Abstract Introduction. There is a great human concern about antibiotics resistance due to their inappropriate use as growth promoters in animal husbandry. Objective. To evaluate the effect of a high level of zinc as a substitute to antibiotics in nursery pigs. Material and methods. The study was carried out from June to August 2022 in the province of Chiriqui, Panama. The experimental period was composed of three phases with 14 days per phase. The nursery pigs (n= 54) were distributed to one of three treatments with six replicates per treatment and three pigs per replicate. The treatments were: 1) control diet, which was formulated to meet the nutritional requirements for nursery pigs; 2) similar to treatment 1, plus 200 mg of amoxicillin/kg of feed and 40 mg of florfenicol/kg of feed during phase 1 (P1) and phase 2 (P2), respectively; and 3) similar to treatment 1, plus 2000 ppm and 1600 ppm of zinc during P1 and P2, respectively. In phase 3 (P3), all pigs were fed a common diet. Results. The supplementation of zinc improved the average daily gain in all phases. Pigs fed zinc diet had better F:G ratio in P2 compared to pigs fed antibiotic diet (p < 0.05). A higher concentration of hemoglobin and percentage of monocytes was found in pigs fed with higher level of zinc than the other treatments (p < 0.05). Furthermore, Pigs fed the antibiotic, or the control diet had a lower percentage of fecal dry matter compared to those supplemented with zinc. (p < 0.05). Conclusion. The supplementation of high levels of zinc exerted improvements, in comparison to the antibiotic, in terms of hemoglobin concentration, incidence of diarrhea and weight gain in pigs during 42 days after weaning.

Resumen Introducción. Existe una gran preocupación humana por la resistencia a los antibióticos debido a su uso inadecuado como promotores del crecimiento en la cría de animales. Objetivo. Evaluar el efecto de altos niveles de zinc como sustituto del antibiótico en lechones destetados. Material y métodos. El estudio se realizó de junio a agosto de 2022 en la provincia de Chiriquí, Panamá. El periodo experimental estuvo compuesto por tres fases con 14 días por fase. Los cerdos destetados (n= 54) fueron asignados a uno de tres tratamientos con seis repeticiones por tratamiento y tres cerdos por repetición. Los tratamientos fueron: 1) dieta control, formulada para suplir los requerimientos nutricionales para cerdos destetados; 2) similar al tratamiento 1, más 200 mg de amoxicilina/kg de alimento y 40 mg de florfenicol/kg de alimento durante la fase 1 (P1) y fase 2 (P2), respectivamente; y 3) similar al tratamiento 1, más 2000 ppm y 1600 ppm de zinc durante P1 y P2, respectivamente. En la fase 3 (P3), todos los cerdos fueron alimentados con una dieta común. Resultados. La suplementación con zinc mejoró la ganancia de peso en todas las fases. Los cerdos alimentados con zinc tuvieron mejor relación F:G en P2 en comparación a los cerdos suplementados con antibiótico (p < 0.05). Se encontró una mayor concentración de hemoglobina y porcentaje de monocitos en cerdos alimentados con zinc que en los otros tratamientos (p < 0.05). Los cerdos alimentados con antibiótico o la dieta control tuvieron un menor porcentaje de materia seca fecal en comparación a los suplementados con zinc (p < 0.05). Conclusión. La suplementación de altos niveles de zinc ejerció mejoras, en comparación al antibiótico, en cuanto a la concentración de hemoglobina, incidencia de diarrea y ganancia de peso en cerdos durante los 42 días posteriores al destete.

Resumen La bacteria Escherichia coli causa la colibacilosis en animales de granja que actúan como reservorios de cepas patógenas. La resistencia antimicrobiana de E. coli productor de betalactamasas de espectro extendido [BLEE] es un grave problema de salud pública y se puede atribuir a factores relacionados con el consumo de alimentos y el contacto con animales domésticos. El objetivo de este estudio fue determinar la presencia y patrones de resistencia antimicrobiana de E. coli BLEE aislado en muestras fecales provenientes de bovinos productores de leche de la provincia de Pichincha. Se analizaron un total 182 muestras de heces de bovinos: 112 muestras de bovinos faenados en el Camal Metropolitano de la provincia de Pichincha y 70 muestras de la colección de la Unidad de Investigación de Enfermedades Transmitidas por Alimentos y Resistencias a los Antimicrobianos [UNIETAR], se realizó el aislamiento de E. coli BLEE, la identificación bioquímica y pruebas de resistencia a los principales antibióticos utilizados. Se logró identificar 93 muestras positivas a E. coli BLEE (51 %), el análisis fenotípico reveló que los antibióticos amoxicilina más ácido clavulánico, cefepime, ceftazidima, ciprofloxacina, amikacina y tetraciclina presentaron porcentajes de resistencia mayores al 80 %. Además, se observó una baja resistencia a la nitrofurantoína, cefoxitin y ertapenem, mientras que ningún aislado fue resistente a la tigeciclina. El 100 % de los aislados presentaron fenotipos de multirresistencia y el patrón más frecuente estuvo compuesto por 7 familias de antibióticos. En conclusión, estos resultados sugieren que E. coli originaria de bovinos lecheros podría ser un reservorio de genes BLEE.

