Diaphragmatic Ultrasound Predictors of High-Flow Nasal Cannula Therapeutic Failure in Critically Ill Patients With SARS-CoV-2 Pneumonia.

OBJECTIVES: High flow nasal cannula (HFNC) is frequently used in patients with acute respiratory failure, but there is limited evidence regarding predictors of therapeutic failure. The objective of this study was to assess diaphragmatic ultrasound criteria as predictors of failure to HFNC, defined as the need for orotracheal intubation or death. METHODS: Prospective cohort study including adult patients consecutively admitted to the critical care unit, from July 24 to October 20, 2020, with respiratory failure secondary to SARS-CoV-2 pneumonia who required HFNC. After 12 hours of HFNC initiation we measured ROX index (ratio of SpO2 /FiO2 to respiratory rate), excursion and diaphragmatic contraction speed (diaphragmatic excursion/inspiratory time) by ultrasound, both in supine and prone position. RESULTS: In total, 41 patients were analyzed, 25 succeeded and 16 failed HFNC therapy. At 12 hours, patients who succeeded HFNC therapy presented higher ROX index in supine position (9.8 [9.1-15.6] versus 5.4 [3.9-6.8], P < .01), and higher PaO2 /FiO2 ratio (186 [135-236] versus 117 [103-162] mmHg, P = .03). To predict therapeutic failure, the supine diaphragmatic contraction speed presented sensitivity of 89% and a specificity of 57%, while the ROX index presented a sensitivity of 92.8% and a specificity of 75%. CONCLUSIONS: Diaphragmatic contraction speed by ultrasound emerges as a diagnostic complement to clinical tools to predict HFNC success. Future studies should confirm these results.

Differential expression of heat shock protein genes in Rhipicephalus sanguineus (Acari: Ixodidae) exposed to temperature and humidity variations.

The brown dog tick (Rhipicephalus sanguineus), a well-recognized parasite that is an important vector of many pathogens, widely distributed in the world, can be found in dogs and many other host animals, including humans. However, the response of this species to climate changes is not fully understood yet. Therefore, this study aimed to analyze the expression of the genes encoding for hsp20 and hsp70 of nymphs and eggs of R. sanguineus in response to different relative humidity and temperature. While no significant differences were observed in hsp70 levels in nymphs, striking variations were found for hsp20. On the contrary, significant differences were found on the expression levels of both HSPs when exposed at different treatments. Expression of hsp20 was more affected by relative humidity than by temperature, which could imply that hsp20 may have a more critical protective role during vulnerable developmental stages of the tick than hsp70.

Salmonella serovars and antimicrobial resistance in strains isolated from wild animals in captivity in Sinaloa, Mexico.

The aim of the present study was to evaluate the frequency of antibiotic resistance in Salmonella spp. strains from wild animals in captivity at the Culiacan Zoo and the Mazatlan Aquarium in Sinaloa, Mexico. We identified 17 different Salmonella enterica serovars at a prevalence of 19.90% (Culiacan Zoo) and 6.25% (Mazatlan Aquarium). Antibiotic sensitivity tests revealed that, of the 83 strains studied, 100% were multidrug resistant (MDR). The drugs against which the greatest resistance was observed were: penicillin, erythromycin, dicloxacillin, ampicillin, cephalothin, and chloramphenicol. We therefore conclude that MDR is common among Salmonella isolates originating from wild animals in captivity in Sinaloa.

Caldesmon: new insights for diagnosing endometriosis.

