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Streptococcus agalactiae es una bacteria colonizante que ha emergido en los últimos años como causante de infecciones neonatales, perinatales y en pacientes con compromiso inmunológico. La caracterización del polisacárido capsular, de las proteínas de superficie (c, X, R), así como el análisis de marcadores moleculares, permiten su clasificación en serotipos y genotipos. Esto resulta de utilidad para fines epidemiológicos y para estudios de virulencia de la bacteria. El objetivo de este trabajo fue conocer los serotipos prevalentes y la sensibilidad antimicrobiana de aislamientos provenientes de procesos infecciosos en pacientes de distintas zonas de Argentina. En la muestra analizada se obtuvo predominio de los serotipos Ia y III, seguido de II y IV. Todas las cepas resultaron sensibles a penicilina. Se observó 6% de resistencia a eritromicina y 4,5% a clindamicina. En 3 de las cepas se detectó fenotipo MLS (resistencia a macrólidos, lincosaminas y estreptograminas) constitutiva y en una cepa, resistencia MLS inducible. Los resultados logrados en este estudio destacan la importancia de efectuar un relevamiento de los serotipos más frecuentes en nuestro país en vistas a la prevención de esta infección con una vacuna que realmente sea eficaz, como así también el conocimiento de la sensibilidad antimicrobiana para lograr éxito terapéutico en los tratamientos.Streptococcus agalactiae is an endogenous bacterium that has emerged in the last 20 years as an etiological agent in both neonatal and perinatal infections, and in immunocompromised patients. The differentiation of the capsular polysaccharide, the presence of surface proteins c, X, R, and molecular methods allow classification in serotypes and genotypes. This identification is a useful tool for epidemiological purposes and virulence studies in this bacterium. The objective of this work was to study the serotypes and the antimicrobial susceptibility of isolates recovered from invasive diseases in different areas of Argentina. In the analyzed sample a fair predominance of Ia and III serotypes was recovered, followed by II and IV serotypes. All the isolates were found to be sensitive to penicillin. A 6% of resistance to erythromycin and a 4.5% to clindamycin were detected. In three of the isolates, constitutive MLS phenotype (resistance to macrolides, lincosamins and streptogramins) was founded, while in the remaining one, inducible MLS phenotype was detected. These results stress the importance of conducting a surveillance of the prevalent serotypes in our country with the goal of future prevention of this disease with an effective vaccine. The knowledge of the antimicrobial susceptibility profile will be also important to obtain therapeutic success in the treatment.

A mastite em ovelhas da raça Santa Inês apresenta-se como um problema de grande proporção e gravidade e é dificilmente tratada com sucesso. O objetivo deste estudo foi caracterizar aspectos clínicos, epidemiológicos e etiológicos da mastite clínica em ovelhas de corte criadas no norte do Paraná. O presente estudo foi realizado entre os meses de outubro de 2009 a setembro de 2010 envolvendo 54 rebanhos de ovinos de corte de diferentes raças. Durante as visitas às propriedades, um questionário foi preenchido com a finalidade de caracterizar o problema. Setenta ovelhas com mastite clínica foram examinadas e amostras de secreção láctea foram colhidas para exame microbiológico. A mastite foi considerada um problema relevante em 39 propriedades (72,3%), com frequência média de 6,74%. Casos crônicos e agudos de mastite foram observados em 69% e 31% das ovelhas examinadas, respectivamente. Em ambos os casos, a mastite flegmonosa foi a forma mais encontrada (65,5% dos casos). O agente etiológico mais prevalente foi Staphylococcus coagulase negativo (54,5%), seguido por S. aureus e A. pyogenes (11,5% cada). Mannheimia haemolytica foi isolada em dois casos. Sistema de criação não extensivo e raça Santa Inês foram identificados como fatores de risco para o desenvolvimento de mastite clínica. Secagem das fêmeas após 120 dias de lactação e separação de fêmeas doentes do rebanho foram associadas com menor ocorrência da doença. Recomenda-se a limpeza adequada das instalações e a secagem mais tardia, principalmente em rebanhos Santa Inês.

