WEBVTT

00:00:00.600 --> 00:00:02.520
Good morning everyone.

00:00:02.520 --> 00:00:06.520
Thank you so much for joining us here
today on the Rey Juan Carlos University

00:00:06.520 --> 00:00:10.520
campus. For many of you, this will surely
be your first contact with the

00:00:10.520 --> 00:00:14.520
university, and specifically with this
institution, Rey Juan Carlos

00:00:14.520 --> 00:00:18.520
University. We hope this experience is
very pleasant and that we will soon

00:00:18.520 --> 00:00:22.520
be here in these classrooms and on this
campus. Between us, in this great

00:00:22.520 --> 00:00:26.200
university family, the reason we are
gathered here today is twofold.

00:00:26.200 --> 00:00:30.200
On the one hand, we want to celebrate in
a very special way the closing

00:00:30.200 --> 00:00:34.200
of the third edition of Micromundo RJ C
in which many of us here today

00:00:34.200 --> 00:00:38.200
have participated in one way or another.
To the teachers who have been

00:00:38.200 --> 00:00:42.200
involved in this Service-Learning
project, we want to thank you for

00:00:42.200 --> 00:00:45.840
the enthusiasm you have put into this
activity and we hope to continue counting

00:00:45.840 --> 00:00:47.680
on your help.

00:00:47.680 --> 00:00:48.840
For many editions.

00:00:49.920 --> 00:00:53.920
On the other hand, the second reason for
this event is to celebrate the first

00:00:53.920 --> 00:00:57.160
edition of the Awareness Day on the
silent pandemic caused by

00:00:57.160 --> 00:00:58.800
multi-resistance to antimicrobials.

00:00:59.320 --> 00:01:01.160
The motto We are JC.

00:01:01.160 --> 00:01:05.160
This initiative has been organized by a
group from the High Performance Research

00:01:05.160 --> 00:01:07.840
Group in Biotechnology and Ecology for
Global Change at Rey Juan Carlos

00:01:07.840 --> 00:01:09.200
University.

00:01:09.240 --> 00:01:13.240
I co-CG, together with the research
professors of the Institute for

00:01:13.240 --> 00:01:17.040
Research Technologies for Sustainability
at this University.

00:01:17.840 --> 00:01:21.840
With this conference, which we hope will
continue for many years, we intend

00:01:21.840 --> 00:01:25.560
to bring together leading experts in the
field of antimicrobial

00:01:25.560 --> 00:01:28.560
resistance, covering both its basic and
more applied aspects.

00:01:28.880 --> 00:01:32.880
The day has a clear objective: to focus
on resistance to antibiotics and

00:01:32.880 --> 00:01:36.880
antifungals, an increasingly relevant
problem globally, but one that still

00:01:36.880 --> 00:01:40.360
does not receive the attention it
deserves outside of the scientific field.

00:01:41.040 --> 00:01:44.000
To achieve this, we have designed a
program that combines outreach, science,

00:01:44.000 --> 00:01:45.480
and debate.

00:01:46.480 --> 00:01:49.120
Throughout the day we will be giving the
floor to experts from different

00:01:49.120 --> 00:01:50.480
institutions who

00:01:50.480 --> 00:01:54.000
will provide complementary views on the
problem of antimicrobial resistance.

00:01:54.720 --> 00:01:58.720
After the first three presentations, we
will take a short break where we can

00:01:58.720 --> 00:02:02.640
enjoy coffee, soft drinks, and sweet and
savory snacks, courtesy of the organizing

00:02:02.640 --> 00:02:04.640
team of these sessions.

00:02:04.880 --> 00:02:07.520
After this coffee break we will have
three more presentations and an

00:02:07.520 --> 00:02:08.880
interactive session

00:02:08.880 --> 00:02:11.560
led by the group of experts from the
National Plan against antimicrobial

00:02:11.560 --> 00:02:12.920
resistance.

00:02:13.320 --> 00:02:17.320
To conclude the day, we will offer the
possibility of visiting two of the

00:02:17.320 --> 00:02:21.680
research facilities available at the UMH
Technological Support Center, CJC.

00:02:22.080 --> 00:02:25.320
The organism cultivation laboratory,
cultivation,

00:02:25.320 --> 00:02:28.320
crops and the water treatment plant.

00:02:29.280 --> 00:02:33.280
Well, as Sergio said, with this first
edition, which we

00:02:33.280 --> 00:02:37.080
hope will be many more, we intend to
create a meeting

00:02:37.080 --> 00:02:40.080
place between microbiology and public
health.

00:02:40.640 --> 00:02:44.640
It also aims to give greater visibility
to microbiology within the

00:02:44.640 --> 00:02:48.640
Rey Juan Carlos University and to help
antibiotic resistance cease

00:02:48.640 --> 00:02:51.640
to be a silent pandemic and become an
increasingly

00:02:51.640 --> 00:02:54.640
well-known and understood issue in
society.

00:02:54.640 --> 00:02:58.640
And so, from the organization we wanted
to give a huge

00:02:58.640 --> 00:03:02.640
thank you to all the attendees and
especially to the

00:03:02.640 --> 00:03:06.640
speakers who made time in their busy
schedules to come

00:03:06.640 --> 00:03:10.880
here and share their research, ideas and
knowledge.

00:03:11.000 --> 00:03:15.640
So, let's move on to the presenters of
the talks.

00:03:16.160 --> 00:03:16.680
Thank you.

00:03:18.720 --> 00:03:22.720
Hey! It's a pleasure to start this day
with Dr. Jessica Gil Serna,

00:03:22.720 --> 00:03:27.240
Professor of Microbiology at the
Complutense University of Madrid.

00:03:27.680 --> 00:03:31.280
Throughout his career he has stood out
for his commitment to

00:03:31.280 --> 00:03:34.280
scientific dissemination and educational
innovation.

00:03:35.160 --> 00:03:39.800
EH leading initiatives that connect
research with society.

00:03:40.200 --> 00:03:44.200
His research focuses on agri-food
microbiology and

00:03:44.200 --> 00:03:48.200
mycology applied to the study, detection
and control

00:03:48.200 --> 00:03:53.520
of fungi, ethnic mycotoxins and
mycotoxins in agri-food systems.

00:03:53.960 --> 00:03:57.960
It is one of the world's leading
promoters with an already consolidated

00:03:57.960 --> 00:04:01.960
impact both nationally and
internationally, and its work has been

00:04:01.960 --> 00:04:05.960
recognized for its contribution to
raising awareness about

00:04:05.960 --> 00:04:10.600
antimicrobial resistance and involves
fostering vocations among young people.

00:04:10.600 --> 00:04:12.960
Today he's going to introduce us to
microworlds.

00:04:12.960 --> 00:04:17.880
Ten years of citizen science to protect
the future of antimicrobials.

00:04:18.640 --> 00:04:22.000
Thank you so much for the presentation
and thank you so much for the invitation.

00:04:22.000 --> 00:04:25.120
It's always a pleasure to be in this
forum and be able to talk about the

00:04:25.120 --> 00:04:26.680
microworld.

00:04:27.120 --> 00:04:29.680
I know many of you have already
participated in Microworld, so perhaps

00:04:29.680 --> 00:04:31.000
what I'm going to

00:04:31.000 --> 00:04:34.000
tell you here today isn't something that
will be completely new to you.

00:04:34.200 --> 00:04:38.200
But hey, it's always good to dedicate a
little time to

00:04:38.200 --> 00:04:42.200
reflecting on the importance of this
project and everything

00:04:42.200 --> 00:04:46.840
we have managed to accomplish in these
ten years of the project.

00:04:47.480 --> 00:04:51.240
Okay, this is a good introduction, and
then we'll see if I can get this done.

00:04:51.240 --> 00:04:55.240
I know that there are people who are
really experts on this subject

00:04:55.240 --> 00:04:59.600
who will give us a lot of information
about antimicrobial resistance.

00:04:59.960 --> 00:05:03.960
But what I want to tell you is that this
is not something new; it is

00:05:03.960 --> 00:05:08.240
something we have known for a very long
time that has been happening.

00:05:08.240 --> 00:05:12.240
For example, when Fleming was awarded the
Nobel Prize

00:05:12.240 --> 00:05:16.240
for the discovery of penicillin, he
warned us that this

00:05:16.240 --> 00:05:20.240
could happen, that bacteria or
microorganisms in

00:05:20.240 --> 00:05:23.680
general could learn to resist these
treatments.

00:05:23.880 --> 00:05:27.880
What Fleming was referring to was the
possibility that there could

00:05:27.880 --> 00:05:31.880
be ignorant men who overused antibiotics,
and that this could make

00:05:31.880 --> 00:05:36.240
it so that these bacteria could no longer
be treated with those antibiotics.

00:05:36.600 --> 00:05:40.600
But it is true that there is something
that marked a turning point,

00:05:40.600 --> 00:05:44.600
which is in 2016 when what we know as the
Onil report was published,

00:05:44.600 --> 00:05:48.600
which gave us a series of data that
really frightened us a bit,

00:05:48.600 --> 00:05:52.600
especially the politicians, who are the
ones who have to put money

00:05:52.600 --> 00:05:56.240
into this so that it can be done, so that
research can be done in this field and

00:05:56.240 --> 00:05:58.080
progress can be made.

00:05:58.400 --> 00:06:02.400
The Onil report told us that if we did
nothing, by 2050

00:06:02.400 --> 00:06:06.400
we would have more deaths due to
infections caused by

00:06:06.400 --> 00:06:11.160
antimicrobial-resistant microorganisms
than from cancer.

00:06:11.520 --> 00:06:15.520
That was something that really caught our
attention, and that's

00:06:15.520 --> 00:06:18.960
when the idea that we had to do something
was kind of raised.

00:06:19.360 --> 00:06:23.360
Currently, even though this report was
published

00:06:23.360 --> 00:06:27.360
ten years ago, it's still something we
continue to

00:06:27.360 --> 00:06:31.360
use and try to ensure that this never
happens, that

00:06:31.360 --> 00:06:35.360
it doesn't happen in 2050. So, we could
say that from

00:06:35.360 --> 00:06:39.360
this point on, even though we already
knew it was a

00:06:39.360 --> 00:06:44.880
problem, we began to dedicate a series of
efforts to try to stop it.

00:06:45.360 --> 00:06:49.120
And here a project emerged, which is the

00:06:49.120 --> 00:06:52.120
initiative that started in Wisconsin.

00:06:52.120 --> 00:06:56.120
Thanks to this, to this microbiology
professor, Joan

00:06:56.120 --> 00:07:00.120
Altman, who realized that it was
essential to involve

00:07:00.120 --> 00:07:04.120
society, in this case university
students, to try to

00:07:04.120 --> 00:07:08.120
solve this problem using a strategy in
which she involved

00:07:08.120 --> 00:07:12.440
university students in the discovery of
new antibiotics.

00:07:12.480 --> 00:07:16.680
This initiative, as I said, is a little
different.

00:07:16.680 --> 00:07:19.880
The university in the United States,
compared to what it is here, was not a

00:07:19.880 --> 00:07:21.520
subject in a degree program.

00:07:21.520 --> 00:07:25.520
If you don't know, there's a kind of
series of courses that university

00:07:25.520 --> 00:07:28.760
students can take, and what I was trying
to do was use

00:07:28.760 --> 00:07:31.760
this strategy to discover new
antimicrobials.

00:07:31.760 --> 00:07:35.760
It was also partly to encourage students
to

00:07:35.760 --> 00:07:39.760
pursue science degrees, and Joan Elfman
wanted

00:07:39.760 --> 00:07:43.760
this initiative strategy to spread
throughout

00:07:43.760 --> 00:07:48.520
the United States, but also throughout
the world.

00:07:48.680 --> 00:07:52.200
So what I did was a series of training
sessions for people who

00:07:52.200 --> 00:07:55.200
wanted to bring this strategy to their
universities.

00:07:55.560 --> 00:07:58.640
And this is where Micromundo arrives in
Spain.

00:07:58.960 --> 00:08:02.960
We used to call it the initiative, then
we changed the name and it was thanks

00:08:02.960 --> 00:08:06.480
to Professor Víctor Jiménez Cid who
coordinates, coordinates

00:08:06.480 --> 00:08:09.480
this project with me at the Complutense
University.

00:08:10.200 --> 00:08:14.200
Micromundo is coming to Spain, but what
we wanted

00:08:14.200 --> 00:08:17.760
here was to give this project a little
twist.

00:08:17.760 --> 00:08:21.760
Furthermore, the birth of Micromundo was
very funny because when Victor came

00:08:21.760 --> 00:08:25.760
back from doing that wonderful course in
Wisconsin about the initiative,

00:08:25.760 --> 00:08:29.040
what he thought was I can't do this
alone, I have to find people who want to

00:08:29.040 --> 00:08:30.680
get involved in this.

00:08:30.680 --> 00:08:34.680
And then one day we suddenly received a
very random email saying they

00:08:34.680 --> 00:08:38.680
wanted microbiology professors who wanted
to raise awareness about

00:08:38.680 --> 00:08:42.680
antimicrobial resistance by embarking on
this project, and to be

00:08:42.680 --> 00:08:46.320
honest, with a bit of fear, a few of us
got together and started.

00:08:46.320 --> 00:08:49.320
We started there. This, this project.

00:08:49.680 --> 00:08:53.680
Furthermore, in the birth of Micromundo,
I wanted, as you know,

00:08:53.680 --> 00:08:57.680
to delve deeper into what we call those
strategies or angels.

00:08:57.920 --> 00:09:00.120
We will never be able to stop the
strategy.

00:09:00.120 --> 00:09:04.120
If we focus solely on human health, we
need to bring together a large

00:09:04.120 --> 00:09:08.680
number of professionals to implement this
strategy for antimicrobials.

00:09:08.680 --> 00:09:12.280
Juan, health isn't just ours, it's very
much ours.

00:09:12.280 --> 00:09:15.280
We usually think we are the center of the
universe, but that's not the case.

00:09:15.320 --> 00:09:19.080
So we have to keep in mind that human
health depends a lot

00:09:19.080 --> 00:09:22.080
on environmental health and animal
health.

00:09:22.280 --> 00:09:26.280
So Micromundo emerged as a union between
different faculties,

00:09:26.280 --> 00:09:29.880
different faculties such as the Faculty
of Biology, the Faculty

00:09:29.880 --> 00:09:32.880
of Veterinary Medicine and the Faculty of
Pharmacy.

00:09:32.920 --> 00:09:36.920
Thus, in 2016, the Microworld project
emerged, with a series

00:09:36.920 --> 00:09:40.920
of objectives that have not changed since
the beginning.

00:09:40.920 --> 00:09:44.920
What the different policies tell us about
what needs to be

00:09:44.920 --> 00:09:49.120
done to end this problem is fundamentally
based on four pillars.

00:09:49.120 --> 00:09:54.440
There you have them: education, research,
surveillance, and action.

00:09:54.440 --> 00:09:58.360
Well, in the case of Micromundo we are
going to face two or we are going to use

00:09:58.360 --> 00:10:00.320
two of those pillars.

00:10:00.520 --> 00:10:04.520
We are going to try to educate society
about this problem,

00:10:04.520 --> 00:10:07.840
but we are also going to do research to
collaborate

00:10:07.840 --> 00:10:10.840
in the discovery of new antimicrobials.

00:10:11.160 --> 00:10:14.200
So we were very clear about it from the
beginning, we were very clear about it.

00:10:14.200 --> 00:10:17.440
Those of you who have participated
already know what Micromundo wants.

00:10:17.440 --> 00:10:20.280
The first step is to disseminate
scientific culture.

00:10:20.280 --> 00:10:24.280
We want to raise awareness among the
population that this is a problem, and

00:10:24.280 --> 00:10:28.280
also to help them understand that we are
starting from the premise that people

00:10:28.280 --> 00:10:31.560
may not be very clear about the concept
of infectious diseases.

00:10:31.560 --> 00:10:35.560
The concept of angels, we have to make
this

00:10:35.560 --> 00:10:39.560
society able to understand all these
aspects

00:10:39.560 --> 00:10:42.640
so that we can all work together.

00:10:43.000 --> 00:10:46.800
But MicroMundos also wants to generate
scientific vocations.

00:10:46.920 --> 00:10:49.920
Everyone who's out there has already
participated in Microworld.

00:10:50.160 --> 00:10:54.160
As you know, one of the things is that we
want to get involved

00:10:54.160 --> 00:10:58.640
in a real experiment, because we really
do need scientists.

00:10:58.640 --> 00:11:02.640
In this world, vocations are declining;
science is

00:11:02.640 --> 00:11:06.640
getting that, let's say, rumor, which is
partly true,

00:11:06.640 --> 00:11:10.640
that it's a very difficult career, but we
need young

00:11:10.640 --> 00:11:14.640
people who are eager to do research to
address problems,

00:11:14.640 --> 00:11:19.280
especially these global health problems
that affect us all.

00:11:19.280 --> 00:11:22.560
But well, this would be the general goal
regarding awareness, to create scientific

00:11:22.560 --> 00:11:24.240
vocations.

00:11:24.280 --> 00:11:28.280
But you already know that Micromundo is
also a citizen

00:11:28.280 --> 00:11:32.280
science project because we are very clear
that tinkering,

00:11:32.280 --> 00:11:35.760
using, and being involved in a real
process makes

00:11:35.760 --> 00:11:38.760
this awareness process much more
effective.

00:11:39.120 --> 00:11:43.120
So what we're going to do is involve a
lot of

00:11:43.120 --> 00:11:47.120
young scientists in their schools to
discover,

00:11:47.120 --> 00:11:52.040
or try to discover, new antimicrobial
compounds.

00:11:52.320 --> 00:11:56.720
We think that's one of the nicest things
about Microworld.

00:11:57.120 --> 00:12:00.720
But if all this were not enough, you can
see that Micromundo is not a project, it

00:12:00.720 --> 00:12:02.560
is not a simple project.

00:12:02.560 --> 00:12:06.600
Furthermore, it is a Service-Learning
project because we don't want to be.

00:12:06.600 --> 00:12:10.600
As a university professor, I am not the
one who goes to

00:12:10.600 --> 00:12:14.600
high schools to teach people how to do a
series of

00:12:14.600 --> 00:12:18.600
experiments and discover new antibiotics;
rather,

00:12:18.600 --> 00:12:22.600
it is the university students who go to
those educational

00:12:22.600 --> 00:12:26.120
centers to lead that awareness-raising
work.

00:12:26.360 --> 00:12:30.360
So it's a Service-Learning project
because we're going to do a

00:12:30.360 --> 00:12:34.360
service to the community with all this
that we've talked about,

00:12:34.360 --> 00:12:38.360
that awareness, that generation of
scientific culture in society,

00:12:38.360 --> 00:12:42.960
but also our university students are
going to learn, learn many things.

00:12:42.960 --> 00:12:46.960
Many times, practically every year,
people tell me when we're going to do

00:12:46.960 --> 00:12:50.960
a microworld, that they didn't think
being teachers was so difficult or

00:12:50.960 --> 00:12:55.040
about all the organizational work and
everything that needs to be prepared.

00:12:55.280 --> 00:12:58.320
So they learn the first thing to
disseminate.

00:12:58.320 --> 00:13:02.320
We're going to explain very complex
concepts to people who don't know

00:13:02.320 --> 00:13:06.320
much about them yet, but we'll also be
doing organizational tasks related

00:13:06.320 --> 00:13:09.600
to teaching and all that. So, besides
being a citizen science

00:13:09.600 --> 00:13:12.600
project, it's also a service-learning
project.

00:13:14.040 --> 00:13:17.640
And many of you also know how we work.

00:13:17.880 --> 00:13:21.760
I say Micromundo, I say it with all my
heart, with all my love always.

00:13:21.760 --> 00:13:26.320
But Micromundo is a bit of a cult because
we have a pyramid structure.

00:13:26.640 --> 00:13:30.640
Look, we're going to have a university
professor who

00:13:30.640 --> 00:13:34.640
will work with a group of about five
university students

00:13:34.640 --> 00:13:38.640
and they will go to a high school to do
that research work

00:13:38.640 --> 00:13:42.200
in order to try to discover new
antibiotics.

00:13:42.440 --> 00:13:46.440
So we work with this structure that
allows us to

00:13:46.440 --> 00:13:50.440
work with students at the institute, so
we can

00:13:50.440 --> 00:13:54.800
analyze a lot of samples with our citizen
science project.

00:13:54.800 --> 00:13:58.800
Then we'll look at the data a bit because
everything Micromundo has achieved

00:13:58.800 --> 00:14:01.440
is truly overwhelming, and it's also a
bit of a cult, I tell you, I say it with

00:14:01.440 --> 00:14:02.800
all

00:14:02.800 --> 00:14:06.800
due respect, because normally when a
person participates in Micromundo they

00:14:06.800 --> 00:14:10.360
get so hooked in schools that they ask us
again, "Please come back

00:14:10.360 --> 00:14:13.360
another year to do that," as do the
teachers themselves.

00:14:13.360 --> 00:14:17.360
I am motivated. I have been here for ten
years continuing to do

00:14:17.360 --> 00:14:21.360
Micromundo every year, but also our
university students who like

00:14:21.360 --> 00:14:24.400
Micromundo and want to continue
participating every year they are at

00:14:24.400 --> 00:14:25.920
university.

00:14:25.920 --> 00:14:29.920
So this is a bit of the organization we
have, and this

00:14:29.920 --> 00:14:33.920
organization allows us to have such
beautiful images

00:14:33.920 --> 00:14:38.760
as these very young university professors
who are studying.

00:14:38.760 --> 00:14:42.760
In the case of the Faculty of Biology,
for example, we have students

00:14:42.760 --> 00:14:46.400
between the third year of undergraduate
studies and the first year of master's

00:14:46.400 --> 00:14:48.240
studies.

00:14:48.240 --> 00:14:52.240
They are the ones who will participate
there, so a very nice collaboration

00:14:52.240 --> 00:14:55.560
is established with the high school
students, because in

00:14:55.560 --> 00:14:58.560
the end that gap, they are only a few
years apart.

00:14:58.560 --> 00:15:02.560
It's like they're kind of working among
friends, and

00:15:02.560 --> 00:15:06.160
we have a lot of high school students who
are going

00:15:06.160 --> 00:15:09.160
to get involved in that real experiment.

00:15:09.760 --> 00:15:13.760
On the first day we're going to do four
sessions at Micromundo. On the

00:15:13.760 --> 00:15:17.760
first day we're going to do those
awareness talks about the importance

00:15:17.760 --> 00:15:21.760
of antimicrobial resistance, we're going
to talk to them about

00:15:21.760 --> 00:15:25.600
Micromundo and we're also going to give
them a kit so they can go and take a soil

00:15:25.600 --> 00:15:27.520
sample wherever they want.

00:15:27.880 --> 00:15:31.880
What we want is for all the students to
be very original, going to

00:15:31.880 --> 00:15:35.880
places never explored, where no one has
ever seen the diversity

00:15:35.880 --> 00:15:39.880
of those soils, and the soil is selected
because it is one of the

00:15:39.880 --> 00:15:43.560
places where we have the most
microorganisms and we know that there is

00:15:43.560 --> 00:15:45.400
a lot of competition.

00:15:45.400 --> 00:15:49.400
As you know, microorganisms don't produce
antibiotics for us;

00:15:49.400 --> 00:15:52.640
that's just something we say, "well,"
they produce antibiotics for us humans to

00:15:52.640 --> 00:15:54.280
use.

00:15:54.280 --> 00:15:54.840
That's not the case.

00:15:54.840 --> 00:15:58.240
They usually use it to carve out a niche
for themselves, to carve out a niche in

00:15:58.240 --> 00:15:59.960
that environment.

00:16:00.200 --> 00:16:04.200
So all the high school students are going
to go and

00:16:04.200 --> 00:16:07.440
get a soil sample wherever they like or

00:16:07.440 --> 00:16:10.440
whatever sample they want to analyze.

00:16:10.440 --> 00:16:12.200
The second one: Oops, I've used the wrong
arrow.

00:16:12.200 --> 00:16:16.360
On the second day, what we're going to do
is isolate those bacteria from the soil.

00:16:16.640 --> 00:16:17.400
Let's do it.

00:16:17.400 --> 00:16:22.480
I really like this day because it's a
practice we also do at university.

00:16:22.480 --> 00:16:26.480
We do it in microbiology practicals; I
always tell my second-year

00:16:26.480 --> 00:16:30.280
students that they do it much better at
the institute than they do.

00:16:30.360 --> 00:16:34.360
I don't know if it's because you're much
more focused, or because you're

00:16:34.360 --> 00:16:38.160
much more keen, which is something very
different, but it's a

00:16:38.160 --> 00:16:41.160
practice that is not easy at an
experimental level.

00:16:41.400 --> 00:16:45.080
It works wonderfully in schools, and
that's where we have our first "Wow"

00:16:45.080 --> 00:16:46.960
moments!

00:16:47.040 --> 00:16:50.880
When we arrive and have those plates,
microbiology is a

00:16:50.880 --> 00:16:53.880
field that is, well, a very challenging
one.

00:16:54.120 --> 00:16:57.360
Disseminating information in the field of
microbiology is a significant

00:16:57.360 --> 00:17:00.360
challenge, because we are talking about
things that cannot be seen.

00:17:00.360 --> 00:17:04.360
These are super abstract things, but the
first day we arrive with

00:17:04.360 --> 00:17:08.360
the plates and we can see, the students
see that we can indeed see

00:17:08.360 --> 00:17:11.720
the soil bacteria that have grown in the
culture media.

00:17:11.720 --> 00:17:13.440
Well, that's something that's always in
style.

00:17:13.440 --> 00:17:17.440
Those "wow" moments when we see them are
something very beautiful,

00:17:17.440 --> 00:17:21.440
and from these microorganisms that we
have managed to isolate,

00:17:21.440 --> 00:17:25.440
what we are going to do is check if they
are capable of producing those

00:17:25.440 --> 00:17:29.440
antibiotic compounds, and for that we are
going to use some bacteria

00:17:29.440 --> 00:17:33.440
that we call escape bacteria, and escape
bacteria are the ones that

00:17:33.440 --> 00:17:37.440
are being researched the most because
they are multi-resistant

00:17:37.440 --> 00:17:40.840
bacteria associated with hospital
infections.

00:17:41.160 --> 00:17:46.000
They have a very serious problem that I'm
sure we'll hear a lot about today.

00:17:46.240 --> 00:17:50.240
Of course, we can't bring escaped
bacteria into a school, so what we're

00:17:50.240 --> 00:17:54.240
bringing are the cousins ​​of these
bacteria, and we're going to test,

00:17:54.240 --> 00:17:58.240
through some simple experiments, whether
these bacteria are capable

00:17:58.240 --> 00:18:01.600
of producing compounds that will inhibit
our bacteria.

00:18:01.920 --> 00:18:05.920
When we get to the 4th day, we're going
to see if we can say

00:18:05.920 --> 00:18:09.920
that these bacteria actually produce
antibiotics,

00:18:09.920 --> 00:18:13.920
and here we call it the Eureka moment,
because everyone

00:18:13.920 --> 00:18:17.920
gets very happy and it's the most
beautiful day at the

00:18:17.920 --> 00:18:21.920
institute, because we start to see our
growth inhibition

00:18:21.920 --> 00:18:27.760
on those plates and from here on out, the
microworld at the institute ends.

00:18:27.760 --> 00:18:30.360
But we're trying to leave that mark,
aren't we?

00:18:30.360 --> 00:18:34.360
We hope that everything we have done may
be

00:18:34.360 --> 00:18:38.360
useful both for high school students and,

00:18:38.360 --> 00:18:42.480
who knows, perhaps for science at some
point.

00:18:42.960 --> 00:18:46.960
And this is what we do, many of you have
already participated

00:18:46.960 --> 00:18:50.960
in it, and as I mentioned, the Microworld
project started

00:18:50.960 --> 00:18:55.120
at the Complutense University and we have
evolved a lot.

00:18:55.440 --> 00:18:59.440
We started in 2016 and as you can see, we
are increasingly able

00:18:59.440 --> 00:19:03.840
to involve more university students in
visiting more centers.

00:19:03.840 --> 00:19:04.840
It depends a lot.

00:19:04.840 --> 00:19:06.000
We would love to visit.

00:19:06.000 --> 00:19:11.520
We have 150 centers that are interested
in this, but we can't reach any more.

