RESUMEN

INTRODUCTION: Diagnosis and management of congenital and traumatic articular ailments carry an additional problem in young people. Arthroscopy has improved treatment of these injuries, which are more frequent. OBJECTIVE: To describe the experience of arthroscopic handling in pediatric patients affected with knee disease, managed at a third level hospital in Puebla, Mexico. MATERIAL AND METHODS: Descriptive, retrospective, cross sectional study performed in patients having knee disease, admitted at Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia Puebla, from March first, 2015 to February 28th, 2018. Lysholm and IKDC functional scales and Tegner functional satisfaction scale were applied at zero, six and twelve months. Student's t and Wilcoxon tests were used. RESULTS: 29 young ones of five to 17 years of age became recruited, slightly more women (62.06%). The most frequently affected limb was the left one, with 55.17%. The disorders found are: discoid meniscus, harm of the anterior cruciate ligament, idiopathic inflammatory synovitis, tumor, meniscal injury, chondral damage, patellar hyperlaxity. Lysholm and IKDC registered improvement from the first semester. Tegner registered their ability to go back to previous daily occupations. On the Lysholm scale, there was improvement at six months. On the Tegner scale there was complete incorporation to their activities (previous to the presentation and surgical intervention). At six months subsequent to treatment, the IKDC evidenced improvement and recovery, and reintegration to their activities. Statistically significant differences (p 0.01) resulted, in measurements at zero, six and 12 months. CONCLUSIONS: Congenital and traumatic illnesses were found, the latter ones sports related. Arthroscopic approach registered positive functional results in these children.

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INTRODUCCIÓN: El diagnóstico y manejo de numerosos trastornos articulares congénitos y traumáticos revisten un problema adicional en la población joven. La artroscopía ha mejorado el tratamiento de estas lesiones cada vez más frecuentes. OBJETIVO: Describir la experiencia de la aproximación artroscópica en enfermos pediátricos quienes presentan patología de rodilla, admitidos en un tercer nivel de atención en Puebla, México. MATERIAL Y MÉTODOS: Estudio descriptivo, retrospectivo, transversal, realizado en pacientes niños con problemas de rodilla, atendidos por artroscopía, del primero de Marzo 2015 al 28 de Febrero 2018. Se les aplicaron las escalas funcionales de Lysholm e IKDC y de satisfacción funcional de Tegner al momento de la lesión, a los seis y a los doce meses. Se utilizó t de Student y Wilcoxon. RESULTADOS: Se reclutaron 29 jóvenes de cinco a 17 años de edad con mayor porcentaje de mujeres (62.06 %). El miembro más afectado fue el izquierdo con 55.17%. Las patologías fueron: menisco discoide, traumatismo de ligamento cruzado anterior, sinovitis inflamatoria idiopática, tumoración, lesión meniscal, daño condral, hiperlaxitud rotuliana. En dichas escalas Lysholm e IKDC se halló mejoría desde el primer semestre. En la escala Tegner hubo incorporación completa a sus actividades previas al padecimiento. Se encontraron diferencias estadísticamente significativas (p 0.01) en las comparaciones de sus funciones a los cero, seis y doce meses de evolución. CONCLUSIONES: Se encontraron daños de frecuencia congénita y traumática, éstas relacionadas al deporte; a través del tratamiento artroscópico hubo resultados funcionales favorables en esa población pediátrica.

