Transferable mechanisms of quinolone resistance are more frequent among enterotoxigenic Escherichia coli isolates displaying low-level quinolone resistance

@#This study analysed the mechanisms of quinolone resistance among enterotoxigenic Escherichia coli (ETEC) in a periurban area of Lima, Peru. The susceptibility to nalidixic acid and ciprofloxacin, the role of Phe-Arg-b-Naphtylamyde inhibitable-(PAbN) efflux pumps, the presence of mutations in gyrA and parC as well as the presence of aac(6’)Ib-cr, qepA, qnrA, qnrB, qnrC, qnrD, qnrVC and oqxAB were determined in 31 ETEC from previous case/control studies of children’s diarrhoea. Discordances between disk diffusion, with all isolates showing intermediate or fully resistance to nalidixic acid, and minimal inhibitory concentration (MIC), with 7 isolates being below considered resistance breakpoint, were observed. Twenty-one isolates possessed gyrA mutations (19 S83L, 2 S83A). AAC(6’) Ib-cr, QnrS, QnrB and QepA were found in 7, 6, 2 and 1 isolates respectively, with 3 isolates presenting 2 transferable mechanisms of quinolone resistance (TMQR) concomitantly. TMQR were more frequent among isolates with MIC to nalidixic acid ranging from 2 to 16 mg/L (p=0.03), while gyrA mutations were more frequent among isolates with nalidixic acid MIC > 128 mg/L (p=0.0002). In summary, the mechanisms of quinolone resistance present in ETEC isolates in Peru have been described. Differences in the prevalence of underlying mechanisms associated with final MIC levels were observed. The results suggest two different evolutive strategies to survive in the presence of quinolones related to specific bacterial genetic background.

PRIMER REPORTE DE Cryptosporidium parvum EN TERNEROS HOLSTEIN (Bos taurus) DE MANIZALES, CALDAS, COLOMBIA / FIRST REPORT OF Cryptosporidium parvum IN HOLSTEIN CALVES (Bos taurus) FROM MANIZALES, CALDAS, COLOMBIA

El objetivo de este estudio fue identificar especies o genotipos del protozoario parásito Cryptosporidium presentes en heces colectadas de terneros Holstein del municipio de Manizales, Departamento de Caldas, Colombia. El ADN fue extraído a 80 muestras de materia fecal, de las cuales 11 fueron diagnosticadas positivas para Cryptosporidium spp., mediante reacción en cadena de la polimerasa (PCR). El análisis PCR-RFLP del locus 18S ADNr, identificó la presencia de Cryptosporidium parvum en todas las muestras positivas analizadas. Este hallazgo sugiere que el ganado puede ser una fuente potencial de infección por Cryptosporidium en humanos y se constituye en el primer reporte publicado de C. parvum en bovinos de Manizales, Caldas.

The objective of this study was to identify species or genotypes of Cryptosporidium parasite present in feces collected from Holstein calves in Manizales city, Caldas Department, Colombia. DNA was extracted from 80 fecal samples, which 11 were diagnosed positive for Cryptosporidium spp., by the Polymerase Chain Reaction method. PCR-RFLP analysis of 18S rDNA locus identified the presence of Cryptosporidium parvum in all samples tested positive. This finding suggests that cattle may be a potential source of human infection by Cryptosporidium, and it becomes the first published report of C. parvum in cattle in Manizales, Caldas.

Genotipificación y resistencia antibacteriana de cepas de Campylobacter spp aisladas en niños y en aves de corral / Genotyping and antibacterial resistance of Campylobacter spp strains isolated in children and in free range poultry

Poultry is a main reservoir and source of human infection in campylobacteriosis. Three hundred and forty one stool samples (291 human, 50 avian) were analyzed. In the human group, 220 samples were collected from children with acute diarrheal disease (183 inpatients, 37 outpatients) and 71 from healthy children. Erythromycin and ciprofloxacin agar dilution MIC tests, Penner serotyping and RAPD-PCR genotyping were performed on 23 strains isolated. C. jejuni was reported only in patients with acute diarrhea (5.4 percent inpatients, 2.2 percent outpatients). Campylobacter prevalence in poultry was 34 percent. Cross-resistance to nalidixic acid and ciprofloxacin was found in 33.3 percent of human samples and 11.8 percent of animal samples. Human samples could not be typed using the Penner method. F serotype was the most expressed in poultry. We obtained a total of 14 genotypes (4 / 5 human and 10/15 avian). In conclusion, the predominant species in poultry and humans was C. jejuni, a significant amount of quinolone-resistant human and avian samples were obtained, and avian genotypes and serotypes were not found in human samples. The latter would mean that another source of infection could exist; therefore other reservoirs must be studied.

