A large multicenter Ralstonia pickettii outbreak in critically ill patients during the COVID-19 pandemic: Epidemiological and clinical characteristics of 66 cases.

Objective: To describe a multicenter outbreak of R. pickettii that occurred in a large number of critically ill patients in a city in Colombia, during the COVID-19 pandemic. Methods: In April 2021, the National Institute for Food and Drug Surveillance (INVIMA) reported an outbreak of R. pickettii infection associated with contaminated intravenous medications. The Municipal Health Department began collecting data for all cases identified by the hospitals and the results of microbiological studies. Medical records and death certificates of included cases were reviewed. Results: Between March and May 2021, 66 cases of R. pickettii bloodstream infections from nine hospitals were documented. The median age of the patients was 60 years (IQR 51-72), and most of them had comorbidities (78.8%), mainly arterial hypertension and diabetes mellitus. At the time of the R. pickettii bloodstream infection, 89.4% had COVID-19, 86.4% were on mechanical ventilation, and 98.5% were receiving corticosteroids. The overall mortality was 81.8%. Nearly 60% of the deaths were related to R. pickettii bloodstream infections. R. pickettii was identified in the cultures from intravenous medications. Conclusions: This large multicenter outbreak caused by intravenous medications contaminated with R. pickettii mainly affected critically ill COVID-19 patients. Mortality was high and largely related to R. pickettii bloodstream infection.

Characterization and evaluation of Colombian propolis on the intestinal integrity of broilers.

Nutritional additives such as propolis seek to improve intestinal health as an alternative to the global ban on in-feed antibiotics used as growth promoters (AGP). The objective of this study was to evaluate the effect of propolis supplementation in diet of broilers. Four hundred and fifty straight-run Ross 308 AP broilers were fed with a basal diet (BD) throughout the whole experimental period. Birds were randomly distributed into 5 groups at d 14: negative control without antibiotics nor propolis (AGP-), positive control 500 ppm of Zinc Bacitracin as growth promoter (AGP+), and 3 groups supplemented with 150, 300, and 450 ppm of propolis. Every group included 6 replicates of 15 birds each. Propolis concentration was increased from d 22 to 42, in experimental groups to 300, 600, and 900 ppm of propolis, and 10% of raw soybean was included as a challenge in all groups during the same period. Analysis of productive parameters, intestinal morphometry, and relative quantification of genes associated with epithelial integrity by qPCR were performed at 21 and 42 d. The groups with the greatest weights were those that consumed diets including 150 (21 d) and 900 ppm (42 d) of propolis compared with all treatments. The lowest score of ISI was found at 300 (21 d) and 600 ppm (42 d). A lower degree of injury in digestive system was seen with the inclusion of 300 ppm (21 d) and 900 ppm (42 d). Up-regulation of zonula occludens-1 (ZO-1) was observed in jejunum of broilers supplemented with 150 and 300 ppm at 21 d. Up-regulation of ZO-1 and TGF-ß was also evidenced in ileum at all propolis inclusion levels at 42-day-old compared to AGP+ and AGP-. The beneficial effects were evidenced at inclusion levels of 150 ppm in the starter and 900 ppm in the finisher. According to the results, the Colombian propolis inclusion can improve productive performance, physiological parameters, and gene expression associated with intestinal integrity.

Propolis from native Stingless Bees: ultrasound-assisted extraction / Propóleos de abejas nativas sin aguijón: extracción asistida por ultrasonido

BACKGROUND: Propolis has been considered a highly valuable material due to its therapeutic properties. However, in Colombia, the commercialization of propolis is limited not only by low production but also by the little knowledge about its efficient extraction. Therefore, finding an optimal and economical extraction method to obtain propolis is a necessity for beekeepers that would open new possibilities for industrial use and, therefore, for the market. OBJECTIVES:The objective of this study was to evaluate a conventional and ultrasound-assisted extraction method, seeking to obtain the highest yield and a high amount of content of bioactive compounds in propolis extracts. METHODS: The extraction was carried out for three crude propolis from different types of bees: Tetragoniscaangustula or Angelita (ANG), Meliponaeburnea or Melipona(MEL), and Scaptotrigonaspp (SCT). The extracts were characterized by color, pH, visual appearance, solid content, antioxidant capacity, total polyphenol content, and bacterial inhibition capacity. RESULTS: The highest extraction performance was obtained when the ultrasound-assisted method was used, especially for the ANG extract, which in addition to presenting inhibition for gram-negative (E. coli) and gram-positive (S. Aureus) bacteria, had the best antioxidant activity with a value of 545 mg GAE / 100 g of sample and total polyphenol content of 1,884 mg GAE / 100 g of sample. CONCLUSIONS: Ultrasound-assisted extraction can be considered a low-cost alternative to increase the extraction performance of crude propolis, together with its total polyphenol content and antioxidant capacity, without altering its physical properties

