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[Background] Salmonella enterica subsp. diarizonae (IIIb) is frequently isolated from the environment, cold-blooded reptiles, sheep and humans; however only a few studies describe the isolation of this subspecies from invasive human infections. The factors contributing to this unusual behavior are currently unknown., [Results] We report here the genome features of two diarizonae strains, SBO13 and SBO27, isolated from endocervical tissue collected post-abortion and from cerebrospinal fluid of a newborn child, respectively, in the city of Santa Cruz, Bolivia. Although isolated six years apart, SBO27 in 2008 and SBO13 in 2014, both strains belong to the same sequence type 1256 (ST1256) and show a high degree of genome conservation sharing more than 99% of their genes, including the conservation of a ~ 10 kb plasmid. A prominent feature of the two genomes is the presence of 24 genomic islands (GIs), in addition to 10 complete Salmonella pathogenicity islands (SPI) and fragments of SPI-7, a pathogenicity island first reported in the human-adapted serovar Typhi. Some of the GIs identified in SBO13 and SBO27 harbor genes putatively encoding auto-transporters involved in adhesion, lipopolysaccharide modifying enzymes, putative toxins, pili-related proteins, efflux pumps, and several putative membrane cation transport related-genes, among others. These two Bolivian isolates also share genes encoding the type-III secretion system effector proteins SseK2, SseK3 and SlrP with other diarizonae sequence types (ST) mainly-associated with infections in humans. The sseK2, sseK3 and slrP genes were either absent or showing frameshift mutations in a significant proportion of genomes from environmental diarizonae isolates., [Conclusions] The comparative genomic study of two diarizonae strains isolated in Bolivia from human patients uncovered the presence of many genes putatively related to virulence. The statistically-significant acquisition of a unique combination of these functions by diarizonae strains isolated from humans may have impacted the ability of these isolates to successfully infect the human host., This work was supported by grants 215RT-0493 from Programa Iberoamericano de Ciencia y Tecnología para el Desarrollo (CYTED), BIO2016–77639-P (AEI/FEDER, UE) and PCIN-2016-082, from Spanish Ministry of Economy and Competitiveness and European Regional Development Funds (FEDER), awarded to FGdP; and, grants DGAPA IN213516, CONACyT 239659 and FC-2015-2/950, awarded to JLP. PV gratefully acknowledges funding grants DGAPA-PAPIIT IN211814 and IN206318 and CONACyT FC-2015-2/879. Other supporting grants were from Comisión Sectorial de Investigación Científica (CSIC), Universidad de la República (Proyecto Grupos I + D 2014), awarded to LB. CS was supported by CONACyT FC-2015-2/879., We acknowledge support of the publication fee by the CSIC Open Access Support Initiative through its Unit of Information Resources for Research (URICI)

The authors studied changes in the upper airway in morbidly obese women and the relationship to sleep apnea-hypopnea syndrome (OSAS).Patients underwent a cardiorespiratory polygraphic study, respiratory function test (spirometry, plethysmography, maximum inspiratory pressures and arterial blood gas analysis), and computed tomographic studies of the upper airway.40 morbidly obese women being evaluated for bariatric surgery (mean age 39.6 +/- 9.6 years old, BMI 48.7 +/- 5.6 kg/m2) were studied. 37 women had OSAS, and 14 had severe OSAS. Results on respiratory function tests were normal. BMI and weight had a positive correlation with apnea-hypopnea index (AHI), apnea index (AI), desaturation index (DI), lowest oxygen saturation and CT90. Uvula diameter had a negative correlation with FEV1, FVC, VC IN and a positive correlation with TLC. Retropharynx soft tissue at the retropalatal level had a negative correlation with FEV1, FVC and VC IN. The oropharynx area at maximal inspiration (total lung capacity) obtained a negative correlation with the AHI (r = - 0.423, P = 0.044), AI (r = - 0.484, P = 0.042) and DI (r = - 0.484, P = 0.019).Prevalence of OSAS in morbidly obese women is very high. Our results show the significant correlation between BMI and AHI in morbidly obese women. Uvula diameter and retropharynx soft tissue are the upper airway parameters with higher relationship with pulmonary function. A reduction in the cross-sectional area of the airway at the level of the oropharynx could be related to the severity of OSAS in morbidly obese women.

