Vaccines against extraintestinal pathogenic Escherichia coli (ExPEC): progress and challenges.

The emergence of antimicrobial resistance (AMR) is a principal global health crisis projected to cause 10 million deaths annually worldwide by 2050. While the Gram-negative bacteria Escherichia coli is commonly found as a commensal microbe in the human gut, some strains are dangerously pathogenic, contributing to the highest AMR-associated mortality. Strains of E. coli that can translocate from the gastrointestinal tract to distal sites, called extraintestinal E. coli (ExPEC), are particularly problematic and predominantly afflict women, the elderly, and immunocompromised populations. Despite nearly 40 years of clinical trials, there is still no vaccine against ExPEC. One reason for this is the remarkable diversity in the ExPEC pangenome across pathotypes, clades, and strains, with hundreds of genes associated with pathogenesis including toxins, adhesins, and nutrient acquisition systems. Further, ExPEC is intimately associated with human mucosal surfaces and has evolved creative strategies to avoid the immune system. This review summarizes previous and ongoing preclinical and clinical ExPEC vaccine research efforts to help identify key gaps in knowledge and remaining challenges.

Progress toward a vaccine for extraintestinal pathogenic E. coli (ExPEC) II: efficacy of a toxin-autotransporter dual antigen approach.

Extraintestinal pathogenic Escherichia coli (ExPEC) is a leading cause of worldwide morbidity and mortality, the top cause of antimicrobial-resistant (AMR) infections, and the most frequent cause of life-threatening sepsis and urinary tract infections (UTI) in adults. The development of an effective and universal vaccine is complicated by this pathogen's pan-genome, its ability to mix and match virulence factors and AMR genes via horizontal gene transfer, an inability to decipher commensal from pathogens, and its intimate association and co-evolution with mammals. Using a pan virulome analysis of >20,000 sequenced E. coli strains, we identified the secreted cytolysin α-hemolysin (HlyA) as a high priority target for vaccine exploration studies. We demonstrate that a catalytically inactive pure form of HlyA, expressed in an autologous host using its own secretion system, is highly immunogenic in a murine host, protects against several forms of ExPEC infection (including lethal bacteremia), and significantly lowers bacterial burdens in multiple organ systems. Interestingly, the combination of a previously reported autotransporter (SinH) with HlyA was notably effective, inducing near complete protection against lethal challenge, including commonly used infection strains ST73 (CFT073) and ST95 (UTI89), as well as a mixture of 10 of the most highly virulent sequence types and strains from our clinical collection. Both HlyA and HlyA-SinH combinations also afforded some protection against UTI89 colonization in a murine UTI model. These findings suggest recombinant, inactive hemolysin and/or its combination with SinH warrant investigation in the development of an E. coli vaccine against invasive disease.

Actualización sobre el tratamiento óptico en niños miopes / Update on Optical Treatment in Myopic Children

La miopía constituye un problema de salud pública a nivel mundial, y se espera que afecte a un número cada vez mayor de personas en las próximas décadas. El control de la progresión de este defecto refractivo se ha convertido en una parte importante de la práctica clínica, ante la ausencia de un tratamiento protocolizado con el objetivo de disminuirla, se han valorado varias opciones terapéuticas. El objetivo del estudio fue proporcionar información actualizada sobre el tratamiento óptico en niños miopes. Para su realización se revisaron publicaciones, en idioma español e inglés, disponibles en bases de datos como PubMed, Ebsco, Google Académico, SciELO entre otras(AU)

Myopia constitutes a worldwide public health problem, and is expected to affect an increasing number of people in the coming decades. The control of the progression of this refractive defect has become an important part of clinical practice, and in the absence of a protocolized treatment with the aim of reducing it, several therapeutic options have been evaluated. The aim of the study was to provide updated information on optical treatment in myopic children. For its realization, publications were reviewed, in Spanish and English, available in databases such as PubMed, Ebsco, Google Scholar, SciELO, among others(AU)

Tratamiento óptico en la ambliopía refractiva / Optical Treatment in Refractive Amblyopia