Considerable effort has been invested in searching for less invasive methods of diagnosing endometriosis. Previous studies have indicated altered levels of the CALD1 gene (encoding the protein caldesmon) in endometriosis. The aims of our study were to investigate whether average CALD1 expression and caldesmon protein levels are differentially altered in the endometrium and endometriotic lesions and to evaluate the performance of the CALD1 gene and caldesmon protein as potential biomarkers for endometriosis. Paired biopsies of endometrial tissue (eutopic endometrium) and endometriotic lesions (ectopic endometrium) were obtained from patients with endometriosis to evaluate CALD1 gene expression and caldesmon protein levels by real-time PCR and Western blot analysis, respectively. In addition, immunostaining for caldesmon to determine cellular localization was also performed. Endometrium from women without endometriosis was used as a control. Increased CALD1 expression and caldesmon levels were detected in the endometriotic lesions. The electrophoretic profile of caldesmon by Western blot analysis was clearly different between the control group (endometrium of women without endometriosis) and the group of women with endometriosis (eutopic endometrium and endometriotic lesions). Caldesmon expression as determined by immunostaining showed no variation among the cell types in endometriotic lesions and eutopic endometrium. Stromal cells marked positively in eutopic endometrium from control patients and in the endometriotic lesions. The presence of caldesmon in the endometrium of patients with and without endometriosis permitted diagnoses with 95% sensitivity (specificity 100%) and 100% sensitivity (specificity 100%) for the disease and for minimal to mild endometriosis in the proliferative phase of the menstrual cycle, respectively. In the secretory phase, minimal to mild endometriosis was detected with 90% sensitivity and 93.3% specificity. Caldesmon is a possible predictor of endometrial dysregulation in patients with endometriosis. A potential limitation of our study is the fact that other endometrial diseases were not excluded, and therefore prospective studies are needed to confirm the potential of caldesmon as a biomarker exclusively for endometriosis.

5% lidocaine medicated plaster use in children with neuropathic pain from burn sequelae.

OBJECTIVE: Neuropathic pain is a challenge in children with burn sequelae. Although relatively infrequent, the intensity and chronicity of neuropathic pain negatively impact functionality and quality of life. The use of 5% lidocaine medicated plaster has not previously been reported in children. We explored the effectiveness and safety of 5% lidocaine medicated plaster to treat neuropathic pain in children with burn sequelae. DESIGN: Three-month prospective, uncontrolled study. SETTING: Corporation of Aid to Burned Children (COANIQUEM), a nonprofit pediatric burn rehabilitation center in Chile. SUBJECTS: Fourteen pediatric patients with burn sequelae neuropathic pain. OUTCOME MEASURES: Demographics, burn and pain evolution (type, intensity [using Wong-Baker FACES], and Douleur Neuropathique 4 [DN4]), and patient functionality. Plasma lidocaine levels were measured at 0, 12, 36, and 60 hours after treatment commencement. RESULTS: Fourteen patients were evaluable for plasma lidocaine levels. Twelve patients were available for clinical assessment (two patients lost to follow-up) [mean (standard deviation)]: age, 11 years 7 months (2 years 6 months); weight, 45 kg (11.9 kg); burn evolution, 5 years 6 months (4 years); time between burn and pain onset, 3 years 6 months (3 years 2 months); time between pain onset and treatment, 5.1 months (4.8 months); lidocaine, between < and ½ plaster; initial pain intensity (FACES), 6.8 (1.6); final pain intensity, 0 in 11/12 patients; DN4, initial-6, final-2.3. All patients reported improved functionality. Plasma lidocaine levels were ≤27.45 ng/mL (>180 times below critical levels). No adverse reactions occurred. CONCLUSIONS: These are the first published data suggesting that 5% lidocaine medicated plaster improves patient functionality, and is effective and safe for the treatment of neuropathic pain in pediatric patients with burn sequelae.

Cranberry impairs selected behaviors essential for virulence in Proteus mirabilis HI4320.

Proteus mirabilis is an etiological agent of complicated urinary tract infections. North American cranberries (Vaccinium macrocarpon) have long been considered to have protective properties against urinary tract infections. This work reports the effects of cranberry powder (CP) on the motility of P. mirabilis HI4320 and its expression of flaA, flhD, and ureD. Our results show that swimming and swarming motilities and swarmer-cell differentiation were inhibited by CP. Additionally, transcription of the flagellin gene flaA and of flhD, the first gene of the flagellar master operon flhDC, decreased during exposure of P. mirabilis to various concentrations of CP. Moreover, using ureD-gfp, a fusion of the urease accessory gene ureD with gfp, we show that CP inhibits urease expression. Because we demonstrate that CP does not inhibit the growth of P. mirabilis, the observed effects are not attributable to toxicity. Taken together, our results demonstrate that CP hinders motility of P. mirabilis and reduces the expression of important virulence factors.

