Misdiagnosed superior mesenteric artery syndrome due to diabetic gastroparesis. Case report and literature review.

INTRODUCTION: Superior mesenteric artery syndrome (SMAS) is a rare cause of upper intestinal obstruction. This occurs due to duodenal compression between the superior mesenteric artery and the aorta. Anatomical alterations, eating disorders, after some surgical procedures, and trauma are frequent causes of this rare syndrome. Diabetes is a highly prevalent disease that can cause gastroparesis in up to 12 %. Its association with SMAS is extremely rare and challenging to identify. CASE PRESENTATION: A 32-year-old man experienced nausea and vomiting after diagnosis and treatment for type II diabetes. He was treated for diabetic gastroparesis for 2 years without improvement until he lost 40 kg of weight. After imaging studies, a distance between the superior mesenteric artery and the aorta of 5.3 mm and an angle of 17 degrees were detected, corroborating the diagnosis of SMAS syndrome. Due to medical failure, surgical treatment via duodenojejunostomy was performed. DISCUSSION: Diabetes is a very prevalent disease in the world population that can cause gastrointestinal symptoms. In our patient, diabetic gastroparesis delayed the diagnosis of SMAS until severe symptoms of upper intestinal obstruction and significant weight loss occurred. In our patient, due to medical failure, surgical treatment significantly improved his symptoms and stopped his weight loss. CONCLUSION: Superior mesenteric artery syndrome is a rare syndrome, and challenging to differentiate from diabetic gastroparesis. Delays in management may result in excessive weight loss. Surgical treatment can improve symptoms and weight loss.

Monitoring System for Operating Variables in Incubators in the Neonatology Service of a Highly Complex Hospital through the Internet of Things (IoT).

BACKGROUND: Around 15 million premature babies are born annually, requiring specialized care. Incubators are vital for maintaining their body temperature, which is crucial for their well-being. Ensuring optimal conditions in incubators, including constant temperature, oxygen control, and comfort, is essential for improving the care and survival rates of these infants. METHODS: To address this, an IoT-based monitoring system was developed in a hospital setting. The system comprised hardware components such as sensors and a microcontroller, along with software components including a database and a web application. The microcontroller collected data from the sensors, which was then transmitted to a broker via WiFi using the MQTT protocol. The broker validated and stored the data in the database, while the web application provided real-time access, alerts, and event recording. RESULTS: Two certified devices were created, employing high quality components. The system was successfully implemented and tested in both the biomedical engineering laboratory and the neonatology service of the hospital. The results of the pilot test supported the concept of IoT-based technology, demonstrating satisfactory responses in temperature, humidity, and sound variables within the incubators. CONCLUSIONS: The monitoring system facilitated efficient record traceability, allowing access to data over various timeframes. It also captured event records (alerts) related to variable problems, providing information on duration, date, hour, and minutes. Overall, the system offered valuable insights and enhanced monitoring capabilities for neonatal care.

Interdisciplinary training academy for integrated substance/opioid use disorder prevention and health care: A workforce catalyst report.

INTRODUCTION: Addressing the opioid crisis requires attention to the fact that people with opioid use disorder are affected by multiple systems and professionals working across disciplines (e.g., primary health care, social work, psychology). Thus, we developed the Interdisciplinary Training Academy for Integrated Substance/Opioid Use Disorder Prevention and Health care (ITA). The purpose of the ITA is to connect multiple systems to aid in the development of practitioners who are broadly prepared to address the opioid crisis. METHOD: Herein, we use preliminary descriptive methods to illustrate early outcomes related to 30 weeks of interprofessional training rotations across all system levels related to policy, prevention, treatment, integrated care, harm reduction and recovery support services. RESULTS: Overall, the ITA has assisted fellows in garnering 7,257 hr of training to become holistically competent behavioral health providers. Preliminary data indicate that most cohort graduates intend to pursue employment in a telehealth or primary care setting that serves medically underserved communities. DISCUSSION: In sum, we offer a new concept for remote field education that engages learners as curriculum developers, educators, and emerging practitioners with expertise across ecological systems. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Patrones de adherencia en células HEp-2 de cepas de Escherichia coli aisladas de ríos contaminados de La Habana / Adherence patterns in HEp-2 cells of Escherichia coli strains isolated from contaminated rivers in Havana