Abstract Escherichia coli causes colibacillosis in farm animals that act as reservoirs for pathogenic strains. Antimicrobial resistance of E. coli producing Extended Spectrum Beta-lactamases [ESBL] is a serious public health problem that can be attributed to factors related to food consumption and contact with domestic animals. This study aimed to determine the presence and patterns of antimicrobial resistance of ESBL E. coli isolated from fecal samples from dairy cattle in the Pichincha province. A total of 182 bovine feces samples were analyzed, 112 samples from cattle slaughtered at the official slaughterhouse in Quito-Pichincha province, and 70 samples from the collection of the Foodborne Diseases and Antimicrobial Resistance Research Unit [UNIETAR]. The isolation of ESBL E. coli, biochemical identification, and resistance tests using the main antibiotics were carried out at UNIETAR. It was possible to identify 93 positive samples for ESBL E. coli (51%), phenotypic analysis revealed that antibiotics such as amoxicillin plus clavulanic acid, cefepime, ceftazidime, ciprofloxacin, amikacin, tetracycline, presented resistance higher than 80%. Furthermore, low resistance to nitrofurantoin, cefoxitin, and ertapenem was observed, while no isolate was resistant to tigecycline. One hundred percent of the isolates presented multi-resistance phenotypes, with the most frequent pattern being composed of 7 families of antibiotics. In conclusion, these results suggest that E. coli from dairy cattle origin could be an important reservoir of ESBL genes.

Abstract Background: Healthcare-associated infections are a prevalent issue in health systems that affect everyone. The incidence and prevalence of healthcare-associated infections depend on the context in which they occur. An example of this is ventilator-associated pneumonia in intensive care units. Objective: To analyze the determinants of ventilator-associated pneumonia in an intensive care unit of a central hospital in northern Portugal. Methodology: A retrospective, descriptive-correlational quantitative study was conducted with 705 patients admitted to the ICU of the hospital under investigation. Results: The results show that male gender, previous antibiotic use, endotracheal reintubation, level of consciousness, cuff pressure, ventilation time, injury, poisoning, and certain other consequences of external causes as admitting diagnosis are among the determinants of ventilator-associated pneumonia. Moreover, the incidence of ventilator-associated pneumonia was of 4.5%. Conclusion: The study recommends the judicious use of antibiotics, limiting the duration of invasive ventilation, implementing ventilator weaning protocols, and auditing compliance with the care bundle for ventilator-associated pneumonia. This study sheds light on the prevention of ventilator-associated pneumonia and its recommendations contribute to better care and more effective and safer nursing interventions.

Resumo Enquadramento: As infeções associadas aos cuidados de saúde (IACS) são uma problemática atual dos sistemas de saúde variando a sua incidência, prevalência do contexto de cuidados. A pneumonia associada à ventilação (PAV) é disso um exemplo ocorrendo em unidades de cuidados intensivos (UCI). Objetivo: Analisar determinantes da PAV, em doentes internados numa UCI de um hospital central do norte de Portugal. Metodologia: Estudo descritivo-correlacional e retrospetivo, com base nos registos de 705 doentes internados na UCI. Resultados: Constituíram-se determinantes da PAV o sexo masculino, tratamento prévio com antibiótico, reintubação endotraqueal, nível de consciência, pressão de cuff, tempo de ventilação, diagnóstico de entrada lesões, envenenamento e algumas outras consequências de causas externas. A incidência de PAV foi de 4,5%. Conclusão: O uso criterioso de antibióticos, o menor tempo possível de ventilação invasiva, a implementação de protocolos de desmame ventilatório e auditorias ao cumprimento da bundle da PAV podem contribuir para melhores cuidados e intervenções de enfermagem mais eficazes e seguras.

