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Cassava is an essential tuber crop used to produce food, feed, and beverages. Whitefly pests, including Aleurothrixus aepim (Goeldi, 1886) (Hemiptera: Aleyrodidae), significantly affect cassava-based agroecosystems. Plant odours have been described as potential pest management tools, and the cassava clone M Ecuador 72 has been used by breeders as an essential source of resistance. In this study, we analysed and compared the volatile compounds released by this resistant clone and a susceptible genotype, BRS Jari. Constitutive odours were collected from young plants and analysed using gas chromatography-mass spectrometry combined with chemometric tools. The resistant genotype released numerous compounds with previously described biological activity and substantial amounts of the monoterpene (E)-ß-ocimene. Whiteflies showed non-preferential behaviour when exposed to volatiles from the resistant genotype but not the susceptible genotype. Furthermore, pure ocimene caused non-preferential behaviour in whiteflies, indicating a role for this compound in repellence. This report provides an example of the intraspecific variation in odour emissions from cassava plants alongside information on odorants that repel whiteflies; these data can be used to devise whitefly management strategies. A better understanding of the genetic variability in cassava odour constituents and emissions under field conditions may accelerate the development of more resistant cassava varieties.
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La neurofibromatosis tipo I o enfermedad de Von Recklinghausen es una de las enfermedades genéticas que afectan el sistema nervioso, denominada así por su origen común embrionario. Es una enfermedad autosómica dominante, progresiva, de evolución impredecible, que afecta la piel y el sistema nervioso central y periférico. Se presenta el caso de una escolar, femenina, de siete años de edad que ingresó en el Hospital Pediátrico Paquito Gonzáles Cueto debido a la presencia de varias manchas en la piel color "café con leche". Se recogió como antecedente familiar la presencia de neurofibromatosis tipo 1 en la abuela y bisabuela materna, esta última ya fallecida por dicha causa. Al examen físico se constataron nódulos de Lisch en espesor del iris del ojo izquierdo. Los estudios de imágenes evidenciaron varias lesiones nodulares hiperintensas en T2 y FLAIR, a nivel de la cápsula interna y externa bilateral y ventricular izquierda, la mayor de 20 x 11 mm, así como imagen hipointensa a nivel del nervio óptico izquierdo, de 7 mm. Se diagnosticó como neurofibromatosis tipo I. Por ser una de las enfermedades menos estudiadas en nuestro medio se decidió la publicación de este caso.
Neurofibromatosis type I or Von Recklinghausen's disease is one of the genetic diseases that affect the nervous system, named for its common embryonic origin. It is an autosomal dominant, progressive disease with an unpredictable course that affects the skin and the central and peripheral nervous system. The case of a seven-year-old female schoolchild who was admitted to the Paquito Gonzáles Cueto Pediatric Hospital due to the presence of several "coffee-with-milk" spots on her skin is presented. The presence of type 1 neurofibromatosis in her maternal grandmother and great-grandmother, the latter already deceased from said cause, was collected as a family history. On physical examination, Lisch nodules were found in the thickness of the iris of the left eye. Imaging studies revealed several hyperintense nodular lesions on T2 and FLAIR, at the level of the internal and external bilateral and left ventricular capsule, the largest measuring 20 x 11 mm, as well as a hypointense image at the level of the left optic nerve, measuring 7 mm. It was diagnosed as neurofibromatosis type I. Because it is one of the least studied diseases in our environment, it was decided to publish this case.
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The spontaneous disappearance of a segment of bone in a short period without the existence of a tumoral disease that justifies it is an exceptional event. We report the case of an older adult in whom the upper epiphysis of the right humerus and part of the acromion disappeared in a period of 3 weeks in the absence of a malignant tumor. Bone biopsy revealed osteoclasts, lymphatic vessels, and blood vessels. This disorder was first reported in 1838 and in 1955 it was established as a specific disease by Gorham and Stout. Since then, it has been named in their honor.