Introducción: El proceso de adherencia es fundamental en el desarrollo de la mayoría de las infecciones ocasionadas por Escherichia coli. Para los patotipos de esta especie se describen tres patrones de adherencia diferentes: adherencia localizada, adherencia difusa y adherencia agregativa, los cuales se relacionan con los procesos patogénicos específicos que ocasiona en la clínica. Sin embargo, son pocos los estudios en relación con los fenotipos de adherencia in vitro de E. coli aisladas del ambiente. Objetivo: Determinar los fenotipos de adherencia de cepas de E. coli aisladas de ecosistemas dulceacuícolas de La Habana. Métodos: Se analizaron 108 cepas de E. coli aisladas de los ríos Almendares, Quibú y Luyanó de La Habana. Se determinó el patrón de adherencia mediante ensayos de adherencia en cultivo celular de la línea HEp-2 así como el serotipo de cada cepa. Resultados: El 25 por ciento de las cepas de E. coli aisladas fueron adherentes y el 75 por ciento fueron no adherentes. Veintidós cepas mostraron el típico patrón de adherencia difusa y cinco cepas mostraron una adherencia agregativa. Se encontraron cepas de los dos patrones de adherencia en los tres ríos evaluados. Las cepas presentaron 24 serotipos diferentes. Conclusiones: Se demostró que las cepas de E. coli ambientales circulantes en estos ecosistemas presentan características adherentes, cuya patogenicidad implica un riesgo potencial para la salud humana, especialmente en edades pediátricas(AU)

Introduction: Adherence is crucial to the development of most Escherichia coli infections. Three different adherence patterns have been described for pathotypes of this species: localized, diffuse and aggregative adherence, based on the specific clinical pathogenic processes they bring about. However, few studies have been conducted about in vitro adherence phenotypes of E. coli isolated from the environment. Objective: Determine the adherence phenotypes of E. coli strains isolated from freshwater ecosystems in Havana. Methods: An analysis was conducted of 108 E. coli strains isolated from the rivers Almendares, Quibú and Luyanó in Havana. Determination was made of the adherence pattern by adherence assays in HEp-2 cell line cultures, as well as of the serotype for each strain. Results: Of the E. coli strains isolated, 25 percent were adherent and 75 percent were not. Twenty-two strains displayed the typical diffusely adherent pattern and five displayed aggregative adherence. Strains exhibiting the two adherence patterns were found in the three rivers evaluated. The strains contained 24 different serotypes. Conclusions: The environmental E. coli strains circulating in these ecosystems were found to have adherent characteristics whose pathogenicity implies a potential risk to human health, particularly in childhood(AU)

Implications of the mutation S164A on Bacillus subtilis levansucrase product specificity and insights into protein interactions acting upon levan synthesis.

Mutation S164A largely affects the transfructosylation properties of Bacillus subtilis levansucrase (SacB). The variant uses acceptors such as glucose and short levans with an average molecular weight of 7.6 kDa more efficiently than SacB, leading to the enhanced synthesis of medium and high molecular weight polymer and a blasto-oligosaccharide series with a polymerization degree of 2-10. A 3-fold increase in blasto-oligosaccharides yield is provoked by the modified interplay between the variant and glucose. Despite its modified product specificity, protein-carbohydrate and protein-protein interactions are still a major factor affecting size and distribution of levan molecular weight. This study highlights the importance of critical factors such as protein concentration in the analysis of wild-type and mutagenized levansucrases. Docking experiments with the crystal structures of SacB and variant S164A - the latter obtained at a 2.6 Å resolution - identified unreported potential binding subsites for fructosyl moieties on the surface of both enzymes.

