Antibiotic resistance in wildlife from Antarctic Peninsula.

Although considered one of the most pristine ecosystems, Antarctica has been largely influenced by human activities during the last 50 years, affecting its unique biodiversity. One of the major global threats to health is the emergence of antibiotic-resistant bacteria that may be actively transferred to wildlife. We cultured and tested for antibiotic resistance in 137 cloacal and fresh fecal samples of several avian and marine mammal species from the Antarctic Peninsula, the most impacted area in Antarctica. Alarmingly, 80 % of the isolates showed antibiotic resistance, either phenotypically or genotypically. Most of the resistant bacteria, such as Enterobacteriaceae and Enterococcus species, are part of local gastrointestinal microbiota. Penguins and pinnipeds harbored a great diversity of antibiotic resistance and must be eligible as sentinels for future studies. These results show that antibiotic resistance has rapidly transferred to bacteria in Antarctic wildlife, which is a global matter of concern.

Advances in imaging technologies for the assessment of peripheral neuropathies in rheumatoid arthritis.

Peripheral neuropathy in patients with rheumatoid arthritis is associated with a maladaptive autoimmune response that may cause chronic pain and disability. Nerve conduction studies are the routine method performed when rheumatologists presume its presence. However, this approach is invasive, may not reveal subtle malfunctions in the early stages of the disease, and does not expose abnormalities in structures surrounding the nerves and muscles, limiting the possibility of a timely diagnosis. This work aims to present a narrative review of new technologies for the clinical assessment of peripheral neuropathy in Rheumatoid Arthritis. Through a bibliographic search carried out in five repositories, from 1990 to 2020, we identified three technologies that could detect peripheral nerve lesions and perform quantitative evaluations: (1) magnetic resonance neurography, (2) functional magnetic resonance imaging, and (3) high-resolution ultrasonography of peripheral nerves. We found these tools can overcome the main constraints imposed by the previous electrophysiologic methods, enabling early diagnosis.

Outpatient minor oral surgery in patients with hemophilia: A case series of 23 patients.

Hemophilia is an inherited coagulation disorder characterized by deficiency of the coagulation factor VIII or IX. When the management of hemostasis is inadequate, these patients are at high risk of experiencing intra and postoperative bleedings after tooth extractions. Coagulation factor replacement therapy allows performing most surgical procedures safely, although the factor levels and length of treatment have not been clearly determined. In this study, we present our experience in a retrospective series of 112 ambulatory tooth extractions under local anesthesia in 23 patients with hemophilia using a coagulation factor replacement therapy in combination with tranexamic acid. The results obtained with this protocol were satisfactory and only one episode of mild postoperative bleeding occurred after seven days in a patient who did not have good treatment compliance. Key words:Hemophilia, factor replacement therapy, tooth extractions, postoperative complications.

Parasitism Elicits a Stress Response That Allocates Resources for Immune Function in South American Fur Seals (Arctocephalus australis).

Parasites can cause chronic stress in some animal species, and this type of stress response has been associated with adverse consequences for the host. In order to know whether parasitism elicited a stress response associated with decreased host fitness, hookworm (Uncinaria sp.) infection was studied in a colony of South American fur seals (Arctocephalus australis) in which hookworms infect nearly all pups born in a reproductive season. A parasite-free group was generated by treating a subset of pups with an antiparasitic drug before they developed patent hookworm infection. Stress and metabolic hormones, energy balance, and humoral and cellular immune parameters were measured in this group and hookworm-infected pups. Hookworms elicited a marked increase in plasma cortisol levels in fur seal pups. These hookworm-infected pups were able to maintain constant glucose levels, despite losing body mass over the course of infection potentially because of increased protein catabolism. Infected pups were able to mount an effective immune response against the parasite and eliminated hookworms from the intestine, recovering partial body mass lost as a result of hookworm infection at the end of the study period. As shown in previous studies, adequate glucose levels are critical for proper T lymphocyte reactivity, and it is possible that, through activation of a stress response, energy can be readily available for immune response against the parasite contributing to early recovery from infection. Although there are potential fitness costs to mounting a sustained stress response, these could also be adaptive and promote survival during critical life-history stages.

