Chylooperitoneum in the cardiovascular possurgical. Presentation of a case

Introduction: Chyloperitoneum is defined as the presence of lymph of thoracic or intestinal origin in the abdominal cavity. It is reported infrequently and is a rare manifestation of multiple deseases. Most of the cases are secondary and are associated with direct trauma to the peritoneal dialysis. Renal replacement therapy is necessary in up to 10% of children who undergo cardiac surgery with extracorporeal circulation, indicated in cases of water overload, acute renal dysfunction or ionic alterations. Objective: To report the case of a 15-day-old newborn, operated on for Transposition of the Great Vessels, who presented as a postoperative complication, dicharge of chylous content through the Tenckhoff, after a peritoneal dialysis regimen due to acute renal failure and fluid overload. Results: Despite the therapeutic measures taken, the patient maintains centuries-old losses of lymph, which lead to nutritional and immunological deterioration with the consequent multiple organ dysfunction and death. Conclusions: The perpetuation of lymph losses in the postoperative period of cardiovascular surgery produces a nutritional and immunological deterioration of the patient, with a high risk of mortality due to sepsis.

Genetic and phenotypic determinants of resistance to antibiotics in Aeromonas spp., strains isolated from pediatric patients

Introduction: Intestinal and extraintestinal infections by Aeromonas spp., remain controversial, due to the existence of healthy carriers of Aeromonas spp. In children under five years old, the diarrhea of infectious origin constitutes the second cause of mortality and remains a major concern for public health. The aim of this work was to detect the pheno/genotype of β-lactamases and class 1 integrons in Aeromonas spp., strains isolated from pediatric patients in a tertiary referral hospital in Mexico. Methodology: Sixty-six strains of Aeromonas spp., were isolated from clinical samples of pediatric origin and were identified by RFLP-PCR 16S rRNA. Resistance phenotype according to CLSI, genetic and phenotypic detection of extended-spectrum β-lactamases (ESBL) and metallo-b-lactamases (MBL) was performed. Finally, characterization of class 1 integrons was performed. Results: Aeromonas spp., strains of diarrheic origin were more predominant. A wide heterogeneity was detected, where A. caviae was the predominant specie. Second-generation cephalosporins, fluoroquinolones, and nitrofurans had best antimicrobial activity; moreover, antibiotics of the β-lactamic and lincosamides families showed lower inhibitory activity. Phenotypically, prevalences of 4.55% and 3.03% were detected for MBL (intestinal origin) and ESBL (extraintestinal origin), respectively. blaIMIS-cphA and blaTEM-1 genes, and nineteen class 1 integrons carrying two variants of cassettes corresponding to adenylyl transferases (aadA), and dihydrofolate reductases (dfrA). Monogenic array with aadA1 cassette was predominantly. Conclusions: ESBL and class 1 integrons, in Aeromonas collected from pediatric patients, determines a major detection challenge for the clinical microbiology laboratory and represents a remarkable epidemiological risk of nosocomial spread of multidrug-resistant determinants.

EPIDEMIOLOGICALAND CLINICO-PATHOLOGICALANALYSIS AND OUTCOMES OF EXTRA-INTESTINAL GIST AT A TERTIARY CARE HOSPITAL IN SOUTH INDIA

INTRODUCTION: Extraintestinal GIST (EGIST) is a rare mesenchymal tumor. There is lack of sufficient literature regarding EGISTs. We have undertaken a retrospective observational study to analyze the epidemiology, clinicopathological features and outcomes of EGISTs. METHODS: All patients with the diagnosis of EGIST in the department of Surgical Gastroenterology, SVIMS from January 2015 to December 2019 were included. Patient’s demographics, laboratory and imaging findings, intra-operative findings, tumor pathology and outcomes were analyzed. RESULTS: Fourteen patients were included. Of these, 8 (57.14%) were males. Mean age was 53.43 years. Most patients (85.71%) presented with abdominal pain. Most common site of EGIST was retroperitoneum (50%). Preoperative imaging was diagnostic of GIST of gastro-intestinal origin in all patients. 71.43% tumors were >10cm in size and 50% had >10 mitotic index. Twelve patients underwent radical surgery. All were advised adjuvant therapy. Mean hospital stay was 7.07 days. Median survival was 38.5 months (range 4-60 months). CONCLUSION: EGISTs are more likely to be malignant, large in size, with high mitotic rates. Imaging may not be accurate for diagnosis. Owing to low incidence of EGISTs, multi-center studies are required to study their clinical and pathological behavior.

Hygienic-sanitary quality in milk and cheese sold clandestinely in the municipality of Sinop - Mato Grosso, Brazil

Dairy products such as raw milk and artisanal cheeses are marketed in open markets and directly at home throughout Brazil, even with prohibitions in Brazilian legislation, leading in many cases to the production of food without hygienic conditions that can be configured as an important source transmission of pathogens and, consequently, a danger to public health. Escherichia coli is an agent of intestinal origin and, in addition to some strains possess pathogenic potential, its presence in the food indicates inadequate hygienic practices. This study aimed to evaluate the hygienic-sanitary quality of these products to determine if they are suitable for human consumption. Eight samples of milk and eight cheese sold clandestinely in the municipality of Sinop in the State of Mato Grosso were analyzed. All of them were submitted to the Most Likely Number Test (NMP) for the detection of Total and Thermotolerant Coliforms, isolation in Methylene Blue Eosin Agar (EMB) and identification of Escherichia coli by means of biochemical tests. Among the 8 milk samples, 62.5% (5/8) presented levels of Thermotolerant Coliform than allowed by the legislation and 87.5% (7/8) above the levels allowed for Total Coliforms. Among the 8 cheese samples, 50% (4/8) presented values higher than that allowed for Thermotolerant Coliforms and 87.5% (7/8) for Total Coliforms. Of the 80 colonies initially isolated from raw milk and cheese samples, 56.25% (45/80) presented Escherichia coli characteristics. The great majority of the analyzed samples demonstrate a low hygienic-sanitary quality being considered possible sources of pathogens to the consuming population.

