Cirugía transumbilical asistida versus multipuerto en pacientes pediátricos con diagnóstico de apendicitis aguda / Assisted versus multiport transumbilical surgery for acute appendicitis in pediatric patients

Introducción. La prevención de las complicaciones en el manejo de la apendicitis aguda sigue siendo un reto para el cirujano pediatra; por lo que es de gran importancia comparar las opciones de manejo quirúrgico, para saber si es posible prevenir dichos resultados, que finalmente llevan a un aumento en el uso de recursos necesarios para tratar a un paciente. El objetivo de este estudio fue comparar las complicaciones postoperatorias y los costos de la laparoscopia transumbilical asistida y la laparoscopia multipuerto, en pacientes pediátricos en un hospital general de cuarto nivel de la ciudad de Bogotá, D.C., Colombia, entre octubre de 2011 y enero de 2019. Métodos. Estudio observacional, descriptivo, retrospectivo, de corte transversal, con muestreo no probabilístico a conveniencia, en el que se incluyeron los pacientes entre 0 y 16 años de edad, con historia clínica completa y diagnóstico postquirúrgico de apendicitis aguda, los cuales fueron intervenidos mediante cirugía laparoscópica transumbilical asistida o por multipuerto. Se hizo un análisis descriptivo univariado y bivariado. Resultados. De los 850 pacientes operados en ese periodo, la técnica quirúrgica más usada fue multipuerto (n=528, 62,1%) y se presentaron complicaciones en 59 (6,94%) de los pacientes. El diagnóstico postquirúrgico más frecuente fue apendicitis no perforada (n=762, 89,6%). Al comparar los dos grupos se encontró un valor de p de 0,9685 para la edad, 0,5364 para el diagnóstico postquirúrgico, 0,1127 para las complicaciones postoperatorias y 0,0085 para el costo. Discusión. El costo de hospitalización y las complicaciones de los pacientes a quienes se les practicó apendicectomía transumbilical asistida es similar a la técnica por multipuerto

Introduction. The prevention of complications in the management of acute appendicitis remains a challenge for the pediatric surgeon. Therefore, it is of great importance to compare the surgical management options, to know if it is possible to prevent these results, which ultimately lead to an increase in the use of resources necessary to treat a patient. The objective of this study was to compare the postoperative complications and costs of assisted transumbilical laparoscopy and multiport laparoscopy in pediatric patients. Method. Observational, descriptive, retrospective, cross-sectional study with non-probabilistic convenience sampling, where patients between 0 and 16 years old with a complete medical history, with a postsurgical diagnosis of acute appendicitis, who underwent assisted transumbilical surgery or by multiport performed at a fourth level general hospital in Bogotá, Colombia, between October 2011 and January of 2019. A descriptive univariate and bivariate analysis was performed. Results. Of the 850 patients operated on in this period, the most used surgical technique was multiport (n=528; 62.1%) and complications occurred in 59 (6.94%) of the patients. The most frequent postsurgical diagnosis was non-perforated appendicitis (n=762; 89.6%). Comparing the two groups, a p-value of 0.9685 was found for age, 0.5364 for postsurgical diagnosis, 0.1127 for postoperative complications, and 0.0085 for cost. Discussion. The cost of hospitalization and complications for patients who underwent assisted transumbilical appendectomy is similar to the multiport technique

Prevalence of organ-space surgical site infections after appendectomy for ruptured appendix in children / Prevalencia de la infección del sitio operatorio órgano-espacio en apendicitis perforada en niños

Abstract Introduction: Appendicitis can be classified as non-perforated and perforated; based on such classification, the reported organ-space surgical site infection (OS-SSI) rate is 0.8% and 18%, respectively. Objective: To establish the prevalence of OS-SSI in patients with perforated appendicitis treated in a pediatric hospital in 2012. Materials and methods: Retrospective, observational and descriptive study conducted at Fundación Hospital Pediátrico La Misericordia, with a random sample of200 patients, ofwhich 160 met the inclusion criteria. Results: 20 patients (12.5%) presented with OS-SSI and all of them received antibiotic treatment; 70% did not require abscess drainage. Patients ≥8 years of age had 5 times more abscesses than younger ones (17.6% vs. 3.4%). OS-SSI was found in 33% of patients with free fecalith and in 50% of the patients who required postoperative management at the ICU vs. 9.5% of the patients who received management in the intermediate care unit and the inpatient hospital floors. The total rate of surgical site infection was 24.3% (11.8% superficial, 0% deep and 12.5% organ-space). Conclusions: The prevalence of OS-SSI found here is lower than what has been reported in the literature. Being 8 years or older and having free fecalith are risk factors to develop this type of infection. The higher frequency of OS-SSI in patients treated at the ICU during the post-operative period observed here suggests that this condition may be associated with septic shock.