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Osteólisis Esencial , Humanos , Osteólisis Esencial/patología , Osteólisis Esencial/diagnóstico por imagen , Húmero/patología , Húmero/diagnóstico por imagen , Masculino , Femenino , Anciano , Biopsia , Persona de Mediana EdadRESUMEN
BACKGROUND: IgG4-related disease (IgG4 RD) is an immune-mediated fibro-inflammatory disorder, with tissue infiltration of IgG4+ plasma cells. It causes pseudotumors, tumors, and a wide spectrum of clinical manifestations. AIM: To report the clinical, laboratory, histopathological and treatment characteristics of a group of Chilean patients with IgG4 RD. MATERIAL AND METHODS: Review of medical records of 52 patients aged 18 to 76 years with IgG4 RD seen at six medical centers. RESULTS: Elevated IgG4 serum levels (> 135 mg/dl) were found in 18 of 44 (41%) patients. There was histological confirmation of the disease in 46 patients. The most common sites of involvement were lungs, eyes and kidneys. Eighteen (35%) patients had only one organ involved, 34 (65%) patients had two organs and 13 (25%) patients had three or more organs. The involvement of two organs was significantly more common in men (p < 0.05). In patients with only one organ involvement, the most frequent location was orbital and meningeal. All patients with kidney or lung disease had multiorgan involvement. All patients received corticosteroid therapy, 67% synthetic immunosuppressants, and 16% rituximab. CONCLUSIONS: ER-IgG4 can affect any tissue. Multiorgan involvement was more common in this series, with preference for lungs, eyes and kidneys. An excellent response to steroids is characteristic of the disease, but with a high relapse rate that requires additional immunosuppression.
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Humanos , Masculino , Enfermedades Autoinmunes/tratamiento farmacológico , Enfermedad Relacionada con Inmunoglobulina G4/diagnóstico , Enfermedad Relacionada con Inmunoglobulina G4/tratamiento farmacológico , Inmunoglobulina G , Rituximab/uso terapéutico , Inmunosupresores/uso terapéutico , Riñón/patologíaRESUMEN
Autoimmune lymphoproliferative syndrome (ALPS) is a rare disease defined as a defect in the lymphocyte apoptotic pathway. Currently, the diagnosis of ALPS is based on clinical aspects, defective lymphocyte apoptosis and mutations in Fas, FasL and Casp 10 genes. Despite this, ALPS has been misdiagnosed. The aim of this work was to go one step further in the knowledge of the disease, through a molecular and proteomic analysis of peripheral blood mononuclear cells (PBMCs) from two children, a 13-year-old girl and a 6-year-old boy, called patient 1 and patient 2, respectively, with clinical data supporting the diagnosis of ALPS. Fas, FasL and Casp10 genes from both patients were sequenced, and a sample of the total proteins from patient 1 was analyzed by label-free proteomics. Pathway analysis of deregulated proteins from PBMCs was performed on the STRING and PANTHER bioinformatics databases. A mutation resulting in an in-frame premature stop codon and protein truncation was detected in the Fas gene from patient 2. From patient 1, the proteomic analysis showed differences in the level of expression of proteins involved in, among other processes, cell cycle, regulation of cell cycle arrest and immune response. Noticeably, the most down-regulated protein is an important regulator of the cell cycle process. This could be an explanation of the disease in patient 1.
