RESUMEN Introducción: la necrosis pancreática se presenta entre 10 y 20 % de los pacientes con pancreatitis aguda, tiene una mortalidad de 10 a 25 % y si se agrega infección a la necrosis entre 40 y 70 %. Objetivo: describir el manejo clínico quirúrgico de la necrosis pancreática infectada en el Servicio de Cirugía General del Hospital Nacional entre el periodo 2021-2022. Metodología: estudio observacional descriptivo de corte temporal transversal. En pacientes internados en el Servicio de Cirugía General del Hospital Nacional por pancreatitis aguda grave con necrosis pancreática infectada. Resultados: se analizaron un total de 30 pacientes. La media de edad fue de 39 años. Predominó en nuestra población pacientes de sexo masculino en el 56.67 %. En cuanto a las comorbilidades asociadas un 33.3 % los pacientes presentaron principalmente Diabetes mellitus tipo 2 e Hipertensión arterial; en menor medida Obesidad en un 23.3 %. De la población en estudio 76.6 % recibieron tratamiento quirúrgico y 23.33% tratamiento médico principalmente antibiótico terapia. De los pacientes sometidos a tratamiento quirúrgico 9 fueron a necrosectomia abierta, 7 a drenaje percutáneo, y en menor medida drenaje biliar y endoscópico. En cuanto a la mortalidad por necrosis pancreática infectada encontramos un 10 % de mortalidad. Discusión: la mayor parte de los pacientes con pancreatitis aguda grave sufren de necrosis pancreática; la necrosis pancreática infectada se asocia con mayor riesgo de mortalidad y en su mayoría requieren tratamientos invasivos. Conclusión: el manejo mínimamente invasivo en el tratamiento inicial de la necrosis pancreática infectada podría resolver la mayoría de los casos sin necesidad de realizar necrosectomia; reservando esta última solo a los que fracasan en el tratamiento inicial.

ABSTRACT Introduction: pancreatic necrosis occurs between 10 and 20 % of patients with pancreatitis, has a mortality of 10 to 25 % and if infection is added to the necrosis between 40 and 70 %. Objective: to describe the surgical and clinical management of infected necrotizing pancreatitis in patients admitted to the General Surgery Service of the Hospital Nacional between the period 2021-2022. Methodology: this was an observational, descriptive and cross-section study with a temporal cut. We included patients admitted to the general surgery service of the National Hospital with severe acute pancreatitis with infected necrotizing pancreatitis. Results: a total of 30 patients were included. The mean age was 39 years. Male patients prevailed in our population in 56.67 %. Regarding the associated comorbidities, 33.3 % of the patients presented mainly type 2 diabetes mellitus and arterial hypertension; to a lesser extent Obesity in 23.3 %. In the study population, 76.6 % received surgical treatment and 23.33 % medical treatment, mainly antibiotic therapy. Of the patients who underwent surgical treatment, 9 were open necrosectomy, 7 had percutaneous drainage, and to a lesser extent biliary and endoscopic drainage. Regarding mortality due to infected necrotizing pancreatitis, we found a 10% mortality. Discussion: most of the patients with severe acute pancreatitis suffer from necrotizing pancreatitis; infected necrotizing pancreatitis is associated with increased risk of mortality and most require invasive treatment. Conclusion: minimally invasive management in the initial treatment of infected necrotizing pancreatitis, which could resolve most cases without the need to perform necrosectomy; the latter should be reserved for those who fail the initial treatment.

Abstract Poultry production is one of the most important agricultural sectors worldwide due to the high nutritional value of its products, such as meat and eggs, for human consumption. In this regard, veterinary antibiotics are used to treat or prevent disease-causing pathogens in order to ensure and maintain production. The objective of the study was to design and validate two questionnaires for assessing the risk of veterinary antibiotics used in egg-laying hens and their perceived impact in relation to food safety. Its logic and the validity of its content were determined by expert evaluation. Its construct validity was assessed by exploratory factor analysis, and its reliability, with Cronbach's Alpha coefficient. The survey was applied to 44 establishments or egg producers in the Espaillat province and to 385 consumers in the Santo Domingo province. A Cronbach's alpha coefficient of 0.799 was obtained for egg producers and veterinarians, and of 0.771, for consumers. The principal component analysis identified a KMO sample size adequacy measure of 0.558 for egg producers and veterinarians, and 0.797 for consumers. The questionnaire for egg producers and veterinarians consists of 8 factors and 22 items, and the questionnaire for consumers, of 3 factors and 8 items. The results confirm that the scale found is reliable and valid for the construct the risks associated with the potential consumption of food containing veterinary antibiotic residues.

Resumen La producción avícola es uno de los sectores agropecuarios de mayor importancia a nivel mundial por sus grandes aportes nutricionales en productos como la carne y el huevo para fines de la alimentación humana. En este sentido, para asegurar y mantener la producción se utilizan antibióticos veterinarios para tratar o prevenir agentes patógenos que causan enfermedades. El objetivo del estudio fue diseñar y validar dos cuestionarios para evaluar el riesgo de los antibióticos veterinarios de uso en gallinas ponedoras de huevos y su percepción de impacto con relación con la seguridad alimentaria. Se determinaron su lógica y validez de contenido mediante la evaluación por expertos. La validez de constructo se realizó mediante el análisis factorial exploratorio y la confiabilidad con el coeficiente de Alpha de Cronbach. Se aplicó a 44 establecimientos o productores de huevos en la provincia Espaillat y 385 consumidores de la provincia Santo Domingo. Se obtuvo un coeficiente de alfa de Cronbach de 0.799 para productores de huevos y veterinarias y 0.771 para los consumidores. El análisis de componente principales permitió identificar la medida de adecuación del tamaño de muestra KMO de 0.558 para los productores de huevos y veterinarias y 0.797 para los consumidores. El cuestionario está conformado por 8 factores y 22 ítems para los productores de huevos y veterinarias y 3 factores y 8 ítems para los consumidores. Los resultados confirman que la escala encontrada es confiable y válida para la construcción de los riesgos asociados al posible consumo de los alimentos con residuos de antibióticos veterinarios.

