RESUMEN La obsesión moderna por la seguridad (desde el miedo extremo a los gérmenes hasta la xenofobia) termina en el aislamiento. En este artículo exploramos qué hay detrás de esta preocupación por la seguridad, las metáforas que la rodean (y que provienen de la inmunología) y una forma de escapar del miedo tomando como punto de partida la idea deleuziana de la ética nómada. Desde una perspectiva contemporánea de cómo funcionan los sistemas inmunológicos, repensamos las metáforas: en la medida en que surgen nuevas caracterizaciones de la inmunidad, existe la necesidad de aproximarnos a las respuestas no defensivas, no reactivas a las demandas del devenir. Implica repensar la alteridad, la necesidad de abrazarla en lugar de evitarla, y su importancia para entender lo que nos hace humanos. Argumentaremos que la ética nómada requiere una epistemología nómada, un reconocimiento de que una comprensión y un control plenos de la realidad pueden estar fuera de nuestro alcance y, por lo tanto, una aceptación de formas de conocimiento parciales, tentativas y diversas.

ABSTRACT The modern obsession with safety (which ranges from extreme fear of germs to xenophobia) ends in isolation. In this paper, we explore what is behind of this concern with safety, the metaphors that surround it (which come from immunology), and a way to escape from fear using the Deleuzian idea of nomadic ethics as a point of departure. From a contemporary perspective of how immune systems work, we rethink the metaphors used to describe it: as far as new characterizations of immunity arise, there is a need to approach a notion of non-defensive, non-reactive answers to the ever-changing demands of a world in motion, of becoming. It implies rethinking alterity, the need to embrace it instead of avoiding it, and the need to understand its importance, the way in which it makes us humans. We will argue that nomadic ethics require a nomadic epistemology, an acknowledgement that a full understanding and control of reality may be beyond our reach, and therefore an acceptance of partial, tentative, and diverse forms of knowledge.

Resumen Introducción: La presencia de infecciones secundarias en pacientes críticos y la resistencia a los antibióticos suelen ser factores determinantes en la evolución clínica de estos pacientes. Objetivo: Describir los patógenos aislados en cultivos de sangre y de secreciones traqueales en pacientes de la UCI con COVID-19 y evaluar la relación entre la presencia de infecciones secundarias y la mortalidad a 60 días. Métodos: Estudio de cohorte analítico retrospectivo realizado en 273 adultos ingresados a la UCI con COVID-19 de la Subred Integrada de Servicios de Salud del Sur - Hospital El Tunal, Bogotá, Colombia entre abril y diciembre de 2020. Se obtuvieron los datos de los registros de cultivos en sangre y en secreciones de la tráquea. Se llevó a cabo un análisis bivariado mediante un modelo de riesgos proporcionales o regresión de Cox para evaluar la relación entre el desarrollo de infecciones secundarias y la mortalidad a 60 días. Resultados: Se reportó al menos un cultivo en sangre positivo en 96/511 (18.8%). De los 214 cultivos de sangre realizados dentro de las 48 horas siguientes al ingreso a la UCI, 7,7% resultaron positivos. Se aislaron en total 127 gérmenes en los cultivos en sangre, en su mayoría bacterias gramnegativas (61,4%) - seguido de hongos (25,2%). Adicionalmente, 39.5% fueron multirresistentes, siendo la resistencia los carbapenémicos el patrón de resistencia a los antibióticos más frecuente (33,3% de todos los aislados de bacterias gramnegativas). Finalmente, la presencia de infecciones secundarias en esta cohorte no se asoció con mortalidad a 60 días (HR: 1,012, IC 95%: 0,721-1,420; p= 0,946). Conclusiones: A pesar de que la prevalencia de super infecciones fue moderadamente alta, la prevalencia de coinfección fue baja. Las bacterias gramnegativas fueron las predominantes y casi un tercio de los gérmenes eran multirresistentes.

Abstract Introduction: The presence of secondary infections in critically ill patients and antibiotic resistance are often determining factors in the clinical evolution of these patients. Objective: To describe the pathogens isolated in blood cultures and tracheal secretion cultures in ICU patients with COVID-19 and to evaluate the association between the presence of secondary infections and 60-day mortality. Methods: Retrospective analytical cohort study conducted in 273 adults admitted to the ICU with COVID-19 at the Subred Integrada de Servicios de Salud del Sur - Hospital El Tunal, Bogotá, Colombia between April and December 2020. Data from records of blood or tracheal secretion cultures were collected. A bivariate analysis was performed using a Cox proportional-hazards regression model to assess the association between the development of secondary infections and 60-day mortality. Results: At least one positive blood culture was reported in 96/511 patients (18.8%). Of the 214 blood cultures performed within 48 hours after ICU admission, 7.7% were positive. A total of 127 germs were isolated from blood cultures - mostly gram-negative bacteria (61.4%) - followed by fungi (25.2%). Additionally, 39.5% were multidrug-resistant, and carbapenem resistance was the most common antibiotic resistance pattern (33.3% of all gram-negative bacteria isolates). Finally, in this cohort, the presence of secondary infections was not associated with 60-day mortality (HR: 1.012, 95%CI: 0.7211.420; p= 0.946). Conclusions: Although the prevalence of superinfection was moderately high, the prevalence of coinfection was low. Gram-negative bacteria were predominant, and almost one third of the germs were multidrug-resistant.

Resumen: El silencio es un fenómeno multiforme con diferentes implicaciones en el proceso educativo. Relegado a los márgenes del discurso pedagógico, la cuestión del silencio resurge por su conexión con los temas de la atención y la escucha, su influencia en el ambiente del aula y en la calidad del proceso de enseñanza y aprendizaje. Asumiendo que la reconstrucción de la pedagogía se fortalece cuando parte de los orígenes de nueva construcción contenidos en su propia estructura socio-histórica y cultural, este estudio retoma la propuesta pedagógica de Maria Montessori con el objetivo de identificar la concepción y los tipos de silencio preconizados en el método de esta pedagoga e interpretarlos como expresión de principios que marcaron el debate sobre la educación escolar en el siglo XX. Este estudio hermenéutico destaca una concepción positiva del silencio, revalorizando el silencio interior y su faceta de recogimiento, las perspectivas de su ejercicio en el contexto formal de la educación infantil, del desarrollo personal y social potenciado por la unidad entre cuerpo y mente.

