RESUMO
Carbapenemase-producing Klebsiella pneumoniae (CRKP) are increasingly reported worldwide being necessary the local epidemiological monitoring. Our aim was to characterize the hypermucoviscous CRKP isolates collected in our hospital during a 6 months period. Carriage of the carbapenemase genes (bla KPC, bla NDM, bla VIM and bla OXA-48), extended spectrum ß-lactamases (bla SHV-2, bla CTX-M) and the virulence genes (magA, k2A, rmpA, wabG, uge, allS, entB, ycfM, kpn, wcaG, fimH, mrkD, iutA, iroN, hly and cnf-1) were determined by multiplex-PCR. Genetic relationship among the isolates was performed by PFGE and MLST. A total of 35 isolates were recovered, being the urinary and respiratory tract the most common infection sites (34.2%). The bla KPC-2 gene was present in all the isolates, coexisting with bla CTX-M-2 (45.7%), bla SHV-2 (28.6%), and bla CTX-M-2/bla SHV-2 (14.3%). The capsular serotype K2 corresponded with 68.6% of the isolates. Virulence factors frequency were variable [adhesins (97.1%), siderophores (94.3%) and phagocytosis resistance (wabG 48.5%, uge 80% and ycfM 57.1%)]. A total of 10 STs were identified although 40% of them clustered on ST25-CC65, and 17% to ST17. The incidence of KPC-2-producing K. pneumoniae reported by the hospital was 0.290 per 1000 admissions. In summary we described an epidemic scenario of multidrug resistant hypermucoviscous KPC-2 producing ST25 K. pneumoniae in our institution.
RESUMO
We present here a review of the work on neuromodulation - defined as application of an inhibitory or excitatory current - on intracranial structures for the treatment of drug-resistant epilepsy. Near 250 patients were treated using a neuromodulation technique of the cerebellum (paravermian cortex), the CM-pf nucleus of the thalamus, the hippocampus, epileptogenic foci, and anterior ventral nucleus of the thalamus, with a one- to 15-year follow-up. Four contact strips were used for cerebellar and functional region neuromodulation, and DBS-type depth electrodes were stereotactically implanted for CM-pf and anterior nuclei of the thalamus and hippocampal neuromodulation. Electric stimulation was cyclic in almost all trials, using low frequency (10-40 Hz) for excitation and high frequency (60-185 Hz) for inhibition. Seizure frequency reduction was variable, depending on the neuromodulation site and patient selection, although seizure duration decreased in most patients. Cerebellar neuromodulation was followed by a 78% reduction in tonic and tonic-clonic seizures, CM-pf neuromodulation by an 83% reduction in tonic-clonic seizures and atypical absence of Lennox-Gastaut syndrome, with a 17.2% seizure-free and drug-free patient rate. Hippocampal neuromodulation was followed by a 73% reduction in partial complex seizures, with a 33% seizure-free patient rate. Anterior ventral nucleus of the thalamus was followed by a 63% reduction in tonic-clonic, tonic and atonic seizures. Several prognostic factors were identified in order to improve future results. There was no mortality and morbidity was limited to skin erosion at the neurostimulator site. Seizure reduction was associated with improved neuropsychological performance and better quality of life. Neuromodulation is safe and effective for the treatment of epileptic seizures of various origins. Several targets may be associated in a single patient, especially when bilateral hippocampal seizure foci are present.
Assuntos
Sistema Nervoso Central/fisiologia , Estimulação Encefálica Profunda , Epilepsia/terapia , Sistema Nervoso Central/fisiopatologia , Córtex Cerebral/fisiopatologia , Córtex Cerebral/cirurgia , Estimulação Encefálica Profunda/efeitos adversos , Eletrodos Implantados , Seguimentos , Humanos , Procedimentos Neurocirúrgicos , Técnicas Estereotáxicas , Tálamo/fisiopatologia , Tálamo/cirurgia , Resultado do TratamentoRESUMO
El tratamiento endoscópico con dilatación neumática en pacientes con membranas esofágicas únicas o múltiples así como anillos en pacientes sintomáticos tiene resultados excelentes en la remisión transitoria de la disfagia, requiriendo dilataciones subsecuentes en forma esporádica, la endoscopia es el mejor método diagnóstico, el esofagograma es normal en la mayoría de los pacientes, en menos de un tercio pueden observarse indentaciones irregulares en el contorno esofágico recibiendo el nombre de esófago felino o felinización del esófago, los estudios manométricos y la pH-metría no han demostrado nada concluyente
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Endoscopia do Sistema Digestório , Esôfago/anormalidades , Transtornos de Deglutição/congênito , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Diafragma/anormalidadesRESUMO
Desde el conocimiento en la década de los 60's del compromiso isquémico del colon, secundario al uso de anticonceptivos orales y de las lesiones visualizadas en la colonoscopia, se han reportado más casos en la literatura. Observando una prevalencia seis veces mayor en mujeres jóvenes con colitis isquémica, secundaria al uso de anticonceptivos orales, afectando principalmente el colon izquierdo, respetando el recto, en algunas ocasiones puede afectar el colon derecho, sin afectar el fondo de saco de ciego o en forma segmentaria, con una regresión total del o de los segmentos afectados en los primeros dos días a una semana al suspender el uso de los anticonceptivos orales