pet dogs in the Metropolitan Region of Chile, studying their geographical distribution and evaluating associations of phenotypic resistance to different antibiotics. Thus, in E. coli we detected AMR to all critical drugs assessed, including 34.1% to amoxicillin, 20.1% to colistin, 15.7% to enrofloxacin, and 9.2% to cefotaxime. On the other hand, AMR prevalence in E. faecalis was 8.1% for ampicillin and 3.4% for vancomycin; while for E. faecium the AMR prevalence was 19.1% for ampicillin and 10.2% for vancomycin. Additionally, significant differences in prevalence of the different possible AMR were detected according to their geographical distribution, suggesting the existence of various risk factors and stressing the need to establish mitigation measures specific to the differences identified.

Phenotypic and genotypic antimicrobial resistance in Escherichia coli strains isolated from household dogs in Chile.

Introduction: Antimicrobial resistance (AMR) is a major threat to animal and public health worldwide; consequently, several AMR surveillances programs have been implemented internationally in both human and veterinary medicine, including indicator bacteria such as Escherichia coli. However, companion animals are not typically included in these surveillance programs. Nevertheless, there have been reports of increasing levels of antimicrobial resistance in E. coli strains isolated from dogs worldwide. In Chile, there is limited information available on AMR in E. coli isolated from companion animals, which prevents the establishment of objective prevention and control measures. Methods: For this reason, the aim of this study was to characterize the phenotypic and genotypic AMR of E. coli strains isolated from healthy household dogs in Chile. For this purpose, a multi-stage sampling was carried out in the Metropolitan Region of Chile, obtaining samples from 600 healthy dogs. These samples were processed using traditional bacteriology and molecular techniques to isolate E. coli strains. We assessed the minimal inhibitory concentration of 17 antimicrobials and conducted a search of six antimicrobial resistance genes, as well as class 1 and 2 integrons, in the isolated strains. Results: Two-hundred and twenty-four strains of E. coli were recovered, and 96.9% (n = 217) showed resistance to at least one drug and only 3.1% (n = 7) were susceptible to all analyzed antimicrobials. Most strains were resistant to cefalexin (91.5%, n = 205, 1st-generation cephalosporin), followed by ampicillin (68.3%, n = 153) and cefpodoxime (31.3%, n = 70, 3rd-generation cephalosporin). Moreover, 24.1% (n = 54) tested positive for extended-spectrum-ß-lactamases and 34.4% (n = 77) were multidrug resistant. As for the AMR genes, the most detected was qnrB (28.1%, n = 63), followed by blaCTX-M (22.3%, n = 50), and blaTEM-1 (19.6%, n = 44). Additionally, 16.1% (n = 36) harbored class 1 integrons. Our study shows that E. coli strains isolated from healthy household dogs exhibit resistance to several relevant drugs and also antimicrobial resistance genes considered critical for human health. These results can be used as a starting point for the prevention and control of antimicrobial resistance from companion animals. This background should be considered when formulating future resistance surveillance programs or control plans in which companion animals must be included.

Active Surveillance of Antimicrobial Resistance and Carbapenemase-Encoding Genes According to Sites of Care and Age Groups in Mexico: Results from the INVIFAR Network.

We analyzed the antimicrobial resistance (AMR) data of 6519 clinical isolates of Escherichia coli (n = 3985), Klebsiella pneumoniae (n = 775), Acinetobacter baumannii (n = 163), Pseudomonas aeruginosa (n = 781), Enterococcus faecium (n = 124), and Staphylococcus aureus (n = 691) from 43 centers in Mexico. AMR assays were performed using commercial microdilution systems (37/43) and the disk diffusion susceptibility method (6/43). The presence of carbapenemase-encoding genes was assessed using PCR. Data from centers regarding site of care, patient age, and clinical specimen were collected. According to the site of care, the highest AMR was observed in E. coli, K. pneumoniae, and P. aeruginosa isolates from ICU patients. In contrast, in A. baumannii, higher AMR was observed in isolates from hospitalized non-ICU patients. According to age group, the highest AMR was observed in the ≥60 years age group for E. coli, E. faecium, and S. aureus, and in the 19-59 years age group for A. baumannii and P. aeruginosa. According to clinical specimen type, a higher AMR was observed in E. coli, K. pneumoniae, and P. aeruginosa isolates from blood specimens. The most frequently detected carbapenemase-encoding gene in E. coli was blaNDM (84%).

Functions of potassium channels blocked by low micromolar 4-aminopyridine in the crayfish nervous system.