The contrasting hidden consequences of parasitism: Effects of a hematophagous nematode (Uncinaria sp.) in the development of a marine mammal swimming behavior.

Parasites are an important part of ecosystems, playing a critical role in their equilibrium. However, the consequences of parasitism beyond the direct effects associated with disease and mortality are not completely understood. This gap in knowledge is in part due to the difficulties to isolate the effect of single parasite species on physiological and behavioral traits in natural systems.The South American fur seal (Arctocephalus australis)-hookworm (Uncinaria sp.) interaction offers an ideal system to overcome these difficulties and study the behavioral and physiological effects of parasites in their hosts.Hookworms cause stunted growth and anemia in pinniped pups, which could affect early life active behaviors such as swimming. The aim of this study was to determine the effects of hookworms (Uncinaria sp.) on the development of swimming capabilities in A. australis through physiological and ethological analyses.Higher parasite burden was associated with reduced growth rates and lower blood hemoglobin concentrations, whereas scaled body mass and blood hemoglobin levels had an important positive effect on the water activity of the pups. However, antihookworm treatment did not affect the level of water activity of the pups, and pups with high hookworm burden increased their time budget in water. This was probably related to lower maternal attendance in heavily parasitized pups, leaving these pups more time to perform water activities. Therefore, pups with heavy hookworm burden, despite having decreased growth rates and blood hemoglobin concentrations, compensated for their handicap in physiological traits related to swimming by spending more time in the water.This work offers new insights to understand the contrasting effects of parasites on aquatic organisms, and the compensatory mechanisms employed by infected animals to avoid the worst consequences of parasitism.

Prevención de osteonecrosis asociada a medicamentos y ensayo clínico multicéntrico, Facultad de Odontología, Universidad de Buenos Aires / Prevention of drug-related osteonecrosis and multicentric clinical trial, School of Dentistry, University of Buenos Aires

La osteonecrosis asociada a medicamentos (ONAM) es un efecto adverso poco frecuente pero potencialmente serio que afecta a pacientes que reciben o recibieron tratamiento con drogas antirresortivas o antiangiogénicas. A partir de una revisión narrativa de la literatura, el presente artículo aporta conceptos básicos e información actualizada acerca de incidencia, factores de riesgo y prevención de ONAM desde la perspectiva de la Práctica Basada en la Evidencia. Además pone en conocimiento a la comunidad profesional de la Facultad de Odontología de la Universidad de Buenos Aires acerca de las actividades de investigación clínica llevadas a cabo en este área en la Cátedra de Cirugía y Traumatología Buco-Máxilo-Facial I de nuestra casa de estudios (AU)

Medicine related osteonecrosis of the jaws (MRONJ) is a rare but potentially serious side effect experienced by patients receiving treatment with antiresorptive or antiangiogenic drugs. Through a narrative review of the literature, this paper provides basic concepts and updated data about incidence, risk factors and prevention of MRONJ from the Evidence Based Practice perspective. It also informs the professional community of the School of Dentistry of the University of Buenos Aires about the clinical research activities carried out in this area in the Oral and Maxillofacial Surgery I Department (AU)

Immune-mediated hookworm clearance and survival of a marine mammal decrease with warmer ocean temperatures.

Increases in ocean temperature are associated with changes in the distribution of fish stocks, and the foraging regimes and maternal attendance patterns of marine mammals. However, it is not well understood how these changes affect offspring health and survival. The maternal attendance patterns and immunity of South American fur seals were assessed in a rookery where hookworm disease is the main cause of pup mortality. Pups receiving higher levels of maternal attendance had a positive energy balance and a more reactive immune system. These pups were able to expel hookworms through a specific immune mediated mechanism and survived the infection. Maternal attendance was higher in years with low sea surface temperature, therefore, the mean hookworm burden and mortality increased with sea surface temperature over a 10-year period. We provide a mechanistic explanation regarding how changes in ocean temperature and maternal care affect infectious diseases dynamics in a marine mammal.

Respiratory Mites ( Orthohalarachne diminuata) and ß-hemolytic Streptococci-Associated Bronchopneumonia Outbreak in South American Fur Seal Pups ( Arctocephalus australis).

