Meningitis posquirúrgica por Acinetobacter baumannii multirresistente. Actividad sinérgica in vivo de la asociación sulbactam/avibactam / Post-surgical meningitis due to multiresistant Acinetobacter baumannii. In vivo synergistic activity of the sulbactam/avibactam association

Acinetobacter baumannii (AB) es un bacilo gram negativo, no fermentador,con frecuencia oportunista, ubicuo en el medio ambiente, con capacidad para sobrevivir en condiciones medioambientales adversas promoviendo su persistencia y diseminación en diferentes áreas de un hospital. Ha sido relacionado con múltiples brotes de infecciones asociadas al cuidado de la salud como neumonía, bacteriemias, contaminación de heridas quirúrgicas o infecciones del tracto urinario, especialmente entre pacientes con comorbilidades graves, como aquellos que motivan el ingreso a unidades de cuidados intensivos (UCI). Las cepas más problemáticas son aquellas resistentes a los carbapenémicos, resistencia causada por enzimas de la clase de las oxacilinasas (bla OXA) cromosómicas o plasmídicas y más recientemente bla NDM-1. La aparición de estas cepas deja escasos antimicrobianos activos (colistin, minociclina, tigeciclina; amikacina) que son limitados en su eficacia y su uso se asocia con toxicidad. A esto se agrega, como en la paciente que se describe, que desarrolló una meningitis posquirúrgica, la limitada capacidad de difusión en el sistema nervioso central (SNC) de estas últimas opciones. Una de las alternativas terapéuticas, es buscar asociaciones como sulbactam/avibactam que mostraron una adecuada actividad sinérgica y bactericida en asilamientos resistentes a ampicilina/sulbactam en base a una significativa reducción de la CIM que permite administrar dosis habituales, con mejor tolerancia y lograr concentraciones terapéuticas en SNC. Se presenta una paciente que desarrolló una meningitis posquirúrgica debida a una cepa de AB multirresistente.

Acinetobacter baumannii (AB) is a non-fermenting gram-negative bacillus, largely opportunistic, ubiquitous in the environment, with the ability to survive in adverse environmental conditions, promoting its persistence and dissemination in different areas of the hospital. It has been implicated in many outbreaks of healthcare-associated infections such as pneumonia, bacteremia, surgical wounds contamination, or urinary tract infections, especially among patients with previous severe illnesses such as those requiring admission to intensive care units (ICU). The most problematic strains are those resistant to carbapenems, resistance caused by chromosomal or plasmid oxacillinase class (bla OXA), and more recently bla NDM-1. The appearance of these strains leaves few active antimicrobials (Colistin, Minocycline, Tigecycline; Amikacin) that are limited in their efficacy and toxic. To this we must add, as is the case of our patient who presented post-surgical meningitis, the limited diffusion capacity in the central nervous system (CNS) of these last options. One of the therapeutic alternatives is to search for synergistic associations such as sulbactam/avibactam that showed rapid synergistic and bactericidal activity in isolates resistant to ampicillin/sulbactam due to a significant reduction in its MIC, which allows us to administer usual, better tolerated doses that reach therapeutic concentrations in CNS. Here, we present a patient who developed a post-surgical meningitis due to multiresistant AB

A Long-Term Study on the Effect of Cyanobacterial Crude Extracts from Lake Chapultepec (Mexico City) on Selected Zooplankton Species.

Many urban lakes in Mexico City such as Lake Chapultepec are infested with high densities of cyanobacteria, particularly Microcystis. We tested the effect of cyanotoxins from cyanobacterial crude extracts on the demographic variables of zooplankton. The rotifers Brachionus havanaensis and Brachionus calyciflorus, and the cladocerans Ceriodaphnia dubia and Moina macrocopa were used for the assays. Temperature effects on the response of B. calyciflorus and 2 clones of M. macrocopa were tested. We hypothesized that with an increase in cyanotoxin concentration and temperature there would be an increase in the adverse effect on the test species and that the clone of Moina previously exposed to cyanobacteria from Lake Chapultepec would be more resistant to the cyanotoxins. Demography experiments showed that B. havanaensis was more sensitive than C. dubia. The negative effect of the cyanobacterial crude extract on B. calyciflorus was greater at 30 °C than at 20 °C or 25 °C. The strain of M. macrocopa isolated from Lake Chapultepec was more resistant to the cyanotoxins than the strain that had not been previously exposed to the cyanobacteria. The present study indicated that cyanobacteria in Lake Chapultepec are highly toxic and, considering the recreational use of this lake, should be controlled. Environ Toxicol Chem 2020;39:2409-2419. © 2020 SETAC.