Asunto(s)

Artroscopía , Hospitales , Adolescente , Niño , Estudios Transversales , Femenino , Humanos , México , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

In Argentina, NDM metallo-ß-lactamase was first reported in 2013. By now, it has disseminated throughout the country in diverse Gram negative bacteria. Here, we report the case of a paediatric patient that underwent a 1-year hospitalisation due to erythrodermic psoriasis in 2014 and received multiple antimicrobial treatments. During his stay, five isolates were obtained from rectal swabs (rs) or blood culture (bc) suspicious of carbapenemase production: a K. quasipneumoniae subsp. quasipneumoniae (rs), Citrobacter freundii (rs), Escherichia coli (bc), Enterobacter cloacae (rs), and a Serratia marcescens (bc). The isolates were studied with broth microdilution, biparental conjugation and plasmid and whole genome sequencing (Illumina). All isolates harboured an 138,998-bp type 1 IncC plasmid that carried blaNDM-1, bleMBL, blaCMY-6, rmtC, aac(6')-Ib, and sul1 resistance genes. Additionally, the blaNDM-plasmids contained ISKpn8 an insertion sequence previously described as associated only to blaKPC. One isolate, a colistin-resistant E. coli, also carried a mcr-1-containing an IncI2 plasmid, which did not harbour additional resistance. The whole genome of K. quasipneumoniae subsp. quasipneumoniae isolate was fully sequenced. This isolate harboured, additionally to blaNDM, three plasmid-mediated quinolone resistance genes: qnrB4, qnrB52 and aac(6')-Ib-cr1. The E. cloacae isolate also harboured qnrA1. These findings alert to the underestimated horizontal dissemination of multidrug-resistant plasmids limiting treatment options with last resort antimicrobials.

Asunto(s)

Enterobacteriaceae/genética , Enterobacteriaceae/aislamiento & purificación , Plásmidos/genética , Antibacterianos/farmacología , Niño , Preescolar , Farmacorresistencia Bacteriana/genética , Enterobacteriaceae/clasificación , Enterobacteriaceae/efectos de los fármacos , Escherichia coli/genética , Transferencia de Gen Horizontal , Hospitales , Humanos , Filogenia , Psoriasis/microbiología

RESUMEN

The worldwide dissemination of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae ST258 demands a rapid PCR-based typing method to detect unique genes of the ST258 clone. This study evaluates a PCR developed by Adler et al. (2014) for the detection of ST258 in K. pneumoniae clinical isolates centered on the identification of the pilv-I and prp genes. We tested 143 clinical isolates from Argentina (n=109), Chile (n=1), Colombia (n=1), Costa Rica (n=2), Ecuador (n=5), El Salvador (n=2), Nicaragua (n=5), Panamá (n=2), Paraguay (n=2), Perú (n=3) and Trinidad and Tobago (n=11) recovered from 2006 to 2015. blaKPC, pilv-l and prp genes were detected by PCR and sequenced by standard procedures. ST258 and non-ST258 were defined by PFGE and/or MLST. Isolates were grouped according to PFGE patterns: 58 were compatible with ST258 (group 1) and 85 with non-ST258 (group 2). MLST study was done on an arbitrary selection of isolates. The pilv-l gene was present only in ST258 isolates, regardless of the presence of the blaKPC gene. Results for the prp gene were variable. Its presence did not define ST258. The pilv-I PCR had a sensitivity and specificity of 100%, respectively, for the detection of ST258 in the isolates under investigation. Given our findings, the pilv-I PCR could replace more time and resource consuming methods, allowing for more rapid detection of the circulating high risk K. pneumoniae clone ST258 in Latin American (LA) countries.

Asunto(s)

Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/genética , Reacción en Cadena de la Polimerasa/métodos , Proteínas Bacterianas/genética , Humanos , Infecciones por Klebsiella/epidemiología , Klebsiella pneumoniae/clasificación , Klebsiella pneumoniae/aislamiento & purificación , América del Sur/epidemiología , beta-Lactamasas/genética

RESUMEN

South American camelids have several biological, morphological and behavioural adaptations that allow them to live in geographical areas dominated by high altitudes. The liver has hematopoietic functions during the prenatal life, which could be modified in response to the unfavorable habitat. However, there are no previous data on the prenatal development of the liver in these species. In the present work, a study on the macroscopic and microscopic morphology of the liver of the alpaca during ontogeny was performed. Forty-one animals ranging in age from 20 days of embryonic development to adults were studied. Macroscopic and microscopic observations were performed on samples subjected to different techniques. Less than 7-g specimens were studied with stereoscopic magnifying glass. The general characteristics of the prenatal liver are similar to those of other mammals, and the structures related to hematopoietic function follow an ontogenic pattern similar to that of previously studied precocial species. However, there are differences in morphology when compared to descriptions for the Old World camelids, including the absence of relation between the caudate lobe and the right kidney and the lack of interlobular connective tissue.

