Hitchhiking to the abyss.

We investigated, for the first time, the hitchhiker-host fidelity of deep-diving whale sharks and Chilean devil rays. We found that two of the most ubiquitous oceanic hitchhikers, the common remora and the pilot fish, are able to follow their hosts to bathypelagic depths, where they are exposed to extreme gradients of light, dissolved oxygen, temperature, and pressure. We documented a deep dive of a large whale shark hosting remoras and pilot fish. Common remora was observed at the deepest section of the dive, at 1460 m, where the water temperature was 3.6°C. A pilot fish was recorded at 900 m, during the ascent phase, with the water temperature of 7.5°C. Although the adaptations that allow these hitchhikers to mitigate the impacts of such extreme environmental conditions remain unknown, we discuss these findings in the framework of the ecophysiology of deep diving and the hitchhiker-host fidelity.

Perfiles de resistencia a fluoroquinolonas en cocos Gram positivos de importancia clínica / Fluoroquinolone's resistance profiles in Gram-positive cocci of clinical importance

Para evaluar la resistencia a fluoroquinolonas en aislamientos clínicos de cocos grampositivos se revisaron los resultados de los cultivos procesados en el Centro de Referencia Bacteriológica del Servicio Autónomo Hospital Universitario de Maracaibo, durante el periodo enero 2011-diciembre 2015. Los datos fueron analizados mediante el software WHONETTM, (versión 5,6) y el IBM® SPSS® Statistics para Windows, (versión 25). Se encontró una frecuencia de 29,70% para los cocos grampositivos (9.292 cepas), correspondiendo el 76,18% de los aislamientos al género Staphylococcus (7.072); 15,30% a Enterococcus (1.422) y 8,59% a Streptococcus (798). Para Staphylococcus, la resistencia fue mayor en cepas resistentes a meticilina. Las tasas de resistencia más elevadas se detectaron en los enterococos, especialmente en Enterococcus faecium resistente a vancomicina. No se detectó resistencia a fluoroquinolonas en las cepas de Enterococcus faecalis resistentes a vancomicina. Los estreptococos, incluyendo Streptococcus pneumoniae, se mostraron, mayormente, sensibles a las fluoroquinolonas. La mayoría de las cepas de estafilococos y enterococos; presentó, resistencia cruzada a todas las fluoroquinolonas probadas. La distribución de la resistencia a las fluoroquinolonas por año de estudio en cada género bacteriano fue diferente. La resistencia a las fluoroquinolonas muestra una tendencia creciente en los tres géneros de cocos grampositivos evaluados

To evaluate the resistance to fluoroquinolones in clinical isolates of Gram-positive cocci records of processed culture al the Bacteriological Reference Center of the Autonomous Service University Hospital of Maracaibo during the period January 2011-December 2015, were reviewed. The data was analyzed using WHONETTM software (version 5.6) and IBM® SPSS® Statistics for Windows (version 25). A frequency of 29.70% was found for Gram-positive cocci (9,292 strains), with 76.18% of isolates corresponding to the genus Staphylococcus (7,072); 15.30% to Enterococcus (1422) and 8.59% to Streptococcus (798). For Staphylococcus, resistance was higher in methicillin-resistant strains. The highest resistance rates were detected in enterococci, especially vancomycin-resistant Enterococcus faecium. No resistance to fluoroquinolones was detected in vancomycin-resistant Enterococcus faecalis strains. Streptococci, including Streptococcus pneumoniae, were mostly sensitive to fluoroquinolones. Most strains of staphylococci and enterococci; presented cross resistance to all tested fluoroquinolones. The distribution of resistance to fluoroquinolones per year of study in each bacterial genus was different. Resistance to fluoroquinolones shows an increasing trend in the three genera of Gram-positive cocci evaluated

Rapidly expanded partially HLA DRB1-matched fungus-specific T cells mediate in vitro and in vivo antifungal activity.

Invasive fungal infections are a major cause of disease and death in immunocompromised hosts, including patients undergoing allogeneic hematopoietic stem cell transplant (HSCT). Recovery of adaptive immunity after HSCT correlates strongly with recovery from fungal infection. Using initial selection of lymphocytes expressing the activation marker CD137 after fungal stimulation, we rapidly expanded a population of mainly CD4+ T cells with potent antifungal characteristics, including production of tumor necrosis factor α, interferon γ, interleukin-17, and granulocyte-macrophage colony stimulating factor. Cells were manufactured using a fully good manufacturing practice-compliant process. In vitro, the T cells responded to fungal antigens presented on fully and partially HLA-DRB1 antigen-matched presenting cells, including when the single common DRB1 antigen was allelically mismatched. Administration of antifungal T cells lead to reduction in the severity of pulmonary and cerebral infection in an experimental mouse model of Aspergillus. These data support the establishment of a bank of cryopreserved fungus-specific T cells using normal donors with common HLA DRB1 molecules and testing of partially HLA-matched third-party donor fungus-specific T cells as a potential therapeutic in patients with invasive fungal infection after HSCT.