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Síndrome Linfoproliferativo Autoinmune , Adolescente , Síndrome Linfoproliferativo Autoinmune/diagnóstico , Síndrome Linfoproliferativo Autoinmune/genética , Niño , Femenino , Humanos , Leucocitos Mononucleares , Masculino , Mutación , Proteómica , Receptor fas/genéticaRESUMEN
INTRODUCTION: Gout is the most common inflammatory arthritis, but was not considered in most COVID-19 and rheumatic diseases reports. Our aim was to describe changes in clinical data, treatment, function and quality of life for gout patients during COVID-19 pandemic. METHODS: Prospective, descriptive and analytical study of 101 consecutive gout (ACR/EULAR 2015) patients from our clinic evaluated during pandemic by phone call (n=52) or phone call + face-to-face (n=68) that accepted to participate. Variables are demographics, clinical and treatment data, HAQ, EQ5D questionnaires and COVID-19-related data. Patients were divided in two groups: flare (n=36) or intercritical gout (n=65) also; available pre-pandemic data was obtained from 71 patients. Statistical analyses are X2, paired t-test and Wilcoxon test. RESULTS: Included gout patients were males (95.8%), mean (SD) age 54.7 (10.7) years and disease duration 16.4 (9.8) years; 90% received allopurinol, 50% colchicine as prophylaxis and 25% suspended ≥ 1 medication. Comparison of pre-pandemic vs pandemic data showed > flares (4.4% vs 36%, p=0.01), more flares in the last 6 months: 0.31 (0.75) vs 1.71 (3.1), (p=0.004 and > urate levels: 5.6 (1.7)vs 6.7 (2.2) mg/dL, p=0.016. Unexpectedly, function and quality-of-life scores improved: HAQ score 0.65 (2.16) vs 0.12 (0.17), p= 0.001. Seven patients were COVID-19-confirmed cases; they had significantly more flares, higher urate levels and lower allopurinol doses and two died. CONCLUSIONS: In gout patients, flares were 9 times more frequent during pandemic also, they had increased urate levels but led to an unexpected improvement in HAQ and functionality scores. Resilience and lifestyle changes in gout during COVID-19 pandemic require further studies. Key Points ⢠COVID-19 pandemic is associated with 4 times more flares in gout patients. ⢠Increased flares were also seen in previously well-controlled gout patients. ⢠Increased serum urate levels were also found in gout patients during pandemic. ⢠In our gout clinic, 8/101 patients were diagnosed as COVID-19+, and two of them died.
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COVID-19 , Gota , Alopurinol/uso terapéutico , Gota/tratamiento farmacológico , Gota/epidemiología , Supresores de la Gota/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Estudios Prospectivos , Calidad de Vida , SARS-CoV-2 , Ácido ÚricoRESUMEN
BACKGROUND: IgG4-related disease (IgG4 RD) is an immune-mediated fibro-inflammatory disorder, with tissue infiltration of IgG4+ plasma cells. It causes pseudotumors, tumors, and a wide spectrum of clinical manifestations. AIM: To report the clinical, laboratory, histopathological and treatment characteristics of a group of Chilean patients with IgG4 RD. MATERIAL AND METHODS: Review of medical records of 52 patients aged 18 to 76 years with IgG4 RD seen at six medical centers. RESULTS: Elevated IgG4 serum levels (> 135 mg/dl) were found in 18 of 44 (41%) patients. There was histological confirmation of the disease in 46 patients. The most common sites of involvement were lungs, eyes and kidneys. Eighteen (35%) patients had only one organ involved, 34 (65%) patients had two organs and 13 (25%) patients had three or more organs. The involvement of two organs was significantly more common in men (p < 0.05). In patients with only one organ involvement, the most frequent location was orbital and meningeal. All patients with kidney or lung disease had multiorgan involvement. All patients received corticosteroid therapy, 67% synthetic immunosuppressants, and 16% rituximab. CONCLUSIONS: ER-IgG4 can affect any tissue. Multiorgan involvement was more common in this series, with preference for lungs, eyes and kidneys. An excellent response to steroids is characteristic of the disease, but with a high relapse rate that requires additional immunosuppression.