Resumo: O silêncio é um fenómeno multifacetado com diferentes implicações no processo educativo. Remetido para as margens do discurso educacional, o tema do silêncio ressurge pela sua ligação aos temas da atenção e da escuta, bem como pela sua influência no ambiente de sala de aula e na qualidade do processo de ensino e aprendizagem. Pressupondo que a reconstrução da pedagogia se fortalece quando parte dos germes de construção nova contidos na sua própria conceção socio-histórica e cultural, este estudo retoma a proposta pedagógica de Maria Montessori. Neste sentido, pretende-se identificar a ideia e os tipos de silêncio preconizados no método desta pedagoga, assim como interpretá-los como expressão de princípios que marcaram o debate sobre a educação escolar no século XX. Este estudo, de natureza hermenêutica, destaca não apenas uma conceção positiva do silêncio como também a valorização do silêncio interior e a sua faceta de recolhimento. Assim, ainda serão relevantes as perspetivas da sua exercitação em contexto formal de educação infantil e do desenvolvimento pessoal e social potenciado pela unidade entre corpo e mente.

Abstract: Silence is a multifaceted phenomenon with different implications in the educational process. The concept of silence, which has been set aside from educational discourse, reappears due to its connection to the themes of attention and listening. It also resurfaces due to its influence on the classroom environment and the quality of the teaching and learning process. Assuming that the reconstruction of pedagogy is strengthened when it starts from the germs of new construction contained in its own socio-historical and cultural construction, this study takes up Maria Montessori's pedagogical proposal to identify the conception and types of silence advocated in the method of this pedagogue and interpret them as an expression of principles that marked the debate on school education in the 20th century. This study, of a hermeneutic nature, highlights a positive conception of silence, the appreciation of inner silence and its facet of recollection, as well as the perspectives of its exercise in a formal context of early childhood education and personal and social development enhanced by the unity between body and mind.

ABSTRACT Periodontitis is an immunoinflammatory disorder of microbial etiology caused by unique germs in the oral cavity that can spread through the bloodstream, activate the host's inflammatory response and promote the formation, maturation and exacerbation of atheromatous plaque. Several clinical studies have investigated the possible relationship between periodontal disease and diseases resulting from atherosclerosis such as ischemic heart disease and ischemic cerebrovascular disease. An exhaustive bibliographic review of scientific articles published in the databases: Pubmed, Medline, LILACS, Scielo, in the period between 2012 and 2022, in Spanish and English was carried out. The following were used as descriptors: periodontitis, cerebrovascular disease and atherosclerosis. The included reports indicate that cerebrovascular disease and atherosclerotic disease present the alterations with the greatest associations with periodontitis, however, larger studies are needed to determine the role of the severity and extent of periodontitis in these diseases.

RESUMEN La periodontitis es un trastorno inmunoinflamatorio de etiología microbiana causado por gérmenes únicos en la cavidad bucal que pueden diseminarse a través del torrente sanguíneo, activan la respuesta inflamatoria del huésped y favorecen la formación, maduración y exacerbación de la placa de ateroma. Varios estudios clínicos han investigado la posible relación entre la enfermedad periodontal y las enfermedades consecuentes de la aterosclerosis como la cardiopatía isquémica y la enfermedad cerebrovascular isquémica. Se realizó una revisión bibliográfica exhaustiva de artículos científicos publicados en las bases de datos: Pubmed, Medline, LILACS, Scielo, en el período comprendido entre el 2012 y el 2022, en idioma español e inglés. Se utilizaron como descriptores: periodontitis, enfermedad cerebrovascular y aterosclerosis. Los reportes incluidos indican que la enfermedad cerebrovascular y la enfermedad aterosclerótica presentan las alteraciones con mayores asociaciones con la periodontitis, sin embargo, se necesitan estudios más amplios para determinar el papel de la severidad y extensión de la periodontitis en estas enfermedades.

RESUMEN Introducción: La prueba de Papanicolaou estudia las células exfoliadas de la unión escamo-columnar del cuello uterino para la detección de células anómalas y también es útil para el diagnóstico de infecciones cervicovaginales. Objetivo: Caracterizar a las pacientes con infecciones cervicovaginales asintomáticas, diagnosticadas por prueba de Papanicolaou. Métodos: Se realizó una investigación observacional, descriptiva y transversal, en 656 pacientes con infección cervicovaginal asintomática, diagnosticadas por prueba de Papanicolaou. Se estudiaron: gérmenes, edad, inicio de las relaciones sexuales, número de compañeros sexuales, anomalías de células epiteliales cervicales. La información se obtuvo mediante interrogatorio, examen clínico y prueba de Papanicolaou. Se utilizaron técnicas de estadística descriptiva para el cálculo de las frecuencias absolutas, porcentajes, media y desviación estándar. Resultado: Se halló un predominio de la vaginosis bacteriana (46 %), seguido de la infección por Candida spp (38,2 %). La edad media de las pacientes fue de 36,4 años. Se observó que en 244 mujeres la edad de inicio de las relaciones sexuales fue de 16 - 20 años (37,2 %). Tuvieron un compañero sexual activo 531 casos (80,9 %). El 86 % no presentó lesiones cervicales, pero el 72,7 % de las infecciones por VPH sí tuvieron. Conclusiones: La generalidad de las mujeres tiene vaginosis bacteriana, son adultas, con inicio precoz de las relaciones sexuales y un compañero sexual activo. Gran parte no presentan lesiones cervicales, la mayoría, con infección por VPH, poseen anomalías de las células epiteliales cervicales.