Susceptibilidad a meticilina y vancomicina en Staphylococcus aureus aislados de hemocultivos / Susceptibility to methicillin and vancomycin in Staphylococcus aureus isolated from blood cultures

Para determinar la susceptibilidad a meticilina y vancomicina en cepas de Staphylococcus aureus aisladas de hemocultivos, se analizaron los registros de pacientes ingresados en las Unidades de Cuidados Intensivos del Servicio Autónomo Hospital Universitario de Maracaibo durante el período enero 2011-diciembre 2015. Se procesaron 35.341 hemocultivos; 5.072 (14,35%) fueron positivos; en 455 (8,97%) se aislaron 96 cepas de Staphylococcus aureus (21,09%), de las cuales, 78 (81,25%) fueron resistentes y 18 (18,75%), sensibles a meticilina. Todos los aislados resultaron sensibles a vancomicina. El 61,45% de las cepas expresó multirresistencia. No se encontró diferencia estadísticamente significativa en la frecuencia de aislamiento de Staphylococcus aureus por año, edad y sexo del paciente (p > 0,05); pero si según el tipo de unidad y la presencia de co-resistencia antimicrobiana (p < 0,05). Los elevados niveles de resistencia a meticilina y la evidencia de fenotipos sensibles a vancomicina con valores elevados de concentración inhibitoria mínima (> 1 µg/ml), demandan la vigilancia sistemática del patrón de susceptibilidad antimicrobiana a fin de guiar a los clínicos para elegir la terapia empírica adecuada, contribuyendo al reforzamiento continuo de las precauciones estándar y al establecimiento de las políticas locales de administración y regulación del uso de antimicrobianos

To determine susceptibility to methicillin and vancomycin in blood-isolated strains of Staphylococcus aureus isolated from blood cultures, patient records entered in the Intensive Care Units of the Autonomous Hospital University Service of Maracaibo were analyzed during the period January 2011-December 2015. 35,341 blood cultures were processed; 5.072 (14,35%) were positive; in 455 (8.97%)96 strains of Staphylococcus aureus (21.09%) were isolated, of which 78 (81.25%) were resistant and 18 (18.75%), sensitive to methicillin. All isolates were sensitive to vancomycin. 61.45% of the strains expressed multi-resistance. No statistically significant difference in the frequency of isolation of Staphylococcus aureus per year, age and sex of the patient (p > 0.05) was found; but if according to the type of unit and the presence of antimicrobial co-resistance (p ˂ 0.05). The high levels of methicillin resistance and the evidence of vancomycin-sensitive phenotypes with high minimum inhibitory concentration values (>1 µg/ml), require systematic monitoring of the antimicrobial susceptibility pattern in order to guide clinicians to choose appropriate empirical therapy, contributing to the continuous strengthening of standard precautions and the establishment of local policies for the administration and regulation of the use of antimicrobials

Calidad microbiológica del agua subterránea como riesgo epidemiológico en la producción de enfermedad diarreica infantil. Revisión Sistemática / Microbiological quality of groundwater as an epidemiological risk in the production of Childhood Diarrheal Disease. Systematic review

El agua de consumo humano y su calidad son determinantes para la salud pública. Esta revisión pretende recopilar y analizar información acerca de la relación entre la enfermedad diarreica en niños menores de cinco (5) años y la contaminación de las fuentes de agua subterránea. Se consultaron las bases: PubMed, ScienceDirect, SpringerLink, SciELO y Google Scholar, sin limitación en fechas de publicación; utilizando los descriptores: agua subterránea, diarrea, enfermedad gastrointestinal infantil, contaminación microbiana, calidad del agua, diarrea infantil, agua potable, técnicas moleculares y técnicas bioquímicas, analizándose un total de ciento sesenta y nueve (169) publicaciones. Se encontró relación entre la contaminación microbiana del agua subterránea y la diarrea infantil. El agua subterránea se contamina debido a fugas de fosas sépticas, métodos inadecuados de manejo de desechos y escorrentías de agua de lluvia, determinando la prevalencia de diarrea infantil. De allí, la importancia de monitorear la calidad del agua como factor de riesgo, con la detección y cuantificación de bioindicadores, mediante métodos rutinarios y novedosos, e incorporar intervenciones dirigidas a mejorar la accesibilidad a fuentes de agua controladas y la educación sanitaria en la búsqueda de asegurar la protección del agua y la disminución en la prevalencia de la diarrea infantil. Esta revisión está registrada en PROSPERO bajo el número ID 129254

