Differences in Virulence Factors and Antimicrobial Susceptibility of Uropathogenic Enterococcus spp. Strains in a Rural Area of Uganda and a Spanish Secondary Hospital.

Enterococcus faecalis and Enterococcus faecium have become two of the most important agents of nosocomial diseases due to their constantly growing resistance. Enterococcal infections are associated with biofilms, which are intrinsically sensitive to antimicrobials. The main goal of this study was to compare and relate their capacity to form biofilm and their antimicrobial sensitivity, as well as their virulence factors and their implicated genes, of strains isolated from patients with urinary tract infection (UTI) in a rural hospital in Uganda and a secondary hospital in Spain. A prospective study was conducted with 104 strains of E. faecalis and E. faecium isolated from patients with suspected UTI and who presented leukocyturia at the Saint Joseph Kitgum hospital (Uganda) and at the Hospital Universitario Principe de Asturias (Spain). All microorganisms were identified in Spain by MALDI-TOF mass spectrometry. Antimicrobial susceptibility studies were carried out using the Vitek® 2 system (Biomériux, France). The biofilm formation capacity was studied by photospectrometry. Phenotypic and genotypic virulence factors were studied in all cases by PCR or expression techniques. In Uganda, we found a higher incidence of E. faecium (65.3%, n = 32), contrary to the situation found in Spain where most of the bacteria found belonged to E. faecalis (92.7%, n = 51). All E. faecalis strains were found to have very low levels of resistance to ampicillin, imipenem, and nitrofurantoin. However, E. faecium exhibited more than 25% resistance to these antibiotics. Although the esp gene has been shown in the results obtained to be an important initial agent in biofilm formation, we have also demonstrated in this study the intervention of other genes when esp is not present, such as the ace1 gene. No statistically significant relationships were found between the presence of agg and gelE genes and increased biofilm formation. The significant difference between the incidence of E. faecalis and E. faecium and biofilm formation, between samples from Spain and Uganda, shows us very different profiles between countries.

SARS-CoV-2 Point Mutation and Deletion Spectra, and Their Association with Different Disease Outcome

Mutant spectra of RNA viruses are important to understand viral pathogenesis, and response to selective pressures. There is a need to characterize the complexity of mutant spectra in coronaviruses sampled from infected patients. In particular, the possible relationship between SARS-CoV-2 mutant spectrum complexity and disease associations has not been established. In the present study, we report an ultra-deep sequencing (UDS) analysis of the mutant spectrum of amplicons from the nsp12 (polymerase)- and spike (S)-coding regions of thirty nasopharyngeal isolates (diagnostic samples) of SARS-CoV-2 of the first COVID-19 pandemic wave (Madrid, Spain, April 2020) classified according to the severity of ensuing COVID-19. Low frequency mutations and deletions, counted relative to the consensus sequence of the corresponding isolate, were overwhelmingly abundant. We show that the average number of different point mutations, mutations per haplotype and several diversity indices was significantly higher in SARS-CoV-2 isolated from patients who developed mild disease than in those associated with moderate or severe disease (exitus). No such bias was observed with RNA deletions. Location of amino acid substitutions in the three dimensional structures of nsp12 (polymerase) and S suggest significant structural or functional effects. Thus, patients who develop mild symptoms may be a richer source of genetic variants of SARS-CoV-2 than patients with moderate or severe COVID-19. IMPORTANCEThe study shows that mutant spectra of SARS-CoV-2 from diagnostic samples differ in point mutation abundance and complexity, and that significantly larger values were observed in virus from patients who developed mild COVID-19 symptoms. Mutant spectrum complexity is not a uniform trait among isolates. The nature and location of low frequency amino acid substitutions present in mutant spectra anticipate great potential for phenotypic diversification of SARS-CoV-2.

High SARS-CoV-2 viral load is associated with a worse clinical outcome of COVID-19 disease

COVID-19 severity and progression are determined by several host and virological factors that may influence the final outcome of SARS-CoV-2-infected patients. The objective of this work is to determine a possible association between the viral load, obtained from nasopharyngeal swabs, and the severity of the infection in a cohort of 448 SARS-CoV-2-infected patients from a hospital in Madrid during the first outbreak of the pandemic in Spain. To perform this, we have clinically classified patients as mild, moderate and severe COVID-19 according to a number of clinical parameters such as hospitalization requirement, need of oxygen therapy, admission to intensive care units and/or exitus. Here we report a statistically significant correlation between viral load and disease severity, being high viral load associated with worse clinical prognosis, independently of several previously identified risk factors such as age, sex, hypertension, cardiovascular disease, diabetes, obesity, and lung disease (asthma and chronic obstructive pulmonary disease). The data presented here reinforce the viral load as a potential biomarker for predicting disease severity in SARS-CoV-2-infected patients. It is also an important parameter in viral evolution since it relates to the numbers and types of variant genomes present in a viral population, a potential determinant of disease progression.