Resumo O presente trabalho de pesquisa apresenta a importância antiviral e antibacteriana da gordura corporal de Saara hardwickii, comumente chamado de lagarto de cauda espinhosa. O óleo foi extraído de gorduras corporais localizadas na região ventral desse animal usando hidrocarbonetos, por exemplo, n-hexano, metanol, butanol e acetato de etila, como solvente. A atividade antibacteriana do óleo do lagarto foi testada em linhagens padrão e multirresistentes de Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa e Proteus vulgaris, de forma isolada e com antibiótico ampicilina. Para o potencial antibacteriano, acetato de etila e extrato de butanol apresentaram melhor zona de inibição (7 mm) com P. aeruginosa e S. aureus, respectivamente. Para o potencial antiviral, o extrato de butanol e o extrato de metanol apresentaram melhor título de hemaglutinação de 4 com as cepas virais NDV e IBV, respectivamente. Conclui-se que o óleo do lagarto possui potencial antimicrobiano contra diferentes cepas de patógenos (vírus e bactérias).

Abstract Present research work represents antiviral and antibacterial value of body fat of Saara hardwickii commonly called as spiny tailed lizard. Oil was extracted from body fats located in the ventral region of this animal using hydrocarbons e.g., n-hexane, methanol, butanol and ethyl acetate as a solvent. The antibacterial activity of lizard oil was tested against standard as well as multi-resistant lines ofEscherichia coli, Styphalococcus aureus, Pseudomonas aeruginosa and Proteus vulgaris alone and with antibiotic ampicillin. For antibacterial potential, Ethyl acetate and Butanol solvent extract showed best zone of inhibition (7mm) with P. aeruginosa and S. aureus respectively. For antiviral potential, Butanol and Methanol extract showed best HA (Hemagglutination) titer of 04 with NDV and IBV viral strain respectively. It is concluded that lizard oil has antimicrobial potential against different pathogens strains (virus, bacteria).

Resumo O estudo teve como objetivo analisar os efeitos dos antibióticos promotores de crescimento (AGPs), di-hidrato de oxitetraciclina e fosfato de tilosina na microflora intestinal de frangos de corte. Os AGPs foram fornecidos em diferentes concentrações isoladamente ou em combinações por 42 dias de criação. Amostras fecais foram coletadas do intestino (duodeno, jejuno e ceco) de frangos de corte no 14º, 28º e 42º dias de ensaio. As amostras foram cultivadas em diferentes meios seletivos e a identificação bacteriana foi realizada por diferentes ferramentas de diagnóstico bioquímico e molecular. Os resultados mostraram um efeito significativo dos AGPs no crescimento de microrganismos patogênicos como Escherichia coli e Clostridium perfringens no intestino. Curiosamente, um crescimento prejudicado foi observado para ambas as bactérias, mostrando um efeito significativo (P <0,05) de AGPs em E. coli e C. perfringens nos dias 14, 28 e 42. Este efeito foi observado apenas e em combinação com o uso de AGPs. Os dados mostraram ainda que o efeito foi mais proeminente em combinação e com um aumento da concentração de AGPs. Nenhum comprometimento foi observado no crescimento de L. reuteri em diferentes locais do intestino e duração (14º, 28º e 42º dias). Os resultados mostraram que o uso de AGPs na dieta não tem efeito nocivo nas bactérias benéficas, no entanto, foi observado um crescimento prejudicado nas bactérias nocivas. Sugere-se que uma combinação de AGPs (OXY-1.0+TP-0.5) seja econômica e não tenha efeito prejudicial sobre o frango de corte. O uso de AGPs em uma dose recomendada e por um período de tempo específico é seguro para uso em aves tanto como promotor de crescimento quanto para prevenção de doenças.

Abstract The study was aimed to analyse the effects of antibiotic growth promoters (AGPs), Oxytetracycline di-hydrate and Tylosin phosphate on the intestinal microflora in broiler chicken. The AGPs were provided in different concentrations solely or in combinations for 42 days of rearing. Faecal samples were collected from the intestine (duodenum, jejunum and caeca) of broiler chicken on 14th, 28th and 42nd days of trial. Samples were cultured on different selective medium and bacterial identification was performed by different biochemical and molecular diagnostic tools. Results showed a significant effect of AGPs on the growth of pathogenic microorganisms such as Escherichia coli and Clostridium perfringens in the intestine. Interestingly, an impaired growth was observed for both bacterium showing a significant effect (P<0.05) of AGPs on E. coli and C. perfringens on day 14th, 28th, and 42nd. This effect was observed solely and in combination while using AGPs. Data further showed that the effect was more prominent in combination and with an increase concentration of AGPs. Remarkably, no impairment was seen on the growth of L. reuteri at different sites of intestine and duration (14th, 28th, and 42nd days). The results showed that the use of AGPs in diet has no harmful effect on beneficial bacteria, however, an impaired growth was seen on the harmful bacteria. It is suggested that a combination of AGPs (OXY-1.0+TP-0.5) is economical and have no harmful effect on the broiler chicken. The use of AGPs in a recommended dose and for a specific period of time are safe to use in poultry both as growth promoter and for the prevention of diseases.

