A Hansel & Gretel breadcrumb-style dynamically deployed communication network paradigm using mesh topology for planetary subsurface exploration.

We introduce a dynamically deployed communication network (DDCN) paradigm using mesh topology in support of a distributed robotic multi-agent approach for the autonomous exploration of subsurface environments, i.e., caves, lava tube caves, lakes, and oceans, etc. The DDCN, comprising wireless communication beacons autonomously deployed via a rover or submersible in a Hansel & Gretel-inspired breadcrumb style, allows for the longest and most robust communication link between subterranean robotic agent(s) within, e.g., a lave tube cave or a subsurface ocean, and associated surface-borne robotic agent(s). Moreover, we briefly touch on the development of a robotic testbed and wired/wireless communication beacons in support of such astrobiological surface/subsurface exploration scenarios. Candidate lava tube caves have been identified on the Moon and Mars, raising possibilities for planetary exploration, astrobiology, habitat construction for future astronauts, and potential mining operations. Subterranean caverns, and in particular relatively deep lava tube caves, provide a possible refuge for life under otherwise challenging planetary surface conditions, and, as such, are of prime astrobiological relevance. Lava tube caves or other subsurface environments may also be suitable habitats for astronauts and subsequent human settlement but are yet to be explored in part due to difficulties ensuring continued communication with a robotic probe inside these environments. Moreover, the existence of subsurface oceans on ocean worlds, such as Europa, Enceladus, and Titan, has been backed by varying levels of evidence since the 1980s, though there has been no confirmation, i.e., direct observation, thus far. Such environments are also shielded from radiation, and, in combination with the hypothesized presence of water, are additional candidate environments for finding extant or fossilized life. The DDCN paradigm introduced herein directly addresses NASA's Space Technology Grand Challenges - "All Access Mobility" by enabling the most unconstrained exploration of subsurface environments through a dynamic communication network which ensures transmission of data from and possibly commands to the subsurface robotic probe. 2023 COSPAR. Published by Elsevier B.V. All rights reserved.

Subgingival Microbiota and Periodontal Clinical Status in Patients with Plaque Psoriasis: A Cross-Sectional Study.

Plaque Psoriasis (PP) and periodontitis are inflammatory disorders with a bidirectional association. They both have a qualitatively similar immune-modulatory cascade, cytokine profile, and a recently described dysbiosis. Different oral bacterial species compositions in the periodontal pocket might play a role in the development of PP. To describe the subgingival microbiota of the Mexican population with PP and the periodontal conditions. Subjects were divided into two groups: periodontal health (PH) (PH-non-PP, PH-PP) and periodontitis (PD) (P-non-PP, PD-PP). Following clinical examination, the patients were classified into three groups according to the degree of psoriasis as measured by the Psoriasis Area Severity Index (PASI) and the periodontal status according to the parameters of the American Academy of Periodontology (AAP). Subgingival microbiota samples of each patient were used to determine 40 species of periodontal bacteria by checkerboard DNA-DNA hybridization. IL-2 and IL-6 were measured by ELISA. Of the forty-eight patients with PP, 21 patients had PH and 27 patients had PD. PD-PP group has a significant increase in the percentage of plaque, gingival redness, pocket probing depth, and clinical attachment loss (P<0.001) compared to PH-PP group. Microbiologically PD-PP exhibited significantly higher mean counts for A. georgiae, A. israelii, A. naeslundii from blue complex (P<0.001) than PD-non-PP. Moreover, the counts of these Actinomyces in PD-PP increased according to the severity of index PASI. The concentration of IL-2 and IL-6 were increased in saliva from PH-PP and PD-PP patients compared to PH non-PP. PP individuals harbored a particular sub-gingival microbiota profile different from non-PP. The severity of psoriasis was related to dysbiosis of microbiota -PASI > 5 related to periodontitis with the predominance of Actinomyces periodontal, irrespective of their periodontal condition. Finally, the severity of psoriasis could be unbalanced in subgingival microbiota and increase the risk to develop periodontitis.

First Ecuadorian statement consensus for the evaluation and treatment of osteoporosis.