Las aves de consumo constituyen uno de los principales reservorios y fuente de infección humana de la campilo-bacteriosis. Se analizaron 341 muestras de deposiciones, 291 humanas y 50 aviares. De las muestras, 220 de niños con síndrome diarreico agudo-SDA (183 hospitalizados y 37 consultantes ambulatorios) y 71 niños sanos. A las 23 cepas obtenidas se les realizó CIM por dilución en agar a eritromicina y ciprofloxacina, serotipificación de Penner y genotipiicación por RAPD-PCR. Se encontró Campylobacterjejuni sólo en pacientes con SDA, de ellos 5,4 por ciento ambulatorios y 2,2 por ciento hospitalizados. En aves, la prevalencia de Campylobacter spp., fue de 34 por ciento. Hubo resistencia cruzada a ácido nalidixico y ciprofloxacina en 33,3 por ciento cepas de origen humano y 11,8 por ciento animal. Las cepas humanas fueron no tipiicables por el método de Penner. Predominó entre las aves el serotipo F. Se obtuvo un total de 14 genotipos (4/5 humanos y 10/15 aviares). En conclusión, la especie predominante en aves de corral y en humanos fue C. jejuni, existiendo una alta prevalencia de cepas de origen humano y aviar resistentes a quinolonas. Los genotipos y serotipos aviares no fueron encontrados en cepas de origen humano, lo que indica que podría existir otra fuente de infección, por lo que se requiere estudiar otros reservorios.

Artificial cooling as an alternative to increase productivity and welfare of steers under heat stress / Resfriamento artificial como alternativa para aumentar o bem-estar de novilhos sob estresse térmico

The effects of a cooling system on productive efficiency and welfare of Holstein steers were evaluated during the summer. Sixty steers in the finishing phase were randomly allotted to one of two treatment-groups. Animals of control group were only provided with shade (non-cooled group) and a group of animals under a cooling system were installed in the shaded area (cooled group), which were operated daily from 09am to 6pm during the 69d of the study. The averages of environmental temperature and relative humidity were 35.4ºC and 35.3 percent, respectively, with a temperature-humidity index average of 81.4 during the study. Individual body weight was recorded every two weeks, while body surface temperature and respiratory frequency were recorded three times per week. Blood samples were biweekly taken from coccygeal vein for determination of T3 and T4. The average daily gain in the cooled group gain (1.46kg/d) was similar (P=0.21) to non-cooled group (1.37kg/d). Body surface temperature (35.9ºC vs 38.7ºC) and respiratory frequency per minute (77 vs 104) were lower (P<0.01) in the cooled group than in non-cooled group, respectively. Triiodotironine levels were similar (P=0.30) in cooled (0.80ng/mL) and non-cooled (0.87ng/mL) groups, while, tiroxine level was lower (P<0.01) in cooled group (44.0ng/mL) compared to non-cooled group (56.6ng/mL). The cooling system did not improve productive parameters but the welfare in the cooled group was increased.

Avaliou-se um sistema de resfriamento para aumentar a eficiência produtiva e o bem-estar de novilhos durante o verão. Utilizaram-se 60 animais em fase de acabamento, distribuídos aleatoriamente em dois grupos: os do grupo-controle permaneceram somente sob sombra (grupo não resfriado) e os do grupo sob sistema de resfriamento, sob área sombreada, diariamente, das 9 às 18h, durante 69 dias de estudo. As médias registradas de temperatura ambiente e umidade relativa foram 35,4ºC e 35,3ºC, respectivamente, com índice de temperatura-umidade de 81,4 durante o período de estudo. O peso individual foi anotado a cada duas semanas, e a temperatura da superfície corporal e a frequência respiratória foram registrados três vezes por semana. Amostras de sangue foram tomadas da veia coccígea duas vezes por semana para determinação de T3 e T4. O ganho médio diário no grupo sob resfriamento (1,46kg/dia) foi similar (P=0,21) ao do grupo-controle (1,37kg/dia). A temperatura da superfície corporal (35,9ºC versus 38,7ºC) e a frequência respiratória/minuto (77 versus 104) foram mais baixas (P<0,01) no grupo sob resfriamento do que no grupo-controle (P<0,01), respectivamente. Níveis de triiodotironina foram similares (P=0,30) em animais com resfriamento (0,80ng/mL) e sem resfriamento (0,87ng/mL), enquanto o nível de tiroxina foi mais baixo (P<0,01) no grupo com resfriamento (44,0ng/mL versus 56,6ng/mL). O sistema de resfriamento não afetou parâmetros produtivos, porém o bem-estar dos animais do grupo com resfriamento foi melhor.

