The influence of environmental bacteria in freshwater stingray wound-healing

Invasion by bacteria can influence the course of healing of wounds acquired in aquatic environment. In this study, the bacteria present in Potamotrygon motoro stingray mucus and in the Alto Paraná river water were identified, and their ability to induce tissue injury and resist antibiotics was determined. Biochemical identification analysis showed that 97% of all bacterial isolates were Gram negative, Aeromonas spp., Enterobacter cloacae and Citrobacter freundii being the species most prevalent. Gelatinase and caseinase were produced by Aeromonas hydrophila, Aeromonas sobria and Pseudomonas aeruginosa strains. Erythrocyte hemolysis assay showed that A. sobria, A. hydrophila and to a lesser extent, other Gram-negative bacteria produced hemolysin. It was also observed that molecules released in culture by these bacteria were toxic to human epithelial cells. Antibiogram results showed that 68% of all bacterial isolates were resistant to at least one type of antibiotic, mainly B-lactams. Finally, it was demonstrated that although P. motoro venom was toxic to epithelial cells it did not influence bacterial proliferation. In summary, the results obtained in this work indicate that during the accident, the mucus of P. motoro and the environmental water may transfer into the wound pathogenic multi-resistant bacteria with the potential to cause severe secondary infections.     

Sugar intake from sweetened beverages and diabetes: A narrative review

Type 2 diabetes mellitus (T2DM) is one of the fastest growing public health concerns around the world. Sugar-sweetened beverage (SSB) consumption has been proven to be associated with adverse health consequences in the diabetic population. Reducing SSB consumption, body weight control, healthy diets, and increased physical activity have been suggested as strategies to improve diabetes prevention and management. This literature review provides an overview of: (1) The association between SSB consumption and the risk of T2DM; (2) Types of SSB consumption and T2DM; (3) The effect of obesity and inflammation on the association between SSB consumption and risk of T2DM; and (4) SSB consumption in T2DM patients. There is still work to be done to determine how SSB consumption is related to T2DM, but the current research on identifying the association between SSB consumption and T2DM is promising, with the most promising studies confirming the connection between SSBs, T2DM risk, and diabetes management. Future studies should explore more effective SSB related diabetes prevention and management interventions.     

Treatment of intraductal papillary mucinous neoplasms, neuroendocrine and periampullary pancreatic tumors using robotic surgery: a safe and feasible technique

In the last few years, robotic surgery has started to take its place in pancreatic surgery. Robotic surgery provides advantages such as enhanced visualisation and freedom of dissection within a confined space and also allows economical surgery. The aim of this study was to evaluate the feasibility, safety and short-term outcome of the robotic approach using the da Vinci robotic system in pancreatic/peripancreatic tumors other than pancreatic carcinomas. Fifteen patients with eight intraductal papillary mucinous neoplasms, four pancreatic neuroendocrine and three periampulary tumors were included in this initial series. Seven left pancreatectomies, five pancreatoduodenectomies and two total pancreatectomies were performed at Albert Einstein Hospital, S?o Paulo, Brazil. The mean operating room time for all the procedures was 503 min (315–775 min). Blood transfusion was necessary in one patient (3 units). The mean length of stay for all patients was 16 days (5–52 days). Large series of robotic pancreatic surgery should be described and the decision as to its routine use will come from cumulative experience. This surgical system allows difficult procedures to be performed more easily, effectively and precisely.     

Obstructive sleep apnea negatively impacts objectively measured physical activity

Sleep and Breathing - Obesity and obstructive sleep apnea (OSA) are frequent comorbid conditions. The impact of OSA on objectively measured physical activity (PA), independent of obesity, is not...     

Guidelines for Safety of Trainees Rotating Abroad: Consensus Recommendations from the Global Emergency Medicine Academy of the Society for Academic Emergency Medicine,Council of Emergency Medicine Residency Directors,and the Emergency Medicine Residents' Association

The goal of a global health elective is for residents and medical students to have safe, structured, and highly educational experiences. In this article, the authors have laid out considerations for establishing a safe clinical site; ensuring a traveler's personal safety, health, and wellness; and mitigating risk during a global health rotation. Adequate oversight, appropriate mentorship, and a well‐defined safety and security plan are all critical elements to a successful and safe experience.