ABSTRACT Objective: To evaluate the impact of COVID-19 social distancing recommendations on nutritional status, pulmonary function, and morbidity in patients with cystic fibrosis (CF). Methods: A retrospective cohort study including patients older than six years with a diagnosis of CF was performed. Demographic and clinical data, anthropometric measurements, pulmonary function, days of antibiotic use, and length of hospital stay were recorded. Variables were recorded at three time points relative to the baseline for implementation of social distancing measures: T-1 (14 months before implementation), T0 (baseline), and T1 (14 months after implementation). Delta (Δ) was calculated for each period: Δ1 (pre-pandemic T0-T-1) and Δ2 (pandemic T1-T0). Results: The study included 25 patients, with a mean age of 11.7±4.3 years. The mean forced expiratory volume in the first second (FEV1) was 85.6±23.6%, and body mass index (BMI) was 17.5±3.0 kg/m2. When comparing the two periods (Δ1 and Δ2), there was a significant increase in the FEV1/forced vital capacity (FVC) ratio (p=0.013) and in the forced expiratory flow between 25 and 75% of vital capacity (FEF25–75%) (p=0.037) in the pandemic period. There was also a significant reduction (p=0.005) in the use of antibiotics in the pandemic period compared with the pre-pandemic period. The Δ1 and Δ2 values did not differ significantly for BMI, FEV1, or length of hospital stay. Conclusions: COVID-19 social distancing recommendations had a positive impact (decrease) on morbidity (use of antibiotics) and small airway obstruction (FEF25–75%) in patients with CF.

RESUMO Objetivo: Avaliar o impacto das recomendações de medidas de distanciamento social por COVID-19 sobre estado nutricional, função pulmonar e morbidade em pacientes com fibrose cística (FC). Métodos: Estudo de coorte, retrospectivo, que incluiu pacientes com diagnóstico de FC e idade superior a seis anos. Foram registrados os dados demográficos, antropométricos, clínicos, de função pulmonar e o total de dias de uso de antibiótico e de hospitalizações. As variáveis foram registradas em três momentos relativos ao início das recomendações de distanciamento social: T-1 (14 meses antes), T0 (início das recomendações) e T1 (14 meses depois). Foram calculados deltas (Δ) para cada um dos períodos: Δ1 (pré-pandemia T0-T-1) e Δ2 (pandemia T1-T0). Resultados: Vinte e cinco pacientes, com média de idade de 11,7±4,3 anos, sendo 76% homozigotos para Δf508 e 28% colonizados por Pseudomonas aeruginosa, foram incluídos. A média do volume expiratório forçado no primeiro segundo (VEF1) foi de 85,6±23,6 (% do previsto) e o índice de massa corporal (IMC) foi de 17,5±3,0 kg/m2. Ao compararmos os períodos (Δ1 e Δ2), houve aumento significativo do VEF1/CVF (p=0,013) e do FEF25–75% (p=0,037) no período das recomendações de distanciamento. Também se observou redução significativa (p=0,005) do uso de antibióticos no período da pandemia em comparação ao período anterior a ela. Não houve diferenças significativas nos deltas para o IMC, VEF1 e dias de hospitalização. Conclusões: As recomendações de distanciamento social por COVID-19 tiveram impacto positivo (redução) sobre a morbidade (uso de antibióticos) e a obstrução de vias aéreas de menor calibre (FEF25–75%) em pacientes com FC.

Resumo As doenças infecciosas são a principal causa de morte no mundo. Assim, a nanotecnologia oferece uma excelente oportunidade para tratar infecções microbianas resistentes a medicamentos. Numerosos antibióticos têm sido usados para inibir o crescimento e a morte de micróbios, mas o desenvolvimento de resistência e o surgimento de efeitos colaterais limitaram severamente o uso desses agentes. Devido ao desenvolvimento da nanotecnologia, as nanopartículas são amplamente utilizadas como antimicrobianos. As nanopartículas de prata e quitosana têm propriedades antifúngicas, antivirais e antibacterianas, e muitos estudos confirmam as propriedades antifúngicas das nanopartículas de prata. Atualmente, o uso de nanopartículas no diagnóstico e tratamento de doenças infecciosas tem se desenvolvido em razão do menor número de efeitos colaterais e também à ajuda dessas partículas na efetiva entrega de fármacos ao tecido-alvo. Os lipossomas também são usados como transportadores de entrega de drogas, genes e modelagem de membranas celulares em animais e humanos. Os lipossomas também são usados como transportadores de entrega de drogas, genes e modelagem de membranas celulares em animais e humanos. A capacidade desses lipossomas de encapsular grandes quantidades de fármacos, minimizar efeitos colaterais indesejados, alta eficácia e baixa toxicidade tem despertado o interesse de pesquisadores. Este artigo de revisão examina esforços recentes de pesquisadores para identificar e tratar doenças infecciosas usando nanopartículas antimicrobianas e nanotransportadores de drogas. mundo Assim medicamentos micróbios agentes antimicrobianos antibacterianas Atualmente tecidoalvo. tecidoalvo tecido alvo. alvo tecido-alvo drogas humanos indesejados