Prevalence of Salmonella enterica serovar Albany in captive zoo wild animals in the Culiacán Zoo in Mexico.

Salmonellosis is an important zoonotic disease but little is known about the role that free-living animals play as carriers of this pathogen. Moreover, the primary route of infection in the wild needs to be elucidated. The aim of this study was to determine the source and the route of transmission of Salmonella enterica serovar Albany (S. Albany) infection in captive zoo wild animals in the Culiacán Zoo. A total of 267 samples were analyzed including 220 fecal samples from zoo animals, 15 fecal samples from rodents, 5 pooled samples each of two insects (Musca domestica and Periplaneta americana), and 22 samples of animal feed. We detected S. Albany in 28 (10.5%) of the samples analyzed, including in samples from raw chicken meat. Characterization of isolates was performed by serotyping and pulsed-field gel electrophoresis. All isolates shared a single pulsed-field gel electrophoresis profile, indicating a possible common origin. These data suggest that the infected meat consumed by the wild felines was the primary source of infection in this zoo. It is likely that the pathogen was shed in the feces and disseminated by insects and rats to other locations in the zoo.

Serologic Profile of Donors In Argentina.

BACKGROUND: Constructing serologic profiles of donors is the first step in establishing traceability in the donation and transplant process. These data allow us to implement various strategies to enhance the recipients' quality of care. We present the serologic profiles of donors in Argentina between 2017 and 2021. METHODS: Donation processes initiated in 2017 to 2021 and registered in the National Information System of Procurement and Transplantation of the Argentine Republic were selected. The presence of complete serologic studies was considered an inclusion criterion. The serologic variables for viruses included HIV, human T-cell lymphotropic virus (HTLV), cytomegalovirus (CMV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Those for bacteria included Treponema pallidum and the genus Brucella, and those for parasites included Trypanosoma cruzi and Toxoplasma gondii. RESULTS: A total of 18,242 processes were initiated in the period 2017 to 2021. A total of 6015 processes had documented complete serologic studies. Most donors came from 2 jurisdictions: Buenos Aires (27.72%) and CABA (15.13%). Cytomegalovirus (84.70%) and T. gondii (40.94%) were the most prevalent serologies. We identified 0.25% reactive serologies for HIV, 0.24% for HTLV, 0.79% for HCV, and 2.49% for T. pallidum. In reference to HBV markers, 0.19% of donors presented Ag HBs, and the Ac HBc + Ac HBs association was observed in 2.31% of donors. Reactive serology for brucellosis was demonstrated in 1.11% of donors. Reactive serology for Chagas disease was found in 0.9% of donors. CONCLUSIONS: Given the wide variation in seroprevalence in the different jurisdictions of the country, the jurisdictional and national levels of government should be responsible for monitoring changes in behavior that require modification of selection and prevention strategies.

Inhibition of Escherichia coli CFT073 fliC expression and motility by cranberry materials.

In humans, uropathogenic Escherichia coli (UPEC) is the most common etiological agent of uncomplicated urinary tract infections (UTIs). Cranberry extracts have been linked to the prevention of UTIs for over a century; however, a mechanistic understanding of the way in which cranberry derivatives prevent bacterial infection is still lacking. In this study, we used a fliC-lux reporter as well as quantitative reverse transcription-PCR to demonstrate that when UPEC strain CFT073 was grown or exposed to dehydrated, crushed cranberries or to purified cranberry-derived proanthocyanidins (cPACs), expression of the flagellin gene (fliC) was inhibited. In agreement with these results, transmission electron microscopy imaging of bacteria grown in the presence of cranberry materials revealed fewer flagella than those in bacteria grown under control conditions. Furthermore, we showed that swimming and swarming motilities were hindered when bacteria were grown in the presence of the cranberry compounds. Because flagellum-mediated motility has been suggested to enable UPEC to disseminate to the upper urinary tract, we propose that inhibition of flagellum-mediated motility might be a key mechanism by which cPACs prevent UTIs. This is the first report to show that cranberry compounds inhibit UPEC motility via downregulation of the fliC gene. Further studies are required to establish whether these inhibitors play a role in vivo.