Resumen Introducción. La apendicitis se clasifica en no perforada y perforada; de acuerdo a esta clasificación, la tasa de infección del sitio operatorio órgano-espacio (ISO-OE) es de 0.8% y 18%, respectivamente. Objetivo. Determinar la prevalencia de ISO-OE en pacientes con apendicitis perforada en un hospital pediátrico en 2012. Materiales y métodos. Estudio retrospectivo y observacional descriptivo de corte transversal. La muestra fue aleatoria y de 200 pacientes, 160 cumplieron los criterios de inclusión. Resultados. Los 20 pacientes (12.5%) que presentaron ISO-OE recibieron manejo antibiótico; 70% no requirió drenaje de colección. Los pacientes ≥8 años presentaron 5 veces más ISO-OE (17.6% vs. 3.4%). El 33% de los pacientes con fecalito en cavidad y el 50% que se hospitalizó en post-operatorio inmediato en la unidad de cuidados intensivos (UCI) desarrollaron ISO-OE versus 9.5% de los pacientes atendidos en la unidad de cuidados intermedios y pisos. El total de ISO fue 24.3%: 11.8% superficial, 0% profunda y 12.5% de órgano-espacio. Conclusiones. La prevalencia de ISO-OE encontrada es menor a la reportada en la literatura. La edad ≥8 años y el fecalito en cavidad son factores de riesgo para desarrollar este tipo de infección. La mayor frecuencia de ISO-OE en pacientes manejados en el posoperatorio en UCI sugiere que esta condición puede estar asociada con el choque séptico.

Shigatoxigenic and atypical enteropathogenic Escherichia coli in fish for human consumption

ABSTRACT Shigatoxigenic and enteropathogenic Escherichia coli with virulence and multidrug resistance profile were isolated from Nile tilapia. This study finding is of great importance to public health because they help understand this pathogen epidemiology in fish and demonstrate how these animals can transmit E. coli related diseases to humans.

Characterization of avian pathogenic Escherichia coli isolated from free-range helmeted guineafowl

Abstract Avian pathogenic Escherichia coli (APEC) isolates from apparently healthy free range helmeted guineafowl were characterized. Most of them had a high frequency of virulence associated genes, multi drug resistance and high pathogenicity. We demonstrated that helmeted guineafowl have potential to transmit antibiotic resistant APEC to other species including humans.

In-vivo evaluation of pathogenicity and antimicrobial profile susceptibility from Escherichia coli samples isolated from commercial layer hens / Avaliação da patogenicidade in vivo e do perfil de resistência antimicrobiana de amostras de Escherichia coli isoladas de galinhas de postura comercial

Antimicrobial sensitivity and pathogenicity level of 90 strains of Escherichia coli isolated from livers and intestines from commercial layer hens presenting diarrhea were analyzed. To evaluate the antimicrobial susceptibility, all samples were subjected to antimicrobial susceptibility testing using 11 commercial drugs. The results have showed none of the strains was susceptible to all antibiotics tested. All samples showed resistance to two or more drugs. According to the mortality rate of the birds, the in-vivo pathogenicity test classifies the strains into four classes: high, intermediate, low and nonpathogenic. The test has showed 23 (25.5%) of the samples were highly pathogenic, 21 (23.3%) of intermediate pathogenicity, 23 (25.5%) low pathogenic, and 23 (25.5%) nonpathogenic. When the results of the classes of pathogenicity from isolates have been associated with antimicrobial susceptibility, nonpathogenic strains were less sensitive to the antibiotic ampicillin and increased sensitive to streptomycin antimicrobial compared to the others classes of pathogenic. Nonpathogenic strains showed resistance to many antimicrobials, an alert for poultry, since these bacteria might acquire the virulence genes and infect birds, others animals and even human beings.(AU)

Foram verificados a sensibilidade antimicrobiana e o índice de patogenicidade de 90 amostras de Escherichia coli isoladas do fígado e do intestino de pintainhas de postura comercial com diarreia. Para avaliar a sensibilidade antimicrobiana, todas as amostras foram submetidas ao teste de susceptibilidade antimicrobiana por meio de 11 drogas comerciais. Os resultados demonstraram que nenhuma das estirpes foi sensível a todos os antimicrobianos testados. Todas as amostras apontaram resistência a duas ou mais drogas. De acordo com o índice de mortalidade das aves, o teste de patogenicidade in vivo classificou as estirpes em quatro classes: alta, intermediária, baixa e não patogênica. O teste revelou que 23 (25,5%) das amostras foram de alta patogenicidade, 21 (23,3%) de patogenicidade intermediária, 23 (25,5%) de baixa patogenicidade e 23 (25,5%) não patogênicas. Quando os resultados das classes de patogenicidade dos isolados foram associados à sensibilidade antimicrobiana, estirpes não patogênicas apresentaram menor sensibilidade ao antimicrobiano ampicilina e maior sensibilidade ao antimicrobiano estreptomicina, quando comparadas com as estirpes das demais classes de patogenicidade. Estirpes não patogênicas exibiram resistência a vários antimicrobianos, representando um alerta para a avicultura, uma vez que essas bactérias podem adquirir genes de virulência e, assim, infectar aves, outros animais e até mesmo o seres humanos.(AU)

Characterization of avian pathogenic Escherichia coli isolated from free-range helmeted guineafowl

Abstract Avian pathogenic Escherichia coli (APEC) isolates from apparently healthy free range helmeted guineafowl were characterized. Most of them had a high frequency of virulence associated genes, multi drug resistance and high pathogenicity. We demonstrated that helmeted guineafowl have potential to transmit antibiotic resistant APEC to other species including humans.