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Enfermedades Autoinmunes , Enfermedad Relacionada con Inmunoglobulina G4 , Masculino , Humanos , Enfermedad Relacionada con Inmunoglobulina G4/diagnóstico , Enfermedad Relacionada con Inmunoglobulina G4/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Inmunoglobulina G , Rituximab/uso terapéutico , Riñón/patología , Enfermedades Autoinmunes/tratamiento farmacológicoRESUMEN
HLA-DRB1 shared epitope (SE) alleles are important genetic contributors for the risk of developing anti-citrullinated protein antibodies (ACPA)-positive rheumatoid arthritis (RA), particularly in Caucasians. We aimed to analyze the contribution of HLA-DRB1 alleles and single nucleotide polymorphisms (SNPs) within the major histocompatibility complex (MHC) region to the susceptibility to develop ACPA-positive RA in a Latin American (LA) population with admixed ancestry. A total of 289 ACPA-positive RA patients and 510 controls were enrolled in this study. The presence of HLA-DRB1*04:01, *09:01 and *10:01 was increased in ACPA-positive RA patients compared with healthy controls (p < 0.0001, p < 0.001 and p < 0.01, respectively), whereas DRB1*07:01 and *08:02 was associated with a decreased risk of ACPA-positive RA (p < 0.001 and p < 0.01, respectively). These results showed a strong correlation with estimates from studies in Asians but not in Caucasian populations. The present study describes the protective effects of the HLA-DRB1*07:01 and *08:02 alleles in ACPA-positive RA patients in a LA population for the first time. Identifying relationships between HLA-DRB1 alleles and RA is important for identifying disease associations in different ethnic groups in order to reach a better understanding of RA worldwide.
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According to the World Health Organization, diarrheal infections cause 525 000 deaths of children under five years of age every year, and shigellosis. Shigellosis is a relevant cause of dysentery, which increases the morbidity and mortality in pediatric patients. Therefore, emergingthe emergence of antimicrobial resistant strains of Shigella is a concerningworrisome problem worldwide. We report the case of a 7-year-old patient with acute dysentery caused by CTX-M Type ESBL Producing Shigella flexneri, being. This was the first case treated in the Specialties Hospital of Specialties of the Armed Forces N°1, in Quito, Ecuador. The antibiogram demonstrated sensibilityshowed sensitivity to ampicillin-sulbactam. As a result, after five days of microbiologically directed treatment, the patient improved his condition without relapse. Proper clinical diagnoses and accurate laboratory studies like stool culture and antibiogram are crucial to givingindicate an appropriate therapy in infections caused by Shigella and other enteric bacilli(AU)
Según la Organización Mundial de la Salud, las infecciones diarreicas provocan 525 000 muertes de niños menores de cinco años de edad cada año. La shigelosis es una causa importante de disentería que aumenta la morbilidad y mortalidad de los pacientes pediátricos. Es por eso que el surgimiento de cepas de Shigella resistentes a los antibióticos es un preocupante problema a nivel mundial. Presentamos el caso de un paciente de 7 años de edad con disentería aguda provocada por Shigella flexneri productora de BLEE tipo CTX-M. Se trata del primer caso tratado en el Hospital de Especialidades de las Fuerzas Armadas Nº 1, en Quito, Ecuador. El antibiograma mostró sensibilidad a la combinación ampicilina/sulbactam. Al cabo de cinco días de tratamiento microbiológico, el paciente mejoró su estado y no se produjeron recaídas. Un diagnóstico clínico correcto, así como estudios precisos de laboratorio como los cultivos de heces y los antibiogramas, son vitales para indicar una terapia apropiada en las infecciones causadas por Shigella y otros bacilos entéricos(AU)
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Humanos , Masculino , Niño , Diagnóstico Clínico , Disentería/prevención & control , Disentería Bacilar/tratamiento farmacológico , Pruebas de Sensibilidad Microbiana/métodosRESUMEN
La infección por Neisseria meningitidis es causa frecuente de meningitis y septicemia en personas con factores de riesgo; presenta graves complicaciones entre las que se encuentra la púrpura fulminans; patología poco frecuente pero devastadora que inicia con la aparición de lesiones purpúricas en la piel y que finalmente produce compromiso vascular importante, ocasionando necrosis de tejidos profundos, lo cual lleva a amputaciones. Se reporta el caso de un adulto joven, masculino, miembro de las fuerzas militares, en quien se confirma infección por meningococo; presenta meningococcemia sin meningitis, desarrolla púrpura fulminans y finalmente, después de estabilización hemodinámica, requiere amputaciones múltiples secundarias: transtibiales bilaterales y en falanges de mano izquierda. Posterior al egreso de la hospitalización inicia proceso de rehabilitación y 9 meses después logra deambulación con prótesis en miembros inferiores.