Induction of a state of iron limitation in uropathogenic Escherichia coli CFT073 by cranberry-derived proanthocyanidins as revealed by microarray analysis.

Transcriptional profiles of uropathogenic Escherichia coli CFT073 exposed to cranberry-derived proanthocyanidins (PACs) were determined. Our results indicate that bacteria grown on media supplemented with PACs were iron deprived. To our knowledge, this is the first time that PACs have been shown to induce a state of iron limitation in this bacterium.

Identification of Critical Residues in the Carboxy Terminus of the Dopamine Transporter Involved in the G Protein ßγ-Induced Dopamine Efflux.

The dopamine transporter (DAT) plays a crucial role in the regulation of brain dopamine (DA) homeostasis through the re-uptake of DA back into the presynaptic terminal. In addition to re-uptake, DAT is also able to release DA through a process referred to as DAT-mediated DA efflux. This is the mechanism by which potent and highly addictive psychostimulants, such as amphetamine (AMPH) and its analogues, increase extracellular DA levels in motivational and reward areas of the brain. Recently, we discovered that G protein ßγ subunits (Gßγ) binds to the DAT, and that activation of Gßγ results in DAT-mediated efflux - a similar mechanism as AMPH. Previously, we have shown that Gßγ binds directly to a stretch of 15 residues within the intracellular carboxy terminus of DAT (residues 582-596). Additionally, a TAT peptide containing residues 582 to 596 of DAT was able to block the Gßγ-induced DA efflux through DAT. Here, we use a combination of computational biology, mutagenesis, biochemical, and functional assays to identify the amino acid residues within the 582-596 sequence of the DAT carboxy terminus involved in the DAT-Gßγ interaction and Gßγ-induced DA efflux. Our in-silico protein-protein docking analysis predicted the importance of F587 and R588 residues in a network of interactions with residues in Gßγ. In addition, we observed that mutating R588 to alanine residue resulted in a mutant DAT which exhibited attenuated DA efflux induced by Gßγ activation. We demonstrate that R588, and to a lesser extent F5837, located within the carboxy terminus of DAT play a critical role in the DAT-Gßγ physical interaction and promotion of DA efflux. These results identify a potential new pharmacological target for the treatment of neuropsychiatric conditions in which DAT functionality is implicated including ADHD and substance use disorder.

Molecular Detection of Leishmania (L.) mexicana (Kinetoplastida: Trypanostomatidae) DNA in Culicoides furens (Diptera: Ceratopogonidae) from an Area with Autochthonous Canine Leishmaniasis in Northwestern Mexico.

PURPOSE: Mexico is considered endemic for Leishmania; recent reports indicate autochthonous human and canine leishmaniasis caused by Leishmania mexicana in Sinaloa state. Lutzomyia sand fly are the primary vector of the parasite, although no records of phlebotomine vectors of Leishmania exist from Sinaloa. Other hematophagous dipterans, like Culicoides, could represent possible vectors of Leishmania in absence of phlebotomines. The known distribution of Culicoides includes the southern portion of Sinaloa state, in northwestern Mexico, with records of Culicoides furens. However, no studies have demonstrated the presence of Leishmania in C. furens or its possible participation in the parasite's life cycle in Mexico. This study, therefore, sought to detect DNA of Leishmania in C. furens captured in an endemic area of autochthonous canine leishmaniasis in northwestern Mexico. METHODS: Culicoides were captured with CDC light traps, identified morphologically, and organized in pools. DNA was extracted, and used to amplify the ribosomal ITS1 region of Leishmania. PCR products were digested with HaeIII endonuclease; the banding patterns obtained were compared to reference strains. RESULTS: Leishmania mexicana DNA was detected in five out of nine pools (55%) of female C. furens. CONCLUSION: This study offers the first evidence of L. mexicana DNA in C. furens, in an endemic area of canine leishmaniasis in northwestern Mexico, where no evidence exists of the presence of phlebotomine sand fly.