Epidemiologia y etiología de la dacriocistitis aguda en el servicio de oftalmología del Hospital Guillermo Grant Benavente, Concepción: Chile / Epidemiology and etiology of acute dacryocystitis in the ophthalmology service of the Guillermo Grant Benavente Hospital, Concepcion. Chile

La Dacriocistitis Aguda (DA) consiste en una inflamación del saco lagrimal y conducto nasolagrimal, secundario a un proceso infeccioso mayoritariamente o a estenosis senil del conducto, traumatismos, tumores, sinusitis, conjuntivitis crónica y/o canaliculitis. Los grupos etarios más afectados son los lactantes y personas de edad avanzada, especialmente mujeres. Los agentes infecciosos más frecuentemente involucrados son Staphylococcus aureus y Streptococcus beta-hemolítico. Objetivos: Determinar la frecuencia de la patología, tiempo de hospitalización, la distribución por edad, la prevalencia por sexo de esta patología, tipo de tratamiento recibido por los pacientes. Metodología: los datos requeridos para el estudio se obtuvieron de la revisión de los antecedentes de hospitalización y de las fichas clínicas. Resultados: En un total de 1.870 hospitalizaciones oftalmológicas efectuadas entre Junio y Diciembre de 2007, 102 fueron por DA (5,5 por ciento). El 78 por ciento de estos era de sexo femenino y el mayor número de consultas se dieron en personas con edades entre los 70 y 79 años (33.3 por ciento). El 52.9 por ciento de los casos necesitó solo un día de hospitalización, recibiendo tratamiento sistémico el 15,7 por ciento de los pacientes que presentaba complicaciones o reagudización del cuadro. Conclusiones: El porcentaje de hospitalizaciones por DA constituye el 5,5 por ciento del total de hospitalizaciones por patologías oculares, la cual se manifiesta mayormente en mujeres adultas mayores, con hospitalizaciones de un día y antibióticoterapia sistémica efectuada con cloxacilina.

Acute dacryocystitis is an inflammation of the lacrimal sac and nasolacrimal duct, mostly secondary infection process, or senile duct stenosis, trauma, tumors, sinusitis, or chronic conjunctivitis and canaliculitis. The age groups most affected are infants and elderly, especially women. Infectious agents most commonly involved are Staphylococcus aureus and Streptococcus beta-hemolytic. There are no epidemiological studies or history of national and local causative of this condition. Objectives: To determine the frequency of hospitalization, the age distribution by sex and prevalence of this disease, know the length of hospital employee and the treatment received by patients Methodology: The data required for the study was obtained from a review of clinical records of patients Results. A total of 1870 hospitalizations eye made between June and Oecember 2007, 102 were for dacryocystitis (55 percent). 78 percent of patients were female and the largest number of inquiries occurred in patients aged 70 to 79 years (33.3 percent) The 52.9 percent of cases needed only one day of hospitalization, receiving systemic treatment for 15.7 percent of patients had complications or exacerbation of the clinical, being the drug of choice, cloxacillin. Conclusions: The incidence of hospitalizations for acute dacryocystitis is 5.5 percent of total hospitalizations for ocular pathologies. Oacryocystitis occurs mostly in older adults, whose age ranges are between 60 and 89 years, mostly female. The hospitalization time required is not more than one day to prepare for surgery, for the treatment of infectious event is performed as an outpatient. Systemic antibiotic therapy conducted in patients who show no response to empiric therapy is cloxacillin.

Disección aórtica y síndrome de Marfán en el embarazo: A propósito de un caso clínico / Acute type A aortic dissection in pregnant patient with Marfan syndrome: Report of one case

Aortic dissection is a life-threatening disease that requires immediate surgical intervention. Marfan syndrome is a hereditary disease with an autosomaldominant transmission, which affects the connective tissue, with skeletal, cardiovascular and ocular involvement. It is one of the most prevalent connective tissue disorders, presenting a risk of aortic dissection of approximately 1% even without dilatation of the aorta. When dissectionoccurs during pregnancy and requires surgical intervention (type A dissection), maternal mortality is high (20%-30%). We report a 38 year-old woman with Marfan syndrome that hadan acute type A aortic dissection and severe aortic regurgitation at 37 weeks of gestation. The patient underwent a cesarean section and delivered a healthy baby. Afterwards, aortic valverepair and ascending aortic replacement was successfully performed under circulatory arrest with deep hypothermia. Additionally mitral valve repair for degenerative disease with posterior, autologous pericardium mitral valve ring was performed.