Although mites of the Orthohalarachne genus are common parasites of otariids, their role as agents of disease and in causing population-level mortality is unknown. In the austral summer of 2016, there was an increase in mortality among South American fur seal ( Arctocephalus australis) pups at Guafo Island, Northern Chilean Patagonia. Pups found dead or terminally ill had moderate to marked, multifocal, mucopurulent bronchopneumonia associated with large numbers of respiratory mites ( Orthohalarachne diminuata) and rare Gram-positive cocci. In lung areas less affected by bronchopneumonia, acute interstitial pneumonia with marked congestion and scant hemorrhage was evident. Bacteria from pups dying of bronchopneumonia were isolated and identified as Streptococcus marimammalium and Streptococcus canis. Respiratory mites obstructed airflow, disrupted airway epithelial lining, and likely facilitated the proliferation of pathogenic ß-hemolytic streptococci, leading to severe bronchopneumonia and death of fur seal pups. An abrupt increase in sea surface temperature in Guafo Island corresponded to the timing of the bronchopneumonia outbreak. The potential role of environmental factors in the fur seal pup mortality warrants further study.

Complete mitochondrial genome of the South American fur seal (Arctocephalus australis).

The complete mitochondrial DNA sequence of the South America fur seal (Arctocephalus australis) was obtained by a shotgun sequencing approach. The mitogenome is 16,372 bp in length and includes the genes coding for the two rRNA species (12S and 16S), 13 protein-coding genes, 22 transfer RNA genes, and a control region. The base composition is 33.0% for A, 26.7% for C, 26.1 for T and 14.2% for G, with an overall GC content of 40.9%. The description of this mitogenome will be useful for further phylogeny and genetic studies on Pinnipeds.

La importancia del tratamiento multidisciplinario en los trastornos temporomandibulares / The importance of multidisciplinay treatment intemporomandibular disorders / A importância do tratamento multidisciplinar das desordens temporomandibulares

Introducción: las disfunciones temporomandibulares constituyen un grupo heterogéneo de afecciones que involucran a la articulación temporomandibular y los músculos masticadores y del cuello. Existe consenso acerca que las disfunciones temporomandibulares son de naturaleza multifactorial en relación a factores musculares, articulares, oclusales, psicológicos e inmunológicos. Objetivo: Valorar los beneficios del tratamiento multidisciplinario en pacientes diagnosticados de disfunción temporomandibular, llevado a cabo en el Servicio de Cirugía Maxilofacial de la Unidad Asistencial Hospital César Milstein. Material y método: Estudio retrospectivo descriptivo de 206 pacientes que consultaron por algún tipo de disfunción temporomandibular desde enero de 2011 a diciembre de 2015. Se evaluaron un total de 111 pacientes (103 mujeres y 8 hombres) con una edad promedio de 65,6 (24-82), con diagnóstico de desorden interno de la articulación temporomandibular, utilizando la Clasificación de Wilkes. Los 111 pacientes recibieron tratamiento conservador como primera medida. Resultados: 89 pacientes se vieron beneficiados en cuanto a la reducción del dolor y al aumento en el rango de la apertura oral; 21 pacientes necesitaron tratamiento quirúrgico mínimamente invasivo y 1 paciente necesitó intervención quirúrgica a través de cirugía abierta. El 80% respondió al tratamiento conservador, mientras que el 20% necesitó algun tratamiento quirúrgico. La escala visual analógica de dolor inicial fue 7,6 cm (3-10) y la final 1,14 cm (0-5). La máxima apertura oral inicial fue de 34 mm (21-50) y la final de 40 mm (35-50). Conclusión: Debido a la etiologia multifactorial de las disfunciones temporomandibulares, el fracaso en el tratamiento puede deberse a la falta de abordaje interdisciplinario. La combinación de diferentes terapéuticas nos permite alcanzar resultados más favorables, en contraposición a la realización de modalidades terapéuticas únicas y aisladas.