Characterization and antimicrobial resistance patterns of Escherichia coli isolated from feces of healthy broiler chickens / Padrões da caracterização e resistência a antimicrobianos de Escherichia coli isolada das fezes de frangos de corte saudáveis

Avian pathogenic Escherichia coli (APEC) strains are isolated from lesions of poultry presenting colibacillosis, which is a disease that causes either systemic or localized clinical signs. Such strains share many characteristics with E. coli strains that cause extra-intestinal illness in humans. There is not a consensus on how to define the APEC pathotype with regard to the presence of virulence traits. On the other hand, in the past few years, five minimal predictors for APEC detection were proposed. The E. coli isolates in this work were tested through polymerase chain reaction (PCR) to the five proposed minimal predictors and cva C. The strains presenting them were categorized as potential APEC. The APEC and non-APEC categories showed high resistance (> 50%) to cephalotin, erythromycin, streptomycin, sulphametoxazol/trimethoprim, ampicillin, and amoxicillin. Potential APEC strains were significantly more resistant to cephalotin (p < 0.05) and neomcycin (p < 0.01) than non-APEC. These latter were significantly more resistant to tetracycline (p < 0.01) than the potential APEC strains. These results demonstrate that feces of poultry present E. coli strains with resistant features, showing or not the potential of causing colibacillosis in poultry. Because APEC and extra-intestinal illness in humans may be similar, these resistant strains are of interest to public health.(AU)

Cepas de Escherichia coli patogênica para aves (APEC) estão isoladas das lesões de frangos com colibacilose, uma doença que causa sinais clínicos sistêmicos ou localizados. As APEC compartilham algumas características com as cepas de Escherichia coli que produzem doenças extraintestinais nos seres humanos. Ainda não há um consenso sobre a definição de patotipos das cepas de APEC, no que diz respeito à presença das características de virulência. Entretanto, nos últimos anos, foram definidos cinco indicadores mínimos para a identificação de patotipos das cepas de APEC. Os isolados de E. coli utilizados neste trabalho foram testados por meio de reação em cadeia de polimerase (PCR) para os cinco indicadores mínimos e para cva C. Os isolados que possuíam os cinco indicadores mínimos foram definidos como potenciais cepas de APEC. As categorias APEC e não APEC apresentaram alta resistência (> 50%) à cefalotina, eritromicina, estreptomicina, sulfametoxazol mais trimetoprim, ampicilina e amoxicilina. Possíveis cepas de APEC foram significativamente mais resistentes à cefalotina (p < 0,05) e neomicina (p < 0,01) do que as cepas não-APEC. Estas foram significativamente mais resistentes à tetraciclina (p < 0,01) do que as possíveis cepas de APEC. Esses resultados demonstram que as fezes dos frangos de corte albergam cepas de E.coli com características de resistência, apresentando ou não potencialidade de causar colibacilose. Em função das características de similaridade entre APEC e doenças extraintestinais nos seres humanos, estas cepas resistentes são de interesse à saúde pública.(AU)

Acute generalized exanthematous pustulosis related to phenytoin administration. Case report / Pustulosis exantemática aguda generalizada relacionada al uso de fenitoína. Reporte de caso

The occurrence of acute generalized exanthematous pustulosis adverse reactions to medication administration is becoming more frequent. This article reports the case of a 78-year-old woman who attended the clinic with generalized papules and pustules on the scalp, trunk and limbs, with a concordant histology study and who was diagnosed with acute generalized exanthematous pustulosis (AGEP) associated with the use of phenytoin, a medication that may cause different skin reactions and that has been previously related to this disease. The patient was treated with systemic steroids and the disease had a satisfactory outcome.

La aparición de reacciones adversas a medicamentos del tipo pustulosis exantemática generalizada aguda es cada vez más frecuente. Se presenta el caso de una paciente de 78 años quien acude a consulta presentando unas pápulas y pústulas generalizadas en cuero cabelludo, tronco y extremidades, con estudio de histología compatible y a la que se le diagnostica pustulosis exantemática aguda generalizada (PEAG) asociada al uso de fenitoína, una medicación que puede provocar distintas reacciones cutáneas y que previamente se ha asociado a esta enfermedad. La paciente es tratada con esteroides sistémicos y la enfermedad llega a una resolución satisfactoria

Idiopathic meconium peritonitis as a surgical emergency: A case report in a newborn / Peritonitis meconial idiopática como urgencia quirúrgica. Reporte de caso en una recién nacida

Meconium peritonitis is a rarely described condition that is typically found in fetal and perinatal patients. It manifests in different ways and requires an early diagnosis. In this case report, a clinical suspicion of the disease was made at the antenatal period through an obstetric ultrasound scan showing an abdominal mass in both the bottom and top right quadrants. The patient initial symptoms were those of acute intestinal obstruction. Nevertheless, these symptoms improved after surgical approach was timely performed. Based on this outcome, it can be concluded that a favorable outcome to this pathology depends on its early diagnosis, since an early diagnosis decreases morbidity and mortality chances.