ABSTRACT Introduction: The Papanicolaou test studies the exfoliated cells of the squamo-columnar junction of the cervix for the detection of abnormal cells and is also useful for the diagnosis of cervicovaginal infections. Objective: To characterize patients with asymptomatic cervicovaginal infections diagnosed by Papanicolaou test. Methods: An observational, descriptive and cross-sectional investigation was carried out in 656 patients with asymptomatic cervicovaginal infection, diagnosed by Papanicolaou test. The following were studied: germs, age, initiation of sexual relations, number of sexual partners, anomalies of cervical epithelial cells. The information was obtained through interrogation, clinical examination and Papanicolaou test. Descriptive statistical techniques were used to calculate absolute frequencies, percentages, mean and standard deviation. Result: A predominance of bacterial vaginosis was found (46%), followed by Candida spp infection (38.2%). The average age of the patients was 36.4 years. It was observed that in 244 women the age at which sexual relations began was 16 - 20 years (37.2%). 531 cases (80.9%) had an active sexual partner. 86% did not present cervical lesions, but 72.7% of HPV infections did. Conclusions: The majority of women have bacterial vaginosis, they are adults, with early onset of sexual relations and an active sexual partner. Most of them do not have cervical lesions, the majority, with HPV infection, have anomalies of the cervical epithelial cells.

Resumo A administração pós-natal precoce de antibióticos tem sido associada a efeitos duradouros no desenvolvimento e comportamento do cérebro. Pesquisas conduzidas em animais livres de germes demonstraram que o impacto da colonização do microbioma na regulação do eixo hipotálamo-hipófise-adrenal (HPA) e nas vias neuroendócrinas é substancial, o que desempenha um papel crucial no gerenciamento do estresse. No entanto, ainda é incerto se a exposição a antibióticos em ratas mães (geração F0) antes do desmame está associada a mudanças neurocomportamentais em filhotes (geração F1) durante a idade adulta. Para investigar os efeitos, perturbamos a microbiota intestinal de ratas (geração F0) administrando cefixima (CEF), um antibiótico comumente usado para fins obstétricos, em doses clinicamente relevantes (1 mg/kg, 2,5 mg/kg ou 5 mg/kg). Comportamentos semelhantes à ansiedade em descendentes adultos foram avaliados por meio da utilização do labirinto em cruz elevado (EPM) e paradigma de campo aberto (OFP) após um intervalo de seis semanas a partir do nascimento (PND42). Após as avaliações comportamentais, os ratos foram sacrificados, e seus cérebros e sangue coletados para análise bioquímica. A concentração plasmática de corticosterona foi usada para avaliar a atividade do HPA, enquanto a reação em cadeia da polimerase quantitativa em tempo real (PCR) foi empregada para determinar os níveis de transcrição do receptor de glicocorticoide (GR) Nr3c1. Os descendentes de F1 que receberam antibióticos antes do desmame passaram menos tempo no braço aberto do EPM. As alterações foram acompanhadas por níveis aumentados de corticosterona na corrente sanguínea. O estudo da expressão gênica revelou diminuição nos níveis de transcrição do mRNA de Nr3c1. Esta pesquisa enfatiza os possíveis efeitos a longo prazo da exposição a antibióticos antes do desmame no desenvolvimento de ansiedade na prole na idade adulta. pósnatal pós natal cérebro hipotálamohipófiseadrenal hipotálamo hipófise adrenal HPA (HPA substancial estresse entanto geração F0 F adulta CEF, CEF , (CEF) obstétricos 1 ( mgkg mg kg 25 2 2, mg/kg. . mg/kg) EPM (EPM OFP (OFP PND42. PND42 PND (PND42) comportamentais sacrificados bioquímica PCR (PCR GR (GR Nr3c1 Nrc Nr c sanguínea (CEF PND4 (PND42 Nr3c (PND4 (PND

Abstract Early postnatal administration of antibiotics has been linked to lasting effects on brain development and behavior. Research conducted on animals that are free from germs has demonstrated that the impact of microbiome colonization on the regulation of the hypothalamic-pituitary-adrenal (HPA) axis and neuroendocrine pathways is substantial, which play a crucial role in stress management. Nevertheless, it is still uncertain if the exposure to antibiotics in rat dams (F0-generation) before weaning is associated with neurobehavioral changes in rat offspring (F1-generation) during adulthood. In order to investigate the effects, we perturbed the intestinal microbiota of rat dams (F0 generation) by administering cefixime (CEF), an antibiotic commonly used for obstetric purposes, at clinically relevant doses (1 mg/kg, 2.5 mg/kg or 5 mg/kg). Anxiety-like behaviors in adult offspring was evaluated through the utilization of elevated plus maze (EPM) and open field paradigm (OFP) following a six-week interval from birth (PND42). Subsequent to behavioral assessments, the rats were euthanized, and their brains and blood was collected for biochemical analysis. Plasma corticosterone concentration was used to assess HPA activity, whereas the quantitative real-time polymerase chain reaction (PCR) was employed to determine the transcription levels of the glucocorticoid receptor (GR) Nr3c1. The offspring of F1 that were administered antibiotics before being weaned spent less time in the EPM open arm. The alterations were accompanied by increased levels of corticosterone in the bloodstream. The gene expression study revealed a decrease in the levels of mRNA transcription of Nr3c1. This research emphasizes the possible long-term effects of antibiotic exposure before weaning on the development of anxiety in offspring upon adulthood. behavior hypothalamicpituitaryadrenal hypothalamic pituitary adrenal (HPA substantial management Nevertheless F0generation Fgeneration F0 generation F (F0-generation F1generation (F1-generation adulthood (F CEF, CEF , (CEF) purposes 1 ( mgkg mg kg 25 2 2. mg/kg. . mg/kg) Anxietylike Anxiety like (EPM OFP (OFP sixweek six week PND42. PND42 PND (PND42) assessments euthanized analysis activity realtime real PCR (PCR GR (GR Nr3c1 Nrc Nr c arm bloodstream longterm long term (CEF PND4 (PND42 Nr3c (PND4 (PND