Polimorfismos del gen del receptor de vitamina D y riesgo de fractura de cadera en la mujer adulta mayor de la Región del Bío Bío / Vitamin D receptor gene polymorphisms and risk of hip fracture in Chilean elderly women

Background: Osteoporotic hip fractures are devastating events in older women. There is a genetic modulation of bone phenotypic parameters including bone density (BMD) and bone fragility fractures. Vitamin D receptor (VDR) gene polymorphisms explain a small part of the genetic influence on BMD, whereas their effect on fractures remains uncertain. Aim: To examine the contributions of VDR genotypes to the susceptibility to hip fracture in elderly Chilean women. Patients and methods: We recruited 126 women (67 with fractures and 59 without) from Bio-Bio Region, Chile, aged 65 to 94 years. Genotyping for Bsm-l, Apa-1, Taq-1 and Fok-1 VDR polymorphisms was performed using polymerase chain reaction methods. All hip fractures were confirmed by X-ray. Results: The alíele frequencies were 0.49 for B, 0.57 for A, 0.60 for T and 0.65 for F in the Bsm-l, Apa-1, Taq-1 and Fok-1 polymorphisms respectively. The prevalence of these VDR gene polymorphisms in women with fractures were 16 percent BB, 69 percent Bb, 15 percent bb for Bsm-l; 30 percent AA, 46 percent Aa, 14 percent aa for Apa-1; 17 percent TT, 34 Tt, 8 percent tt for Taq-1 and 43 percentFF, 41 percent Ff, 16 percent ff for Fok-1. All VDR genotype frequencies did not differ from Hardy- Weinberg expectations. Alíele or genotype frequencies did not differ between women with or without fractures. These results did not change when analysis was adjusted by age weight, height or gynecologic history. Conclusions: The genotype frequencies of the VDR polymorphisms are in accordance with the frequencies of other Hispanic and Caucasian populations. Our results suggest that VDR polymorphisms are not associated with the risk of hip fracture in older women of this Region of Southern Chile.

FACO/LUZ: hacia la construcción de un modelo educativo integral en odontología (parte I) / FACO/LUZ: towards the construction of an integred educational model in dentistry (part I)

Construir un modelo educativo integral que de respuesta a los retos de la odontología como ciencia comprometida socialmente, tanto en el contexto nacional como latinoamericano. Parte de algunas consideraciones que develan los principios y las políticas del Estado que rigen la educación superior en el mundo contemporáneo. Para la construcción de la propuesta, la Facultad de Odontología de la Universidad del Zulia, FACO/LUZ, dio apertura a escenarios de discusión con la participación de los actores involucrados en el proceso, con la finalidad de evaluar la experiencia institucional en materia curricular. Igualmente, realizó un análisis crítico de las tendencias mundiales en educación y salud, a objeto de incorporarlas a la propuesta. En sus alcances el modelo posibilita la formación de talento humano cuya praxis apunte a la transformación cuali-cuantitativa, de la situación de salud bucal de la población. En su marco filosófico reafirma el modelo educativo docencia-servicio-investigación e inserta conceptos actuales relacionados con la bioética, transculturalidad, la epidiscipilinariedad y el uso de las lenguas autóctonas de la región y el país. Finalmente, el modelo permite integrar la teoría y la práctica (estudio-trabajo) en el marco de la estratégia de la atención primaria en salud.

Tratamiento de lesiones vasculares binignas cutaneas toracocervicofaciales por luz pulsada / Treating benign vascular lession cutaneous thoraxccervicofacial for intence pulsed light

Durante el siglo pasado numerosos procedimientos fueron descriptos para resolver aquella afecciones cutáneas benignas con componente vascular. Estps procedimientos solían dejar coimo secuelas del tratamiento cicatrices, hipopigmentación, hiperpigmentación o eran ineficaces para la resolución de la patología. Desde 1962 se agregó el uso de láseres vasculares. Estos presentaban todavía la posibilidad de efectos indeseados como así tambien la dificultad para la resolución de la amplia gama de las lesiones vasculares benignas. Se presentan los resultados obtenidos sobre 27 lesiones vasculares benignas cutáneas (angiomas y malformaciones vasculares) y dermopatías con compònente vascular localizadas en tórax, cuello y/o rostro de 25 pacientes, tratados entre junio de 1999 y marzo de 2001, mediante el uso de tecnología luz pulsada. Los autores hacen referencia a diferencias y similitudes entre laser y la luz pulsada, y presentan otras dermatopatías con componente vascular plausibles de ser tratadas mediante esta tecnología.