Osteoporosis management has become more relevant as the life expectancy increases. In Ecuador, approximately 19% of adults over 65 years of age have been diagnosed with osteoporosis. There is no national consensus for the management and prevention of the disease being this proposal the first Ecuadorian consensus. INTRODUCTION: In Ecuador, it is estimated that around 19% of adults over 65 years of age have osteoporosis. Due to the increase in life expectancy in the world population, the evaluation and management of osteoporosis has become more relevant. Currently, there is no national consensus for the management and prevention of the disease. The Ecuadorian Society of Rheumatology presented the project for the elaboration of the first Ecuadorian consensus for the management and prevention of osteoporosis. METHODS: A panel of experts in multiple areas and extensive experience was invited to participate. The consensus was carried out using the Delphi method. Six working dimensions were created: definition and epidemiology of osteoporosis, fracture risk prediction tools, non-pharmacological treatment, pharmacological treatment, calcium and vitamin D, and glucocorticoid-induced osteoporosis. RESULTS: The first round was held in December 2021, followed by the second round in February 2022 and the third round in March 2022. The data was shared with the specialists at the end of each round. After three rounds of work, a consensus was reached for the management and prevention of osteoporosis. CONCLUSION: This is the first Ecuadorian consensus for the management and treatment of postmenopausal osteoporosis.

Defects of Nutrient Signaling and Autophagy in Neurodegeneration.

Neurons are post-mitotic cells that allocate huge amounts of energy to the synthesis of new organelles and molecules, neurotransmission and to the maintenance of redox homeostasis. In neurons, autophagy is not only crucial to ensure organelle renewal but it is also essential to balance nutritional needs through the mobilization of internal energy stores. A delicate crosstalk between the pathways that sense nutritional status of the cell and the autophagic processes to recycle organelles and macronutrients is fundamental to guarantee the proper functioning of the neuron in times of energy scarcity. This review provides a detailed overview of the pathways and processes involved in the balance of cellular energy mediated by autophagy, which when defective, precipitate the neurodegenerative cascade of Parkinson's disease, frontotemporal dementia, amyotrophic lateral sclerosis or Alzheimer's disease.

Feasibility Trial to Evaluate Tendon Stiffness Obtained from Shear Wave Elastography Imaging as a Biomarker of Aromatase Inhibitor-Induced Arthralgias.

Aromatase inhibitor-induced arthralgia (AIA) comprises significant, activity-limiting musculoskeletal symptoms, including joint pain, myalgia, and joint stiffness. We conducted a prospective feasibility study in postmenopausal women diagnosed with early-stage (0-3) hormone receptor positive (HR+) breast cancer who were candidates for treatment with adjuvant AI therapy (n = 16). Tendons of the hands and wrists and the median nerve were imaged using gray-scale and power Doppler ultrasound (US) and US SWE. Arthralgia symptoms were evaluated using the Breast Cancer Prevention Trial (BCPT) Symptom Checklist musculoskeletal subscale (MS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and stiffness subscales. At baseline, there were significant differences in the SW velocities of tendons between dominant and nondominant hands. Increased velocity in 2 of 6 tendons and the median nerve was associated with greater pain at baseline, whereas slower velocity of the extensor digitorum tendon (suggesting decreased stiffness) was associated with a higher WOMAC stiffness score. Increased SW velocity (suggestive of increased stiffness) at baseline in the abductor pollicis longus tendon was associated with a worsening of all three pain and stiffness measures by 6 months. Future studies should evaluate SWE scores related to AIA outcomes in a larger sample size.

VISTATM: Visual Impairment Subtle Touch AidTM - a range detection and feedback system for sightless navigation.

We devised a low-tech, low-cost, robust, and minimally obtrusive navigational travelling aid to be paired with and bolster standard white cane use for people with visual impairments. The device combines ultrasonic range detection with proportional vibrational output. The navigational aid was devised using a sensing belt equipped with independent ultrasonic sensors for distance measurements. Sensors were mounted using adjustable mobile clips to allow for user variability. The sensing belt was connected to a stimulation belt affixed to the ribcage. The stimulation belt used vibrating motors with vibration proportional to the distance between the belt wearer and surrounding obstacles sensed by corresponding ultrasonic sensors. The device was validated through preliminary testing on blindfolded, but fully sighted, persons and one blind person (all authors) in navigating a novel environment without supplemental aid. Testing sessions varied from 45 to 90 min. In preliminary tests, the devised ultrasonic-sensor-belt and vibration-actuator-equipped belt combination was capable of informing users of surrounding obstacles in real-time while navigating a hallway with several turns.