Neisseria meningitidis infection is a frequent cause of meningitis and septicemia in people with risk factors; it presents serious complications including purpura fulminans, a rare but devastating pathology that starts with the appearance of purpuric lesions on the skin and finally produces important vascular compromise, causing necrosis of deep tissues, which leads to amputations. We report the case of a young adult male, member of the military forces, in whom meningococcal infection is confirmed; he presents meningococcemia without meningitis, develops purpura fulminans and finally, after hemodynamic stabilization, requires multiple secondary amputations: bilateral transtibial and left hand phalanges. After discharge from the hospital, she started rehabilitation and 9 months later she was able to ambulate with prosthesis in the lower limbs.
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Humanos , Masculino , AdolescenteRESUMEN
Nanoparticles (montmorillonite, MMT) can enhance biopolymer-based film properties. The structure-property relationship between polymers and nanoparticles may be explained by the rheological tests of nanocomposite forming solutions (NFS). The aim of this work was to study the effect of MMT concentration and amylose content on the rheological properties of NFS based on corn starch and glycerol following two preparation methods, through steady shear and dynamic tests. The organization level of NFS was influenced by the addition order of the components. Decreasing in flow index behavior when increasing amylose content was attributed to interactions between the starch components. In all NFS, G' was higher than Gâ³ indicating a gel-like behavior and suggesting that the MMT reinforced the starch matrix as observed by the increase in the storage modulus of films with MMT. Films obtained from method 2 have better mechanical properties probably due to the starch-MMT interactions.
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Amilosa/química , Bentonita/química , Nanocompuestos/química , Almidón/química , Reología , Resistencia a la TracciónRESUMEN
INTRODUCTION: Ignavigranum ruoffiae is an extremely rare cause of human infections. CASE PRESENTATION: An 83-year-old male with a painless, ten-day-old, erythematous skin abscess on his left flank, which had showed a purulent discharge for 48 h, was admitted to the Emergency service. He was treated with cephalexin, disinfection with Codex water and spray of rifampicin. Five days later, surgical drainage of the abscess was proposed due to the torpid evolution of the patient. Samples were taken for culture, and antibiotic treatment with trimethoprim-sulfamethoxazole was established. The patient returned after 10 days showing healing of the abscess. Microbiological studies showed a few Gram-positive cocci present as single cells and short chains that grew after 72 h of incubation at 35 °C with CO2 on 5â% sheep blood agar. Colonies presented a strong sauerkraut odour. Initial biochemical test results were negative for catalase, aesculin and bile-aesculin, and positive for pyrrolidonyl arylamidase, leucine aminopeptidase and growth in 6.5â% NaCl broth, which prompted the preliminary identification of Facklamia species or I. ruoffiae. The positive result for arginine deamination and negative result for hippurate hydrolysis, failure to produce acid from mannitol, sucrose, sorbitol or trehalose, plus the distinctive sauerkraut odour identified the organism as I. ruoffiae. The phenotypic identification was confirmed by 16S rRNA gene sequence analysis. The strain seemed to be susceptible to the antimicrobials tested but had decreased susceptibility to carbapenems. CONCLUSION: This case provides more insights into the phenotypic characteristics and antimicrobial resistance profile of I. ruoffiae.