00:19:11.520 --> 00:19:15.520
We would love to, but... But so you see,
it's just like a Pokémon evolution,

00:19:15.520 --> 00:19:19.040
the Microworld evolution at the
Complutense University.

00:19:19.080 --> 00:19:23.080
And if you've done a little calculation
and connected the dots

00:19:23.080 --> 00:19:27.080
with the title of my talk, you can
imagine that Micromundo, since

00:19:27.080 --> 00:19:31.080
it arrived in Spain, is celebrating its
anniversary because we're

00:19:31.080 --> 00:19:34.400
turning ten years old doing this
beautiful project.

00:19:35.080 --> 00:19:36.840
Not even the pandemic could stop us.

00:19:36.840 --> 00:19:40.440
It is true that we were unable to make
those in-person visits to the schools,

00:19:40.440 --> 00:19:42.240
but we hope that...

00:19:42.240 --> 00:19:46.240
But we made a lot of material, we made
online games, infographics, a

00:19:46.240 --> 00:19:50.640
lot of things that are available and you
can have them if you are interested.

00:19:50.960 --> 00:19:54.960
And here I want to tell you that this
"long live microworld" thing was

00:19:54.960 --> 00:19:58.720
coined by the journalists of the
Scientific Culture Unit of the

00:19:58.720 --> 00:20:01.720
Complutense University and I love it, so
I use it.

00:20:01.920 --> 00:20:05.920
But what I want, what is one of the
things that excites

00:20:05.920 --> 00:20:10.400
us most at Micromundo UCM, is that we
don't stay at UCM.

00:20:10.680 --> 00:20:14.680
We have been fortunate enough to be able
to extend microworld

00:20:14.680 --> 00:20:19.000
to many other universities, and that is
why we are here today.

00:20:19.360 --> 00:20:23.360
Because look, we started in 2016 and a
lot of universities have joined,

00:20:23.360 --> 00:20:27.360
not only from Spain, we also have, we
call it the Iberian Microworld

00:20:27.360 --> 00:20:30.880
Network, because there are also
universities in Portugal that are working

00:20:30.880 --> 00:20:32.640
on this.

00:20:32.840 --> 00:20:34.920
If you find each other, you're down here.

00:20:34.920 --> 00:20:38.920
In 2023, the Rey Juan Carlos University
joined this

00:20:38.920 --> 00:20:42.920
project, and the truth is that for us it
is exciting to

00:20:42.920 --> 00:20:46.920
see how this project grows and that there
are so many

00:20:46.920 --> 00:20:50.040
universities that are interested in doing
it.

00:20:50.440 --> 00:20:54.440
So, since the Micromundo project had
grown so much a

00:20:54.440 --> 00:20:58.440
couple of years ago, we wondered if we
had really made

00:20:58.440 --> 00:21:01.560
an impact, if we had achieved our goals,

00:21:01.560 --> 00:21:04.560
and if what we were doing was worthwhile.

00:21:04.560 --> 00:21:08.560
So we started doing a lot of
calculations, asking universities,

00:21:08.560 --> 00:21:12.520
"Hey, what have you done, how much have
you done?"

00:21:12.520 --> 00:21:15.160
And we didn't get the results we wanted.

00:21:15.160 --> 00:21:18.480
The results we obtained were so
overwhelming that we decided to make a

00:21:18.480 --> 00:21:20.160
publication.

00:21:20.520 --> 00:21:21.160
Because?

00:21:21.160 --> 00:21:23.760
Can't you imagine? Now I'll tell you.

00:21:23.760 --> 00:21:26.560
Everything Micromundo had achieved in
eight years.

00:21:26.560 --> 00:21:27.600
Okay, this does it.

00:21:27.600 --> 00:21:32.760
It was in the year 2023, so let's hope
it's in a few days.

00:21:32.760 --> 00:21:36.520
Given that more universities are joining
in a couple of years, we can recap all of

00:21:36.520 --> 00:21:38.400
this.

00:21:38.400 --> 00:21:39.840
But look at this one.

00:21:39.840 --> 00:21:42.120
If you're curious, here's the article.

00:21:42.120 --> 00:21:43.720
But look closely, okay?

00:21:43.720 --> 00:21:47.720
In eight years the Micromundo Ibérica
community

00:21:47.720 --> 00:21:51.640
had managed to analyze more than 9500
soil samples.

00:21:52.040 --> 00:21:56.040
This is outrageous if we think about
laboratories; doing that

00:21:56.040 --> 00:21:59.480
with a research group would be extremely
complicated.

00:21:59.920 --> 00:22:03.920
We have involved or are involving more
than 18,000 high

00:22:03.920 --> 00:22:09.000
school students who have analyzed more
than 145,000 microorganisms.

00:22:09.280 --> 00:22:13.120
Okay, the results are, as I said, they
were super surprising to us.

00:22:13.680 --> 00:22:17.680
Of all that we have analyzed, we found a
positive

00:22:17.680 --> 00:22:21.680
antibiotic in 6244, which corresponds to
approximately

00:22:21.680 --> 00:22:25.440
4% of the microorganisms we have
analyzed.

00:22:25.800 --> 00:22:29.400
It is true that that 4% is most likely
due to microorganisms

00:22:29.400 --> 00:22:32.400
that produce antibiotics that we already
know.

00:22:32.400 --> 00:22:36.400
Okay, there are many soil bacteria that
we have already characterized many

00:22:36.400 --> 00:22:39.640
times and we know what they produce, but
it is true that this is where we have our

00:22:39.640 --> 00:22:41.280
bottleneck.

00:22:41.600 --> 00:22:44.640
We have a lot of potentially
antibiotic-producing

00:22:44.640 --> 00:22:47.640
microorganisms, but we are not capable.

00:22:47.640 --> 00:22:52.360
I already said in the presentation, I
work with fungi of food interest.

00:22:52.360 --> 00:22:56.360
My research topic is not antimicrobials,
but it

00:22:56.360 --> 00:22:59.720
is true that some of the groups
participating

00:22:59.720 --> 00:23:02.720
in Micromundo do focus on this.

00:23:02.720 --> 00:23:06.720
So look, Micromundo has already taken its
first,

00:23:06.720 --> 00:23:10.040
its first steps in the discovery of new

00:23:10.040 --> 00:23:13.040
compounds that could be used at some
point.

00:23:13.040 --> 00:23:17.040
This 2024 article described a compound
isolated from a

00:23:17.040 --> 00:23:21.040
bacterium in the microworld, which was a
bacterium or a cin,

00:23:21.040 --> 00:23:24.720
but which is effective in treating
certain bacteria.

00:23:25.080 --> 00:23:26.040
If you see it, it's there.

00:23:26.040 --> 00:23:30.040
It's very nice to read, to read that
material and methods because

00:23:30.040 --> 00:23:34.040
they mention, they mention the person or
the student in this case

00:23:34.040 --> 00:23:38.720
who isolated this bacteria and who
started or could have started this.

00:23:38.760 --> 00:23:41.160
This research is one.

00:23:41.160 --> 00:23:45.120
It is a bacterium that is isolated from a
bacterium that is

00:23:45.120 --> 00:23:48.120
Bacillus altitud Inis and they called it
SC 22.

00:23:48.120 --> 00:23:50.880
You have it there because it says so.

00:23:50.880 --> 00:23:54.880
EC starts with the center where it was
isolated, which was the

00:23:54.880 --> 00:23:58.880
Izal center in Madrid, and the other C is
for Carlota, who is

00:23:58.880 --> 00:24:02.040
the student who was able to isolate this
bacteria

00:24:02.040 --> 00:24:05.040
during her participation in Micromundo.

00:24:05.680 --> 00:24:09.680
It's still in high school, but this year
we're going

00:24:09.680 --> 00:24:13.680
to have another article very soon related
to another

00:24:13.680 --> 00:24:17.680
Micromundo bacteria, so little by little
Micromundo

00:24:17.680 --> 00:24:21.680
is making those advances or we're
achieving those

00:24:21.680 --> 00:24:25.560
advances in research that we'd also like
to share.

00:24:26.000 --> 00:24:30.000
So, to conclude and to reflect
effectively with

00:24:30.000 --> 00:24:33.920
Micromundo on everything we do at all
levels, we manage to help raise

00:24:33.920 --> 00:24:35.920
awareness.

00:24:36.240 --> 00:24:37.640
Furthermore, the.

00:24:37.640 --> 00:24:41.640
We really like the group of high school
students because we know

00:24:41.640 --> 00:24:45.640
you are a voice, because when you leave
creating a microworld you

00:24:45.640 --> 00:24:49.640
will tell your friends, your parents,
your families. And that is

00:24:49.640 --> 00:24:52.880
very important for this awareness-raising
work.

00:24:52.880 --> 00:24:56.880
We need to get that message to the entire
population,

00:24:56.880 --> 00:25:02.480
but we are also trying to make progress
in that research work.

00:25:02.480 --> 00:25:06.480
We are able to analyze a large number of
microorganisms and it is

00:25:06.480 --> 00:25:10.480
true that we are going step by step, but
we are achieving some

00:25:10.480 --> 00:25:13.480
things and above all to promote those
scientific

00:25:13.480 --> 00:25:16.480
vocations which, I repeat, is super
important.

00:25:16.480 --> 00:25:18.880
For example, it's bound to happen to you,
if it hasn't happened to you yet, it

00:25:18.880 --> 00:25:20.080
will.

00:25:20.440 --> 00:25:24.440
When I'm in my class, I teach
microbiology to second-year

00:25:24.440 --> 00:25:28.440
biology students and some students come
up to me and tell me that

00:25:28.440 --> 00:25:32.440
they did a microworld project at their
high school and that it

00:25:32.440 --> 00:25:35.520
helped them decide to study biology in
this case.

00:25:35.520 --> 00:25:38.520
So for us that's super important

00:25:38.520 --> 00:25:41.520
and it really fills us with pride.

00:25:41.720 --> 00:25:45.720
But the best thing about this whole
project is not the

00:25:45.720 --> 00:25:49.720
awareness, it's not the research, but how
excited we all

00:25:49.720 --> 00:25:53.720
are, the teachers, the students at the
institute, when

00:25:53.720 --> 00:25:57.840
we hold events like this, we come here,
we collect diplomas.

00:25:58.080 --> 00:26:02.080
So what I want to say to end my talk is
that we should continue

00:26:02.080 --> 00:26:07.560
to maintain that enthusiasm and never
lose that motto of long live Micromundo.

00:26:08.040 --> 00:26:11.720
And of course, thank you to everyone who
participates, those who have

00:26:11.720 --> 00:26:14.720
participated and those who are
participating in this project.

00:26:14.880 --> 00:26:15.600
Thank you so much.

00:26:25.120 --> 00:26:29.120
Well, next we continue with Jerónimo
Beltrán,

00:26:29.120 --> 00:26:33.120
senior researcher at the Ramón y Cajal
Institute

00:26:33.120 --> 00:26:37.120
for Health Research, who has a solid
track record

00:26:37.120 --> 00:26:41.120
in biomedical research, participating in
numerous

00:26:41.120 --> 00:26:45.960
competitive projects both nationally and
internationally.

00:26:46.240 --> 00:26:50.240
His work focuses on the evolutionary
biology of microorganisms

00:26:50.240 --> 00:26:54.240
and the dynamics of antibiotic
resistance, especially on

00:26:54.240 --> 00:26:59.080
mechanisms of horizontal gene transfer
and bacterial evolution.

00:26:59.320 --> 00:27:04.120
His research contributes to understanding
how resistance arises and spreads.

00:27:04.120 --> 00:27:07.160
A key aspect to addressing this global
challenge.

00:27:07.480 --> 00:27:11.440
Today she joins us to share her
experience and her vision on current

00:27:11.440 --> 00:27:13.440
challenges in health research.

00:27:14.360 --> 00:27:17.360
Thank you so much.

00:27:20.000 --> 00:27:24.000
Well, thank you all very much for being
here and especially

00:27:24.000 --> 00:27:27.040
for inviting me to share some of my
ideas, as

00:27:27.040 --> 00:27:30.040
my presenter said, who did a great job.

00:27:30.280 --> 00:27:31.600
Well, I'm a researcher.

00:27:31.600 --> 00:27:34.720
Basically, I dedicate myself to
researching and trying to

00:27:34.720 --> 00:27:37.720
understand how the evolution of
antimicrobial resistance works.

00:27:37.840 --> 00:27:40.840
I do this at the Ramón y Cajal Hospital
in Madrid.

00:27:40.880 --> 00:27:44.040
And well, uh, throughout my career that's
basically what I've dedicated myself to

00:27:44.040 --> 00:27:45.640
all these years.

00:27:45.640 --> 00:27:49.640
And well, today I'm going to talk a
little bit about, as I was saying, these

00:27:49.640 --> 00:27:53.640
ideas I have, about how we got to this
problem of the silent pandemic, as

00:27:53.640 --> 00:27:57.640
these conferences are called, and also
about some possibilities we have

00:27:57.640 --> 00:28:01.160
apart from the use of antibiotics, or in
some way rethinking how we can tackle

00:28:01.160 --> 00:28:02.920
this problem.

00:28:03.280 --> 00:28:05.680
Through alternative mechanisms.

00:28:05.680 --> 00:28:08.800
These are new strategies that we are
trying to develop in the laboratory.

00:28:10.280 --> 00:28:13.280
So I wanted to begin.

00:28:16.720 --> 00:28:17.960
To that job.

00:28:17.960 --> 00:28:21.960
Uh, I wanted to start this presentation
with this image which, for

00:28:21.960 --> 00:28:25.240
those of you who don't know, is Darwin
asking for silence.

00:28:25.760 --> 00:28:29.760
And I think it's a very beautiful image
because it exemplifies very well how

00:28:29.760 --> 00:28:33.760
evolution, and in particular the
evolution of antimicrobial resistance,

00:28:33.760 --> 00:28:36.920
has silenced all our efforts to end
infectious diseases.

00:28:37.800 --> 00:28:40.440
And this is because antimicrobial
resistance is nothing more than an

00:28:40.440 --> 00:28:41.800
evolutionary problem.

00:28:42.240 --> 00:28:45.960
It is a problem that arises, at least in
theory, from the natural evolution of all

00:28:45.960 --> 00:28:47.840
organisms.

00:28:47.840 --> 00:28:51.840
Bacteria, like all other organisms,
adapt, change, and get

00:28:51.840 --> 00:28:55.280
used to the environment in which they
live, right?

00:28:55.360 --> 00:28:58.920
And this is so, as I say, for all
organisms, from whales, humans and of

00:28:58.920 --> 00:29:00.720
course bacteria.

00:29:00.720 --> 00:29:03.880
And also the finches, which are the ones
that inspired

00:29:03.880 --> 00:29:06.880
Charles Darwin to propose the theory of
evolution.

00:29:07.440 --> 00:29:09.360
And in the case of resistance,
antibiotics.

00:29:09.360 --> 00:29:13.360
This happens in a kind of vicious circle
that I'm going to tell you

00:29:13.360 --> 00:29:17.360
about now. Back in 1900, well, in the
1930s, the first antibiotics

00:29:17.360 --> 00:29:21.360
began to be marketed, penicillin, which
Fleming discovered,

00:29:21.360 --> 00:29:25.360
as you all know. This meant that bacteria
had to change, they had

00:29:25.360 --> 00:29:29.360
to adapt to the presence of penicillin in
the places where they

00:29:29.360 --> 00:29:33.360
were going to cause infections, and so
on. And that generated an

00:29:33.360 --> 00:29:37.360
evolution, and the evolution of
resistance meant that infectious

00:29:37.360 --> 00:29:41.240
diseases that could previously be treated
very easily with

00:29:41.240 --> 00:29:44.240
penicillin became increasingly common.

00:29:44.320 --> 00:29:46.400
Well, before we had diseases that
couldn't be cured.

00:29:46.400 --> 00:29:48.440
Penicillin appeared, now we can cure
them.

00:29:48.440 --> 00:29:51.760
Everyone was very happy, but suddenly the
evolution of resistance made this no

00:29:51.760 --> 00:29:53.440
longer possible.

00:29:53.720 --> 00:29:56.560
Then, suddenly, penicillin stops working.

00:29:56.560 --> 00:30:00.560
This creates a serious health problem,
which is what we find ourselves

00:30:00.560 --> 00:30:04.560
in today, and it means that society has
to develop new antibiotics,

00:30:04.560 --> 00:30:08.560
which is somewhat what all of you who
have participated in micromundo

00:30:08.560 --> 00:30:12.560
have been working on, trying to find new
antibiotics to be able to tip

00:30:12.560 --> 00:30:16.240
the scales back in our favor and give
this circle another turn.

00:30:16.240 --> 00:30:17.880
But this is somehow a...

00:30:17.880 --> 00:30:20.320
It is an inevitable consequence of
antibiotic use.

00:30:20.320 --> 00:30:22.280
Resistant bacteria will always emerge.

00:30:22.280 --> 00:30:25.840
So, we have been in this vicious circle
for practically 100 years

00:30:25.840 --> 00:30:28.840
since the massive introduction of the use
of antibiotics.

00:30:28.840 --> 00:30:32.840
Going around in this vicious circle a
bit, and calling it a vicious

00:30:32.840 --> 00:30:36.160
circle is what it's normally called, but
in evolution we call it a Red Queen

00:30:36.160 --> 00:30:37.840
dynamic.

00:30:38.480 --> 00:30:42.480
I don't know if you know this, but the
Red Queen is a character from the story

00:30:42.480 --> 00:30:46.480
Alice in Wonderland, and in that story,
which is a story by Louis Carroll,

00:30:46.480 --> 00:30:50.480
what happens is that Alice travels
through different places, all of them

00:30:50.480 --> 00:30:54.480
very fantastical, and at a certain point
she encounters this character

00:30:54.480 --> 00:30:58.480
who is the Red Queen, and in the place
where the Red Queen is in that country,

00:30:58.480 --> 00:31:01.760
what happens is that, as the Red Queen
explains to her, you

00:31:01.760 --> 00:31:04.760
have to run as fast as you can to stay in
the same place.

00:31:05.200 --> 00:31:08.480
And if you wanted to run, if you wanted
to go further, you would have to run at

00:31:08.480 --> 00:31:10.160
least twice as fast.

00:31:10.680 --> 00:31:13.240
Well, this is somewhat what happens with
antibiotic resistance.

00:31:13.240 --> 00:31:17.240
We're running as fast as we can, but
simply to maintain some kind of balance

00:31:17.240 --> 00:31:20.680
with the bacteria that are becoming
increasingly resistant.

00:31:20.680 --> 00:31:24.400
If we really want to end infectious
diseases, we should go at least double or

00:31:24.400 --> 00:31:26.280
triple the speed.

00:31:26.280 --> 00:31:28.240
And we've been doing this this cycle.

00:31:28.240 --> 00:31:30.760
During that time, as I say, 100 years.

00:31:30.760 --> 00:31:34.000
And in this process, sometimes we have
been a little ahead of

00:31:34.000 --> 00:31:37.000
resistant bacteria, and other times a
little behind.

00:31:37.280 --> 00:31:40.120
Right now I'd say we're kind of tied,
right?

00:31:40.120 --> 00:31:41.480
But hey, here we are.

00:31:41.480 --> 00:31:43.720
And throughout this process, we have
developed many antibiotics, we have

00:31:43.720 --> 00:31:44.880
stopped

00:31:44.880 --> 00:31:47.880
using others that have lost
effectiveness, and we are still here.

00:31:48.080 --> 00:31:52.080
But in this process the bacteria have
changed, they have evolved, they have,

00:31:52.080 --> 00:31:55.440
they have, they have become resistant to
many of the antibiotics.

00:31:55.440 --> 00:31:57.880
I don't like this image because I think
it sums it up very well.

00:31:57.880 --> 00:32:01.560
In 1928, bacteria were sensitive to
antibiotics.

00:32:01.720 --> 00:32:06.080
We could throw anything on them and they
would die.

00:32:06.080 --> 00:32:10.040
And today we have super bacteria that are
resistant even to the last line

00:32:10.040 --> 00:32:12.040
antibiotics we use in the hospital.

00:32:12.840 --> 00:32:14.120
So.

00:32:14.120 --> 00:32:16.360
Well, this is it.

00:32:16.360 --> 00:32:18.320
And as you know, this has had
consequences.

00:32:18.320 --> 00:32:20.240
Jessica has already mentioned it.

00:32:20.240 --> 00:32:22.720
I like this fact because it exemplifies
it very well.

00:32:22.720 --> 00:32:26.720
It has been estimated that last year
alone, antibiotic resistance or diseases

00:32:26.720 --> 00:32:30.520
associated with antibiotic resistance
caused 20,000 deaths in Spain.

00:32:31.080 --> 00:32:33.320
That's a number only in Spain in a year.

00:32:33.320 --> 00:32:34.040
It's a number.

00:32:34.040 --> 00:32:37.920
It's a huge number, especially when
compared to other numbers.

00:32:38.040 --> 00:32:40.080
For example, this is five times more than
the number of deaths in traffic

00:32:40.080 --> 00:32:41.120
accidents.

00:32:41.800 --> 00:32:45.520
And I would like to take advantage of the
fact that these conferences are

00:32:45.520 --> 00:32:48.520
titled about the silent pandemic to make
a reflection.

00:32:48.640 --> 00:32:52.680
I believe this pandemic is not silent in
hospitals, it is a noisy pandemic.

00:32:53.040 --> 00:32:55.680
In other words, we are very aware of what
is happening.

00:32:55.680 --> 00:32:58.520
It is a clinical problem that is seen
every day in hospitals.

00:32:58.520 --> 00:33:01.680
It is silent, perhaps for society,
because its importance is not being

00:33:01.680 --> 00:33:03.280
conveyed.

00:33:03.280 --> 00:33:05.920
As I was saying, it causes more deaths
than ours, traffic accidents, and we are

00:33:05.920 --> 00:33:07.280
all

00:33:07.280 --> 00:33:11.080
used to seeing ads raising awareness
among drivers to wear their seatbelts.

00:33:11.080 --> 00:33:12.200
Anyway, things that are very good.

00:33:12.200 --> 00:33:15.160
I'm not saying that shouldn't be done,
it's very important to do that, but

00:33:15.160 --> 00:33:18.160
perhaps we should also do campaigns to
raise awareness about this problem.

00:33:19.160 --> 00:33:21.040
And well, this is one of the things.

00:33:21.040 --> 00:33:25.040
And also, as Jessica has said, if we do
nothing, the most alarmist

00:33:25.040 --> 00:33:29.040
predictions from ten years ago say that
antibiotic resistance

00:33:29.040 --> 00:33:32.960
will cause more than 10 million deaths
worldwide by 2050, not

00:33:32.960 --> 00:33:35.960
being the leading cause of death in the
world.

00:33:36.280 --> 00:33:39.520
But here, in this prediction, which is a
bit alarmist, there is a

00:33:39.520 --> 00:33:42.520
part that I like: if we do nothing, I
believe we can do things.

00:33:42.520 --> 00:33:45.160
You who have participated in Micromundo
and have done something, and we who are

00:33:45.160 --> 00:33:46.520
in

00:33:46.520 --> 00:33:49.560
the laboratory all day chipping away at
the stone to try to find

00:33:49.560 --> 00:33:52.560
new solutions, well, we are also doing
something, aren't we?

00:33:53.280 --> 00:33:55.560
So,

00:33:55.560 --> 00:33:59.560
My view is that it is obviously necessary
to develop new antibiotics, and that is

00:33:59.560 --> 00:34:02.200
a very long and complex process, as you
know, and one in which large

00:34:02.200 --> 00:34:03.560
pharmaceutical

00:34:03.560 --> 00:34:06.640
companies have to be involved, because it
is very difficult to

00:34:06.640 --> 00:34:09.640
do it from a small laboratory like the
one I work in, right?

00:34:10.120 --> 00:34:14.120
But what we can do is try to think
outside the box

00:34:14.120 --> 00:34:18.120
or try to find other types of solutions
that aren't

00:34:18.120 --> 00:34:22.000
so expensive to produce and that might
help

00:34:22.000 --> 00:34:25.000
fight this silent pandemic. Right?

00:34:25.480 --> 00:34:29.480
So, as I was saying, we are now in this
scenario where resistance is, let's

00:34:29.480 --> 00:34:32.600
say, overcoming our ability to produce
new antibiotics.

00:34:33.040 --> 00:34:37.040
And I think what we should do, or what I
can do, what I can contribute from

00:34:37.040 --> 00:34:41.040
my lab, is to try to develop new
strategies that we can use in combination

00:34:41.040 --> 00:34:44.560
with these new antibiotics to overcome
resistance. Right?

00:34:44.560 --> 00:34:47.200
And I've depicted these strategies with
this gentleman, like this, with virtual

00:34:47.200 --> 00:34:48.560
reality

00:34:48.560 --> 00:34:52.000
glasses, all very modern, because I think
that's a bit of the future, what we have

00:34:52.000 --> 00:34:53.760
to do from now until the future.

00:34:54.480 --> 00:34:58.000
So, in today's talk I'm going to talk to
you.

00:34:58.000 --> 00:35:01.280
Well, many new strategies have been
proposed to fight antimicrobial

00:35:01.280 --> 00:35:02.960
resistance.

00:35:03.000 --> 00:35:07.000
I had thought about telling you a little
about all of them, kind of like a

00:35:07.000 --> 00:35:11.000
class, but in the end I decided it's
better to tell you about the ones we're

00:35:11.000 --> 00:35:15.000
doing or researching in my lab, because
well, they're the ones I know the

00:35:15.000 --> 00:35:18.360
most about, which is important, and
because, well, I think

00:35:18.360 --> 00:35:21.360
they illustrate the ideas we have in the
field quite well.

00:35:21.560 --> 00:35:24.560
So today I'm going to talk to you
specifically about two.

00:35:24.600 --> 00:35:28.600
One is antibiotic repurposing, which
involves using drugs that are

00:35:28.600 --> 00:35:32.600
obsolete, that we no longer use because
they have lost effectiveness,

00:35:32.600 --> 00:35:35.680
and finding a way to make them effective
again in some way;

00:35:35.680 --> 00:35:38.680
it is a recycling of antibiotics that are
no longer used.

00:35:39.280 --> 00:35:43.280
And the second is perhaps the most
futuristic, which is to use a

00:35:43.280 --> 00:35:47.280
system called CRISPR Cas9, accompanied by
Phage therapy to design

00:35:47.280 --> 00:35:51.280
a kind of molecular scissors, an
ultra-specific antibiotic that

00:35:51.280 --> 00:35:54.560
allows us to eliminate only those
bacteria that are resistant in a

00:35:54.560 --> 00:35:56.200
population.

00:35:56.200 --> 00:35:59.680
Well, it sounds a bit strange, but I'll
explain it more calmly now.

00:36:00.520 --> 00:36:04.960
So, let's look a little bit at the first
one, this antibiotic repurposing.

00:36:05.800 --> 00:36:09.800
As you know, the development of a new
antibiotic is

00:36:09.800 --> 00:36:15.320
a very long, very expensive process and
full of possible failures.

00:36:16.240 --> 00:36:20.240
First, we need to do a study, find a
target, a site, a molecule,

00:36:20.240 --> 00:36:23.560
something we can attack, a vulnerability
of the bacteria.

00:36:23.560 --> 00:36:26.240
Once we have found it, we need to look
for a drug that is able to eliminate that

00:36:26.240 --> 00:36:28.960
bacteria by exploiting that
vulnerability.

00:36:29.440 --> 00:36:32.080
Then some experiments are done in the
laboratory, somewhat similar to those you

00:36:32.080 --> 00:36:33.440
have done in

00:36:33.440 --> 00:36:36.880
Micromundo, to see if that antibiotic is
capable of killing bacteria afterwards.

00:36:36.880 --> 00:36:39.880
That needs to be tested on a mouse, which
is what it says here, "in vivo," right?

00:36:40.400 --> 00:36:44.400
Then, once all that works, it goes to
clinical trials and in

00:36:44.400 --> 00:36:49.000
humans phase one is done to verify that
the molecule is not toxic to humans.

00:36:49.360 --> 00:36:52.000
Phase two is carried out, in which an
attempt is made to demonstrate that it is

00:36:52.000 --> 00:36:53.360
really capable of

00:36:53.360 --> 00:36:55.920
eliminating infections, at least on a
small scale, then phase three, and

00:36:55.920 --> 00:36:57.200
finally it is registered.