La ambliopía ha sido conceptualizada de diferentes maneras a lo largo de los años. La mayoría de los autores la define como una reducción de la agudeza visual mejor corregida, que resulta del procesamiento anormal de las imágenes visuales en una etapa temprana de la vida y que no se puede atribuir a anomalías estructurales del ojo o de la vía visual. Se realizó una revisión sobre el tratamiento óptico o adaptación refractiva en la ambliopía refractiva, así como los diferentes factores que pueden interferir en el éxito de este tratamiento. Se ejecutó una búsqueda en bases de datos electrónicas como PubMed, Cochrane Library, INFOMED, EBSCO, SCIELO y de ensayos clínicos y textos de la especialidad. Hasta el 2002 esta terapéutica era una de las opciones para estos pacientes y se indicaba siempre asociada al tratamiento con parche o penalizaciones. En la actualidad constituye la primera opción terapéutica en el paciente ambliope(AU)

Amblyopia has been conceptualized in different ways over the years. Most authors define it as a reduction in best-corrected visual acuity resulting from abnormal processing of visual images early in life that is not attributable to structural abnormalities of the eye or visual pathway. A review was made on the optical treatment or refractive adaptation in refractive amblyopia, as well as the different factors that may interfere in the success of this treatment. A search was carried out in electronic databases such as PubMed, Cochrane Library, INFOMED, EBSCO, SCIELO and clinical trials and texts of the specialty. Until 2002 this therapy was one of the options for these patients and was always indicated in association with patch treatment or penalties. Nowadays it is the first therapeutic option for amblyopic patients(AU)

Parálisis aislada del músculo oblicuo inferior izquierdo / Isolated Left Inferior Oblique Muscle Palsy

La parálisis aislada del músculo oblicuo inferior constituye la parálisis menos frecuente de todas las que afectan a los músculos extraoculares. Se realiza la presentación de una paciente de seis años de edad con antecedentes de salud que fue traída por su madre a la consulta de oftalmología pediátrica y estrabismo por presentar una desviación ocular desde los primeros meses de nacida. Se planteó como posibles diagnósticos un síndrome de Brown del ojo izquierdo o una parálisis del músculo oblicuo inferior izquierdo, se confirmó el segundo diagnóstico con el test de ducción forzada. Existen varias opciones quirúrgicas para estos pacientes. El objetivo fue determinar si se logra el alineamiento quirúrgico en la posición primaria de mirada con la intervención quirúrgica propuesta de recesión del recto superior derecho 5 mm. La paciente se encuentra alineada en posición primaria de mirada, sin limitación de las versiones y sin tortícoli(AU)

Isolated palsy of the inferior oblique muscle is the least frequent of all palsies affecting the extraocular muscles. We present a six-year-old female patient with a medical history who was brought by her mother to the pediatric ophthalmology and strabismus clinic because she presented an ocular deviation since the first months of her life. A Brown's syndrome of the left eye or left inferior oblique muscle palsy was proposed as possible diagnoses, the second diagnosis was confirmed with the forced duction test. There are several surgical options for these patients. The objective was to determine if surgical alignment in the primary gaze position is achieved with the proposed surgical intervention of right superior rectus recession 5 mm. The patient is aligned in the primary gaze position, without limitation of the versions and without torticollis(AU)

Multiresponse optimization of the extrusion process for ready-to-eat snacks from pineapple byproducts and maize flour.

This research aimed to optimize the processing conditions to obtain ready-to-eat extruded snacks with a high fiber content from mixtures of pineapple byproduct powder (PBP) and nixtamalized maize flour (PBP-NMF) or maize flour (PBP-MF). The effects of barrel temperature, feed moisture content, and PBP were evaluated. The increase in barrel temperature has a negative effect on the bulk density, the water absorption index, and the texture in both mixtures (PBP-MF and PBP-NMF) and increases the expansion index and the water solubility index in the mixture with MF. The increase in the feed moisture content increased the bulk density and water absorption index in both mixtures and the texture in the mixtures with MF. The increasing PBP decreases the expansion index and increases the water solubility index in both mixtures. The increase in PBP in the mixtures with MF decreases the water absorption index, texture, and bulk density. From the optimization, four products were obtained, two for the NMF mixture and two for the MF mixtures. The optimal formulations can be considered a good source of total fiber (12.46-12.78 g/100 g) and protein (8.27-8.85 g/100 g) with good acceptance by consumers. PRACTICAL APPLICATION: Pineapple byproducts in combination with nixtamalized and nonnixtamalized maize flour are viable raw materials for the development of ready-to-eat extruded snacks with a high content of dietary fiber and good acceptance by consumers. Due to their characteristic nutritional properties, the consumption of this ready-to-eat snack could present potential benefits for human health.