4-aminopyridine (4-AP) is a potassium channel blocker that has been used to treat patients with multiple sclerosis and Lambert-Eaton disease. The concentration of this drug in the blood of patients was estimated to be in low or submicromolar range. Animal studies have shown that 4-AP at such low concentration selectively blocks a subset of channels in Kv1 or Kv3 families. The crayfish opener neuromuscular junction and ventral superficial flexor (VSF) preparations were used to examine functions of K+ channels blocked by low concentrations of 4-AP. At opener motor axons, intracellular recordings show that 4-AP could increase action potential (AP) amplitude, duration, and after-depolarization (ADP) at 10 µM. As 4-AP concentration was increased, in twofold steps, AP amplitude did not increase further up to 5 mM. AP duration and ADP increased significantly mainly in two concentration ranges, 10-50 µM and 1-5 mM. The effects of 50 µM 4-AP on the VSF were less consistent than that observed at the opener motor axons. 4-AP did not change AP amplitude of motor axons recorded with an extracellular electrode and change in AP repolarizing potential was observed in ∼25% of the axons. EPSP recorded simultaneously with AP showed an increase in amplitude with 4-AP treatment only in 30% of the axon-EPSP pairs. 4-AP also increased firing frequencies of ∼50% of axons. In four animals, 4-AP "awakened" the firing of APs from an axon that was silent before the drug. The mixture of positive and negative 4-AP effects summarized above was observed in the same VSF preparations in all cases (n = 8). We propose that there is a significant diversity in the density 4-AP-sensitive potassium channels among motor axons of the VSF. Functional significance in the differences of 4-AP sensitivity of the two motor systems is discussed.

[Quality care in an intensive therapy unit at private hospital]. / Calidad de atención en una unidad de terapia intensiva del sector privado.

BACKGROUND: The aim of this article is to evaluate the quality of care in intensive care, with international quality indices. METHODS: It was a descriptive study in an intensive care private care in Mexico. 2012 indicators are analyzed in a total of 446 hospital patients. The quality indicators were in line with international recommendations. The severity was determined by the scale SAPS III. RESULTS: Indicator of ventilation associated pneumonia was below the recommended standard (11.7 vs. 12 per thousand), bacteremia related central venous catheter in accepted ranges (5.7 vs. 4 per thousand). The ulcer prophylaxis, prevention of pulmonary embolism and prevention of falls in high compliance proportions (> 90, > 95 % and 0 falls). The rates of unplanned extubation and re-intubation below indicators (< 1 per thousand days intubation and < 12 %). While indicators varied by classification of severity of the condition, the goals were met. Mortality was lower than that estimated by gravity. CONCLUSION: In this therapy the implementation of internationally recommended actions has helped maintain an adequate quality of care. The effort has impacted not only the patients with acute conditions of admission, but also patients with high mortality or Hazard.

Introducción: el objetivo es evaluar la calidad de la atención en una unidad de terapia intensiva con índices internacionales de calidad. Métodos: estudio descriptivo, en una unidad de cuidados intensivos de atención privada en México. Se analizan los indicadores de 2012 con un total de 446 pacientes hospitalizados. Los indicadores de calidad fueron acordes a recomendaciones internacionales. La gravedad fue determinada por la escala SAPS III. Resultados: el indicador de neumonías asociadas a ventilación se encontró por debajo del estándar recomendado (11.7 frente a 12 por mil); la bacteremia relacionada a catéter venoso central en rangos aceptados (5.7 frente a 4 por mil). Las acciones de profilaxis de úlceras, prevención de tromboembolia pulmonar y prevención de caídas en altas proporciones de cumplimiento (> 90, > 95 % y 0 caídas). Las tasas de extubación no programada y reintubaciones estuvieron por debajo de los indicadores (< 1 por mil días intubación y < 12 %). La mortalidad fue menor a la estimada por la gravedad. Conclusión: En esta terapia la implementación de acciones recomendadas a nivel internacional ha permitido mantener una adecuada calidad de atención. El esfuerzo a impactado no solo a los pacientes con condiciones agudas de ingreso, sino también a pacientes con alto riesgo de mortalidad.