Trends in progression-free survival (PFS) and time to progression (TTP) over time within first-line aromatase inhibitors trials in hormone receptor-positive advanced breast cancer.

BACKGROUND: Over the last 20 years, aromatase inhibitors (AI) have been tested in clinical trials as first-line therapy for hormone receptor-positive (HR-positive) advanced breast cancer (ABC), firstly as experimental arms, when they proved to be effective, and recently as control arms. This analysis aims to evaluate trends in progression-free survival (PFS) and time to progression (TTP) over time. PATIENTS AND METHODS: A literature review was conducted using the MEDLINE database to identify randomized controlled phase II or III trials which reported PFS or TTP of at least one arm using first-line AI HR-positive ABC patients. A linear correlation was used to access the association between the year of the first patient enrolled and the observed PFS/TTP. RESULTS: The search retrieved 19 trials, accounting for 4552 postmenopausal patients divided into 21 separate AI treatment arms. The PFS/TTP increased from 6 to 9 months in the earlier trials to 13-16 months in the current era, representing an absolute gain of approximately 7 months, without the addition of any other drug. Our analysis showed a positive correlation between the year of the first patient enrolled in these trials and median PFS/TTP reported (R 2 = 0.34; p < 0.01). No correlation was found between the year of the first patient included in these trials and other potential prognostic factors such as visceral metastasis at baseline (R 2 = 0.26; p = 0.20) or exposure to adjuvant therapy (R 2 = 0.05; p = 0.18). CONCLUSION: Patients treated with first-line AIs in the more recently conducted trials have longer PFS/TTP when compared to their counterparts treated with the same drugs in older studies. These findings have important implications for the estimation of sample size and follow-up periods for the planning of future trials as well as in the translation of the results into clinical practice decisions.

The sequential use of endocrine treatment for advanced breast cancer: where are we?

BACKGROUND: Hormone receptor-positive advanced breast cancer is an increasing health burden. Although endocrine therapies are recognised as the most beneficial treatments for patients with hormone receptor-positive advanced breast cancer, the optimal sequence of these agents is currently undetermined. METHODS: We reviewed the available data on randomised controlled trials (RCTs) of endocrine therapies in this treatment setting with particular focus on RCTs reported over the last 15 years that were designed based on power calculations on primary end points. RESULTS: In this paper, data are reviewed in postmenopausal patients for the use of tamoxifen, aromatase inhibitors and fulvestrant. We also consider the available data on endocrine crossover studies and endocrine therapy in combination with chemotherapy or growth factor therapies. Treatment options for premenopausal patients and those with estrogen receptor-/human epidermal growth factor receptor 2-positive tumours are also evaluated. CONCLUSION: We present the level of evidence available for each endocrine agent based on its efficacy in advanced breast cancer and a diagram of possible treatment pathways.

Hipotermia en el tratamiento del traumatismo de cráneo grave. Caso clínico y revisión de la literatura / Hypothermia in the treatment of skull trauma serious. Clinical case and review of literature

El tratamiento de la hipotermia comenzó hace más de cuatro décadas, pero en los últimos años, su uso cobró más relevancia, por lo que se realizaron múltiples estudios. Lamentablemente, los resultados son controvertidos en el tratamiento de la hipertensión intracraneal secundaria al trauma. Presentamos a un paciente con traumatismo de cráneo grave e hipertensión intracraneal resistente, en el que se utilizó la hipotermia controlada, con buena respuesta.(AU)

Treatment of hypothermia started more than four decades ago. But in recent years its use became more relevant, and multiple studies were performed. Results are controversial in the treatment of intracranial hypertension in trauma. We present a patient with severe cranial trauma and refractory intracranial hypertension, treated with controlled hypothermia, with a good response.(AU)

What is the role of chemotherapy in estrogen receptor-positive, advanced breast cancer?