Resumen Marco contextual: Las infecciones asociadas a los cuidados sanitarios (IACS) son un problema actual en los sistemas sanitarios, y su incidencia y prevalencia varían en función del entorno asistencial. Un ejemplo de ello es la neumonía asociada a la ventilación mecánica (PAV), que se da en las unidades de cuidados intensivos (UCI). Objetivo: Analizar los determinantes de la PAV en pacientes ingresados en la UCI de un hospital central del norte de Portugal. Metodología: Estudio descriptivo-correlacional y retrospectivo, basado en los registros de 705 pacientes ingresados en la UCI. Resultados: Los factores determinantes de la PAV fueron el sexo masculino, el tratamiento antibiótico previo, la reintubación endotraqueal, el nivel de consciencia, la presión del manguito, el tiempo de ventilación, el diagnóstico de entrada de lesiones, la intoxicación y algunas otras consecuencias de causas externas. La incidencia de PAV fue del 4,5%. Conclusión: El uso prudente de antibióticos, el menor tiempo posible de ventilación invasiva, la aplicación de protocolos de destete del ventilador y las auditorías de cumplimiento del paquete de PAV pueden contribuir a mejorar los cuidados y a que las intervenciones de enfermería sean más eficaces y seguras.

Antibiotic resistance is a global threat, with a disproportionate burden of mortality in low- and middle-income countries. It is increasing in both the public and private healthcare sectors within South Africa, especially in Gram-negative organisms, and is associated with increased use of World Health Organization watch and reserve antibiotics. There is a need for improved access to new antibiotics to treat infections caused by drug-resistant organisms in order to limit side-effects and improve patient outcomes of currently available antibiotics. We propose the responsible introduction of these new antibiotics with both administrative and clinical oversight in order to preserve the longevity of these precious antibiotics.

Abstract Hailey-Hailey disease is a rare genodermatosis described in 1939, with an autosomal dominant inheritance pattern, characterized by compromised adhesion between epidermal keratinocytes. It has an estimated prevalence of 1/50,000, with no gender or race predilection. It results from a heterozygous mutation in the ATP2C1 gene, which encodes the transmembrane protein hSPA1C, present in all tissues, with preferential expression in keratinocytes. Mutations in the ATP2C1 gene cause changes in the synthesis of junctional proteins, leading to acantholysis. It usually begins in adulthood, with isolated cases at the extremes of life. It manifests as vesico-bullous lesions mainly in the flexural areas, which develop into erosions and crusts. Chronic lesions may form vegetative or verrucous plaques. Pruritus, a burning feeling and pain are common. It evolves with periods of remission and exacerbation, generally triggered by humidity, friction, heat, trauma and secondary infections. The diagnosis is based on clinical and histopathological criteria: marked suprabasal acantholysis, loosely joined keratinocytes, giving the appearance of a “dilapidated brick wall”, with a few dyskeratotic cells. The acantholysis affects the epidermis and spares the adnexal epithelia, which helps in the differential diagnosis with pemphigus vulgaris. Direct immunofluorescence is negative. The main differential diagnoses are Darier disease, pemphigus vegetans, intertrigo, contact dermatitis, and inverse psoriasis. There is no cure and the treatment is challenging, including measures to control heat, sweat and friction, topical medications (corticosteroids, calcineurin inhibitors, antibiotics), systemic medications (antibiotics, corticosteroids, immunosuppressants, retinoids and immunobiologicals) and procedures such as botulinum toxin, laser and surgery. There is a lack of controlled clinical trials to support the choice of the best treatment. HaileyHailey Hailey 1939 pattern keratinocytes 150000 1 50 000 1/50,000 predilection ATPC ATP C ATP2C hSPA1C hSPAC hSPA tissues proteins adulthood life vesicobullous vesico bullous areas crusts plaques Pruritus common exacerbation humidity friction heat infections criteria dilapidated wall, wall , wall” cells epithelia vulgaris negative vegetans intertrigo dermatitis psoriasis challenging corticosteroids (corticosteroids inhibitors antibiotics, antibiotics antibiotics) (antibiotics immunosuppressants immunobiologicals toxin surgery 193 15000 5 00 1/50,00 19 1500 0 1/50,0 150 1/50, 15 1/50 1/5 1/