Ultrasound shear wave elastography of the anterior talofibular and calcaneofibular ligaments in healthy subjects.

AIM OF STUDY: Most sprained lateral ankle ligaments heal uneventfully, but in some cases the ligament's elastic function is not restored, leading to chronic ankle instability. Ultrasound shear wave elastography can be used to quantify the elasticity of musculoskeletal soft tissues; it may serve as a test of ankle ligament function during healing to potentially help differentiate normal from ineffective healing. The purpose of this study was to determine baseline shear wave velocity values for the lateral ankle ligaments in healthy male subjects, and to assess inter-observer reliability. MATERIAL AND METHODS: Forty-six ankles in 23 healthy male subjects aged 20-40 years underwent shear wave elastography of the lateral ankle ligaments performed by two musculoskeletal radiologists. Each ligament was evaluated three times with the ankle relaxed by both examiners, and under stress by a single examiner. Mean shear wave velocity values were compared for each ligament by each examiner. Inter-observer agreement was evaluated. RESULTS: The mean shear wave velocity at rest for the anterior talofibular ligament was 2.09 ± 0.3 (range 1.41-3.17); and for the calcaneofibular ligament 1.99 ± 0.36 (range 1.29-2.88). Good inter-observer agreement was found for the anterior talofibular ligament and calcaneofibular ligament shear wave velocity measurements with the ankle in resting position. There was a significant difference in mean shear wave velocities between rest and stressed conditions for both anterior talofibular ligament (2.09 m/s vs 3.21 m/s; p <0.001) and calcaneofibular ligament (1.99 m/s vs 3.42 m/s; p <0.0001). CONCLUSION: Shear wave elastography shows promise as a reproducible method to quantify ankle ligament stiffness. This study reveals that shear waves velocities of the normal lateral ankle ligaments increased with applied stress compared to the resting state.

Shear wave elastography detects novel imaging biomarkers of aromatase inhibitor-induced joint pain: a pilot study.

AIM: To determine whether differences in joint and tendon stiffness as measured by ultrasound shear wave elastography are present in breast cancer patients with aromatase inhibitor-associated arthralgias compared to age-comparable healthy control women. METHODS: Postmenopausal women with stage I-III breast cancer who were taking adjuvant aromatase inhibitors and complained of joint pain were enrolled (n = 6). Postmenopausal women with no history of breast cancer, hormone treatment, or joint pain served as controls (n = 7). All subjects had bilateral hands and wrists evaluated by gray-scale and power Doppler ultrasound, and shear wave elastography ultrasound. RESULTS: Patients with AI-associated arthralgias had significantly stiffer tendons than controls in the 1st extensor compartment (long axis; p = 0.001), 4th extensor compartment (long axis; p = 0.014), 3rd metacarpophalangeal joint (p = 0.002), the pooled values of the extensor compartments, both long (p = 0.044) and short axes (p = 0.035), and the pooled values for the metacarpophalangeal joints (p = 0.002). On ultrasound, the patients (but not controls) presented with hyperemia and increased tenosynovial fluid in the flexor and extensor tendon sheaths, and the median nerves were symptomatic and bifid; however, these differences were not statistically significant. CONCLUSIONS: This is the first study to identify increased tendon stiffness as a putative physiological characteristic of aromatase inhibitor-associated arthralgias. Future studies should determine whether increased tendon stiffness is a risk factor for the development of aromatase inhibitor-associated arthralgias, or a result of aromatase inhibitor treatment.