Most breast tumors depend on female sex hormones for development and growth, thus being amenable to endocrine therapies. In the management of estrogen receptor (ER)-positive, advanced breast cancer, conventional wisdom dictates the use of endocrine therapy for patients with good prognostic features, whereas chemotherapy is recommended for the treatment of visceral crisis. There is, however, considerable uncertainty regarding the best initial strategy for patients with poor prognostic features other than visceral crisis, such as small-volume visceral involvement and a short disease-free interval after adjuvant therapy. In this article, we examine the role of chemotherapy in ER-positive, advanced breast cancer. Our review of the literature suggests that, in the absence of visceral crisis, endocrine agents should always be considered a major option for the initial treatment of ER-positive, metastatic breast cancer due to their proven efficacy and favorable toxicity profile. Although certain chemotherapy agents can induce higher response rates and more rapid responses, which are desirable effects in particular situations, the up-front use of chemotherapy does not seem to influence the overall outcome of the disease. In the subset of patients with epidermal growth factor type 2-positive disease, on the other hand, current data still do not support the use of endocrine agents alone.

[Association between indoor contamination and respiratory diseases in children living in Temuco and Padre Las Casas, Chile]. / Fuentes de contaminación intradomiciliaria y enfermedad respiratoria en jardines infantiles y salas cunas de Temuco y Padre Las Casas, Chile.

BACKGROUND: Indoor air pollution, is the main cause of population exposure to polluting agents. AIM: To establish an environmental profile of indoor contamination emission sources in families of children under 5 years that assist to kindergartens in Temuco and Padre Las Casas. To associate respiratory disease episodes in children with indoor contamination. MATERIAL AND METHODS: Cross sectional analysis of 355 family groups subjected to questionnaires about indoor contamination and number of respiratory disease episodes. RESULTS: Forty six percent of mothers or caregivers smoked, 37% smoked at home and 93% smoked one to two cigarettes per day. There was a significant association between respiratory diseases in children and drying clothes in the kitchen, using firewood for heating and the presence of humidity in the dwelling. Mothers identified as indoor contaminants the use of braziers in 76% of cases and firewood stoves in 24%. Ninety seven percent considered that these appliances were detrimental for respiratory health. CONCLUSIONS: The lack of awareness about indoor contamination among subjects of low socioeconomic status should prompt educational campaigns to modify behaviors in their dwellings.

Fuentes de contaminación intradomiciliaria y enfermedad respiratoria en jardines infantiles y salas cunas de Temuco y Padre Las Casas, Chile / Association between indoor contamination and respiratory diseases in children living in Temuco and Padre Las Casas, Chile

Background: Indoor air pollution, is the main cause of population exposure to polluting agents. Aim: To establish an environmental profile of indoor contamination emission sources in families of children under 5years that assist to kindergartens in Temuco and Padre Las Casas. To associate respiratory disease episodes in children with indoor contamination. Material and methods: Cross sectional analysis of 355 family groups subjected to questionnaires about indoor contamination and number of respiratory disease episodes. Results: Forty six percent of mothers or caregivers smoked, 37 percent smoked at home and 93 percent smoked one to two cigarettes per day. There was a significant association between respiratory diseases in children and drying clothes in the kitchen, using firewood for heating and the presence of humidity in the dwelling. Mothers identified as indoor contaminants the use of braziers in 76 percent of cases and firewood stoves in 24 percent. Ninety seven percent considered that these appliances were detrimental for respiratory health. Conclusions: The lack of awareness about indoor contamination among subjects of low socioeconomic status, should prompt educational campaigns to modify behaviors in their dwellings.

[Criteria on the legalization of abortion]. / Algunos criterios para la despenalización del aborto.

We revised ethical concepts related to abortion from the points of view of the mothers; life, health, and considerations are made concerning the embryo or fetus as a biological, ontological, moral, and potential person. Certain religious matters on abortion are described and commented on. Effects of abortion penalization in Mexico and the legislation in the Mexican states are examined, as well as the motives of depenalization in certain countries.

[Acceptance or refusal of abortion for maternal reasons. Survey of 3021 employees of the Federal Government]. / Aceptación o rechazo del aborto por motivos maternos. Encuesta en 3021 empleados del Gobierno Federal.

A survey was conducted among 3021 employees from the Mexican Federal Government regarding their acceptance or rejection of abortion in five different circumstances. Socioeconomic information was obtained from the interviewed and the result was that 23% totally rejected abortion, and 6% accepted abortion in any situation. Abortion was accepted by 61% in case of pregnancy threatens the mother's life; 63% in case a single woman has been raped; 41% if there are so many children and such situation implies economic problems for the family; 13% if the couple prefers to wait for an economic improvement; and 18% if the couple has decided to have no more than two kids. Also from the interviewed, 16% pointed out that abortion must be an exclusive decision from the woman and 29% thought it must be a shared decision with the partner. Abortion is better accepted by young people, by couples with few children or living in free union and by people with higher education level and higher income. It is also better accepted by people with no religion, or people who do not attend religious services or by whom religion does not affect their decisions in life.