Abstract Background Hidradenitis suppurativa (HS) is a chronic inflammatory disease that leads to the formation of nodules, abscesses and fistulas, with the formation of scars and fibrosis, causing significant impairment in patient quality of life. The diagnosis is clinical, using scores to classify the severity of the condition; currently the most recommended classification is the International Hidradenitis Suppurativa Severity Scoring System (IHS4). Doppler ultrasound has been used to complement the clinical evaluation of patients with HS. It is possible to observe subclinical lesions that change the staging, the severity of the case, and its treatment, either clinical or surgical. Correct treatment is essential to minimize the consequences of this disease for the patient. Objective To establish an outpatient protocol for the use of Doppler ultrasound in the care of patients with HS. Methods A narrative review of the literature was carried out on the use of Doppler ultrasound in patients with hidradenitis suppurativa; a referring protocol and technique orientations for imaging assessment in HS were created. Results Recommendation to perform ultrasound evaluation of symptomatic areas eight weeks after using antibiotics and four, 12, and 24 weeks after starting immunobiologicals; apply SOS-HS ultrasound severity classification. Study limitations The review did not cover all literature on ultrasound and HS; no systematic review was carried out, but rather a narrative one. Conclusions The correct assessment of patients staging must be carried out using dermatological ultrasound to avoid progression to scars and fibrosis, which compromise patients quality of life. (HS nodules fistulas fibrosis life condition IHS4. IHS4 IHS . (IHS4) case surgical created four 12 2 immunobiologicals SOSHS SOS one (IHS4 1 (IHS

Abstract PA is a gram-negative pathogen that is highly aggressive and known to cause several nosocomial infections, leading to significant morbidity and mortality levels. Individuals with compromised immunity are especially vulnerable to life-threatening infections caused by this bacterium. PA importance as a pathogen is further underscored by its virulence, increasing resistance to antibiotics, and its ability to adapt to diverse environmental conditions. In this study, MO extract antibacterial activity was evaluated using Ec methods, such as CV, EIS and polarization curves (Tafel’s law), against pathogenic bacteria, including PA. The performance of the developed CPE modified by MO was herein tested with C6H12O6, by CV technique. The CV recorded at the CPE-MO surface showed a well-defined peak, which was due to C₆H₁₂O₆ Ec oxidation. PA addition to the electrolyte solution containing C₆H₁₂O₆ caused its oxidation peak to disappear. The hypothesis that PA would adhere to the CPE-MO surface, blocking the active sites and, subsequently, C₆H₁₂O₆ oxidation, was proposed. To verify this hypothesis, polarization curves and EIS, which revealed the presence of a non-conductive film on the CPE-MO surface, were employed. The morphology of the elaborated electrodes surfaces was characterized by SEM.

Antimicrobial resistance (AMR), in which microbes adapt to and resist current therapies, is a well-recognised global problem that threatens to reverse gains made by modern medicine in the last decades. AMR is a complex issue; however, at its core, it is driven by the overuse and inappropriate use of antimicrobials. Socioeconomic factors have been identified as significant contributors to the emergence and exacerbation of AMR, especially in populations facing inadequate access to healthcare, poor sanitation services and high morbidity and mortality rates. Weak healthcare systems and water, sanitation and hygiene have been highlighted as fundamental risk factors for AMR emergence and transmission. Behavioural factors, such as purchasing antibiotics without a prescription from a registered healthcare professional, not completing the prescribed course or overly prolonged courses of antibiotics, using antibiotics to treat viral infections, lack of access to quality antibiotics, and the proliferation of substandard or falsified (SF) drugs, have also been identified as significant contributors to AMR. Low- and middle-income countries have a higher incidence of antibiotics being dispensed without a prescription than higher-income countries.

Abstract Multiple pregnancies carry an increased risk of preterm birth, mortality and long-term infant morbidity. We report a case of delayed delivery following a trichorionic triamniotic pregnancy. The pregnant woman was hospitalized due to preterm premature rupture of membranes at 26 weeks. Tocolytics and corticosteroids were provided. Despite these efforts, the first fetus was born vaginally, 48 hours later. After delivery, antibiotics and tocolytics were administered to delay the birth of the remaining fetuses, which occurred after two weeks. All three babies are healthy, with normal neurological development, and the postpartum period was uneventful.

Resumo As gestações múltiplas têm um maior risco de parto prematuro e morbimortalidade neonatal. Este artigo descreve um caso de parto diferido numa gravidez tricoriónica e triamniótica. A grávida foi hospitalizada devido à rutura prematura das membranas às 26 semanas, recebendo tocolíticos e corticosteroides. O primeiro feto nasceu por parto eutócico 48 horas depois. Após o parto, foram administrados antibióticos e tocolíticos, protelando em duas semanas o nascimento dos fetos restantes. Os três bebés estão saudáveis, com desenvolvimento neurológico normal, e o pós-parto decorreu sem complicações.