Curli produced by Escherichia coli PHL628 provide protection from Hg(II).

The role of curli, amyloid extracellular fibers, in the tolerance of Escherichia coli PHL628 to Hg(II) was examined. Our findings indicate that by sorbing Hg(II) extracellularly, curli protect the cells. To our knowledge, this is the first time a protective role of curli against toxic metals has been demonstrated.

10 Years of Implementation of the "Glasgow 7" Quality Guarantee Program in the Mendoza Central Hospital: Epidemiology and Evolution of Neurocrytic Patients.

INTRODUCTION: In 2003, the Glasgow 7 Quality Guarantee Program was put into effect in Argentina with the objective of standardizing the donation and transplant process throughout the country, establishing the observation and registration of all neurocritical patients with a score on the Glasgow Coma Scale of 7 of 15 or less admitted to critical beds of selected establishments. MATERIALS AND METHODS: The following study is retrospective, observational, and cohort-based. It was developed in the Central Hospital of Mendoza, in the critical units, including guard, coronary, cardiovascular surgery recovery, and intensive care therapy. The inclusion criteria were admission to the institution with a score on the Glasgow Coma Scale of 7 or less with a structural cause of coma. Data collection was carried out in the national online database SINTRA. RESULTS: From January 1, 2008, to December 31, 2018, 1757 patients were enrolled at the Central Hospital of Mendoza, Argentina with Glasgow scores of 7 or less. The most frequent cause of coma was brain trauma (934 patients; 53%), followed by stroke (614 patients; 35%). Of those who scored 3 of 15 in the GCS upon admission, 65% progressed to brain death, whereas 72% of those who scored 7 were discharged. Of all these patients, 270 became donors, accounting for 43% of all brain deaths, whereas 187 had refused to become organ donors (30.6%). Of the total real donors, 55% were multiorganic (150 donors).

Functional tomographic fluorescence imaging of pH microenvironments in microbial biofilms by use of silica nanoparticle sensors.

Attached bacterial communities can generate three-dimensional (3D) physicochemical gradients that create microenvironments where local conditions are substantially different from those in the surrounding solution. Given their ubiquity in nature and their impacts on issues ranging from water quality to human health, better tools for understanding biofilms and the gradients they create are needed. Here we demonstrate the use of functional tomographic imaging via confocal fluorescence microscopy of ratiometric core-shell silica nanoparticle sensors (C dot sensors) to study the morphology and temporal evolution of pH microenvironments in axenic Escherichia coli PHL628 and mixed-culture wastewater biofilms. Testing of 70-, 30-, and 10-nm-diameter sensor particles reveals a critical size for homogeneous biofilm staining, with only the 10-nm-diameter particles capable of successfully generating high-resolution maps of biofilm pH and distinct local heterogeneities. Our measurements revealed pH values that ranged from 5 to >7, confirming the heterogeneity of the pH profiles within these biofilms. pH was also analyzed following glucose addition to both suspended and attached cultures. In both cases, the pH became more acidic, likely due to glucose metabolism causing the release of tricarboxylic acid cycle acids and CO(2). These studies demonstrate that the combination of 3D functional fluorescence imaging with well-designed nanoparticle sensors provides a powerful tool for in situ characterization of chemical microenvironments in complex biofilms.

Puesta en marcha de erradicación de la EPOC. Programa Multidisciplinario de Prevención, Diagnóstico y Manejo de la Pre-EPOC / Implementation of a COPD Eradication Program. Multidisciplinary Program for Prevention, Diagnosis, and Management of Pre-COPD