La peritonitis meconial es una entidad poco descrita, propia de la edad fetal y perinatal, que se presenta de diversas formas y requiere un diagnóstico temprano. En el presente caso se realiza sospecha clínica desde el periodo antenatal, por medio de una ecografía obstétrica que muestra una masa abdominal ocupando el cuadrante derecho inferior y superior. La paciente inicia con síntomas agudos de obstrucción intestinal que mejoran luego de un abordaje quirúrgico oportuno. De acuerdo a lo anterior, se concluye que un desenlace favorable en esta patología depende de un diagnóstico temprano, pues a través del mismo se disminuyen las probabilidades de morbilidad y mortalidad

Cambio en la clasificación macroscópica de la apendicitis. ¿Tiene algún impacto? Estudio retrospectivo en un Hospital Universitario Pediátrico / Change in the macroscopic classification of appendicitis. Does it have any impact? Retrospective study in a Pediatric teaching hospital

Antecedentes. La definición actual de apendicitis diferencia la aguda en apéndices no perforados y perforados. Esta clasificación describe los apéndices perforados como aquellos con la presencia de un orificio visible en el apéndice o la presencia de un fecalito libre en la cavidad y ha cambiado el manejo postoperatorio actual. Objetivo. Determinar si el cambio en la definición macroscópica de la apendicitis aguda tiene alguna influencia en la duración de la estancia hospitalaria y la tasa de complicaciones dado el cambio en el manejo antibiótico postoperatorio. Materiales y métodos. Se llevó a cabo un rastreo de aquellos pacientes llevados a cirugía con diagnóstico de apendicitis aguda durante el primer semestre del año 2009 y el segundo semestre del año 2011 en la Fundación HOMI. Se excluyeron los pacientes llevados a laparoscopia diagnóstica por estudio del dolor abdominal, apendicectomias incidentales y los pacientes manejados en el protocolo de apendicectomía de Intervalo. Resultados. Se observó una disminución en el número de días de hospitalización/año y en el número de dosis de antibiótico/año y reducción en el número de complicaciones, lo cual demuestra que la clasificación y el protocolo de manejo actual no se correlacionan con un aumento en el número de complicaciones y se asocia con menores costos. Conclusión. El cambio en la clasificación macroscópica y el aportar la nueva definición sobre apendicitis perforada ha logrado disminuir la estancia hospitalaria y la cantidad de antibióticos utilizados sin una repercusión significativa en la tasa de complicaciones.

Background. The current definition differences the acute appendix in nonperforated and perforated. This classification describes the perforated appendicitis as those with the presence of a visible hole in the appendix or the presence of a free fecalito in the cavity and changed the postoperative current management. Objective. Determine whether the change in the macroscopic definition of acute appendicitis have any influence on the length of hospital stay and complication rates given the change in the post-operative antibiotic treatment. Materials and Methods. Patients undergoing surgery with a diagnosis of acute appendicitis in the first half of 2009 and the second half of 2011. Patients excluded were those taken to surgery for diagnostic laparoscopy by study of abdominal pain, also incidental appendectomy and patients managed in the protocol of appendectomy interval. Results. A decrease in the number of hospital days /year and the number of doses of antibiotic/ year and decrease in the number of complications was observed which demonstrates that the classification and current management protocol are not correlated with an increase in number of complications and is associated with lower costs. Conclusions. The change in the macroscopic classification and provide the new definition of perforated appendicitis has reduced hospital stay and the amount of antibiotics used without a significant impact on the rate of complications.

Thoracoscopic management of an esophageal lung, report of a case / El manejo toracoscópico de un pulmón esofágico, el informe del caso

Esophageal lung is a rare broncopulmonary foregut malformation, in which the main stem bronchus arises from the esophagus. Since the description by Keely et al. in 1960, less than 25 cases have been reported. We present a case of a 4-month-old female, who was referred to our institution after 2 months of management for respiratory recurrent infections. Contrast studies were performed during the evaluation and a right broncography was identified in the esophagogram. Bronchoscopy was performed confirming the atresic right bronchus. Complementary imaging and cardiology evaluation confirmed the absence of major vascular anomalies, especially a pulmonary artery sling that has been described in relation with this entity. Due to the hypoplastic lung in the absence of major vascular anomalies, thoracoscopic pneumonectomy was deemed possible. Procedure was performed with four ports and 3 mm equipment was used. Special attention was made identifying and dissecting the vascular structures first, and then the arising esophageal bronchus was dissected. The hypoplastic lung was extracted trough a small incision inferior to the axilla.We consider that due to the hypoplastic lung and vessels, the thoracoscopic approach is safe and feasible for the management of the esophageal lung and even for de esophageal bronchus in the absence of major vascular anomalies.

