Acinetobacter baumannii Resistance: A Real Challenge for Clinicians.

Acinetobacter baumannii (named in honor of the American bacteriologists Paul and Linda Baumann) is a Gram-negative, multidrug-resistant (MDR) pathogen that causes nosocomial infections, especially in intensive care units (ICUs) and immunocompromised patients with central venous catheters. A. baumannii has developed a broad spectrum of antimicrobial resistance, associated with a higher mortality rate among infected patients compared with other non-baumannii species. In terms of clinical impact, resistant strains are associated with increases in both in-hospital length of stay and mortality. A. baumannii can cause a variety of infections; most involve the respiratory tract, especially ventilator-associated pneumonia, but bacteremia and skin wound infections have also been reported, the latter of which has been prominently observed in the context of war-related trauma. Cases of meningitis associated with A. baumannii have been documented. The most common risk factor for the acquisition of MDR A baumannii is previous antibiotic use, following by mechanical ventilation, length of ICU/hospital stay, severity of illness, and use of medical devices. Current efforts focus on addressing all the antimicrobial resistance mechanisms described in A. baumannii, with the objective of identifying the most promising therapeutic scheme. Bacteriophage- and artilysin-based therapeutic approaches have been described as effective, but further research into their clinical use is required.

Antibiotic-Resistant Septicemia in Pediatric Oncology Patients Associated with Post-Therapeutic Neutropenic Fever.

Death in cancer patients can be caused by the progression of tumors, their malignity, or other associated conditions such as sepsis, which is a multiphasic host response to a pathogen that can be significantly amplified by endogenous factors. Its incidence is continuously rising, which reflects the increasing number of sick patients at a higher risk of infection, especially those that are elderly, pediatric, or immunosuppressed. Sepsis appears to be directly associated with oncological treatment and fatal septic shock. Patients with a cancer diagnosis face a much higher risk of infections after being immunosuppressed by chemotherapy, radiotherapy, or anti-inflammatory therapy, especially caused by non-pathogenic, Gram-negative, and multidrug-resistant pathogens. There is a notorious difference between the incidence and mortality rates related to sepsis in pediatric oncologic patients between developed and developing countries: they are much higher in developing countries, where investment for diagnosis and treatment resources, infrastructure, medical specialists, cancer-related control programs, and post-therapeutic care is insufficient. This situation not only limits but also reduces the life expectancy of treated pediatric oncologic patients, and demands higher costs from the healthcare systems. Therefore, efforts must aim to limit the progression of sepsis conditions, applying the most recommended therapeutic regimens as soon as the initial risk factors are clinically evident-or even before they are, as when taking advantage of machine learning prediction systems to analyze data.

The Use of Probiotic Therapy to Modulate the Gut Microbiota and Dendritic Cell Responses in Inflammatory Bowel Diseases.

: Recent investigations have shown that different conditions such as diet, the overuse of antibiotics or the colonization of pathogenic microorganisms can alter the population status of the intestinal microbiota. This modification can produce a change from homeostasis to a condition known as imbalance or dysbiosis; however, the role-played by dysbiosis and the development of inflammatory bowel diseases (IBD) has been poorly understood. It was actually not until a few years ago that studies started to develop regarding the role that dendritic cells (DC) of intestinal mucosa play in the sensing of the gut microbiota population. The latest studies have focused on describing the DC modulation, specifically on tolerance response involving T regulatory cells or on the inflammatory response involving reactive oxygen species and tissue damage. Furthermore, the latest studies have also focused on the protective and restorative effect of the population of the gut microbiota given by probiotic therapy, targeting IBD and other intestinal pathologies. In the present work, the authors propose and summarize a recently studied complex axis of interaction between the population of the gut microbiota, the sensing of the DC and its modulation towards tolerance and inflammation, the development of IBD and the protective and restorative effect of probiotics on other intestinal pathologies.

[Reflections concerning the care process in the emergency medical services]. / Reflexiones sobre el proceso de atención en los servicios de urgencias.

In this paper we share some reflections regarding the care process in the emergency medical services, as well as some of the challenges with which these fundamental services deal. We highlight the increasing amount of patients and the complexity of some of the clinical cases, which are some of the causes that lead to the overcrowding of these services.

En el presente artículo se presentan algunas reflexiones sobre el proceso de atención en los servicios de urgencias médicas, así como algunos de los retos que enfrentan estos componentes fundamentales del sector salud de nuestro país. Se hace énfasis en el creciente volumen y la complejidad de los casos atendidos en estos servicios, lo cual contribuye a su saturación.