Antidiabéticos orales y su interacción con medicamentos modificadores de enfermedad

RESUMEN Los antidiabéticos orales (ADO) en pacientes con diabetes mellitus 2 y con comorbilidades reumatológicas no han demostrado interacción relevante con fármacos modificadores de la enfermedad (DMARDs), se debe recordar que la toma de varios medicamentos eleva el riesgo de interacciones o efectos adversos sobre todo si estos tienen un metabolismo en el mismo órgano. El objetivo es dar a conocer que interacciones existen entre los ADO y los DMARDs, mediante la búsqueda de artículos de revisión, guías farmacológicas y estudios. El resultado más sobresaliente fue el hallazgo de un estudio que abarca el uso de un DPP-4 (inhibidor de la dipeptidil peptidasa-4) especificamente sitagliptina como efecto protector frente a la toxicidad producida por el metotrexato. En pacientes con enfermedades reumatológicas y que padecen de diabetes mellitus 2, el uso de la hidroxicloroquina se ha comprobado que logra disminuir los niveles de lípidos, pero no específicamente como interacción medicamentosa con algún ADO, es una propiedad innata de la hidroxicloroquina. Se encontró evidencia de que existe correlación de hipoglicemia en pacientes que toman fármacos secretagogos y sulfazalacina.

ABSTRACT Oral antidiabetics drugs (OADs) in patients with diabetes mellitus 2 and with rheumatic comorbidities have not demonstrated relevant interaction with disease-modifying drugs (DMARDs). It should be remembered that taking several medications increases the risk of interactions or adverse effects especially if these have their metabolism in the same organ. The objective is to make known what interactions exist between OADs and DMARDs, by searching for review articles, pharmacological guides and studies. The most outstanding result was the finding of a study that covers the use of a DPP-4 (dipeptidyl peptidase-4 inhibitor), specifically sitagliptin as a protective effect against the toxicity produced by methotrexate. In patients with rheumatic diseases who also suffer from diabetes mellitus 2, the use of hydroxychloroquine has been shown to reduce lipid levels, but not specifically as a drug interaction with any OADs, it is an innate property of hydroxychloroquine. Evidence was found that there is a correlation of hypoglycemia in patients taking secretagogue drugs and sulfasalazine.

Conceptual design considerations for a wireless intraocular pressure sensor system for effective glaucoma management.

As a leading form of preventable visual impairment, it is imperative to assess glaucoma treatment as a function of intraocular pressure (IOP). IOP can spike throughout the day. This necessitates a device that can (1) monitor IOP outside of clinical visits by providing a memory when IOP exceeds a set threshold indicating the possibility for glaucomatous damage to occur; and (2) accurately assess IOP. Both requirements point ultimately towards the development of an implantable device. The Wireless Intraocular Pressure Sensor System (WIPSS) devised by our team uses optical technologies and may assist an overseeing clinician with assessing glaucoma treatment efficacy and avoiding irreversible glaucomatous visual field loss downstream.

Frontiers of cancer imaging and guided therapy using ultrasound, light, and microwaves.

This review describes emerging techniques within the last 5 years that employ ultrasound for detecting and staging malignancy, tracking metastasis, and guiding treatment. Ultrasound elastography quantifies soft tissue elastic properties that change as a tumor grows and proliferates. Hybrid imaging modalities that combine ultrasound with light or microwave energy provide novel contrast for mapping blood oxygen saturation, transport of particles through lymphatic vessels and nodes, and real-time feedback for guiding needle biopsies. Combining these methods with smart nanoparticles and contrast agents further promotes new paradigms for cancer imaging and therapy.

[Stethoscope or staphyloscope?: Potential vector in nosocomial infections]. / ¿Estetoscopio o estafiloscopio?: Potencial vector en las infecciones asociadas a la atención de la salud.

Healthcare-associated infections (HCAI) are a problem worldwide. In our country, the estimated incidence of HCAI is 70,000 per year. This results in an increase in the average length of hospital stay by 10 days per patient, an estimated annual cost of US $ 70 million and an overstay of 700 thousand bed days a year. For over 30 years stethoscopes have been considered as potential HCAI vectors, since pathogens like methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus strains adhere and colonize them. These organisms can be transmitted between patients if the instruments are not sanitized. Several studies conclude that disinfecting the stethoscope with isopropyl alcohol eliminates up to 99% of bacteria. Simple, economic measures such as implementation of guidelines for stethoscope disinfection are a clear opportunity for preventing infections.