Introduction: temporomandibular disorders are an heterogeneous group of disorders related to the temporomandibular joint and to the masticatory and neck muscles. There exists agreement regarding the nature of temporomandibular disorders, including muscular, joint, oclussal, psycological and immunological factors. Objective: To assess the benefits of the multidisciplinary treatment in patients with temporomandibular disorders, carried out at the Maxillofacial Surgery Department of the Cesar Milstein Hospital Material and method: A retrospective descriptive study of 206 patients, assessed for temporomandibular disorders between january 2011 and december 2015. A total of 111 patients with diagnosis of internal temporomandibular joint disorder were evaluated using the Wilkes Classification. 103 females and 8 males, with a mean age of 65.6 years old (24-82). All of the patients received conservative treatment as a first choice. Results: 89 patients improved pain score and increased mouth opening range. 21 patients required minimally invasive surgical treatment and 1 patient needed open surgery. 80% responded to conservative treatment, while 20% required some type of surgical treatment. The initial Visual Analog Scale for pain was 7.6 cm (3-10) and the final 1.14 cm (0-5). The Maximum Mouth Opening was 34 mm (21-50) and the final 40 mm (35-50). Conclusions: Due to multifactorial ethiology of temporomandibular disorders, failure on its treatment may be because of the lack of an interdisciplinary approach. The combination of different therapies allows to achieve better results, in comparison with unique and isolated therapeutic modalities.

Introdução: as disfunções temporomandibulares (DTM) são um grupo heterogeneo de condições que envolvem a articulação temporomandibular (ATM) e os músculos mastigatórios e do pescoço. Há consenso que as disfunções temporomandibulares são de natureza multifactorial relacionada a fatores musculares, articulares, oclusais, psicológicos e inmunologicos. Objetivo: Avaliar os benefícios do tratamento multidisciplinar em pacientes diagnosticados de disfunção temporomandibular realizados no Serviço de Cirurgia Maxilofacial da Unidade Assistencial Hospital César Milstein. Material e método: estudo retrospectivo descritivo de 206 pacientes que consultaram por algum tipo de disfunção temporomandibular desde janeiro 2011 a dezembro 2015. Um total de 111 pacientes (103 mulheres e 8 homens) com idade média de 65,6 (24- 82) foram avaliados, com diagnóstico de transtorno interno da articulação temporomandibular, utilizando a Classificação de Wilkes. Os 111 pacientes receveron tratamento conservador como primeira medida. Resultados: 89 pacientes foram beneficiados na redução do dor e aumento no rango de apertura oral. 21 pacientes necessitaram de tratamento cirúrgico minimamente invasivo e 1 paciente necessitou de intervenção cirúrgica através de cirurgia aberta. 80% responderam ao tratamento conservador, enquanto 20% exigiram algum tratamento cirúrgico. A escala visual analógica de dor (EVA) inicial foi de 7,6 cm (3-10) e a final 1,14 cm (0-5). A máxima abertura oral (MAO) inicial foi de 34 mm (21-50) e a final de 40 mm (35-50). Conclusões: Devido à etiologia multifatorial dos disfunções temporomandibulares, o fracasso no tratamento pode ser devido à falta de abordagem interdisciplinar. A combinação de diferentes terapias nos permite obter resultados mais favoráveis, em oposição à realização de modalidades terapêuticas únicas e isoladas.

Migración de caninos inferiores: reporte de un caso y reseña de la literatura / Transmigrant impacted mandibular canines: report of a case and review of the literature

Objetivo: el objetivo de este trabajo es presentar la exodoncia de un canino inferior izquierdo transpuesto y evaluar las alternativas terapéuticas frente a casos similares. Caso clínico: se desarrolla el caso de una mujer de 30 años de edad con migración del canino inferior izquierdo. Conclusión: se destaca la importancia de otener un diagnóstico clínico y radiográfico temprano para poder realizar tratamientos precoces, a fin de evitar la migración y sus posibles complicaciones. Se enfatiza también la necesidad del estudio anatomopatológico de los tejidos blandos obtenidos con la pieza quirúrgica.(AU)

Migración de caninos inferiores: reporte de un caso y reseña de la literatura / Transmigrant impacted mandibular canines: report of a case and review of the literature

Objetivo: el objetivo de este trabajo es presentar la exodoncia de un canino inferior izquierdo transpuesto y evaluar las alternativas terapéuticas frente a casos similares. Caso clínico: se desarrolla el caso de una mujer de 30 años de edad con migración del canino inferior izquierdo. Conclusión: se destaca la importancia de otener un diagnóstico clínico y radiográfico temprano para poder realizar tratamientos precoces, a fin de evitar la migración y sus posibles complicaciones. Se enfatiza también la necesidad del estudio anatomopatológico de los tejidos blandos obtenidos con la pieza quirúrgica.