00:36:57.400 --> 00:37:00.840
This whole process can easily take 20
years from the time one finds a

00:37:00.840 --> 00:37:03.840
potential antibiotic until one manages to
bring it to market.

00:37:04.280 --> 00:37:08.280
And in all these small phases there is
the possibility that your antibiotic,

00:37:08.280 --> 00:37:12.280
the one you are fighting to get and get,
may not move on to the next phase because

00:37:12.280 --> 00:37:16.280
it is toxic in humans, because it does
not work as well as you expected in mice,

00:37:16.280 --> 00:37:20.280
or for a thousand and one reasons, or
because you are not able to produce it

00:37:20.280 --> 00:37:24.400
in sufficient quantity to bring it to
market, to get it to patients.

00:37:24.400 --> 00:37:27.480
In short, it's a super complicated
process and that's why, among

00:37:27.480 --> 00:37:30.480
other things, it's so difficult for us to
develop new antibiotics.

00:37:30.720 --> 00:37:34.720
Well, this idea of ​​recycling or
repositioning drugs tries

00:37:34.720 --> 00:37:38.720
to skip all the initial phases and use
drugs that are already

00:37:38.720 --> 00:37:43.080
approved, that we already know are safe,
that we already know work.

00:37:43.080 --> 00:37:47.080
We aim to restore their effectiveness in
combating antibiotic resistance, and

00:37:47.080 --> 00:37:50.920
for this we rely on an evolutionary
concept called collateral sensitivity.

00:37:51.720 --> 00:37:53.920
This happens because of the bacteria.

00:37:53.920 --> 00:37:57.040
This is a bit tricky, but I'll try to
explain it well because I'm not very good

00:37:57.040 --> 00:37:58.600
at it.

00:37:58.720 --> 00:38:02.600
Well, it turns out that when bacteria
acquire resistance to one antibiotic,

00:38:02.600 --> 00:38:05.600
they sometimes become sensitive to a
second antibiotic.

00:38:05.600 --> 00:38:07.240
Okay. It's like a vulnerability.

00:38:07.240 --> 00:38:10.800
They cannot become resistant to all
antibiotics at once.

00:38:11.080 --> 00:38:13.480
If you think about it, this happens in
all of them.

00:38:13.480 --> 00:38:18.040
In all living beings we have animals that
run very fast and others that run a lot.

00:38:18.440 --> 00:38:20.800
Or a person who is able to run a
marathon, although that is not an

00:38:20.800 --> 00:38:22.000
evolutionary example.

00:38:22.000 --> 00:38:24.000
But okay, fine. Let's use the example.

00:38:24.000 --> 00:38:26.640
I wouldn't normally win the 100-meter
dash because you have to specialize, and

00:38:26.640 --> 00:38:28.000
when

00:38:28.000 --> 00:38:31.040
bacteria acquire resistance in some way
they also specialize, and

00:38:31.040 --> 00:38:34.040
when they specialize they lose resistance
to other antibiotics.

00:38:35.080 --> 00:38:37.120
And we'll see it with an example.

00:38:37.120 --> 00:38:38.680
Imagine these two antibiotics.

00:38:38.680 --> 00:38:41.680
Okay, we have this antibiotic that I
represent here with a magnet.

00:38:41.800 --> 00:38:44.440
This is an antibiotic that has fallen
into disuse, that we can no longer use

00:38:44.440 --> 00:38:45.800
because the bacteria

00:38:45.800 --> 00:38:48.840
we find in the clinic, in hospitals, are
already resistant to this antibiotic and

00:38:48.840 --> 00:38:50.360
we have stopped using it.

00:38:50.360 --> 00:38:51.880
But hey, antibiotics still exist.

00:38:51.880 --> 00:38:55.880
We still have vials, we can still buy it,
although it's practically not used

00:38:55.880 --> 00:38:59.520
anymore, and then we have an antibiotic,
B, which is super modern, although well,

00:38:59.520 --> 00:39:01.360
I've drawn it with an arrow.

00:39:01.360 --> 00:39:04.440
Maybe have a laser beam attached, but
hey, you know what I mean?

00:39:04.440 --> 00:39:08.440
The idea is not a modern antibiotic that
we are using in the clinic and

00:39:08.440 --> 00:39:11.960
that works very well, except when
bacteria become resistant.

00:39:12.560 --> 00:39:15.200
So, when we put the antibiotic on a
bacterium like this, well, since this is

00:39:15.200 --> 00:39:16.560
a

00:39:16.560 --> 00:39:20.480
magnet and this bacterium has no metal in
it, the bacterium is very happy.

00:39:20.480 --> 00:39:22.600
It's durable and there are absolutely no
problems.

00:39:22.600 --> 00:39:24.800
This antibiotic is no good to us.

00:39:24.800 --> 00:39:28.800
However, when we use antibiotic B, we are
able to eliminate

00:39:28.800 --> 00:39:32.080
this bacteria in the vast majority of
cases.

00:39:32.320 --> 00:39:34.560
But there is one case where this doesn't
happen, and that is when this bacteria

00:39:34.560 --> 00:39:35.680
becomes resistant.

00:39:36.440 --> 00:39:39.080
And that happens because the bacteria,
let's say, develops this shell that

00:39:39.080 --> 00:39:40.440
allows it to

00:39:40.440 --> 00:39:42.960
protect itself from this very modern
antibiotic and this bacteria that is

00:39:42.960 --> 00:39:44.240
resistant.

00:39:44.240 --> 00:39:45.760
Well, right now she's so happy.

00:39:45.760 --> 00:39:47.960
And this is a problem because we are
already making it so that we can no

00:39:47.960 --> 00:39:49.080
longer

00:39:49.080 --> 00:39:52.080
use this antibiotic against these
bacteria; it will no longer work.

00:39:52.080 --> 00:39:56.200
So, what would happen if we used the
antibiotic I showed you earlier?

00:39:56.200 --> 00:39:57.280
The one who is a magnet?

00:39:57.280 --> 00:40:01.280
Well, this bacterium, indeed, now has
this metallic shell, let's

00:40:01.280 --> 00:40:04.840
say in this example, and with the magnet
and so it will work.

00:40:05.000 --> 00:40:08.520
So now we have managed to make this
bacterium hypersensitive to this

00:40:08.520 --> 00:40:11.520
antibiotic, not to the antibiotic that
was no longer in use.

00:40:11.640 --> 00:40:15.640
Simply knowing how it will evolve makes
it hypersensitive

00:40:15.640 --> 00:40:19.280
to an antibiotic that we couldn't use
before.

00:40:19.880 --> 00:40:21.400
This is what we're doing in my lab.

00:40:21.400 --> 00:40:24.040
We are taking very old antibiotics like
Citro medicine, which is no longer used

00:40:24.040 --> 00:40:25.400
except

00:40:25.400 --> 00:40:28.040
for some very specific respiratory
infections, and we are discovering that

00:40:28.040 --> 00:40:29.400
bacteria

00:40:29.400 --> 00:40:32.920
become resistant to last-spectrum
antibiotics, as we are going to hear.

00:40:32.920 --> 00:40:35.360
But it doesn't matter, cephalosporins
become more sensitive to this

00:40:35.360 --> 00:40:36.600
azithromycin.

00:40:36.640 --> 00:40:39.280
It is an antibiotic that is no longer
used, and so, by combining antibiotics,

00:40:39.280 --> 00:40:40.640
we are able

00:40:40.640 --> 00:40:44.520
to eliminate resistant bacteria that we
would not otherwise be able to eliminate.

00:40:44.960 --> 00:40:46.440
This requires a lot of work.

00:40:46.440 --> 00:40:49.080
We need to investigate all the bacteria
that are resistant, find out what other

00:40:49.080 --> 00:40:50.440
antibiotics they have become

00:40:50.440 --> 00:40:52.760
more sensitive to, and that's why it's
not something that's being used in

00:40:52.760 --> 00:40:53.920
clinics right now.

00:40:53.920 --> 00:40:56.560
But I believe that if we continue working
along these lines, we will be able to

00:40:56.560 --> 00:40:57.920
develop these

00:40:57.920 --> 00:41:01.160
antibiotic combinations using antibiotics
that are already available to make

00:41:01.160 --> 00:41:02.800
treatments more effective.

00:41:03.920 --> 00:41:06.280
So, in short, what's this all about?

00:41:06.280 --> 00:41:10.280
This is about finding that Achilles'
heel, that vulnerability of resistant

00:41:10.280 --> 00:41:14.280
bacteria, and developing combinations of
antibiotics that are rationally

00:41:14.280 --> 00:41:18.040
chosen, that exploit this vulnerability,
this Achilles' heel.

00:41:18.040 --> 00:41:22.840
And we can combine the two antibiotics or
give sequential treatments, etc., etc.

00:41:22.840 --> 00:41:25.800
And the other advantage of this type of
idea is that it would prevent the

00:41:25.800 --> 00:41:27.280
evolution of resistance.

00:41:27.280 --> 00:41:29.680
When a bacterium becomes resistant to one
antibiotic, the other kills it, and those

00:41:29.680 --> 00:41:32.080
that do not become resistant are killed
by the other antibiotic.

00:41:32.080 --> 00:41:34.720
The first one, in short, is a game in
which with two antibiotics you are able

00:41:34.720 --> 00:41:37.360
to kill both the sensitive and the
resistant ones.

00:41:37.560 --> 00:41:40.200
It would be very quick to implement in
the clinic because it simply involves

00:41:40.200 --> 00:41:41.560
combining and changing

00:41:41.560 --> 00:41:43.960
the treatments we are giving in
hospitals, but there is no need to invent

00:41:43.960 --> 00:41:45.160
anything new.

00:41:45.160 --> 00:41:49.160
And well, this is an idea that I think is
one of the

00:41:49.160 --> 00:41:53.480
treatments that we could soon start
seeing in the clinic.

00:41:54.800 --> 00:41:58.800
Let's move on now, after the recycling of
antibiotics, to this

00:41:58.800 --> 00:42:01.960
other idea that we are developing in my
laboratory,

00:42:01.960 --> 00:42:04.960
which is the use of CRISPR Nine and Phage
therapy.

00:42:05.680 --> 00:42:07.280
I'm going to tell you a little bit about
all this.

00:42:07.280 --> 00:42:11.280
This responds to a clinical need that
exists in the hospital, in

00:42:11.280 --> 00:42:15.280
hospitals, when a patient is admitted for
any reason, because

00:42:15.280 --> 00:42:19.280
they have broken a leg, because they have
any type of disease not

00:42:19.280 --> 00:42:23.280
directly related to antibiotic
resistance, what often happens

00:42:23.280 --> 00:42:27.280
to patients, especially when they are
older, is that in their

00:42:27.280 --> 00:42:31.000
digestive tract, as you know, they harbor
a microbiota, a lot

00:42:31.000 --> 00:42:34.000
of bacteria that are there naturally, as
we all have.

00:42:34.000 --> 00:42:37.680
But patients who are hospitalized for a
long time end up being colonized by

00:42:37.680 --> 00:42:39.520
resistant bacteria.

00:42:39.520 --> 00:42:41.600
Another one from Mexico here, these
little red ones that I'm showing you

00:42:41.600 --> 00:42:42.640
here.

00:42:42.640 --> 00:42:43.400
Okay?

00:42:43.400 --> 00:42:47.400
This happens because the resistant
bacteria is very skillful and is able

00:42:47.400 --> 00:42:51.680
to live, colonize, and establish itself
in people's intestines from there.

00:42:51.680 --> 00:42:54.400
It's not symptomatic, nothing's wrong,
you have it in your intestine but you

00:42:54.400 --> 00:42:55.800
don't notice anything.

00:42:55.800 --> 00:42:57.800
Let's not say it doesn't cause any
disease.

00:42:57.800 --> 00:43:01.560
But what is known is that patients who
are colonized by these bacteria have a

00:43:01.560 --> 00:43:03.440
higher risk of developing infections.

00:43:03.440 --> 00:43:07.440
When bacteria move from the intestine to
other areas of the

00:43:07.440 --> 00:43:11.440
body and are also able to transmit to
other patients within

00:43:11.440 --> 00:43:16.120
the same service or the same hospital
ward, it eventually ends up.

00:43:16.120 --> 00:43:20.120
We end up having entire wards or entire
departments of the hospital

00:43:20.120 --> 00:43:23.960
with patients with high rates of
colonization, and that indirectly causes

00:43:23.960 --> 00:43:25.920
infection rates to rise.

00:43:25.920 --> 00:43:29.920
In short, it's a serious health problem,
let's say, and we don't have an easy

00:43:29.920 --> 00:43:32.560
solution because we can't give
antibiotics to these patients because

00:43:32.560 --> 00:43:33.920
they

00:43:33.920 --> 00:43:37.920
don't actually have any infection, and
using them would be like using a

00:43:37.920 --> 00:43:41.320
sledgehammer to crack a nut and we would
be digging our own grave

00:43:41.320 --> 00:43:44.320
because we would be facilitating the
emergence of resistance.

00:43:44.800 --> 00:43:48.640
So, in my laboratory, what we have
invented is this concept of autobiotics

00:43:48.640 --> 00:43:50.560
that I am now going to explain to you.

00:43:50.960 --> 00:43:54.960
What we do is a good thing, a little
scatological, and

00:43:54.960 --> 00:43:58.840
that is that we can take fecal samples
from, well, here

00:43:58.840 --> 00:44:01.840
we can take fecal samples from patients.

00:44:02.040 --> 00:44:05.640
These fecal samples, the poop, contain
the patient's microbiota,

00:44:05.640 --> 00:44:08.640
all the bacteria that populate that
patient's intestine.

00:44:08.680 --> 00:44:11.320
Then we developed a method that allows us
to isolate this microbiota, separate it

00:44:11.320 --> 00:44:12.680
from

00:44:12.680 --> 00:44:15.920
the fecal matter, eliminate the feces and
keep only the bacteria, which is

00:44:15.920 --> 00:44:17.560
ultimately what interests us.

00:44:17.800 --> 00:44:20.440
And once we have this isolated
microbiota, we are able to treat it with

00:44:20.440 --> 00:44:21.800
this

00:44:21.800 --> 00:44:24.440
ultra-specific antibiotic that I am now
going to explain to you and eliminate

00:44:24.440 --> 00:44:25.800
only

00:44:25.800 --> 00:44:29.240
the bacteria that bothers us, which is
the red one, the one that is resistant.

00:44:29.920 --> 00:44:33.920
And that gives us a healthy microbiota
that we can reimplant in the

00:44:33.920 --> 00:44:37.800
patient, put into some little pills and
give to the patient to take.

00:44:37.920 --> 00:44:40.560
In this way it would work as a kind of
probiotic, not like the Actimel you drink

00:44:40.560 --> 00:44:41.920
in the

00:44:41.920 --> 00:44:44.560
mornings, but much better because this
month instead of just having a

00:44:44.560 --> 00:44:45.920
lactobacillus,

00:44:45.920 --> 00:44:48.560
it has the entire microbiota of the
patient, all the part of the microbiota

00:44:48.560 --> 00:44:49.920
that is

00:44:49.920 --> 00:44:52.640
healthy, that is correct, that is diverse
and necessary for the functioning of the

00:44:52.640 --> 00:44:54.040
intestine.

00:44:54.360 --> 00:44:59.320
And we have selectively eliminated the
harmful bacteria.

00:45:00.000 --> 00:45:03.880
So this sounds really cool, but here's
the hard part.

00:45:04.040 --> 00:45:04.960
How do we do this?

00:45:04.960 --> 00:45:07.600
How do we eliminate just one bacterium
within a complex and very, very diverse

00:45:07.600 --> 00:45:08.960
population?

00:45:09.280 --> 00:45:13.040
Well, we use the CRISPR Cas9 system.

00:45:13.040 --> 00:45:16.640
I don't know if you're aware of it, but
this has been a revolution in modern

00:45:16.640 --> 00:45:18.480
molecular biology.

00:45:18.480 --> 00:45:22.480
It was discovered by a man named Francis
Mojica in the salt flats of Santa

00:45:22.480 --> 00:45:26.480
Pola in the 1990s, and after his work
many people have appeared and

00:45:26.480 --> 00:45:30.480
finally Jennifer Luna and Emmanuel
Charpentier were given the Nobel

00:45:30.480 --> 00:45:33.520
Prize for the use of this technology to
edit genomes.

00:45:33.640 --> 00:45:38.000
And this will allow us to cure a lot of
diseases and it's really a revolution.

00:45:38.000 --> 00:45:40.640
And what's important for you to
understand is that what this allows us to

00:45:40.640 --> 00:45:42.000
do is

00:45:42.000 --> 00:45:45.400
examine the DNA of a bacterium, which is
that string of letters that

00:45:45.400 --> 00:45:48.400
encodes all the information that the
bacterium needs to survive.

00:45:48.400 --> 00:45:51.080
Antibiotic resistance will also be coded.

00:45:51.080 --> 00:45:55.080
So with this technology we can look for
that specific sequence

00:45:55.080 --> 00:45:58.240
that only codes for antibiotic resistance
and will

00:45:58.240 --> 00:46:01.240
only have those bacteria that are
resistant.

00:46:01.640 --> 00:46:05.640
And that will cause this system to
produce a specific

00:46:05.640 --> 00:46:09.760
cut in the DNA of that bacterium, and DNA
cuts are lethal.

00:46:09.760 --> 00:46:12.800
Only those bacteria that have the
sequence we

00:46:12.800 --> 00:46:15.800
want, in this case a resistance gene,
will die.

00:46:15.800 --> 00:46:18.920
The problem with this technology is that
it is very difficult to make it reach the

00:46:18.920 --> 00:46:20.520
bacteria.

00:46:20.520 --> 00:46:22.600
In other words, this works very well in a
test tube.

00:46:22.600 --> 00:46:24.120
This works amazingly well.

00:46:24.120 --> 00:46:27.120
But how do we introduce this technology
into bacteria?

00:46:27.640 --> 00:46:32.400
Well, the real problem is, well, if you
imagine that's a bacterium, okay?

00:46:32.400 --> 00:46:35.080
And this is the DNA of the bacteria.

00:46:35.080 --> 00:46:38.120
The real problem is that the membrane,
the envelope of the bacteria, is actually

00:46:38.120 --> 00:46:39.640
not very permeable.

00:46:39.640 --> 00:46:42.800
The bacteria have decided, they decide
what goes in,

00:46:42.800 --> 00:46:45.800
what goes out, and they do it in a very
specific way.

00:46:46.000 --> 00:46:49.120
And it's really very difficult to
introduce things through that membrane,

00:46:49.120 --> 00:46:50.680
through that bacterial envelope.

00:46:50.680 --> 00:46:53.680
Okay, because it has many layers and is
very permeable.

00:46:53.800 --> 00:46:57.800
So what we did in the lab was, well,
design a Trojan

00:46:57.800 --> 00:47:01.360
horse that allows us to trick the
bacteria

00:47:01.360 --> 00:47:04.360
into introducing the CRISPR system.

00:47:04.680 --> 00:47:07.680
And that Trojan horse is a bacteriophage
virus.

00:47:07.720 --> 00:47:08.600
Here's a little drawing.

00:47:08.600 --> 00:47:10.400
But bacteriophages look like this.

00:47:10.400 --> 00:47:12.600
And these viruses are naturally occurring
viruses of bacteria.

00:47:12.600 --> 00:47:15.160
Just like we have cold or flu viruses.

00:47:15.160 --> 00:47:19.160
Bacteria have their own viruses that
cause colds or worse,

00:47:19.160 --> 00:47:23.160
and we can take those viruses in the
laboratory, modify them,

00:47:23.160 --> 00:47:27.160
use them at will, unify them at will so
that instead of putting

00:47:27.160 --> 00:47:31.920
in their own genetic information, they
put in our CRISPR, CAS system.

00:47:32.320 --> 00:47:35.120
And these viruses are very good at
putting things inside bacteria because

00:47:35.120 --> 00:47:37.960
that's how they live, by infecting
bacteria.

00:47:38.320 --> 00:47:41.840
So with this system, can we now use our
method to kill sensitive bacteria as we

00:47:41.840 --> 00:47:43.640
do now?

00:47:43.640 --> 00:47:47.640
Well, we have these bacteriophage viruses
that are going to attach to the bacteria,

00:47:47.640 --> 00:47:50.280
they're going to work like a Trojan
horse, they're going to introduce this

00:47:50.280 --> 00:47:51.640
CRISPR-Cas

00:47:51.640 --> 00:47:54.280
system that's going to recognize the
resistance gene that you have there, in

00:47:54.280 --> 00:47:55.600
that

00:47:55.600 --> 00:47:58.600
little red square, only and exclusively
that resistance gene.

00:47:59.160 --> 00:48:02.080
The system works like scissors cutting
DNA.

00:48:02.080 --> 00:48:05.040
That is lethal to the bacteria and it
dies.

00:48:05.040 --> 00:48:08.040
This sounds a bit like science fiction,
but it works.

00:48:08.400 --> 00:48:11.560
When we put the bacteriophages we make in
the lab into

00:48:11.560 --> 00:48:14.560
fecal samples from patients, this is what
we see.

00:48:14.560 --> 00:48:18.560
Well, I don't want to bore you with the
data, but basically we

00:48:18.560 --> 00:48:22.520
are able to eliminate more than 99.99% of
the target bacteria without modifying any

00:48:22.520 --> 00:48:24.520
others.

00:48:24.520 --> 00:48:26.680
In other words, the rest of the bacteria
in the patient's healthy microbiota are

00:48:26.680 --> 00:48:27.760
still there.

00:48:28.000 --> 00:48:30.240
They're healthy, they're alive and
kicking.

00:48:30.240 --> 00:48:32.480
We only killed the one we wanted to kill.

00:48:32.480 --> 00:48:36.480
So this is a hyper-specific system that
is very advantageous compared to other

00:48:36.480 --> 00:48:39.600
systems like antibiotics, which are
somewhat non-specific.

00:48:39.600 --> 00:48:40.600
That's one part of the problem.

00:48:40.600 --> 00:48:42.840
We not only kill the bacteria we want,
but all the others as well.

00:48:44.200 --> 00:48:48.200
So with this we have developed these
autobiographical systems,

00:48:48.200 --> 00:48:53.120
which are very versatile and allow us to
modify the human microbiome on demand.

00:48:53.120 --> 00:48:56.040
And this has implications that go beyond
antibiotic resistance.

00:48:56.040 --> 00:48:58.640
Because, well, it is known that the
microbiome is the collection of bacteria

00:48:58.640 --> 00:48:59.960
that lives in our gut.

00:48:59.960 --> 00:49:03.480
They affect many other diseases such as
neurological diseases and such.

00:49:03.480 --> 00:49:06.160
And this, well, could work in that sense.

00:49:06.160 --> 00:49:08.800
The only problem we have is that we
probably need to change the legislation

00:49:08.800 --> 00:49:10.160
to

00:49:10.160 --> 00:49:13.520
make this possible, because right now
there is no legislation that allows us to

00:49:13.520 --> 00:49:15.200
use this on humans.

00:49:15.200 --> 00:49:17.320
There is still a lot of work to do; we
have to conduct clinical trials.

00:49:17.320 --> 00:49:20.800
Anyway. Well, but that's one of the
problems we're

00:49:20.800 --> 00:49:23.800
going to look at, and well, that's what
we do.

00:49:23.800 --> 00:49:25.440
And what can you do?

00:49:25.440 --> 00:49:28.080
I was wondering, it seemed to me that it
would be relevant to talk about what you

00:49:28.080 --> 00:49:29.440
can

00:49:29.440 --> 00:49:32.320
do, since many of you have participated
in Micromundo, which is already quite

00:49:32.320 --> 00:49:33.800
something.

00:49:34.280 --> 00:49:38.280
But anyway, I brought this pamphlet from
the World Health Organization,

00:49:38.280 --> 00:49:42.280
which basically tells you that all you
have to do is use antibiotics

00:49:42.280 --> 00:49:46.280
properly, as and for as long as the
health personnel say, and wash your

00:49:46.280 --> 00:49:51.000
hands; these are the recommendations of
the World Health Organization.

00:49:51.000 --> 00:49:54.520
I think it's really important that we use
antibiotics properly, but I also think

00:49:54.520 --> 00:49:56.320
there are other options.

00:49:56.320 --> 00:49:58.360
Well, apart from that, there's something
we all have to do.

00:49:58.360 --> 00:50:02.120
You also have the option of becoming
scientists and doing your bit to try and

00:50:02.120 --> 00:50:04.040
solve this.

00:50:04.120 --> 00:50:04.880
This problem.

00:50:05.920 --> 00:50:08.200
I don't know how much time I have.

00:50:08.200 --> 00:50:11.200
Bad, bad, bad.

00:50:11.320 --> 00:50:13.560
No? Well,

00:50:13.560 --> 00:50:14.880
Well, this is a picture of the lab.

00:50:14.880 --> 00:50:18.400
So here I have a place where I can stop
or show you something to motivate new

00:50:18.400 --> 00:50:20.160
generations to become scientists.

00:50:20.160 --> 00:50:23.160
I think I'm going to teach it.

00:50:23.960 --> 00:50:27.960
Okay, this is an illustration that I
really like because I think it

00:50:27.960 --> 00:50:31.360
exemplifies a lot of what I feel, which
is science, what

00:50:31.360 --> 00:50:34.360
science means to me, and working in
science every day.

00:50:34.880 --> 00:50:38.880
Imagine that this circle you see here is
all human knowledge, everything is

00:50:38.880 --> 00:50:42.880
in there, it's there, Mozart's music is
there, Fleming's penicillin is

00:50:42.880 --> 00:50:46.080
there, your grandmother's paella is
there, everything that humanity knows is

00:50:46.080 --> 00:50:47.720
there, okay?

00:50:47.920 --> 00:50:51.600
And when we are born and grow up, we
acquire knowledge.

00:50:51.600 --> 00:50:52.720
That, that little part.

00:50:52.720 --> 00:50:56.360
We don't know how to walk, crawl, or cry
when things go wrong.

00:50:56.800 --> 00:50:58.880
Then we'll talk about forgiveness.

00:50:58.880 --> 00:51:01.240
We go to school and learn a little more.

00:51:01.240 --> 00:51:03.200
That's where elementary math comes in.

00:51:03.200 --> 00:51:05.880
Well, anyway, a little bit of literature,
things.

00:51:07.120 --> 00:51:10.320
Then we go to high school and university
and we start

00:51:10.320 --> 00:51:13.320
learning about everything that life is
about.

00:51:13.520 --> 00:51:17.200
But this structure, which is a more
specific knowledge, begins to appear.

00:51:17.200 --> 00:51:19.840
If you go to university and study
biology, or in my case, for example,

00:51:19.840 --> 00:51:21.200
which

00:51:21.200 --> 00:51:25.240
is what I did, that's biology, knowledge
that one acquires from biology.

00:51:25.240 --> 00:51:28.320
Then maybe you'll do a university
master's degree in something even more

00:51:28.320 --> 00:51:29.880
specific.

00:51:29.880 --> 00:51:33.880
Sorry, I'm having a terrible time with
this pointer on a more

00:51:33.880 --> 00:51:37.880
specific thing, which is what molecular
biology research is,

00:51:37.880 --> 00:51:41.880
and you gradually specialize more and
more and then if you want

00:51:41.880 --> 00:51:45.880
you do a doctorate, which is four years
in the lab trying,

00:51:45.880 --> 00:51:49.880
investigating some problem and you get to
a very specific place,

00:51:49.880 --> 00:51:53.840
which is there. Okay, that place is one
of the most wonderful

00:51:53.840 --> 00:51:56.840
places in the world because it is the
frontier of human knowledge.

00:51:56.840 --> 00:52:00.040
There you are, here, and beyond that,
nothing is known.

00:52:00.040 --> 00:52:03.040
It is, it is, it is, it is absolute
ignorance.

00:52:03.080 --> 00:52:06.160
And then what you do is work really hard
and do a lot

00:52:06.160 --> 00:52:09.160
of experiments to achieve something like
that.

00:52:09.320 --> 00:52:12.320
A small push at the frontiers of human
knowledge.

00:52:12.560 --> 00:52:15.720
And that could be a small discovery
against autobiotic

00:52:15.720 --> 00:52:18.720
resistance, or it could be anything else.

00:52:18.720 --> 00:52:21.360
And that's fascinating, because in
reality, for you, this is what it looks

00:52:21.360 --> 00:52:22.720
like during those

00:52:22.720 --> 00:52:25.280
four years that you're struggling with
that insurmountable wall of human

00:52:25.280 --> 00:52:26.560
knowledge.