Resumen La mastitis bovina es una enfermedad que afecta a las ganaderías de pequeños y medianos productores de los cantones Cayambe y Pedro Moncayo, Provincia de Pichincha-Ecuador. El tratamiento de esta enfermedad resulta complicado debido a la variedad de microorganismos que la provocan. El presente estudio se enfocó en la determinación molecular por medio de reacción en cadena de la polimerasa (PCR) de los agentes etiológicos de la mastitis. Esta técnica presenta múltiples ventajas al reconocer familia, género y especie de microorganismos, y es un método capaz de detectar genes de resistencia de antibióticos, lo que resulta importante al momento de diagnosticar y tratar enfermedades. El objetivo de esta investigación se centró en la identificación de bacterias causantes de la mastitis bovina, utilizando pruebas bioquímicas y moleculares. Las pruebas bioquímicas como tinción Gram, Catalasa, Coagulasa, y Agar Manitol Sal fueron eficientes para obtener cepas puras y determinar el género de algunas bacterias. Se utilizaron primers específicos (RNA16S) para la identificación molecular de 9 agentes etiológicos causantes de la enfermedad en las unidades productivas. Los microorganismos encontrados fueron; Staphylococcus pasteuri, Staphylococcus warneri, Staphylococcus sp., Staphylococcus epidermidis, Staphylococcus aureus, Staphylococcus saprophyticus, Sphingomonas sp., Streptococcus dysgalactiae, Streptococcus uberis, la mayoría presentes en mastitis clínica. Para detectar genes de resistencia se utilizaron primers específicos, de los cuales 7 muestras presentaron el gen para resistencia a blaTEM (β-lactámicos) y 6 muestras presentaron el gen para resistencia a tetA (tetraciclinas). Se identificó multirresistencia en las especies: Staphylococcus pasteuri, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus uberis, Sphingomonas sp.

Abstract Bovine mastitis is a disease that affects the farms of small and medium producers in the cantons of Cayambe and Pedro Moncayo, Pichincha Province-Ecuador. Treating this disease is not easy due to the different microorganisms that cause it. This study focused on the molecular determination by means of polymerase chain reaction (PCR) of the etiological agents of mastitis, having multiple advantages when recognizing family, gender and species of microorganisms. It is a method capable of detecting resistance genes of antibiotics, an important analysis when diagnosing and treating diseases. The aim of this research is to identify bacteria causing bovine mastitis by using biochemical and molecular tests. Biochemical tests such as: Gram staining, Catalase, Coagulase, and Mannitol Salt Agar were efficient to obtain pure strains and determine the gender of some bacteria. Specific primers (RNA16S) were used for the molecular identification of 9 etiological agents causing the disease in the productive units. The microorganisms found were Staphylococcus pasteuri, Staphylococcus warneri, Staphylococcus sp., Staphylococcus epidermidis, Staphylococcus aureus, Staphylococcus saprophyticus, Sphingomonas sp., Streptococcus dysgalactiae, Streptococcus uberis, mostly present in clinic mastitis. To detect resistance genes, specific primers were used, of which 7 samples presented the gene for resistance to blaTEM (β-lactam) and 6 samples presented the gene for resistance to tetA (tetracyclines). Multi-resistance was identified in the species Staphylococcus pasteuri, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus uberis, Sphingomonas sp.

RESUMEN Introducción: Gram-positive staphylococci are responsible for over 90% of cases of postoperative infectious endophthalmitis, with Staphylococcus epidermidis accounting for approximately 70% of isolated microorganisms. Objetivo: Evualuar la relación entre la virulencia de S. epidermidis y la gravedad de la endoftalmitis en un modelo animal. Metodología: Se dividieron conejos albinos de Nueva Zelanda en dos grupos y se les administraron 100 unidades formadoras de colonias de cepas de S. epidermidis. En el grupo virulento, cuatro conejos recibieron una cepa multirresistente de S. epidermidis portadora de gen mecA, ica y atlE, de la microbiota conjuntival de un paciente y tres conejos la cepa S. epidermidis ATCC 35984 formadora de biopelículas. En el grupo no-virulento, se inocularon cinco conejos con una cepa sensible a todos los antibióticos probados y que carecía de los genes mecA, ica y atlE, también de un paciente y tres conejos recibieron la cepa S. epidermidis ATCC 29122 no productora de biopelícula. Se realizaron exámenes clínicos y ecográficos cada tres horas hasta la aparición de síntomas de endoftalmitis, seguido de evaluaciones clínicas diarias. Las evaluaciones histológicas se realizaron 15 días después de la inoculación. Resultados: El grupo menos virulento mostró una inflamación más leve y un daño intraocular reducido en comparación con el grupo más virulento según observaciones clínicas y ecográficas. Sin embargo, el análisis histopatológico reveló una inflamación similar en todos los grupos, 15 días después de la inoculación. Discusión: Las cepas de S. epidermidis menos virulentas indujeron una inflamación menos grave, como se observó mediante evaluaciones clínicas y ecográficas. Sin embargo, las evaluaciones histopatológicas a largo plazo mostraron efectos comparables a los observados con la cepa más virulenta.