SUMMARY OBJECTIVE: The aim of this study was to assess the rate of bacterial infections in COVID-19-hospitalized patients and to analyze the most prevalent germs, sources, risk factors, and its impact on in-hospital mortality. METHODS: This observational retrospective study was conducted on 672 patients hospitalized between April and August 2020 in Nossa Senhora da Conceição Hospital, a public hospital located in Porto Alegre, Brazil. The inclusion criterion was adult patients hospitalized with confirmed COVID-19. Data were collected through chart review. Risk factors for bacterial infection and mortality were analyzed using both univariate and multivariate robust Poisson regression models. RESULTS: Bacterial coinfection was observed in 22.2% of patients. Risk factors for bacterial infections were dementia (RR=2.06 (1.18–3.60); p=0.011), cerebrovascular disease (RR=1.75 (1.15–2.67); p=0.009), active cancer (RR=1.52 (1.082–2.15); p=0.01), need for noninvasive ventilation (RR=2.320 (1.740–3.094); p<0.01), invasive mechanical ventilation (RR=4.63 (2.24–9.56); p<0.01), and renal replacement therapy (RR=1.68 (1.26–2.25); p<0.01). In the adjusted model, bacterial infections were not associated with mortality (0.96 (0.75–1.24); p=0.79). The most common source of infection was due to respiratory, blood, and central venous catheters, with 69 (29.36%), 61 (25.96%), and 59 (25.11%) positive cultures, respectively. CONCLUSION: We observed a high rate of bacterial infections in COVID-19-hospitalized patients, most commonly of respiratory source. Neurologic and oncologic morbidities and need for ventilation and renal replacement therapy was associated with risk factors for bacterial infections. Nevertheless, an association between bacterial infections and hospital mortality was not established. OBJECTIVE COVID19hospitalized COVIDhospitalized COVID 19 germs sources inhospital METHODS 67 202 Hospital Alegre Brazil COVID19. COVID19 19. COVID-19 review models RESULTS 222 22 2 22.2 RR=2.06 RR206 RR 06 (RR=2.0 1.18–3.60 118360 1 18 3 60 (1.18–3.60) p=0.011, p0011 p p=0.011 , 0 011 p=0.011) RR=1.75 RR175 75 (RR=1.7 1.15–2.67 115267 15 (1.15–2.67) p=0.009, p0009 p=0.009 009 p=0.009) RR=1.52 RR152 52 (RR=1.5 1.082–2.15 1082215 082 (1.082–2.15) p=0.01, p001 p=0.01 01 p=0.01) RR=2.320 RR2320 320 (RR=2.32 1.740–3.094 17403094 740 094 (1.740–3.094) p<0.01, p<0.01 p<0.01) RR=4.63 RR463 4 63 (RR=4.6 2.24–9.56 224956 24 9 56 (2.24–9.56) RR=1.68 RR168 68 (RR=1.6 1.26–2.25 126225 26 25 (1.26–2.25) p<0.01. . model 0.96 096 96 (0.9 0.75–1.24 075124 (0.75–1.24) p=0.79. p079 p=0.79 79 p=0.79) blood catheters 6 29.36%, 2936 29.36% 29 36 (29.36%) 25.96%, 2596 25.96% (25.96%) 5 25.11% 2511 11 (25.11% cultures respectively CONCLUSION Nevertheless established 20 COVID1 COVID-1 22. RR=2.0 RR20 (RR=2. 1.18–3.6 11836 (1.18–3.60 RR=1.7 RR17 7 (RR=1. 1.15–2.6 11526 (1.15–2.67 p000 p=0.00 00 RR=1.5 RR15 1.082–2.1 108221 08 (1.082–2.15 p00 p=0.0 RR=2.32 RR232 32 (RR=2.3 1.740–3.09 1740309 74 09 (1.740–3.094 p<0.0 RR=4.6 RR46 (RR=4. 2.24–9.5 22495 (2.24–9.56 RR=1.6 RR16 1.26–2.2 12622 (1.26–2.25 0.9 (0. 0.75–1.2 07512 (0.75–1.24 p07 p=0.7 293 29.36 (29.36% 259 25.96 (25.96% 25.11 251 (25.11 COVID- RR=2. RR2 (RR=2 1.18–3. 1183 (1.18–3.6 RR=1. RR1 (RR=1 1.15–2. 1152 (1.15–2.6 1.082–2. 10822 (1.082–2.1 p0 p=0. RR=2.3 RR23 1.740–3.0 174030 (1.740–3.09 p<0. RR=4. RR4 (RR=4 2.24–9. 2249 (2.24–9.5 1.26–2. 1262 (1.26–2.2 0. (0 0.75–1. 0751 (0.75–1.2 29.3 (29.36 25.9 (25.96 25.1 (25.1 RR=2 (RR= 1.18–3 118 (1.18–3. RR=1 1.15–2 115 (1.15–2. 1.082–2 1082 (1.082–2. p=0 1.740–3. 17403 (1.740–3.0 p<0 RR=4 2.24–9 224 (2.24–9. 1.26–2 126 (1.26–2. ( 0.75–1 075 (0.75–1. 29. (29.3 25. (25.9 (25. RR= (RR 1.18– (1.18–3 1.15– (1.15–2 1.082– 108 (1.082–2 p= 1.740–3 1740 (1.740–3. p< 2.24– (2.24–9 1.26– 12 (1.26–2 0.75– 07 (0.75–1 (29. (25 1.18 (1.18– 1.15 (1.15– 1.082 10 (1.082– 1.740– 174 (1.740–3 2.24 (2.24– 1.26 (1.26– 0.75 (0.75– (29 (2 1.1 (1.18 (1.15 1.08 (1.082 1.740 17 (1.740– 2.2 (2.24 1.2 (1.26 0.7 (0.75 1. (1.1 1.0 (1.08 1.74 (1.740 2. (2.2 (1.2 (0.7 (1. (1.0 1.7 (1.74 (2. (1 (1.7

ABSTRACT Introduction: Urinary tract infection in children is a health problem. Currently, resistance to Escherichia coli, the main pathogen in this disease, is increasing worldwide. Objective: To describe the behavior of antimicrobial resistance in vitro in the causal agents of urinary tract infection in children. Methods: A cross-sectional descriptive observational study was carried out in the Microbiology laboratory of William Soler Ledea Pediatric Hospital, during 2021 - 2022. The sample included 342 positive urine cultures with a count of more than 105 CFU/mL corresponding to children admitted with clinical diagnosis of urinary infection. The identification of the germ was carried out by conventional biochemical tests. Antimicrobial susceptibility was evaluated by Kirby-Bauer method and the production of extended-spectrum β-lactamases was determined. Results: Escherichia coli represented 76% of the isolates. In the total number of isolated germs, resistance was detected to: aminopenicillins and third-generation cephalosporins (30%), ciprofloxacin (20.8%), norfloxacin and sulfaprim (17.3%), gentamicin (8.2%) and amikacin (3.5%). Fosfomycin had only 4.7% resistant isolates. 21% of the total isolates were producers of extended-spectrum β-lactamases. Escherichia coli was the largest producer with 74%. Conclusions: The results suggest that the causal agents of urinary infection in children present problems of resistance to beta-lactams that are frequently accompanied by resistance to other pharmacological groups, this constitutes a health problem revealing the need for continuous monitoring of the antimicrobial susceptibility of these pathogens.