Water for human consumption and its quality are determinants for public health. This review aims to collect and analyze information about the relationship between diarrheal disease in children under five (5) years of age and contamination of groundwater sources. The bases: PubMed, ScienceDirect, SpringerLink, SciELO and Google Scholar, without limitation on publication dates, using the descriptors: groundwater, diarrhea, childhood gastrointestinal disease, microbial contamination, water quality, childhood diarrhea, drinking water, molecular techniques and biochemical techniques, were consulted, analyzing a total of one hundred sixty-nine (169) publications. A relationship was found between microbial contamination of groundwater and childhood diarrhea. Groundwater is contaminated due to septic tank leaks, inadequate methods of waste management and rainwater runoff, determining the prevalence of childhood diarrhea. From there, the importance of monitoring water quality as a risk factor, with the detection and quantification of bioindicators, through routine and novel methods, and incorporating interventions aimed at improving accessibility to controlled water sources and health education in the search to ensure water protection and the decrease in the prevalence of childhood diarrhea. This revision is registered in PROSPERO under the number ID 129254.

Etiología de la diarrea infantil en Shushufindi, Ecuador / Etiology of the child diarrhea in Shushufindi, Ecuador

La diarrea infecciosa es un importante problema de salud mundial; sin embargo, poco se sabe sobre su etiología en la ciudad de Shushufindi, Ecuador. El objetivo de esta investigación fue determinar la etiología de la diarrea infecciosa en niños. Se recolectaron 154 muestras fecales provenientes de niños de ambos sexos que acudieron al laboratorio de un centro de salud durante el periodo enero-marzo 2018. Se realizó coprocultivo, examen parasitológico directo e inmunoensayo cromatográfico. En 124 muestras (80,52%) se detectó la presencia de organismos enteropatógenos, de las cuales 74 (59,68%) fueron positivas para bacterias; 36 (29,03%) para parásitos y 14 (11,29%) para rotavirus. Los organismos aislados fueron: 35 (28,23%) Salmonella sp.; 26 (20,97%) Shigella sp.; 13 (10,48%) Campylobacter sp.; 15 (12,10%) G. intestinalis; 10 (8,06%) T. trichiura; 5 (4,03%) E. histolytica/dispar/moshkovskii; 3 (2,42%) A. lumbricoides; S. stercoralis y rotavirus14 (11,29%), cada uno. Se encontró asociación estadísticamente significativa entre la presencia de parásitos y la edad y sexo del paciente; así como también entre la presencia de bacterias y la edad de los niños. Este estudio demuestra la participación de un pequeño grupo de patógenos como los principales agentes causales de la diarrea infecciosa en la población infantil estudiada.

Infectious diarrhea is a major global health problem; however, little is known about its etiology in the city of Shushufindi, Ecuador. The objective of this investigation was to determine the etiology of infectious diarrhea in children. 154 fecal samples were collected from children of both sexes who attended the laboratory of a health center during the period January-March 2018. Stool culture, direct parasitological examination and immunochromatographic assay were performed. In 124 samples (80.52%) the presence of enteropathogenic organisms was detected, of which 74 (59.68%) were positive for bacteria; 36 (29.03%) for parasites and 14 (11.29%) for rotavirus. The isolated organisms were: 35 (28.23%) Salmonella spp.; 26 (20.97%) Shigella spp.; 13 (10.48%) Campylobacter spp.; 15 (12.10%) G. intestinalis; 10 (8.06%) T. trichiura; 5 (4.03%) E. histolytica/dispar/moshkovskii; 3 (2.42%) A. lumbricoides; S. stercoralis and rotavirus 14 (11.29%), each one. A statistically significant association was found between the presence of parasites and the age and sex of the patient; as well as between the presence of bacteria and the age of children. This study demonstrates the participation of a small group of pathogens as the main causative agents of infectious diarrhea in the child population studied.

Kynurenine 3-Monooxygenase Activity in Human Primary Neurons and Effect on Cellular Bioenergetics Identifies New Neurotoxic Mechanisms.