At 07:39 on 11 March 2004 terrorist bomb explosions ocurred in 4 trains in Madrid killing 177 people instantly and 14 more later in the hospital. This report describes the organization, clinical management and patterns of injuries in casualties who were taken to our chil-patients were taken to the Gregorio Marañon hospital and 12 to the children's one. The mean age was 16 years (14-21), Two of them were critically ill and needed intensive care (ITP 5). Tympanic perforations occurred in 81% victims with moderate to severe trauma, shrapnel wounds in 36% and eye lesions in 27%. Among critically ill patients blast lung injury, cranial and abdominal trauma were the most important lesions. Training in AITP courses and hospital logistics were essential in clinical management of these casualties.

Objectives:To estimate the frequency of and risk factors for surgical-site infections (SSIs) in Bolivia, and to study the performance of the National Nosocomial Infections Surveillance (NNIS) System risk index in a developing country.Design:A prospective study with patient follow-up until the 30th postoperative day.Setting:A general surgical ward of a public hospital in Santa Cruz, Bolivia.Patients:Patients admitted to the ward between July 1998 and June 1999 on whom surgical procedures were performed.Results:Follow-up was complete for 91.5% of 376 surgical procedures. The overall SSI rate was 12%. Thirty-four (75.6%) of the 45 SSIs were culture positive. A logistic regression model retained an American Society of Anesthesiologists score of more than 1 (odds ratio [OR], 1.87), a not-clean wound class (OR, 2.28), a procedure duration of more than 1 hour (OR, 1.81), and drain (OR, 1.98) as independent risk factors for SSI. There was no significant association between the NNIS System risk index and SSI rates. However, a “local” risk index constructed with the above cut-off points showed a linear trend with SSI (P < .001) and a relative risk of 3.18 for risk class 3 versus a class of less than 3.Conclusions:SSIs cause considerable morbidity in Santa Cruz. Appropriate nosocomial infection surveillance and control should be introduced. The NNIS System risk index did not discriminate between patients at low and high risk for SSI in this hospital setting, but a risk score based on local cutoff points performed substantially better.

To assess the usefulness of a technique for inserting hookwires guided by computed tomography to locate and resect pulmonary nodules by video-assisted thoracoscopy. To describe the procedure and its complications.Nine pulmonary nodules were located in nine patients. All were/= 2 cm in diameter, radiologically undefined and of unknown origin. Four patients had a history of cancer. The nodules were located using the needle/hookwire system (Kopans), guided by computed tomography and were resected by video-assisted thoracic surgery.The hookwire was placed correctly in 8 patients and incorrectly in 1. Thoracotomy was necessary for 1 patient. The histologic diagnosis was benign for all 9 nodules; 5 were hamartomas, 2 were necrotic or fibrotic nodules, 1 was a granuloma and 1 was an anthracotic node. Hospital stay ranged from 1 to 8 days (mean 3.3 days).The location of pulmonary nodes by hookwire and needle for later resection by video-assisted thoracoscopic surgery is a simple, safe way to facilitate removal in some cases, for diagnosis and treatment.

A novel water quality intervention that consists of point-of-use water disinfection, safe storage and community education was field tested in Bolivia. A total of 127 households in two periurban communities were randomized into intervention and control groups, surveyed and the intervention was distributed. Monthly water quality testing and weekly diarrhoea surveillance were conducted. Over a 5-month period, intervention households had 44% fewer diarrhoea episodes than control households (P=0·002). Infants P=0·05) and children 5–14 years old (P=0·01) in intervention households had significantly less diarrhoea than control children. Campylobacter was less commonly isolated from intervention than control patients (P=0·02). Stored water in intervention households was less contaminated with Escherichia coli than stored water in control households (PE. coli contamination of stored water and less diarrhoea than control households. This promising new strategy may have broad applicability for waterborne disease prevention.