Spectroelectrochemical Enzyme Sensor System for Acetaldehyde Detection in Wine.

A new spectroelectrochemical two-enzyme sensor system has been developed for the detection of acetaldehyde in wine. A combination of spectroscopy and electrochemistry improves the analytical features of the electrochemical sensor because the optical information collected with this system is only associated with acetaldehyde and avoids the interferents also present in wines as polyphenols. Spectroelectrochemical detection is achieved by the analysis of the optical properties of the K3[Fe(CN)6]/K4[Fe(CN)6] redox couple involved in the enzymatic process: aldehyde dehydrogenase catalyzes the aldehyde oxidation using ß-nicotinamide adenine dinucleotide hydrate (NAD+) as a cofactor and, simultaneously, diaphorase reoxidizes the NADH formed in the first enzymatic process due to the presence of K3[Fe(CN)6]. An analysis of the characteristic UV-vis bands of K3[Fe(CN)6] at 310 and 420 nm allows the detection of acetaldehyde, since absorption bands are only related to the oxidation of this substrate, and avoids the contribution of other interferents.

Discovery of the First Lytic Staphylococcus pseudintermedius/Staphylococcus aureus Polyvalent Bacteriophages.

Background: There are no verified lytic Staphylococcus pseudintermedius phages in the literature and few temperate phage genomes in databases. S. pseudintermedius is an opportunistic zoonotic pathogen of great importance in veterinary and human medicine. Materials and Methods: We discovered phages against canine-derived S. pseudintermedius isolates by screening dog feces, hair, and skin swabs. Fourteen new phages were isolated and characterized by genomic analysis, transmission electron microscopy, and host range determination. Results: Three phages-DH2, DH5, and DS10, a phage K variant-were predicted lytic by sequencing, a designation supported by mitomycin C induction. All three are S. pseudintermedius and Staphylococcus aureus polyvalent phages, with DH2 and DS10 being strong killers of both species. Conclusions: We report discovery of the first verified lytic S. pseudintermedius phages and suggest dog hair as a novel reservoir. DH2, DH5, and DS10 are promising candidates toward developing an anti-Staphylococcal phage cocktail.

Síndrome de POEMS: a propósito de un caso / POEMS syndrome: A case report

RESUMEN El síndrome POEMS es una enfermedad de patogenia desconocida. El acrónimo deriva de las principales manifestaciones clínicas de este cuadro: polineuropatía, organomegalia, endocrinopatía, gammapatía monoclonal y trastornos de la piel. Estudios recientes sugieren la asociación de mutaciones genéticas con inmunoglobulina λ. En este reporte presentamos el caso de un paciente de 56 años, con un cuadro clínico de diez meses de evolución. Al inicio, se presentó un edema en los miembros inferiores e hipertricosis, y luego aparecieron los síntomas gastrointestinales, linfadenopatía inguinal y parestesia de miembros inferiores. Enfatizamos la importancia de este caso clínico debido a que, en nuestro país, los informes de pacientes con el síndrome POEMS son escasos, y en el departamento de La Libertad no existe ningún reporte. Además, el tiempo para diagnosticar esta enfermedad es prolongado.

ABSTRACT POEMS syndrome is a disease of unknown pathogenesis. The acronym stands for the disease's main clinical manifestations: polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin disorders. Recent studies suggest the association of genetic mutations with immunoglobulin λ. We report the case of a 56-year-old male patient with a 10-month clinical picture, whose initial signs and symptoms were lower limb edema and hypertrichosis, followed by gastrointestinal symptoms, inguinal lymphadenopathy and lower limb paresthesia. We emphasize the importance of this clinical case, given the limited reports of POEMS syndrome at the national level and no reported cases in the department of La Libertad, and the long time it takes to diagnose such disease.