Upregulation of the kynurenine pathway (KP) of tryptophan metabolism is commonly observed in neurodegenerative disease. When activated, L-kynurenine (KYN) increases in the periphery and central nervous system where it is further metabolised to other neuroactive metabolites including 3-hydroxykynurenine (3-HK), kynurenic acid (KYNA) and quinolinic acid (QUIN). Particularly biologically relevant metabolites are 3-HK and QUIN, formed downstream of the enzyme kynurenine 3-monooxygenase (KMO) which plays a pivotal role in maintaining KP homeostasis. Indeed, excessive production of 3-HK and QUIN has been described in neurodegenerative disease including Alzheimer's disease and Huntington's disease. In this study, we characterise KMO activity in human primary neurons and identified new mechanisms by which KMO activation mediates neurotoxicity. We show that while transient activation of the KP promotes synthesis of the essential co-enzyme nicotinamide adenine dinucleotide (NAD+), allowing cells to meet short-term increased energy demands, chronic KMO activation induces production of reactive oxygen species (ROS), mitochondrial damage and decreases spare-respiratory capacity (SRC). We further found that these events generate a vicious-cycle, as mitochondrial dysfunction further shunts the KP towards the KMO branch of the KP to presumably enhance QUIN production. These mechanisms may be especially relevant in neurodegenerative disease as neurons are highly sensitive to oxidative stress and mitochondrial impairment.

Distribución de especies y susceptibilidad antimicrobiana en cepas de Enterococcus de origen clínico / Distribution of species and antimicrobial susceptibility in Enterococcus strains of clinical origin

A fin de establecer la frecuencia de aislamiento de las diferentes especies de enterococos, su distribución de acuerdo al tipo de muestra y servicio de atención al paciente y determinar la resistencia antimicrobiana, se analizaron 1.624 cepas provenientes de cultivos bacteriológicos de pacientes atendidos en el Centro de Referencia Bacteriológica del Servicio Autónomo Hospital Universitario de Maracaibo, durante el período Enero 2010 - Diciembre 2015. Las especies más frecuentes fueron E. faecalis (52,46%) y E. faecium (41,38%). El mayor número de cepas se obtuvo a partir de muestras de piel y tejidos blandos (54,92%), orina (23,15%) y sangre (17,27%). Los servicios con mayor frecuencia de aislamiento fueron: hospitalización de adultos (47,71%) y hospitalización pediátrica (16,38%). No se encontró asociación estadísticamente significativa entre la especie de enterococos y el tipo de muestra o el servicio de atención al paciente (p>0,05). Se detectó más resistencia en E. faecium que en E. faecalis. Los enterococos están adquiriendo cada vez mayor resistencia antimicrobiana y, por lo tanto, se hace necesario mantener una vigilancia permanente sobre ellos, realizar su adecuada identificación y detectar oportunamente la resistencia, con el fin de aplicar medidas preventivas adecuadas antes de que estos microorganismos causen un mayor impacto intrahospitalario.

In order to establish the frequency of isolation of the different species of enterococci, their distribution according to the type of sample and patient care service and determine the antimicrobial resistance, 1,624 strains obtained from bacteriological cultures of patients attended in the Bacteriological Reference Center at the Autonomous Service University Hospital of Maracaibo, during the period January 2010 - December 2015, were analyzed. The most frequent species were E. faecalis (52.46%) and E. faecium (41.38%). The greatest number of strains was obtained from skin and soft tissues samples (54.92%), urine (23.15%) and blood (17.27%). Services with increased frequency of isolation were: hospitalization of adults (47.71%) and pediatric hospitalization (16.38%). It did not find statistically significant association between the specie of enterococci and sample type, or patient care service (p > 0.05). It was detected more resistance in E. faecium than in E. faecalis. The enterococci are acquiring ever greater antimicrobial resistance, and therefore, it is necessary to maintain permanent vigilance over them, perform their proper identification and timely detect resistance, in order to apply preventive measures before these microorganisms cause a greater intrahospital impact.

Infección urinaria en pacientes con diabetes mellitus tipo 2: frecuencia, etiología, susceptibilidad antimicrobiana y factores de riesgo / Urinary infection in patients with type 2 diabetes mellitus: frequency, etiology, antimicrobial susceptibility and risk factors