Susceptibilidad in vitro de cepas de helicobacter pylori: aislamiento de cepas resistentes a claritromicina / In vitro antimicrobial susceptibility of helicobacter pylori strains isolated in Chile

Background: Our laboratory has carried out an epidemiological surveillance of Helicobacter pylori antimicrobial susceptibility since 1997. Aim: To report the antimicrobial susceptibility of H pylori strains, isolated in Chile from August 1997 to August 2000. Material and methods: Ninety one H pylori strains, obtained from antral gastric biopsies during upper gastrointestinal endoscopies were studied. Susceptibility towards clarithromycin, amoxicillin, bismuth subcitrate and metronidazole was studied by an agar diffusion technique. Results: All strains were susceptible to amoxicillin and two strains were resistant to clarithromycin. Forty two percent of strains were resistant to metronidazole and 13 per cent were resistant to bismuth subcitrate. Conclusions: These results underscore the need to maintain an epidemiological surveillance of H pylori antimicrobial susceptibility, to modify its eradication therapy accordingly

Intubación orotraqueal transmilohiodea en cirugía maxilofacial / Trans-mylohyoid orotracheal intubation in maxilofacial surgery

Los pacientes con alteraciones en las relaciones intermaxilares para la intubación y el mantenimiento del tubo endotraqueal durante la cirugía craneomaxilofacial. La fijación del tubo nasotraqueal puede ser seccionado accidentalmente en el momento de las osteomías. Se describe la técnica de pasaje transmilohiodeodel tubo orotraqueal y se detallan sus indicaciones y resultados. Entre Mayo de 1995 y Abril de 1997 se utilizó el método en diez pacientes con resultados favorables. Se indica como alternativa de intubación el uso de la vía orotraqueal, con abocamiento a la piel a través del músculo milohioideo, con el fin de obtener un mejor espacio quirúrgico y evotar los riesgos de obstrucción, extubación accidental y sección de la cánula endotraqueal, sin tener que recurrir a una traqueostomía

Ciclosporosis: informe de un caso clínico en Concepción, Chile / Cyclosporosis: report of a case in Concepción, Chile

Cyclospora cayetanensis is a newly recognized parasite widely distributed throughout the world, and isolated from children, immunocompetent adults and HIV infected individuals. The clinical manifestations of the infection are watery prolonged diarrhea, anorexia, fatigue, nausea, bloating and weight loss. In immunocompetent individuals, diarrhea is usually self limited but may last several weeks. In immunocompromised hosts it is prolonged, severe and can be associated with biliary tract involvement. We report a 50 years old female that, five days after returning from Cuba, presented with low grade fever, anorexia, fatigue, explosive diarrhea and weight loss. Physical examination was normal. A stool specimen contained many organisms with morphological features of Cyclospora caetanensis. The diagnosis was confirmed at the Centers for Disease Control (Atlanta Ga)

Polipos de la uretra prostatica en adultos / Polypos of prostatic urethra in adults

Los pólipos de la uretra prostática pueden presentarse clínicamente como hematuria, hemospermia, obstrucción o disuria; ellos ocurren más frecuentemente de lo sospechado. La presentación clínica, los hallazgos uretrocistoscópicos, patológicos y el tratamiento son revisados. Nosotros informamos 3 casos de pólipos de la uretra prostática, creemos que son benignos y deberán ser resecados como una medida diagnóstica y algunas veces terapéutica

Pielonefritis enfisematosa / Emphysematous Pyelonephritis

La Pielonefritis enfisematosa es infrecuente y todavía en algunos casos mortal. Se describe un caso en una mujer diabética de 48 años de edad en el Hospital Universitario del Valle. Aproximadamente 80 casos de pielonefritis enfisematosa han sido reportados desde el primer caso descrito por Kelly and Mac Callum en 1898. La patología, radiología, clínica y algunos conceptos de patogénesis, diagnóstico y manejo son discutidos