¿Estetoscopio o estafiloscopio?: Potencial vector en las infecciones asociadas a la atención de la salud / Stethoscope or staphyloscope?: Potential vector in nosocomial infections

Healthcare-associated infections (HCAI) are a problem worldwide. In our country, the estimated incidence of HCAI is 70,000 per year. This results in an increase in the average length of hospital stay by 10 days per patient, an estimated annual cost of US $ 70 million and an overstay of 700 thousand bed days a year. For over 30 years stethoscopes have been considered as potential HCAI vectors, since pathogens like methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus strains adhere and colonize them. These organisms can be transmitted between patients if the instruments are not sanitized. Several studies conclude that disinfecting the stethoscope with isopropyl alcohol eliminates up to 99% of bacteria. Simple, economic measures such as implementation of guidelines for stethoscope disinfection are a clear opportunity for preventing infections.

Las infecciones asociadas a la atención de la salud (IAAS) son un problema a mundial. Sólo en nuestro país se estima una incidencia de 70.000 al año, lo que se traduce en un aumento de la estadía hospitalaria en 10 días promedio por paciente, un costo anual estimado en 70 millones de dólares y una sobre-estadía de 700 mil días cama al año. La evidencia señala que diferentes instrumentos de uso hospitalario resultan contaminados por patógenos; entre ellos, el estetoscopio se ha identificado como potencial vector de IAAS hace más de 30 años y adquiere gran relevancia al ser de uso generalizado. Microorganismos patógenos, incluyendo cepas de Staphylococcus aureus resistente a meticilina y cepas de Enterococcus resistente a vancomicina se adhieren y contaminan los estetoscopios, pudiendo transmitirse a otros pacientes si no son desinfectados. Diversos estudios concluyen que la desinfección del estetoscopio con alcohol isopropílico elimina hasta 99% de estas y otras bacterias, por lo que existe una clara oportunidad para aportar a la prevención de las IAAS, interviniendo a través de la implementación de medidas sencillas, económicas y operativas al corto plazo, normando por ejemplo la limpieza del estetoscopio.

Vaginosis bacteriana por Gardnerella vaginalis: Nuevas enseñanzas desde la ecología molecular / Bacterial vaginosis by Gardnerella vaginalis: New lessons from molecular ecology

La vaginosis bacteriana (VB), es la afección vaginal más frecuente en las mujeres en edad reproductiva generada por un desbalance en el ecosistema vaginal que ocasiona complicaciones severas para la salud reproductiva. Existen hipótesis de origen biológico que relacionan la presencia de organismos como Gardnerella vaginalis, Prevotella sp, Atopobium vaginae como la causa más frecuente relacionada con la vaginosis, los cuales logran desplazar poblacionalmente microorganismos con capacidad protectora del epitelio vaginal como Lactobacillus crispatus y Lactobacillus jensenii. En la actualidad y de acuerdo a la OMS, la vaginosis bacteriana estaría implicada en alteraciones durante el embarazo como parto pre termino, bajo peso al nacer, corioamnionitis, ruptura prematura de membranas (RPM), endometritis post parto, entre otras. En los últimos años, con base estudios apoyados en datos de patrones moleculares, así como tecnología de análisis de genomas, surge una visión mucho más completa de condiciones ecológicas y agentes participantes en la vaginosis bacteriana.

Bacterial vaginosis (BV) is the most common vaginal condition in women of reproductive age generated due to an imbalance in the vaginal ecosystem that causes severe reproductive health complications. There are biological origin hypothesis linking the presence of organisms such as Gardnerella vaginalis, Prevotella sp, Atopobium vaginae as the most common cause related vaginosis, which manage to replace the microorganisms population wich protective abilities within the vaginal epithelium as Lactobacillus crispatus and Lactobacillus jensenii. At present, and according to WHO, bacterial vaginosis would be involved in disturbances during pregnancy and preterm delivery, low birth weight, chorioamnionitis, premature rupture of membranes (PROM), postpartum endometritis, among others. In recent years, based on data from molecular studies based on molecular patterns and genome analysis technology, a much more broaden picture of environmental conditions and agents involved in bacterial vaginosis has arise.