Subfrontal Schwannoma: Case Report and Review of Literature.

BACKGROUND: Although attributing the origin of schwannomas from the olfactory nerve is nearly impossible, if they do not have Schwann cells, intracranial supratentorial schwannomas are mainly located in the anterior skull base. CASE DESCRIPTION: We present the case of a 46-year-old female who presented with right tinnitus, dizziness, and bifrontal headache, progressive, starting 2 years before. Imaging studies revealed an incidentally neoplastic, extraaxial, homogeneously appearing tumor on the right anterior skull base. The patient underwent surgical treatment with total resection of the tumor by a bicoronal approach. The histopathologic study reported schwannoma. CONCLUSION: We describe this case in detail and discuss the likely origin of this tumor, with a concomitant literature review.

A Giant Occipital Encephalocele in Neonate with Spontaneous Hemorrhage into the Encephalocele Sac: Surgical Management.

The presence of giant occipital encephalocele represents a surgical challenge. However, preoperative magnetic resonance imaging with venography can help in delineating relation of venous sinus, content of the sac and help classify occipital encephalocele into infra-torcular and torcular depending on the relation with position of torcula. However, the presence of old hemorrhage into encephalocele sac is extremely rare and in the detailed PubMed search, the authors could find one such case, reported by Nath et al. The author reports a case of giant occipital encephalocele; during surgery, evidence of old bleed was noted. Pertinent literature and management are reviewed briefly.

La promoción de salud desde el enfoque de gestión de la calidad en la Universidad de La Habana

Fundamento: La humanidad está afrontando el incremento de algunas enfermedades, prevenibles y curables, de ahí la importancia de la promoción de salud para elevar la percepción de riesgo de la población; debido a ello en la Universidad de La Habana se diseñó un Festival Recreativo Educativo en Salud a partir del sistema de gestión de la calidad de la extensión universitaria implementado. Objetivo: Sistematizar el Festival Recreativo Educativo en Salud como experiencia de gestión de la calidad en promoción de salud. Metodología: Se realizó una sistematización prospectiva empleándose elementos de la investigación-acción-participativa en el período septiembre 2012 a febrero 2016. Se aplicó la técnica positivo-negativo-interesante y un cuestionario para evaluar el grado de satisfacción de los participantes. Resultados: Se diseñaron, organizaron y ejecutaron, trece tipologías de actividades en diez ediciones del Festival, alcanzando 4259 personas, de las que el 87,8 % mostró un alto grado de satisfacción. Conclusiones: A través de esta experiencia se propone una nueva metodología para trabajar la promoción de salud en la comunidad universitaria, no como herramienta, sino como proceso de promoción cultural, dirigido a despertar en la comunidad universitaria y la población, el interés por la salud y la asunción de la responsabilidad individual y colectiva.

Background: Humanity is facing the increase of certain diseases, preventable and curable, hence the importance of health promotion to raise the risk perception of the population; due to this, it was designed a Health Education Recreation Festival at the University of Havana based on the quality management system of the university extension implemented. Objective: To systematize the Health Education Recreation Festival as an experience of quality management in health promotion. Methodology: A prospective systematization was carried out using elements participatory action research from September 2012 to February 2016. PNI technique and a questionnaire to assess the degree of satisfaction of participants were applied. Results: Thirteen types of activities were designed, organized and executed in ten editions of the Festival, reaching 4259 people, of which 87.8 % showed a high degree of satisfaction. Conclusions: Through this experience, a new methodology is proposed to work on health promotion in the university community, not as a tool, but as a process of cultural promotion, aimed at awakening in the university community and the population, interest in health and the assumption of individual and collective responsibility.