[Quality of the presentation of free research papers in the National Congress of Gastroenterology: Morelia-1997]. / Calidad de presentación de los trabajos libres de investigación en el Congreso Nacional de Gastroenterología: Morelia-1997.

BACKGROUND: The quality of the presentation of a free paper in a medical congress is not necessarily related to the quality of the methodology. OBJECTIVE: To analyze the quality of the presentation of the free papers in the National Congress of Gastroenterology in Mexico (Morelia-1997). METHODS: A prospective study was designed to evaluate the following aspects: Limitation to time assigned, adequate use and design of slides, and mentioning of the main methodologic characteristics. RESULTS: There was a high quality of presentation in the majority of papers. The most frequent problems identified, amenable to improvement, were non-limitation to assigned time (24%), as well as problems in the design of slides (too many lines/columns in 32% and excessive number in 23%). CONCLUSIONS: The knowledge of the results may help to improve the presentations of the free papers in the national congresses of gastroenterology.

Emergency contraception in Mexico City: what do health care providers and potential users know and think about it?

Emergency contraception promises to reduce Mexico's high unwanted pregnancy and unsafe abortion rates. Because oral contraceptives are sold over-the-counter, several emergency contraceptive regimens are already potentially available to those women who know about the method. Soon, specially packaged emergency contraceptives may also arrive in Mexico. To initiate campaigns promoting emergency contraception, we interviewed health care providers and clients at health clinics in Mexico City, ascertaining knowledge, attitudes, and practices concerning the method. We found limited knowledge, but nevertheless cautious support for emergency contraception in Mexico. Health care providers and clients greatly overestimated the negative health effects of emergency contraception, although clients overwhelmingly reported that they would use or recommend it if needed. Although providers typically advocated medically controlled distribution, clients believed emergency contraception should be more widely available, including in schools and vending machines with information prevalent in the mass media and elsewhere.

PIP: An interview was conducted to ascertain knowledge, attitudes, and practices concerning emergency contraception (EC) among health care providers and potential EC users in metropolitan Mexico. Findings showed that there was a limited knowledge about EC per se and its method, but nevertheless, most of the participants were cautious to support EC in Mexico. Health care providers and clients greatly overestimated the negative health effects of EC, although clients overwhelmingly reported that they would use or recommend it if needed. Although providers typically advocated medically controlled distribution, clients believe EC should be more widely available, including in schools and vending machines, with information prevalent in the mass media and elsewhere.

Gender differences in sexual practices and sexually transmitted infections among adults in Lima, Peru.

OBJECTIVES: This study examined the prevalences of antibodies to Treponema pallidum, Chlamydia trachomatis, and herpes simplex virus type 2 in a sample of Peruvian adults. METHODS: Among adults seeking health certification in Lima, Peru, 600 were randomly selected to undergo interviews and serologic testing. RESULTS: Men's reported mean lifetime number of partners (10.6) far exceeded women's (1.1), yet antibody to sexually transmitted infection pathogens among sexually experienced participants was 2.8 times more prevalent among women than among men. Among men, female sex workers accounted for 37% of recent partners, and only sex with female sex workers while using condoms less than half of the time was independently associated with antibody (odds ratio = 3.6, 95% confidence interval = 1.5, 8.8). among women, number of partners was associated with any sexually transmitted infection antibody, while intercourse before 18 years of age was associated with C trachomatis antibody. At every level of perceived risk, sexually transmitted infection antibody was more frequent among women. CONCLUSIONS: Men having unprotected sex with female sex workers had the greatest risk of acquiring infections and (by inference) of transmitting them to women.

Traditional birth attendants in Mexico: advantages and inadequacies of care for normal deliveries.

In Mexico, traditional birth attendants (TBAs) are an essential resource for health care, especially in small rural communities where they attend approximately 45% of all deliveries. Both rural and urban women seek care with the TBAs because, amongst other things, they share the same cultural codes. In this study, qualitative and quantitative methods were used to analyze the concepts, resources and process of care during birth in rural areas of the state of Morelos. Results show that the socio-economic characteristics of the TBAs are similar to those of the patients, that they share the same precarious living conditions, and the resources to which they have access for providing care during births. When choosing a TBA as a health care provider, both the economic aspect and the importance of a shared symbolism come into play. We observed advantages in some of the traditional practices which should be incorporated into the medical system, for example protection through the massage of the perineum at the moment of expulsion. Nevertheless, there are inadequacies for which the implementation of training programs is fundamental, before articulate primary care programs using the TBAs can be promoted.