Asunto(s)

Camélidos del Nuevo Mundo/embriología , Hígado/anatomía & histología , Hígado/embriología , Microscopía/veterinaria , Animales , Camélidos del Nuevo Mundo/anatomía & histología , Embrión de Mamíferos/anatomía & histología , Riñón/anatomía & histología

RESUMEN

This study investigated the molecular characteristics of six blaKPC-positive Enterobacteriaceae recovered from three patients in Argentina. Antimicrobial susceptibility testing was performed following Clinical and Laboratory Standards Institute (CLSI) 2014 recommendations. Molecular characterisation of the isolates was performed by biparental conjugation, PCR, sequencing, S1 nuclease restriction, and Southern blot hybridisation with a blaKPC probe using standard protocols and conditions. The isolates studied were as follows. Case 1: Escherichia coli (ECO-P1) and Klebsiella pneumoniae (KPN-P1) isolated from a rectal swab harboured blaKPC-2 in transposon Tn4401a on non-typeable and non-conjugative plasmids. Case 2: Enterobacter cloacae (ECL-P2) and K. pneumoniae (KPN-P2) were isolated from two blood cultures. blaKPC-2 was found in a novel genetic variant of ISKpn8-blaKPC-2-ISKpn6-like on conjugative plasmids of IncL/M type. Case 3, Citrobacter freundii (CFR-P3) and Klebsiella oxytoca (KOX-P3) were isolated from skin and skin-structure infection. The blaKPC gene was detected on ISKpn8-ΔblaTEM-blaKPC-2-ISKpn6-like located on an IncA/C conjugative plasmid. CFR-P3 and KOX-P3 harboured blaPER-2 in addition to the blaKPC gene. In conclusion, we document the horizontal dissemination of blaKPC-2 from diverse Enterobacteriaceae clinical isolates with different genetic backgrounds. This is the first report of E. coli harbouring blaKPC associated with Tn4401a in Argentina.

RESUMEN

Typical haemolytic uraemic syndrome (HUS) is caused by Shiga toxin (Stx)-producing Escherichia coli infections and is characterized by thrombotic microangiopathy that leads to haemolytic anaemia, thrombocytopenia and acute renal failure. Renal or neurological sequelae are consequences of irreversible tissue damage during the acute phase. Stx toxicity and the acute inflammatory response raised by the host determine the development of HUS. At present there is no specific therapy to control Stx damage. The pathogenic role of reactive oxygen species (ROS) on endothelial injury has been largely documented. In this study, we investigated the in-vivo effects of Stx on the oxidative balance and its contribution to the development of HUS in mice. In addition, we analysed the effect of anti-oxidant agents as therapeutic tools to counteract Stx toxicity. We demonstrated that Stx induced an oxidative imbalance, evidenced by renal glutathione depletion and increased lipid membrane peroxidation. The increased ROS production by neutrophils may be one of the major sources of oxidative stress during Stx intoxication. All these parameters were ameliorated by anti-oxidants reducing platelet activation, renal damage and increasing survival. To conclude, Stx generates a pro-oxidative state that contributes to kidney failure, and exogenous anti-oxidants could be beneficial to counteract this pathogenic pathway.