Foram examinadas 713 vacas de três rebanhos leiteiros localizados na região norte do Estado do Paraná e sudoeste do Estado de São Paulo, das quais 137 apresentaram mastite. Nas três propriedades foram detectados oito animais (1,12%) com mastite clínica por Mycoplasma bovis. Destes animais, quatro tratados com oxitetraciclina e tilosina e três com enrofloxacina, não responderam ao tratamento e foram descartados no decorrer da lactação. Uma vaca medicada com enrofloxacina recuperou quase que totalmente a secreção láctea mas a eliminação de M. bovis persistiu por toda lactação. Esta vaca apresentou cura bacteriológica na lactação seguinte. O descarte dos animais positivos, monitora-mento bacteriológico e a aplicação correta das medidas de prevenção para as mastites contagiosas controlaram a disseminação de M. bovis nos rebanhos.In this study 713 cows were examined. The animals were from three dairy farms in northern Paraná and the southwest of the State of São Paulo. From these cows, 137 had mastitis. On the three farms, 8 cows (1.12%) with Mycoplasma bovis mastitis were detected. Four were treated with tylosin and oxytetracyclin and three with enrofloxacin. There was no response to the treatments, and these animals were culled during the lactation period. One cow treated with enrofloxacin almost totally recovered milk production, but elimination of M. bovis continued during the lactation, and there was no bacteriological cure. This cow had a normal milk production in the next lactation period, without elimination of M. bovis. Culling of positive animals, the bacteriological study and correct application of preventive practices for contagious mastitis controlled the dissemination of M. bovis to other animals.

ABSTRACT: Mastitis represents an important health problem for Santa Inês breed, causing losses to the producer, due to loss of ewes or the decrease in weight gain of lambs. The aim of this work was to assess the health of the mammary gland of Santa Inês ewes at the drying and puerperium and to investigate the efficacy of a dry-off therapy with gentamicin. In this study, 64 ewes were divided in a control group (GC) and treatment group (GT), and the health of the mammary gland was assessed at the drying and puerperium. The GT ewes received 250mg of gentamicin (Gentocin® DryCow/Schering-Plough, product indicated for use in dairy cows) in each mammary half. For diagnosis, clinical examination, California Mastitis Test, somatic cell count and milk culture was performed. In the GC, of the 45 (70.3%) healthy mammary halves at the drying, 12 developed subclinical mastitis and nine clinical mastitis at the puerperium. In the GT, among 51 (79.7%) healthy mammary halves at the drying, six developed subclinical mastitis and 11 clinical mastitis at the puerperium. No association was observed between treatment and the occurrence of mastitis at puerperium. Of the 19 (29.7%) mammary halves of the GC that presented subclinical mastitis at the drying, three remained with subclinical mastitis and five developed clinical mastitis at the puerperium. In the GT, of the 13 (20.3%) mammary halves that had subclinical mastitis at the drying, four remained with subclinical mastitis and four developed clinical mastitis. No association was observed between treatment and cure or persistence of mastitis at the puerperium. The main microorganisms isolated, at the drying and puerperium, from animals with subclinical or clinical mastitis were Staphylococcus spp., predominantly coagulase negative Staphylococcus (CSN). At the puerperium, 29 cases of clinical mastitis occurred, 19 with isolation, where 10 were CNS and six S. aureus. Mannheimia haemolytica was isolated in one case of subclinical mastitis and other of clinical mastitis. News protocols and different ways of handling at drying and at puerperium must be investigated.

Areas covered by seminatural grasslands have been in constant decline for decades in Europe. This trend is particularly strong for mountain territories, where such traditional agricultural practices as cattle grazing are no longer economically feasible. This study was conducted in the subalpine pasture of Cinte Tesino (TN, Italy), where local farmers have applied the following different management strategies: shorter and longer grazing durations during the season and a complete abandonment for the last 15 years. We aimed to study how these different management strategies impact the functioning and diversity of vegetation and the chemical and biological characteristics of the soil. Species richness was higher in plots subjected to longer grazing with a prevalence of D. caespitosa in terms of biomass share. A decline in species richness in abandoned plots was accompanied by an increase in the share of other graminoids in collected biomass. A concomitant increase in leaf N concentration and light availability in grazed plots resulted in higher photosynthetic efficiency in some species, as revealed by the δ 13 C of plant tissues. Soils under grazing were characterised by a higher concentration of total and extractable N, almost doubled microbial biomass C and increased extracellular enzymes activity, evidencing nutrient cycling mobilization. While the microbial pool was characterised by lower mineralization rates, C was lost from the soil with 15 years of abandonment. The longer grazing season demonstrated to be the most beneficial, promoting species richness, C accumulation and better soil microbial functioning. A change in soil pH from strongly acidic to moderately acidic with longer grazing is likely one of the important factors adding to the success in the functioning of primary producers and decomposers in this site.