La promoción de salud desde el enfoque de gestión de la calidad en la Universidad de La Habana / Health promotion from the perspective of quality management at the University of Havana

Fundamento: La humanidad está afrontando el incremento de algunas enfermedades, prevenibles y curables, de ahí la importancia de la promoción de salud para elevar la percepción de riesgo de la población; debido a ello en la Universidad de La Habana se diseñó un Festival Recreativo Educativo en Salud a partir del sistema de gestión de la calidad de la extensión universitaria implementado. Objetivo: Sistematizar el Festival Recreativo Educativo en Salud como experiencia de gestión de la calidad en promoción de salud. Metodología: Se realizó una sistematización prospectiva empleándose elementos de la investigación-acción-participativa en el período septiembre 2012 a febrero 2016. Se aplicó la técnica positivo-negativo-interesante y un cuestionario para evaluar el grado de satisfacción de los participantes. Resultados: Se diseñaron, organizaron y ejecutaron, trece tipologías de actividades en diez ediciones del Festival, alcanzando 4259 personas, de las que el 87,8 % mostró un alto grado de satisfacción. Conclusiones: A través de esta experiencia se propone una nueva metodología para trabajar la promoción de salud en la comunidad universitaria, no como herramienta, sino como proceso de promoción cultural, dirigido a despertar en la comunidad universitaria y la población, el interés por la salud y la asunción de la responsabilidad individual y colectiva.

Background: Humanity is facing the increase of certain diseases, preventable and curable, hence the importance of health promotion to raise the risk perception of the population; due to this, it was designed a Health Education Recreation Festival at the University of Havana based on the quality management system of the university extension implemented. Objective: To systematize the Health Education Recreation Festival as an experience of quality management in health promotion. Methodology: A prospective systematization was carried out using elements participatory action research from September 2012 to February 2016. PNI technique and a questionnaire to assess the degree of satisfaction of participants were applied. Results: Thirteen types of activities were designed, organized and executed in ten editions of the Festival, reaching 4259 people, of which 87.8 % showed a high degree of satisfaction. Conclusions: Through this experience, a new methodology is proposed to work on health promotion in the university community, not as a tool, but as a process of cultural promotion, aimed at awakening in the university community and the population, interest in health and the assumption of individual and collective responsibility.

La promoción de salud desde el enfoque de gestión de la calidad en la Universidad de La Habana / Health promotion from the perspective of quality management at the University of Havana

La humanidad está afrontando el incremento de algunas enfermedades, prevenibles y curables, de ahí la importancia de la promoción de salud para elevar la percepción de riesgo de la población; debido a ello en la Universidad de La Habana se diseñó un Festival Recreativo Educativo en Salud a partir del sistema de gestión de la calidad de la extensión universitaria implementado. Objetivo: Sistematizar el Festival Recreativo Educativo en Salud como experiencia de gestión de la calidad en promoción de salud(AU)

Determinantes de adherencia terapéutica en diabéticos consulta externa - Hospital Regional de Sonsonate del ISSS enero - marzo 2017 / Determinants of therapeutic adherence in diabetics Regional Hospital of the ISSS, Sonsonate January - March 2017