ABSTRACT Introduction: Gram-positive staphylococci are responsible for over 90% of cases of postoperative infectious endophthalmitis, with Staphylococcus epidermidis accounting for approximately 70% of isolated microorganisms. Objective: To evaluate the relationship between S. epidermidis virulence and severity of endophthalmitis in an animal model. Methodology: New Zealand albino rabbits were divided into two groups and administered 100 colony-forming units of S. epidermidis strains. In the virulent group, four rabbits received a multi-antibiotic resistant, mecA, ica, and atlE gene carrying S. epidermidis strain, from a patient´s conjuntival microbiota and three a biofilm-forming S. epidermidis ATCC 35984. In the non-virulent group, five rabbits were inoculated with a strain sensitive to all tested antibiotics and lacking mecA, ica, and atlE genes, also from a patient and three rabbits received the non-producer biofilm S. epidermidis ATCC 29122. Clinical and ultrasound examinations were conducted every three hours until endophthalmitis symptoms appeared, followed by daily clinical assessments. Histological evaluations were performed 15 days post-inoculation. Results: The less virulent group displayed milder inflammation and reduced intraocular damage in comparison to the more virulent group based on clinical and ultrasound observations. Nevertheless, histopathological analysis revealed similar inflammation in all groups, 15 days post-inoculation. Discussion: Less virulent S. epidermidis strains induced less severe inflammation as observed through clinical and ultrasound assessments. However, long-term histopathological assessments showed effects comparable to those seen with the more virulent strain.

RESUMEN Introducción: El uso inadecuado de antibióticos contribuye al aumento de la resistencia bacteriana, las cepas resistentes son muy difíciles de tratar con los antibióticos disponibles. Objetivo: Evaluar la efectividad del tratamiento farmacológico empírico con Cefotaxima y Ceftriaxona en servicios clínicos y quirúrgicos del hospital “Dr. Benigno Sánchez” de Quillacollo, durante la gestión 2022. Metodología: Es un estudio observacional de tipo analítico, subtipo casos y controles, longitudinal prospectivo. La población fue pacientes 1395, obteniendo una muestra de 884 pacientes subdividiendo en grupos casos n=741 y controles n=126. Resultados: En el servicio quirúrgico la frecuencia entre varones y mujeres fue de 45 % y 55 % respectivamente; 73 % del total no presentó enfermedades de base, el 90 % del total tuvo una hospitalización de menos de una semana con 95 % de mejoría sin diferencia significativa entre casos y controles. En el servicio de clínico, 60 % fueron mujeres el resto varones, 50 % del total no presentó enfermedades de base, el 78 % del total tuvo una hospitalización de menos de una semana con 85 % de mejoría sin diferencia significativa entre casos y controles. Discusión: Las características sociodemográficas, el presente estudio identificó que en el servicio quirúrgico a la edad media fue 43 años, de estos 45 % fueron varones y 55 % mujeres, en cambio en el servicio clínico, la edad media fue de 55 años, 60 % mujeres el resto varones. El presente estudio identificó que, en el servicio quirúrgico, el 95 % de los casos cuentan con mejoría, sin que exista una relación entre la terapia empleada o no. En el servicio clínico se apreció un 85 % de mejoría sin que exista diferencia entre los grupos. No existe una diferencia significativa entre los grupos, en los servicios medico quirúrgicos, con respecto a la mejoría.