ANTECEDENTES: El propóleos ha sido considerado un material de alto valor por sus propiedades terapéuticas. Sin embargo, en Colombia la comercialización de propóleos está limitada no solo por la baja producción sino también por el incipiente conocimiento sobre la extracción eficiente de este. Por ello, encontrar un método de extracción óptimo y económico para la obtención de propóleos es una necesidad para los apicultores que abriría nuevas posibilidades para el uso industrial y por tanto para el mercado. OBJETIVOS: El objetivo de este estudio fue evaluar un método de extracción convencional y asistido por ultrasonido (US) buscando el mayor rendimiento y alto contenido de compuestos bioactivos en extractos de propóleos. MÉTODOS: La extracción se realizó para tres propóleos crudos de diferentes tipos de abejas Tetragonisca angustula o Angelita(ANG), Melipona eburnea o Melipona (MEL) y Scaptotrigona spp (SCT). Todos los extractos se caracterizaron por su color, pH, apariencia visual, contenido de sólidos, capacidad antioxidante, contenido total de polifenoles y capacidad de inhibición bacteriana. RESULTADOS: El mayor rendimiento de extracción se obtuvo cuando se usó el método asistido por ultrasonido y específicamente para el extracto ANG, que además de presentar inhibición para bacterias gram negativas (E. coli) y gram positivas (S. Aureus), tuvo la mejor actividad antioxidante con un valor de 545 mg GAE / 100 g de muestra y contenido total de polifenoles de 1884 mg GAE / 100 g de muestra. CONCLUSIONES: La extracción asistida por ultrasonido puede considerarse una alternativa de bajo costo para aumentar el rendimiento de extracción del propóleos crudo, así como su contenido total de polifenoles y capacidad antioxidante sin alterar sus propiedades físicas

Evaluación del impacto del cambio diagnóstico de los gliomas aplicando la nueva clasificación de la OMS de 2016 sobre una serie de casos / Assessment of the impact of glioma diagnostic reclassification following the new 2016 WHO classification on a series of cases

Antecedentes y objetivo: El objetivo de este trabajo es evaluar el cambio del diagnóstico molecular sobre el histológico de una serie de tumores gliales al revisar el diagnóstico con la clasificación de la OMS de 2016. Materiales y métodos: Se realiza un estudio retrospectivo de los tumores gliales (oligodendrogliomas y astrocitomas) tratados en nuestro centro entre enero de 2012 y junio de 2016, y una revisión diagnóstica según su estudio molecular. Se lleva a cabo el análisis estadístico de variables epidemiológicas, histológicas y de genética molecular (mutaciones en IDH y presencia de codeleción 1p19q), variación en el diagnóstico al introducir la nueva clasificación tumoral e impacto clínico de dicha reclasificación. Resultados: De los 147 casos de tumores gliales revisados, se obtuvo el diagnóstico molecular en 74 casos (50,3%). En 23 casos (31%) cambió el diagnóstico, predominando en 20 (87%) el diagnóstico previo de oligodendroglioma (69,6% grado II y 17,4% grado III). Solo 3 de los 23 casos cambiaron de diagnóstico inicial astrocitario al oligodendroglial. Respecto al patrón molecular en estos 23 casos, se detectó IDH mutado en 16 (69,6%) y codeleción 1p19q negativa en 20 (87%). Según la estirpe celular, de los 27 oligodendrogliomas de esta serie, 20 (74%) cambiaron de diagnóstico por tener la codeleción negativa, pasando a ser astrocitomas. Se observó una tendencia a un mayor cambio de diagnóstico en pacientes jóvenes (<40 años), p=0,065, mayoritariamente con diagnóstico previo de oligodendrogliomas, sin relación con el sexo. Además, se detectó una mayor frecuencia de cambio de diagnóstico entre los tumores con IDH mutado (69,6%), p=0,003. Respecto a la supervivencia o el patrón clínico, no se detectaron cambios significativos entre los tumores con o sin cambio diagnóstico, a pesar de no recibir tratamiento de elección, tras un seguimiento medio de 16 meses, en probable relación con el bajo grado lesional. Conclusiones: Dentro del espectro de tumores astrocitarios y oligodendrogliales en nuestro centro, la clasificación diagnóstica con genética molecular evidencia importantes cambios respecto al diagnóstico morfológico. Estos cambios afectan especialmente a los diagnósticos previos de oligodendrogliomas y a los pacientes jóvenes en los casos revisados, y con patrones moleculares de mutación en la IDH y de ausencia de codeleción 1p19q. Si bien se pueden plantear dudas respecto a la clínica, el pronóstico y el tratamiento realizado en estos casos, se requieren estudios específicos en estos aspectos para lograr unas conclusiones apropiadas