El pulmón esofágico es una malformación broncopulmonar rara del intestino anterior, en la que el bronquio principal del tallo surge del esófago. Desde la descripción de Keely et al. en 1960, se informaron menos de 25 casos. Presentamos el caso de una mujer de 4 meses de edad, que fue remitida a nuestra institución después de 2 meses de tratamiento por infecciones respiratorias recurrentes. Se realizaron estudios de contraste durante la evaluación y se identificó una broncografía derecha en el esofagograma. Se realizó broncoscopia confirmando el bronquio derecho atresico. La evaluación complementaria de imágenes y cardiología confirmó la ausencia de anomalías vasculares mayores, especialmente una honda de la arteria pulmonar que se ha descrito en relación con esta entidad. Debido al pulmón hipoplásico en ausencia de anomalías vasculares mayores, se consideró posible la neumonectomía toracoscópica. El procedimiento se realizó con cuatro puertos y se utilizó un equipo de 3 mm. Se prestó especial atención a la identificación y disección de las estructuras vasculares primero, y luego se disecó el bronquio esofágico resultante. El pulmón hipoplásico se extrajo a través de una pequeña incisión inferior a la axila. Consideramos que, debido al pulmón y los vasos hipoplásicos, el abordaje toracoscópico es seguro y factible para el manejo del pulmón esofágico e incluso para el bronquio esofágico en ausencia de mayor anomalías vasculares

Sorologia e suscetibilidade antimicrobiana em isolados de Escherichia coli de pesque-pagues / Serology and patterns of antimicrobial susceptibility in Escherichia coli isolates from pay-to-fish ponds

Pesquisou-se a ocorrência de Escherichia coli (EPEC, EIEC, O157) em água e peixe (pele, trato digestivo e músculo) de pesque-pagues da microbacia do Córrego Rico, Jaboticabal (SP). Foram isoladas 115 cepas de E. coli, entre as quais 49 (43%) foram sorogrupadas como EPEC. Os sorogrupos mais frequentes foram O125, O126 e O158. Dentre as amostras testadas, 60 (52%) apresentaram resistência simultânea a dois antimicrobianos. A análise de correspondência foi realizada com o intuito de verificar as possíveis correspondências envolvendo o local de isolamento, sorogrupos e multirresistência e, com isso, pôde-se observar que o músculo apresentou menor correspondência com os demais fatores analisados. Porém, o isolamento de sorogrupos EPEC neste estudo representa risco à saúde dos consumidores.(AU)

The occurrence of Escherichia coli (EPEC, EIEC and O157) in water and fish (skin, gut and muscle) in pay-to-fish ponds of the micro bay of Córrego Rico, in Jaboticabal (SP), was assessed. One hundred and fifteen strains of E. coli were isolated, and 49 (43%) were serogrouped as EPEC. The most common serogroups were O125, O126 and O158. Among the tested samples, 60 (52%) showed simultaneous resistance to two antimicrobials. A correspondence analysis was performed to assess possible correlations involving the site of isolation, serogroups and multi-resistance. The results of this analysis showed that the muscle was less correlated with the the other factors. However, the isolation of EPEC serogroups in this study demonstrates a risk to public health.(AU)

Tumor neuroectodérmico primitivo de la pared torácica: tumor de Askin en niños / Primitive neuroectodermal tumor of the chest wall: Askin tumor in children

Resumen Antecedentes. El tumor neuroectodérmico primitivo (TNEP) de la pared torácica o Tumor de Askin, es un tumor maligno clasificado dentro de los TNEP periféricos y perteneciente a los tumores de la familia del sarcoma de Ewing (FSE). Este tipo de neoplasia de la región toracopulmonar es muy poco frecuente y suele presentarse con mayor frecuencia en la población pediátrica. Objetivo. Describir algunas características de pacientes con Tumor de Askin de la Fundación Hospital La Misericordia. Materiales y métodos. Se realizó un análisis retrospectivo de los casos atendidos en una sola institución, Fundación Hospital de la Misericordia, en un lapso de 16 años. Resultados. Se encontraron 8 pacientes, 7 varones, 4 con metástasis al diagnóstico, 2 en pulmón y 2 en hueso, a 2 se les hizo resección quirúrgica completa del tumor al diagnóstico, los demás pacientes fueron llevados a biopsia y quimioterapia citoreductora previa a la cirugía para resección tumoral. Todos recibieron quimioterapia con protocolos para Sarcoma de Ewing y radioterapia en 6 casos. A la fecha están vivos 5 pacientes (62%) con una mediana de seguimiento de 32 meses; 3 de ellos tenían metástasis en el diagnóstico. De los 3 pacientes muertos, 2 no tenían metástasis en el diagnóstico, ambos recayeron y fallecieron por progresión de enfermedad; el otro abandonó el tratamiento a los 6 meses del diagnóstico. Dos pacientes en recaída recibieron quimioterapia de 2 líneas a altas dosis con rescate autólogo, uno está vivo y el otro falleció por progresión de la enfermedad. Conclusión. Se describieron las características clínicas, de laboratorio, diagnóstico, tratamiento y pronóstico de este grupo de pacientes.