00:52:26.680 --> 00:52:31.240
It is a very hard and difficult thing,
full of failures and frustrations.

00:52:31.760 --> 00:52:34.400
But at some point you achieve it, and
however small that effort may be, you

00:52:34.400 --> 00:52:35.760
have

00:52:35.760 --> 00:52:39.440
contributed to human knowledge in a
practically significant way.

00:52:39.440 --> 00:52:43.440
A tiny thing, practically ridiculous if
you

00:52:43.440 --> 00:52:47.760
will, but humanity now knows more than
before.

00:52:47.760 --> 00:52:51.400
Thanks to your work and the work of many
others, we are able to advance human

00:52:51.400 --> 00:52:53.240
knowledge.

00:52:53.240 --> 00:52:55.880
So, well, I think that's one of the best
things you can do in life, and that's to

00:52:55.880 --> 00:52:57.240
work

00:52:57.240 --> 00:53:00.440
on trying to advance human knowledge
rather than getting into

00:53:00.440 --> 00:53:03.440
the same place as Newton, Einstein, and
your grandmother.

00:53:03.440 --> 00:53:07.160
So it's a spectacular place and nothing
more.

00:53:07.160 --> 00:53:08.560
That's all. Thank you very much.

00:53:18.800 --> 00:53:22.800
I wanted to ask if there will really be
future

00:53:22.800 --> 00:53:26.560
applications of the therapy and what you
have done.

00:53:26.600 --> 00:53:29.920
Autobiotics, probiotics.

00:53:30.760 --> 00:53:34.400
So, is it really viable?

00:53:34.400 --> 00:53:38.400
Because from what I understand, when a
person is in a hospital

00:53:38.400 --> 00:53:42.400
and has a serious infection, sepsis or
something like that, even

00:53:42.400 --> 00:53:45.920
if they do tests in the labs for
antibiotics and all that, it takes quite

00:53:45.920 --> 00:53:47.720
a long time.

00:53:48.040 --> 00:53:51.040
For example, a new culture can take up to
five days to test positive.

00:53:51.560 --> 00:53:55.560
So, if applying that can actually speed
up the process of

00:53:55.560 --> 00:53:59.560
applying a treatment, because of course,
until a positive

00:53:59.560 --> 00:54:03.560
result is given, I understand that more
generic antibiotics

00:54:03.560 --> 00:54:06.800
are given, to which there can also be
resistance.

00:54:06.800 --> 00:54:10.800
You're absolutely right. What we're doing
in hospitals right

00:54:10.800 --> 00:54:14.800
now is giving empirical treatment. We
know roughly the

00:54:14.800 --> 00:54:18.800
prevalence of resistance, so we choose a
treatment that, if

00:54:18.800 --> 00:54:22.840
everything is statistically normal, is
expected to work. Right?

00:54:22.840 --> 00:54:25.360
But this idea doesn't go in that
direction.

00:54:25.360 --> 00:54:28.680
No, we don't want to treat acute
infections, like sepsis, not things that

00:54:28.680 --> 00:54:30.360
could kill you by tomorrow.

00:54:30.360 --> 00:54:33.320
We just need to use the antibiotics we
have available, that's all.

00:54:33.320 --> 00:54:36.280
I don't intend to replace that because...
Because it would be very difficult.

00:54:36.280 --> 00:54:38.920
This is somewhat aimed at treating other
patients who are not in such a hurry,

00:54:38.920 --> 00:54:40.280
those I was

00:54:40.280 --> 00:54:42.920
telling you about who are colonized, who
are fine, nothing is wrong with them,

00:54:42.920 --> 00:54:44.280
it's just

00:54:44.280 --> 00:54:47.280
that it is known that they have a greater
risk of developing an

00:54:47.280 --> 00:54:50.280
infection, of getting an infection and of
spreading the resistance.

00:54:50.280 --> 00:54:53.880
So the idea would be to fight it before
that infection occurs.

00:54:53.880 --> 00:54:56.280
It's a bit like a preventative measure,
you know? Right?

00:54:56.280 --> 00:54:59.680
They simply have to take a capsule of
their own treated microbiota and

00:54:59.680 --> 00:55:02.680
that should displace the resistant
bacteria from the gut.

00:55:03.720 --> 00:55:05.480
Okay, two related questions.

00:55:05.480 --> 00:55:07.840
Okay, you can understand one and then not
the other, because they all follow one

00:55:07.840 --> 00:55:09.040
another.

00:55:09.040 --> 00:55:13.040
And as for the sequential ones, they are
trying to do it separately, but

00:55:13.040 --> 00:55:17.040
no, because I understand that the
objective is for you to know which clones

00:55:17.040 --> 00:55:21.040
are spreading in the community and you
say, well, I'm going to design a

00:55:21.040 --> 00:55:25.040
phage against these clones that carry
this very bad enzyme that eats this

00:55:25.040 --> 00:55:28.320
antibiotic, because the idea would be to
make it preventive.

00:55:28.320 --> 00:55:29.920
As I just explained.

00:55:29.920 --> 00:55:32.640
But what's going on? Or have you tried
it?

00:55:32.640 --> 00:55:36.640
What happens when that microbiome is also
exposed

00:55:36.640 --> 00:55:40.640
to antibiotics, at concentrations that
could

00:55:40.640 --> 00:55:44.000
select for resistance to the Phage
itself?

00:55:44.560 --> 00:55:47.400
That's been studied. Are you looking into
it?

00:55:47.400 --> 00:55:48.320
No, of course not.

00:55:48.320 --> 00:55:51.120
This is one of the problems with gene
therapy in general and this approach in

00:55:51.120 --> 00:55:52.520
particular.

00:55:52.880 --> 00:55:55.520
Bacteria develop resistance to
antibiotics and phages, and also to

00:55:55.520 --> 00:55:56.880
anything

00:55:56.880 --> 00:56:01.320
that might kill them, because they change
and adapt just like all living things.

00:56:01.520 --> 00:56:05.120
So the answer is to try to use it.

00:56:05.120 --> 00:56:06.040
That is, the idea behind this.

00:56:06.040 --> 00:56:10.040
Right now we are still in a very, very
early stage of this project, but

00:56:10.040 --> 00:56:14.040
the idea is to develop a cocktail, to
have a cocktail of phages that

00:56:14.040 --> 00:56:18.040
target different antibiotic resistance
genes that we know will be

00:56:18.040 --> 00:56:21.840
prevalent in the laboratory and that
should mitigate resistance.

00:56:22.160 --> 00:56:24.480
If you have different phages that are
going to enter the bacteria through

00:56:24.480 --> 00:56:26.840
different routes, that should make it
easier.

00:56:26.840 --> 00:56:29.160
But well, these are things that
definitely need to be looked into.

00:56:38.920 --> 00:56:43.040
Hey, one thing for those of you who have
added the code for the credits

00:56:43.040 --> 00:56:46.040
new vouchers.

00:56:46.440 --> 00:56:48.280
Okay.

00:56:48.280 --> 00:56:52.280
We now have the honor of introducing
Belén Aracil García, senior scientist

00:56:52.280 --> 00:56:56.240
at the National Center for Microbiology
of the Institute of Health.

00:56:56.240 --> 00:57:00.240
Carlos Tercero is a recognized expert in
antibiotic resistance,

00:57:00.240 --> 00:57:04.240
with extensive research experience
focused on the surveillance

00:57:04.240 --> 00:57:08.000
and characterization of resistant
bacteria.

00:57:08.320 --> 00:57:12.320
Belén has participated in national and
international monitoring networks,

00:57:12.320 --> 00:57:15.280
contributing to the establishment of
control strategies to address this global

00:57:15.280 --> 00:57:16.760
problem.

00:57:17.640 --> 00:57:21.280
His publications and scientific
collaborations have been key to

00:57:21.280 --> 00:57:24.280
improving knowledge about the spread of
resistance.

00:57:24.440 --> 00:57:28.280
In his talk on Antibiotic Resistance, he
will help

00:57:28.280 --> 00:57:31.280
us to better understand this challenge.

00:57:36.720 --> 00:57:38.280
Thank you very much for the presentation.

00:57:38.280 --> 00:57:39.480
Thank you so much for inviting me.

00:57:39.480 --> 00:57:39.960
It's a pleasure.

00:57:39.960 --> 00:57:43.960
It's a bit difficult for me because it's
a very diverse forum, because

00:57:43.960 --> 00:57:47.960
we have everyone from institute staff,
undergraduate and postgraduate

00:57:47.960 --> 00:57:51.960
students, professors, uh, so well, I'm
going to try, uh, to make it

00:57:51.960 --> 00:57:55.800
suitable for all of you so that at least
some part of it contributes something to

00:57:55.800 --> 00:57:57.760
all of you.

00:57:58.120 --> 00:58:01.880
And well, anything you want to ask me or
that wasn't clear, well,

00:58:01.880 --> 00:58:04.880
here or through my email or whenever you
want, okay?

00:58:05.560 --> 00:58:07.760
And well, uh, kind of what they've said.

00:58:07.760 --> 00:58:10.160
I'm a doctor from the Autonomous
University, you know?

00:58:10.160 --> 00:58:14.160
I specialized in Clinical Microbiology
and Parasitology and

00:58:14.160 --> 00:58:18.160
joined the Carlos III Health Institute,
at the National Center

00:58:18.160 --> 00:58:22.160
for Microbiology, and I have been working
on antibiotic

00:58:22.160 --> 00:58:26.160
resistance for 30 years. This center,
which has now been

00:58:26.160 --> 00:58:30.160
modernized, and as you can see in these
very innovative

00:58:30.160 --> 00:58:34.160
facilities, has a kind of quadruple
focus. Firstly, we are

00:58:34.160 --> 00:58:38.160
dedicated to the reference diagnosis of
everything that

00:58:38.160 --> 00:58:41.160
hospitals do not diagnose and want to go
a little further or do not have the means

00:58:41.160 --> 00:58:42.680
to do so.

00:58:42.880 --> 00:58:46.880
When we take charge, it is a monitoring
program of what we have, which

00:58:46.880 --> 00:58:51.360
is voluntary and free and which provides
service to all Spanish communities.

00:58:51.920 --> 00:58:55.920
Then we have a surveillance operation; we
monitor the most prevalent clones

00:58:55.920 --> 00:58:59.960
and epidemics and everything that is
supposedly circulating in the country.

00:59:00.160 --> 00:59:04.160
We characterize it by different means,
different

00:59:04.160 --> 00:59:08.160
methods and lately mainly by massive
genome

00:59:08.160 --> 00:59:12.160
sequencing. We have a research part that,
as you

00:59:12.160 --> 00:59:16.160
can see here in Pichar, has about 20% in
which we

00:59:16.160 --> 00:59:19.600
carry out different lines of research,

00:59:19.600 --> 00:59:22.600
especially thermal resistance.

00:59:22.760 --> 00:59:25.320
The last line is already controversial.

00:59:25.320 --> 00:59:26.120
Step.

00:59:26.120 --> 00:59:30.120
And well, then we have teaching, we have
teaching for the 4th year of

00:59:30.120 --> 00:59:34.120
ESO plus business program, we have
teaching for laboratory

00:59:34.120 --> 00:59:38.120
technicians, we have undergraduate and
postgraduate university

00:59:38.120 --> 00:59:41.560
courses. So we cover a very wide range of
different scenarios.

00:59:41.800 --> 00:59:47.240
Well, to bring microbiology a little
closer to everything, to all teaching.

00:59:48.720 --> 00:59:50.400
And well, what can I tell you?

00:59:50.400 --> 00:59:53.040
So I'm going to give a general
introduction, I'm going to talk to you

00:59:53.040 --> 00:59:54.400
about bacteria,

00:59:54.400 --> 00:59:57.560
mainly for the section for people in
secondary school, eh?

00:59:57.560 --> 00:59:59.760
I'm going to talk to you about
resistance, antibiotics, and then I want

00:59:59.760 --> 01:00:00.880
to give

01:00:00.880 --> 01:00:03.880
you some general conclusions that I think
will be useful to all of us.

01:00:04.520 --> 01:00:07.280
Well, no, I don't know, I don't know.

01:00:07.280 --> 01:00:11.280
I have shown this emblem that is also on
the poster, which is an emblem

01:00:11.280 --> 01:00:14.880
that is now like the one that tries to
popularize what is the commitment to

01:00:14.880 --> 01:00:16.680
resistance.

01:00:16.680 --> 01:00:20.680
Antibiotics is an emblem of a Swedish boy
who entered

01:00:20.680 --> 01:00:24.560
it in a contest and won, which is a bit
like that, uh,

01:00:24.560 --> 01:00:27.560
commitment, no, love is a band-aid too.

01:00:27.720 --> 01:00:30.080
And at the same time, they are two
capsules of antibiotic that he is trying

01:00:30.080 --> 01:00:31.280
to take.

01:00:31.280 --> 01:00:34.160
Well, a little bit, uh, to give it this
three-pronged approach it can have,

01:00:34.160 --> 01:00:35.600
right?

01:00:35.600 --> 01:00:37.040
The resistance treatment?

01:00:38.680 --> 01:00:39.920
Well, they are bacteria.

01:00:39.920 --> 01:00:43.920
Bacteria are the most primitive living
beings, they are 4 1,000,000,000

01:00:43.920 --> 01:00:47.080
years old and are also the most abundant
on the planet.

01:00:47.240 --> 01:00:50.720
As you know, they are adapted to any
condition and any habitat.

01:00:51.120 --> 01:00:55.120
And well, they belong to the prokaryotic
superkingdom and have two domains: the

01:00:55.120 --> 01:00:59.120
archaea domain, which are not pathogenic
in principle, and the bacteria domain,

01:00:59.120 --> 01:01:02.320
which are pathogenic, and they reproduce
every 20 minutes.

01:01:02.320 --> 01:01:06.320
So this gives us a possibility of change
and variation that

01:01:06.320 --> 01:01:09.360
we could not have except in millions of
years,

01:01:09.360 --> 01:01:12.360
well, thousands of years in mammals.

01:01:12.360 --> 01:01:16.360
So of course, this allows them to have
that versatility and variation

01:01:16.360 --> 01:01:20.800
that makes them adapt to any medium, as
has already been said in this forum.

01:01:20.800 --> 01:01:25.160
And well, they can colonize and they can
infect all those with whom they colonize.

01:01:25.160 --> 01:01:29.160
They are not malignant; some are part of
our microbiota and we even have

01:01:29.160 --> 01:01:33.160
to preserve them because they protect us
from, or prevent us from being

01:01:33.160 --> 01:01:36.840
colonized and confronted by, others that
are indeed more numerous.

01:01:40.080 --> 01:01:42.240
You all know him, right?

01:01:42.240 --> 01:01:46.240
We have an active natural immunity versus
the passive immunity that

01:01:46.240 --> 01:01:49.320
is transmitted to us by our mothers
during pregnancy and through

01:01:49.320 --> 01:01:50.880
breastfeeding.

01:01:51.120 --> 01:01:54.800
Sometimes it's nonspecific, natural,
killer

01:01:54.800 --> 01:01:57.800
phagocytosis, complement, interferon, eh?

01:01:57.800 --> 01:02:00.920
And then there is another one that is
specified as normally mediated

01:02:00.920 --> 01:02:03.920
by T and B lymphocytes, which you then
know create memory.

01:02:04.000 --> 01:02:07.640
And well, you know that we also have
information that can be passive.

01:02:08.120 --> 01:02:08.960
For example, these.

01:02:08.960 --> 01:02:12.960
Do you remember Ebola when there was no
way to treat it, and then a person

01:02:12.960 --> 01:02:16.960
was brought in, or permission was
requested from a person who had

01:02:16.960 --> 01:02:20.400
managed to overcome the infection and
those antibodies.

01:02:20.400 --> 01:02:22.960
That person who had already created
immunity was given to another person

01:02:22.960 --> 01:02:24.280
after

01:02:24.280 --> 01:02:27.280
passive immunity and then active
immunization from vaccines.

01:02:27.520 --> 01:02:30.400
You know that there are many types that
unfortunately.

01:02:30.400 --> 01:02:33.280
Well, it's the vaccination schedule of
the Community of Madrid, but it's not the

01:02:33.280 --> 01:02:34.720
same everywhere.

01:02:34.720 --> 01:02:37.360
And what do I say is unfortunately,
because I think there are very good

01:02:37.360 --> 01:02:38.720
things

01:02:38.720 --> 01:02:42.720
about the transfer to communities, but
this was a bit controversial because

01:02:42.720 --> 01:02:46.560
it depends on where you are and how you
are, whether you're vaccinated,

01:02:46.560 --> 01:02:49.560
some things are covered, others aren't,
right?

01:02:49.680 --> 01:02:53.120
Some are funded and others are not, but
well, this is our current one from the

01:02:53.120 --> 01:02:54.840
Community of Madrid.

01:02:54.840 --> 01:02:58.840
And then the other answer is the curative
one, the phages, which

01:02:58.840 --> 01:03:02.840
Jerónimo has already mentioned a bit, and
well, antibiotics are

01:03:02.840 --> 01:03:06.840
a bit more my field of expertise, in
which I think I am a bit more

01:03:06.840 --> 01:03:10.840
knowledgeable, which are antibiotics,
well, antibiotics are

01:03:10.840 --> 01:03:14.120
medicines that fight bacteria or prevent
their growth.

01:03:14.320 --> 01:03:18.320
So the concept of it being bacteriostatic
or using its death,

01:03:18.320 --> 01:03:22.880
which is called bactericidal, was where
they act at different levels.

01:03:23.000 --> 01:03:27.000
This is a bacterium in a schematic way,
since they can act at the

01:03:27.000 --> 01:03:31.000
level of cell wall synthesis, at the
level of nucleic acid synthesis,

01:03:31.000 --> 01:03:35.680
at the level of protein synthesis, and so
on, at the level at which they act.

01:03:35.840 --> 01:03:41.000
Well, we have the opportunity to fight it
in different places.

01:03:41.000 --> 01:03:43.400
They are different mechanisms. What's
happening?

01:03:43.400 --> 01:03:47.400
The problem we have is that antibiotics
are being created by the

01:03:47.400 --> 01:03:51.400
bacteria, due to its versatile ability to
create resistance and

01:03:51.400 --> 01:03:55.080
especially because of the frequent
divisions every 20 minutes.

01:03:55.280 --> 01:03:59.200
Well, it's able to avoid these
antibiotics.

01:03:59.960 --> 01:04:00.760
What I'm telling you.

01:04:00.760 --> 01:04:04.760
Ability to develop different mechanisms
to survive antibiotics

01:04:04.760 --> 01:04:09.840
and great ease in exchanging information
through transfer plasmids.

01:04:11.240 --> 01:04:15.240
So it makes the original bacteria, well,
maybe in less than a day,

01:04:15.240 --> 01:04:18.760
especially if it's subjected to
antibiotics, right?

01:04:18.800 --> 01:04:21.800
Well, it makes one that thanks.

01:04:23.440 --> 01:04:27.840
This is a slide that shows it to us, huh?

01:04:27.840 --> 01:04:31.640
Visually very good, because here we have
a different population

01:04:31.640 --> 01:04:34.640
in which sometimes only one is resistant.

01:04:34.880 --> 01:04:38.880
The thing is, with antibiotic exposure,
that

01:04:38.880 --> 01:04:42.640
exposure only selects those that have

01:04:42.640 --> 01:04:45.640
something to A in different directions.

01:04:45.640 --> 01:04:49.560
What it does is select only the one that
has the change or only the one that

01:04:49.560 --> 01:04:51.560
avoids the medication.

01:04:51.560 --> 01:04:54.560
Avoid sensitivity.

01:04:55.880 --> 01:05:00.160
This, well, we have already mentioned
several times throughout the morning.

01:05:00.160 --> 01:05:03.160
Is that Alexander Fleming, huh?

01:05:03.440 --> 01:05:06.520
Penicillin was one of the major
milestones in history.

01:05:06.520 --> 01:05:09.720
I imagine it's a story that was
completely accidental.

01:05:09.720 --> 01:05:13.720
Not by leaving, uh, Al on a long weekend,
a bacterium

01:05:13.720 --> 01:05:17.480
exposed, uh, to the environmental
conditions, was

01:05:17.480 --> 01:05:20.480
colonized by a fungus that is what he
saw.

01:05:20.480 --> 01:05:23.600
As you can see here, she has a
sensitivity that could have some power

01:05:23.600 --> 01:05:25.200
against them.

01:05:27.800 --> 01:05:29.160
Huh? What did he achieve?

01:05:29.160 --> 01:05:33.160
Well, look, this is what we had before
around 1942, which is considered

01:05:33.160 --> 01:05:37.200
the end of the antibiotic era, which is
when antibiotics began to be used.

01:05:37.520 --> 01:05:41.200
This is a case of a septic cell, uh, with
a staphylococcus aureus.

01:05:41.520 --> 01:05:46.040
A girl who got a sharp object stuck here
in her jaw.

01:05:46.280 --> 01:05:47.760
Well, this is what we had before.

01:05:47.760 --> 01:05:49.520
We had cellulite.

01:05:49.520 --> 01:05:53.520
Uh. Well, uh, it was terrible in, uh, in
what is the,

01:05:53.520 --> 01:05:57.520
sorry, in what is the mandibular area,
even

01:05:57.520 --> 01:06:01.520
hereditary, and this is what was achieved
with

01:06:01.520 --> 01:06:04.960
the antibiotic treatment 15 days after
the...

01:06:06.760 --> 01:06:10.280
So, what did this mean, or did it mean a
change? Huh?

01:06:10.280 --> 01:06:13.280
Absolutely. Uh, uh.

01:06:13.520 --> 01:06:15.000
How do you

01:06:15.000 --> 01:06:17.040
eh?

01:06:17.040 --> 01:06:21.040
Well, it was unprecedented, wasn't it? At
first, there was a bit of

01:06:21.040 --> 01:06:25.040
triumphalism because people thought we
had eradicated infectious

01:06:25.040 --> 01:06:28.280
diseases, that we were completely immune
to them, and

01:06:28.280 --> 01:06:31.280
that from now on there would be a before
and after.

01:06:31.280 --> 01:06:35.280
It is true that there was a before and
after, because the evolution

01:06:35.280 --> 01:06:39.280
has been completely different and then
they began to create different

01:06:39.280 --> 01:06:42.920
drugs and molecules that were derived
from or had the same

01:06:42.920 --> 01:06:45.920
intentions or the same mechanisms as the
first ones.

01:06:46.440 --> 01:06:49.720
But unfortunately, despite that
situation, there

01:06:49.720 --> 01:06:52.720
has never been a better situation than
this one.

01:06:53.360 --> 01:06:57.360
Do you see, if you look at the causes of
death from

01:06:57.360 --> 01:07:02.040
infections in the 1920s, how these deaths
decreased over time?

01:07:02.040 --> 01:07:03.440
Well, these are all the causes.

01:07:05.560 --> 01:07:06.360
For the causes.

01:07:06.360 --> 01:07:08.800
These are the causes that are not things
that have followed the same temporal

01:07:08.800 --> 01:07:10.040
evolution.

01:07:10.320 --> 01:07:13.680
These are the causes that were infectious
and that, with the

01:07:13.680 --> 01:07:16.680
chaotic administration of therapy, were
decreasing.

01:07:16.760 --> 01:07:22.400
But this, uh, at the beginning, uh, was a
triumphalist perception that was had.

01:07:23.120 --> 01:07:27.120
Uh, if you look at the timeline, the
timeline above tries to

01:07:27.120 --> 01:07:31.120
show the synthesis of the different
substances or the

01:07:31.120 --> 01:07:36.240
different families of antibiotics with
the different mechanisms over time.

01:07:36.560 --> 01:07:38.720
The 1930s to the 2000s.

01:07:38.720 --> 01:07:42.880
This timeline below is the emergence or
development of the resistance.

01:07:42.880 --> 01:07:46.520
But if you look closely, it happens
practically from the

01:07:46.520 --> 01:07:49.520
moment a molecule starts to be created,
right?

01:07:49.520 --> 01:07:53.520
Well, a few years later, sometimes a few
months later, resistance

01:07:53.520 --> 01:07:56.640
mechanisms to those same molecules begin
to develop.

01:07:56.840 --> 01:08:00.840
That's why Jessica mentioned at the
beginning of the talk

01:08:00.840 --> 01:08:04.840
that Fleming was very visionary and said
from the beginning

01:08:04.840 --> 01:08:08.840
that if people weren't capable, of
course, if they behaved

01:08:08.840 --> 01:08:12.840
ignorantly and weren't able to use these
molecules correctly,

01:08:12.840 --> 01:08:17.680
then their days were numbered, because
practically, as you can see.

01:08:20.680 --> 01:08:24.680
From the moment of their creation,
resistance

01:08:24.680 --> 01:08:29.520
began to appear, right? And what has
happened 80 years later?

01:08:29.520 --> 01:08:32.960
Well, you've probably seen popular
science magazines that talk about super

01:08:32.960 --> 01:08:34.680
bacteria.

01:08:34.680 --> 01:08:38.680
It's a term that microbiologists don't
particularly like, because

01:08:38.680 --> 01:08:42.680
they're not super bacteria, but it's true
that antibiotic pressure and

01:08:42.680 --> 01:08:46.680
evolution have allowed us, thanks to the
versatility I mentioned in

01:08:46.680 --> 01:08:50.600
bacteria, to now have microorganisms that
are not very difficult to treat.

01:08:50.600 --> 01:08:54.640
So these are all the bacteria we know of,
huh?

01:08:55.160 --> 01:08:59.160
In our environment, these are only the
ones that are pathogenic in humans. These

01:08:59.160 --> 01:09:02.360
are the ones that are resistant to some
antibiotic, the ones that

01:09:02.360 --> 01:09:05.360
are multi-resistant, the ones that are
extremely resistant.

01:09:05.360 --> 01:09:08.080
They only have two families of
antibiotics left, those are the ones they

01:09:08.080 --> 01:09:09.440
don't have left.

01:09:09.440 --> 01:09:12.200
And that's because it's a small subset.

01:09:12.200 --> 01:09:13.080
But of course, what's the problem?

01:09:13.080 --> 01:09:17.080
That this small subset is grouped in a
space that is of

01:09:17.080 --> 01:09:21.040
people who are susceptible, is of people
who are

01:09:21.040 --> 01:09:24.040
vulnerable, have immune defects, are
treated.

01:09:24.040 --> 01:09:26.480
So this is really difficult, huh?

01:09:26.480 --> 01:09:30.480
After arriving at solutions, we need to
make sure

01:09:30.480 --> 01:09:34.480
they are successful, because, as I was
saying,

01:09:34.480 --> 01:09:38.120
medicine isn't like it used to be.
Medicine used

01:09:38.120 --> 01:09:41.120
to be more limited, but what do we do
now?

01:09:41.120 --> 01:09:45.120
We perform organ transplants, we have
chemotherapy for cancer,

01:09:45.120 --> 01:09:49.120
we have intensive care units, premature
babies are increasingly

01:09:49.120 --> 01:09:53.120
premature and almost all have a very high
survival rate, which is

01:09:53.120 --> 01:09:56.840
an achievement for society and for our
current medicine.

01:09:57.040 --> 01:10:01.120
But all this means that therapy is
essential.

01:10:01.440 --> 01:10:04.480
So, of course, this severely limits the
options.

01:10:04.680 --> 01:10:08.240
When we find ourselves in that small

01:10:08.240 --> 01:10:11.240
rectangle or square that I showed you.

01:10:13.320 --> 01:10:16.480
What can also happen is that all of this
is usually centered in hospitals

01:10:16.480 --> 01:10:19.480
and therefore has a very large impact on
nosocomial outbreaks.

01:10:19.520 --> 01:10:23.520
Outbreaks are when in the same place you
know that for

01:10:23.520 --> 01:10:27.520
there to be an outbreak, it has to be, uh
uh, that the

01:10:27.520 --> 01:10:31.120
bacteria are being produced equally in
space and time.

01:10:31.320 --> 01:10:35.320
So if they all accumulate in a place that
is an intensive care

01:10:35.320 --> 01:10:39.320
unit, in a place where there are people
who are very vulnerable,

01:10:39.320 --> 01:10:43.320
then we have bacteria that are very
resistant at the patient

01:10:43.320 --> 01:10:47.320
level, so the therapeutic alternatives
decrease, and they

01:10:47.320 --> 01:10:51.840
suffer increases in morbidity and
mortality, right?