Las infecciones urinarias son comunes en pacientes diabéticos. El objetivo de esta investigación fue: determinar la frecuencia, etiología, susceptibilidad antimicrobiana y factores de riesgo asociados a infección urinaria en pacientes con diabetes tipo 2. Se estudiaron 108 pacientes ambulatorios, con diagnóstico presuntivo de infección de vías urinarias, durante el periodo mayo 2016 - mayo 2017, en la ciudad de Jipijapa, Ecuador. Para el urocultivo se utilizó la técnica del asa calibrada. La susceptibilidad a los antibióticos se determinó mediante el método de Kirby & Bauer. Las variables cualitativas se compararon con ji cuadrado o la prueba exacta de Fisher. Se calculó el Odd radio (OR) y sus intervalos de confianza (IC) del 95%. Valores de p ≤ 0,05 fueron considerados significativos. La frecuencia de infección urinaria fue de 73,15%. El microorganismo más frecuentemente aislado fue Escherichia coli (78,48%). Los mayores porcentajes de resistencia se observaron para amoxicilina (78,87%) y cefalexina (71,83%). Los malos hábitos de higiene, la presencia de cálculos renales y una vida sexual activa resultaron factores de riesgo para las infecciones urinarias. La nitrofurantoina, fosfomicina, fluoroquinolonas y algunos betalactámicos, todavía representan una alternativa de utilidad en la quimioterapia de las infecciones urinarias no complicadas en pacientes diabéticos.

Urinary infection is common in diabetic patients. The objective of this research was to determine the frequency, etiology, antimicrobial susceptibility and risk factors associated with urinary tract infection in patients with type 2 diabetes. 108 outpatients with a presumptive diagnosis of urinary tract infection during May 2016-May 2017, in the city of Jipijapa, Ecuador, were studied. For the uroculture the calibrated loop technique was used. The susceptibility to antibiotics was determined by the Kirby & Bauer method. The qualitative variables were compared with chi-squared or Fisher's exact test. The Odd radio (OR) and its 95% confidence intervals (CI) were calculated. Values of p ≤ 0.05 were considered significant. A frequency of 73.15% of urinary infection was found. The microorganism most frequently isolated was Escherichia coli (78.48%). The highest percentages of resistance were observed for amoxicillin (78.87%) and cephalexin (71.83%). Bad hygiene habits, the presence of kidney stones and an active sex life were risk factors for urinary tract infections. Nitrofurantoin, fosfomycin, fluoroquinolones and some beta-lactams still represent a useful alternative in the chemotherapy of uncomplicated urinary tract infections in diabetic patients.

Frecuencia y resistencia antimicrobiana en Staphylococcus / Frequency and antimicrobial resistance in Staphylococcus

La presente investigación tuvo como objetivo establecer la frecuencia de aislamiento de las diferentes especies de estafilococos y determinar la resistencia antimicrobiana de las cepas aisladas. Se realizó un estudio retrospectivo, en cepas aisladas en el Centro de Referencia Bacteriológica del Servicio Autónomo Hospital Universitario de Maracaibo, durante el período enero 2011 ­ diciembre 2015. Se obtuvo un porcentaje de aislamiento para S. aureus del 61,36% y 38,64% para coagulasa negativa, observándose mayor frecuencia de aislamiento en el área de hospitalización para ambos grupos de microorganismos. Las muestras de piel y tejidos blandos representaron las principales fuentes de aislamiento para S. aureus; mientras que para el grupo coagulasa negativa, fueron las muestras de sangre. Todas las cepas fueron sensibles a los glicopéptidos. La resistencia para los b-lactámicos fue acentuada para ambos grupos bacterianos, mostrando variabilidad para macrólidos y lincosamidas y para los restantes antibióticos probados, se encontraron bajos porcentajes de resistencia. Los resultados demuestran que S. aureus es la especie más frecuente del género; seguida de S. epidermidis y S. haemolyticus entre coagulasa negativa. Ambos grupos de microorganismos expresan fenotipos de resistencia a penicilina y eritromicina, sensibilidad a vancomicina y teicoplanina y susceptibilidad variable al resto de antibióticos evaluados.

The objective of the present investigation was to establish the frequency of isolation of the different species of staphylococci and to determine the antimicrobial resistance of the isolated strains. A retrospective study was carried out in isolated strains at the Bacteriological Reference Center of the Autonomous Service of the University Hospital of Maracaibo during the period January 2011 to December 2015. A percentage of isolation was obtained for S. aureus of 61.36% and 38,64% for coagulase negative, showing a higher frequency of isolation in the hospitalization area for both groups of microorganisms. Skin and soft tissue samples represented the main sources of isolation for S. aureus; while for the coagulase negative group, they were blood samples. All strains were sensitive to glycopeptides. Resistance for ß-lactams was accentuated for both bacterial groups, showing variability for macrolides and lincosamides and for the remaining antibiotics tested, low percentages of resistance were found. The results show that S. aureus is the most frequent species of the genus; followed by S. epidermidis and S. haemolyticus, among coagulase negative. Both groups of microorganism express phenotypes of resistance to penicillin and erythromycin, sensitivity to vancomycin and teicoplanin and variable susceptibility to the rest of evaluated antibiotics.