Summary Background. The primitive neuroectodermal tumor (TNEP) of the chest wall, or Askin tumor, is a malignant neoplasia classified within the Ewing family of tumours (FSE). This particular type of malignancy of the chest wall is rare and usually appears in the pediatric population. Objective. Describe some characteristics of patients with Askin tumor of the Fundacion Hospital de La Misericordia. Materials and methods. A retrospective analysis of cases treated at a single institution, Fundación Hospital de la Misericordia, in a 16 years period was performed. Results. 8 patients were found, 7 boys, 4 with metastases at the diagnosis, 2 in lungs and 2 in bone, 2 underwent surgery at diagnosis. For the other 6 patients surgical resection was done after chemotherapy. All patients received chemotherapy and 6 received radiotherapy. To date, 5 patients are alive (62 %) with a median follow up of 32 months; 3 of them had metastases at diagnosis. 3 patients died, 2 of which had no metastases in the diagnosis, both relapsed and died of disease progression, the other abandoned treatment at 6 months after diagnosis. Other 2 patients that relapsed received chemotherapy plus autologous transplant, one is alive and the other one died due to disease progression. Conclusion. Clinical, laboratory, diagnosis, treatment and prognosis characteristics of this patient group were described.

Identification and antimicrobial susceptibility patterns of Pasteurella multocida isolated from chickens and japanese quails in Brazil

A study was performed to verify the presence of Pasteurella multocida in eight different poultry groups of 90 birds each. Groups I to IV were chickens (I being > 6 weeks of age with a history of respiratory illness, II > 6 weeks of age and free of respiratory illness, III < 6 weeks of age with respiratory illness and IV being < 6 weeks of age and with no respiratory illness. Groups V to VIII had the matching characteristics of Groups I to V but consisted of Japanese Quails. The P. multocida isolation rate from the groups was as follows; Group I 56/90 (62.3%) Group II 18/90 (20.0%), Group III 12/90 (13.3%), Group IV 3/90 (3.33%), Group V 8/90 (8.88%), Group VI 2/90 (2.22%) Group VII 2/90 (2.22%) and Group VIII 1/90 (1.11%). These isolation rates were not significantly different within the groups of a bird type but the overall chicken isolation rate was significantly higher than the quail isolation rate (p < 0.01). All isolates were examined for their sensitivity to four antimicrobial agents. The results showed only low levels of resistance to the agents tested. The highest level of resistance detected was to cephalothin (5.1% of isolates) followed by amikacin (3.4%).

Phenotypical characterization and adhesin identification in Escherichia coli strains isolated from dogs with urinary tract infections

Pathogenic strains of Escherichia coli are the most common bacteria associated with urinary tract infections in both humans and companion animals. Standard biochemical tests may be useful in demonstrating detailed phenotypical characteristics of these strains. Thirteen strains of E. coli isolated from dogs with UTIs were submitted to biochemical tests, serotyping for O and H antigens and antimicrobial resistance testing. Furthermore, the presence of papC, sfa, and afa genes was evaluated by PCR, and genetic relationships were established using enterobacterial repetitive intergenic consensus PCR (ERIC-PCR). The antimicrobial that showed the highest resistance rate among the isolates was nalidixic acid (76.9%), followed by cephalotin (69.2%), sulfamethoxazole + trimethoprim (61.5%), tetracycline (61.5%), streptomycin (53.8%), ciprofloxacin (53.8%), ampicillin (46.2%), gentamicin (30.8%) and chloramphenicol (23.1%). No isolate was resistant either to meropenem or nitrofurantoin. Among the five clusters that were identified using ERIC-PCR, one cluster (A) had only one strain, which belonged to a serotype with zoonotic potential (O6:H31) and showed the genes papC+, sfa+, afa-. Strains with the genes papC-, sfa+, afa- were found in two other clusters (C and D), whereas all strains in clusters B and E possessed papC-, sfa-, afa- genes. Sucrose and raffinose phenotypic tests showed some ability in discriminating clusters A, B and C from clusters D and E.

Genetic similarity between staphylococcus sp isolated from human and hospital settings, and susceptibility to different antimicrobials / Similaridade genética entre estafilococos isolados de humanos e camas hospitalares e resistência à diferentes antimicrobianos

One hundred and forty-three samples from human hands and hospital beds were collected at a teaching hospital in the city of Ribeirão Preto/SP by swabs, and placed in BHI broth. Following a 24 h incubation period at 37ºC, they were seeded on Petri dishes containing Agar "Staphylococcus Medium 110". Colonies typical of the genus Staphylococcus were collected and stored at 4ºC until tested for catalase, mannitol, hemolysis, DNAse and coagulase. Strains were analyzed by RAPD-PCR to verify their similarity, and tested for sensitivity to ten different antibiotics. From the ninety-two isolated strains, 67 (72,8 percent) were coagulase- negative and 25 (27,2 percent) coagulase-positive. Similarity analysis showed a great heterogeneity among strains, but some presented 100 percent similarity. Resistance to oxacilin was encountered in 39 (42 percent) of the strains. Two coagulase- negative strains were resistant to vancomycin, and eleven (12 percent) were considered multiresistant. Measures such as hand disinfection of the staff and hospital beds and rationalization of antibiotic use could contribute to decrease pathogen transmission and selection pressure, diminishing the frequency and lethality of nosocomial infections.