Abstract Infectious diseases are the leading cause of death worldwide. Thus, nanotechnology provides an excellent opportunity to treat drug-resistant microbial infections. Numerous antibiotics have been used to inhibit the growth and kill of microbes, but the development of resistance and the emergence of side effects have severely limited the use of these agents. Due to the development of the nanotechnology, nanoparticles are widely used as antimicrobials. Silver and chitosan nanoparticles have antifungal, antiviral and antibacterial properties, and many studies confirm the antifungal properties of silver nanoparticles. Nowadays, the use of nanoparticles in the diagnosis and treatment of infectious diseases has developed due to less side effects and also the help of these particles in effective drug delivery to the target tissue. Liposomes are also used as carriers of drug delivery, genes, and modeling of cell membranes in both animals and humans. The ability of these liposomes to encapsulate large amounts of drugs, minimize unwanted side effects, high effectiveness and low toxicity has attracted the interest of researchers. This review article examines recent efforts by researchers to identify and treat infectious diseases using antimicrobial nanoparticles and drug nano-carriers. worldwide Thus drugresistant resistant infections microbes agents antimicrobials Nowadays tissue genes humans drugs nanocarriers. nanocarriers nano carriers. nano-carriers

Resumen La colangitis aguda es una infección de la vía biliar, asociada a la obstrucción de esta. El cultivo de la bilis es positivo en la mayoría de los casos y el agente etio lógico más frecuente es Escherichia coli. La colangitis aguda por Candida sp es un hallazgo poco común, que es más frecuente en pacientes con inmunocompromiso, uso de corticoides, tratamiento antibiótico prolongado o procedimientos quirúrgicos de la vía biliar. Presenta mos el caso de una mujer de 67 años, que no presen taba ninguno de los antecedentes mencionados, y que consultó por fiebre, dolor abdominal e ictericia. En la resonancia magnética nuclear de abdomen se constató imagen litiásica en el colédoco con dilatación de la vía biliar. Requirió drenaje endoscópico del tracto biliar. En el examen microscópico directo del líquido biliar se evidenciaron levaduras y bacilos Gram negativos, y en el cultivo se aisló Klebsiella pneumoniae productora de betalactamasa de espectro extendido (BLEE) y Candida glabrata. La paciente completó el tratamiento antibiótico con piperacilina tazobactam y anidulafungina con buena evolución. La infección de la vía biliar por la asociación de bacilos Gram negativos y Candida sp es una entidad poco frecuente, más en pacientes sin enfermedades subyacentes.

Abstract Acute cholangitis is a bile duct infection associated with bile duct obstruction. Bile culture is positive in most cases, and the most frequent etiological agent is Escherichia coli. Candida sp acute cholangitis is a rare finding, which is more common in patients with im munosuppression, use of corticosteroids, prolonged antibiotic treatment or surgical procedures of the bile duct. We present the case of a 67-year-old woman with none of the above-mentioned history who consulted for fever, abdominal pain and jaundice. MRI of the ab domen revealed a lithiasic image in the common bile duct with dilation. It required endoscopic drainage of the biliary tract. Direct microscopic examination of the bile fluid revealed gram-negative bacilli and yeast, and in the culture of bile fluid Klebsiella pneumoniae produc ing extended spectrum beta-lactamase (ESBL) and Can dida glabrata were isolated. The patient completed the antibiotic treatment with piperacillin tazobactam and anidulafungin with good evolution. Bile duct infection by association of Gram-negative bacilli and Candida sp is a rare entity, more in patients without underlying diseases.

ABSTRACT Objective: To describe two different degrees of clinical commitment and results in the evolution of infectious endarteritis in patients without a previous diagnosis of aortic coarctation. Case description: Two male patients aged 13 and 9 years old were admitted. The first due to a fever for 2 months, which started after dental cleaning, and the second due to high blood pressure, both patients with asthenia and weight loss. In the first case, the transthoracic echocardiogram showed aortic coarctation, and the transesophageal echocardiogram showed the presence of vegetations in the post-coarctation area, without pseudoaneurysms, with blood culture positive for Streptococcus mitis. This patient was treated for six weeks with crystalline penicillin, resolving the infection without complications. The second case was assessed for high blood pressure with a history of fever, and was treated with antibiotics. When performing a transthoracic echocardiogram, aortic coarctation was observed with a saccular image classified as a pseudoaneurysm by angiography and tomography. Blood culture was negative, and the patient developed an episode of hematemesis whose initial etiology could not be determined. Before surgical repair, he had a second episode of copious hematemesis with hypovolemic shock and death. Comments: We need to have a high index of clinical suspicion to establish the diagnosis of aortic coarctation complicated by endarteritis and start the appropriate antibiotic treatment, always maintaining surveillance for the early detection of pseudoaneurysms.