RESUMEN Introducción: La infección del tracto urinario en niños constituye un problema de salud. En la actualidad, la resistencia al Escherichia coli, principal patógeno en esta enfermedad, se encuentra en aumento a nivel mundial. Objetivo: Describir el comportamiento de la resistencia antimicrobiana in vitro en los agentes causales de infección del tracto urinario en niños. Métodos: Se realizó un estudio observacional descriptivo de corte transversal en el laboratorio de Microbiología del Hospital Pediátrico William Soler Ledea, durante los años 2021- 2022. La muestra incluyó 342 urocultivos positivos con recuento de más de 105 UFC/ml correspondientes a niños ingresados con diagnóstico clínico de infección urinaria. La identificación del germen se realizó por pruebas bioquímicas convencionales. Se evaluó la susceptibilidad antimicrobiana por el método de Kirby- Bauer y se determinó la producción de β-lactamasas de espectro extendido. Resultados: Escherichia coli representó el 76 % de los aislamientos. En el total de gérmenes aislados se detectó resistencia a: aminopenicilinas y cefalosporinas de tercera generación (30 %), ciprofloxacino (20,8 %), norfloxacino y sulfaprim (17,3 %), gentamicina (8,2 %) y amikacina (3,5 %). Fosfomicina tuvo solo un 4,7 % de aislados resistentes. Un 21 % del total de aislamientos fueron productores de β-lactamasas de espectro extendido; Escherichia coli fue la mayor productora con un 74 %. Conclusiones: Los resultados sugieren que los agentes causales de infección urinaria en niños presentan problemas de resistencia a betalactámicos que se acompaña con frecuencia de resistencia a otros grupos farmacológicos, esto constituye un problema de salud y revela la necesidad del monitoreo continuo de la susceptibilidad antimicrobiana de estos patógenos.

Resumo O desenvolvimento dentário pode apresentar alterações e alterações na forma, tamanho, estrutura e número de dentes. As anormalidades quantitativas incluem dentes supranumerários, que se desenvolvem além do número típico de dentes. Por outro lado, a fusão é uma anomalia da forma que resulta da união de dois germes dentários, que podem ser completos ou incompletos dependendo do estágio de desenvolvimento. A fusão dentária, que pode resultar em dentes duplos ou coroa dividida, é relativamente comum, com prevalência de 0,1% a 2,5%; No entanto, a fusão de três dentes, conhecida como "dente triplo", é uma anomalia rara, com prevalência de 0,02% na dentição decídua. Apresentamos o caso incomum de um menino de 5 anos com uma tripla fusão na dentição decídua entre dois incisivos inferiores e um dente supranumerário.

Resumen El desarrollo dental puede presentar cambios y alteraciones en la forma, tamaño, estructura y cantidad de dientes. Dentro de las anomalías de cantidad se encuentran los dientes supernumerarios, los cuales se desarrollan en adición a la cantidad típica de dientes. Por su parte, la fusión es una anomalía de forma que resulta de la unión de dos gérmenes dentales, pudiendo ser completa o incompleta según el estado de desarrollo. La fusión dental, que puede resultar en dientes dobles o una corona dividida, es relativamente común, con una prevalencia del 0,1% al 2,5%; sin embargo, la fusión de tres dientes, conocida como "diente triple", es una anomalía poco frecuente, con una prevalencia del 0,02% en la dentición primaria. Se reporta el caso inusual de un niño de 5 años con una triple de fusión en su dentición primaria entre dos incisivos inferiores y un diente supernumerario.

Abstract Tooth development can present changes and alterations in the shape, size, structure, and number of teeth. Among the quantity anomalies are supernumerary teeth, which develop in addition to the typical number of teeth. On the other hand, fusion is an anomaly of form that results from the union of two dental germs, which can be complete or incomplete depending on the stage of development. Dental fusion, which can result in double teeth or a split crown, is relatively common, with a prevalence of 0.1% to 2.5%; However, three-tooth fusion, known as "triple tooth," is a rare anomaly, with a prevalence of 0.02% in the primary dentition. We present the unusual case of a 5-year-old boy with a triple fusion in his primary dentition between two lower incisors and a supernumerary tooth.

RESUMEN La tuberculosis (TB) es una de las principales enfermedades infecciosas a nivel mundial y sigue siendo un grave problema de salud pública en muchos países. La Organización Mundial de la Salud (OMS) estima que un tercio de la población está infectada con TB y la tasa de infección aumenta casi un 1% por año. Esta revisión tiene como objetivo exponer la identidad de la tuberculosis congénita rara y fatal si no se trata y resaltar las características clínicas y la dificultad de diagnóstico y la conciencia entre los pediatras para realizar un manejo terapéutico inmediato desde el inicio de la sospecha. Este estudio se propone detectar que el pronóstico es malo para los recién nacidos, seguido de una evolución fatal cuando el diagnóstico se retrasa. Se presenta a continuación el caso de un recién nacido de sexo masculino de 24 días de vida por parto cesárea, por RPM nacido de una madre que presentó infección por SARS-COV-2 14 días previos al parto. A los 5 días de post parto adormecimiento y debilidad de miembros inferiores, sin síntomas respiratorios, posteriormente fiebre de 5 días de evolución, con diagnóstico de TB cerebral sin síntomas respiratorios, RN con fiebre y tos de 3 días, hepatomegalia de 4.5 cm, sin adenopatías. Ecografía abdominal dentro de parámetros normales, ecocardiograma con despegamiento pericárdico laminar, ecografía cerebral, ecografía abdominal fondo de ojo dentro de parámetros normales. Radiografía de tórax mostró infiltrado nodulillar difuso bilateral compatible con diseminación miliar tuberculosa. Al ingreso se inició cobertura antibiótica con Cefotaxima más Ampicilina a dosis meníngea. Analítica laboratorial al ingreso perfil hepático alterado, glóbulos blancos en rango, presentó granulaciones toxicas 3% y reactantes de fase aguda aumentados. Se realizó punción lumbar con cultivo de LCR negativo para gérmenes comunes y micobacterias por lo cual se descendió antibioticoterapia a completando 9 días totales. En muestras seriadas durante 3 días de líquido gástrico tinción de Ziehl-Neelsen BAAR +++ en las 3 muestras, GENEXPERT M. tuberculosis detectado y secreción traqueal tinción de BAAR +++. Inició terapia antibacilar H10/R20/Z20/E20. Durante su internación presenta alteración de perfil hepático por lo cual se ajusta dosis H5/R10/Z15/E15 en conjunto con Piridoxina. Durante tratamiento antibacilar a los 10 meses presentó en ecografía abdominal múltiples calcificaciones en hígado y ecografía cerebral de control con dilatación leve de los ventrículos laterales en ambos lados. Al finalizar tratamiento al examen físico se constató hígado a 2 cm RCD al año de vida, crecimiento y desarrollo normal para la edad, controles oftalmológicos y auditivos sin hallazgos patológicos. El recién nacido recibió 2 meses de HRZE y 10 meses de HR completando 12 meses totales de tratamiento en conjunto con Piridoxina hasta 10 días posterior a la suspensión de antibacilares y la madre recibió 4 meses de HRZE y 8 meses de HR completando 12 meses de tratamiento antibacilar.