Vergencias fusionales. Exploración e importancia en la práctica clínica / Fusion Vergences. Exploration and Importance in Clinical Practice

La vergencia fusional se define como la vergencia estimulada por la disparidad retiniana que genera un movimiento vergencial para mantener la visión binocular simple, son movimientos binoculares disyuntivos en los que ambos ojos se dirigen en la misma dirección para fijar un objeto y a la vez se desplazan en sentido opuesto. La amplitud de fusión desempeña un importante papel en mantener una visión binocular simple. Los valores fuera de la norma son significativos en el diagnóstico de posibles disfunciones binoculares no estrábicas. Con este artículo se pretende mostrar los diferentes criterios relacionados con la evaluación de la amplitud de las reservas fusionales, cual es la prueba más usada y los rangos considerados dentro de límites normales, para lo que se realizó una búsqueda en diferentes publicaciones y textos de la especialidad(AU)

Fusional vergence is defined as the vergence stimulated by retinal disparity that generates a vergence movement to maintain simple binocular vision, they are disjunctive binocular movements in which both eyes are directed in the same direction to fix an object and at the same time they move in opposite way. Fusion amplitude plays an important role in maintaining single binocular vision. Values outside the norm are significant in the diagnosis of possible non-strabismic binocular dysfunctions. This article aims to show the different criteria related to the evaluation of the amplitude of fusional reserves, which is the most used test and the ranges considered within normal limits, for which a search was carried out in different publications and texts of the specialty(AU)

Caracterización de la ambliopía refractiva / Characterization of Refractive Amblyopia

Objetivo: Relacionar el tipo y profundidad de la ambliopía con el tipo y magnitud del defecto refractivo. Métodos: Estudio transversal en 27 pacientes entre cinco y 18 años con ambliopía refractiva atendidos por vez primera en la consulta de Oftalmología Pediátrica y Estrabismo del Instituto Cubano de Oftalmología Ramón Pando Ferrer. Resultados: La edad en que fueron examinados por primera vez fue similar en ambos tipos de ambliopía, pero ligeramente mayor en la ambliopía anisometrópica (media ocho años). Se halló una correlación significativa entre el nivel de profundidad de la ambliopía y la magnitud del defecto refractivo, en el ojo derecho (p = 0,001), no siendo así en el ojo izquierdo (p = 0 ,304). Conclusiones: En el grupo de estudio la edad en que son examinados se considera tardía y no existen diferencias en cuanto a género y color de piel. Existe un ligero predominio de la ambliopía isoametrópica sobre la anisometrópica, predominando el ojo izquierdo en la ambliopía anisometrópica. El defecto refractivo que se asocia con más frecuencia a la ambliopía refractiva es el astigmatismo en contra de la regla. A medida que aumenta la magnitud del defecto refractivo aumenta la profundidad de la ambliopía en el ojo derecho, no siendo así en el ojo izquierdo(AU)

Objective: To relate the type and depth of amblyopia with the type and magnitude of refractive error. Methods: Cross-sectional study carried out in 27 patients aged 5-18 years with refractive amblyopia first treated in the pediatric ophthalmology and strabismus consultation of Ramón Pando Ferrer Cuban Institute of Ophthalmology. Results: The age at which the patients were first examined was similar in both types of amblyopia, but slightly higher in anisometropic amblyopia (mean of 8 years). A significant correlation was found between the depth of amblyopia and the magnitude of the refractive error in the right eye (P=0.001), not being so in the left eye (P=0.304). Conclusions: In the study group, the age at which they are examined is considered late and there are no differences in gender or skin color. There is a slight predominance of isometropic amblyopia over anisometropic amblyopia, with a predominance of the left eye in anisometropic amblyopia. The refractive error most frequently associated with refractive amblyopia is against-the-rule astigmatism. As the magnitude of the refractive error increases, the depth of amblyopia increases in the right eye, but not in the left eye(AU)

Teamwork to Survive in Hostile Soils: Use of Plant Growth-Promoting Bacteria to Ameliorate Soil Salinity Stress in Crops.