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La especie Bifidobacterium scardovii está constituida por bacilos gram positivos anaerobios facultativos, cuyo desarrollo es estimulado por el CO2 y la anaerobiosis. Excepcionalmente se la ha asociado a infecciones humanas. Se presenta el caso de un paciente anoso con infección urinaria por B. scardovii y Enterococcus faecalis, ambos microorganismos aislados en 2 urocultivos consecutivos. El bacilo no desarrolló en los medios de cultivo habituales, pero sí en agar chocolate en CO2 y en agar Brucella suplementado, incubados durante 72 h a 35°C. La coloración de Gram alertó acerca de su presencia al observarse abundantes bacilos gram positivos irregulares con extremos bifurcados en forma de Y, y escasos cocos gram positivos. Es importante la coloración de Gram en orinas con piuria y la siembra en medios enriquecidos por tiempos prolongados. En este caso, sin el resultado del Gram y con el desarrollo de E. faecalis, no hubiésemos advertido la presencia del agente mayoritario.
Bifidobacterium scardovii species consists of facultative anaerobic gram-positive rods whose growth is stimulated by CO2 and anaerobiosis. Exceptionally it has been associated with infections in humans. An elderly male patient with a urinary tract infection due to B. scardovii and Enterococcus faecalis is presented here; both microorganisms were isolated from two consecutive urine samples. The bacillus did not grow on standard media, but on chocolate agar incubated in CO2 and on supplemented Brucella agar in an anaerobic atmosphere, incubated for 72 h at 35°C. Gram staining with abundant irregular gram-positive rods with Y-shaped ends and some gram-positive cocci alerted to its presence. The importance of the Gram stain test in urine samples with pyuria and the growth on enriched media for long periods is highlighted here. In this case, if we had not had the Gram stain test results, and had considered only the E. faecalis growth, we would have lost the major etiologic agent.
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Anciano , Humanos , Masculino , Infecciones Urinarias , Bifidobacterium , Infecciones por Bifidobacteriales , Infecciones Urinarias/microbiología , Orina , Bifidobacterium/aislamiento & purificación , Infecciones por Bifidobacteriales/microbiología , AnaerobiosisRESUMEN
Functional electrical stimulation cycling has been proposed as an assistive technology with numerous health and fitness benefits for people with spinal cord injury, such as improvement in cardiovascular function, increase in muscular mass, and reduction of bone mass loss. However, some limitations, for example, lack of optimal control strategies that would delay fatigue, may still prevent this technology from achieving its full potential. In this work, we performed experiments on a person with complete spinal cord injury using a stationary tadpole trike when both cadence tracking and disturbance rejection were evaluated. In addition, two sets of experiments were conducted 6 months apart and considering activation of different muscles. The results showed that reference tracking is achieved above the cadence of 25 rpm with mean absolute errors between 1.9 and 10% when only quadriceps are activated. The disturbance test revealed that interferences may drop the cadence but do not interrupt a continuous movement if the cadence does not drop below 25 rpm, again when only quadriceps are activated. When other muscle groups were added, strong spasticity caused larger errors on reference tracking, but not when a disturbance was applied. In addition, spasticity caused the last experiments to result in less smooth cycling.