ABSTRACT Tuberculosis (TB) is one of the major infectious diseases worldwide and continues to be a serious public health problem in many countries. The World Health Organization (WHO) estimates that one third of the population is infected with TB and the infection rate is increasing by almost 1% per year. This review aims to expose the identity of rare and fatal congenital tuberculosis if left untreated and to highlight the clinical features and the difficulty of diagnosis and awareness among pediatricians to perform immediate therapeutic management from the onset of suspicion. This study aims to detect that the prognosis is poor for newborns, followed by a fatal course when diagnosis is delayed. The case of a 24-day-old male newborn by cesarean section, due to PROM born to a mother who presented SARS-COV-2 infection 14 days prior to delivery, is presented below. At 5 days postpartum, numbness and weakness of the lower limbs, without respiratory symptoms, later fever of 5 days of evolution, with a diagnosis of cerebral TB without respiratory symptoms, newborn with fever and cough of 3 days, hepatomegaly of 4.5 cm, without adenopathies. Abdominal ultrasound within normal parameters, echocardiogram with laminar pericardial detachment, brain ultrasound, fundus abdominal ultrasound within normal parameters. Chest X-ray showed bilateral diffuse nodular infiltrate compatible with tuberculous miliary dissemination. On admission, antibiotic coverage was started with Cefotaxime plus Ampicillin at a meningeal dose. Laboratory analysis on admission altered liver profile, white blood cells in range, presented 3% toxic granulations and increased acute phase reactants. A lumbar puncture was performed with a negative CSF culture for common germs and mycobacteria, for which antibiotic therapy was decreased to a total of 9 days. In serial samples for 3 days of gastric fluid Ziehl-Neelsen AFB staining +++ in the 3 samples, GENEXPERT M. tuberculosis detected and tracheal secretion AFB staining +++. He started H10/R20/Z20/E20 antibacillary therapy. During his hospitalization, he presented an alteration in the liver profile, for which the H5/R10/Z15/E15 dose was adjusted in conjunction with Pyridoxine. During antibacillary treatment at 10 months, abdominal ultrasound revealed multiple calcifications in the liver and control brain ultrasound with mild dilatation of the lateral ventricles on both sides. At the end of treatment, the physical examination confirmed the liver at 2 cm RCD at one year of life, normal growth and development for age, ophthalmological and hearing controls without pathological findings. The newborn received 2 months of HRZE and 10 months of HR, completing a total of 12 months of treatment in conjunction with Pyridoxine up to 10 days after the suspension of antibacillary drugs, and the mother received 4 months of HRZE and 8 months of HR, completing 12 months of treatment. antibacillary.

ABSTRACT Introduction: Intestinal infections are related to disorders of the immune system and intestinal microbiota. They can be recurrent and produce other intestinal and systemic alterations, which worsen with antimicrobial therapy. Ozone therapy has been used in the treatment of intestinal infections. Objectives: To compile information on the biological, therapeutic effects and safety of the administration of ozone by rectal insufflation in the treatment of intestinal infections. Methods: Google Scholar search engine was used for searching information. Articles were consulted in PubMed and SciELO databases of the Virtual Health Library. In addition, a general search was carried out in Spanish and English, based on the most relevant articles about the study. The keywords used were infections, insufflation, gastrointestinal microbiome, ozone as more specific terms. No restrictions on geographic area or age were applied in the study. Conclusions: The rectal application of ozone is safe, it has useful biological and therapeutic actions to treat intestinal infections, acting as an immunomodulator and protector of the intestinal microbiota, which allows us to face this health problem from a preventive, curative and rehabilitation point of view of the damage caused, both by germs and by the effects of antibiotics.

RESUMEN Introducción: Las infecciones intestinales se relacionan con trastornos del sistema inmune y de la microbiota intestinal. Pueden ser recurrentes y producir otras alteraciones intestinales y sistémicas, que empeoran con la terapia antimicrobiana. La ozonoterapia ha sido usada en el tratamiento de infecciones intestinales. Objetivos: Recopilar información sobre los efectos biológicos, terapéuticos y la seguridad de la administración del ozono por insuflación rectal en el tratamiento de las infecciones intestinales. Métodos: Para la búsqueda de información se empleó el motor de búsqueda Google Académico. Se consultaron artículos en las bases de datos PubMed y SciELO de la Biblioteca Virtual de Salud. Además, se realizó una búsqueda general en los idiomas español e inglés, a partir de los artículos más relevantes acerca del estudio. Se utilizaron como palabras clave: infecciones, insuflación, microbioma gastrointestinal, ozono como términos más concretos. En el estudio no se aplicó ninguna restricción acerca del ámbito geográfico ni de la edad. Conclusiones: La aplicación rectal de ozono es segura, tiene acciones biológicas y terapéuticas útiles para tratar las infecciones intestinales. Actúa como inmunomodulador y protector de la microbiota intestinal, lo que permite enfrentar esta problemática de salud desde el punto de vista preventivo, curativo y de rehabilitación de los daños causados, tanto por los gérmenes como por los efectos de los antibióticos.