Foram coletadas 143 amostras de mãos de humanos e camas hospitalares, através de "swabs" no caldo BHI, em um hospital escola da cidade de Ribeirão Preto/SP. As amostras coletadas foram incubadas a 37ºC por 24 horas e após este período as culturas foram semeadas em placas de Petri contendo agar "Staphylococcus Médium 110". As colônias típicas do gênero Staphylococcus foram colhidas e estocados a 4ºC até o momento de elaboração das provas de catalase, manitol, hemólise, DNAse e coagulase. As cepas isoladas foram analisadas através da técnica de RAPD-PCR para verificar o grau de similaridade. A sensibilidade das cepas isoladas foi testada frente a 10 diferentes antibióticos. Das 92 cepas de Staphylococcus sp isoladas, 67 (72,8 por cento) foram identificados como Staphylococcus coagulase-negativas e 25 (27,2 por cento) como Staphylococcus coagulase-positivas. A análise de similaridade mostrou uma grande heterogeneidade entre as cepas, entretanto foram isoladas algumas cepas com 100 por cento de similaridade. Resistência a oxacilina foi encontrada em 39 (42 por cento) cepas. Duas cepas de estafilococos coagulase-negativos mostraram-se resistentes a vancomicina. Onze cepas (12 por cento) de estafilococos foram consideradas multirresistentes. Medidas de desinfecção das mãos de pessoal e dos leitos hospitalares e a racionalização do uso indiscriminado de antibióticos podem contribuir para a queda da transmissão de patógenos e diminuição da pressão de seleção, e conseqüentemente diminuindo a freqüência e letalidade das infecções nosocomiais.

Isolation of Pseudomonas aeruginosa strains from dental office environments and units in Barretos, state of São Paulo, Brazil, and analysis of their susceptibility to antimicrobial drugs / Isolamento de cepas de Pseudomonas aeruginosa provenientes do meio ambiente e de equipos dentarios em clinicas dentarias em Barretos, São Paulo, Brasil; analises da susceptibilidade das cepas a drogas antimicrobianas

A wide variety of opportunistic pathogens has been detected in the tubing supplying water to odontological equipment, in special in the biofilm lining of these tubes. Among these pathogens, Pseudomonas aeruginosa, one of the leading causes of nosocomial infections, is frequently found in water lines supplying dental units. In the present work, 160 samples of water, and 200 fomite samples from forty dental units were collected in the city of Barretos, State of São Paulo, Brazil and evaluated between January and July, 2005. Seventy-six P. aeruginosa strains, isolated from the dental environment (5 strains) and water system (71 strains), were tested for susceptibility to six antimicrobial drugs most frequently used against P. aeruginosa infections. Susceptibility to ciprofloxacin, followed by meropenem was the predominant profile. The need for effective means of reducing the microbial burden within dental unit water lines is emphasized, and the risk of exposure and cross-infection in dental practice, in special when caused by opportunistic pathogens like P. aeruginosa, are highlighted.

Uma ampla variedade de patógenos oportunistas tem sido detectadas nos tubos de alimentação de água dos equipos odontológicos, particularmente no biofilme formado na superfície do tubo. Entre os patógenos oportunistas encontrados nos tubos de água, Pseudomonas aeruginosa é reconhecida como uma das principais causadoras de infecções nosocomiais. Foram coletadas 160 amostras de água e 200 amostras de fomites em quarenta clinicas odontológicas na cidade de Barretos, São Paulo, Brasil, durante o período de Janeiro a Julho de 2005. Setenta e seis cepas de P. aeruginosa, isoladas a partir dos fomites (5 cepas) e das amostras de água (71 cepas), foram analisadas quanto à susceptibilidade à seis drogas antimicrobianas freqüentemente utilizadas para o tratamento de infecções provocadas por P. aeruginosa. As principais suscetibilidades observadas foram para a ciprofloxacina, seguida pelo meropenem. A necessidade de um mecanismo efetivo para reduzir a contaminação bacteriana dentro dos tubos de alimentação de água dos equipos odontológicos foi enfatizada, e o risco da exposição ocupacional e infecção cruzada na prática odontológica, em especial quando causada por patógenos oportunistas como a P. aeruginosa foi realçado.

Research on staphylococcus spp in biofilm formation in water pipes and sensibility to antibiotics

Water from dental equipment presents risks for surgeon-dentists as well as for patients because it might work as a means of dissemination/ transmission of microorganisms. The objective of this study was to verify the quality of the water used in dental equipment by means of microbiological analysis, accomplishing the count of Staphylococcus spp. There have been collected 160 samples of water from reservoirs, taps used for hand washing, air-water syringes, and high-speed handpieces, in 40 dental offices in the city of Barretos, São Paulo. The rules concerning bacteriological analysis in cfu/mL from Standard Methods for the Examination of Water and Wastewater have been followed. The analysis of the results has made it possible to verify that out of the total of samples, 28% did not meet the standards of potability established by the American Dental Association. Regarding the origin of analyzed S. aureus, the most contaminated sites were high-speed handpieces in private offices (76%) and in dental care plan offices (71%), followed by air-water syringe in dental care plan offices (64%). For S. epidermidis samples, the most contaminated sites were high-speed handpieces in SUS (Brazilian Government Health System) dental offices (22%) and in dental care plan offices (14%). The most contaminated sites were dental offices that saw patients under dental care plans. Concerning tested antibiotics, the ones that presented better results as to sensibility to strain S. epidermidis were vancomycin and ciprofloxacin (100%) and, as to sensibility to strain S. aureus, it was ciprofloxacin (97%).