01:10:51.840 --> 01:10:54.480
We need to try other alternatives and
synergy with antibiotics, but this also

01:10:54.480 --> 01:10:55.840
has a

01:10:55.840 --> 01:10:58.480
community-level dimension, because there
is a risk of dissemination in the

01:10:58.480 --> 01:10:59.840
hospital,

01:10:59.840 --> 01:11:03.520
between hospitals, and we need to assess
these risks and take control measures

01:11:03.520 --> 01:11:06.520
because there could even be cross-border
outbreaks.

01:11:06.520 --> 01:11:09.560
We now live in a global society where
there is more and more

01:11:09.560 --> 01:11:12.560
travel, and we are all increasingly in
contact with each other.

01:11:12.560 --> 01:11:16.360
So the possibility that this could escape
borders and go to

01:11:16.360 --> 01:11:19.360
other places is also a very worrying
threat.

01:11:21.200 --> 01:11:22.200
And there is a paradox.

01:11:22.200 --> 01:11:25.880
The paradox is that at the same time as
resistance is increasing, the development

01:11:25.880 --> 01:11:27.720
of antibiotics is decreasing.

01:11:27.720 --> 01:11:30.960
That's why we need to be more creative
and create new alternatives.

01:11:31.400 --> 01:11:32.600
And why do you think this is?

01:11:32.600 --> 01:11:35.480
Well, the truth is that it's not
profitable.

01:11:35.480 --> 01:11:37.960
So, how would you say it's profitable?
Why is it profitable?

01:11:37.960 --> 01:11:41.080
Because it rents because it is a
self-limiting infection in terms of time

01:11:41.080 --> 01:11:42.680
and people.

01:11:42.680 --> 01:11:45.960
And then you spend 20 years developing
research

01:11:45.960 --> 01:11:48.960
to put it into a very limited treatment.

01:11:49.160 --> 01:11:52.720
If you develop an antelope using oral
diabetics, well, that's it.

01:11:52.880 --> 01:11:56.880
Doesn't this produce an economic increase
for commercial and pharmaceutical

01:11:56.880 --> 01:12:00.480
companies, which is ultimately how they
finance themselves?

01:12:00.760 --> 01:12:03.560
Which is much more than creating an
antibiotic.

01:12:03.560 --> 01:12:08.480
So, I think that's partly why we've had a
bottleneck.

01:12:08.480 --> 01:12:12.480
And well, a bottleneck, because in recent
years only antibiotics

01:12:12.480 --> 01:12:16.480
derived from already known families had
been created, and currently

01:12:16.480 --> 01:12:20.480
new antibiotics are related to the
synthesis of inhibitors, which

01:12:20.480 --> 01:12:24.480
are like combinations of the previous
ones, or as Jerónimo has also

01:12:24.480 --> 01:12:28.320
told us, resorting to antibiotics that
were somewhat obsolete and that have now

01:12:28.320 --> 01:12:30.240
been used again.

01:12:35.880 --> 01:12:39.200
I think we've already mentioned this
several times during the talk.

01:12:39.200 --> 01:12:43.200
The burden of multidrug-resistant
bacteria creates an

01:12:43.200 --> 01:12:47.200
attributable mortality of 25,000 people
per year and an

01:12:47.200 --> 01:12:50.520
additional 2.5 million hospitalizations
per year.

01:12:50.720 --> 01:12:52.680
Hospital costs €900.

01:12:52.680 --> 01:12:54.600
Productivity losses, 600 million.

01:12:54.600 --> 01:12:59.680
This, which seems to be about money, is
of great interest to hospital managers.

01:12:59.680 --> 01:13:03.360
Well, you can tell him that there's
something very important you want to buy,

01:13:03.360 --> 01:13:05.200
but he won't finance it.

01:13:05.200 --> 01:13:09.200
But if you speak to him in economic
terms, that is, if you

01:13:09.200 --> 01:13:13.200
tell him that it is avoidable, not only
because of the disease

01:13:13.200 --> 01:13:17.200
it causes, but also because of the
monetary savings it

01:13:17.200 --> 01:13:21.200
causes, then that is also an advantage we
can use, because

01:13:21.200 --> 01:13:25.200
this is true and it is also true that
this gentleman, the

01:13:25.200 --> 01:13:29.200
British economist, who has been mentioned
twice already,

01:13:29.200 --> 01:13:33.200
was hired by the government of Cameroon
to do a report that

01:13:33.200 --> 01:13:36.960
was of the highest level, the one that
quantifies the

01:13:36.960 --> 01:13:39.960
impact of antibiotic-resistant bacteria.

01:13:39.960 --> 01:13:43.920
So this is basically a summary that's
already been discussed twice, right?

01:13:44.000 --> 01:13:48.000
He commented that 100 million deaths
could be attributed

01:13:48.000 --> 01:13:51.200
to the year 2050 if nothing was done.

01:13:51.400 --> 01:13:55.400
While it is true that we have in our
hands, well, the advantage of being

01:13:55.400 --> 01:13:59.080
able to be, uh, uh, aware of the
situation above all and be able to take

01:13:59.080 --> 01:14:00.960
measures in this regard.

01:14:01.480 --> 01:14:05.480
The $20 million figure each year also
seems like a significant

01:14:05.480 --> 01:14:08.760
amount to me, and well, it's just one,
you know?

01:14:08.760 --> 01:14:10.080
That one, eh

01:14:11.360 --> 01:14:15.360
Its importance, of course, lies in terms
of human

01:14:15.360 --> 01:14:19.360
losses and loss of life, loss of health
and morbidity,

01:14:19.360 --> 01:14:22.880
but economically it also represents a

01:14:22.880 --> 01:14:25.880
significant expense for everyone.

01:14:26.560 --> 01:14:30.560
I'm also using one of the many

01:14:30.560 --> 01:14:34.560
infographics that the WHO has

01:14:34.560 --> 01:14:38.560
to raise awareness. I've put it

01:14:38.560 --> 01:14:43.960
here so you can see how we're all
involved.

01:14:43.960 --> 01:14:46.760
In the selection of resistance
propagation.

01:14:46.760 --> 01:14:48.080
Antibiotics, huh?

01:14:48.080 --> 01:14:52.080
The person who goes to a hospital, uh,
causes a selection of those

01:14:52.080 --> 01:14:55.360
bacteria and they spread, and then that
spread can occur to the general

01:14:55.360 --> 01:14:57.000
population.

01:14:57.000 --> 01:15:01.480
And also because you know that it has
been poorly regulated over time, right?

01:15:01.480 --> 01:15:05.480
The addition that was made so much in
antibiotics, uh,

01:15:05.480 --> 01:15:09.440
to food as well as on farms, because you
know it's a growth factor for animals,

01:15:09.440 --> 01:15:11.440
uh?

01:15:11.440 --> 01:15:15.440
If you have an agent, that is, some
animals that are tabulated and

01:15:15.440 --> 01:15:19.440
that are in an intensive production and
they are given antibiotics,

01:15:19.440 --> 01:15:22.760
since they are all in contact and
infections are

01:15:22.760 --> 01:15:25.760
prevented, especially when it is
beekeeping, eh?

01:15:25.760 --> 01:15:27.680
More so than the coil.

01:15:27.680 --> 01:15:31.680
Well, what happens is that, uh, you get
higher meat

01:15:31.680 --> 01:15:35.160
production and higher economic income.

01:15:35.360 --> 01:15:39.360
So for a very long time, both animals on

01:15:39.360 --> 01:15:43.360
farms and their food have been
indiscriminately

01:15:43.360 --> 01:15:47.360
supplemented with these antibiotics

01:15:47.360 --> 01:15:52.080
because better profits were obtained.

01:15:52.560 --> 01:15:54.320
Was it paid for afterwards?

01:15:54.320 --> 01:15:55.880
So, what are the consequences?

01:15:55.880 --> 01:15:58.520
Well, because right now there are so
many, uh, children, for example babies,

01:15:58.520 --> 01:15:59.880
that you

01:15:59.880 --> 01:16:02.840
do a blood test and they have markers of
resistance without ever having consumed

01:16:02.840 --> 01:16:04.320
antibiotics.

01:16:04.680 --> 01:16:08.680
And that's because all the foods that
have consumed milk, including

01:16:08.680 --> 01:16:12.200
infant formula, have been derived from
products that have been supplemented with

01:16:12.200 --> 01:16:14.000
antibiotics.

01:16:14.360 --> 01:16:18.360
And so right now if we take different
samples at different

01:16:18.360 --> 01:16:24.280
levels, uh, ecological, environmental and
food, we can find food remains.

01:16:24.680 --> 01:16:28.680
Fortunately, there have been some plans,
especially in veterinary

01:16:28.680 --> 01:16:32.680
medicine, like the plan, for example, for
choline control, which

01:16:32.680 --> 01:16:36.680
they will surely tell you about at the
last minute, which has greatly

01:16:36.680 --> 01:16:40.560
reduced that consumption and has
controlled this situation, but

01:16:40.560 --> 01:16:43.560
which until a few years ago was very
worrying.

01:16:44.840 --> 01:16:48.840
And well, it has importance from an
ecological perspective, because it

01:16:48.840 --> 01:16:52.000
is a public health problem recognized as
a priority by all

01:16:52.000 --> 01:16:55.000
agencies such as the WHO, the European
Union or the CDC.

01:16:55.400 --> 01:16:59.400
And from an individual perspective, of
course it is a clinical and therapeutic

01:16:59.400 --> 01:17:03.000
problem, since it conditions the
evolution of infectious diseases.

01:17:03.000 --> 01:17:07.000
It's a bit like what was shown in the
previous slide, or Angels, but

01:17:07.000 --> 01:17:11.000
this is very trendy right now, and what
it's trying to say is that

01:17:11.000 --> 01:17:15.000
the entire environment, animals, people,
and the consumption

01:17:15.000 --> 01:17:19.000
of any product currently need to be
regulated because we are all

01:17:19.000 --> 01:17:22.680
co-responsible for preserving these
antibiotics that will be useful to us in

01:17:22.680 --> 01:17:24.560
the future.

01:17:25.320 --> 01:17:27.080
Well, this is kind of the same thing.

01:17:29.920 --> 01:17:33.920
Um, I want to emphasize that it's
important that we control the use

01:17:33.920 --> 01:17:37.520
of antibiotics, that they are used
prudently, because the

01:17:37.520 --> 01:17:40.520
use of antibiotics is what selects in a
certain way.

01:17:41.520 --> 01:17:45.520
The resistance of the commensal flora
causes the resistant

01:17:45.520 --> 01:17:49.520
strain to spread, which the patient with
an underlying pathology

01:17:49.520 --> 01:17:54.040
may be vulnerable to and then may
manifest an opportunistic infection.

01:17:54.280 --> 01:17:58.280
So antibiotics are really the only
molecule, the only drug whose

01:17:58.280 --> 01:18:01.840
adverse effects not only affect the
person, but can affect other different

01:18:01.840 --> 01:18:03.640
people.

01:18:07.680 --> 01:18:11.640
And I also want to send you this message
that I hope will stick, okay?

01:18:11.640 --> 01:18:14.640
Okay, antibiotics are used to treat
bacteria.

01:18:14.720 --> 01:18:18.720
Most of the common respiratory illnesses
that

01:18:18.720 --> 01:18:22.760
occur throughout the winter are caused by
viruses.

01:18:23.360 --> 01:18:26.560
An antibiotic will never be effective
against a

01:18:26.560 --> 01:18:29.560
virus, so maybe we have to do quite a
lot, huh?

01:18:29.560 --> 01:18:33.560
It's also about teaching, but not only to
this forum, to the general

01:18:33.560 --> 01:18:37.560
public, that antibiotics should only be
used when they are truly

01:18:37.560 --> 01:18:41.360
going to be useful, because they are
useless for colds.

01:18:41.360 --> 01:18:45.360
So, well, I'm going to put this here many
times simply so that

01:18:45.360 --> 01:18:48.600
this message, those things are not useful
for

01:18:48.600 --> 01:18:51.600
treating colds, because they are not
used.

01:18:51.600 --> 01:18:51.840
Okay?

01:18:56.600 --> 01:19:00.280
Well, I also want you to remember that
the inappropriate use of antibiotics is

01:19:00.280 --> 01:19:02.160
the main cause of resistance.

01:19:02.560 --> 01:19:05.600
So, if we use antibiotics, huh?

01:19:05.720 --> 01:19:09.720
Did Jerónimo also tell us that they
should only be used

01:19:09.720 --> 01:19:14.920
for the time and with the instructions
that the doctor tells you?

01:19:14.920 --> 01:19:18.920
It's true that in this country the
antibiotic box is poorly designed

01:19:18.920 --> 01:19:22.920
because there's always too much or too
little. So you always have a

01:19:22.920 --> 01:19:27.120
remnant in your bathroom cabinet to use
later, and you shouldn't throw it away.

01:19:27.120 --> 01:19:31.120
You know that in pharmacies it is only
disposed of at the time and with

01:19:31.120 --> 01:19:34.880
the prescription and with the indication
that the doctor or the person treating us

01:19:34.880 --> 01:19:36.760
has told us.

01:19:37.760 --> 01:19:40.400
And that's it, some conclusions that
antibiotic resistance and

01:19:40.400 --> 01:19:41.760
multi-resistance

01:19:41.760 --> 01:19:45.000
are constantly evolving and have
important implications both clinically

01:19:45.000 --> 01:19:46.640
and for treatment.

01:19:47.080 --> 01:19:51.080
Uh, it's true that it's a random event,
but it generally prevails

01:19:51.080 --> 01:19:54.440
among the universe of bacteria in the use
of antibiotics.

01:19:54.440 --> 01:19:57.760
Select this resistant strain, making it
predominant, and once the

01:19:57.760 --> 01:20:00.760
mechanism is selected, it can spread and
perpetuate itself.

01:20:01.480 --> 01:20:05.480
The responsible use of antibiotics is key
to reducing this first step,

01:20:05.480 --> 01:20:09.480
and continuous surveillance and the study
of resistance mechanisms

01:20:09.480 --> 01:20:13.160
via dissemination are essential elements
in this control.

01:20:13.880 --> 01:20:16.640
And I want to send you three messages,
the one from Walsch, which I've already

01:20:16.640 --> 01:20:18.040
told you about.

01:20:18.240 --> 01:20:22.240
So we are all responsible in every area:
food,

01:20:22.240 --> 01:20:26.240
veterinary medicine, the environment,
etc. Prudent

01:20:26.240 --> 01:20:30.240
use is very important, as I've said, and
as has also

01:20:30.240 --> 01:20:34.240
been mentioned here, hand hygiene is very
important,

01:20:34.240 --> 01:20:38.240
both for us and for healthcare personnel,
because

01:20:38.240 --> 01:20:42.120
it prevents a very high percentage of
cases.

01:20:42.320 --> 01:20:45.400
In fact, we just celebrated May 5th,

01:20:45.400 --> 01:20:48.400
which is Handwashing Saturday.

01:20:48.400 --> 01:20:52.400
Just as there is a use, there is a day
for the prudent use of antibiotics, which

01:20:52.400 --> 01:20:55.480
is November 18, and with these
initiatives we try to popularize and

01:20:55.480 --> 01:20:57.040
spread awareness.

01:20:57.200 --> 01:21:00.680
These initiatives are fundamental and
key, because they will

01:21:00.680 --> 01:21:03.680
allow us to use the antibiotics we don't
have tomorrow.

01:21:04.240 --> 01:21:08.680
These are all the organizations with
which we collaborate or work.

01:21:08.680 --> 01:21:12.680
This is my research group, the Carlos III
of FNM, and well,

01:21:12.680 --> 01:21:16.680
I'm leaving you with this message that we
are all responsible

01:21:16.680 --> 01:21:20.680
for ensuring that we don't find ourselves
in this situation

01:21:20.680 --> 01:21:24.680
again, in this beautiful golden picture
where we return

01:21:24.680 --> 01:21:30.320
once more to the era of major infections
and the pre-antibiotic era.

01:21:30.840 --> 01:21:33.840
And thank you very much for your
attendance.

01:21:35.320 --> 01:21:38.320
Thank you so much.

01:21:40.480 --> 01:21:43.480
Infections caused by bacteria, not
viruses.

01:21:43.720 --> 01:21:47.720
The problem is that many of these
microbes produce,

01:21:47.720 --> 01:21:51.200
let's say, pathologies with the same
symptoms,

01:21:51.200 --> 01:21:54.200
such as fever, headache, sore throat.

01:21:54.480 --> 01:21:57.640
But having a fever does not mean that we
have a bacterial

01:21:57.640 --> 01:22:00.640
infection and that we need to use an
antibiotic.

01:22:00.920 --> 01:22:03.920
Okay, it's very important that we
understand this clearly.

01:22:04.320 --> 01:22:05.800
How do these drugs work?

01:22:05.800 --> 01:22:08.240
Well, because of the principle of
selective toxicity.

01:22:08.240 --> 01:22:09.640
What does this mean?

01:22:09.640 --> 01:22:13.640
They will act in specific, important,
vital places

01:22:13.640 --> 01:22:17.640
for the bacterial cell, but they will not
act on our

01:22:17.640 --> 01:22:21.640
cells, nor on the cell of a virus, nor on
the cell of a

01:22:21.640 --> 01:22:25.520
parasite, because they have nothing to do
with each other.

01:22:25.720 --> 01:22:29.720
Okay, normally, because they act in vital
sites

01:22:29.720 --> 01:22:33.280
such as the cell wall, the cell membrane.

01:22:33.280 --> 01:22:37.280
They inhibit protein synthesis, the
synthesis of genetic

01:22:37.280 --> 01:22:41.280
material, or function in metabolic
cascades that synthesize

01:22:41.280 --> 01:22:45.600
vital substances for the bacterial cell,
such as folic acid.

01:22:45.600 --> 01:22:46.800
Okay.

01:22:46.800 --> 01:22:49.760
Okay, that's one thing, huh?

01:22:49.760 --> 01:22:53.760
Antibiotics, as we have already
discussed, were centered

01:22:53.760 --> 01:22:57.400
or emerged with the discovery of
penicillin.

01:22:58.040 --> 01:23:01.960
I really like the discovery of penicillin
because it is a

01:23:01.960 --> 01:23:04.960
clear example of what it means to work as
a team.

01:23:05.080 --> 01:23:09.080
One person alone won't get very far, but
if they work in a

01:23:09.080 --> 01:23:13.280
research team, they can go very far and
achieve great things.

01:23:13.280 --> 01:23:15.400
And that's what happened with penicillin.

01:23:15.400 --> 01:23:20.920
Dr. Alexander Fleming was working with
cultures, in this case of Staphylococcus.

01:23:21.040 --> 01:23:25.040
Okay, as we can see in the image, he went
on vacation and when he

01:23:25.040 --> 01:23:29.200
came back, he saw that there was
something strange in his Petri dish.

01:23:30.200 --> 01:23:33.960
This thing here, which was a bit
environmental, the plate

01:23:33.960 --> 01:23:36.960
was contaminated with penicillin, not
Tatum.

01:23:36.960 --> 01:23:40.960
And he saw that the bacteria he had
cultivated there did

01:23:40.960 --> 01:23:44.960
not grow around that fungus and he
thought, "Ah, well then

01:23:44.960 --> 01:23:48.960
this fungus has released something." He
called that

01:23:48.960 --> 01:23:52.040
something penicillin, and he saw that

01:23:52.040 --> 01:23:55.040
penicillin inhibited the growth of those
bacteria.

01:23:55.440 --> 01:23:57.920
And that's where it remained, as an
anecdote, a laboratory experiment, after

01:23:57.920 --> 01:23:59.200
all.

01:23:59.960 --> 01:24:03.680
And it wasn't until later with these very
serious gentlemen.

01:24:03.680 --> 01:24:07.680
Flores in the year 39 who returned to
this discovery

01:24:07.680 --> 01:24:11.680
and were able to purify and produce this
penicillin

01:24:11.680 --> 01:24:15.680
on a large scale in order to, what they
wanted was

01:24:15.680 --> 01:24:21.520
to demonstrate that this really inhibited
an infection.

01:24:21.520 --> 01:24:25.520
So what they did was take a small group
of mice, inject them with

01:24:25.520 --> 01:24:29.520
a deadly bacterium, streptococcus, then
inject them with

01:24:29.520 --> 01:24:34.600
penicillin, and they saw that only those
mice that had penicillin survived.

01:24:34.760 --> 01:24:38.760
They had already demonstrated that
penicillin

01:24:38.760 --> 01:24:44.320
could inhibit or reduce an infection and
keep those infected mice alive.

01:24:44.320 --> 01:24:47.600
Okay, this was a great discovery that was
later...

01:24:47.600 --> 01:24:51.600
These three researchers were awarded the
Nobel

01:24:51.600 --> 01:24:55.600
Prize in Physiology or Medicine, and
later, in

01:24:55.600 --> 01:24:59.600
1941, clinical trials were conducted with
people

01:24:59.600 --> 01:25:03.880
to study the effectiveness of this
antibiotic.

01:25:04.200 --> 01:25:08.200
But the big boom was its use in World War
II, where

01:25:08.200 --> 01:25:12.200
practically every soldier carried a
backpack

01:25:12.200 --> 01:25:15.680
with a dose of penicillin to combat those

01:25:15.680 --> 01:25:18.680
war wounds and many lives were saved.

01:25:18.680 --> 01:25:19.840
Okay, a lot of lives.

01:25:19.840 --> 01:25:23.840
That was, therefore, a revolution in
medicine, and

01:25:23.840 --> 01:25:28.720
later penicillin began to be used in the
civilian population.

01:25:30.200 --> 01:25:31.520
During this revolution.

01:25:31.520 --> 01:25:35.520
Of course, many more antibiotics came
along.

01:25:35.520 --> 01:25:39.520
Everyone wanted to design new
penicillins,

01:25:39.520 --> 01:25:43.520
new antibiotics, and here we can see on a
timeline

01:25:43.520 --> 01:25:46.600
from the 1900s to practically 2025

01:25:46.600 --> 01:25:49.600
how things have gone last year.

01:25:50.080 --> 01:25:52.960
Is this a very, very, very brief summary?

01:25:52.960 --> 01:25:56.280
So how has the industry

01:25:56.280 --> 01:25:59.280
developed in these times?

01:25:59.280 --> 01:26:02.960
We can see that the great golden age of
antimicrobials

01:26:02.960 --> 01:26:05.960
was from the 1930s to the 1950s and
1960s.

01:26:06.560 --> 01:26:10.520
We see all this yellow part of yellow
arrows.

01:26:10.680 --> 01:26:14.680
These are drugs, antibiotics that have
been developed and

01:26:14.680 --> 01:26:18.280
we have many gaps, many empty spaces
where there is no

01:26:18.280 --> 01:26:21.280
drug design, no new drugs, as is
happening now.

01:26:21.280 --> 01:26:25.280
Lately we have seen that, uh, the problem

01:26:25.280 --> 01:26:29.280
with the lack of these new drugs is due
to the

01:26:29.280 --> 01:26:33.600
red line, which is the emergence of
resistance.

01:26:33.760 --> 01:26:37.760
Okay, if we look at penicillin and it was
put on the market

01:26:37.760 --> 01:26:42.520
in 1941-42, we can see that there were
already resistances.

01:26:42.840 --> 01:26:46.840
Five years later, five years later there
was already resistance,

01:26:46.840 --> 01:26:50.240
and Mr. Fleming had already predicted
this.

01:26:50.720 --> 01:26:54.720
If we go to the last drug that appears on
the list,

01:26:54.720 --> 01:26:58.720
except for Sano Vale which was marketed
in 2004,

01:26:58.720 --> 01:27:02.680
we see that it already has resistance in
2021.

01:27:03.000 --> 01:27:07.000
Seven years later, there are already
bacteria resistant to one of

01:27:07.000 --> 01:27:10.480
the new antibiotics that has been
developed recently.

01:27:10.760 --> 01:27:14.760
Okay, so as my colleague Belén said
earlier, this isn't profitable

01:27:14.760 --> 01:27:18.760
for the pharmaceutical industry. Nobody
wants to lose money

01:27:18.760 --> 01:27:22.760
or invest a lot of money to bring a new
drug to market, knowing

01:27:22.760 --> 01:27:25.960
that in five years it won't have the same
effect.

01:27:25.960 --> 01:27:28.960
than before.

01:27:29.480 --> 01:27:33.440
If we think about what these antibiotics
have given us, what has been the clinical

01:27:33.440 --> 01:27:35.440
impact?

01:27:35.840 --> 01:27:40.560
So think about all these images I'm
showing you here to heal a wound.

01:27:41.240 --> 01:27:45.240
Imagine if they said that in ten or
twenty

01:27:45.240 --> 01:27:49.240
years, a small wound on your skin could
be fatal.

01:27:51.160 --> 01:27:52.400
Okay, because I could do it.

01:27:52.400 --> 01:27:56.400
In fact, there are already people dying
from poorly healed wounds

01:27:56.400 --> 01:28:00.400
because there are no antibiotics in that
person that are effective

01:28:00.400 --> 01:28:04.720
in curing a possible septicemia that may
develop after that wound.

01:28:05.600 --> 01:28:06.640
Okay.

01:28:06.640 --> 01:28:10.880
Well, the uses I've given you are very
illustrative, aren't they?

01:28:10.880 --> 01:28:16.480
A bacterial infection in the hospital can
be treated, but it can also be prevented.

01:28:16.480 --> 01:28:21.800
Patients are often given an antibiotic to
prevent future infections, such as...

01:28:22.000 --> 01:28:24.560
When we go to the dentist, someone who
hasn't been to the dentist has had a

01:28:24.560 --> 01:28:25.840
tooth pulled and

01:28:25.840 --> 01:28:28.840
they've been told, "Well, now you have to
take an antibiotic for a week."

01:28:28.840 --> 01:28:31.080
It's to prevent infections.

01:28:31.080 --> 01:28:35.080
After they perform that extraction in the
operating

01:28:35.080 --> 01:28:38.440
rooms, they make an incision, right?

01:28:38.720 --> 01:28:42.720
Well, that incision will be in contact
with bacteria that

01:28:42.720 --> 01:28:46.720
may be present in the operating room
environment, on

01:28:46.720 --> 01:28:50.680
surgical equipment, or on the gowns of
the professionals.

01:28:50.680 --> 01:28:54.680
No, although everything is in a sterile
environment, we are never free

01:28:54.680 --> 01:28:58.680
from the possibility of some bacteria
being out there causing some

01:28:58.680 --> 01:29:02.040
harm to cancer patients, to transplant
patients who are going to undergo a

01:29:02.040 --> 01:29:03.720
transplant.

01:29:04.120 --> 01:29:08.560
Many of these chemotherapy treatments
produce immunosuppression.

01:29:08.560 --> 01:29:12.560
The immune system becomes weaker, and
these patients

01:29:12.560 --> 01:29:16.600
may be more susceptible to developing an
infection.

01:29:16.600 --> 01:29:19.680
An infection is valid, as are transplant
recipients.

01:29:19.960 --> 01:29:23.560
So, look at all these examples.

01:29:23.920 --> 01:29:28.960
Well, great discoveries or great advances
in modern medicine.

01:29:29.400 --> 01:29:33.400
If they couldn't be carried out, well,
we'd die very

01:29:33.400 --> 01:29:37.400
easily, right? And if we think about it
from a

01:29:37.400 --> 01:29:40.520
pharmacological point of view, why

01:29:40.520 --> 01:29:43.520
would we want to use antibiotic
treatment?

01:29:43.880 --> 01:29:46.960
We need to be clear about two very
important things.

01:29:47.120 --> 01:29:47.440
Okay?

01:29:47.440 --> 01:29:51.200
And this is already related to the
rational use of antibiotics,

01:29:51.200 --> 01:29:54.200
the good rational use of antibiotics.

01:29:54.960 --> 01:29:58.960
Well, to treat an infection, the
antibiotic has to reach an

01:29:58.960 --> 01:30:02.960
optimal concentration, usually higher
than the minimum

01:30:02.960 --> 01:30:06.960
inhibitory concentration, which is the
minimum concentration

01:30:06.960 --> 01:30:10.720
we need to stop the growth of bacteria at
the site of infection.

01:30:10.840 --> 01:30:13.840
So we need to think about where we have
that infection?