A comparative and functional genomics analysis of the genus Romboutsia provides insight into adaptation to an intestinal lifestyle

Cultivation-independent surveys have shown that the recently described genus Romboutsia within the family Peptostreptococcaceae is more diverse than previously acknowledged. The majority of Romboutsia-associated 16S rRNA gene sequences have an intestinal origin, but the specific roles that Romboutsia species play in the digestive tract are largely unknown. The complete genomes of the human intestinal isolate Romboutsia hominis FRIFIT (DSM 28814) and the soil isolate Romboutsia lituseburensis A25KT (DSM 797) were sequenced. An evaluation of the common traits of this recently defined genus was done based on comparative genome analysis of the two strains together with the previously elucidated genome of the type species Romboutsia ilealis CRIBT. These analyses showed that the genus Romboutsia covers a broad range of metabolic capabilities with respect to carbohydrate utilization, fermentation of single amino acids, anaerobic respiration and metabolic end products. Main differences between strains were found in their abilities to utilize specific carbohydrates, to synthesize vitamins and other cofactors, and their nitrogen assimilation capabilities. In addition, differences were found with respect to bile metabolism and motility-related gene clusters.

Compartmentalization of intestinal bacteria by hepatic ILC3s prevents infections after surgery

ABSTRACTInfections after surgical interventions are assumed to be caused by contamination. We show by analyzing multicentric data of 6561 patients that surgical infections as well as sepsis had a predominantly enteric microbial signature irrespective of the type of surgery, suggesting failure of intestinal bacterial compartmentalization. In mice, we reveal that hepatic surgery induced dysregulation of intestinal and hepatic type 3 innate lymphoid cells (ILC3s) and intestinal leakage resulting in enteric bacterial translocation via lymphatic vessels. In the absence of hepatic ILC3s, inflammasome activation and the induction of antimicrobial peptide encoding genes, bacteria colonized remote systemic organs and impaired surgical outcomes. Conversely, mammalian-microbial commensalism is required for the education of host immunity to ensure optimal hepatic healing responses. In fact, microbial-derived products were sufficient for the induction of proliferative transcriptional networks in the mouse liver, as illustrated by serum transfer experiments, mass spectrometry and RNA expression analysis, indicating that the balanced exposure of the host to commensals is essential for recovery. This study reveals the intestinal origin of microbes causing complications after surgical interventions and highlights host protective mechanisms of controlled commensalism that prevent infections.One Sentence SummaryIntestinal bacteria cause surgical infections

The Lymphatic Headmaster of the Mast Cell-Related Splanchnic Inflammation in Portal Hypertension

Portal hypertension is a common complication of liver disease, either acute or chronic. Consequently, in chronic liver disease, such as the hypertensive mesenteric venous pathology, the coexisting inflammatory response is classically characterized by the splanchnic blood circulation. However, a vascular lymphatic pathology is produced simultaneously with the splanchnic arterio-venous impairments. The pathological increase of the mesenteric venous pressure, by mechanotransduction of the venous endothelium hyperpressure, causes an inflammatory response involving the subendothelial mast cells and the lymphatic endothelium of the intestinal villi lacteal. In portal hypertension, the intestinal lymphatic inflammatory response through the development of mesenteric-systemic lymphatic collateral vessels favors the systemic diffusion of substances with a molecular pattern associated with damage and pathogens of intestinal origin. When the chronic hepatic insufficiency worsens the portal hypertensive inflammatory response, the splanchnic lymphatic system transports the hyperplasied intestinal mast cells to the mesenteric lymphatic complex. Then, an acquired immune response regulating a new hepato-intestinal metabolic scenario is activated. Therefore, reduction of the hepatic metabolism would reduce its key centralized functions, such as the metabolic, detoxifying and antioxidant functions which would try to be substituted by their peroxisome activity, among other functions of the mast cells.

Fetal abdominal cysts: antenatal course and postnatal outcomes

Background There is little information on which to base the prognostic counselling as to whether an antenatally diagnosed fetal abdominal cyst will grow or shrink, or need surgery. This study aims to provide contemporary data on prenatally diagnosed fetal abdominal cysts in relation to their course and postnatal outcomes. Methods Fetal abdominal cysts diagnosed over 11 years in a single centre were identified. The gestational age at diagnosis and cyst characteristics at each examination were recorded (size, location, echogenity, septation and vascularity) and follow-up data from postnatal visits were collected. Results Eighty abdominal cysts were identified antenatally at 28+4 weeks (range 11+0–38+3). Most (87%) were isolated and the majority were pelvic (52%), simple (87.5%) and avascular (100%). Antenatally, 29% resolved spontaneously; 29% reduced in size; 9% were stable and 33% increased in size. Forty-one percent of cysts under 20 mm diameter increased in size, while only 20% of cysts with a diameter of over 40 mm increased in size. The majority of cysts were ovarian in origin (n=45, 56%), followed by intestinal (n=15, 18%), choledochal (n=3, 4%), liver (n=2, 3%) and renal/adrenal origins (n=2, 3%), respectively. In 16% (n=13), the antenatal diagnosis was not obvious. Seventy-five percent of the cysts that persisted postnatally required surgical intervention. Conclusion Most antenatally diagnosed fetal abdominal cysts were ovarian in origin. Though most disappeared antenatally, nearly three quarters required surgical intervention when present after birth. Cysts of intestinal origin are more difficult to diagnose antenatally and often require surgery.