Background and objectives: The aim of this project is to assess diagnostic reclassification based on molecular data over morphology in a series of glial tumours since the introduction of the 2016 WHO classification of brain tumours. Materials and methods: Retrospective review of glial tumours (oligodendrogliomas and astrocytomas) treated in our centre between January 2012 and June 2016 in which a review of diagnosis was performed when molecular studies were added. Statistical analysis included evaluation of variables of epidemiology, morphology and molecular data (mainly IDH mutation and 1p19q codeletion), diagnostic changes after new classification was considered, and clinical impact in cases of diagnostic reclassification. Results: From a total of 147 glial tumours reviewed in our centre, molecular diagnosis was obtained in 74 cases (50.3%). Initial diagnosis changed in 23 cases (31%), and 20 (87%) of them had a prior histological diagnosis of oligodendroglioma (69.6% grade II - and 17.4% grade III). Only 3 of these 23 cases diagnosis changed from astrocytoma to oligodendroglioma. Among reclassified tumours, there was a common molecular pattern, as findings showed mutant IDH in 16 cases (69.6%) and no codeletion in 20 cases (87%). According to the cell of origin, of the whole group of 27 oligodendrogliomas in our series (reclassified and non-reclassifed), 20 cases (74%) became astrocytomas, despite typical oligodendroglial morphology, due to absence of 1p19q codeletion. There was a trend for diagnosis reclassification in younger patients (<40 years), P=.065, mainly in those with a prior diagnosis of oligodendroglioma, with no statistical differences based on gender or clinical data. Besides, reclassification was more common among tumours with mutant IDH (69.6%), P=.003, than those with wild type IDH. In terms of survival, despite receiving different treatments, no significant changes were detected between reclassified and non-reclassified tumours after a mean follow-up of 16 months, partly related to lower grade of these lesions. Conclusions: Within the spectrum of the glial tumours treated in our institution, this new classification including molecular genetics over morphological data has provided marked diagnostic changes. These changes appear mainly in tumours previously diagnosed as oligodendrogliomas and in younger patients, with molecular patterns of mutant IDH and 1p19q codeletion. Although diagnosis reclassification may affect clinic, prognosis or therapeutic management of these tumours, deeper and prospective studies on these specific aspects are needed

Assessment of the impact of glioma diagnostic reclassification following the new 2016 WHO classification on a series of cases. / Evaluación del impacto del cambio diagnóstico de los gliomas aplicando la nueva clasificación de la OMS de 2016 sobre una serie de casos.