01:30:13.840 --> 01:30:15.320
Where is that focus?

01:30:15.320 --> 01:30:19.880
In urine, in the lungs, in the brain, in
bones, in blood.

01:30:20.320 --> 01:30:24.320
It's not the same as treating a urinary
tract infection where

01:30:24.320 --> 01:30:28.240
we might take some sachets of medicine
orally and have the solution in a matter

01:30:28.240 --> 01:30:30.200
of a day.

01:30:30.200 --> 01:30:32.560
The infection is very well controlled.

01:30:32.560 --> 01:30:35.960
Okay, the drug goes to the kidneys, is
eliminated through

01:30:35.960 --> 01:30:38.960
urine, and that's where it will have its
effect. Okay.

01:30:38.960 --> 01:30:42.400
That bactericidal effect is very easy to
achieve.

01:30:42.680 --> 01:30:45.560
Okay, in theory there are no resistances.

01:30:45.560 --> 01:30:49.760
On the other hand, an infection that is
in a bone is more complicated.

01:30:49.760 --> 01:30:53.760
These treatments are much longer-lasting,
with higher

01:30:53.760 --> 01:30:57.760
concentrations of antibiotics, because a
bone is quite

01:30:57.760 --> 01:31:01.600
hidden and the drug has to travel a long
way to reach that

01:31:01.600 --> 01:31:04.600
bone, to that focus of infection in that
bone.

01:31:05.000 --> 01:31:06.520
Okay. Good.

01:31:08.960 --> 01:31:12.960
Therefore, the effectiveness of
antibiotic

01:31:12.960 --> 01:31:16.960
treatment will always depend on the
concentration

01:31:16.960 --> 01:31:20.320
of the antibiotic and the treatment time.

01:31:20.760 --> 01:31:23.760
Okay. And the doctor knows this.

01:31:23.880 --> 01:31:27.880
The doctor knows how much to dose and for
how long, because

01:31:27.880 --> 01:31:32.000
that is already evidenced by the clinical
guidelines.

01:31:32.120 --> 01:31:34.680
Okay, we don't know.

01:31:34.680 --> 01:31:38.680
That's why we have to listen to what the
doctor tells us, that a treatment

01:31:38.680 --> 01:31:42.480
lasts seven days, because we shouldn't
interrupt it after three just because we

01:31:42.480 --> 01:31:44.400
feel better.

01:31:44.560 --> 01:31:47.960
Do we have to last those seven days

01:31:47.960 --> 01:31:50.960
and take it as specified, okay?

01:31:50.960 --> 01:31:54.480
The goal is not to kill bacteria with a
cannon.

01:31:54.480 --> 01:31:56.680
I'll take an antibiotic now and that'll
be it.

01:31:56.680 --> 01:32:00.680
There's no need to overthink it; we need
to expose

01:32:00.680 --> 01:32:04.680
those bacteria to the correct dose and
for the correct

01:32:04.680 --> 01:32:08.680
amount of time. Otherwise, we'll create
an environment

01:32:08.680 --> 01:32:12.680
rich in antibiotics at doses that are
therapeutic,

01:32:12.680 --> 01:32:16.680
doses that are not effective at a
therapeutic level.

01:32:16.680 --> 01:32:20.680
In that poor environment, what we'll do
is allow the

01:32:20.680 --> 01:32:24.680
bacteria to have free rein to transmit
genetic

01:32:24.680 --> 01:32:28.680
material, to mutate, to transfer
plasmids, and

01:32:28.680 --> 01:32:32.320
ultimately to become resistant.

01:32:32.360 --> 01:32:34.680
Okay, and we can't afford that kind of
environment.

01:32:34.680 --> 01:32:38.920
We cannot achieve that, we cannot give
bacteria that break.

01:32:39.800 --> 01:32:43.360
Okay, then the only way is to do it with
the

01:32:43.360 --> 01:32:46.360
correct doses and the correct time.

01:32:48.640 --> 01:32:52.240
Uh, sometimes the treatments.

01:32:52.240 --> 01:32:55.520
Well, the doctor doesn't have to know
them beforehand, not in very serious or

01:32:55.520 --> 01:32:57.200
unknown infections.

01:32:57.560 --> 01:33:01.560
Do we need to resort to further
antibiotic

01:33:01.560 --> 01:33:07.320
testing to see what that bacteria is
sensitive to or resistant to?

01:33:07.480 --> 01:33:11.040
In this box, I've included a urine sample

01:33:11.040 --> 01:33:14.040
that has been cultured. Right?

01:33:14.520 --> 01:33:18.520
Have different antibiotics been tested on
the mirabilis

01:33:18.520 --> 01:33:21.640
bacteria, and does this show what that

01:33:21.640 --> 01:33:24.640
bacteria is sensitive or resistant to?

01:33:24.720 --> 01:33:25.640
Okay, in this case.

01:33:25.640 --> 01:33:28.360
Well, we have that it's sensitive to it.
Isn't that right?

01:33:28.360 --> 01:33:30.200
No, if that's the case, then no.

01:33:30.200 --> 01:33:33.000
That would be the correct antibiotic.

01:33:33.000 --> 01:33:36.520
Okay, but as I was saying, this has to be
decided by the doctor.

01:33:36.520 --> 01:33:40.840
We cannot self-diagnose or self-medicate.

01:33:41.200 --> 01:33:41.480
Okay?

01:33:41.480 --> 01:33:45.480
Is it the doctor who has to give us all
this information,

01:33:45.480 --> 01:33:49.480
right? Regarding antibiotics, which are
essential medicines

01:33:49.480 --> 01:33:52.760
for humanity because they save lives,
right?

01:33:52.760 --> 01:33:56.760
The WHO has listed 41 of them, out of all
the

01:33:56.760 --> 01:34:02.160
hundreds of antibiotics that exist, as
essential antibiotics.

01:34:02.800 --> 01:34:04.120
Okay.

01:34:04.120 --> 01:34:07.560
And those essential antibiotics are in
turn classified using a traffic light

01:34:07.560 --> 01:34:09.320
system.

01:34:09.640 --> 01:34:14.440
Green light, yellow light, red light to
optimize its use.

01:34:14.920 --> 01:34:15.920
OK.

01:34:15.920 --> 01:34:19.800
So we have that, it's called the aware
system.

01:34:19.960 --> 01:34:23.960
Vale from English a of access or a of
watch of

01:34:23.960 --> 01:34:28.080
surveillance and reserve network or
reserve.

01:34:28.480 --> 01:34:29.280
Okay.

01:34:29.280 --> 01:34:33.280
Therefore, doctors have to optimize the
use of

01:34:33.280 --> 01:34:37.280
these drugs, so that the antibiotic drugs
that

01:34:37.280 --> 01:34:41.320
should be used most are those in the
green category.

01:34:41.600 --> 01:34:45.600
Okay, because they are very safe drugs,
with few adverse effects.

01:34:45.600 --> 01:34:49.600
They are very cheap, have a limited
spectrum of action, and are

01:34:49.600 --> 01:34:53.560
useful for treating the most common
infections in the population.

01:34:53.760 --> 01:34:59.680
Okay, so these are drugs that are used as
a first or second choice. Agreed.

01:34:59.680 --> 01:35:02.440
By the year 2030, the.

01:35:02.440 --> 01:35:06.440
The World Health Organization has set a

01:35:06.440 --> 01:35:10.440
challenge: 70% of the drugs used, of the

01:35:10.440 --> 01:35:14.120
antibiotics used, out of 100% of the
drugs

01:35:14.120 --> 01:35:17.120
used, 70% must be in this category.

01:35:17.120 --> 01:35:18.680
Oh, sorry, I've gone off on a tangent.

01:35:18.680 --> 01:35:20.880
They have to be in this green category.

01:35:20.880 --> 01:35:22.240
OK.

01:35:22.240 --> 01:35:26.240
Then we have those in the yellow group,
the yellow-orange

01:35:26.240 --> 01:35:30.240
traffic light, which are drugs,
antibiotics that are used in

01:35:30.240 --> 01:35:33.840
serious infections and are first or
second choice, but only in serious

01:35:33.840 --> 01:35:35.640
infections.

01:35:35.680 --> 01:35:38.200
They are worth certain things afterward,
such as a nosocomial infection, for

01:35:38.200 --> 01:35:39.480
example.

01:35:39.640 --> 01:35:40.720
Okay.

01:35:40.720 --> 01:35:44.160
Uh, its use generates a risk of
resistance, so its use must be

01:35:44.160 --> 01:35:45.880
restricted.

01:35:45.880 --> 01:35:49.240
It is only worth using in specific
situations

01:35:49.240 --> 01:35:52.240
where it is described as working.

01:35:52.240 --> 01:35:55.480
And then we have the banned antibiotics,
okay?

01:35:55.520 --> 01:35:59.520
Or those used as a last resort, the red
light

01:35:59.520 --> 01:36:03.520
antibiotics, which are reserved for
infections

01:36:03.520 --> 01:36:07.000
known to be caused by multi-resistant
bacteria.

01:36:07.000 --> 01:36:11.000
Severe nosocomial infections require ICU
medication, a

01:36:11.000 --> 01:36:15.400
valuable resource for intensive care
units for bacterial diseases.

01:36:15.400 --> 01:36:19.000
Above all, there are those that are
acquired at the hospital level and whose

01:36:19.000 --> 01:36:20.800
effectiveness must be preserved.

01:36:20.800 --> 01:36:26.120
They need to be managed very well to be
used only on those occasions.

01:36:26.320 --> 01:36:29.320
They are expensive drugs with more
adverse effects.

01:36:29.720 --> 01:36:33.840
It is already known that there is
bacterial resistance to these drugs.

01:36:33.840 --> 01:36:37.840
Therefore, we cannot afford to overuse
these drugs,

01:36:37.840 --> 01:36:41.840
because if tomorrow they cease to be
useful in these

01:36:41.840 --> 01:36:45.840
serious diseases that can already cause
the patient's

01:36:45.840 --> 01:36:49.400
death, then this problem would worsen.

01:36:50.760 --> 01:36:54.760
Well, within this color-coded traffic
light system, a study of the

01:36:54.760 --> 01:36:58.720
consumption of these drugs by these
categories has also been done.

01:36:58.720 --> 01:36:59.320
Okay?

01:36:59.320 --> 01:37:03.320
So, we're going to meet the challenge of

01:37:03.320 --> 01:37:06.760
having 70% of the antibiotics used

01:37:06.760 --> 01:37:09.760
in 2030 be in the green category.

01:37:10.240 --> 01:37:14.240
And we can see that at an international
level, well,

01:37:14.240 --> 01:37:19.960
we're there, we're not at 70% yet, but
we're getting there together.

01:37:20.400 --> 01:37:21.400
OK.

01:37:21.400 --> 01:37:24.720
But what about the map on the right, the
scheme on the right,

01:37:24.720 --> 01:37:27.720
which is consumption in our country, in
Spain?

01:37:28.000 --> 01:37:31.000
What do you think?

01:37:32.920 --> 01:37:33.960
Pretty bad, right?

01:37:33.960 --> 01:37:36.160
I would say very bad, very bad.

01:37:36.160 --> 01:37:38.720
We still have a lot to learn.

01:37:38.720 --> 01:37:39.520
OK.

01:37:39.520 --> 01:37:41.480
We've been getting by all these years.

01:37:41.480 --> 01:37:44.800
The one behind the antibiotics in the
yellow

01:37:44.800 --> 01:37:47.800
category, as you can see here. Okay.

01:37:47.920 --> 01:37:53.400
And those that are in the green category
have to reach 70% by 2030.

01:37:53.440 --> 01:37:57.440
So we have a long way to go to optimize
the use

01:37:57.440 --> 01:38:01.840
of these antibiotics and use them
correctly.

01:38:02.440 --> 01:38:03.600
Okay.

01:38:03.600 --> 01:38:06.160
So what messages are we going to take
home with us?

01:38:07.800 --> 01:38:11.800
Boys and girls, you can start telling
this to

01:38:11.800 --> 01:38:17.360
your family, your friends, everyone,
because this is the Bible.

01:38:17.560 --> 01:38:17.920
Okay.

01:38:17.920 --> 01:38:21.920
This must be strictly followed because we
are all

01:38:21.920 --> 01:38:25.560
responsible for the proper use of these
drugs.

01:38:25.960 --> 01:38:29.240
Well, they are only used for bacterial
infections.

01:38:29.400 --> 01:38:33.400
We've said it repeatedly, let's be clear:
having a fever,

01:38:33.400 --> 01:38:39.040
sore throat, pain, headache does not mean
we have a bacterial infection.

01:38:39.200 --> 01:38:39.640
OK.

01:38:39.640 --> 01:38:42.160
What if we take unnecessary medication?

01:38:42.160 --> 01:38:44.520
Well, these drugs also have adverse
effects.

01:38:44.520 --> 01:38:48.520
I don't have time to list them all, but
they alter the microbiota, produce

01:38:48.520 --> 01:38:51.760
allergies, and a lot of other effects
that are not so well known to the

01:38:51.760 --> 01:38:53.400
population.

01:38:53.400 --> 01:38:56.760
Because they exist, because all drugs
produce adverse

01:38:56.760 --> 01:38:59.760
effects and antibiotics are no exception.

01:39:00.760 --> 01:39:03.760
Well, they are only used under medical
prescription.

01:39:03.880 --> 01:39:08.440
Okay, this is very important because it's
about people self-diagnosing.

01:39:08.480 --> 01:39:12.840
He even goes to the doctor asking,
ordering, that he be given an antibiotic.

01:39:12.840 --> 01:39:13.360
Let's see.

01:39:13.360 --> 01:39:16.640
Well, it will have to be the doctor who
says if it's a bacterial

01:39:16.640 --> 01:39:19.640
infection and if an antibiotic will be
needed.

01:39:19.640 --> 01:39:21.960
No? Okay.

01:39:21.960 --> 01:39:24.200
The treatment must be followed correctly.

01:39:24.200 --> 01:39:26.840
By the way, antibiotics used to be easier
to get at the pharmacy without a

01:39:26.840 --> 01:39:28.200
prescription;

01:39:28.200 --> 01:39:32.120
now nobody will go to a pharmacy to buy
an antibiotic because if you don't have a

01:39:32.120 --> 01:39:34.120
prescription they won't sell it to you.

01:39:34.120 --> 01:39:36.400
Okay, it's always with a doctor's
prescription.

01:39:36.400 --> 01:39:39.360
The treatment, the dose, and the duration
must be followed correctly.

01:39:39.360 --> 01:39:42.200
Because of those principles we have seen
before, pharmacological, the form of

01:39:42.200 --> 01:39:43.640
administration.

01:39:43.640 --> 01:39:47.640
And this is important if the treatment is
three pills

01:39:47.640 --> 01:39:52.320
a day for seven days, because that dosage
must be followed.

01:39:52.760 --> 01:39:56.760
Okay, you have to follow the drug's
technical data sheet

01:39:56.760 --> 01:40:01.720
and take into account what time of day it
is taken and with what food.

01:40:01.720 --> 01:40:05.720
Some antibiotics can be taken with food,
others on an empty stomach, and others

01:40:05.720 --> 01:40:09.160
cannot be taken with dairy products
because they are inactivated.

01:40:09.520 --> 01:40:12.840
Okay, so there's a lot of fine print
behind it before

01:40:12.840 --> 01:40:15.840
we can carry out an effective treatment.

01:40:16.320 --> 01:40:17.120
OK.

01:40:17.120 --> 01:40:18.480
And what about adherence to treatment?

01:40:18.480 --> 01:40:20.000
Never interrupt treatment.

01:40:20.000 --> 01:40:24.000
It is true that after 24 hours following
antibiotic treatment, the

01:40:24.000 --> 01:40:27.160
patient feels much better, and the fever
disappears.

01:40:27.640 --> 01:40:30.320
Okay, the pain disappears.

01:40:30.320 --> 01:40:33.440
But that doesn't mean we've eradicated
the infection

01:40:33.440 --> 01:40:36.440
and that there aren't any bacteria out
there yet.

01:40:36.520 --> 01:40:37.600
OK.

01:40:37.600 --> 01:40:41.040
Clinical guidelines state that the
infection lasts for seven days.

01:40:41.320 --> 01:40:42.240
Well, it's seven days.

01:40:42.240 --> 01:40:43.560
They are not one or two.

01:40:43.560 --> 01:40:46.440
No matter how much I might feel improved.
Okay.

01:40:48.200 --> 01:40:50.920
And lastly, do not use leftover scraps.

01:40:50.920 --> 01:40:54.800
This has also been mentioned before: do
not self-medicate.

01:40:54.840 --> 01:40:58.520
In Spain, we tend to keep any leftover
medication in the medicine cabinet just

01:40:58.520 --> 01:41:00.360
in case.

01:41:00.360 --> 01:41:04.360
Well, in a month I'll have another
self-infection that I

01:41:04.360 --> 01:41:07.480
self-diagnose and go to the medicine
cabinet.

01:41:07.480 --> 01:41:09.880
I'm taking an antibiotic that will be
incomplete because it's made from

01:41:09.880 --> 01:41:11.120
leftovers.

01:41:11.680 --> 01:41:13.160
I'm not going to do anything with him.

01:41:13.160 --> 01:41:17.160
It will be completely inappropriate,
ineffective,

01:41:17.160 --> 01:41:22.600
and will encourage resistance or the
emergence of resistant bacteria.

01:41:22.720 --> 01:41:26.720
And in this sense, uh, this news that
came out last

01:41:26.720 --> 01:41:30.720
week and that Belén also mentioned
earlier, the

01:41:30.720 --> 01:41:34.720
Spanish Agency for Medicines has decided
to change

01:41:34.720 --> 01:41:38.240
the packaging of antibiotic medicines.

01:41:38.240 --> 01:41:39.240
Because?

01:41:39.240 --> 01:41:43.240
Because in the example I've given you
here, an infection is

01:41:43.240 --> 01:41:48.240
treated for seven days with three pills a
day, seven times three would be 21 pills.

01:41:48.280 --> 01:41:52.200
Okay, so the containers came with 30 or
40 pills, that's why we had some left

01:41:52.200 --> 01:41:54.200
over and kept them at home.

01:41:54.200 --> 01:41:58.200
Danger, danger, danger of abusing them in
the future. Now

01:41:58.200 --> 01:42:02.200
that clinical evidence has shown that the
durations of

01:42:02.200 --> 01:42:06.200
antibiotic treatments are being reviewed,
the packaging

01:42:06.200 --> 01:42:09.960
has been adjusted to the number of
tablets that are actually needed for that

01:42:09.960 --> 01:42:11.840
treatment.

01:42:11.960 --> 01:42:15.960
So, let me give you the example of
amoxicillin, which is the most commonly

01:42:15.960 --> 01:42:19.400
used antibiotic, which used to come in
packs of 30 and 40 tablets and now has

01:42:19.400 --> 01:42:21.160
been reduced to 20.

01:42:21.760 --> 01:42:25.760
Okay, so this new proposal that came out

01:42:25.760 --> 01:42:31.600
in the news last week, well, it is a good
solution, right?

01:42:31.760 --> 01:42:35.760
By at least reducing the misuse by taking
leftover

01:42:35.760 --> 01:42:40.080
medicines from the medicine cabinet and
self-medication.

01:42:40.480 --> 01:42:43.560
Okay, then let's hope it works.

01:42:44.080 --> 01:42:48.080
And to finish up, I'll end with Mr.
Fleming's

01:42:48.080 --> 01:42:52.080
prophecy, which he said in his Nobel
Prize

01:42:52.080 --> 01:42:56.160
speech and which was already known,
right?

01:42:56.640 --> 01:42:58.680
And he said it just like that, exactly as
he said it.

01:42:58.680 --> 01:43:02.520
The day will come when penicillin will be
available for purchase by anyone in

01:43:02.520 --> 01:43:04.440
stores and pharmacies.

01:43:04.840 --> 01:43:08.840
Then there will be the danger that an
ignorant man could

01:43:08.840 --> 01:43:12.840
easily take an insufficient dose and, by
exposing his

01:43:12.840 --> 01:43:16.840
microbes to non-lethal amounts of the
drug, make them

01:43:16.840 --> 01:43:20.840
resistant, because 80, 80 years later,
these words still

01:43:20.840 --> 01:43:26.560
resonate, Vale, in this world we have,
threatened by these resistant bacteria.

01:43:27.280 --> 01:43:28.800
And that's all.

01:43:28.800 --> 01:43:31.800
Thank you so much.

01:43:37.080 --> 01:43:41.080
Uh. Next up, Alejandro K12, senior
scientist at the

01:43:41.080 --> 01:43:44.800
National Center for Biotechnology of the
CSIC.

01:43:45.640 --> 01:43:49.640
Uh. His work focuses on bacterial
evolution and the mechanisms

01:43:49.640 --> 01:43:54.040
that allow microorganisms to develop
resistance to antibiotics.

01:43:54.640 --> 01:43:58.040
EH has published in high-impact
scientific journals

01:43:58.040 --> 01:44:01.040
and has participated in international
projects.

01:44:01.440 --> 01:44:06.040
They are investigating how to stop the
emergence of these resistances.

01:44:06.440 --> 01:44:10.440
His approach combines evolutionary
biology and experimental

01:44:10.440 --> 01:44:14.000
microbiology, providing an innovative
perspective

01:44:14.000 --> 01:44:17.000
for understanding this phenomenon.

01:44:17.720 --> 01:44:21.160
Today he will share with us some of his
most recent

01:44:21.160 --> 01:44:24.160
advances from cutting-edge research.

01:44:35.240 --> 01:44:36.440
Good morning.

01:44:36.440 --> 01:44:39.200
Thank you so much for having me here.

01:44:39.200 --> 01:44:42.240
The truth is, uh, the task we've

01:44:42.240 --> 01:44:45.240
been given is a bit of a nightmare.

01:44:45.240 --> 01:44:49.240
I'm going to admit it because they told
me I'm going to give an

01:44:49.240 --> 01:44:53.120
informative talk about my work, but one
that's also informative, about antibiotic

01:44:53.120 --> 01:44:55.080
resistance.

01:44:55.080 --> 01:44:57.720
And well, I'm letting you know that there
will be high school students, there will

01:44:57.720 --> 01:44:59.080
be

01:44:59.080 --> 01:45:02.120
undergraduate students, there may be some
PhDs, so it's like, excuse me, uh, what

01:45:02.120 --> 01:45:03.640
am I basing this on?

01:45:03.640 --> 01:45:06.040
So I want to start with a survey here.

01:45:06.040 --> 01:45:07.080
Okay.

01:45:07.080 --> 01:45:08.880
Uh. Could you raise your hand?

01:45:08.880 --> 01:45:11.880
Those of you who haven't finished high
school?

01:45:12.960 --> 01:45:16.160
This entire block here. Everyone.

01:45:16.160 --> 01:45:19.160
I'm a high school student, but this is
the front row.

01:45:19.560 --> 01:45:21.400
And what do you know about the last year?

01:45:21.400 --> 01:45:24.400
Latest?

01:45:24.480 --> 01:45:25.520
Okay.

01:45:25.520 --> 01:45:27.560
Okay. And you're studying science?

01:45:27.560 --> 01:45:29.120
Are there any who don't go into science?

01:45:32.120 --> 01:45:32.880
Can you raise your hand?

01:45:32.880 --> 01:45:35.880
The one who doesn't go into science.

01:45:36.040 --> 01:45:39.040
More presences outside of outside.

01:45:40.440 --> 01:45:40.720
Okay.

01:45:40.720 --> 01:45:42.760
No no.

01:45:42.760 --> 01:45:45.200
So now I'm coming back to you.

01:45:45.200 --> 01:45:46.760
Now? Well, with us.

01:45:46.760 --> 01:45:49.040
Here are the people who understand that
they finished high school.

01:45:49.040 --> 01:45:50.480
And here we have it. We have it.

01:45:50.480 --> 01:45:52.880
How many people are doing the degree?

01:45:52.880 --> 01:45:56.560
He doesn't have the pre-degree yet. Okay.

01:45:56.560 --> 01:45:59.240
All science degrees. I imagine.

01:45:59.240 --> 01:46:00.160
Okay, then the rest.

01:46:00.160 --> 01:46:04.080
I imagine they're people working on their
theses. Or higher.

01:46:04.080 --> 01:46:04.960
No no.

01:46:04.960 --> 01:46:08.960
Are there any people here who don't work

01:46:08.960 --> 01:46:12.000
professionally in science but

01:46:12.000 --> 01:46:15.000
already have a degree or work in
education?

01:46:15.000 --> 01:46:18.000
What do you do?

01:46:18.080 --> 01:46:21.080
What do you do for a living?

01:46:21.280 --> 01:46:22.880
English?

01:46:22.880 --> 01:46:25.480
Well, don't worry because he has some
things in English in the talk.

01:46:25.480 --> 01:46:27.240
Okay. So, this is for everyone.

01:46:29.280 --> 01:46:29.840
So be it.

01:46:29.840 --> 01:46:32.840
You're a mixed bag. Okay. Fine, let's go.
Good.

01:46:32.960 --> 01:46:35.960
I'm going back to hang out with the
people from high school.

01:46:36.400 --> 01:46:39.160
Do you know what a Codon is?

01:46:39.160 --> 01:46:41.200
What is a codon?

01:46:41.200 --> 01:46:44.200
Let him dare to tell me.

01:46:45.680 --> 01:46:46.120
Someone.

01:46:46.120 --> 01:46:49.040
Anyone up for it?

01:46:49.040 --> 01:46:52.040
What a load of crap it's made of.

01:46:52.960 --> 01:46:53.400
There's one.

01:46:53.400 --> 01:46:56.200
He's gesturing. You make the gesture.
That's it.

01:46:56.200 --> 01:46:59.480
This is a codon that contains DNA
letters. No.

01:47:00.440 --> 01:47:02.720
How many letters?

01:47:02.720 --> 01:47:04.800
And what's the point of that? What
information does it provide?

01:47:04.800 --> 01:47:07.800
What training does it contain?

01:47:09.480 --> 01:47:10.200
An amino acid.

01:47:10.200 --> 01:47:12.160
Okay. Each codon gives you one amino
acid. Good.

01:47:12.160 --> 01:47:13.520
Very well. Okay.

01:47:13.520 --> 01:47:15.800
I have more questions for you.

01:47:15.800 --> 01:47:17.360
Do you know what an active center is?

01:47:17.360 --> 01:47:19.480
Area of ​​any active center?

01:47:19.480 --> 01:47:20.600
A biological context.

01:47:20.600 --> 01:47:22.440
I'm not talking about a bank branch.

01:47:22.440 --> 01:47:25.440
An active center of something.

01:47:25.680 --> 01:47:27.600
An enzyme.

01:47:27.600 --> 01:47:30.920
Here it is. It describes how an enzyme's
active site plan

01:47:30.920 --> 01:47:33.920
works, what happens in the active site of
an enzyme.

01:47:35.200 --> 01:47:35.840
Is there any activity?

01:47:35.840 --> 01:47:37.040
Is there some kind of magic involved?

01:47:37.040 --> 01:47:39.080
Is something happening in the active site
of an enzyme?

01:47:39.080 --> 01:47:39.760
You can tell me.

01:47:39.760 --> 01:47:41.600
We don't know what it is. They haven't
explained it to us.

01:47:41.600 --> 01:47:42.480
It's one.

01:47:42.480 --> 01:47:45.480
Have you never heard about incentives?

01:47:46.320 --> 01:47:47.600
They consult with the person next to
them.

01:47:47.600 --> 01:47:49.800
Well, it's active. The magic isn't
happening.

01:47:49.800 --> 01:47:50.040
Okay.

01:47:50.040 --> 01:47:53.840
This happens to the catalysis of enzymes
that eat antibiotics.

01:47:54.240 --> 01:47:57.280
The chemical reaction that destroys or
neutralizes the antibiotic.

01:47:57.280 --> 01:47:58.280
Okay.

01:47:58.280 --> 01:47:58.520
Okay.

01:47:58.520 --> 01:48:01.480
Okay, I'll get started then.

01:48:01.480 --> 01:48:04.480
Hey. Could you dim this light here a
little?

01:48:05.000 --> 01:48:08.000
Let's see.

01:48:08.960 --> 01:48:11.960
No. How do I turn this off?

01:48:14.360 --> 01:48:14.680
For someone else.

01:48:14.680 --> 01:48:17.680
This is what the screens say, but I'll be
here pointing.