La adherencia terapéutica se describe como el acuerdo mutuo entre el paciente y su voluntad de aceptar lo indicado por el médico, con el fin de producir y obtener un resultado deseado. Se realizó un estudio de tipo descriptivo de corte transversal, con el objetivo de determinar el porcentaje de pacientes con terapia insuliníca con mal apego al tratamiento aplicando el cuestionario de determinantes de adherencia (CDA), a través de opciones de respuesta tipo Likert con puntajes que exploran variables psicosociales relacionadas con el apego al tratamiento, con la percepción del paciente hacia el régimen terapéutico y su relación con el profesional de salud, además de describir las características clínicas y sociodemográficas de estos pacientes. Este estudio se realizó en el área de consulta externa del Hospital Regional de Sonsonate del Instituto Salvadoreño del Seguro Social (ISSS), durante el período comprendido entre enero a marzo del 2017, con una muestra de 231 pacientes que asistieron a sus controles y cumplieron criterios de inclusión. Las características sociodemográficas que más destacaron en los pacientes entrevistados en la consulta externa que utilizan insulina fueron mayor de 60 años (58.9%) del sexo femenino (62.8%), viven con sus familiares (91.3%), mientras que dentro de las características clínicas son DM2 (98.7%), más de 5 años de padecer la enfermedad (88.7%) asisten a sus controles de forma regular (83.5%) con comorbilidad asociada (84.4%) y malos hábitos (73.2%). Se identificó con el CDA 54 pacientes con mal apego al tratamiento representando el 23.4%, donde los factores psicosociales influyeron en un 66.7%, seguido de factores relacionados con el régimen terapéutico en un 64.8%.y la interacción con el personal sanitario con un 31.5%. Se recomienda implementar un programa de atención para identificar por medio del CDA a los pacientes diabéticos con mal apego al tratamiento, dándoles seguimiento por un equipo multidisciplinario

Educación para la Salud desde el curriculum electivo como experiencia de formación integral de estudiantes universitarios / Education for health from an elective curriculum: experience of comprehensive formation of university students

Introducción: la universidad contemporánea juega un rol fundamental en la preparación del ser humano como ente activo de la sociedad, por lo que la formación de los futuros profesionales, debe tender, no solo a una sólida formación académica, sino también a favorecer el compromiso con la realidad social. Objetivo: socializar la experiencia de implementación de tres asignaturas electivas de promoción de salud y la contribución de estas a la formación integral del estudiante universitario. Métodos: se desarrolló una investigación descriptiva longitudinal de carácter prospectivo con la utilización de métodos teóricos y empíricos. Para evaluar el desarrollo de las asignaturas electivas se diseñó una investigación-acción-participativa. Resultados: se diseñó una estrategia pedagógica de integración de los procesos sustantivos universitarios, a través de la cual se diseñaron y ejecutaron tres asignaturas electivas impartidas durante cuatro cursos académicos en la Facultad de Biología y la Facultad de Geografía de la Universidad de La Habana a 233 estudiantes, el 70 por ciento de los cuales, como mínimo, calificó a las asignaturas con elementos positivos. Conclusiones: la experiencia de integración de los procesos sustantivos universitarios a través de acciones docentes de promoción de salud, constituye un espacio valioso que favorece el acercamiento de la universidad a los problemas sociales, realizando un aporte a la comunidad, asumiendo al mismo tiempo, un compromiso social, aspecto esencial del modelo del formación de cualquier profesional cuya esfera de actuación incluya a la Salud Pública.

Introduction: the contemporary university plays a key role in preparing the human being as active entity of society, so the formation of future professionals should attain not only a strong academic background but also promote the commitment with the social reality. Objective: to socialize the experience of implementing three elective health promotion subjects and their contribution to the comprehensive formation of the university student. Methods: a prospective longitudinal and descriptive study on the use of theoretical and empirical methods. For the evaluation of the development of elective subjects, a participatory action research was designed. Results: there was designed a pedagogic strategy for integrating university substantive processes through which three elective subjects were designed and given to 233 students during four academic courses in the Faculty of Biology and the Faculty of Geography of the University of Havana. At least, seventy percent of these students assessed these subjects with positive elements. Conclusions: The experience of integration of university substantive processes through educational health promotion activities is a valuable space that brings university closer to social problems, thus making a contribution to the community while providing a social commitment which is an essential aspect of any professional training including public health.