BACKGROUND AND OBJECTIVES: The aim of this project is to assess diagnostic reclassification based on molecular data over morphology in a series of glial tumours since the introduction of the 2016 WHO classification of brain tumours. MATERIALS AND METHODS: Retrospective review of glial tumours (oligodendrogliomas and astrocytomas) treated in our centre between January 2012 and June 2016 in which a review of diagnosis was performed when molecular studies were added. Statistical analysis included evaluation of variables of epidemiology, morphology and molecular data (mainly IDH mutation and 1p19q codeletion), diagnostic changes after new classification was considered, and clinical impact in cases of diagnostic reclassification. RESULTS: From a total of 147 glial tumours reviewed in our centre, molecular diagnosis was obtained in 74 cases (50.3%). Initial diagnosis changed in 23 cases (31%), and 20 (87%) of them had a prior histological diagnosis of oligodendroglioma (69.6% grade ii and 17.4% grade iii). Only 3 of these 23 cases diagnosis changed from astrocytoma to oligodendroglioma. Among reclassified tumours, there was a common molecular pattern, as findings showed mutant IDH in 16 cases (69.6%) and no codeletion in 20 cases (87%). According to the cell of origin, of the whole group of 27 oligodendrogliomas in our series (reclassified and non-reclassifed), 20 cases (74%) became astrocytomas, despite typical oligodendroglial morphology, due to absence of 1p19q codeletion. There was a trend for diagnosis reclassification in younger patients (<40 years), P=.065, mainly in those with a prior diagnosis of oligodendroglioma, with no statistical differences based on gender or clinical data. Besides, reclassification was more common among tumours with mutant IDH (69.6%), P=.003, than those with wild type IDH. In terms of survival, despite receiving different treatments, no significant changes were detected between reclassified and non-reclassified tumours after a mean follow-up of 16 months, partly related to lower grade of these lesions. CONCLUSIONS: Within the spectrum of the glial tumours treated in our institution, this new classification including molecular genetics over morphological data has provided marked diagnostic changes. These changes appear mainly in tumours previously diagnosed as oligodendrogliomas and in younger patients, with molecular patterns of mutant IDH and 1p19q codeletion. Although diagnosis reclassification may affect clinic, prognosis or therapeutic management of these tumours, deeper and prospective studies on these specific aspects are needed.

Protocol for mandibular reconstruction with zygomatic implants (zygomatic mandibular implant).

INTRODUCTION: This study describes a modified protocol using transmandibular zygomatic implants with immediate occlusal loading for the comprehensive dental rehabilitation of previously reconstructed mandibular defects and reports preliminary results of this modified protocol. MATERIALS AND METHODS: Fifteen patients (6 female and 9 male), with a mean of age 40.26 years (range 12 to 68 years), had previously undergone immediate mandibular reconstruction using either autologous bone grafting, bone transport, or microvascular free-flap reconstruction for a variety of diagnoses. Transmandibular zygomatic implants were subsequently placed, depending on the type of defect. Implant stability was evaluated by insertion torque, percussion testing, and the implant stability quotient (ISQ). The patients were rehabilitated with an immediate provisional prosthesis. All patients' records included pre and postoperative clinical examination, radiographs, CT scan, and photographic analysis. All patients were followed for a minimum of 36 months. RESULTS: All patients were dentally rehabilitated immediately with functional and esthetic hybrid dentures based on either acrylic or porcelain on a metal framework. Among all cases of transmandibular zygomatic implants, the ISQ was greater than 75, which allowed immediate prosthetic loading. The zygomatic implants were considered to be successful if they were asymptomatic with no clinical mobility and no sign of infection. We have also added new indications for placement of transmandibular implants in cases of sequelae of gunshot trauma, dentoalveolar defects, and complications of orthognathic surgery, partially edentulous and/or failure of prior mandibular reconstruction. CONCLUSIONS: The zygomatic implant is an excellent immediate loading option for mandibular dental rehabilitation among patients with mandibular defects. According to our observation, immediate occlusal loading of transmandibular zygomatic implants has a very good potential for success.

Animal and human bite injuries: a 5-year retrospective study in a large urban public hospital in Venezuela.

INTRODUCTION: Animal bite injuries to the head and neck regions are an important public health problem. Most of these bites are from dogs. A 10-year retrospective study was undertaken to determine the prevalence of animal and human bites. MATERIALS AND METHODS: This retrospective study was done from January 2011 to December 2016 and included 387 patients with a mean age of 21.51 years. Data collection included age, sex, days of hospitalization, lesion type, and clinical management. RESULTS: Majority of patients were in age group of 21-29 years, followed by 31-55 years. Out of the total 281 patients, 42 patients (51.60%) were males and 34 patients (48.40%) were females. Mean hospital stay was 7.2 days with a minimum of 5 days and a maximum of 12 days. Surgical management included cleansing and primary closure of the wound. CONCLUSIONS: We concluded that the use of empiric antibiotic prophylaxis is essential for management of facial animal bite, and the antibiotic of first choice is amoxicillin-clavulanic acid. The aim of immediate surgical repair (< 6 h) is to avoid infections. The persistence of dog bite is public health problem in Venezuela.