Anastomosis bronquial telescopica en trasplante experimental de pulmon en perros / Brochial telescopic anastomosis in experimental lung transplant in dogs

Presentamos la experiencia realizada en 33 trasplantes de pulmon en perros, utilizando la anastomosis bronquial con una sutura telescopica. Se dividio a la poblacion en 3 grupos; A: 12 trasplantes consecutivos sin buquedas de sobrevida alejada; B: 12 trasplantes consecutivos con sobrevida m xima de 7 dias; C: 9 trasplantes consecutivos con sobrevida libre. En todos los casos la anatomosis se efectuo con surget de cido poliglicolico 410 en la porcion membranosa y puntos separados en la porcion cartilaginosa. No hubo casos de dehiscencia de la sutura. Dos perros presentaron estenosis bronquial provocada por la protrusion intraluminal del cartilago donante. Los estudios histopatologicos demostraron la infiltracion de la pared bronquial del injerto por elementos inflamatorios se produce en los primeros dias del postoperatorio y se acentua con el transcurso de ste hasta llegar a la necrosis de toda la pared. Se concluye que la anastomosis bronquial telescopica es una te cnica sencilla y segura con bajo indice de complicaciones

Anastomosis bronquial telescopica en trasplante experimental de pulmon en perros / Brochial telescopic anastomosis in experimental lung transplant in dogs

Presentamos la experiencia realizada en 33 trasplantes de pulmon en perros, utilizando la anastomosis bronquial con una sutura telescopica. Se dividio a la poblacion en 3 grupos; A: 12 trasplantes consecutivos sin buquedas de sobrevida alejada; B: 12 trasplantes consecutivos con sobrevida m xima de 7 dias; C: 9 trasplantes consecutivos con sobrevida libre. En todos los casos la anatomosis se efectuo con surget de cido poliglicolico 410 en la porcion membranosa y puntos separados en la porcion cartilaginosa. No hubo casos de dehiscencia de la sutura. Dos perros presentaron estenosis bronquial provocada por la protrusion intraluminal del cartilago donante. Los estudios histopatologicos demostraron la infiltracion de la pared bronquial del injerto por elementos inflamatorios se produce en los primeros dias del postoperatorio y se acentua con el transcurso de ste hasta llegar a la necrosis de toda la pared. Se concluye que la anastomosis bronquial telescopica es una te cnica sencilla y segura con bajo indice de complicaciones

[Mercury in the hair of pregnant and lactating Chilean mothers]. / Mercurio en el cabello de embarazadas y madres lactantes chilenas.

Mercury-containing industrial waste has been released into the coastal waters of the Eighth Region of Chile for around two decades. This study, carried out from 1991 to 1993, sought to measure mercury concentrations in the hair of pregnant and lactating women from villages near the coast and in the interior of the region in order to examine the relationship between the concentration of mercury and seafood consumption. The survey questionnaire used in 1991 to determine seafood consumption did not ask about the frequency of consumption of fish, shellfish, and algae but only whether the women who were pregnant or breast-feeding consumed a minimum of one fish-based meal per week. The questionnaire used in 1992 and 1993 asked about the daily and weekly consumption of seafood in general (fish, shellfish, and algae). Spectrophotometry was used to determine the total mercury concentration in samples of 100 mg of hair from 153 pregnant and lactating women in 11 fishing villages of the Eighth Region where seafood is regularly consumed. None of the women had occupational exposure to mercury. Total mercury concentration was also determined in hair samples from a control group composed of 26 pregnant and lactating women from Pinto and El Carmen, villages in the interior of the same region where seafood was rarely eaten. The arithmetic mean of the total mercury concentration in hair was 1.81 mg/kg of body weight for the study group (standard deviation [SD] 1.52) and 0.42 mg/kg for the control group (SD 0.15)--a statistically significant difference (P < 0.01). Pairwise comparisons also revealed statistically significant differences (P < 0.05) between the mean for the interior group and the means for the women in the nine villages closest to the sources of the pollution, but not between the mean for the interior group and those for women in the two villages at the extreme north and south of the study zone, who lived farthest from the contaminated waters. The total mercury concentration in hair was significantly higher in women who indicated that they ate fish seven or more times per week; in those who said they ate fish, shellfish, or algae five or more times per week; and in those who had lived 20 or more years in their village. No statistically significant differences were found when the results were analyzed by age.