01:48:20.520 --> 01:48:23.240
I have two more questions before we
begin.

01:48:23.240 --> 01:48:26.240
No, what I really want is for her to know
why I'm going to be pointing there.

01:48:26.800 --> 01:48:27.560
This cannot be done. No.

01:48:33.320 --> 01:48:34.000
Okay, no problem.

01:48:34.000 --> 01:48:35.640
It's okay. Okay.

01:48:35.640 --> 01:48:37.760
I have more questions here.

01:48:37.760 --> 01:48:39.320
Do you know who this man is?

01:48:39.320 --> 01:48:42.320
Well, a random guy.

01:48:42.920 --> 01:48:44.920
Who?

01:48:44.920 --> 01:48:46.400
Laplace?

01:48:46.400 --> 01:48:47.520
Well no.

01:48:47.520 --> 01:48:49.560
Well, he's finishing high school.

01:48:49.560 --> 01:48:52.080
Who is this man?

01:48:52.080 --> 01:48:55.080
Do you recognize yourself?

01:48:55.400 --> 01:48:58.400
It's Darwin.

01:48:58.400 --> 01:48:59.040
It's Darwin.

01:48:59.040 --> 01:49:00.960
Okay.

01:49:00.960 --> 01:49:03.560
Do you know what Darwin did?

01:49:03.560 --> 01:49:05.720
It halts evolution. Okay.

01:49:05.720 --> 01:49:06.000
Okay.

01:49:06.000 --> 01:49:09.000
So the other question I had is whether
you know who Laplace is.

01:49:09.080 --> 01:49:11.680
Do you know who Laplace was?

01:49:11.680 --> 01:49:12.680
Mathematicians and physicists.

01:49:12.680 --> 01:49:13.720
Okay.

01:49:13.720 --> 01:49:16.720
Okay, then, let's go.

01:49:16.880 --> 01:49:19.160
Uh, this won't work.

01:49:19.160 --> 01:49:22.160
This isn't going to work.

01:49:22.720 --> 01:49:23.840
The date down.

01:49:23.840 --> 01:49:25.960
Perfect. Okay.

01:49:25.960 --> 01:49:29.400
Here we have Mr. Alexander Fleming, who
has come up in practically every talk. Or

01:49:29.400 --> 01:49:31.120
so it seems to me.

01:49:31.120 --> 01:49:32.600
Uh, it's just that... One.

01:49:32.600 --> 01:49:34.200
Penicillin. Okay.

01:49:34.200 --> 01:49:38.200
Well, I'm going to tell you my story
because it turns out that this

01:49:38.200 --> 01:49:42.200
gentleman discovered penicillin at St.
Mary's Hospital in London,

01:49:42.200 --> 01:49:45.800
which belongs to Imperial College, the
Imperial College of London, where I was a

01:49:45.800 --> 01:49:47.600
professor.

01:49:47.600 --> 01:49:51.640
So I've had to tell this story several
times and I'm going to tell it again.

01:49:51.640 --> 01:49:55.160
So if you can take a stroll around there,
around Kensington, you'll see this

01:49:55.160 --> 01:49:56.960
plaque.

01:49:56.960 --> 01:49:58.640
Oh, sorry, I'm getting carried away.

01:49:58.640 --> 01:50:02.240
It is said that Mr. Alexander Fleming
discovered

01:50:02.240 --> 01:50:05.240
penicillin on the second floor of this
building.

01:50:05.240 --> 01:50:06.080
Okay.

01:50:06.080 --> 01:50:10.440
And the story has been told a thousand
times and it is always described as luck.

01:50:10.440 --> 01:50:13.040
What a stroke of luck this man had
because he found penicillin.

01:50:13.040 --> 01:50:15.560
This. Watch out, this. Watch out, very
careful.

01:50:15.560 --> 01:50:17.080
Okay, that's not how it is.

01:50:17.080 --> 01:50:19.200
This story has been told many times.

01:50:19.200 --> 01:50:23.200
It's true he was very lucky, but let's
see, because we have to be careful

01:50:23.200 --> 01:50:26.680
and I say this from experience, because
when I first heard this

01:50:26.680 --> 01:50:29.680
story, the normal version, Fleming was so
lucky!

01:50:29.680 --> 01:50:33.120
The first thing I did was call my mother
and say, "Hey, this is going to be a

01:50:33.120 --> 01:50:34.840
disaster."

01:50:34.840 --> 01:50:36.800
Thanks to that, he found penicillin
yesterday.

01:50:36.800 --> 01:50:37.960
A Nobel Prize.

01:50:37.960 --> 01:50:40.240
You've always told me I'm a disaster.

01:50:40.240 --> 01:50:41.880
I think it's very good.

01:50:41.880 --> 01:50:43.280
But it's not that simple.

01:50:43.280 --> 01:50:45.160
Okay, it's not that simple.

01:50:45.160 --> 01:50:45.800
Let's take it one step at a time.

01:50:45.800 --> 01:50:47.120
First of all, he was lucky.

01:50:47.120 --> 01:50:49.760
He was very lucky. Why?

01:50:49.760 --> 01:50:52.760
Why has it been told here as well?

01:50:52.800 --> 01:50:53.440
It has also been mentioned.

01:50:53.440 --> 01:50:59.280
Here is the famous plaque where, well, a
fungus was found.

01:50:59.280 --> 01:51:02.840
How come your tomatoes grow when you
leave them open?

01:51:03.560 --> 01:51:06.200
It turns out I had put a bacterium here.

01:51:06.200 --> 01:51:09.200
And here is a ring they called The Ring
of Death.

01:51:09.200 --> 01:51:11.240
Ring of death? Because no bacteria grow
here.

01:51:11.240 --> 01:51:12.200
Therefore.

01:51:12.200 --> 01:51:14.680
In conclusion, the fungus is producing
something that kills the bacteria.

01:51:16.040 --> 01:51:17.040
Okay, because he was lucky.

01:51:17.040 --> 01:51:19.720
First, because it's a bit of a mess, not
because the lab is full of plates, but

01:51:19.720 --> 01:51:21.080
because you shouldn't throw them away.

01:51:21.080 --> 01:51:24.760
This plaque, by the way, I suppose this
is not the original plaque, not the ship

01:51:24.760 --> 01:51:26.600
in general, it was the isolated colonies.

01:51:26.600 --> 01:51:27.240
And this is one.

01:51:27.240 --> 01:51:30.640
This is a plate to make it look like
almost a month ago.

01:51:30.640 --> 01:51:33.360
The plate in the lab is growing. Okay.

01:51:33.360 --> 01:51:36.360
Uh, it was about to be thrown away when a
visitor

01:51:36.360 --> 01:51:39.360
came to the lab and asked what she was
doing.

01:51:39.520 --> 01:51:42.480
And the man kept picking up plate after
plate until he picked up this one and

01:51:42.480 --> 01:51:45.440
said, "Well, look, the pollution has
grown here."

01:51:45.440 --> 01:51:49.880
What is that? It's a fungus, damn it, see
if there's a ring of death here.

01:51:49.880 --> 01:51:51.320
They're not growing. What's going on
here?

01:51:51.320 --> 01:51:53.240
In other words, he was lucky to have
gotten that exact license plate.

01:51:53.240 --> 01:51:54.240
She's showing it to someone.

01:51:55.360 --> 01:51:59.360
In addition, the plate where I had
bacteria contained almost a

01:51:59.360 --> 01:52:03.800
bacterium called Staphylococcus, which
grows much faster than the fungus.

01:52:03.800 --> 01:52:06.040
Okay, this is a story that isn't often
told.

01:52:06.040 --> 01:52:08.800
How could the fungus have been growing
there?

01:52:08.800 --> 01:52:11.520
When the bacteria grow much more, the
bacteria should have grown and not given

01:52:11.520 --> 01:52:12.920
rise to it.

01:52:12.920 --> 01:52:16.920
Well, it turns out that, uh, this plaque
was growing

01:52:16.920 --> 01:52:20.920
in the laboratory when there was a cold
wave in London.

01:52:20.920 --> 01:52:24.920
So the cold favors the growth of the
fungus, and therefore

01:52:24.920 --> 01:52:28.920
this fungus was happily growing there and
was ready to be seen.

01:52:28.920 --> 01:52:31.000
Okay, okay.

01:52:31.000 --> 01:52:31.640
He was lucky.

01:52:31.640 --> 01:52:32.960
But the.

01:52:32.960 --> 01:52:38.720
The moral of this story is that being a
disaster, being lucky, isn't enough. No.

01:52:38.720 --> 01:52:42.480
And for this I always like to remember
Mr. Louis Pasteur.

01:52:42.480 --> 01:52:43.440
Do you know who Pasteur was?

01:52:46.760 --> 01:52:47.760
Another great microbiologist.

01:52:47.760 --> 01:52:50.720
Are you familiar with pasteurized milk?

01:52:50.720 --> 01:52:52.880
Are you familiar with vaccines?

01:52:52.880 --> 01:52:54.920
This is the man who did all those things.

01:52:54.920 --> 01:52:55.920
Okay.

01:52:55.920 --> 01:52:59.600
And Pasteur had this rather spastic motto
that

01:52:59.600 --> 01:53:02.600
says, "Fortune favors the prepared mind."

01:53:02.600 --> 01:53:05.560
English teachers. Am I translating this
correctly?

01:53:05.560 --> 01:53:07.040
Yes, perfectly.

01:53:07.040 --> 01:53:08.920
So this is key. Okay.

01:53:08.920 --> 01:53:10.400
Being lucky isn't enough.

01:53:10.400 --> 01:53:14.000
You have to be mentally prepared and then
be willing to put your

01:53:14.000 --> 01:53:17.000
heart and soul into things and make them
happen.

01:53:17.000 --> 01:53:18.080
Okay.

01:53:18.080 --> 01:53:21.080
We get a Nobel Prize just for being a
little sloppy at home.

01:53:21.160 --> 01:53:23.000
OK.

01:53:23.000 --> 01:53:23.240
Okay.

01:53:23.240 --> 01:53:25.520
We continue.

01:53:25.520 --> 01:53:26.480
It was already mentioned here as well.

01:53:26.480 --> 01:53:30.480
But indeed, when antibiotics were
discovered, they were a miracle

01:53:30.480 --> 01:53:34.080
medicine, because suddenly a lot of
infections that made

01:53:34.080 --> 01:53:37.080
people's lives very miserable could be
treated.

01:53:37.480 --> 01:53:41.040
This is a poster that you will see in
many talks of this style where they

01:53:41.040 --> 01:53:44.040
advertised on the street: Hey, we have a
cure for gonorrhea.

01:53:44.600 --> 01:53:48.600
Gonorrhea, as you know, is a sexually
transmitted disease that, if left

01:53:48.600 --> 01:53:52.080
untreated, can spread to the rest of the
body and make life very, very miserable.

01:53:52.080 --> 01:53:53.840
For people.

01:53:55.240 --> 01:53:56.560
What's happening?

01:53:56.560 --> 01:53:58.400
Why are we here today?

01:53:58.400 --> 01:54:02.400
Well, shortly after penicillin began to
be

01:54:02.400 --> 01:54:06.520
administered, the first reports of
resistance appeared.

01:54:06.680 --> 01:54:08.560
A few years later. Okay.

01:54:08.560 --> 01:54:11.800
But it's okay, because we have a lot of
people looking for antibiotics right now.

01:54:11.840 --> 01:54:14.840
Okay, let's find another antibiotic.
Okay.

01:54:14.880 --> 01:54:19.240
A few years later, their meals appeared,
which we then marketed.

01:54:19.240 --> 01:54:22.280
There were some really cute little
bandages for.

01:54:22.280 --> 01:54:23.240
Thank you.

01:54:23.240 --> 01:54:26.640
A wound or to treat the infection in just

01:54:26.640 --> 01:54:29.640
a few years. Resistance appears.

01:54:29.640 --> 01:54:31.240
Well, don't panic.

01:54:31.240 --> 01:54:33.680
We're going to continue investigating.
Looking for antibiotics.

01:54:33.680 --> 01:54:35.480
Tetracycline appears.

01:54:35.480 --> 01:54:37.520
It works very well.

01:54:37.520 --> 01:54:40.600
A few years later, just a few weeks
later, resistance appears.

01:54:41.240 --> 01:54:44.240
Well, I think you've got the hang of it.

01:54:44.600 --> 01:54:48.720
Basically, that's happened with every
antibiotic we've launched. Right?

01:54:49.200 --> 01:54:51.960
In other words, there are no antibiotics
where you can say it's guaranteed that

01:54:51.960 --> 01:54:53.360
there won't be resistance.

01:54:53.360 --> 01:54:55.960
This is a losing battle.

01:54:55.960 --> 01:54:59.800
There may be different opinions, but it's
a battle that is truly won simply by

01:54:59.800 --> 01:55:01.760
bringing out new antibiotics.

01:55:01.760 --> 01:55:03.600
This is throwing money away.

01:55:03.600 --> 01:55:08.840
And this is why people who have money
don't want to throw it away.

01:55:09.920 --> 01:55:15.440
He is escaping from it, which would be
the company of Discovering Antibiotics.

01:55:15.440 --> 01:55:20.520
Here I am showing you the number of
approved antibiotics (Blue Line).

01:55:20.840 --> 01:55:24.240
This would be the time from the 1980s to
2010.

01:55:24.680 --> 01:55:27.720
And this blue line is the number of
antibiotics that have been approved for

01:55:27.720 --> 01:55:29.240
use.

01:55:29.240 --> 01:55:30.880
The line is going down.

01:55:30.880 --> 01:55:32.400
What does that mean?

01:55:32.400 --> 01:55:35.400
Sometimes fewer antibiotics are being
withdrawn.

01:55:35.520 --> 01:55:36.920
And then here they are telling us.

01:55:36.920 --> 01:55:40.920
In 1990 there were 18 companies with
active

01:55:40.920 --> 01:55:45.320
research programs in the development of
new drugs.

01:55:46.160 --> 01:55:49.160
In 2010 there were only four.

01:55:49.480 --> 01:55:50.520
They're escaping, they say.

01:55:50.520 --> 01:55:53.440
It's not worth it for me to invest a lot
of money, develop a new compound, only to

01:55:53.440 --> 01:55:56.360
have antibiotics appear immediately
afterward.

01:55:56.360 --> 01:55:58.080
I'm going to dedicate myself to what
brings in the most money, like the Tempi

01:55:58.080 --> 01:55:58.960
for example.

01:55:58.960 --> 01:56:01.560
Or you know, it reduces obesity.

01:56:04.600 --> 01:56:09.920
Okay, so now I'll introduce myself, uh, I
work at the CSIC.

01:56:10.040 --> 01:56:13.040
That is the Higher Council for Scientific
Research.

01:56:13.600 --> 01:56:17.600
So, I work in evolutionary biology with
microorganisms, okay?

01:56:17.600 --> 01:56:21.360
And one of the things we do in the lab
has to do with antibiotics.

01:56:21.360 --> 01:56:26.840
But I would never risk trusting a great
authority on the subject of antibiotics.

01:56:26.840 --> 01:56:30.840
I simply use this model because it is
very useful, because

01:56:30.840 --> 01:56:34.840
it is very necessary, and also because,
for the things I do,

01:56:34.840 --> 01:56:38.680
I also take advantage of all the
knowledge that other people have

01:56:38.680 --> 01:56:40.640
developed over time.

01:56:40.840 --> 01:56:44.840
So, this is a bit of a new concept that
I'm putting here again. This

01:56:44.840 --> 01:56:49.040
gentleman here isn't Laplace, this
gentleman is Darwin, okay?

01:56:49.760 --> 01:56:53.760
The father of the theory of evolution is
trying to recruit

01:56:53.760 --> 01:56:57.800
people into his army to adopt an
evolutionary view.

01:56:57.800 --> 01:57:01.200
Say, "Hey, the problem of antibiotic
resistance is something that just happens

01:57:01.200 --> 01:57:02.920
out of nowhere."

01:57:02.920 --> 01:57:06.320
It's not evolution in action.

01:57:06.640 --> 01:57:07.400
Okay?

01:57:07.400 --> 01:57:11.200
It's the survival of the fittest in
action.

01:57:11.240 --> 01:57:15.000
Okay, it's the giraffes whose necks grow
because they're the ones eating the

01:57:15.000 --> 01:57:16.880
leaves at the top the best.

01:57:16.880 --> 01:57:19.360
It happens that here, instead of being
the one who eats the top leaves best,

01:57:19.360 --> 01:57:21.880
it's the one who isn't killed by the
antibiotic.

01:57:25.040 --> 01:57:28.040
Let's go.

01:57:29.680 --> 01:57:31.400
Someone might say, "But this is the
moment."

01:57:31.400 --> 01:57:33.640
This sounds familiar to me, that
evolution was something very slow and

01:57:33.640 --> 01:57:34.800
gradual.

01:57:34.800 --> 01:57:37.120
The word gradual is closely associated
with evolution.

01:57:37.120 --> 01:57:37.840
Because?

01:57:37.840 --> 01:57:41.840
Originally, when Darwin wrote his great
treatise, based on

01:57:41.840 --> 01:57:45.840
his observations, he had this idea that
came from geology

01:57:45.840 --> 01:57:50.360
that, well, all processes take millions
of years and are very slow.

01:57:50.560 --> 01:57:50.920
Because?

01:57:50.920 --> 01:57:56.040
Well, he did quite well, discovering the
theory of evolution back then. Okay.

01:57:56.040 --> 01:58:00.040
So, uh, yes, indeed, if you think about
dinosaurs, extinctions,

01:58:00.040 --> 01:58:04.040
trilobites, these things, it seems like
things happen on

01:58:04.040 --> 01:58:08.040
enormous timescales, but no, indeed, we
know that evolution

01:58:08.040 --> 01:58:11.600
can happen very quickly, especially in
microbes,

01:58:11.600 --> 01:58:14.600
viruses, bacteria, and fungi, right?

01:58:14.720 --> 01:58:18.560
We're talking mostly about bacteria here,
but they pass by very quickly.

01:58:19.800 --> 01:58:20.200
Because?

01:58:20.200 --> 01:58:21.040
Do they have anything special?

01:58:21.040 --> 01:58:24.440
Well, they have some tricks up their
sleeves, but elephants

01:58:24.440 --> 01:58:27.440
and people do many of the things they do
too, right?

01:58:27.440 --> 01:58:30.400
For example, spontaneous mutation.

01:58:30.400 --> 01:58:31.760
This is simply a.

01:58:31.760 --> 01:58:33.800
It is an inevitable product of physics
and chemistry.

01:58:33.800 --> 01:58:37.800
Every time the 4 million letters that
make up the genome of

01:58:37.800 --> 01:58:41.160
a bacterium need to be copied, it has to
be done.

01:58:41.160 --> 01:58:42.760
That in less than 30 minutes.

01:58:42.760 --> 01:58:45.600
Imagine what... let's see if I remember.

01:58:45.600 --> 01:58:50.240
The analogy seems to me like copying the
Bible 30 times in less than half an hour.

01:58:50.240 --> 01:58:53.240
Imagine doing that by hand, you're going
to make mistakes, right?

01:58:53.960 --> 01:58:57.960
Furthermore, it's not just errors in the
replication

01:58:57.960 --> 01:59:02.520
machinery; there are a lot of endogenous
and exogenous mutagen sources.

01:59:02.520 --> 01:59:06.480
They're just words, so they seem very
scientific, but it's to say, internal

01:59:06.480 --> 01:59:08.480
sources.

01:59:09.080 --> 01:59:13.080
When you are metabolizing glucose, the
presence of

01:59:13.080 --> 01:59:17.080
oxygen produces oxygen free radicals that
are more

01:59:17.080 --> 01:59:21.080
generic and break DNA and exogenous
sources, that is,

01:59:21.080 --> 01:59:25.080
they come from the external environment,
which can

01:59:25.080 --> 01:59:28.880
be radiation from nuclear bombs, but also
alcohol.

01:59:28.880 --> 01:59:32.720
For example, when alcohol is metabolized
in the body it produces aldehyde, which

01:59:32.720 --> 01:59:34.640
is also a gene.

01:59:34.760 --> 01:59:35.960
So it's inevitable.

01:59:35.960 --> 01:59:38.480
We cannot live without mutation.

01:59:38.480 --> 01:59:42.480
Then bacteria have a very interesting
little trick that I thought Jerónimo

01:59:42.480 --> 01:59:45.920
was going to talk about in a little more
detail, but it is that they are able to

01:59:45.920 --> 01:59:47.640
exchange genes.

01:59:47.640 --> 01:59:50.600
Basically, here we see this blue bacteria
giving a little gift to the green

01:59:50.600 --> 01:59:52.080
bacteria.

01:59:52.080 --> 01:59:56.160
The green bacteria stares at it, eats it,
and turns into blue bacteria.

01:59:56.240 --> 01:59:59.160
It is becoming, it is acquiring that
property. That phenotypic trait may be an

01:59:59.160 --> 02:00:02.080
antibiotic prescription, it may be
something else.

02:00:02.480 --> 02:00:06.080
Thanks to a neighbor, an English teacher,
who

02:00:06.080 --> 02:00:09.080
passed on a gene, a package of genes.

02:00:09.080 --> 02:00:12.080
This is for you. Thank you. You're a
sweetheart.

02:00:12.760 --> 02:00:14.840
I feel very strong now. Good.

02:00:14.840 --> 02:00:16.160
More or less.

02:00:16.160 --> 02:00:19.160
Yes. Okay.

02:00:19.280 --> 02:00:19.640
Very good.

02:00:19.640 --> 02:00:21.280
This is called horizontal gene transfer.

02:00:21.280 --> 02:00:22.120
And that's a problem.

02:00:22.120 --> 02:00:25.120
Okay.

02:00:25.960 --> 02:00:28.160
Okay, the mechanics are very simple.

02:00:28.160 --> 02:00:29.720
Pure Darwin.

02:00:29.720 --> 02:00:32.720
Okay, you have a very large population of
bacteria.

02:00:33.200 --> 02:00:35.600
That's an advantage that bacteria have.

02:00:35.600 --> 02:00:38.720
In a single droplet you can have millions
of bacteria, millions of cells.

02:00:39.080 --> 02:00:42.160
Therefore, the probability that someone
made the

02:00:42.160 --> 02:00:45.160
lucky mistake... We're back to the
element of luck.

02:00:45.160 --> 02:00:49.160
That error that changes precisely that
amino acid in the active site of

02:00:49.160 --> 02:00:52.640
that enzyme that is going to give you
resistance, well, the

02:00:52.640 --> 02:00:55.640
probability is much higher when you have
10 million cells.

02:00:56.600 --> 02:00:59.760
So here I am putting the resistant
bacteria, the one with the happy

02:00:59.760 --> 02:01:01.360
mutation.

02:01:01.360 --> 02:01:04.080
It is a large population, a vast ocean of
cells that are sensitive to the

02:01:04.080 --> 02:01:05.440
antibiotic.

02:01:06.240 --> 02:01:06.920
What happens now?

02:01:08.440 --> 02:01:12.440
The antibiotic arrives, kills everyone,
and the

02:01:12.440 --> 02:01:17.480
resistant bacteria remains, which now has
it all the time.

02:01:17.480 --> 02:01:19.040
Space and resources.

02:01:19.040 --> 02:01:22.040
Food spreads very quickly. Okay.

02:01:22.520 --> 02:01:26.520
This is a detail that is sometimes
overlooked when one thinks about

02:01:26.520 --> 02:01:29.840
how long it has taken whales to evolve
from an ancestor that resembled a

02:01:29.840 --> 02:01:31.520
hippopotamus.

02:01:32.440 --> 02:01:35.440
What he's not thinking about is what we
call selection pressure, selection

02:01:35.440 --> 02:01:36.960
pressure.

02:01:36.960 --> 02:01:40.400
Let's see if I can spend more time in the
water, because there are little fish

02:01:40.400 --> 02:01:42.120
here, nothing to eat me.

02:01:42.120 --> 02:01:46.120
Well, that's an advantage you can take,
but the selection pressure

02:01:46.120 --> 02:01:50.720
of 'oh my god, they're going to kill me,
I'm going to die' is much stronger.

02:01:50.720 --> 02:01:52.040
And what does that mean?

02:01:52.040 --> 02:01:56.160
If I get the beneficial mutation, I'll
have no competition.

02:01:56.680 --> 02:01:58.400
Then I can expand a lot.

02:01:58.400 --> 02:02:01.560
So each evolutionary step happens much
faster.

02:02:02.040 --> 02:02:06.040
And this is why bacteria that are
ingenious at producing mutations,

02:02:06.040 --> 02:02:10.040
sharing them among themselves when we
give them antibiotics,

02:02:10.040 --> 02:02:13.200
are also able to adapt and evolve very
quickly.

02:02:15.800 --> 02:02:16.520
Okay.

02:02:16.520 --> 02:02:20.520
In my laboratory, what we do is study
these processes in real time,

02:02:20.520 --> 02:02:24.520
we do experiments, a discipline known as
experimental evolution,

02:02:24.520 --> 02:02:28.520
and basically we make units of bacteria
and see them under a

02:02:28.520 --> 02:02:32.520
microscope, we study them with different
techniques, we look at

02:02:32.520 --> 02:02:36.520
their genome, we see what tools, what
mechanisms they have followed

02:02:36.520 --> 02:02:40.960
to be able to solve the adaptive problem
that we propose to them.

02:02:40.960 --> 02:02:43.960
In many cases, antibiotics.

02:02:44.480 --> 02:02:48.480
Well, I'm going to tell you a story about
a colleague from

02:02:48.480 --> 02:02:53.720
Harvard University named Michael Bain,
who did something fantastic.

02:02:53.840 --> 02:02:55.880
You don't know what a Petri dish is, do
you?

02:02:55.880 --> 02:02:57.120
Does that ring a bell?

02:02:57.120 --> 02:03:00.120
Where?

02:03:00.640 --> 02:03:04.160
Where did Fleming find the fungus that
was growing? No.

02:03:04.720 --> 02:03:07.680
Well, Mr. Michael and...

02:03:07.680 --> 02:03:09.040
And the head of the laboratory.

02:03:09.040 --> 02:03:12.640
At the time he did that, he happened to
make a giant Petri dish.

02:03:13.160 --> 02:03:16.480
A Petri dish that they also filled with a
kind of gel.

02:03:16.480 --> 02:03:20.480
A type of jelly where bacteria can swim.

02:03:20.480 --> 02:03:22.280
Okay. Good.

02:03:22.280 --> 02:03:23.560
And what does that have to do with
antibiotics?

02:03:24.840 --> 02:03:27.600
The funny thing is that this is a giant
Petri dish.

02:03:27.600 --> 02:03:29.960
What they said is... Well, look at the
edges.

02:03:29.960 --> 02:03:32.960
Let's assume there are no antibiotics of
any kind.

02:03:32.960 --> 02:03:37.280
But then we're going to divide this land
into strips and the next strip.

02:03:37.280 --> 02:03:41.280
There will be an antibiotic concentration
that kills the bacteria in the

02:03:41.280 --> 02:03:44.600
next band ten times the concentration 100
and one thousand.

02:03:44.600 --> 02:03:45.520
Okay.

02:03:45.520 --> 02:03:48.440
And we're going to have a kind of
competition, like when we used to play

02:03:48.440 --> 02:03:49.920
tag.

02:03:49.920 --> 02:03:52.280
I don't know if that's what it's called
in Madrid.

02:03:52.280 --> 02:03:55.280
If that's going to happen now, then no,
no.

02:03:55.320 --> 02:03:59.320
So basically the idea is I'm going to
inoculate the bacteria on each side, on

02:03:59.320 --> 02:04:02.800
each of the ends, and we'll see if they
are able to adapt, to see who reaches

02:04:02.800 --> 02:04:04.560
super resistance first.

02:04:04.880 --> 02:04:05.480
This is the idea.

02:04:07.480 --> 02:04:11.480
So here we have Mr. Michael inoculating a
small amount

02:04:11.480 --> 02:04:15.360
of bacteria, let's say coli bacteria,
there.

02:04:16.280 --> 02:04:20.280
As I was saying, bacteria, among many
other things, are able to

02:04:20.280 --> 02:04:24.240
swim, to swim vigorously when they have
enough of a medium with sufficient low

02:04:24.240 --> 02:04:26.240
viscosity to move.