Electrophoretic Transport of Na(+) and K(+) Ions Within Cyclic Peptide Nanotubes.

One of the most important applications of cyclic peptide nanotubes (CPNTs) is their potential to be used as artificial ion channels. Natural ion channels are large and complex membrane proteins, which are very expensive, difficult to isolate, and sensible to denaturation; for this reason, artificial ion channels are an important alternative, as they can be produced by simple and inexpensive synthetic chemistry paths, allowing manipulation of properties and enhancement of ion selectivity properties. Artificial ion channels can be used as component in molecular sensors and novel therapeutic agents. Here, the electrophoretic transport of Na(+) and K(+) ions within cyclic peptide nanotubes is investigated by using molecular dynamic simulations. The effect of electric field in the stability of peptide nanotubes was studied by calculating the root mean square deviation curves. Results show that the stability for CPNTs decreases for higher electric fields. Selective transport of cations within the hydrophilic tubes was observed and the negative Cl(-) ions did not enter the peptide nanotubes during the simulation. Radial distribution functions were calculated to describe structural properties and coordination numbers and changes in the first and second hydration shell were observed for the transport of Na(+) and K(+) inside of cyclic peptide nanotubes. However, no effect on coordination number was observed. Diffusion coefficients were calculated from the mean square deviation curves and the Na(+) ion showed higher mobility than the K(+) ion as observed in equivalent experimental studies. The values for diffusion coefficients are comparable with previous calculations in protein channels of equivalent sizes.

Tratamiento fibrinolítico con activador del plasminógeno tisular. Resultados en la práctica clínica con un modelo de actuación multidisciplinario / Fibrinolytic treatment with tissue plasminogen activator. Outcomes in clinical practice with a multidisciplinary model of intervention

Introducción y objetivo. El tratamiento del infarto cerebral agudo con activador del plasminógeno tisular (rt-PA) se ha aplicado hasta ahora de forma restrictiva en grandes centros con unidades de ictus de agudos. El objetivo de este estudio es determinar la seguridad y eficacia de este tratamiento en un centro sin experiencia previa siguiendo un modelo multidisciplinario. Pacientes y métodos. Estudio prospectivo y observacional que incluyó pacientes con ictus isquémico agudo de menos de 3 h de evolución tratados con rt-PA endovenoso desde enero de 2004 a diciembre de 2006. Se valoraron variables basales, complicaciones hemorrágicas, respuesta al tratamiento y evolución funcional mediante la escala de Rankin modificada a (mRS) los 3 meses. El tratamiento y control se aplicó siguiendo un protocolo multidisciplinario con una dirección compartida por los servicios de Medicina Intensiva y Neurología. Resultados. Se trataron 46 pacientes, con una edad media de 67 ± 12 años (63% hombres). NIH pretratamiento: 13,6 ± 4,7; mediana: 13,5; rango: 5-22. El tiempo entre el inicio de los síntomas y la llegada al hospital fue de 53 ± 27 min, y el tiempo puerta-aguja, de 69 ± 27 min. A las 24 h, un 48% de los pacientes había mejorado en la escala NIH > 4 puntos. Se observaron un total de 10 transformaciones hemorrágicas (21,7%), ninguna de ellas sintomática. A los tres meses, un 54,3% de los pacientes era independiente funcionalmente (mRS: 0-2). La mortalidad a los 90 días fue del 13,1%. Conclusión. La administración de rt-PA a pacientes con ictus isquémico agudo en la práctica asistencial siguiendo un protocolo multidisciplinario es segura y con una evolución neurológica comparable a ensayos y estudios clínicos