Plants and their microbiomes, including plant growth-promoting bacteria (PGPB), can work as a team to reduce the adverse effects of different types of stress, including drought, heat, cold, and heavy metals stresses, as well as salinity in soils. These abiotic stresses are reviewed here, with an emphasis on salinity and its negative consequences on crops, due to their wide presence in cultivable soils around the world. Likewise, the factors that stimulate the salinity of soils and their impact on microbial diversity and plant physiology were also analyzed. In addition, the saline soils that exist in Mexico were analyzed as a case study. We also made some proposals for a more extensive use of bacterial bioinoculants in agriculture, particularly in developing countries. Finally, PGPB are highly relevant and extremely helpful in counteracting the toxic effects of soil salinity and improving crop growth and production; therefore, their use should be intensively promoted.

Phage Therapy Related Microbial Succession Associated with Successful Clinical Outcome for a Recurrent Urinary Tract Infection.

We rationally designed a bacteriophage cocktail to treat a 56-year-old male liver transplant patient with complex, recurrent prostate and urinary tract infections caused by an extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) (UCS1). We screened our library for phages that killed UCS1, with four promising candidates chosen for their virulence, mucolytic properties, and ability to reduce bacterial resistance. The patient received 2 weeks of intravenous phage cocktail with concomitant ertapenem for 6 weeks. Weekly serum and urine samples were collected to track the patient's response. The patient tolerated the phage therapy without any adverse events with symptom resolution. The neutralization of the phage activity occurred with sera collected 1 to 4 weeks after the first phage treatment. This was consistent with immunoassays that detected the upregulation of immune stimulatory analytes. The patient developed asymptomatic recurrent bacteriuria 6 and 11 weeks following the end of phage therapy-a condition that did not require antibiotic treatment. The bacteriuria was caused by a sister strain of E. coli (UCS1.1) that remained susceptible to the original phage cocktail and possessed putative mutations in the proteins involved in adhesion and invasion compared to UCS1. This study highlights the utility of rationally designed phage cocktails with antibiotics at controlling E. coli infection and suggests that microbial succession, without complete eradication, may produce desirable clinical outcomes.

Factores de riesgo en pacientes miopes en edad pediátrica / Risk factors in pediatric myopic patients

Objetivo: Evaluar la asociación entre los factores de riesgo en pacientes miopes en edad pediátrica. Métodos: Se realizó un estudio con diseño de casos y control para evaluar los factores de riesgo asociados a la miopía en los pacientes atendidos en la consulta del Servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología "Ramón Pando Ferrer". La muestra estuvo conformada por 263 pacientes (123 casos y 140 controles) que cumplieron los criterios de inclusión y de exclusión. Las variables del estudio fueron la edad, el sexo, el color de la piel, la zona de procedencia, el bajo peso al nacer, la prematuridad, las madres fumadoras, el antecedente de familiares con defectos refractivos, las horas de exposición a las pantallas, las horas de exposición a la luz solar y la longitud axial. Resultados: Se encontró correlación entre el antecedente de familiares con defecto refractivo y la presencia de miopía (p = 0,009), y a su vez un riesgo de 1,9 de padecerla; más de 2 horas - pantallas se relaciona con pacientes miopes (p = 0,003) y duplica el riesgo. Más de 2 horas de luz solar fue más frecuente en los controles (p = 0,004) y es un factor de protección; las longitudes axiales fueron mayores en miopes (p = 0,000) y se correlacionó la exposición horas - pantallas con una mayor longitud axial. Conclusiones: Los antecedentes familiares de defectos refractivos aumentan 1,9 veces el riesgo de padecer miopía; la exposición a las pantallas por más de 2 horas al día lo duplica y la exposición a la luz solar por el mismo tiempo lo reduce a la mitad. La longitud axial es mayor en miopes y en los expuestos a las pantallas(AU)