Asunto(s)

Síndrome Hemolítico-Urémico/etiología , Estrés Oxidativo , Toxina Shiga II/metabolismo , Acetilcisteína/farmacología , Animales , Cisteína/análogos & derivados , Cisteína/farmacología , Modelos Animales de Enfermedad , Glutatión/metabolismo , Peroxidación de Lípido , Masculino , Malondialdehído/metabolismo , Ratones , Oxidación-Reducción/efectos de los fármacos , Especies Reactivas de Oxígeno/metabolismo , Escherichia coli Shiga-Toxigénica/metabolismo

RESUMEN

The present work describes the abrupt emergence of Klebsiella pneumoniae carbapenemase (KPC) and characterizes the first 79 KPC-producing enterobacteria from Argentina (isolated from 2006 to 2010). The emergence of bla(KPC-2) was characterized by two patterns of dispersion: the first was the sporadic occurrence in diverse enterobacteria from distant geographical regions, harbouring plasmids of different incompatibility groups and bla(KPC-2) in an unusual genetic environment flanked by ISKpn8-Δbla(TEM-1) and ISKpn6-like. bla(KPC-2) was associated with IncL/M transferable plasmids; the second was the abrupt clonal spread of K. pneumoniae ST258 harbouring bla(KPC-2) in Tn4401a.

Asunto(s)

Infecciones por Klebsiella/epidemiología , Klebsiella pneumoniae/genética , beta-Lactamasas/genética , Argentina/epidemiología , Técnicas de Tipificación Bacteriana , Conjugación Genética , Elementos Transponibles de ADN , Enterobacter/genética , Genes Bacterianos , Hospitales , Humanos , Infecciones por Klebsiella/microbiología , Infecciones por Klebsiella/transmisión , Klebsiella pneumoniae/clasificación , Klebsiella pneumoniae/enzimología , Klebsiella pneumoniae/aislamiento & purificación , Tipificación de Secuencias Multilocus , Plásmidos/genética

RESUMEN

It has been demonstrated that infections due to Shiga toxins (Stx) producing Escherichia coli are the main cause of the haemolytic uraemic syndrome (HUS). However, the contribution of the inflammatory response in the pathogenesis of the disease has also been well established. Neutrophils (PMN) represent a central component of inflammation during infections, and patients with high peripheral PMN counts at presentation have a poor prognosis. The mouse model of HUS, by intravenous injection of pure Stx type 2 (Stx2), reproduces human neutrophilia and allows the study of early events in the course of Stx2-induced pathophysiological mechanisms. The aim of this study was to address the contribution of PMN on Stx2 toxicity in a murine model of HUS, by evaluating the survival and renal damage in mice in which the granulocytic population was depleted. We found that the absence of PMN reduced Stx2-induced lethal effects and renal damage. We also investigated the mechanisms underlying Stx2-induced neutrophilia, studying the influence of Stx2 on myelopoyesis, on the emergence of cells from the bone marrow and on the in vivo migration into tissues. Stx2 administration led to an accelerated release of bone marrow cells, which egress at an earlier stage of maturation, together with an increase in the proliferation of myeloid progenitors. Moreover, Stx2-treated mice exhibited a lower migratory capacity to a local inflammatory site. In conclusion, PMN are essential in the pathogenesis of HUS and neutrophilia is not merely an epiphenomenon, but contributes to Stx2-damaging mechanism by potentiating Stx2 toxicity.

Asunto(s)

Síndrome Hemolítico-Urémico/patología , Neutrófilos/fisiología , Toxina Shiga II/toxicidad , Animales , Células de la Médula Ósea/patología , Quimiotaxis de Leucocito/efectos de los fármacos , Modelos Animales de Enfermedad , Síndrome Hemolítico-Urémico/etiología , Leucocitosis/etiología , Leucocitosis/patología , Masculino , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos C57BL , Neutrófilos/efectos de los fármacos , Conejos