Educación para la Salud desde el curriculum electivo como experiencia de formación integral de estudiantes universitarios / Education for health from an elective curriculum: experience of comprehensive formation of university students

Introducción: la universidad contemporánea juega un rol fundamental en la preparación del ser humano como ente activo de la sociedad, por lo que la formación de los futuros profesionales, debe tender, no solo a una sólida formación académica, sino también a favorecer el compromiso con la realidad social. Objetivo: socializar la experiencia de implementación de tres asignaturas electivas de promoción de salud y la contribución de estas a la formación integral del estudiante universitario. Métodos: se desarrolló una investigación descriptiva longitudinal de carácter prospectivo con la utilización de métodos teóricos y empíricos. Para evaluar el desarrollo de las asignaturas electivas se diseñó una investigación-acción-participativa. Resultados: se diseñó una estrategia pedagógica de integración de los procesos sustantivos universitarios, a través de la cual se diseñaron y ejecutaron tres asignaturas electivas impartidas durante cuatro cursos académicos en la Facultad de Biología y la Facultad de Geografía de la Universidad de La Habana a 233 estudiantes, el 70 por ciento de los cuales, como mínimo, calificó a las asignaturas con elementos positivos. Conclusiones: la experiencia de integración de los procesos sustantivos universitarios a través de acciones docentes de promoción de salud, constituye un espacio valioso que favorece el acercamiento de la universidad a los problemas sociales, realizando un aporte a la comunidad, asumiendo al mismo tiempo, un compromiso social, aspecto esencial del modelo del formación de cualquier profesional cuya esfera de actuación incluya a la Salud Pública(AU)

Introduction: the contemporary university plays a key role in preparing the human being as active entity of society, so the formation of future professionals should attain not only a strong academic background but also promote the commitment with the social reality. Objective: to socialize the experience of implementing three elective health promotion subjects and their contribution to the comprehensive formation of the university student. Methods: a prospective longitudinal and descriptive study on the use of theoretical and empirical methods. For the evaluation of the development of elective subjects, a participatory action research was designed. Results: there was designed a pedagogic strategy for integrating university substantive processes through which three elective subjects were designed and given to 233 students during four academic courses in the Faculty of Biology and the Faculty of Geography of the University of Havana. At least, seventy percent of these students assessed these subjects with positive elements. Conclusions: The experience of integration of university substantive processes through educational health promotion activities is a valuable space that brings university closer to social problems, thus making a contribution to the community while providing a social commitment which is an essential aspect of any professional training including public health(AU)

Isolation and characterization of human primary enterocytes from small intestine using a novel method.

Cell culture studies of enterocytes are important in many fields. However, there are difficulties in obtaining cell lines from adult human intestine, such as microbial contamination of cultures from the tissue samples, short life span of enterocytes, overgrowth of mesenchymal cells, etc. Various model used to obtain adult intestinal cell lines are very complex requiring use of feeder layer or gel matrices. The aim of this study was to establish a novel method for the simple and reproducible isolation of human enterocytes. Enterocytes were isolated from SI samples (n = 5) obtained from cadaveric donors using a mechanical procedure, and separation with immunomagnetic beads coated with anti-EpCAM antibodies. Light and electron microscopy, flow cytometry and immunocytochemistry techniques were used to characterize the isolated cells. Immunohistochemical staining of normal SB biopsies confirmed that the cell cultures maintained an in vivo phenotype as reflected in cytokeratin expression CK18, CK20 and expression of intestine-specific markers such as sucrase isomaltase and maltase glucoamylase. Furthermore, the cells strongly expressed TLR-5, 6, 7, 8 and 10 and several molecules such as CD40, CD86, CD44, ICAM-1 and HLA-DR which are important in triggering cell-mediated immune responses. This novel technique provides a unique in vitro system to study the biology of enterocytes in normal conditions as well as to study inflammatory processes in various small bowel disorders.

Endothelial cell antibody-mediated rejection and successful retransplantation in a heart transplanted patient.

Antibody-mediated rejection (AMR) plays a significant role in cardiac allograft dysfunction, and recently a consensus regarding the diagnosis of AMR has been published. To our knowledge, it has not previously been reported that acute graft failure related to AMR, and antiendothelial cell antibodies can successfully be diagnosed to allow the patient to receive the outlined treatment and undergo a subsequent retransplantation.