Objective: Evaluate the association between risk factors in pediatric myopic patients. Methods: A case-control study was conducted to evaluate the risk factors associated to myopia in patients attending the Pediatric Ophthalmology Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology. The sample was 263 patients (123 cases and 140 controls) who met the inclusion criteria. The study variables were age, sex, skin color, place of residence, low birth weight, prematurity, smoking mothers, a family history of refractive defects, screen time, sun exposure hours and axial length. Results: A correlation was found between a family history of refractive defects and the presence of myopia (p = 0.009), as well as a 1.9 risk of developing the disorder. More than two screen hours were associated to myopic patients (p = 0.003), doubling the risk. More than two sun exposure hours were more frequent among controls (p = 0.004) and constitute a protection factor. Axial lengths were greater among myopics (p = 0.000). Exposure and screen time were correlated with greater axial length. Conclusions: A family history of refractive defects increases the risk for myopia 1.9 times, exposure to screens for more than two hours per day doubles it, and the same number of sun exposure hours reduces it to half. Axial length is greater among myopics and screen exposed people(AU)

Resultados de la cirugía mínimamente invasiva en pacientes con estrabismos horizontales / Results of the minimally invasive surgery in patient with horizontal strabismus

Objetivo: Determinar los resultados de la cirugía mínimamente invasiva en pacientes con estrabismos horizontales. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo de una serie de 19 pacientes (16 ojos derechos, 17 izquierdos) atendidos en el Servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", en el periodo comprendido entre junio de 2018 y julio de 2019, a quienes se les realizó cirugía mínimamente invasiva de estrabismo y fueron seguidos por 6 meses. Se evaluaron las variables: tipo de desviación, agudeza visual, signos posoperatorios, ángulo de desviación pre- y posquirúrgico, éxito quirúrgico, fusión, estereopsis y complicaciones. Resultados: El 73,7 por ciento de los pacientes presentaba esotropías; la media de agudeza visual pre- y posoperatoria entre los dos ojos fue muy similar; el signo posoperatorio más frecuente fue la hiperemia conjuntival ligera (75 por ciento ojos derechos y 64,5 por ciento ojos izquierdos) a las 24 horas. Se encontraron diferencias estadísticas (p < 0,001) en el ángulo de desviación horizontal en dioptrías prismáticas, pre- y poscirugía, con el 84,2 por ciento de éxito quirúrgico. El 78,6 y el 80 por ciento de los pacientes con esotropía y exotropías alcanzaron fusión, pero solo lograron estereopsis el 28,5 y el 60 por ciento de ellos respectivamente. La frecuencia de complicaciones ocurrió en el 15,8 por ciento de los pacientes. Conclusiones: Se alcanzaron buenos resultados motores, así como aceptables en los sensoriales en pacientes operados de estrabismos horizontales por cirugía mínimamente invasiva(AU)

Objective: Determine the results of minimally invasive surgery in patients with horizontal strabismus. Methods: A prospective longitudinal descriptive study was conducted of a series of 19 patients (16 right eyes, 17 left eyes) attending the Pediatric Ophthalmology Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology from June 2018 to July 2019. These patients underwent minimally invasive strabismus surgery and were followed up for six months. The variables considered were deviation type, visual acuity, postoperative signs, pre- and postoperative angle of deviation, surgical success, fusion, stereopsis and complications. Results: Of the patients studied, 73.7 percent presented esotropias; mean pre- and postoperative visual acuity was very similar in the two eyes; the most common postoperative sign was slight conjunctival hyperemia (75 percent right eyes and 64.5 percent left eyes) at 24 hours. Statistical differences (p < 0.001) were found in the horizontal angle of deviation in pre- and postoperative prism diopters, with 84.2 percent surgical success. 78.6 percent and 80 percent of the patients with esotropia and exotropia achieved fusion, but only 28.5 and 60 percent of them, respectively, achieved stereopsis. Complications occurred in 15.8 percent of the patients. Conclusions: Good motor results were obtained, as well as acceptable sensory results in patients undergoing minimally invasive horizontal strabismus surgery(AU)