Aplicaciones móviles para el estudio de la anatomía humana / Mobile applications for the study of human anatomy

RESUMEN: El aprendizaje a través de aplicaciones móviles (Apps) es un tema de gran importancia que está asociado a interactuar con la realidad virtual. Pese a la gran cantidad de Apps disponibles, no existe información suficiente que oriente acerca de la utilidad en la didáctica de la anatomía. Es por ello que este trabajo pretende evaluar el uso de aplicaciones móviles en el estudio de la Anatomía humana. Se realizó la búsqueda de aplicaciones para el estudio de la anatomía humana, utilizando las plataformas de descarga App Store y Google Play. Se jerarquizaron las Apps dando importancia a las que contaran con un mayor número de personas que la hubieran valorado y a la puntuación que le otorgaron sus usuarios. Se incorporaron Apps al estudio de la Anatomía humana en estudiantes de salud de universidades de la ciudad de Manizales (Colombia). Se aplicó un instrumento para evaluar la utilidad en el aprendizaje de las diferentes estructuras humanas. La búsqueda dio como resultado 113 aplicaciones, de las cuales 70 son gratuitas y 43 que tienen un costo para su descarga. De éstas, Anatomy quiz es la que más prefieren los estudiantes al momento de estudiar anatomía. La utilización de Apps para el estudio de la anatomía humana prepara a estudiantes para enfrentarse a una estructura real; se cuenta con especímenes ilimitados para una disección virtual y desarrolla habilidades espaciales. Conocer las Apps disponibles para estudio del cuerpo humano aporta a una mejor didáctica de la Anatomía.

SUMMARY: The learning through mobile applications (Apps) is a subject of great importance that is associated to interact with virtual reality. Despite the large number of Apps available, there is not enough information to guide the usefulness in the didactics of anatomy. That is why this work aims to evaluate the use of mobile applications in the study of human anatomy. Methods were sought for applications for the study of human anatomy, using the App Store and Google Play download platforms. Apps were prioritized giving importance to those that had a greater number of people who had valued it, and the score given by its users. Apps were added to the study of human anatomy in health students at universities in city of Manizales (Colombia). An instrument was applied to evaluate the usefulness in the learning of the different human structures. The search resulted in 113 applications of which 70 are free and 43 have a download cost. Of these, Anatomy quiz is the most preferred by students when studying anatomy. The use of Apps for the study of human anatomy prepares students to face a real structure; unlimited specimens are available for virtual dissection and to develop spatial skills. Knowing the Apps available for the study of the human body contributes to better didactics of anatomy.

Development of Ti-C-N coatings with improved tribological behavior and antibacterial properties.

In artificial metallic joint implants, the failure is provoked by two effects in most of the cases: mass loss and wear debris removed due to tribological-corrosive effects on the implant alloy, and infections due to the presence of bacteria. In this work, several Ti-C-N corrosion and wear protective coatings were developed by Physical Vapour Deposition technology, and deposited on Ti6Al4V alloy. In order to provide the implant antibacterial properties, an additional silver top coating has been deposited. Tribological behavior was characterized through tribocorrosion and fretting tests. On the other hand, wettability tests were performed to study the grade of hydrophilicity/hydrophobia. Additionally, antibacterial properties were evaluated by means of bacterial adhesion tests. As a result of these characterization studies, the coating with the best performance was selected. The as-coated material includes excellent protection against tribocorrosion and fretting effects (in relation to the uncoated one) and the silver layer has been confirmed to exhibit antibacterial properties.