Susceptibilidad antimicrobiana de aislamientos de Escherichia coli procedentes de ecosistemas dulceacuícolas / Antimicrobial susceptibility of Escherichia coli isolates from river water ecosystems

Introducción: la resistencia antimicrobiana constituye uno de los mayores problemas que afronta la salud pública mundial. La aparición de cepas resistentes no solo de origen clínico sino también ambiental agrava la situación. Entre los microorganismos que presentan esta característica se destaca la especie bacteriana Escherichia coli debido a su doble papel como indicador de contaminación fecal y como patógeno. Objetivos: aislar e identificar hasta especie aislamientos de Escherichia coli a partir de muestras de agua procedentes de ríos contaminados de La Habana y determinar la susceptibilidad antimicrobiana in vitro de estos aislados. Métodos: se estudiaron 113 aislamientos de bacterias coliformes aislados de 10 estaciones de muestreo ubicadas en la zona urbana de los ríos capitalinos Almendares, Quibú y Luyanó en el período comprendido de febrero de 2008 hasta junio de 2010. La identificación de los aislados, la determinación de la susceptibilidad antimicrobiana y la búsqueda de b-lactamasas de espectro extendido se realizó mediante el método automatizado VITEK. Resultados: se identificaron 113 cepas ambientales de Escherichia coli. Se demostró que 23 por ciento de los aislamientos resultaron resistentes al menos a uno de los antimicrobianos evaluados. Los mayores porcentajes de resistencia se observaron frente a ampicilina, sulfametoxazol-trimetropin y ciprofloxacina. Conclusiones: la presencia de aislados de E. coli con multirresistencia antimicrobiana en estos ríos indica claramente el riesgo biológico que implica el uso de sus aguas(AU)

Introduction: antimicrobial resistance is one of the biggest problems facing global public health. The emergence of resistant clinical and environmental strains worsens the situation. Among the microorganisms with antimicrobial resistance, Escherichia coli species stands out due to its dual role as fecal contamination indicator and pathogen. Objectives: to isolate and identify Escherichia coli isolates from water samples from polluted rivers located in La Habana, and to determine their antimicrobial in vitro susceptibility. Methods: one hundred thirteen isolates of coliform bacteria isolated from 10 sampling stations in the capital´s urban areas near Almendares, Quibú and Luyanó rivers were studied in the period of February 2008 to June 2010. The identification of isolates, the determination of antimicrobial susceptibility and the search for extended-spectrum b-lactamase were all performed using VITEK automated method. Results: one hundred thirteen environmental strains of Escherichia coli were identified. It showed that 23 percent of the isolates were resistant to at least one of the tested antimicrobials. The highest percentages of resistance were observed to ampicilline, sulfamethoxazole-trimethoprim and ciprofloxacin. Conclusions: the presence of E. coli isolates with multiple antimicrobial resistances in these rivers clearly indicates the biological risk involving the use of their waters(AU)

Susceptibilidad antimicrobiana de aislamientos de Escherichia coli procedentes de ecosistemas dulceacuícolas / Antimicrobial susceptibility of Escherichia coli isolates from river water ecosystems

Introducción: la resistencia antimicrobiana constituye uno de los mayores problemas que afronta la salud pública mundial. La aparición de cepas resistentes no solo de origen clínico sino también ambiental agrava la situación. Entre los microorganismos que presentan esta característica se destaca la especie bacteriana Escherichia coli debido a su doble papel como indicador de contaminación fecal y como patógeno. Objetivos: aislar e identificar hasta especie aislamientos de Escherichia coli a partir de muestras de agua procedentes de ríos contaminados de La Habana y determinar la susceptibilidad antimicrobiana in vitro de estos aislados. Métodos: se estudiaron 113 aislamientos de bacterias coliformes aislados de 10 estaciones de muestreo ubicadas en la zona urbana de los ríos capitalinos Almendares, Quibú y Luyanó en el período comprendido de febrero de 2008 hasta junio de 2010. La identificación de los aislados, la determinación de la susceptibilidad antimicrobiana y la búsqueda de b-lactamasas de espectro extendido se realizó mediante el método automatizado VITEK. Resultados: se identificaron 113 cepas ambientales de Escherichia coli. Se demostró que 23 % de los aislamientos resultaron resistentes al menos a uno de los antimicrobianos evaluados. Los mayores porcentajes de resistencia se observaron frente a ampicilina, sulfametoxazol-trimetropin y ciprofloxacina. Conclusiones: la presencia de aislados de E. coli con multirresistencia antimicrobiana en estos ríos indica claramente el riesgo biológico que implica el uso de sus aguas.