RESUMEN

Haemolytic uraemic syndrome (HUS) is caused by Shiga-toxin-producing Escherichia coli (STEC). Although, Shiga toxin type 2 (Stx2) is responsible for the renal pathogenesis observed in patients, the inflammatory response, including cytokines and polymorphonuclear neutrophils (PMN), plays a key role in the development of HUS. Previously, we demonstrated that Stx2 injection generates an anti-inflammatory reaction characterized by endogenous glucocorticoid (GC) secretion, which attenuates HUS severity in mice. Here, we analysed the effects of Stx2 on the pathogenic function of PMN and the potential role of endogenous GC to limit PMN activation during HUS development in a murine model. For this purpose we assessed the functional activity of isolated PMN after in vivo treatment with Stx2 alone or in simultaneous treatment with Ru486 (GC receptor antagonist). We found that Stx2 increased the generation of reactive oxygen intermediates (ROI) under phobol-myristate-acetate (PMA) stimulation and that the simultaneous treatment with Ru486 strengthened this effect. Conversely, both treatments significantly inhibited in vitro phagocytosis. Furthermore, Stx2 augmented in vitro PMN adhesion to fibrinogen (FGN) and bovine serum albumin (BSA) but not to collagen type I (CTI). Stx2 + Ru486 caused enhanced adhesion to BSA and CTI compared to Stx2. Whereas Stx2 significantly increased migration towards N-formyl-methionyl-leucyl-phenylalanine (fMLP), Stx2 + Ru486 treatment enhanced and accelerated this process. The percentage of apoptotic PMN from Stx2-treated mice was higher compared with controls, but equal to Stx2 + Ru486 treated mice. We conclude that Stx2 activates PMN and that the absence of endogenous GC enhances this activation suggesting that endogenous GC can, at least partially, counteract PMN inflammatory functions.

Asunto(s)

Glucocorticoides/inmunología , Síndrome Hemolítico-Urémico/inmunología , Neutrófilos/inmunología , Toxina Shiga II/inmunología , Animales , Apoptosis/inmunología , Adhesión Celular/inmunología , Inhibición de Migración Celular , Colágeno Tipo II/inmunología , Modelos Animales de Enfermedad , Fibrinógeno/inmunología , Antagonistas de Hormonas/inmunología , Recuento de Leucocitos/métodos , Masculino , Ratones , Ratones Endogámicos BALB C , Mifepristona/inmunología , Fagocitosis/efectos de los fármacos , Fagocitosis/inmunología , Especies Reactivas de Oxígeno/inmunología , Receptores de Glucocorticoides/antagonistas & inhibidores , Albúmina Sérica Bovina/inmunología , Acetato de Tetradecanoilforbol/inmunología

RESUMEN

The concept that during an immune challenge the release of glucocorticoids (GC) provides feedback inhibition on evolving immune responses has been drawn primarily from studies of autoimmune and/or inflammatory processes in animal models. The epidemic form of haemolytic uraemic syndrome (HUS) occurs secondary to infection with Gram-negative bacteria that produce Shiga toxin (Stx). Although Stx binding to the specific receptors present on renal tissue is the primary pathogenic mechanism, inflammatory or immune interactions are necessary for the development of the complete form of HUS. The aim of this study was to investigate the influence of endogenous GC on Stx-toxicity in a mouse model. Stx2 was injected into GC-deprived mice and survival rate, renal damage and serum urea levels were evaluated. Plasma corticosterone and cytosolic GC receptor (GR) concentration were also determined at multiple intervals post-Stx2 treatment. Higher sensitivity to Stx2 was observed in mice lacking endogenous GC, evidenced by an increase in mortality rates, circulating urea levels and renal histological damage. Moreover, Stx2 injection was associated with a transient but significant rise in corticosterone secretion. Interestingly, 24 h after Stx inoculation significant increases in total GR were detected in circulating neutrophils. These results indicate that interactions between the neuroendocrine and immune systems can modulate the level of damage significantly during a bacterial infection.