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Ciclismo , Terapia por Estimulación Eléctrica/métodos , Actividad Motora , Contracción Muscular , Músculo Cuádriceps/inervación , Traumatismos de la Médula Espinal/rehabilitación , Adulto , Fenómenos Biomecánicos , Terapia por Estimulación Eléctrica/instrumentación , Diseño de Equipo , Tolerancia al Ejercicio , Humanos , Masculino , Fatiga Muscular , Fuerza Muscular , Traumatismos de la Médula Espinal/diagnóstico , Traumatismos de la Médula Espinal/fisiopatología , Factores de Tiempo , Resultado del TratamientoRESUMEN
Abstract: Background: Urinary tract infections (UTI) are among the most common infections in pediatric patients. The main etiopathogenic agent is Escherichia coli. The purpose of this study was to determine the antimicrobial resistance pattern of E. coli in pediatric patients and to understand their main clinical and laboratory manifestations. Methods: Fifty-nine patients were included in the study and classified into two groups: hospitalization (H) and external consultation (EC). Every patient presented urine cultures with the isolation of E. coli that included an antibiogram. Clinical signs and symptoms, urinalysis, complete blood count (CBC) and serum inflammatory markers were analyzed. Results: The most common clinical manifestations were fever (H: 76.5%; EC: 88%), vomiting (H: 32.4%; EC: 32%), hyporexia (H: 20.6%; EC: 16%), abdominal pain (H: 20.6%: EC: 28%), and dysuria (H: 14.7%; EC: 32%). Ten patients (16.95%) presented UTI for extended spectrum beta-lactamase (ESBL) E. coli. Ampicillin, nalidixic acid, and trimethoprim-sulfamethoxazole showed a higher resistance rate, being ampicillin the most significant (H: 88.2%; EC: 92%). Leukocyturia, bacteriuria and urine nitrites were frequent alterations in urinalysis (H: 52.9%; EC: 92%). In ESBL E. coli patients, a positive correlation was found between leukocytes in CBC and C-reactive protein (r = 0.9, p < 0.01). Diarrhea and foul-smelling urine were associated with E. coli resistance. Conclusions: The presence of leukocytes, bacteria, nitrites and the Gram stain are the most common indicators. Nitrofurantoin and phosphomycin are good therapeutic options. However, an antibiogram must be conducted to determine the best therapeutic agent.
Resumen: Introducción: Las infecciones de tracto urinario (ITU) se encuentran entre las más frecuentes en pediatría, siendo Escherichia coli el principal agente etiopatogénico. El objetivo de este estudio fue determinar el patrón de resistencia antimicrobiana de E. coli en pacientes pediátricos y conocer sus principales manifestaciones clínicas y de laboratorio. Métodos: Se incluyeron en el estudio 59 pacientes en dos grupos: hospitalización (H) y consulta externa (CE). En cada uno se realizó un urocultivo y un antibiograma con aislamiento de E. coli. Se analizaron signos y síntomas, uroanálisis, hemograma y marcadores séricos de inflamación. Resultados: Las manifestaciones clínicas más frecuentes fueron fiebre (H: 76.5%; CE: 88%), vómito (H: 32.4%; CE: 32%), hiporexia (H: 20.6%; CE: 16%), dolor abdominal (H: 20.6%: CE: 28%) y disuria (H: 14.7%; CE: 32%). Diez pacientes (16.95%) presentaron ITU por E. coli beta-lactamasa de espectro extendido (BLEE). La ampicilina, ácido nalidíxico y trimetroprim con sulfametoxazol mostraron alta resistencia, siendo ampicilina la más significativa (H: 88.2%, CE: 92%). Leucocituria, bacteriuria y nitritos en orina fueron frecuentes en el uroanálisis. En pacientes con E. coli BLEE se encontró una correlación positiva entre los leucocitos y la proteína C reactiva (r = 0.9, p < 0.01). La diarrea y el mal olor en la orina se asociaron con resistencia de E. coli. Conclusiones: La leucocituria, la bacteriuria, los nitritos y la tinción Gram son los indicadores más frecuentes de ITU. La nitrofurantoina y fosfomicina son buenas opciones terapéuticas. Sin embargo, debe realizarse un antibiograma para determinar el mejor tratamiento.