Introduction: antimicrobial resistance is one of the biggest problems facing global public health. The emergence of resistant clinical and environmental strains worsens the situation. Among the microorganisms with antimicrobial resistance, Escherichia coli species stands out due to its dual role as fecal contamination indicator and pathogen. Objectives: to isolate and identify Escherichia coli isolates from water samples from polluted rivers located in La Habana, and to determine their antimicrobial in vitro susceptibility. Methods: one hundred thirteen isolates of coliform bacteria isolated from 10 sampling stations in the capital´s urban areas near Almendares, Quibú and Luyanó rivers were studied in the period of February 2008 to June 2010. The identification of isolates, the determination of antimicrobial susceptibility and the search for extended-spectrum b-lactamase were all performed using VITEK automated method. Results: one hundred thirteen environmental strains of Escherichia coli were identified. It showed that 23 % of the isolates were resistant to at least one of the tested antimicrobials. The highest percentages of resistance were observed to ampicilline, sulfamethoxazole-trimethoprim and ciprofloxacin. Conclusions: the presence of E. coli isolates with multiple antimicrobial resistances in these rivers clearly indicates the biological risk involving the use of their waters.

Transplantation of an allogeneic vein bioengineered with autologous stem cells: a proof-of-concept study.

BACKGROUND: Extrahepatic portal vein obstruction can have severe health consequences. Variceal bleeding associated with this disorder causes upper gastrointestinal bleeding, leading to substantial morbidity and mortality. We report the clinical transplantation of a deceased donor iliac vein graft repopulated with recipient autologous stem cells in a patient with extrahepatic portal vein obstruction. METHODS: A 10 year old girl with extrahepatic portal vein obstruction was admitted to the Sahlgrenska University Hospital in Gothenburg, Sweden, for a bypass procedure between the superior mesenteric vein and the intrahepatic left portal vein (meso Rex bypass). A 9 cm segment of allogeneic donor iliac vein was decellularised and subsequently recellularised with endothelial and smooth muscle cells differentiated from stem cells obtained from the bone marrow of the recipient. This graft was used because the patient's umbilical vein was not suitable and other strategies (eg, liver transplantation) require lifelong immunosuppression. FINDINGS: The graft immediately provided the recipient with a functional blood supply (25-30 cm/s in the portal vein and 40 mL/s in the artery was measured intraoperatively and confirmed with ultrasound). The patient had normal laboratory values for 9 months. However, at 1 year the blood flow was low and, on exploration, the shunt was patent but too narrow due to mechanical obstruction of tissue in the mesocolon. Once the tissue causing the compression was removed the graft dilated. We therefore used a second stem-cell populated vein graft to lengthen the previous graft. After this second operation, the portal pressure was reduced from 20 mm Hg to 13 mm Hg and blood flow was 25-40 cm/s in the portal vein. With restored portal circulation the patient has substantially improved physical and mental function and growth. The patient has no anti-endothelial cell antibodies and is receiving no immunosuppressive drugs. INTERPRETATION: An acellularised deceased donor vein graft recellularised with autologous stem cells can be considered for patients in need of vascular vein shunts without the need for immunosuppression. FUNDING: Swedish Government.