Asunto(s)

Glucocorticoides/fisiología , Síndrome Hemolítico-Urémico/fisiopatología , Toxina Shiga II/antagonistas & inhibidores , Glándulas Suprarrenales/fisiopatología , Animales , Corticosterona/sangre , Modelos Animales de Enfermedad , Esquema de Medicación , Síndrome Hemolítico-Urémico/microbiología , Síndrome Hemolítico-Urémico/patología , Antagonistas de Hormonas/farmacología , Riñón/patología , Masculino , Ratones , Ratones Endogámicos BALB C , Mifepristona/farmacología , Receptores de Glucocorticoides/antagonistas & inhibidores , Toxina Shiga II/toxicidad , Tasa de Supervivencia , Urea/sangre

RESUMEN

Los terneros comienzan a rumiar a las 2 ó 3 semanas de edad, pasando de lactante a rumiante de acuerdo a la influencia de estímulos que recibe de la dieta. (Brody, 1945; Swanson, 1960 y National Research Council, 1989). El objetivo del presente trabajo fue evaluar los cambios en el desarrollo morfohistológico del estómago de terneros lactantes, alimentados con dos sustitutos (tratamientos) que difieren en su composición. Tratamiento A consistió en: derivados de la leche (dl) 65 por ciento, fibra detergente neutro (FDN) 1,75 por ciento y almidón (al) 24,6 por ciento. Tratamiento B: dl 50 por ciento, FDN 6,5 por ciento y al 19,2 por ciento. Se trabajó con un total de 18 terneros machos (9 en cada tratamiento), de raza Holando Argentino a los que se les suministró una dieta consistente en 240 g de sustituto en cada una de las 2 tomas diarias durante 45 días, concentrado ad libitum, disponibilidad de forraje fresco y agua, durante 50 días. Para la evaluación anatómica, se muestrearon 6 terneros, seleccionados para cada fecha y tratamiento, a los días 18-41 y 50, tomando en cada una de ellas un ternero de cada tratamiento. La evaluación consistió en efectuar mediciones de capacidad, longitud, peso vacío, peso relativo de la digesta de los distintos compartimentos del estómago. Utilizando el test de análisis de varianza (ANDEVA), no se observaron diferencias (P > igual 0,05) en peso vivo (PV) entre dietas para las tres fechas, observándose una tendencia de mayor PV en la dieta A. En cambio, en la capacidad del contenido del retículo, como en el espesor del epitelio del mismo, se evidenciaron diferencias significativas (P < 0,05) con R²0,75 y 0,8 respectivamente. Debido a la falta de repeticiones del ensayo y al efecto tiempo, los resultados sólo tienen valor descriptivo. Si bien a temprana edad (18 días) se evaluó mayor capacidad del rumen en terneros alimentados con el sustituto de menor calidad B, a los 50 días, se observa un incremento en el desarrollo del estómago en los alimentados con sustituto de mayor calidad A. Al incorporar al sustituto lácteo mayor por ciento de derivados de la leche, se favorece la capacidad anatómica del estómago, lo cual permitía a los terneros convertirse en rumiantes más tempranamente. Para la evaluación histológica se muestrearon seis terneros seleccionados para cada fecha y tratamiento a los días 18, 41 y 50 días. Las muestras fueron fijadas en formol bufferado al 10 por ciento, luego procesadas por técnicas histológicas

Asunto(s)

Animales , Masculino , Bovinos , Bovinos/crecimiento & desarrollo , Estómago/crecimiento & desarrollo , Leche , Almidón/administración & dosificación , Bovinos/anatomía & histología , Estómago/anatomía & histología , Tamaño de los Órganos

RESUMEN

We present in this paper two cases of auto-immune hemolytic anemie caused by ingestion of alpha-metildope Coombs' test positive. We suggest to make Coombs test to every patient in whose treatment has been included the use of alpha-metildope.

Asunto(s)

Anemia Hemolítica Autoinmune/inducido químicamente , Metildopa/efectos adversos , Administración Oral , Adulto , Anemia Hemolítica Autoinmune/inmunología , Climaterio/efectos de los fármacos , Prueba de Coombs , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Metildopa/administración & dosificación , Persona de Mediana Edad