Epidemiología de bacterias nosocomiales resistentes a los antimicrobianos: [revisión] / Epidemiology of nosocomial bacteria resistant to antimicrobials: [review]

Nosocomial infections are a major challenge for public health because of the high rates of morbidity and mortality generated. It was considered that the excessive or inappropriate use of antibiotics triggers the emergence of resistant strains. Among the clinically important bacteria that most commonly cause nososcomial infections, Gram positive multiresistant pathogens stand out such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus spp (VRE), and the Gram negative strains of Klebsiella pneumoniae, Escherichia coli, Pseudomonas spp. and Acinetobacter baumannii producing expanded spectrum b-lactamases (ESbL). This review describes the behavior of the main bacterial pathogens resistant to antibiotics that cause infections in Europe, United States, and Latin America, emphasizing studies of molecular epidemiology on a global scale, including the major epidemiological studies in Colombia. The genetic structure of S. aureus and Enterococcus spp strains shows a clonal characteristic favored by the predominance of a small number of clones with the capacity to spread globally, due probably to cross-infection. However, the introduction of MRSA strains from the community encourages genetic diversity, tending to establish a genetic polyclonal endemic structure in places like the United States. In Gram negative bacteria, the high genetic diversity among isolates, mainly in Latin American countries, indicates that the polyclonal spread is influenced by horizontal transfer of plasmids, by excessive exposure to antibiotics, and prolonged hospital stays. In Colombia, there is information on nosocomial resistant pathogens, but molecular epidemiological information is still scarce.

Las infecciones nosocomiales constituyen un gran desafío para la salud pública por las altas tasas de morbilidad y mortalidad que generan. Se ha considerado que el uso inapropiado o excesivo de antibióticos desencadena la aparición de cepas resistentes. Entre las bacterias de importancia clínica que con mayor frecuencia causan infecciones nososcomiales, se destacan los patógenos Gram positivos multiresistentes como Staphylococcus aureus con resistencia a meticilina (SARM) y Enterococcus spp. resistentes a vancomicina (ERV). En los Gram negativos, hay resistencia sobre todo con las cepas de Klebsiella pneumoniae, Escherichia coli, Pseudomonas spp. y Acinetobacter baumannii productoras de b-lactamasas de espectro extendido (BLEEs, en inglés: ESbL expanded spectrum b-lactamases). Esta revisión tiene como finalidad realizar una decripción del estado de la resistencia bacteriana a los antibióticos en los principales patógenos que causan infecciones nosocomiales en países de Europa, Estados Unidos y de Latinoamérica, destacando los estudios de epidemiología molecular a escala global e incluyendo los principales estudios epidemiológicos realizados en Colombia. La estructura genética de las cepas de Staphylococus aureus y Enterococcus spp. evidencia una característica clonal favorecida por el predominio de un número pequeño de clones con capacidad de diseminarse en forma global, debida probablemente a infecciones cruzadas. Sin embargo, la introducción de cepas SARM desde la comunidad está favoreciendo la diversidad genética, tendiendo a establecerse una estructura genética policlonal en lugares endémicos como los Estados Unidos. En Colombia se dispone de información sobre los patógenos nosocomiales resistentes, pero la información epidemiológica molecular aún es escasa.

Relación entre virulencia y resistencia antimicrobiana en Acinetobacter baumannii: [revisión] / Relationship between virulence and antimicrobial resistance in Acinetobacter baumannii: [review]

Acinetobacter baumanni causa frecuentemente infecciones intrahospitalarias y actualmente se ha relacionado con el desarrollo de infecciones severas adquiridas en la comunidad. La capacidad de colonizar diversos hábitats y la versatilidad en su metabolismo ha influido en el incremento del número de infecciones nosocomiales, siendo responsable del desarrollo de enfermedades como: sepsis, neumonías y meningitis. Estas infecciones aparecen en forma de brotes, dominados por clones epidémicos con multirresistencia a los antibióticos que causan altas tasas de morbilidad y mortalidad. Las Unidades de Cuidados Intensivos son las más afectadas por el uso masivo de antibióticos que ocasiona la aparición de cepas multirresistentes. Es importante estudiar los mecanismos de patogénesis y la resistencia a los antibióticos, como factores directos que determinan el problema de salud. Por otra parte, las islas de patogenecidad que corresponde a material genético exógeno que ha sido integrado al genoma de la bacteria, explicaría en gran medida el carácter patogénico de la bacteria. Estas transportan genes que confieren multirresistencia a los antibióticos y son responsables directos de llevar genes involucrados en mecanismos patogénicos como son: el sistema de captación de hierro, el sistema para la formación de biopelículas en superficies abióticas, el mecanismo de formación de la proteína de membrana externa 38 y los sistemas de secreción de proteínas tipo IV, que han sido demostrados como responsables directos de la patogénesis de diversos patógenos. En este artículo se revisa la situación actual de la incidencia de las infecciones nosocomiales causadas por A. baumannii multirresistente a los antibióticos, los principales mecanismos de resistencia a fármacos y la asociación de ésta con los mecanismos de patogenicidad. El conocimiento de los elementos involucrados en la patogénesis de A. baumannii permitirá establecer los mecanismos que lleven a controlar su diseminación.