Resumen Introducción: Aunque el tratamiento del mieloma múltiple ha avanzado en los últimos años con el subsecuente aumento en la supervivencia a largo plazo, la mortalidad temprana sigue siendo un fenómeno trascendental, donde las infecciones pueden tener un papel fundamental, por lo que el entendimiento de la epidemiología local puede ayudar a dirigir las medidas de profilaxis antimicrobiana e impactar en desenlaces en la evolución temprana de la enfermedad. Métodos: Se realizó un estudio descriptivo donde se incluyeron 169 pacientes mayores de 18 años hospitalizados en un centro de alta complejidad en Medellín, Colombia, en el periodo de tiempo comprendido entre enero de 2012 y junio de 2021, con máximo 3 meses de diagnóstico confirmado de mieloma múltiple. Se recogieron variables sociodemográficas y clínicas basales de los pacientes, y se describió la presencia de infecciones, los aislamientos microbiológicos y antimicrobianos utilizados. Resultados: De 169 pacientes con mieloma múltiple de reciente diagnóstico, 95 (56.2%) de los pacientes presentaron alguna infección. De los cuales, las infecciones respiratorias y urinarias fueron las más comunes (ambas 15.4%). Los gérmenes más aislados fueron los bacilos gram negativos (33.7%) y los cocos gram positivos (21.1%). Con respecto al uso de profilaxis, la mayoría de los pacientes recibió antiviral 107 (63.3%), azoles 98 (58%), y pocos antibióticos 29 (17.2%). En cuanto al tiempo de aparición de infecciones, los pacientes tuvieron un promedio de 24 días desde el momento del ingreso hospitalario, y de 8 días desde el momento del inicio de la quimioterapia. Con relación a la mortalidad por cualquier causa en los primeros 3 meses, se presentó en el 24% y de estos, 2 tercios estuvieron relacionados con procesos infecciosos. Conclusión: Las infecciones en los pacientes con mieloma múltiple de reciente diagnóstico son una causa importante de mortalidad, a pesar de los esfuerzos preventivos y terapéuticos de las últimas décadas. Se documenta un cambio en la epidemiología de los gérmenes que afectan a estos pacientes. Por esto, es menester reconocer las infecciones en el ámbito hospitalario en mieloma múltiple para establecer guías de manejo locales.

Abstract Introduction: Although the treatment of multiple myeloma has advanced in recent years with a subsequent increase in long-term survival, early mortality remains a transcendental event, where infections may play a key role, understanding the local epidemiology may help to direct antimicrobial prophylaxis measures and impact on outcomes in the early evolution of the disease. Methods: We conducted a descriptive study including 169 patients older than 18 years hospitalized in a high-complexity health center in Medellin, Colombia, in the period between January 2012 and June 2021, with a maximum of 3 months of confirmed diagnosis of multiple myeloma. Baseline sociodemographic and clinical variables of the patients were collected, and the presence of infections, microbiological and antimicrobial isolates used were described. Results: Out of 169 patients with newly diagnosed multiple myeloma, 95 (56.2%) of the patients had some infection. Of these, respiratory and urinary tract infections were the most common (both 15.4%). The most isolated germs were gram-negative bacilli (33.7%) and gram-positive cocci (21.1%). Regarding the use of prophylaxis, most patients received antiviral 107 (63.3%), azoles 98 (58%), and few antibiotics 29 (17.2%). Regarding the time of onset of infections, patients had an average of 24 days from the time of hospital admission, and 8 days from the time of initiation of chemotherapy. In relation to all-cause mortality in the first 3 months, 24% were present and of these, 2 thirds were related to infectious processes. Conclusion: Infections in patients with newly diagnosed multiple myeloma are an important cause of mortality, despite preventive and therapeutic efforts in recent decades. A change in the epidemiology of the germs affecting these patients has been documented. Therefore, it is necessary to recognize infections in the hospital setting in multiple myeloma in order to establish local management guidelines.

ABSTRACT Introduction: Infection is one of the complications that frequently affects critically ill patients. Objective: To determine the presence of opportunistic microorganisms in patients admitted to the Intensive Care Unit (ICU) from January to June 2021 at the Asunción Adventist Sanatorium. Materials and methods: Descriptive, cross-sectional study, in the period January to June 2021. The data were analyzed by EPIINFO, using descriptive statistics. Demographic variables, comorbidities, presence of COVID-19, performed procedure (intubation, mechanical ventilation, tracheostomy), length of stay in the ICU, isolated germs, administered treatment, and most frequently used antibiotics were collected from all the patients evaluated. The variable "length of stay in the ICU" corresponds to the total hospital stay of the patients in that unit. Results: 90 patients were included in the study period. 72 were male, which corresponded to 80%. The average age was 55 ± 5.6 years. Their average hospital stay was 11 days (1-62). The most frequent comorbidities were hypertension, obesity and diabetes mellitus II. The prevalent identified microorganisms were Escherichia coli (n=9), Acinetobacter baumannii (n=9), Enterobacter cloacae (n=3); Pseudomonas aeruginosa (n=5), Staphylococcus aureus (n=1), Candida spp. (n=13), Klebsiella pneumoniae (n=7), Acinobacter sp (n=18). Overall mortality was 63.3% (57 patients). Conclusion: Acinobacter sp. was the most frequently isolated microorganism. Antimicrobial resistance levels were high, with all isolated germs being resistant to ciprofloxacin.