A importância da Família Participante para acompanhantes e idosos hospitalizados: A atuação do enfermeiro / The importance of Family Participant for caregivers of elderly hospitalized patients: Role of the nurse

O artigo é um trabalho de pesquisa, realizado graças à experiência vivida no Programa de Aprimoramento Profissional/PAP em Atendimento Interdisciplinar em Gerontologia e Geriatria, no Hospital Servidor Público Estadual de São Paulo. Nesta pesquisa verificou-se a importância do projeto intitulado “Família Participante”, no qual se identificou a importância desta atividade para os acompanhantes dos idosos hospitalizados, a partir da melhora da interação entre a equipe interdisciplinar, a equipe de enfermagem e os acompanhantes.(AU)

This article it’s a research conducted from an experience made on “Professional Development Program of Interdisciplinary Approach in Gerontology and Geriatrics” at Hospital Servidor Público Estadual de São Paulo. Based on this research, it was possible to realize the relevance of the project “Família Participante” (Participating Family) and the importance of the project, with the respective activities, to the caretaker of the elderlies, like the improvement of the interaction between interdisciplinary team, nurse staff an caretakers.(AU)

A importância da Família Participante para acompanhantes e idosos hospitalizados: A atuação do enfermeiro / The importance of Family Participant for caregivers of elderly hospitalized patients: Role of the nurse

O artigo é um trabalho de pesquisa, realizado graças à experiência vivida no Programa de Aprimoramento Profissional/PAP em Atendimento Interdisciplinar em Gerontologia e Geriatria, no Hospital Servidor Público Estadual de São Paulo. Nesta pesquisa verificou-se a importância do projeto intitulado “Família Participante”, no qual se identificou a importância desta atividade para os acompanhantes dos idosos hospitalizados, a partir da melhora da interação entre a equipe interdisciplinar, a equipe de enfermagem e os acompanhantes...

This article it’s a research conducted from an experience made on “Professional Development Program of Interdisciplinary Approach in Gerontology and Geriatrics” at Hospital Servidor Público Estadual de São Paulo. Based on this research, it was possible to realize the relevance of the project “Família Participante” (Participating Family) and the importance of the project, with the respective activities, to the caretaker of the elderlies, like the improvement of the interaction between interdisciplinary team, nurse staff an caretakers...

Trichosporon species isolated from the perigenital region, urine and catheters of a Brazilian population

The present study aimed to 1) determine the colonization rates of medically important Trichosporon species on normal perigenital skin and 2) determine the isolation rates of Trichosporon spp. isolated from the urine and catheters of Brazilian patients hospitalized in the Intensive Care Unit (ICU). The overall colonization rate of Trichosporon spp. was 11.15 percent (112 isolates). The most common species isolated from normal perigenital skin was T. cutaneum (29.46 percent), followed by T. asteroides (20.53 percent), T. ovoides (15.17 percent), T. inkin (10.71 percent), T. mucoides (8.92 percent), and T. asahii (6.25 percent). From urine and catheters, T. asahii was the species most commonly isolated (76.5 percent; n =23), followed by T. inkin (16.6 percent; n = 5) and T. asteroides (6.6 percent; n = 2). In addition, the highest isolation rate occurred in subjects in the 71- to 80-year-old age range (36.7 percent; n= 11), followed by 61 to 70 (26.7 percent; n = 8), 51 to 60 (13.3 percent; n = 4), 31 to 40 (13.33 percent; n = 4), and 41 to 50 (10 percent; n =3). We concluded that 6 medically important species of the genus Trichosporon colonize the perigenital region in a normal population. The identification of these species is possible by means of classical methods but often requires repeated analyses repetitions due to difficulties in the assimilation process. In contrast, only 3 species of Trichosporon were isolated from urine and catheters.

Corneal volume, pachymetry, and correlation of anterior and posterior corneal shape in subclinical and different stages of clinical keratoconus.

PURPOSE: To evaluate the corneal volume, pachymetry, and correlation of anterior and posterior corneal shape in subclinical and clinical keratoconus. SETTING: Vissum Corporation, Alicante, Spain. METHODS: Eyes were placed into 1 of 4 groups as follows: keratoconus 2 (grade II), keratoconus 1 (grade I), subclinical (subclinical keratoconus), and control (normal eyes). All eyes had an ophthalmologic examination including corneal evaluation (curvature, elevation, asphericity, pachymetry, corneal volume) by rotating Scheimpflug imaging (Pentacam). The posterior-anterior corneal power ratio was also calculated. RESULTS: Seventy-one eyes (51 patients; aged 16 to 64 years) were evaluated. Astigmatism and keratometry of both corneal surfaces were statistically significantly higher in the keratoconus 1 and 2 groups (Por=-0.81) was found between anterior and posterior curvature in the normal and subclinical groups; the correlation was weaker in clinical keratoconus cases (ror=0.81). The posterior-anterior corneal power ratio was significantly higher in the keratoconus 2 group than in the other groups (P

Clinical comparison of two Mexican coccidioidins.