RESUMO Objetivo: Descrever dois diferentes graus de comprometimento clínico e resultados na evolução de endarterite infecciosa em pacientes sem diagnóstico prévio de coarctação da aorta. Descrição do caso: Dois pacientes do sexo masculino com idades entre 13 e nove anos foram internados. O primeiro por febre durante dois meses, iniciada após limpeza dentária. O segundo por hipertensão arterial. Ambos com astenia e perda de peso. No primeiro caso, o ecocardiograma transtorácico mostrou coarctação da aorta e o ecocardiograma transesofágico revelou vegetações na área pós-coarctação, sem pseudoaneurismas. A hemocultura foi positiva para de Streptococcus mitis. Este paciente foi tratado por seis semanas com penicilina cristalina, resolvendo a infecção sem complicações. O segundo caso foi avaliado pela presença de hipertensão arterial, com história de febre tratada com antibióticos. Ao realizar o ecocardiograma transtorácico, observou-se coarctação da aorta com imagem sacular classificada como pseudoaneurisma pela angiografia e tomografia. A hemocultura foi negativa. O paciente desenvolveu um episódio de hematêmese, cuja etiologia inicial não pôde ser determinada. Antes da correção cirúrgica, apresentou um segundo episódio de hematêmese profusa, com choque hipovolêmico e óbito. Comentários: Devemos ter um alto índice de suspeição clínica para poder estabelecer o diagnóstico de coarctação da aorta complicada com endarterite e iniciar o tratamento antibiótico adequado. É preciso manter a vigilância para a detecção precoce de pseudoaneurismas.

Abstract Diarrhea is associated with infectious bacteria that cause mortality in calves, such as Escherichia coli, representing a problem for milk and meat producers globally, causing large economic losses. This study assessed the resistance to E. coli strains isolated from diarrheal feces of newborn calves from the Cajamarca region. Fifty two (52) fecal samples from calves from five provinces of the Cajamarca region were collected for the isolation of E. coli on MacConkey agar with sorbitol. The molecular identification of E. coli was performed by amplification of the uidA gene by conventional PCR and then antibiotic susceptibility/resistance was assessed using the Kirby-Bauer methodology and antibiotic discs with neomycin, tetracycline, sulfamethoxazole-trimethoprim and enrofloxacin. The results were that 96.15 % of E. coli strains were resistant to tetracycline, 51.92 % to sulfamethoprim, 26.92 % to neomycin and 9.61 % to enrofloxacin. It was also demonstrated that 30.76 % had resistance to two drugs, 19.23 % to three drugs and 5.76 % to four drugs; a significant difference was found in resistance to tetracycline (P<0.0001). It is concluded that newborn calves from the Cajamarca region that presented diarrhea are carriers of antibiotic-resistant E. coli, representing a problem for cattle farmers, since these strains can cause the death of animals and contribute to the spread of antibiotic resistance.

Resumen La diarrea está asociada con bacterias infecciosas que ocasionan mortalidad en terneros como Escherichia coli, representando un problema para los productores de leche y carne a nivel global, provocando grandes pérdidas económicas. En este estudio se evaluó la resistencia a cepas de E. coli aisladas de heces diarreicas de terneros recién nacidos de la región Cajamarca. Se recolectaron 52 muestras de heces de terneros de cinco provincias de la región Cajamarca para el aislamiento de E. coli en agar MacConkey con sorbitol. La identificación molecular de E. coli se realizó mediante la amplificación del gen uidA por PCR convencional y luego se evaluó la susceptibilidad/resistencia a antibióticos utilizando la metodología de Kirby-Bauer y el uso de discos de antibiótico con neomicina, tetraciclina, sulfametoxazol-trimetroprim y enrofloxacina. Los resultados fueron que el 96.15 % de cepas de E. coli fueron resistentes a tetraciclina, el 51.92 % a sulfametropim, el 26.92 % a neomicina y el 9.61 % a enrofloxacina. También se demostró que el 30.76 % presentaban resistencia a dos fármacos, el 19.23 % a tres fármacos y el 5.76 % a cuatro fármacos; se encontró diferencia significativa de resistencia a tetraciclina (P<0.0001). Se concluye que los terneros neonatos de la región Cajamarca que presentaban diarrea son portadores de E. coli resistentes a antibióticos, representando un problema para los criadores de ganado vacuno, ya que estas cepas pueden causar la muerte de los animales y contribuyen a la diseminación de la resistencia de antibióticos.

Abstract Ulcerative and necrotizing dermatitis (UND) is a cutaneous disease caused by traumatic skin lesions on the necks of sea turtles. In this study we report the first findings of UND in free-ranging olive ridley turtles (Lepidochelys olivacea) in La Escobilla, Oaxaca, Mexico. We found several skin injury conditions on the necks of nesting turtles in the arribada events of the 2021 nesting season. Samples from injuries were taken with sterile swabs for bacteriological analyses, and antimicrobial resistance profiles were studied. Of the 525 turtles examined, 278 had injuries on the back of the neck (52.9% prevalence). Two bacteria (Pseudomonassp. andStaphylococcussp.) and 1 fungus (Candidasp.) were identified in 8 turtles with UND. Ciprofloxacin was the only antibiotic with high inhibition ofStaphylococcussp. andPseudomonassp. We recommend initiating a continuous monitoring program to follow the occurrence of dermatitis disease inL. olivaceain subsequent years to better document prevalence and progression of skin injuries in more individuals.

Resumen La dermatitis ulcerativa y necrotizante (DUN) es una enfermedad cutánea causada por lesiones traumáticas de la piel sobre el cuello de las tortugas marinas. En este estudio reportamos los primeros hallazgos de DUN en tortugas golfina (Lepidochelys olivacea) de vida libre en La Escobilla, Oaxaca, México. Encontramos diferentes condiciones de lesiones de piel sobre el cuello de tortugas anidantes en los eventos de arribada de la temporada de anidación de 2021. Tomamos muestras de las lesiones con hisopos estériles para los análisis bacteriológicos y estudiamos los perfiles de resistencia antimicrobiana. De las 525 tortugas examinadas, 278 presentaron lesiones en el dorso del cuello (prevalencia del 52.9%). Identificamos 2 bacterias (Pseudomonassp. yStaphylococcussp.) y 1 hongo (Candidasp.) en 8 tortugas con DUN. La ciprofloxacina fue el único antibiótico con alta inhibición deStaphylococcussp. yPseudomonassp. Recomendamos iniciar un programa de monitoreo continuo para el seguimiento de la ocurrencia de la dermatitis enL. olivaceaen los siguientes años, con el fin de documentar de mejor manera la prevalencia y la progresión de las lesiones de la piel en más individuos.

