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El objetivo de este trabajo consistió en determinar la percepción sobre el conocimiento que los padres de niños con dermatitis atópica (DA) tienen sobre la enfermedad y su manejo, y la repercusión que la educación terapéutica (ET) podría tener en ampliarlo.

Supplemental Digital Content is available in the text.Acinetobacter baumanniicauses serious hospital-acquired infections and has been positioned as a priority organism by the World Health Organization. This study includes 36 A. baumanniiisolates from a children hospital recovered between March 2014 and May 2015 in Cochabamba. The majority of the isolates were recovered from blood cultures (n = 10, 31.3%) and respiratory samples (n = 11, 34.4%); 53% of the patients were younger than 1 month old. Most of these isolates (n = 30, 80.6%) were extremely drug resistant and 8.3% were multidrug resistant. The circulation of 2 predominant clones including 25 isolates was determined by pulsed-field gel electrophoresis; 9 of the isolates were considered sporadic strains. The isolates grouped in the predominant clones and 5 of the unrelated sporadic strains were single-locus variant or double locus variant of clonal complex (CC110), belonging to international clone 7; the rest of the isolates were single-locus variant or double locus variant of another clonal complex. All the carbapenem-resistant isolates (88.9%) carried the blaOXA-23-likein a similar structure to Tn2008located on the chromosome, and the aac(3)-IIagene was present in all the aminoglycoside-resistant isolates (86.1%). Strong biofilm producers were found among these isolates, being the strongest ones those recovered from the hospital environment, catheter, blood and cerebrospinal fluid (CSF) all of them belonged to the unrelated sporadic strains. The present study demonstrated the predominance and spread of closely related extremely drug-resistant A. baumanniiisolates, what confers increasing risk to children and is of major concern because of the kind of infections and the lack of therapeutic alternatives to treat them.

The effects of individualised perioperative lung-protective ventilation (based on the open-lung approach [OLA]) on postoperative complications is unknown. We aimed to investigate the effects of intraoperative and postoperative ventilatory management in patients scheduled for abdominal surgery, compared with standard protective ventilation.

-Catenin gene mutations and microsatellite instability (MI) have been reported in endometrioid ovarian carcinomas. In colon but not endometrial cancer, -catenin gene mutations are associated with a replication error phenotype and MI. In this study the authors investigate whether -catenin mutations and MI are two independent oncogenic pathways in endometrioid ovarian carcinomas. They also evaluate the usefulness of these molecular markers in determining the primary origin of simultaneous tumors in the ovary and endometrium. This study was performed on 26 patients diagnosed with primary endometrioid ovarian carcinoma, five of whom also had pathologically diagnosed primary synchronous endometrioid endometrial carcinoma. Immunohistochemical and molecular analyses indicated that there were 25 primary ovarian tumors with four primary synchronous endometrial cancers and one ovarian metastasis of a primary endometrial carcinoma. All studies were performed on formalin-fixed, paraffin-embedded tissue samples. The -catenin expression pattern (nuclear vs. membranous) was analyzed immunohistochemically. Mutations in exon 3 of the -catenin gene were studied by polymerase chain reaction, single-strand conformational polymorphism, and direct sequencing. MI status was established by studying BAT-26 and BAT-25 mononucleotide repeats. In the group with 21 single ovarian tumors, 18 (85) had -catenin nuclear expression, eight (38) had -catenin gene mutations (always associated with -catenin nuclear expression), and four (19) had MI. Only one case (5) had both -catenin gene mutations and MI. The mutations affected one of the serine/threonine residues targeted for phosphorylation by glycogen synthase kinase-3 or adjacent residues. At codon 32, a GAC-to-TAC (D32Y) change was found; at codon 33, two TCT-to-TGT (S33C) changes were found; at codon 37, three TCT-to-TTT (S37F) changes and one TCT-to-TGT (S37C) change were found; and, lastly, one ACC-to-GCC change at codon 41 (T41A) was detected. Four of the 25 endometrioid ovarian carcinomas (16) had an associated synchronous endometrial carcinoma. There was a higher percentage of -catenin mutations (n 3, 75) in synchronous ovarian carcinomas than in single ones, although with a similar percentage of MI (n 1, 25). -catenin mutations were S37C in two cases and D32G in one. One of the four endometrial carcinomas showed an S33C -catenin mutation, and two carcinomas had MI. None of the four tumors had both -catenin gene mutation and MI. -catenin gene mutations were always associated with a nuclear -catenin expression pattern, whereas MI was associated with a membranous pattern. In one patient both the ovarian and the endometrial carcinomas had -catenin gene mutations, in another patient both tumors showed MI, whereas in the remaining two patients the ovarian carcinomas showed -catenin gene mutations and the endometrial carcinomas showed MI. To summarize, the results of this study suggest that -catenin mutations and MI could represent two independent pathways in endometrioid ovarian carcinomas because they occur simultaneously very infrequently (in 5 of these cases). -catenin mutations are always associated with a nuclear -catenin expression pattern, whereas cases with a replication error -plus phenotype showed no abnormal -catenin subcellular localization. The study of the -catenin expression pattern, -catenin mutations, and MI, together with conventional clinicopathologic findings, could aid in distinguishing between the metastatic or independent origin of simultaneous endometrioid ovarian and endometrial carcinomas. Tumors with identical immunohistochemical and molecular features should therefore be considered to have a common origin.

Objectives: To study the evolution between 1999 and 2002 and mechanisms of antibiotic resistance in a multidrug-resistant Acinetobacter baumannii clone predominant in isolates from elderly patients with respiratory tract infections.Methods: Susceptibility to antimicrobials was determined using an agar dilution method. Bacterial clones were identified by PCR-fingerprinting and PFGE with ApaI. Carbapenemases were detected by phenotypic tests; by PCR with primers specific for blaOXA-40, blaIMP, blaVIM-1 and blaVIM-2; and by hybridization with DNA probes. Class 1 integrons were detected using PCR.Results: In 1999 isolates were grouped into two main genotypes: clone I (33%) and clone II (55%). These were also detected in 2002 with a different distribution: clone I (69%), clone II (22%). Resistance to amikacin, meropenem and imipenem increased significantly in clone I over this time, whereas clone II was not affected. In 2002, the incidence of blaOXA-40 rose to 91% in clone I isolates with some also harbouring blaVIM-2 and blaIMP genes. Different class 1 integrons were detected ranging in size from 550 to 1200 bp. No relationship was found between carbapenemases and class 1 integrons.Conclusions: In elderly patients, a single clone became predominant among A. baumannii isolates, coinciding with an increase in antibiotic resistance rates. The majority of isolates harboured the blaOXA-40 carbapenemase gene and some of them also harboured blaVIM-2 and blaIMP genes. The presence of class 1 integrons also increased over time.

Describimos el caso de una paciente que presentó un sarcoma del tabique interauricular con un crecimiento muy acelerado y una evolución clínica fulminante, documentado mediante técnicas diagnósticas de imagen no invasivas, habituales en la práctica cardiológica. La historia natural de algunos tipos de tumores cardíacos malignos tan agresivos como el descrito explica el habitual retraso diagnóstico, la dificultad para instaurar un tratamiento curativo como la cirugía y/o poliquimioterapia/radioterapia y el pronóstico tan sombrío a corto plazo.