La enfermedad pulmonar obstructiva crónica por definición es prevenible, sin embargo, aún faltan gestos para alcanzar este objetivo. Su carácter heterogéneo es uno de los principales obstáculos y retos. Al respecto, los factores de riesgo de enfermedad pulmonar obstructiva crónica están evolucionando, más allá del fumar. La espirometría a pesar de su precisión en el diagnóstico de la enfermedad pulmonar obstructiva crónica, no es sensible para identificar individuos de riesgo, por lo que se requiere de un nuevo abordaje de medicina de precisión en la salud pulmonar. Por esta razón, lanzamos una unidad multidisciplinaria de nuevos abordajes de prevención, predicción de riesgos, definición, diagnóstico y tratamientos que puedan generar cambios significativos. Los objetivos se focalizan en evitar el desarrollo de la enfermedad pulmonar obstructiva crónica a través de un nuevo enfoque en la asistencia médica del paciente en la etapa pre-enfermedad pulmonar obstructiva crónica, como así también en la investigación traslacional para el conocimiento de marcadores teragnósticos de la enfermedad(AU)

Chronic obstructive pulmonary disease (COPD) is preventable by definition; however, there are some steps that need to be taken in order to attain that goal. Its heterogeneous nature is one of the main obstacles and challenges. In this regard, the risk factors for COPD are evolving beyond smoking. Despite the precision of the spirometry in diagnosing COPD, it is not sensitive enough to identify individuals at risk, thus, a new approach is required for precision medicine in lung health. For that reason, we launched a Multidisciplinary Unit with new approaches to prevention, risk prediction, definition, diagnosis, and treatments that can make significant changes. The goals are focused on preventing the development of COPD through a new medical care approach intended for patients in the Pre-COPD stage, as well as translational research for understanding the theragnostic markers of the disease(AU)

Identification of bapA in Strains of Salmonella enterica subsp. enterica Isolated from Wild Animals Kept in Captivity in Sinaloa, Mexico.

bapA, previously named stm2689, encodes the BapA protein, which, along with cellulose and fimbriae, constitutes biofilms. Biofilms are communities of microorganisms that grow in a matrix of exopolysaccharides and may adhere to living tissues or inert surfaces. Biofilm formation is associated with the ability to persist in different environments, which contributes to the pathogenicity of several species. We analyzed the presence of bapA in 83 strains belonging to 17 serovars of Salmonella enterica subsp. enterica from wildlife in captivity at Culiacan's Zoo and Mazatlán's Aquarium. Each isolate amplified a product of 667 bp, which corresponds to the expected size of the bapA initiator, with no observed variation between different serovars analyzed. bapA gene was found to be highly conserved in Salmonella and can be targeted for the genus-specific detection of this organism from different sources. Since bapA expression improves bacterial proliferation outside of the host and facilitates resistance to disinfectants and desiccation, the survival of Salmonella in natural habitats may be favored. Thus, the risk of bacterial contamination from these animals is increased.

Médicos de Família e Cuidados Paliativos: contribuições ao currículo baseado em competências / Family Physicians and Palliative Care: contributions to the competency-based curriculum / Médicos de Familia y Cuidados Paliativos: contribuciones al currículo basado en competencias

O panorama epidemiológico atual mostra um aumento de doenças crônicas ameaçadoras à vida, tornando os Cuidados Paliativos essenciais à prática médica, em todos os níveis de atenção. O papel do médico de família na atenção primária à sáude motivou a Sociedade Brasileira de Medicina de Família e Comunidade a elaborar um currículo baseado em competências, que incluiu os Cuidados Paliativos. Ao analisar e discutir as competências em Cuidados Paliativos, os autores identificaram a necessidade de melhorias e propuseram competências novas e ampliadas. A revisão periódica do currículo deve contemplar as mudanças e avanços na prática do médico de família e atender às demandas de cuidado, incluindo levar Cuidados Paliativos a todos.

The current epidemiological panorama shows an increase in life-threatening chronic diseases. Consequently, palliative care becomes essential to medical practice at all levels of the healthcare system. The role of the family physician in primary health care has motivated the Brazilian Society of Family and Community Medicine to develop a competency-based curriculum, which includes Palliative Care. The authors analysed, discussed and identified the need for improvements in palliative care. Thus, they proposed new and expanded competencies in palliative care for Brazilian family physicians. Periodic review of the curriculum should contemplate changes and advances in family physician's practice and meet the demands of health, including palliative care to everybody in primary care.