Resumen: La infección por Helicobacter pylori es una condición frecuente, que a largo plazo se asocia con desarrollo de enfermedad ulceropéptica y eventualmente cáncer gástrico, que se podrían prevenir con un tratamiento oportuno. Lo óptimo sería lograr un éxito de erradicación mayor al 90%, pero los tratamientos empíricos recomendados no logran esas tasas en condiciones reales. Objetivo: Determinar el porcentaje de éxito del tratamiento empírico de erradicación de primera línea contra H. pylori en pacientes pediátricos atendidos en un hospital terciario. Pacientes y Método: Estudio descriptivo retrospectivo en pacientes con infección por H. pylori detectado en biopsias gástricas y que hubieran recibido tratamiento antibiótico de primera línea durante el periodo 2017-2021. Se consideró erradicación exitosa el resultado negativo de test de antígeno en deposiciones o nuevas biopsias luego de ≥ 1 mes de finalizado el tratamiento. Resultados: Se identificaron 82 pacientes con infección por H. pylori, de los cuales 53 recibieron tratamiento de erradicación. De éstos, 26 (49%) fueron controlados con test de erradicación luego del tratamiento y en ellos el porcentaje de éxito fue de solo 38% (10/26). Conclusiones: La tasa de erradicación con los esquemas empíricos utilizados fue menor a la esperada, lo que evidencia el desafio de buscar estrategias más efectivas de tratamiento incluyendo el estudio de susceptibilidad a antimicrobianos. La adherencia de los pacientes al protocolo de seguimiento también fue baja, lo que deberá reforzarse en el futuro para poder realizar un manejo clínico más adecuado.

Abstract: Helicobacter pylori infection is a common condition that, in the long term, is associated with the development of peptic ulcer disease and eventually gastric cancer, which could be prevented with timely treatment. Optimally, eradication success should be greater than 90%, but the recommended empirical treatments do not achieve these rates in real-life conditions. Objective: To determine the success rate of first-line empirical eradication treatment against H. pylori in pediatric patients treated in a tertiary hospital. Patients and Method: Retrospective descriptive study in patients with H. pylori infection detected in gastric biopsies and who had received first-line antibiotic treatment during the period 2017-2021. A negative result of an antigen test in stools or new biopsies after ≥ 1 month after completing treatment was considered a successful eradication. Results: 82 patients with H. pylori infection were identified, of which 53 received eradication treatment. Of these, 26 (49%) were controlled with eradication tests after treatment with a success rate of only 38% (10/26). Conclusions: The eradication rate with the empirical regimens used was lower than expected which highlights the challenge of seeking more effective treatment strategies, including the study of antimicrobial susceptibility. Patient adherence to the follow-up protocol was also low, which should be reinforced in the future to ensure more appropriate clinical management.

RESUMEN Introducción: Las infecciones de sitio quirúrgico (ISQ), se encuentran entre las infecciones asociadas al cuidado de la salud (IACS) más frecuentes, la profilaxis antibiótica administrada en el período preoperatorio contribuye a prevenir las ISQ. Objetivo: determinar si los esquemas antimicrobianos utilizados para profilaxis en cirugía corresponden a recomendados por Guías Internacionales de Tratamiento de Enfermedades Infecciosas; así como conocer los esquemas antimicrobianos utilizados, estimar el costo de la quimioprofilaxis y comparar con los resultados obtenidos en un estudio similar realizado en el mismo servicio en el año 2005. Materiales y métodos: Estudio descriptivo, observacional, retrospectivo donde se seleccionaron todas las historias clínicas de pacientes de ≤15 años de edad sometidos a apendicectomía, con diagnóstico posquirúrgico de apendicitis congestiva o flegmonosa, desde enero a diciembre del 2022. Se elaboró una planilla electrónica donde se cargaron los siguientes datos: antibiótico utilizado, dosis, número de dosis y momento de la administración. Resultados: 53 pacientes ≤ de 15 años fueron sometidos a apendicectomía, de los cuales 21 llenaban los criterios de inclusión. Fue utilizado Amoxicilina/Sulbactam en 19/21. El número total de dosis administradas fue de 68 dosis y la media de 3,3±1,9 dosis; solo en 8 de los pacientes se administró el antimicrobiano profiláctico en el tiempo correcto; solo 1 paciente recibió el esquema correcto, 1 sola dosis, 1 hora antes del inicio de la cirugía. El costo de la profilaxis antimicrobiana por paciente fue de 15,7 USD. Conclusión: Este trabajo nos permitió verificar la falta de aplicación de guías en el uso de antimicrobianos en la profilaxis quirúrgica, lo cual demuestra: i) la necesidad de revisar y estandarizar la conducta de prescripción relacionada en profilaxis quirúrgica, ii) la importancia de elaborar y socializar una guía de manejo de antimicrobianos y iii) el monitoreo de su implementación.