Osteomyelitis: A Descriptive Study

BACKGROUND: To analyze the incidence and clinical-microbiological characteristics of osteomyelitis (OM) in a tertiary Spanish hospital. METHODS: All cases diagnosed with OM between January 2007 and December 2010 were retrospectively reviewed. The variables examined include epidemiological characteristics, risk factors, affected bone, radiographic changes, histology, microbiological culture results, antibiotic treatment, and the need for surgery. RESULTS: Sixty-three cases of OM were diagnosed. Twenty-six patients (41.3%) had acute OM whereas 37 patients (58.7%) were classified as chronic OM. OM may result from haematogenous or contiguous microbial seeding. In this group, 49 patients (77.8%) presented with OM secondary to a contiguous source of infection and 14 patients had hematogenous OM (22.2%). Staphylococcus aureus was the most commonly found microorganism. CONCLUSIONS: OM mainly affected patients with risk factors related to the presence of vascular diseases. Antibiotic treatment must be guided by susceptibility patterns of individual microorganisms, although it must be performed together with surgery in most of the cases.

Reporte de caso: parálisis facial periférica bilateral postraumática / Case report: post-traumatic bilateral peripheral facial palsy

La parálisis del nervio facial o del VII par craneal, es una de las neuropatías más frecuentes. Se describe el caso de un paciente con parálisis facial periférica bilateral, secundaria a conmoción cerebral con fractura de base de cráneo y fractura temporal, a quien se le realizó tratamiento médico con esteroides sin mejoría, por lo que se decidió hacerle descompresión quirúrgica del nervio facial, con posterior resolución del cuadro clínico.

Facial nerve palsy is one of the most common neuropathies. The case of a bilateral facial nerve palsy is presented, secondary to cerebral commotion, cranial base and temporal fractures and was initiated on steroids with no signs of improvement, then a surgical decompression of the facial nerve was carried out with subsequent resolution of symptoms.

Primary parapharyngeal space tumors in a Mexican cancer center.

OBJECTIVE: To describe clinical and demographic characteristics of the parapharyngeal space tumors and assess surgical approaches used to treat them at our institution. METHODS: A retrospective and descriptive study of the parapharyngeal space tumors, excluding paragangliomas, treated from June 1991 to October 2002 in a cancer center. The study population included 21 patients, 8 men and 13 women, average age of 41 years (range, 20 to 70 years). Fine needle biopsy was done in 5 (24%) patients. Computed tomography (CT) was performed in all patients, and only a few required magnetic resonance image (MRI). RESULTS: Surgical approaches included transcervical alone or in combination with parotidectomy, transoral, or transmandibular (mandibular swing) approach. Laminectomy and segmentary approaches were also performed in 1 patient each. Sixteen (76%) patients had benign lesions and 5 (24%) had malignant tumors. Neurogenic tumors represented 57% of all tumors. Mean tumor size was of 6.7 cm (range, 3 to 11 cm). Six (29%) patients received adjuvant radiotherapy. Complications occurred in 6 (29%) patients, 4 (19%) of which were nervous injuries associated with peripheral nerve sheath tumors. Median disease-free follow-up survival was 33 months (range, 2 to 184 months) despite being an heterogeneous group of histologies. CONCLUSION: Parapharyngeal space is a rare location for head and neck tumors. Cervical approach should be the first choice for large tumors; transoral approach is reserved for tumors less than 3 cm. Conversion to mandibular swing approach when the cervical approach is not offering proper exposure for tumor resection is indicated. Preoperative histologic diagnosis is not required. Nevertheless, CT scan should always be performed in order to exclude paragangliomas, distinguish prestyloid from poststyloid lesions, and to assess the extension of the tumor as well as its relationship with adjacent structures.

Quiste epidermoide gigante de bazo / Giant epidermoid splenic cyst

Introducción. El quiste epidermoide gigante de bazo es poco frecuente y su etiología es desconocida. El objetivo del presente estudio es informar el caso clínico de una adolescente a la cual se le diagnosticó quiste epidermoide gigante de bazo. Caso clínico. Femenino de 13 años de edad, la cual acudió al hospital por presentar un tumor abdominal. El ultrasonido mostró una masa sólida e hipoecoica de 20.5 x 24 x 14.5 cm en el cuadrante superior izquierdo del abdomén. En la tomografía computada de abdomen se observó un tumor quístico de bazo de 21.8 x 20.4 x 14 cm. Se le realizó esplenectomía total y el estudio histopatológico reportó epitelio plano poliestratificado. Conclusiones. El quiste epidermoide gigante de bazo es una causa poco frecuente de esplenomegalia en el niño