Introduction and aims. Until now treatment of acute cerebral infarction with tissue plasminogen activator (rt-PA) has been applied to a limited extent in large medical centres with acute stroke units. The aim of this study is to determine the safety and effectiveness of this treatment in a centre with no previous experience following a multidisciplinary model. Patients and methods. We conducted a prospective, observation-based study involving patients who were treated with intravenous rt-PA within 3 hours of suffering an acute ischaemic stroke between January 2004 and December 2006. Basal variables, haemorrhagic complications, response to treatment and functional progress were evaluated using the modified Rankin Scale (mRS) at 3 months. Treatment and control were applied following a multidisciplinary protocol implemented by the Intensive Medicine and Neurology services. Results. In all, 46 patients were treated, their mean age being 67 ± 12 years (63% males). NIH pre-treatment: 13.6 ± 4.7; median: 13.5; range: 5-22. Time elapsed between the onset of symptoms and arrival at the hospital was 53 ± 27 min, and door-to-needle time was 69 ± 27 min. At 24 hours, 48% of patients had improved their scores on the NIH scale > 4 points. A total of 10 haemorrhagic transformations (21.7%) were observed, none of which were symptomatic. At three months, 54.3% of patients were functionally independent (mRS: 0-2). Mortality rate at 90 days was 13.1%. Conclusions. Administration of rt-PA to patients with acute ischaemic stroke in health care practice following a multidisciplinary protocol is safe and has a neurological progression that is comparable to clinical trials and studies

[Fibrinolytic treatment with tissue plasminogen activator. Outcomes in clinical practice with a multidisciplinary model of intervention]. / Tratamiento fibrinolítico con activador del plasminógeno tisular. Resultados en la práctica clínica con un modelo de actuación multidisciplinario.

INTRODUCTION AND AIMS: Until now treatment of acute cerebral infarction with tissue plasminogen activator (rt-PA) has been applied to a limited extent in large medical centres with acute stroke units. The aim of this study is to determine the safety and effectiveness of this treatment in a centre with no previous experience following a multidisciplinary model. PATIENTS AND METHODS: We conducted a prospective, observation-based study involving patients who were treated with intravenous rt-PA within 3 hours of suffering an acute ischaemic stroke between January 2004 and December 2006. Basal variables, haemorrhagic complications, response to treatment and functional progress were evaluated using the modified Rankin Scale (mRS) at 3 months. Treatment and control were applied following a multidisciplinary protocol implemented by the Intensive Medicine and Neurology services. RESULTS: In all, 46 patients were treated, their mean age being 67 +/- 12 years (63% males). NIH pre-treatment: 13.6 +/- 4.7; median: 13.5; range: 5-22. Time elapsed between the onset of symptoms and arrival at the hospital was 53 +/- 27 min, and door-to-needle time was 69 +/- 27 min. At 24 hours, 48% of patients had improved their scores on the NIH scale > 4 points. A total of 10 haemorrhagic transformations (21.7%) were observed, none of which were symptomatic. At three months, 54.3% of patients were functionally independent (mRS: 0-2). Mortality rate at 90 days was 13.1%. CONCLUSIONS: Administration of rt-PA to patients with acute ischaemic stroke in health care practice following a multidisciplinary protocol is safe and has a neurological progression that is comparable to clinical trials and studies.

[Acute renal insufficiency associated to cocaine consumption]. / Insuficiencia renal aguda por consumo de cocaína.

Acute renal insufficiency associated to cocaine consumption is well known, and normally secondary to rhabdomyolisis. The possibility that renal failure is related to hypertension and to renal histopathological findings indistinguishable of other malignant hypertension conditions is a not as well known fact. Certain derivatives of cocaine are powerful vasospasm inducers, which could be the key of the origin of the ischemic lesions that appears not only in the kidney but in other organs, especially in the nervous system. We present four patients with acute renal insufficiency, two of them because of malignant hypertension, another one because of cocaine consumption with very severe ischemic neurological lesions, but reversible with the withdrawal of the drug, and another one because of rhabdomyolisis. The latest patient had a different evolution probably related to the different habit of consumption and perhaps as a consequence of different derivatives of cocaine.

Hipertensión arterial maligna e insuficiencia renal aguda por consumo de cocaína / Malignant hypertension and acute renal failure due to cocaine abuse

No disponible