ABSTRACT Introduction: Inappropriate use of antibiotics contributes to the increase in bacterial resistance; resistant strains are very difficult to treat with available antibiotics. Objective: To evaluate the effectiveness of empirical pharmacological treatment with Cefotaxime and Ceftriaxone in clinical and surgical services of the “Dr. Benigno Sánchez” from Quillacollo, during the 2022 administration. Methodology: It is an observational study of analytical type, case-control subtype, prospective longitudinal. The population was 1395 patients, obtaining a sample of 884 patients, subdividing cases n=741 and controls n=126 into groups. Results: In the surgical service, the frequency among men and women was 45 % and 55 % respectively; 73 % of the total did not present underlying diseases, 90 % of the total had a hospitalization of less than one week with 95 % improvement without significant difference between cases and controls. In the clinical service, 60 % were women, the rest men, 50 % of the total did not present underlying diseases, 78 % of the total had a hospitalization of less than a week with 85 % improvement without significant difference between cases and controls. Discussion: The sociodemographic characteristics, the present study identified that in the surgical service the average age was 43 years, of these 45 % were men and 55 % women, however in the clinical service, the average age was 55 years, 60 % women the rest men. The present study identified that, in the surgical service, 95 % of the cases have improvement, without there being a relationship between the therapy used or not. In the clinical service, an 85 % improvement was seen with no difference between the groups. There is no significant difference between the groups, in medical surgical services, with respect to improvement.

Resumen Se presenta el caso de un varón de 64 años que fue internado por delirium asociado a ictericia con patrón de colestasis en el hepatograma, y una masa en el pulmón derecho en el contexto de pérdida de peso y síndro me constitucional de 8 meses de evolución. Se realizó punción de la masa pulmonar cuyo cultivo desarrolló colonias blanquecinas identificadas como Nocardia cyria cigeorgica por espectrometría de masas (MALDI-TOF MS). Se llegó al diagnóstico de lupus eritematosos sistémico (LES) por presentar 8 de los criterios de acuerdo con el grupo SLICC 2012 y 24 puntos de acuerdo a los criterios EULAR/ACR 2019. La biopsia hepática mostró leve y variable infiltrado inflamatorio mixto en espacios porta, con ausencia de hepatitis de interfase y presencia de reacción ductular periférica. Se interpretaron estos hallazgos como vincu lados a hepatopatía por LES. El delirium fue interpretado como afectación neuroló gica por LES en base al descarte de otras enfermedades. Recibió tratamiento antibiótico y tras constatarse reducción del tamaño de la masa pulmonar se adminis traron pulsos de ciclofosfamida intravenosa. Evolucionó favorablemente, con normalización del hepatograma y el estado de conciencia, y recuperación del peso en forma progresiva. Al año se lo encontró en buen estado de salud. Justifica el reporte del caso la rara forma de presenta ción del LES de comienzo tardío, así como la nocardiosis pulmonar concomitante sin tratamiento inmunosupre sor previo.

Abstract A case is presented of a 64-year-old male patient who was admitted because of delirium, jaundice, a pattern of cholestasis in the liver profile and a right lung mass in the context of a constitutional syndrome and weight loss in the last eight months. The lung mass was punctured and the culture of the obtained material developed white colonies, identified by mass spectrometry (MALDI-TOF) as Nocardia cyriacigeorgica. Regarding the clinical diagnosis, it was considered as systemic lupus erythematosus (SLE), on the basis of fulfilling 8 criteria according to SLICC 2012 group, and 24 points according to EULAR/ACR 2019. The liver biopsy showed a mixt cellular infiltrate in portal spaces, with absence of interphase hepatitis and presence of peripheral ductular reaction. These findings were interpreted as liver compromise relate to SLE. Delirium was also considered as a neurological mani festation related to SLE on the basis of ruling out other causes. After being treated with antibiotics and documenting a reduction in the size of the lung mass he received cy clophosphamide in intravenous pulses, achieving normal ization of his liver profile and his state of consciousness, and a progressively weight recovering. A year after he was in good health. The report of this case is justified because of the rare presenting form of late onset SLE, as well as the concomi tant pulmonary nocardiosis in the absence of previous immunosuppressant treatment.