Unlabelled: Clonidine has anesthetic-sparing properties and it may reduce the hemodynamic and psychological effects of S+ ketamine. The objectives of this study were to evaluate the interactions between clonidine and ketamine in hemodynamic and the psychological effects. Psychological effects were evaluated in a very detailed way., Method: A prospective, double-blind, placebo-controlled study designed for 48 patients with major burns, aged 18-60 years, ASA II or III, who were scheduled for dressing changes was conducted. Midazolam, S+ ketamine, placebo, or clonidine was used for the anesthesia. Intraoperative hemodynamic alterations over time were assessed. The psychological effects were evaluated in detail using 13 variables, the return of conscience, and analgesia during the first 2h after the procedures., Results: The clonidine group had low arterial pressure during the procedure. At the 30-min evaluation of the psychological variables, five out of 13 were lower in the clonidine group. At the 2-h evaluation, only the Anxious variable was lower in the clonidine group. Cardiac frequency, postoperative analgesia, delirium, and dreaming were not different between both groups. There was no difference in complication rates between both groups., Conclusion: Clonidine in S+ ketamine plus midazolam anesthesia reduces the arterial pressures and the postoperative psychological effects., (Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.)

Introduction: Gastroesophageal reflux disease (GERD) is a pathology with a wide range of clinical and endoscopic manifestations. Epidermal growth factor receptor (EGFR), found in the epithelium of the digestive tract, plays an important role in epithelial repair and shows increased expression in different neoplasms, including esophageal tumors., Objectives: The purpose of this study was to evaluate EGFR expression using immunohistochemistry in esophageal biopsies obtained from patients with GERD, Barrett's esophagus, and adenocarcinoma of the esophagus., Methods: EGFR expression was immunohistochemically determined in biopsies from 194 patients with symptoms suggestive of GERD or adenocarcinoma of the esophagus, seen at two Brazilian university hospitals between January 2003 and December 2008. Based on histopathological analysis, patients were divided into three groups: GERD, Barrett's esophagus and adenocarcinoma of the esophagus. EGFR expression was considered positive when staining was detected in the membrane., Results: Mean age was 55.25 years (range 30-90). Patients with GERD (n = 127) accounted for 65.5% of the sample, compared with 12.4% (n = 24) of patients with Barrett's esophagus and 22.2% (n = 43) of patients with esophageal adenocarcinoma. Immunohistochemical analysis was positive for EGFR in 19.1% of the patients (37/194), divided as follows: 8.7% (11/127) in the GERD group, 25% (6/24) in the Barrett's esophagus group, and 46.5% (20/43) in the esophageal adenocarcinoma group. Statistical analysis revealed significant differences between the three groups (p = 0.0001)., Conclusions: GERD patients showed lower levels of EGFR expression than patients with Barrett's esophagus or patients with adenocarcinoma of the esophagus, suggesting a direct relationship between EGFR expression and disease progression.