Infecção experimental em suínos jovens com Leptospira interrogans sorovar wolffi: determinação de parâmetros bioquímicos / Experimental infection by Leptospira interrogans serovar wolffi in young pigs: determination of biochemical parameters

Um estudo sobre infecção experimental foi realizado em oito suínos, com idade média de 90 dias, machos castrados, da raça Wessex, e distribuídos em dois grupos de quatro suínos cada. Durante 36 dias, foram analisadas as alterações bioquímicas nos soros dos suínos dos dois grupos. O Grupo I foi mantido como testemunho e recebeu 5,0mL de solução fisiológica estéril por via intravenosa (veia cava craniana) e, no Grupo II, os suínos foram inoculados pela mesma via com 5,0mL de cultura de Leptospira interrogans sorovar wolffi , amostra L-10 selvagem isolada de tatu (Dasypus novemcinctus), contendo 1,0 x 10(8) leptospiras/mL. A partir do terceiro dia após a inoculação e em intervalos de 72 horas até o décimo oitavo dia, foram feitas coletas de sangue, sem anticoagulante, dos animais inoculados e testemunhas. Os parâmetros bioquímicos analisados foram: bilirrubina total, direta e indireta, ácidos graxos, glicose e proteínas plasmáticas. Foi detectado um aumento da bilirrubina direta no terceiro dia e um aumento no sexto dia da bilirrubina total e indireta após a inoculação. As dosagens de glicose, ácidos graxos e proteínas plasmáticas apresentaram uma diminuição a partir do terceiro dia da inoculação. Com os resultados obtidos, pode-se concluir que o aumento das taxas de bilirrubinas levam a uma definição de um diagnóstico de hemólise aguda, e que a hipoglicemia, a hipolipidemia e a hipoproteinemia podem estar relacionadas com lesões hepáticas e a uma septcemia.Todas as dosagens em todos os animais retornaram aos seus valores normais a partir do décimo quinto dia.

Eight, 90 days old pigs, of the Wessex lineage all castrated male were used in experiment, divided into two groups of four animals. Biochemical alterations in the serum of the animals were analyzed in both groups during 36 days. Control (Group I) received 5.0mL of a 0.9 percent sterile sodium chloride solution by intracranial vein injection; Group II animals were inoculated by the same way with 5.0mL of a cell culture containing 1.0x10(8)cells/mL of Leptospira interrogans sorovar wolffi, wild strain L-10, isolated from a wild especies of brazilian "armadillo" (Dasypus novemcinctus). Three days after inoculation, blood was collected without anticoagulant; the same process was repeated at 72 hours intervals during eighteen days in both, control and experimental groups. Quantitative biochemical parameters were direct, indirect and total bilirubin, fatty acids and serum proteins. The experimental animals showed an increase of direct bilirubin three days after inoculation. Increases in indirect and total bilirubin were, also, observed after six days. Glucose, fatty acids and serum proteins decreased after the third day of inoculation. In conclusion, the increase in bilirubin levels could be due to acute hemolysis; hypoglycemia, hypolipidemia and hypoproteinemia that could be related to hepatic lesions and septicemia. All parameters returned to normal levels after fifteen days, in all animals tested.

Estudo bacteriológico de matérias primas de origem animal, utilizadas na fabricação de alimentos, na região de Ribeirão Preto, SP / Bacteriological study of substances of animal origin, used in the food manufacture, the region of Ribeirão Preto, SP

Com o objetivo de avaliar a qualidade microbiológica de matérias-primas alimentícias de origem industrial na região de Ribeirão Preto (SP) e determinar a sensibilidade de enteropatógenos, foram examinadas 34 amostras de carne, 38 de queijo e 25 de frango. Os resultados das análises microbiológicas para carne apresentaram ausência de Salmonella sp e valores abaixo do padrão permitido para coliformes fecais. Nas amostras de frango observou-se a ausência de Salmonella sp. Staphylococcus sp e Clostrídios e apresentaram-se dentro dos limites estabelecidos pelo Ministério da Saúde. Do total de 38 amostras de queijo analisadas, foram encontradas nove (24,0 por cento) com a presença de coliformes fecais, acima dos limites estabelecidos pela legislação vigente. Os principais gêneros ou espécies encontrados com maior freqüência nestas amostras foram: Escherichia coli (44, 4 por cento), seguidas por Klebsiella sp (22, 2 por cento), Enterobacter sp (11,1 por cento), Proteus sp (11,1 por cento) e Citrobacter sp (11,1 por cento). Nenhuma das quatro cepas de E. coli isoladas, apresentaram aglutinação com os soros polivalentes A, B e C e respectivos monovalentes das espécies EPEC (E. coli enteropatogênica). Os níveis de Staphylococcus sp encontrados ficaram dentro dos valores permitidos e Salmonella sp não foi detectada.(...) Esses resultados sugerem que dentre as amostras analisadas, o queijo foi a matéria-prima que se demonstrou menos adequada à comercialização e consumo, por oferecer um risco mais efetivo à saúde pública.