Detección de cassette cromosómico en cepas de Staphylococcus aureus resistente a meticilina aisladas en un hospital universitario de la ciudad de Maracaibo / Detection of chromosomal cassette in MRSA Staphylococcus aureus strains isolated in a University Hospital in Maracaibo City

Staphylococcus aureus resistente a meticilina, es un importante patógeno nosocomial y comunitario. El determinante genético de resistencia es el gen mecA. Se han descrito 11 tipos de SCCmec, encontrándose con frecuencia los tipos II, III en infecciones hospitalarias, y los tipos IV y V en infecciones comunitarias. La presente investigación se llevó a cabo para estudiar la distribución de los tipos de SCCmec y su relación con la Leucocidina Panton-Valentine, tipificados mediante la reacción en Cadena de la Polimerasa. Para ello se estudiaron un total de 42 cepas resistentes a meticilina portadoras del gen mecA. Veintinueve (29) cepas mostraron la presencia del cassette cromosomal tipo IV (69,05%); 30,95% presentaron el SCCmec tipo I. Un 61,95% (n=13) de las cepas fueron portadoras del SCCmec IV resultando todas positivas para el gen PVL. Cabe destacar la diseminación del cassette tipo IV en cepas intrahospitalarias portadoras de PVL, lo que es preocupante tanto para la terapéutica como para el agravamiento de las infecciones en los pacientes.

Methicillin-resistant Staphylococcus aureus is an important nosocomial and community pathogen. The genetic determinant of resistance is the mecA gene. 11 types of SCCmec have been described, with types II, III frequently found in hospital infections, and types IV and V in community infections. The present investigation was carried out to study the distribution of the SCCmec types and their relation with the Panton-Valentine Leucocidin, typified by the reaction in the Polymerase Chain. To this end, a total of 42 methicillin-resistant strains carrying the mecA gene were studied. Twenty-nine (29) strains showed the presence of type IV chromosomal cassette (69.05%); 30.95% presented SCCmec type I. A 61.95% (n= 13) of the strains were carriers of SCCmec IV, all of which were positive for the PVL gene. It is worth noting the dissemination of the type IV cassette in intrahospital strains carrying PVL, which is worrisome both for the therapeutic and for the aggravation of infections in patients.

Rehabilitación protésica de adultos mayores con dispepsia funcional / Prosthetics rehabilitation in elderly with functional dyspepsia

Se realizó un estudio descriptivo y transversal de 71 adultos mayores con dispepsia funcional, atendidos en el Servicio de Gastroenterología del Policlínico Sur Asdrúbal López Vázquez de la provincia de Guantánamo, desde mayo de 2012 hasta igual mes de 2014, con el objetivo de evaluar la efectividad de la rehabilitación protésica en estos pacientes. En la serie predominaron el sexo femenino (53,7 por ciento), el grupo etario de 60-69 años (53,7 por ciento), la sensación de plenitud y la saciedad precoz como síntomas principales, así como los dientes perdidos, según el índice de mortalidad dentaria (30,4 por ciento). El tratamiento rehabilitador permitió eliminar casi el total de los síntomas encontrados, por lo cual resultó efectivo y constituye un elemento a tener en cuenta para eliminar o disminuir los síntomas en ancianos con este trastorno

A descriptive and cross-sectional study of 71 elderly with functional dyspepsia, assisted in the Gastroenterology Service of Asdrúbal López Vázquez Southern Polyclinic in Guantánamo, was carried out from May, 2012 to the same month in 2014, with the objective of evaluating the effectiveness of the prosthetics rehabilitation in these patients. In the series there was a prevalence of the female sex (53.7 percent), 60-69 age group (53.7 percent) and early sensation of filling as main symptoms, as well as the lost teeth, according to the dental mortality rate (30.4 percent). The rehabilitative treatment allowed to eliminate almost all the symptoms found, reason why it was effective and constitutes an element to take into account to eliminate or diminish the symptoms in elderly with this disorder

Ultra-Sensitive Droplet Digital PCR for the Assessment of Microchimerism in Cellular Therapies.