Background and Objectives: Pseudomyxoma peritonei is a rare condition related to epithelial neoplasia of the appendix and ovaries. Surgical cytoreduction, peritonectomy, and hyperthermic intraoperative peritoneal chemotherapy (HIPEC) is the treatment of choice. Maintenance of normovolemia, normothermia, postoperative pain management and coagulation status are all responsibility of the anesthesiologist. The objective of this report was to describe a case of peritonectomy with HIPEC., Case Report: This is a 37 year-old female, ASA I, with a history of appendectomy 3 months ago with an anatomopathological report of mucinous cystoadenoma. After review of the pathological sample, a pseudomyxoma peritonei was diagnosed with indication of peritonectomy with HIPEC. An epidural catheter (T11-T12) was placed and a test-dose, as well as morphine, was administered. Anesthesia was induced with remifentanil, 0.4 μg.kg⁻¹.min⁻¹, propofol, and rocuronium, besides rapid-sequence orotracheal intubation. Remifentanil, sevoflurane, and rocuronium were used for anesthesia maintenance according to the TOF. Ropivacaine 50mg, and fentanyl 10 μg. in 10 mL were administered through the epidural catheter 10 minutes before incision. During the surgery, CVP, SpO₂, FeCO₂, temperature, heart rate, MAP, and urine output maintained stable levels within normal limits, including during HIPEC. Reduction of the hematocrit and SvO₂, increased PT, and thrombocytopenia were corrected by administering blood products. After 13 hours of surgery, the patient was admitted to the ICU under controlled ventilation. She was extubated on the 1(st) postoperative day, being discharged from the hospital on the 17(th) day of hospitalization., Conclusions: Surgical cytoreduction and peritonectomy with HIPEC goes back to the decade of 1990 with several studies showing a significant increase in survival. Due to the complexity of the procedure and large surgery the vigilance of the anesthesiologist is fundamental for maintenance of clinical and laboratorial parameters, and recognition and treatment of any changes., (Copyright © 2010 Elsevier Editora Ltda. All rights reserved.)

Streptococcus agalactiae is an endogenous bacterium that has emerged in the last 20 years as an etiological agent in both neonatal and perinatal infections, and in immunocompromised patients. The differentiation of the capsular polysaccharide, the presence of surface proteins c, X, R, and molecular methods allow classification in serotypes and genotypes. This identification is a useful tool for epidemiological purposes and virulence studies in this bacterium. The objective of this work was to study the serotypes and the antimicrobial susceptibility of isolates recovered from invasive diseases in different areas of Argentina. In the analyzed sample a fair predominance of Ia and III serotypes was recovered, followed by II and IV serotypes. All the isolates were found to be sensitive to penicillin. A 6% of resistance to erythromycin and a 4.5% to clindamycin were detected. In three of the isolates, constitutive MLS phenotype (resistance to macrolides, lincosamins and streptogramins) was founded, while in the remaining one, inducible MLS phenotype was detected. These results stress the importance of conducting a surveillance of the prevalent serotypes in our country with the goal of future prevention of this disease with an effective vaccine. The knowledge of the antimicrobial susceptibility profile will be also important to obtain therapeutic success in the treatment.

Although several advances have been made in the management of acute coronary syndromes, the adoption of such measures in clinical practice has been suboptimal. The implementation of critical pathways has been suggested as a strategy to improve clinical effectiveness, although its effect is still to be demonstrated. The objective was to evaluate the impact of a critical pathway on the process of care of patients admitted with acute coronary syndromes in a teaching hospital. In a prospective cohort study, patients 30 years or older admitted to the emergency department with suspected acute coronary syndromes were evaluated. Primary outcomes were major cardiovascular events, percutaneous coronary intervention, and in-hospital mortality during 1 semester before and 4 semesters after implementation of the pathway. Multivariate logistic regression analysis was used to adjust for differences between the periods studied and to identify predictors of poor prognosis. Of the 1003 patients evaluated, 150 (15%) had myocardial infarction, and 240 (24%) had unstable angina. There was no difference in clinical characteristics and risk assessment in the periods evaluated. Overall, the quality of care improved after the pathway, with a significant decrease in complication and mortality rates in the last 2 years. In multivariate analysis, patients admitted in the last semester showed fewer major cardiovascular events (odds ratio = 0.74; P = 0.02) and more percutaneous coronary intervention (odds ratio = 1.3; P = 0.03). The implementation of a critical pathway may have a positive impact on the quality of care of patients with acute coronary syndromes. Further studies are needed to evaluate better this and other initiatives aimed at maximizing clinical effectiveness.

During a 6-year period the authors performed percutaneous dilational tracheostomy (PDT) in 304 cases using the technique introduced by Ciaglia in 1985. A following study on 40 patients evaluated late complications of PDT; none of the patients developed laryngotracheal stenosis. In our experience PDT has been a very sure technique of securing the airway.

Oat cell carcinoma of the larynx is a rare tumor. A throughout search of the literature revealed only 80 cases; the first case in literature was reported by Olofsson in 1972. The tumor often presents in the sixth and seventh decades of life and appears to be highly aggressive and metastases develop early. We have had the opportunity to study ultrastructurally a small cell carcinoma of oat cell type arising in the larynx.