ABSTRACT Introduction: Surgical site infections (SSIs) are among the most frequent healthcare-associated infections (HCIs). Antibiotic prophylaxis administered during the preoperative period contributes to preventing SSIs. Objective: to determine if the antimicrobial regimens used for prophylaxis in surgery correspond to those recommended by International Guidelines for the Treatment of Infectious Diseases; as well as knowing the antimicrobial regimens used, estimating the cost of chemoprophylaxis and comparing the current results with those obtained in a similar study carried out in the same service in 2005. Materials and methods: This was a descriptive, observational and retrospective study where we reviewed all medical records of patients ≤15 years of age undergoing appendectomy, with a post-surgical diagnosis of congestive or phlegmonous appendicitis, from January to December 2022. An electronic spreadsheet was prepared where the following data were uploaded: antibiotic used, dose, number of doses and time of administration. Results: 53 patients ≤ 15 years of age underwent appendectomy, of which 21 met the inclusion criteria. Amoxicillin/Sulbactam was used in 19/21. The total number of doses administered was 68 doses and the average was 3.3±1.9 doses; only in 8 of the patients was the prophylactic antimicrobial administered at the correct time; only 1 patient received the correct regimen, 1 single dose, 1 hour before the start of surgery. The cost of antimicrobial prophylaxis per patient was 15.7 USD. Conclusions: This study allowed us to verify the lack of application of existing guidelines in the use of antimicrobials in surgical prophylaxis, which demonstrates: i) the need to review and standardize prescription behavior related to surgical prophylaxis, ii) the importance of developing and disseminating an antimicrobial management guide and iii) the need to monitor its implementation.

ABSTRACT The aim of this study was to evaluate the effect of supplementation with protected (POA) and non-protected organic acids (UOA) on growth performance, pH of the gastrointestinal tract (GIT), bone and intestinal morphometry in diets with antibiotics and their relationships. The study included 200 1-day-old Cobb 500 male broilers. The birds were randomly distributed in 5 treatments with 4 repetitions and 10 birds per replicate. The diets were: T1: control diet; T2: T1 + zinc bacitracin (50 ppm); T3: T2 + unprotected acidifier (500 g/t); T4: T2 + protected acidifier (500 g/t); T5: T2 + protected acidifier (1000 g/t). On day 42 two birds were slaughtered per unit. The data were analysed under a completely randomized design, the comparison of means with the Tukey test and the Pearson correlation test to establish relationships between variables. The results indicated that both POA and UOA did not influence the productive response. The pH of the cecum was higher in T4 over T2. In bone morphometry, T5 presented a better internal diameter than T2 and bone width than T2 and T3. Intestinal morphometry was significant in the jejunum in the crypt height/depth ratio favourable to T3, T4 and T5 over T2 (p<0.05). Negative relationships were found between crop pH and live weight, breast weight, tibia width and crypt height/depth ratio (-0.37, -0.34, -0.36, -0.36 respectively; p<0.05), as well as between the pH of the cecum and the area of the villi of the ileum (-0.41) and the pH of the gizzard and the height of the villi of the ileum (-0.34). It is concluded that no influence was evident in the addition of POA and UOA on the productive parameters, pH of the GIT, bone and intestinal morphometry in broiler chickens fed with antibiotics. Furthermore, moderate negative relationships were found in the pH of the anterior and posterior GIT with production parameters and intestinal morphometry, respectively.

RESUMEN La investigación tuvo como objetivo evaluar el efecto de la suplementación con ácidos orgánicos protegidos (AOP) y no protegidos (AONP) sobre el rendimiento del crecimiento, pH del tracto gastrointestinal (TGI), morfometría ósea e intestinal en dietas con antibiótico y sus relaciones. Se trabajó con 200 pollos de engorde Cobb 500 machos de 1 día de edad. Las aves se distribuyeron aleatoriamente en 5 tratamientos con 4 repeticiones y 10 aves por réplica. Las dietas fueron: T1: dieta control; T2: T1 + zinc bacitracina (50 ppm); T3: T2 + acidificante no protegido (500 g/t); T4: T2 + acidificante protegido (500 g/t); T5: T2 + acidificante protegido (1000 g/t). El día 42 se sacrificaron dos aves por unidad. Los datos se analizaron bajo un diseño completamente al azar, la comparación de medias se hizo con la prueba de Tukey y la prueba de correlación de Pearson para establecer relaciones entre variables. Los resultados indicaron que tanto AOP como AONP no influyeron en la respuesta productiva. El pH del ciego fue mayor en T4 sobre T2. En morfometría ósea T5 presentó mejor diámetro interno que T2 y ancho del hueso que T2 y T3. La morfometría intestinal fue significativa en yeyuno en la relación altura/profundidad de la cripta favorable a T3, T4 y T5 sobre T2 (p<0.05). Se encontraron relaciones negativas entre el pH del buche con el peso vivo, peso de pechuga, ancho de la tibia y relación altura/profundidad de la cripta (-0.37, -0.34, -0.36, -0.36 respectivamente; p<0.05), así como entre el pH del ciego y el área de las vellosidades del íleon (-0.41) y el pH de la molleja y la altura de las vellosidades del íleon (-0.34). Se concluye que no se evidenció influencia en la adición de AOP y AONP sobre los parámetros productivos, pH del TGI, morfometría ósea e intestinal en pollos de carne alimentados con antibióticos. Además, se encontraron relaciones moderadas negativas en el pH del TGI anterior y posterior con parámetros de producción y morfometría intestinal, respectivamente.