Host associated polymorphisms in the Corynebacterium pseudotuberculosis rpoB gene sequence.

Corynebacterium pseudotuberculosis is a widespread facultative intracellular pathogen that causes caseous lymphadenitis disease in sheep and goats, and generates cutaneous abscesses and granulomas in horses and cattle. Although some genes have been studied for diagnostic and phylogenetic analysis within the genus Corynebacterium, at subspecies level the pathogen has been poorly analyzed. The aim of this study was to characterize C. pseudotuberculosis strains isolated from domestic animals, through the sequencing of a hypervariable rpoB gene segment. As result, there were identified host associated rpoB polymorphisms in strains infecting sheep, goats and horses from Chile. These differences suggest the existence of bacterial genotypes, in which the nucleotide similarity values were ranging from 98.8 to 99.8%. In conclusion, the analysis of polymorphisms in the partial rpoB sequence can be used as a diagnostic tool that differentiates C. pseudotuberculosis strains at subspecies level.

Improving osteoporosis diagnosis in children using image texture analysis.

Bone mineral density (BMD) is used in clinical medicine as an indirect indicator of osteoporosis and fracture risk. From a technical point of view Quantitative Computed Tomography (QCT) should be the gold standard in bone densitometry. On the other hand, it is known that a greater percentage increase in skin dose is needed as the patient size is increased: positive results and side effect of long-term steroid treatment as obesity have been found for Duchenne muscular dystrophy (DMD), characterized by a progressive muscle degeneration and substitution with fat. The present work is an effort to improve osteoporosis diagnostic efficacy in children by analyzing the trabecular bone texture in CT L3 vertebra by two methods which are independent of image intensity: fractal dimension with power spectrum and wavelet packets. As results, comparing healthy children (44 children both sexes) with osteoporotic subjects (13 adult women, aged 52-87 years) great differences were noticed in all image texture indicators (p<0.0146). For DMD children (7 boys, not overweight) classified by z-score as osteoporotic because of their low BMD, texture image analysis did not exhibited high spatial frequencies as in the osteoporotic group; the probability that these two groups were similar was weak (p<0.0059), suggesting a more similar bone condition to normal or osteopenia. None of the pediatric groups exhibited as high spatial frequencies as did the osteoporotic women group. These analyses could help to determine osteoporosis in children, where it is often a diagnostic challenge.

Diarrea, brote en menores de 5 años / Diarrheal diseases: an outbreak in children under 5 years old

Determinar el comportamiento de las enfermedades diarreicas agudas en menores de 5 años por grupos de edades, serie cronológica semanal y distribución por distritos. Identificar factores de riesgo y accionar. Se realizó una investigación-acción en la República de Nauru. Los datos se obtuvieron al realizar entrevistas a médicos, enfermeras, padres o tutores de los niños, se revisaron hojas de cargo, historias clínicas y se visitaron comunidades. Se introdujeron los datos en el programa EPI 6, se utilizaron los programas Epimap 2 para la estratificación por distritos y Excel para la confección de la serie cronológica y gráficos. Los datos se procesaron diariamente, se determinó frecuencias por grupos de edades, se calcularon tasas por 1 000 habitantes y se realizaron acciones comunitarias. En el brote se reportan 645 casos (510,7x 103 habitantes) con predominio en niños de 1 a 3 años, se incrementa significativamente en la semana estadística 18, con un pico máximo en la 21, los distritos Yaren y Anabar se afectan desde el comienzo. Las acciones médicas y comunitarias son efectivas. No se reportan fallecidos por este brote.