Current techniques to assess chimerism after hematopoietic stem cell transplantation (HSCT) are limited in both sensitivity and precision. These drawbacks are problematic in the context of cellular therapies that frequently result in microchimerism (donor chimerism <1%). We have developed a highly sensitive droplet digital PCR (ddPCR) assay using commercially available regents with good performance throughout the range of clinically relevant chimerism measurements, including microchimerism. We tested the assay using spiked samples of known donor-recipient ratios and in clinical samples from HSCT recipients and patients enrolled on clinical trials of microtransplantation and third-party virus-specific T cells (VSTs). The levels of detection and quantification of the assay were .008% and .023%, with high levels of precision with samples of DNA content ranging from 1 to 300 ng DNA. From the panel of 29 insertion-deletion probes multiple informative markers were found for each of 43 HSCT donor-recipient pairs. In the case of third-party cellular therapies in which there were 3 DNA contributors (recipient, HSCT donor, and T-cell donor), a marker to detect the cellular product in a background of recipient and donor cells was available for 11 of 12 cases (92%). Chimerism by ddPCR was able to quantify chimerism in HSCT recipients and comparison against standard STR analysis in 8 HSCT patients demonstrated similar results, with the advantage of fast turnaround time. Persistence of donor microchimerism in patients undergoing microtransplantation for acute myeloid leukemia was detectable for up to 57 days in peripheral blood and bone marrow. The presence of microtransplant product DNA in bone marrow T cells after cell sorting was seen in the 1 patient tested. In patients receiving third-party VSTs for treatment of refractory viral infections, VST donor DNA was detected at low levels in 7 of 9 cases. ddPCR offers advantages over currently available methods for assessment of chimerism in standard HSCT and cellular therapies.

Detección de Betalactamasas de espectro extendido en Enterobacteriaceae en un Centro de Salud de Maracaibo, Venezuela / Detection of Extended-Spectrum ß-lactamase-producing Enterobacteriaceae in a Healthcare Center from Maracaibo city, Venezuela

La alta incidencia de las enfermedades infecciosas y el aumento de la resistencia a los antibióticos se han convertido en la actualidad en un problema de salud pública, siendo las enterobacterias productoras de Betalactamasas de Espectro Extendido (BLEE) un ejemplo de este fenómeno. En el presente estudio se determinó la producción de BLEE en aislados clínicos de la familia Enterobacteriaceae procedentes de una institución de salud de la ciudad de Maracaibo, durante el periodo septiembre de 2014 a febrero de 2015. Para la detección de BLEE se utilizó como método preliminar el de Kirby-Baüer, siguiendo los lineamientos del CLSI; adicionalmente se utilizó como prueba confirmatoria fenotípica el método de sinergia del doble disco y como prueba confirmatoria genotípica la detección de los genes blaCTX-M, blaTEM y blaSHV mediante PCR. Se analizaron 55 enterobacterias productoras de BLEE, distribuidas de la siguiente manera: Escherichia coli 56,36%, Klebsiella pneumoniae 21,82%, Enterobacter cloacae 7,27%, Proteus mirabilis y Serratia marcescens 5,45% para cada especie, por último, Salmonella spp. y Morganella morganii 1,82% respectivamente. En cuanto al tipo de BLEE detectado mediante PCR, se observó que el 83,63% de los aislados presentó el tipo TEM, seguido de CTX-M (23,63%) y SHV (21,81%), mientras que el 27,27% de los aislados produjo dos o tres BLEE de manera simultánea. Los resultados de este estudio confirman la alta diseminación de este mecanismo de resistencia entre las enterobacterias productoras de infecciones en nuestras instituciones públicas de salud, por lo que deben aplicarse medidas de control que permitan controlar y disminuir su incidencia.

The high incidence of the infectious diseases and the antimicrobial resistance arise represent a public health threat today. The extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae are an example of this phenomenon. We determined the ESBL-production in Enterobacteriaceae isolates from a Healthcare Center in Maracaibo, during September 2014 to February 2015. The Kirby-Baüer method was perform to preliminary phenotypic detection of ESBL, according to CLSI guidelines. ESBL-production was confirmed by a double-disk synergy test according to the CLSI standards. To genotypic confirmation, the genes blaCTX-M, blaTEM and blaSHV were amplified by PCR. Fifty-five (n=55) strains were analyzed distributed in Escherichia coli (56.36 %), Klebsiella pneumoniae (21.82 %), Enterobacter cloacae (7.27 %), Proteus mirabilis and Serratia marcescens (5.45 % each one), Salmonella spp. and Morganella morganii (1.82 % each one). The major encoded ESBL was the blaTEM gene (83.63 %); followed by 23.63% of the blaCTX-M gene, and 21.81 % encoded the blaSHV gene. 27.27 % of the isolates produced two or three ESBL simultaneously. These results confirmed the high spread of this resistant mechanism among Enterobacteriaceae-producing infections in our public health institutions, therefore control measures should applied to control and reduce its incidence.

Prospects for adoptive T-cell therapy for invasive fungal disease.