Coccidioidin, an extract from the saprophytic mycelial form of Coccidioides spp., has been a very useful antigen preparation both for skin and serological tests for coccidioidomycosis. Unfortunately, coccidioidin is not currently available for skin testing in the United States. Coccidioidin has been produced commercially in Mexico by a vaccine and reagents laboratory of the Mexican Federal Government. It also has been produced at the Microbiology Laboratory of the Faculty of Medicine, Universidad Nacional Autónoma de México exclusively as an antigen for research projects. The objective of the study was to compare both coccidioidins in their reactivity and safety when applied in humans. One hundred and eighty-four volunteers were tested; median age was 33 (range 14-82). When the cutoff point is set in 5 mm, 88 subjects (47.8%) had a positive test for the commercial coccidioidin and 76 (41.3%; CI(95%) 0.50, 1.15; P = 0.20) were positive with the research antigen. Seventy-five subjects were positive for both antigens and 96 were negative for both. Fifty-nine subjects (31.3%) reported an adverse reaction after the application of the antigen; they were mostly very mild local reactions. Mexican research coccidioidin is a safe and reliable antigen that can be used for the detection of coccidioidomycosis infection in mammals.

Trichosporon species isolated from the perigenital region, urine and catheters of a brazilian population.

The present study aimed to 1) determine the colonization rates of medically important Trichosporon species on normal perigenital skin and 2) determine the isolation rates of Trichosporon spp. isolated from the urine and catheters of Brazilian patients hospitalized in the Intensive Care Unit (ICU). The overall colonization rate of Trichosporon spp. was 11.15% (112 isolates). The most common species isolated from normal perigenital skin was T. cutaneum (29.46%), followed by T. asteroides (20.53%), T. ovoides (15.17%), T. inkin (10.71%), T. mucoides (8.92%), and T. asahii (6.25%). From urine and catheters, T. asahii was the species most commonly isolated (76.5%; n =23), followed by T. inkin (16.6%; n = 5) and T. asteroides (6.6%; n = 2). In addition, the highest isolation rate occurred in subjects in the 71- to 80-year-old age range (36.7%; n= 11), followed by 61 to 70 (26.7%; n = 8), 51 to 60 (13.3%; n = 4), 31 to 40 (13.33%; n = 4), and 41 to 50 (10%; n =3). We concluded that 6 medically important species of the genus Trichosporon colonize the perigenital region in a normal population. The identification of these species is possible by means of classical methods but often requires repeated analyses repetitions due to difficulties in the assimilation process. In contrast, only 3 species of Trichosporon were isolated from urine and catheters.

Corneal tattooing (keratopigmentation) with new mineral micronised pigments to restore cosmetic appearance in severely impaired eyes.

AIM: To investigate keratopigmentation (KTP) with new mineral micronised pigments as a surgical alternative to improve cosmetic appearance in severely impaired eyes. METHODS: 40 eyes underwent KTP alternatively to invasive cosmetic reconstructive surgery. Corneal staining with mineral micronised pigments was performed using an intralamellar or superficial technique. RESULTS: One year postoperatively, all but two patients (95%) were satisfied. Pigmented eyes were improving patient's appearance. Eight cases needed a second KTP. Two patients with preoperative corneal oedema did not obtain an adequate cosmetic appearance due to progressive pigment clearance observed from 6 months postoperatively. Three eyes with traumatic aniridia observed good cosmetic outcome and a significant reduction in glare. CONCLUSIONS: KTP achieves good cosmetic results and is associated with high patient satisfaction, avoiding extensive and mutilating reconstructive surgery.

Pentacam posterior and anterior corneal aberrations in normal and keratoconic eyes.

PURPOSE: The aim was to evaluate the anterior and posterior corneal aberrations provided by the Pentacam system in normal and early to moderate keratoconic eyes. METHODS: Fifteen normal eyes (normal group, mean age 32.60 +/- 7.45 years) and 15 eyes with the diagnosis of keratoconus (keratoconus group, mean age 29.07 +/- 8.66 years) were included in this study. All eyes received a comprehensive ophthalmologic examination including corneal topographic analysis with the Pentacam system. Keratometric, best-fit sphere and corneal aberrometric data were recorded and analysed. Root mean square values (RMS) were calculated for primary coma and coma-like aberrations. RESULTS: Statistically significant differences were found in all anterior aberrometric parameters (all p < 0.02), except for horizontal primary and secondary coma Zernike terms (p = 0.61 and 0.72). Regarding posterior corneal surface, statistically significant differences among groups were found in primary spherical aberration, primary vertical coma, coma RMS and coma-like RMS (all p < 0.01). In the normal group significantly higher levels of primary vertical coma, spherical aberration, coma and coma-like RMS were found for the posterior corneal surface (all p < 0.04). In the keratoconus group, only significant differences among anterior and posterior corneal surfaces were found in coma RMS, coma-like RMS and vertical coma (all p < 0.01). These higher levels of aberrations for the posterior corneal surface do not agree with the theoretical optical properties of this surface. CONCLUSIONS: With the Pentacam system, higher levels of vertical coma, primary coma and coma-like aberrations are present in keratoconic eyes compared to normal eyes. The values provided by this device for posterior corneal aberrations are erroneous.