We report the case of a patient who needed urgent surgical assistance because of massive lower gastrointestinal hemorrhage secondary to a jejunal angiodysplasia (cavernous hemangioma). These lesions are a rare cause of gastrointestinal bleeding of obscure origin. The use of preoperative diagnostic techniques such as oral fiber-optic endoscopy, barium intestinal studies and scintigraphy have little value when the origin of lower gastrointestinal bleeding is in the small bowel. The best yield is obtained with celiac or superior mesenteric angiography. There are some cases in which only an exploratory surgical laparotomy is useful for the diagnostic supported by intraoperative enteroscopy guided by the surgeon.

Congenital polycystic dilatation of the intrahepatic biliary ways (Caroli's disease) is a rare disease. The "pure" type and the one associated with congenital hepatic fibrosis are accepted. Although the current exploration methods, its diagnosis is rare before the surgical procedure. Treatment of the diffuse pure types and the ones associated with hepatic fibrosis is difficult and the outcome is bad. A case of the less frequent type is communicated, in which, as a novelty, intrasurgical echography was used in its treatment.

Endometriosis of the Digestive Tract is an uncommon pathology, especially when ileocecal appendix is involved. Authors report twelve cases of appendiceal endometriosis reviewed from surgical and anatomopathological records. The preoperative diagnosis is almost impossible. The most usual clinical presentation is compatible with that of acute or chronic appendicitis. The definitive diagnosis is confirmed by anatomopathological study of the surgical specimen. The Surgical treatment consists of appendicectomy alone or associated with extirpation of other concomitant neighbouring lesions.

We present the experience with the use of intraoperative ultrasonography in detecting biliary calculi on 55 patients, 19 of which had lithiasis of the common bile duct. Operative ultrasonics imaging of the biliary tree and operative cholangiography had a similar accuracy when both explorations were performed. In this series, accuracy indexes of ultrasonography in diagnosing choledocholithiasis were: sensitivity, 84.21%; specificity, 100%; efficiency, 94%; predictability of a positive test, 100%; predictability of a negative test, 92%. We think ultrasonography is a better exploration in two conditions: when intrahepatic duct lithiasis exists and if calculi are at the end of choledochus, because differentiation with neoplastic changes is easier.

Report of two cases of eosinophilic gastroenteritis. In both cases the presentation was an acute abdomen syndrome. The etiological diagnosis was postoperative, because in the preoperative period there were no data characteristic of this entity. Probably this disease is more frequent than reported and although the treatment is medical, there are some cases in which surgery is justified.

A case is presented of mesenteric venous thrombosis which affects about 30 cm of small intestine in a patient operated one month before for portal hypertension and bleeding from esophagogastric varices, in which an interruption of the portal-azygous venous circulation was made with splenectomy, using the Romero-Torres procedure. We consider that postsplenectomy thrombocytosis has been the first pathogenic factor in the mesenteric venous thrombosis.

The authors present two cases of hepatic echinococcus cyst with destruction of the biliary confluent. The severity of this exceptional lesion requires uncommon treatment. Experience with treatment of biliary fistulas when there is a residual cystic cavity, provides arguments for and against primary suture of these fistulas. In these cases, the required treatment consists in reconstruction of the hepatic biliary ducts destroyed (right, left and common) by using the pericystic envelope itself as a plastic neoformative element. The result has demonstrated its efficacy after many years of use, as we have indicated in this article. "Echinococcus granulosus" itself is only rarely a problem in the host, but a hepatic echinococcus cyst does not only pose a spatial problem, except insofar as it often involves the biliary tree. In the cases reported here, the hepatic echinococcus cyst causes biliary problems in over 60% of the cases (1). These biliary problems were as follows: Compression of the common bile duct by the cys; More often, compression of the intrahepatic bile ducts causes the cyst to open inside the biliary duct and to fissure, leading to a biliocystic fistula.

Twenty-three hepatic resections were performed over a period of four years with the use of a Lin liver clamp and an operative mortality rate of 17.3%. Indications for liver resections were: five primary liver malignancies, four metastatic liver tumors and 14 benign liver diseases. All of the 14 patients with benign diseases survived the operation without developing late symptoms or complications. The survival rate of five patients with malign diseases ranged from three to 31 months. The technical details, advantages and precautions involved in the use of the Lin liver clamp are discussed. This approach improved the rate of operative mortality and facilitated partial lobectomy in cirrhotic livers, but the long-term results are dependent on the disease rather than the result of the operation.