To determine the behavior of acute diarrheal diseases in children under 5 years old by age groups, weekly chronological series, and district distribution, as well as to identify the risk factors and the actions to be taken. A research-action plan was implemented in the Republic of Nauru. The data were collected from interviews to physicians, nurses, parents or tutors of the children. Charge sheets and clinical records were reviewed and communities were visited. The data were introduced in an EPI 6 program, and Epimap 2 programmes were used to stratify by district. Excel was utilized to design chronological series and graphics. Data were daily processed, and frequencies by age group were determined. Rates per 1 000 inhabitants were estimated, and community actions were executed. 645 cases were reported (510.7x 103 inhabitants) in the outbreak, with a predominance in children aged 1-3. A significant increase was observed in the 18th statistic week, with a maximum peak in the 21st week. Yaren and Anabar districts were affected from the beginning. Medical and community actions were effective. No deaths were reported due to this outbreak.

Diarrea, brote en menores de 5 años / Diarrheal diseases: an outbreak in children under 5 years old

Determinar el comportamiento de las enfermedades diarreicas agudas en menores de 5 años por grupos de edades, serie cronológica semanal y distribución por distritos. Identificar factores de riesgo y accionar. Se realizó una investigación-acción en la República de Nauru. Los datos se obtuvieron al realizar entrevistas a médicos, enfermeras, padres o tutores de los niños, se revisaron hojas de cargo, historias clínicas y se visitaron comunidades. Se introdujeron los datos en el programa EPI 6, se utilizaron los programas Epimap 2 para la estratificación por distritos y Excel para la confección de la serie cronológica y gráficos. Los datos se procesaron diariamente, se determinó frecuencias por grupos de edades, se calcularon tasas por 1 000 habitantes y se realizaron acciones comunitarias. En el brote se reportan 645 casos (510,7x 103 habitantes) con predominio en niños de 1 a 3 años, se incrementa significativamente en la semana estadística 18, con un pico máximo en la 21, los distritos Yaren y Anabar se afectan desde el comienzo. Las acciones médicas y comunitarias son efectivas. No se reportan fallecidos por este brote(AU)

To determine the behavior of acute diarrheal diseases in children under 5 years old by age groups, weekly chronological series, and district distribution, as well as to identify the risk factors and the actions to be taken. A research-action plan was implemented in the Republic of Nauru. The data were collected from interviews to physicians, nurses, parents or tutors of the children. Charge sheets and clinical records were reviewed and communities were visited. The data were introduced in an EPI 6 program, and Epimap 2 programmes were used to stratify by district. Excel was utilized to design chronological series and graphics. Data were daily processed, and frequencies by age group were determined. Rates per 1 000 inhabitants were estimated, and community actions were executed. 645 cases were reported (510.7x 103 inhabitants) in the outbreak, with a predominance in children aged 1-3. A significant increase was observed in the 18th statistic week, with a maximum peak in the 21st week. Yaren and Anabar districts were affected from the beginning. Medical and community actions were effective. No deaths were reported due to this outbreak(AU)

La eleccion de la medicina general integral: una problemática actual / The choice of comprehensive medicine: a current problem

Se realizó un estudio descriptivo transversal sobre las causas de rechazo a la Medicina General Integral, entre 75 estudiantes de medicina de primero, cuarto y quinto años, pertenecientes al Policlínico Comunitario Docente Ignacio Agramonte del Municipio Camagüey, durante el primer semestre del curso 1995 - 1996. Los datos obtenidos a través en una encuesta realizada al inicio y final de la estancia, que contenía las variables a estudiar como año en curso, edad, sexo, procedencia, aceptación o rechazo a la Medicina General Integral y sus causas, fueron procesados de forma automatizada. Las principales causas se relacionaron con una deficiente orientación vocacional, lo que se traduce en la no comprensión de la importancia de la promoción y la prevención, orientándose más hacia el cuidado de la enfermedad, lo que parece estar en dependencia de la influencia hospitalaria en su formación, sin tener en cuenta que la comunidad será su escenario de acción. Estas y otras causas de carácter subjetivas y organizativas, son susceptibles de modificarse(AU)