Difficult vertical diplopia studied by video-oculography in aphakia after contact lens use. A case report.

PURPOSE: To establish the utility of a video-oculography system (3D-VOG) in the diagnosis of a patient with difficult idiopathic vertical diplopia. CASE REPORT: We present a clinical case of an 87 year old female who was operated for glaucoma and cataract with the intracapsular technique in both eyes. She reported vertical diplopia with the use of contact lenses but not while using her aphakia spectacles. A complete ophthalmological study was carried out with special interest in the ocular motility study with 3D-VOG. RESULTS: Besides the hypertropia in lateroversion of the non-fixing eye, the video-oculography showed an incyclotorsion of the hypertropic eye, a fundamental factor for the differential diagnosis between bilateral superior oblique overaction and DVD or dissociated vertical divergence. Such a torsional strabismic deviation is very difficult to detail by other methods and is the important clue for diagnosis. The 3D-VOG made this diagnosis possible. CONCLUSIONS: The occurrence of a vertical diplopia with use of contact lenses, and not with spectacles, is explained by the limitation of ocular gaze movements with the aphakia spectacles which limitation is not found with the use of contact lenses, with diplopia appearing in the more extreme lateroversion possible with the contact lenses. The 3D-VOG system enabled us to analyze torsional movements in lateroversion that allowed the diagnosis of bilateral superior oblique overaction to be made.

Tratamento reabilitador em um paciente com bruxismo severo / Rehabilitation treatment in a patient with severe bruxism

Este trabalho é o relato de um caso de bruxismo severo, com desgastes e perdas dentais, além do envolvimento de doença periodontal, que ocasionaram uma dimensão de oclusão reduzida e sintomatologia dolorosa. O paciente foi submetido a tratamento reabilitador, incluindo periondontia e prótese, com ênfase no restabelecimento da oclusão com adequada distribuição da força mastigatória. O tratamento foi realizado em 1 ano e 10 meses e mantém-se estável após 18 meses de conclusão

Estudo experimental de 36 projéteis de arma de fogo quanto à esterilizaçäo e possibilidade de carreamento de bactérias após disparo / Experimental study of 36 gunshots in terms of sterilization and possibility of bacteria transport after shooting

Os autores estudaram experimentalmente três grupos de 12 disparos de armas de fogo calibre 38. O grupo 1 utilizou muniçao comum sem nenhum preparo e serviu como controle; no grupo 2, provocou-se contaminaçao da muniçao com bactérias de E. coli e S. aureus padronizadas; e no grupo 3, utilizou-se muniçao comum, mas transfixando tecido contaminado pelas mesmas bactérias. Nos grupos 1 e 2, nao foi observado crescimento bacteriano em nenhum meio de cultura, fortalecendo a hipótese da esterilizaçao do projétil pelo disparo. No grupo 3, houve crescimento bacteriano tanto num meio de cultura sólido quanto num líquido, demonstrando que um projétil se contamina ao atravessar tecido contaminado, carreando bactérias no seu trajeto.

Histoplasmose clássica de foram disseminada em pacientes imunossuprimidos: relato de quatro casos / Dissminated form of histoplasmosis in imunosupressed pacients: repport of 4 cases

Säo apresentados quatro casos de histoplasmose clássica de forma disseminada em paciente imunossuprimidos. Num deles associada à doença de Hodgkin, nos demais à AIDS. É comentada a literatura brasileira pertinente

Hemoptise/s e síndrome de angústia respiratória aguda como expressöes clínicas dominantes no curso da leptospirose / Massive hemoptysis and adult respiratory distress syndrome like clinical manifestations in leptospirosis

Säo apresentados, a guisa de exemplos, três casos de leptospirose com manifestaçöes clínicas respiratórias e alteraçöes radiográficas e gasométricas compatíveis com envolvimento pulmonar importante. Em dois casos, episódios de hemoptises francas foram assinalados, fato näo raramente detectado na leptospirose e que confunde com freqüência o diagnóstico. Como a doença é endêmica, com elevada prevalência em nosso meio, decidimos mostrar algumas características, clínicas do envolvimento do aparelho respiratório, fazendo uma revisäo de alguns trabalhos sobre o tema