PURPOSE OF REVIEW: Invasive fungal disease (IFD) is a cause of morbidity and mortality in allogeneic hematopoietic stem cell transplant (HSCT) recipients. As more potent broad-spectrum antifungal agents are used in prophylaxis, drug resistance and less common fungal species have increased in frequency. Here we review current treatments available for IFD and examine the potential for adoptive T-cell treatment to enhance current therapeutic choices in IFD. RECENT FINDINGS: There is growing evidence supporting the role of T cells as well as phagocytes in antifungal immunity. T cells recognizing specific antigens expressed on fungal morphotypes have been identified and the role of T-cell transfer has been explored in animal models. The clinical efficacy of adoptive transfer of antigen-specific T cells for prophylaxis and treatment of viral infections post-HSCT has raised interest in developing good manufacturing practice (GMP)-compliant methods for manufacturing and testing fungus-specific T cells after HSCT. SUMMARY: As the outcomes of IFD post-HSCT are poor, reconstitution of antifungal immunity offers a way to correct the underlying deficiency that has caused the infection rather than simply pharmacologically suppress fungal growth. The clinical development of fungus specific T cells is in its early stages and clinical trials are needed in order to evaluate safety and efficacy.

Major Developments in the Design of Inhibitors along the Kynurenine Pathway.

Disrupted kynurenine pathway (KP) metabolism has been implicated in the progression of neurodegenerative disease, psychiatric disorders and cancer. Modulation of enzyme activity along this pathway may therefore offer potential new therapeutic strategies for these conditions. Considering their prominent positions in the KP, the enzymes indoleamine 2,3-dioxygenase, kynurenine 3-monooxygenase and kynurenine aminotransferase, appear the most attractive targets. Already, increasing interest in this pathway has led to the identification of a number of potent and selective enzyme inhibitors with promising pre-clinical data and the elucidation of several enzyme crystal structures provides scope to rationalize the molecular mechanisms of inhibitor activity. The field seems poised to yield one or more inhibitors that should find clinical utility.

Resistencia a oxacilina, eritromicina y gentamicina en cepas de Staphylococcus coagulasa negativa aisladas de hemocultivos / Resistance to oxacillin, erythromycin and gentamycin in coagulase negative Staphylococcus strains isolated from blood cultures

La resistencia a los antimicrobianos en bacterias Gram positivas como Staphylococcus coagulasa negativa constituye una amenaza mundial emergente. El propósito de la presente investigación fue identificar los genes de resistencia a oxacilina (mecA), eritromicina (erm y msrA), y gentamicina aac(6´)/aph(2´´), en cepas de Staphylococcus coagulasa negativa aisladas de hemocultivos de pacientes atendidos en el Hospital Universitario de Maracaibo. La detección fenotípica se realizó mediante métodos automatizados. Se utilizó la reacción en cadena de la polimerasa para detectar la presencia de genes de resistencia a los antimicrobianos. Se estudiaron 34 cepas cuya distribución por especie fue: S. haemolyticus (38,23%), S. epidermidis (29,42%), S. hominis (26,47%), S. xylosus y S. capitis (5,88% cada uno). Todas las cepas fueron resistentes a oxacilina. La resistencia a gentamicina varió entre 38,46% y 100%; mientras que la resistencia a eritromicina osciló entre 77,78% y 100%. Los análisis mostraron la presencia de los genes mecA (100%), ermA (35,2%), ermC (41,17%), msrA (17,64%), y aac(6´)/aph(2´´) (61,76%). En conclusión, se encontró una alta frecuencia de genes de resistencia a estos antibióticos y la Unidad de Cuidados Intensivos fue el servicio médico donde se aisló el mayor porcentaje de cepas portadoras de estos genes.

Resistance to antimicrobials in Gram-positive bacteria such as coagulase negative Staphylococcus is an emerging global threat. The purpose of this research was to identify the genes for resistance to oxacillin (mecA), erythromycin (erm and msrA), and gentamicin aac(6´)/aph(2´´), in Staphylococcus coagulase negative strains isolated from blood cultures from patients attended at the University Hospital in Maracaibo. Phenotypic detection was performed using automated methods. Polymerase chain reaction was used for the detection of antimicrobial resistance genes. Be studied 34 strains whose distribution by species was: S. haemolyticus (38.23%), S. epidermidis (29.42%), S. hominis (26.47%), S. xylosus and S. capitis (5.88% each one). All strains were resistant to oxacillin. Gentamicin resistance varied between 38.46% and 100%; while the erythromycin resistance ranged between 77.78% and 100%. The analyses showed the presence of genes mecA (100%), ermA (35.2%), ermC (41.17%), msrA (17.64%), and aac(6´)/aph (2´´) (61,76%). In conclusion, is found a high frequency of genes for resistance to these antibiotics and the intensive care unit was the health service where the highest percentage of isolated strains carriers of these genes.