El panorama epidemiológico actual muestra un aumento de enfermedades crónicas que amenazan la vida, haciendo que los cuidados paliativos sean esenciales a la práctica médica, en todos los niveles de atención. El papel del médico de familia en la atención primaria a la salud motivó a la Sociedad Brasileña de Medicina de Familia y Comunidad a desarrollar un currículo basado en competencias que incluía Cuidados Paliativos. Al analizar y discutir competencias en Cuidados Paliativos, los autores identificaron la necesidad de mejoras y propusieron nuevas y ampliadas competencias. La revisión periódica del currículo debe incluir cambios y avances en la práctica del médico de familia y atender las demandas de cuidados, incluso llevando los Cuidados Paliativos a todos.

Presentación atípica de púrpura de Schönlein-Henoch, a raíz de un caso / Atypical presentation of Henoch-Schönlein purpura. Regarding a clinical case

El Púrpura de Schonlein Henoch (PSH) corresponde a la vasculitis sistémica más común en la edad pediátrica, presentándose el 90% de los casos antes de los 10 años. Gran parte de los casos son precedidos por una infección respiratoria alta, sugiriendo un potencial gatillante infeccioso, sin embargo la causa subyacente aún se desconoce. El depósito de complejos inmunes IgA en distintas localizaciones lleva a las manifestaciones clínicas órgano especificas: púrpura palpable, artralgias, daño renal, dolor abdominal y otras formas de compromiso gastrointestinal, entre otras. La presencia de lesiones cutáneas constituye uno de los pilares diagnósticos de esta patología y la ausencia de éstas orienta el estudio a otros diagnósticos diferenciales. En cuanto al tratamiento, la mayoría de los casos cursan con buena evolución y resolución espontánea de los síntomas, reservándose el uso de glucocorticoides sistémicos para casos severos, obedeciendo al criterio del médico tratante al no existir guías de manejo específicas. Acontinuación se presentará el caso de una niña de 3 años con diagnóstico de PSH cuya manifestación inicial fue el compromiso gastrointestinal, presentando dolor abdominal y hemorragia digestiva baja previa a la aparición del rash cutáneo.

Henoch Schönlein purpura is a systemic vasculitis most commonly found in children, with 90% of cases detected in the under 10´s. Many cases are preceded by an upper respiratory tract infection which suggests a potential infectious trigger, however the underlying cause is not yet known. Deposition of IgAimmune complexes in different locations gives rise to the organ specific clinical signs: palpable purpura, arthralgias, kidney damage, abdominal pain and other forms of gastrointestinal involvement amongst others. The presence of cutaneous lesions is one of the diagnostic pillars of this pathology and its absence suggests other differential diagnoses. As regards treatment, most cases have a favorable clinical course with spontaneous resolution of symptoms, corticoid use being reserved for severe cases at the physician's discretion as there are no clinical guidelines. We present the case of a 3 year old girl with Henoch Schönlein purpura who originally presented with a gastrointestinal disorder with abdominal pain and lower gastrointestinal bleeding prior to the appearance of the rash.

Inhibition of bacterial motility and spreading via release of cranberry derived materials from silicone substrates.

The motility of bacteria plays a key role in their colonization of surfaces during infection. Derivatives of cranberry fruit have been shown to interfere with bacterial motility. Herein, we report on the incorporation of cranberry derived materials (CDMs) into silicone substrates with the aim of impairing bacterial pathogen motility and spreading on the substrate surface. The release of CDMs from the silicone substrates when soaking in an aqueous medium was quantified for a period of 24h. Next, we showed that CDMs released from two silicone substrates remain bioactive as they downregulate the expression of the flagellin gene of two key uropathogens - Escherichia coli CFT073 and Proteus mirabilis HI4320. Furthermore, we demonstrate that CDM-modified silicone inhibits the swarming motility of P. mirabilis, an aggressive swarmer. The bioactive, CDM-modified substrates can find broad applications in the medical device and food industries where the impairment of bacterial colonization of surfaces is of paramount importance.