RESUMEN Objetivo: Determinar la influencia de los determinantes sociales de la salud en la resistencia antibiótica, en los países de América Latina. Metodología: Estudio documental de tipo revisión sistemática, con análisis interpretativo de la información, se incluyeron a artículos publicados entre 2018 y 2023 de las bases de datos: PubMed, ScienceDirect, Cochrane, Dialnet, Google académico, BVS, LilaCs, Scielo, Epistemonikos, CUIDEN, TripDatabase, BASE Search, Jurn, WorldWideScience, Refseek, Redalyc, EbscoHost y CONRICYT; en los idiomas español, inglés y portugués, que tuvieran como población comunidades y países de América Latina; se excluyeron aquellos con enfoque veterinario o agropecuario. Resultados: Se obtuvieron 4,625 en la búsqueda inicial y posterior a la aplicación de criterios de selección, se analizaron 28 artículos analizó la calidad metodológica, la bibliometría y el análisis temático a través de la interpretación de la información contenida. Conclusión: Los determinantes sociales de la salud estructurales asociados con la resistencia antimicrobiana fueron las políticas públicas, el género, los factores macroeconómicos, el nivel socioeconómico familiar, educativo y la gobernanza.

ABSTRACT Objective: Determine the influence of social determinants of health on antibiotic resistance in Latin American countries. Methodology: Systematic review type documentary study with interpretive analysis of the information, articles published between 2018 and 2023 from the following databases were included: PubMed, ScienceDirect, Cochrane, Dialnet, Google scholar, BVS, LilaCs, SciELO, Epistemonikos, CUIDEN, TripDatabase, BASE Search, Jurn, WorldWideScience, Refseek, Redalyc, EbscoHost and CONRICYT; in the Spanish, English and Portuguese languages, which had Latin American communities and countries as their population; Those with a veterinary or agricultural focus were excluded. Results: 4,625 were obtained in the initial search and after the application of selection criteria, 28 articles were analyzed that analyzed the methodological quality, bibliometrics and thematic analysis through the interpretation of the information contained. Conclusion: The social determinants of structural health associated with antimicrobial resistance were public policies, gender, macroeconomic factors, family socioeconomic level, education, and governance.

ABSTRACT Introduction Vesicovaginal fistula (VVF) is the most common urogenital fistula due to iatrogenic cause, primarily associated with gynecologic surgery (1). Although both conservative and surgical management may be considered, the optimal treatment is still uncertain and several studies were published using different techniques (open, laparoscopic or robotic) and approaches (extravesical, transvesical or transvaginal) (2–5). In this context, we aim to report our initial experience repairing VVF with Single-Port (SP) Transvesical (TV) access. Materials and Methods Four patients with a diagnosis of VVF underwent SP-TV VVF repair between May 2022 and December 2023. Diagnosis was confirmed by cystoscopy, cystogram and in two cases by CT Urogram. Under general anesthesia, before robotic time, patients were placed in lithotomy position and a preliminary cystoscopy was performed. Fistula was noted and a 5fr stent was placed through the fistulous tract. Two ureteral stents were placed. Then, with patient supine, a transverse suprapubic 3cm incision and 2cm cystotomy were made for SP access. First step was to mark and remove fistula tract to the vagina. The edges of the vagina and bladder were dissected in order to have a closure free of tension and to create three different layers to close: vagina, muscularis layer of the bladder and mucosal layer of the bladder. A bladder catheter was placed, and the two ureteral stents were removed at the end of procedure. Results Mean age was 53 years old and three out of 4 patients developed VVF after gynecologic surgery. Two patients underwent VVF repair 6 and 8 months after total hysterectomy. One patient developed VVF after total hysterectomy and oophorectomy followed by radiation therapy. Last patient developed VVF after previous urological procedure. Fistula diameter was between 11 and 15mm. Operative time was 211 min, including preliminary cystoscopy, stents placement and SP-access. All patients were discharged on the same day with a bladder catheter, successfully removed between post-operative day 14-18 after negative cystogram. Only in one case a ureteral stent was left because the fistula was closed to the ureteral orifice and we reported one case of UTI twelve days after surgery, treated with outpatient antibiotics. Mean follow-up was 8 months, patients were scheduled for regular follow-up visits and no recurrence was reported. All patients have at least 3 months of post-operative follow-up. Conclusions Our experience suggests that SP Transvesical VVF repair may be considered as a safe and feasible minimally invasive treatment for small/medium fistulae (10-15mm). (VVF cause 1. 1 . (1) open, open (open extravesical, extravesical (extravesical transvaginal 2–5. 25 2–5 2 5 (2–5) context SinglePort Single Port (SP TV (TV access SPTV 202 2023 Urogram anesthesia performed fr Then supine cm close procedure therapy 15mm mm 21 min SPaccess. SPaccess SP-access postoperative post operative 1418 14 18 14-1 antibiotics followup follow up followup. up. smallmedium small medium 1015mm. 1015mm 10 (10-15mm) (1 2– (2–5 20 141 14- (10-15mm ( (2– (2