La seguridad en el paciente vista desde la educación médica en la segunda década del siglo XXI / Safety of the patients envisioned by medical education in the second decade of the XXI century

En la actualidad la seguridad del paciente es un requisito indispensable de comprender para la infraestructura de la que depende la educación médica. El índice de accidentes mortales por la falta de cuidado en la aplicación de los procedimientos médicos en el ámbito hospitalario ha sido cuantificado en diversas latitudes, llegando a cifras alarmantes. La formación de los estudiantes debe iniciar con la adaptación de los planes de estudio para que incluyan, en sus asignaturas, temas que despierten en el alumno una visión crítica de sus acciones y de su proceder en cuanto a la organización del conocimiento adquirido y puesto en marcha en la práctica cotidiana de la atención médica a sus pacientes. En la Universidad Anáhuac, con el plan de estudios 2010 de la Licenciatura de Médico Cirujano, se ha optado por preparar alumnos con una estrategia didáctica semiflexible, basada en competencias que fomenten el humanismo, la seguridad, la calidad y el valor ético del conocimiento y los recursos terapéuticos y diagnósticos actuales; incluyendo en esto último al uso racional y costo-eficiente de la tecnología médica. Se espera que estos cambios logren mostrar un modelo más eficiente para crear la conciencia en el alumno sobre la relevancia que guarda la seguridad en la práctica médica cotidiana, en todos sus ambientes de trabajo.

Nowadays, patient safety is an indispensable requisite to be able to understand the infrastructure needed for medical care. The index of fatal accidents due to the lack of care in the application of medical procedures in the hospital environment has been quantified in diverse latitudes, reaching alarming numbers. Education of students must start with the adaptation of the curricula to include in the subjects, topics to raise in the student a critical awareness of his/her acts and performance in regard to the organization of the obtained knowledge and its application in the daily medical practice. At the Anáhuac University, the 2010 curricula for the undergraduate medical studies includes preparing students with a semiflexible didactic strategy, based on competences fostering humanism, safety, quality, and the ethical values of knowledge and current diagnostic and therapeutic resources, including in the latter the rational and cost-efficient use of the medical technology. It is hoped that these changes can achieve a more efficient model to bring awareness to the student on the relevance of safety in the daily medical practice, in all the working spheres.

Funduplicación de Nissen por laparoscopía: informe preliminar / Nissens' funduplication through laparoscopy. Preliminary report

Objetivo. Informar la experiencia quirúrgica en 45 pacientes con reflujo gastroesofágico operados con técnica de Nissen por vía laparoscópica. Diseño. Estudio prospectivo, observacional, longitudinal, sin grupo control y sin diseño estadístico. Sede. Servicio de cirugía y anestesiología del Hospital Angeles del Pedregal y Escandón de México. Pacientes. De noviembre 1991 a noviembre 1993, se programaron en forma consecutiva 45 pacientes con reflujo gastroesofágico complicado para funduplicación de Nissen por laparoscopía. El diagnóstico se estableció clínica, edoscópica y manométricamente. Se documentó esofagitis Grado II a V (clasificación de Sarvary-Miller) con 7 casos de estenosis cicatricial y 7 de metaplasia gástrica, 21 manometrías properatorias informaron disminución en la presión del esfínter esofágico inferior (media de 7mmHg con rango de 2 a 9 mmHg). Método. A todos se les realizó funduplicación de Nissen "holgada", de 360º, practicándose evaluación clínica mensual postoperatoria en todos los pacientes. Se realizaron 28 estudios endoscópicos y 22 manométricos de control entre tres y seis meses después del tratamiento quirúrgico. Resultados. Clínicamente se obtuvieron excelentes resultados (ausencia de sintomas de reflujo) en 39 pacientes (86 por ciento), bueno (no sintomas de reflujo, presencia ocasional de efectos colaterales) en 5 (11 por ciento) y malo (reestenosis) en 1. En 28 (62 por ciento) se realizó estudio endoscópico postoperatorio, el cual demostró: ausencia de reflujo y esofagitis en 25 (89.2 por ciento) y mejoría del grado de esofagitis, sin evidencia de reflujo, en 2 (7.1 por ciento); se encontró reestenosisi y reflujo persistente en 1(3.5 por ciento). La manometría esofágica postoperatoria se realizó en 22 pacientes (49 por ciento), con resultado excelente (presiones de 14 a 18 mmHg, media 18 mmHg) en 21 (95 por ciento) y malo en 1. El tiempo operatorio en promedio fue de 100 minutos, (extremos de 46 a 380) y la estancia hospitalaria varió de 16 a 96 hs con promedio de 46 hs. Conclusión. La funduplicación de Nissen por vía laparoscópica es un método seguro, con mínima morbilidad e incapacidad, que restituye la presión del esfinter esofágico inferior y corrige en forma efectiva la esofagitis cusada por reflujo gastroesofágico