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Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Infecciones Urinarias/tratamiento farmacológico , Escherichia coli/efectos de los fármacos , Infecciones por Escherichia coli/tratamiento farmacológico , Antibacterianos/farmacología , Bacteriuria/microbiología , Bacteriuria/tratamiento farmacológico , Infecciones Urinarias/fisiopatología , Infecciones Urinarias/microbiología , Recuento de Células Sanguíneas , Pruebas de Sensibilidad Microbiana , Farmacorresistencia Bacteriana , Ecuador , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/fisiopatología , Infecciones por Escherichia coli/microbiología , Centros de Atención Terciaria , HospitalesRESUMEN
Bifidobacterium scardovii species consists of facultative anaerobic gram-positive rods whose growth is stimulated by CO2 and anaerobiosis. Exceptionally it has been associated with infections in humans. An elderly male patient with a urinary tract infection due to B. scardovii and Enterococcus faecalis is presented here; both microorganisms were isolated from two consecutive urine samples. The bacillus did not grow on standard media, but on chocolate agar incubated in CO2 and on supplemented Brucella agar in an anaerobic atmosphere, incubated for 72h at 35°C. Gram staining with abundant irregular gram-positive rods with Y-shaped ends and some gram-positive cocci alerted to its presence. The importance of the Gram stain test in urine samples with pyuria and the growth on enriched media for long periods is highlighted here. In this case, if we had not had the Gram stain test results, and had considered only the E. faecalis growth, we would have lost the major etiologic agent.
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Infecciones por Bifidobacteriales , Bifidobacterium , Infecciones Urinarias , Anciano , Anaerobiosis , Infecciones por Bifidobacteriales/microbiología , Bifidobacterium/aislamiento & purificación , Humanos , Masculino , Infecciones Urinarias/microbiología , OrinaRESUMEN
En América Latina, los primeros meses del 2016 estuvieron marcados por crecientes reportes de microcefalia, que poco después se demostró estaba causado por el virus zika. Inicialmente su transmisión fue caracterizada como metaxénica (a través del mosquito del dengue, Aedes aegypti), para luego encontrarse evidencias de transmisión sexual. Por ello, el Ministerio de Salud (MINSA) del Perú solicitó evaluar la capacidad de respuesta de sus servicios de salud reproductiva en las áreas de mayor riesgo de contagio, el área nororiental del Perú y Lima, a fin de identificar necesidades y nudos críticos y elaborar un plan de mejora de la oferta de servicios. En el caso de Lima, también se incluyeron dos establecimientos de EsSalud. Mediante entrevistas individuales, grupales, listas de chequeo y guías de observación, se analizaron variables claves del sistema de salud. El presupuesto en las regiones fue siempre menor al solicitado, mientras que el de planificación familiar recibía otros usos. Los horarios de atención fueron limitados, en tanto que se requiere actualizar las competencias del personal para usar el dispositivo intrauterino (DIU) y métodos de larga duración. El 83% de establecimientos tenía desabastecimiento del inyectable mensual, mientras que 17% presentó substock. Asimismo, resultó clara la necesidad de capacitar al personal para la prevención del zika durante las relaciones sexuales, así como antes y durante el embarazo. No se reconoció los vínculos con la violencia sexual. Los servicios orientados a usuarias/os adolescentes brindaban atención con horarios restringidos, además de otras limitaciones a su acceso. Solo el 22% de usuarias había recibido información de parte de los proveedores.
In Latin America, the first months of 2016 were marked by the increasing reports of microcephaly, which was shortly afterwards shown to have been caused by the Zika virus. Initially, its transmission was typified as metaxenic (caused by the Dengue mosquito Aedes aegypti); later, evidences of sexual transmission were detected. Thus, the Ministry of Health of Peru required to evaluate the response capacity of the reproductive health services to needs and critical knots and to draft a plan to improve the offer. In the case of Lima, EsSalud facilities were also included. Through individual and group interviews, and check lists and observation lists, key variables of the health system were analyzed. The budget of the regions was always lower than that requested; the family planning budget was expended in other uses. Office hours were limited. The staff skills on both intrauterine device (IUD) and long-acting reversible contraception (LARC) use needed to be updated. 83% of the facilities had shortage of monthly injectable contraception, and 17% were sub-stocked. Likewise, the staff needed to be trained on Zika prevention during sexual activity, and before and during pregnancy. The links with sexual violence were not recognized. The services for adolescent users had restricted office hours, and other access limitations. Only 22% of the users had received information from the suppliers.