RESUMEN Introducción: Los pacientes quirúrgicos geriátricos tienen afectación funcional y enfermedades asociadas, lo cual aumenta su riesgo quirúrgico con la edad. Objetivo: Determinar el comportamiento del uso de los antibióticos en pacientes geriátricos que requieren cirugía electiva atendidos en el Hospital Vladimir Ilich Lenin del 2018 al 2022. Métodos: Se realizó un estudio descriptivo, observacional, analítico y transversal a pacientes intervenidos por cirugía electiva con tratamiento con antibiótico. Los datos se obtuvieron de las historias clínicas y la entrevista aplicada. Se analizaron variables como edad, sexo, enfermedades asociadas, diagnóstico preoperatorio, tiempo quirúrgico, complicaciones, evolución, filtrado glomerular y dosis antibiótica perioperatoria. Resultados: El empleo de antibióticos fue más utilizado en los grupos de edades de 60 a 64 años y el sexo femenino; las comorbilidades que predominaron fueron la diabetes mellitus, la hipertensión arterial y la cardiopatía isquémica. Los motivos de consulta más frecuentes fueron por litiasis vesicular y por hernias dentro del grupo ASA I de la American Society of Anesthesiologists. Los antibióticos fundamentales fueron con dosis ajustada. Conclusiones: Se necesita de un trabajo diferenciado en cuanto a la atención al adulto mayor. La utilización de un protocolo o algoritmo de trabajo es necesario en la práctica diaria, sobre todo ante la necesidad de una cirugía electiva.

ABSTRACT Introduction: Geriatric surgical patients have functional impairment and associated diseases, which increases their surgical risk with age. Objective: To determine the behavior of antibiotic use in geriatric patients requiring elective surgery attended at Hospital Vladimir Ilich Lenin Hospital from 2018 to 2022. Methods: A descriptive, observational, analytical and cross-sectional study was conducted on patients undergoing elective surgery with antibiotic treatment. The data were obtained from medical records and the applied interview. The analyzed variables included age, sex, associated diseases, preoperative diagnosis, surgical time, complications, evolution, glomerular filtration and perioperative antibiotic dose. Results: Antibiotic use was more frequent in the age group 60 to 64 years and in the female sex; the most frequent comorbidities were diabetes mellitus, arterial hypertension and ischemic heart disease. The most frequent reasons for consultation were vesicular lithiasis and hernias within the ASA I group of the American Society of Anesthesiologists. The fundamental antibiotics were adjusted by doses. Conclusions: An individualized work is needed in terms of care of the older adult. The use of a working protocol or algorithm is necessary in daily practice, especially when elective surgery is required.

Resumen Existen formas de presentación poco frecuentes de sífilis, dentro de las cuales se incluyen la neurosífilis, otosífilis y sífilis ocular. La neurosífilis es la infección del sistema nervioso central por Treponema pallidum. Las manifestaciones clínicas de neurosífilis son variadas e incluyen formas tempranas, tardías y atípicas. Además, la sífilis puede comprometer prácticamente cualquier estructura ocular, en cualquier etapa de la enfermedad, como así también la otosífilis. El diagnóstico de estas en tidades suele ser dificultoso. Sin embargo, resulta impor tante considerarlas como diagnósticos diferenciales, ya que la mayoría de estas manifestaciones son reversibles con tratamiento antibiótico adecuado. Se presenta una serie de casos de pacientes con diagnóstico de neurosí filis, otosífilis y sífilis ocular, que cursaron internación en un hospital de tercer nivel: meningitis sifilítica con compromiso de pares craneales y convulsiones (caso 1), sífilis ocular (caso 2), paresis general (caso 3) y tabes dorsalis (caso 4). La mitad de los pacientes presentó hipoacusia neurosensorial bilateral. El 50% presentó VDRL reactiva en líquido cefalorraquídeo. Todos fueron tratados con penicilina G sódica y en el 50% se optó por el uso de ceftriaxona como modalidad para finalizar el tratamiento en internación domiciliaria. Respecto a la evolución de los pacientes, uno de ellos falleció como consecuencia del cuadro de neurosífilis (caso 1), otro se perdió en el seguimiento (caso 4) mientras que, de los dos restantes, el caso 3 presentó recaída de su enferme dad a los 6 meses del tratamiento y el caso 2 resolvió ad integrum su sintomatología.

Abstract Uncommon forms of syphilis exist, among which neurosyphilis, otosyphilis, and ocular syphilis are included. Neurosyphilis is the infection of the central nervous system caused by Treponema pallidum. The clinical manifestations of neurosyphilis are diverse and include early, late, and atypical forms. Syphilis can affect virtually any ocular structure and can oc cur at any stage of the disease, as well as otosyphilis. The diagnosis of these conditions is often challeng ing. However, it is important to consider them as a differential diagnosis, as most of these clinical mani festations are reversible with appropriate antibiotic treatment. A case series study of patients diagnosed with neurosyphilis, otosyphilis, and ocular syphilis, who were admitted to a tertiary-level hospital, is here presented: syphilitic meningitis with cranial nerve in volvement, and seizures (case 1), ocular syphilis (case 2), general paresis (case 3), and tabes dorsalis (case 4). Half of the patients presented bilateral sensori neural hearing loss; and also half of the patients had reactive VDRL in cerebrospinal fluid. All were treated with aqueous penicillin G, and in two of these cases, ceftriaxone was chosen to complete ambulatory treat ment. One patient had an unfavorable outcome and died (case 1); another was lost in follow-up (case 4); one completely resolved his symptoms (case 2); and another one experienced symptom relapse six months after treatment (case 3).