RESUMEN Introducción: La infección es una de las complicaciones que afecta frecuentemente al paciente crítico. Objetivo: Determinar la presencia de gérmenes oportunistas en pacientes internados en la Unidad de Cuidados Intensivos (UCI) durante el periodo de enero a junio del 2021 en el Sanatorio Adventista de Asunción. Materiales y Métodos: Estudio descriptivo, de corte transversal, en el periodo comprendido de enero a junio de 2021. Los datos fueron analizados por EPIINFO, utilizándose estadística descriptiva. En todos los pacientes evaluados se recogieron variables demográficas, comorbilidades, presencia del COVID-19, instrumentaciones realizadas (intubación, ventilación mecánica, traqueotomía), días de estancia en UCI, gérmenes aislados, tratamiento realizado, antibióticos más frecuentes utilizados. La variable "días de estancia en UCI" corresponde a la estancia total de los pacientes en dicha unidad. Resultados: Fueron incluidos 90 pacientes en el periodo de tiempo de estudio. De ellos: 72 fueron de sexo masculino que correspondió al (80%). La edad promedio fue de 55 ± 5,6 años. La estancia hospitalaria total de los mismos fue en promedio de 11 días (1-62). Las comorbilidades más frecuentes fueron: hipertensión, obesidad y diabetes mellitus II Los microorganismos identificados prevalentes fueron Escherichia coli (n=9), Acinetobacter baumannii (n=9), Enterobacter cloacae (n=3); Pseudomonas aeruginosa (n=5), Staphylococcus aureus (n=1) Candida spp. (n=13), Klebsiella pneumoniae (n=7), Acinobacter sp(n=18). La mortalidad global fue del 63,3% (57 pacientes). Conclusión: Acinobacter sp. fue el microorganismo que se aisló con mayor frecuencia. Los niveles de resistencia a los antimicrobianos fueron elevados siendo todos los gérmenes aislados ciprofloxacina resistente.

Abstract Tooth development depends on a series of reciprocal signaling interactions between the oral epithelium and ectomesenchyme. This study aimed to investigate the role of CK14, a protein involved in Wnt-1/β-catenin signaling, in odontogenesis and the development of odontomas. This cross-sectional, retrospective, immunohistochemical study analyzed 30 compound odontomas, 30 complex odontomas, and 17 tooth germs. Higher immunoexpression of CK14 was observed in odontogenic epithelial cells of tooth germs (p < 0.001) and odontogenic epithelial cells of odontomas (p < 0.001). There was higher immunoexpression of Wnt-1 and β-catenin proteins in epithelial cells of tooth germs (p = 0.002 and p < 0.001, respectively), as well as in the ectomesenchyme of odontomas (p = 0.003 and p < 0.001, respectively). β-Catenin was moderately and significantly correlated with CK14 in the membrane of reduced enamel epithelial cells in odontomas (p = 0.007). Higher immunoexpression of CK14 was observed in the odontogenic epithelium during the bud and cap stages and lower immunoexpression in the internal enamel epithelium during the bell stage. In odontomas, lower expression of Wnt-1/β-catenin and higher immunoexpression of CK14 were found in odontogenic epithelial cells, especially adjacent to the mineralized material resembling the tooth formed in these lesions. CK Wnt1/βcatenin Wnt1βcatenin Wntβcatenin Wnt 1/β catenin 1 β crosssectional, crosssectional cross sectional, sectional cross-sectional retrospective 3 CK1 0.001 0001 0 001 0.001. . Wnt1 Wnt- βcatenin 0002 002 0.00 respectively, respectively , respectively) 0003 003 respectively. βCatenin Catenin 0.007. 0007 0.007 007 0.007) stage lesions 1β 000 00 0.0 0.

Resumo O desenvolvimento dentário depende de uma série de interações de sinalização recíproca entre o epitélio oral e o ectomesênquima. O objetivo deste estudo foi investigar o papel da CK14 das vias WNT-1/β-catenina na odontogênese e no desenvolvimento de odontomas. Este estudo transversal, retrospectivo, imuno-histoquímico analisou 30 odontomas compostos, 30 odontomas complexos e 17 germes dentários. A CK14 apresentou maior imunoexpressão em células epiteliais odontogênicas de germes dentários (p<0,001) e em células epiteliais odontogênicas de odontomas (p<0,001). A Wnt-1 e a β-catenina apresentaram maior imunoexpressão de proteínas nas células epiteliais dos germes dentários (p = 0,002 e p<0,001, respectivamente), bem como no ectomesênquima dos odontomas (p = 0,003 e p < 0,001, respectivamente). A β-catenina correlacionou-se moderada e significativamente com a CK14 na membrana de células epiteliais reduzidas do esmalte em odontomas (p = 0,007). Maior imunoexpressão da CK14 foi observada no epitélio odontogênico nos estágios de botão e capuz com menor imunoexpressão no epitélio interno do órgão do esmalte no estágio de sino. Nos odontomas, foi observado menor expressão de Wnt-1/β-catenina e maior imunoexpressão da CK14 presente nas células epiteliais odontogênicas, especialmente, vizinhas ao material mineralizado semelhante ao dente formado nessas lesões. CK CK1 WNT1/βcatenina WNT1βcatenina WNTβcatenina WNT 1/β catenina 1 β transversal retrospectivo imunohistoquímico imuno histoquímico 3 compostos p<0,001 p0001 0 001 (p<0,001 p<0,001. . Wnt1 Wnt Wnt- βcatenina 0002 002 0,00 respectivamente, respectivamente , respectivamente) 0003 003 0001 0,001 respectivamente. correlacionouse correlacionou se 0,007. 0007 0,007 007 0,007) sino Wnt1/βcatenina Wnt1βcatenina Wntβcatenina especialmente lesões WNT1 1β p<0,00 p000 00 (p<0,00 000 0,0 p<0,0 p00 (p<0,0 0, p<0, p0 (p<0, p<0 (p<0 p< (p<

Resumen Las infecciones siguen siendo una importante causa de morbimortalidad en los pacientes oncológicos, ocasionando retraso en la continuidad del tratamiento y aumentando los costos en salud. Pueden ser producidas por gérmenes que ganan acceso a sitios estériles a través de las barreras epiteliales alteradas por la quimioterapia y la inmunosupresión; con una mortalidad que varía entre el 14 y 42% según diferentes estudios. Algunos microorganismos, no patógenos en otras condiciones, se convierten en patógenos, desencadenando bacteriemias y disfunción multiorgánica severa, como es el caso que presentamos a continuación.

Abstract Infections continue to be an important cause of morbidity and mortality in cancer patients, causing delays in the continuity of treatment and increasing healthcare costs. They can be caused by germs that gain access to sterile areas through epithelial barriers that are altered by chemotherapy and immunosuppression; with a mortality that varies between 14 and 42% according to different studies. Some non-pathogenic microorganisms, in other conditions, become pathogenic, triggering bacteremia and severe multiorgan dysfunction, as is the case presented below.