La resistencia de bacterias a antibióticos, antisépticos y desinfectantes una manifestación de los mecanismos de supervivencia y adaptación / Resistance to bacterial antibiotics, antiseptics and disinfectants a manifestation of the survival and adaptation mechanisms

La resistencia a múltiples sustancias es un problema de salud pública que se viene observando a nivel mundial después de la aparición de los antibióticos. El uso indiscriminado de los antibióticos y la presión selectiva ambiental realizada por antisépticos y desinfectantes ha generado una respuesta de supervivencia en los microorganismos, que los capacita para evadir con eficiencia la acción bactericida de algunos agentes. En la actualidad se intenta dilucidar si hay mecanismos compartidos entre antibióticos, antisépticos y desinfectantes que les permita a las bacterias y otros microorganismos activar genes que potencialmente expresen los cinco mecanismos propuestos hasta ahora como respuesta evolutiva a la intervención humana. La presente revisión examina el estado del arte de los mecanismos mencionados,con énfasis en los que actualmente utilizan las bacterias que causan brotes de resistencia en centros hospitalarios.

Resistance to multiple substances is a problem of public health coming to world-wide level observation since the appearance of antibiotics. Indiscriminate use of antibiotics and the environmental selective pressure made by antiseptics and disinfectants have generated a survival answer in the microorganisms, enabling them to efficiently evade the bactericidal action of some agents. Nowadays the time has come to try to explain if mechanisms shared among antibiotics, antiseptics and disinfectants allow bacteria and other germs to activate genes that potentially express the five mechanisms proposed until now as an evolutionary answer to man’s intervention. The present review examines the state-of-the-art of the mentioned mechanisms, with emphasis about the resistance mechanisms performed by nosocomial bacteria in hospitals centers.

Obesity and the risk of spontaneous abortion after oocyte donation.

OBJECTIVE: To determine whether obesity increases the risk of spontaneous abortion. DESIGN: Retrospective study. SETTING: Oocyte donation program at the Instituto Valenciano de Infertilidad in Spain. PATIENT(S): Seven hundred twelve cycles of recipients of ovum donation with known body mass index (BMI), good-quality embryo transfer, and absence of uterine pathology or clinical history of antiphospholipid antibodies or recurrent abortion. INTERVENTION(S): Recipients were divided in four BMI (kg/m(2)) groups: lean, with BMI <20 (n = 92; 12.9%); normal, with BMI = 20-24.9 (n = 398; 55.9%); overweight, with BMI = 25-29.9 (n = 172; 24.2%); and obese, with BMI >/=30 (n = 50; 7%). Clinical parameters were compared among the groups. MAIN OUTCOME MEASURE(S): Spontaneous abortion rates according to BMI. RESULT(S): No difference was found among the four BMI groups in any of the parameters of the cycle analyzed. The overall abortion rate was 15.8% (57 of 360). There were significant differences in abortion rates between the obese (38.1%), and the normal (13.3%) and overweight (15.5%) groups. When several cutoff BMI values were established (20, 25, and 30), only the obese women demonstrated a greater risk of abortion. Compared with the normal population, the obese group showed a significant fourfold increase in the risk of spontaneous abortion. CONCLUSION(S): Our findings confirm that obesity (BMI >/=30) is an independent risk factor for spontaneous abortion. Therefore, it would be advisable for obese patients to reduce weight before becoming pregnant.