02:04:26.840 --> 02:04:30.840
Uh, what I'm putting here so I'm not just
talking

02:04:30.840 --> 02:04:34.840
to you guys, well, here we have a zoom of
the flagellar

02:04:34.840 --> 02:04:38.840
apparatus of a bacterium which is
basically like

02:04:38.840 --> 02:04:43.920
the propeller of an outboard motor
powered by GTP energy.

02:04:44.440 --> 02:04:48.440
This is spinning, or I knew it but hadn't
forgotten it, but

02:04:48.440 --> 02:04:51.560
at a very high speed and it allows the
bacteria

02:04:51.560 --> 02:04:54.560
to move over distances that are related.

02:04:54.960 --> 02:04:58.640
They are on the order of millimeters to
centimeters per hour.

02:04:58.960 --> 02:05:00.320
Something that measures in microns is
worth it.

02:05:02.600 --> 02:05:05.480
Okay, messages bacteria can swim.

02:05:05.480 --> 02:05:11.120
So let's see if they're really capable of
winning this race.

02:05:11.240 --> 02:05:16.160
I repeat once again how to say the design
of experiments.

02:05:16.640 --> 02:05:20.640
We have a large Petri dish with a very
high concentration

02:05:20.640 --> 02:05:23.960
of antibiotic in the center, inoculated
at the

02:05:23.960 --> 02:05:26.960
ends, and we're going to see what
happens.

02:05:27.440 --> 02:05:29.480
Okay, first I'm going to go through it a
little quickly.

02:05:29.480 --> 02:05:32.080
Okay? And then I stop.

02:05:32.080 --> 02:05:35.080
Huh? The only thing you need to know is
that you'll see this

02:05:35.080 --> 02:05:38.080
little white thing here much better on
these screens, for sure.

02:05:38.120 --> 02:05:41.120
Okay, I'm going to put it here.

02:05:41.560 --> 02:05:42.160
Okay. Here.

02:05:42.160 --> 02:05:43.960
Do you see it? No.

02:05:43.960 --> 02:05:45.400
And here you are. Do you see him, little
white boy?

02:05:45.400 --> 02:05:50.120
For contrast, we are in the zero
antibiotic band.

02:05:50.760 --> 02:05:52.160
So the bacteria is happy.

02:05:52.160 --> 02:05:55.160
The inoculation begins to grow and also
begins to swim.

02:05:55.280 --> 02:05:56.000
And what happens?

02:05:57.760 --> 02:06:00.840
Well, in a matter of hours it has already
colonized

02:06:00.840 --> 02:06:03.840
all these bands where there is no
antibiotic.

02:06:04.240 --> 02:06:06.280
But look how they're all lined up.

02:06:06.280 --> 02:06:09.520
Nobody here dares to take a step, nobody
dares to take a step.

02:06:09.520 --> 02:06:11.200
Where is Mata's antibiotic?

02:06:11.200 --> 02:06:12.760
They're all there, let's see who makes it
to the First Division.

02:06:12.760 --> 02:06:15.760
Okay?

02:06:15.960 --> 02:06:19.200
Well, a little time passes and suddenly
we find.

02:06:19.880 --> 02:06:21.800
What's going on here?

02:06:21.800 --> 02:06:23.000
What is this?

02:06:23.000 --> 02:06:23.840
What's going on here?

02:06:23.840 --> 02:06:25.480
These feathers are coming in.

02:06:25.480 --> 02:06:27.320
And here they are in miniature.

02:06:27.320 --> 02:06:30.320
Does anyone know what that is?

02:06:32.600 --> 02:06:35.600
Again.

02:06:36.400 --> 02:06:37.400
That some have adapted.

02:06:37.400 --> 02:06:39.440
These are what we call mutants.

02:06:39.440 --> 02:06:40.760
These are mutants. Every time, dear.

02:06:40.760 --> 02:06:44.120
A mutation that suddenly allows them to
live.

02:06:44.120 --> 02:06:47.960
And to consume the resources in this
territory that has antibiotics.

02:06:48.280 --> 02:06:50.240
Look, this one here is super good.

02:06:50.240 --> 02:06:54.240
Is it going at full speed, because this
process happens at each of the

02:06:54.240 --> 02:06:58.240
different barriers, they are all
descendants of the same one, so

02:06:58.240 --> 02:07:02.400
each mutation accumulates, the previous
one and each one is worth it?

02:07:03.720 --> 02:07:08.000
And well, finally they reach the end and
we have almost, almost a tie.

02:07:08.000 --> 02:07:10.160
I'm going to repeat it one more time:
inoculate.

02:07:10.160 --> 02:07:11.800
Come on,

02:07:11.800 --> 02:07:16.280
They grow to the edge, the settlers begin
to grow, and we reach the end.

02:07:16.280 --> 02:07:19.760
Okay, so this experiment, what I just
showed

02:07:19.760 --> 02:07:22.760
you, took 11 days, that is, only 11 days.

02:07:23.080 --> 02:07:26.000
These bacteria were able to learn.

02:07:26.000 --> 02:07:30.000
Let's say, if you'll allow me, to resist
antibiotic concentrations

02:07:30.000 --> 02:07:33.800
a thousand times higher than those that
already kill them.

02:07:33.800 --> 02:07:34.280
Okay?

02:07:34.280 --> 02:07:37.800
Here we are, witnessing in real time
before our very

02:07:37.800 --> 02:07:40.800
eyes this tremendous capacity to evolve.

02:07:42.680 --> 02:07:44.960
Well, we're not staying here, are we?

02:07:44.960 --> 02:07:46.960
We see that there are a lot of very
interesting phenomena.

02:07:46.960 --> 02:07:50.840
For example, we found, uh, let's give an
example.

02:07:50.840 --> 02:07:53.720
For example, what we're seeing here,
right?

02:07:53.720 --> 02:07:56.880
This species is like one of the
diversifications that exist, right?

02:07:56.880 --> 02:08:00.440
It's like suddenly several offspring of
the same colony appear and find different

02:08:00.440 --> 02:08:02.240
solutions, right?

02:08:02.480 --> 02:08:06.440
Then you can see cases where it's not
well known.

02:08:06.440 --> 02:08:08.600
Forgive me, those of you on this side.

02:08:08.600 --> 02:08:13.920
Here's a, let's say, a clone elbowing its
way in.

02:08:13.920 --> 02:08:16.640
Basically, it goes in. I don't know if
you notice.

02:08:16.640 --> 02:08:18.560
Then he elbows his way through.

02:08:18.560 --> 02:08:21.280
It is. It's because it acquired a
mutation later than the others.

02:08:21.280 --> 02:08:26.600
But that mutation is great and it
literally gets rid of him.

02:08:27.240 --> 02:08:31.240
Well, the beauty of this work done in
1916 is

02:08:31.240 --> 02:08:35.120
that, uh, they took samples from every
site.

02:08:35.760 --> 02:08:39.760
It was a bit like the phylogenetic tree
of all these populations and

02:08:39.760 --> 02:08:44.400
the sequencing, which allows us to also
know what genetic changes are happening.

02:08:44.400 --> 02:08:48.400
Not only that, but you can take the
bacteria, you can measure its antibiotic

02:08:48.400 --> 02:08:52.280
resistance, which has these colors, okay,
and you can actually know how much

02:08:52.280 --> 02:08:55.280
resistance has been acquired through
which mutations?

02:08:55.880 --> 02:09:01.040
And I'm just going to give you one
example, this case here, okay.

02:09:01.520 --> 02:09:07.200
The colors are a little confusing, but
these arrows are purple, right?

02:09:07.200 --> 02:09:11.200
They refer to what happens between this
evolutionary stage and these

02:09:11.200 --> 02:09:15.160
two children that this evolutionary stage
has and its two children.

02:09:15.160 --> 02:09:19.160
Okay? At this evolutionary stage, this
clone already carried

02:09:19.160 --> 02:09:23.160
all these mutations. It doesn't matter if
I explain what they're

02:09:23.160 --> 02:09:26.960
doing, but basically they're messing with
the enzyme that's

02:09:26.960 --> 02:09:29.960
being compromised by the antibiotic.

02:09:29.960 --> 02:09:33.880
The antibiotics are blocking an enzyme
essential to the bacteria, preventing it

02:09:33.880 --> 02:09:35.840
from functioning, and that's why it dies.

02:09:35.840 --> 02:09:39.840
Well, the bacteria just happens to make
changes in the

02:09:39.840 --> 02:09:44.000
sequence of its protein that presumably
make it resistant.

02:09:44.360 --> 02:09:46.080
The interesting thing is the two
children. You see?

02:09:46.080 --> 02:09:48.080
There are two cases, the two children.

02:09:48.080 --> 02:09:51.920
One of them acquires a 4th mutation in
the same gene.

02:09:51.920 --> 02:09:53.160
Continue.

02:09:53.160 --> 02:09:55.880
It continues along those lines of "I'm
going to make this enzyme."

02:09:55.880 --> 02:09:57.720
Nobody's going to touch it. Okay.

02:09:57.720 --> 02:10:00.800
But there is another one that, as you can
see, is

02:10:00.800 --> 02:10:03.800
acquiring a mutation into a little thing
called Mar.

02:10:03.800 --> 02:10:07.800
Ah, that's good, well it's a good
regulator,

02:10:07.800 --> 02:10:13.520
it's a gene that has to do with the
general stress response.

02:10:13.560 --> 02:10:16.200
This is a gene that, when activated or
touched by bacteria, suddenly says, "We

02:10:16.200 --> 02:10:17.560
are dying,

02:10:17.560 --> 02:10:20.040
we are going to start expelling
everything we don't understand that is

02:10:20.040 --> 02:10:21.320
around here."

02:10:21.320 --> 02:10:24.840
Any toxic product that is suspected of
being toxic will be tested with pumps

02:10:24.840 --> 02:10:26.600
that have bilge pumps.

02:10:26.600 --> 02:10:29.360
Like the water girls, there's everything
outside.

02:10:29.360 --> 02:10:30.920
We're going to close all the doors.

02:10:30.920 --> 02:10:33.440
Okay. Bacteria have doors to get in.
Stuff.

02:10:33.440 --> 02:10:35.240
They have sentries there who allow them
to enter or not.

02:10:35.240 --> 02:10:36.800
They say, "Let's shut everything down."

02:10:36.800 --> 02:10:39.440
We're going to expel everything. Let's
see if we survive.

02:10:39.440 --> 02:10:43.360
So here we have, in a matter of hours, a
diversification into different

02:10:43.360 --> 02:10:45.320
strategies.

02:10:47.120 --> 02:10:50.880
Do you think there might be any long-term
consequences

02:10:50.880 --> 02:10:53.880
between one strategy and the other?

02:10:56.640 --> 02:10:59.640
Have you already put a clue there? No?

02:10:59.720 --> 02:11:02.720
People on this side can also answer.

02:11:03.680 --> 02:11:04.560
It reproduces.

02:11:04.560 --> 02:11:07.640
They are saying something very
interesting here: These mutations can

02:11:07.640 --> 02:11:09.200
have a physiological cost.

02:11:09.200 --> 02:11:11.840
They can make it grow better or worse.
And there are many examples of that.

02:11:11.840 --> 02:11:13.040
But I don't know what I'm saying to you.

02:11:13.040 --> 02:11:17.040
What I want to focus on right now is that
we have a mutation that

02:11:17.040 --> 02:11:21.040
continues the same line of making my
enzyme invulnerable, and

02:11:21.040 --> 02:11:25.040
another mutation that says, "Hey, look,
what I'm going to do is

02:11:25.040 --> 02:11:29.240
put into action a stress control system
due to damage from compounds."

02:11:29.560 --> 02:11:32.560
What consequences could this have in the
future?

02:11:39.440 --> 02:11:40.560
I'm calling here.

02:11:40.560 --> 02:11:42.480
This right here. I'm calling it general
strategy.

02:11:42.480 --> 02:11:44.240
Excuse me, Specialist.

02:11:44.240 --> 02:11:48.240
So I get better and better at resisting
this single antibiotic,

02:11:48.240 --> 02:11:52.240
whereas this strategy here will give
resistance, as they

02:11:52.240 --> 02:11:56.240
prove in the article, to other
antibiotics, so by making you

02:11:56.240 --> 02:12:00.920
resistant to only one at once, it makes
you resistant to others.

02:12:01.560 --> 02:12:02.840
Okay.

02:12:02.840 --> 02:12:04.080
Well,

02:12:04.080 --> 02:12:07.080
I continue because I'm afraid I'll run
out of time.

02:12:08.240 --> 02:12:11.120
This type of experiment allows you to ask
many questions.

02:12:11.120 --> 02:12:14.960
Another thing I want to talk about here
is what happens when we play around with

02:12:14.960 --> 02:12:16.920
these gradients a little.

02:12:16.920 --> 02:12:20.000
So, what are we going to do in this game
now?

02:12:20.000 --> 02:12:21.880
It's a real experiment.

02:12:21.880 --> 02:12:24.640
What they wanted to see is Vale.

02:12:24.640 --> 02:12:28.360
The goal is to reach a thousand times the
resistance.

02:12:28.360 --> 02:12:30.520
It's worth a thousand times the
resistance.

02:12:30.520 --> 02:12:33.480
And we're going to inoculate here at
these two points.

02:12:33.480 --> 02:12:34.120
Because?

02:12:34.120 --> 02:12:38.120
Because in this way we will be able to
see if it is possible

02:12:38.120 --> 02:12:41.360
to reach the same speed in a single
stroke or

02:12:41.360 --> 02:12:44.360
through increasingly smaller increments.

02:12:44.360 --> 02:12:47.840
For example, here days zero, ten zero
here days zero, 1000

02:12:47.840 --> 02:12:50.840
and here you would go directly zero
thousand okay.

02:12:52.480 --> 02:12:55.480
And the same kind of movie.

02:12:55.760 --> 02:12:59.560
At first, the bacteria grow happily in
the area without antibiotics.

02:13:00.960 --> 02:13:04.560
We immediately began to see these mutants
invading and colonizing this new

02:13:04.560 --> 02:13:06.400
environment.

02:13:06.600 --> 02:13:10.600
And what you're going to see is that the
path that

02:13:10.600 --> 02:13:14.600
goes through the low intermediate
concentration

02:13:14.600 --> 02:13:18.560
of one is the first to reach a thousand.

02:13:18.560 --> 02:13:21.080
I'm going to repeat it one more time.
Okay.

02:13:21.080 --> 02:13:22.880
The goal is to reach a thousand.

02:13:22.880 --> 02:13:24.560
Who will reach 1,000 first?

02:13:24.560 --> 02:13:28.160
The descendants of what was here. Why?

02:13:28.160 --> 02:13:30.160
Because they've had a kind of shortcut.

02:13:30.160 --> 02:13:32.840
Or a trampoline or a bridge, whatever you
want to call it.

02:13:32.840 --> 02:13:34.280
That intermediate concentration.

02:13:34.280 --> 02:13:36.440
And that's the message of this slide.

02:13:36.440 --> 02:13:40.720
Intermediate concentrations are
facilitating this evolutionary process.

02:13:41.480 --> 02:13:42.600
Because?

02:13:42.600 --> 02:13:44.240
Because of a tiny concentration.

02:13:44.240 --> 02:13:48.000
I'm selecting a tiny mutation that might
give me a little bit of resistance,

02:13:48.000 --> 02:13:51.000
and maybe mutations that give a little
bit of resistance.

02:13:51.000 --> 02:13:55.000
There are many more mutations that confer
significant resistance,

02:13:55.000 --> 02:13:59.000
but once I take one step and become a
little more resistant, it

02:13:59.000 --> 02:14:03.800
becomes easier to take the next step.
Okay, because this is important.

02:14:03.800 --> 02:14:06.080
It's something that's been discussed here
too.

02:14:06.080 --> 02:14:10.080
You can imagine that in the environment
we have many

02:14:10.080 --> 02:14:15.680
situations where there are very small
concentrations of antibiotics. Okay.

02:14:15.680 --> 02:14:18.320
Antibiotics are being given, huh?

02:14:18.320 --> 02:14:22.320
It's not just in hospitals; it's being

02:14:22.320 --> 02:14:27.680
given to aquaculture, to farm animals,
and to our pets.

02:14:27.680 --> 02:14:30.600
All of that is also eliminated when you
go to the bathroom.

02:14:30.600 --> 02:14:33.560
This is giving antibiotics and going down
the toilet.

02:14:33.560 --> 02:14:34.400
Okay.

02:14:34.400 --> 02:14:39.720
So all these low concentrations of
antibiotics appear in a lot of places.

02:14:39.720 --> 02:14:43.720
And what this experiment is showing is
that these low concentrations

02:14:43.720 --> 02:14:46.840
act as a springboard to high resistance.

02:14:47.080 --> 02:14:48.920
Message again.

02:14:48.920 --> 02:14:51.320
Antibiotics should be used with caution.

02:14:51.320 --> 02:14:54.360
They must be eliminated knowing exactly
what is being done.

02:14:54.680 --> 02:14:57.960
Okay, and its industrial use needs to be
closely monitored.

02:14:58.720 --> 02:14:58.960
Okay.

02:15:00.560 --> 02:15:01.400
Okay, I'll continue.

02:15:01.400 --> 02:15:05.600
How am I doing on time, or just badly?

02:15:05.600 --> 02:15:08.080
Okay. Very good. Let's go quickly.

02:15:08.080 --> 02:15:11.080
Uh, you have up to 20 minutes.

02:15:12.880 --> 02:15:13.600
Ah, okay.

02:15:13.600 --> 02:15:15.200
Well,

02:15:15.200 --> 02:15:16.520
Okay, let's go.

02:15:16.520 --> 02:15:17.840
More than enough.

02:15:17.840 --> 02:15:20.400
Well, so I was talking about experimental
evolution.

02:15:20.400 --> 02:15:24.400
I've told you about a case that's very
visual, but there are several groups

02:15:24.400 --> 02:15:28.320
around the world doing experimental
evolution for different things.

02:15:28.320 --> 02:15:29.000
Okay.

02:15:29.000 --> 02:15:33.000
I'm going to give you another example
that has to do with the use

02:15:33.000 --> 02:15:36.880
of this experimental evolution to look
for weaknesses in antibiotic-resistant

02:15:36.880 --> 02:15:38.840
bacteria.

02:15:38.840 --> 02:15:41.880
So, in this work, uh, it's done by the
group

02:15:41.880 --> 02:15:44.880
that still values ​​the colony unit more?

02:15:44.920 --> 02:15:50.680
What they do is an experimental evolution
of hundreds of mutants.

02:15:50.680 --> 02:15:52.520
It's not as we say.

02:15:52.520 --> 02:15:55.760
I don't know how to say it in Spanish,
because saying

02:15:55.760 --> 02:15:58.760
"disruption" or "deletion" doesn't really
clarify things.

02:15:59.840 --> 02:16:00.440
Mutant, isn't it?

02:16:00.440 --> 02:16:03.040
Cat is a mutant in which we have removed
an entire gene.

02:16:03.040 --> 02:16:04.880
Okay.

02:16:04.880 --> 02:16:05.240
And so?

02:16:05.240 --> 02:16:09.080
Well, it's a very laborious job that,
fortunately for them, was done by some

02:16:09.080 --> 02:16:11.000
Japanese people years ago.

02:16:11.000 --> 02:16:14.280
There is a collection of bacteria that
have all

02:16:14.280 --> 02:16:17.280
the genes that can be deleted, deleted.

02:16:17.880 --> 02:16:19.880
And these people took the genes.

02:16:19.880 --> 02:16:21.040
What did you think?

02:16:21.040 --> 02:16:24.440
There are these genes that are certainly
important for bacteria to be able to

02:16:24.440 --> 02:16:26.160
resist antibiotics.

02:16:26.160 --> 02:16:27.920
We're going to test each and every one
separately.

02:16:27.920 --> 02:16:31.920
We're going to do an evolution with the
idea

02:16:31.920 --> 02:16:35.600
of ​​finding out if there's a key gene.

02:16:35.600 --> 02:16:39.040
Can you imagine if we found a gene that,
when removed, prevents bacteria from

02:16:39.040 --> 02:16:40.760
evolving?

02:16:40.760 --> 02:16:41.720
Hey, that's fantastic.

02:16:41.720 --> 02:16:44.720
There's a target for a drug. No.

02:16:44.920 --> 02:16:47.960
So this is a bit conceptual.

02:16:48.080 --> 02:16:49.400
The idea is as follows.

02:16:49.400 --> 02:16:51.800
We have a collection that is not going to
be homogeneous because each one is a

02:16:51.800 --> 02:16:53.000
mutant.

02:16:53.000 --> 02:16:53.240
There will be.

02:16:53.240 --> 02:16:56.200
They are mutants of important things, of
regulators, of physiological, metabolic

02:16:56.200 --> 02:16:57.720
things.

02:16:58.080 --> 02:17:00.920
Therefore, they have a diversity of
initial resistance.

02:17:00.920 --> 02:17:04.920
Okay, they do the evolution and then they
measure how

02:17:04.920 --> 02:17:08.720
much they have evolved, their capacity to
evolve.

02:17:09.040 --> 02:17:12.320
And they also find that there is
variability and they

02:17:12.320 --> 02:17:15.320
also find a rather interesting
relationship.

02:17:15.320 --> 02:17:19.320
This is of great interest to physicists
because

02:17:19.320 --> 02:17:23.320
we have a kind of delay here in the power
law that

02:17:23.320 --> 02:17:26.360
tells us that the more resistant you

02:17:26.360 --> 02:17:29.360
are initially, the less you adapt.

02:17:29.400 --> 02:17:32.320
It doesn't make intuitive sense if you
have it.

02:17:32.320 --> 02:17:35.760
If you're really bad, then you have a lot
more room to become good. That's not

02:17:35.760 --> 02:17:37.480
fair.

02:17:37.480 --> 02:17:39.840
But the goal is not to find a gene here.

02:17:39.840 --> 02:17:42.680
It's okay that it doesn't evolve much.

02:17:42.680 --> 02:17:44.120
This is evolutionary increase.

02:17:44.120 --> 02:17:47.600
Okay, these genes here don't evolve much,
but they were already

02:17:47.600 --> 02:17:50.600
quite resistant initially, so there's not
much I can do.

02:17:51.320 --> 02:17:53.920
The goal is to find this gene out there.

02:17:53.920 --> 02:17:56.000
That would be the perfect solution.

02:17:56.000 --> 02:18:00.000
Okay, we have a gene that when you remove
it I have no resistance,

02:18:00.000 --> 02:18:03.320
it's very low and I'm not able, I'm not
able to adapt.

02:18:04.160 --> 02:18:05.720
Is this possible?

02:18:05.720 --> 02:18:08.320
Well, as you can imagine, that's exactly
what they find.

02:18:09.360 --> 02:18:13.360
They find this gene by agreement that
codes for one of

02:18:13.360 --> 02:18:16.520
the most important units of one of these

02:18:16.520 --> 02:18:19.520
expulsion pumps that I mentioned earlier.

02:18:19.520 --> 02:18:25.280
These pumps remove all the toxic products
that are inside the cells.

02:18:25.280 --> 02:18:28.080
So this pump here is essential for power.

02:18:28.080 --> 02:18:31.640
It is the first line of defense that
bacteria have against toxic products.

02:18:31.640 --> 02:18:34.280
When you eliminate it, it turns out they
are unable to adapt.

02:18:34.280 --> 02:18:34.760
Because?

02:18:34.760 --> 02:18:38.080
Because one of the ways of adapting that
they found here

02:18:38.080 --> 02:18:41.080
has to do with improving the ability to
expel things.

02:18:41.080 --> 02:18:42.320
Okay.

02:18:42.320 --> 02:18:46.320
Coincidentally, we also know of drugs
that

02:18:46.320 --> 02:18:50.720
are capable of inhibiting this, this,
this pump.

02:18:50.920 --> 02:18:54.920
Therefore, what they propose in this
work, and in subsequent

02:18:54.920 --> 02:18:58.880
ones, is the use of this type of drug as
an adjuvant.

02:18:58.880 --> 02:19:02.880
So, something that helps the antibiotic,
because I give you an

02:19:02.880 --> 02:19:06.880
antibiotic that I know you're going to
become resistant to through

02:19:06.880 --> 02:19:09.880
this mechanism, and I'm already
preventing it, okay?

02:19:10.320 --> 02:19:14.000
This is applied evolutionary thinking.

02:19:14.000 --> 02:19:17.000
Anticipating the enemy's movement is
worthwhile.

02:19:18.600 --> 02:19:19.640
Continuous.

02:19:19.640 --> 02:19:20.960
I'll give another example.

02:19:20.960 --> 02:19:23.080
Same type of same type of experiment.

02:19:23.080 --> 02:19:25.600
It's worth a lot of different mutant
replicas.

02:19:25.600 --> 02:19:29.600
In this case, instead of using a lot of
genes trying to

02:19:29.600 --> 02:19:33.600
find the key gene for resistance, the
approach is to

02:19:33.600 --> 02:19:37.600
always evolve the same strain to a lot of
antibiotics,

02:19:37.600 --> 02:19:40.600
to all the ones that are interesting.

02:19:40.600 --> 02:19:41.720
Okay.

02:19:41.720 --> 02:19:44.720
And I'm going to study when they finish.

02:19:45.560 --> 02:19:48.560
If there is an antibiotic.

02:19:49.120 --> 02:19:51.720
For whom resistance weakens you against
other resistances, this would be

02:19:51.720 --> 02:19:53.040
tremendous.

02:19:53.040 --> 02:19:54.600
That there would be a give and take.

02:19:54.600 --> 02:19:56.960
I don't become resistant to the
antibiotic and I become more sensitive to

02:19:56.960 --> 02:19:58.160
B.

02:19:58.760 --> 02:20:00.880
That would be very interesting.

02:20:00.880 --> 02:20:02.360
Well, this is what they find. Okay.

02:20:03.840 --> 02:20:04.520
This.

02:20:04.520 --> 02:20:05.880
This is called a heat map.

02:20:05.880 --> 02:20:08.320
I don't know if you've ever seen it, but
I'm going to explain it to you.

02:20:08.320 --> 02:20:11.480
It's a matrix where I'm putting all these
names.

02:20:11.480 --> 02:20:12.320
They are antibiotics.

02:20:12.320 --> 02:20:13.280
Okay. Me too.

02:20:13.280 --> 02:20:16.520
Caffeine, gentamicin, medicinal cannabis,
ampicillin, amoxicillin, EpiPen.

02:20:16.920 --> 02:20:18.200
A lot of names you don't need to know.

02:20:18.200 --> 02:20:21.880
The antibiotics here are telling you what
you've

02:20:21.880 --> 02:20:24.880
done computer evolution to on this side.

02:20:24.920 --> 02:20:27.120
Here they tell you what evolution has
become.

02:20:27.120 --> 02:20:28.280
Okay.

02:20:28.280 --> 02:20:32.280
At the top I'm going to do it in the
middle one, at the top they

02:20:32.280 --> 02:20:38.120
are measuring cross-sensitivity or
cross-resistance to the same antibiotics.

02:20:38.120 --> 02:20:42.120
Okay. So, in the example I gave you
above, I make my

02:20:42.120 --> 02:20:45.120
evolution to my little house, okay?

02:20:45.760 --> 02:20:48.600
And now I measure those tough bugs.

02:20:48.600 --> 02:20:52.440
If they are resistant to all these
things, Azulito means that he has become

02:20:52.440 --> 02:20:54.400
sensitive.

02:20:54.480 --> 02:20:57.040
Rojito means that it has become
resistant.

02:20:57.040 --> 02:21:01.040
Hey, with promising medicine we have a
lot of antibiotics

02:21:01.040 --> 02:21:05.200
to which becoming resistant to caffeine
makes me sensitive.

02:21:06.080 --> 02:21:09.880
We can repeat this with all the
combinations and

02:21:09.880 --> 02:21:12.880
we find groups in these blue areas.

02:21:13.400 --> 02:21:16.000
These are weaknesses that could be
exploited.

02:21:16.000 --> 02:21:17.000
OK.

02:21:17.000 --> 02:21:20.440
I'll mention this too, Jerónimo.

02:21:20.840 --> 02:21:25.280
What are called collateral sensitivity
strategies.

02:21:26.960 --> 02:21:28.800
Very good.

02:21:28.800 --> 02:21:30.200
Cross-sensitivity.

02:21:30.200 --> 02:21:33.440
Okay, so we now have two strategies based
on this

02:21:33.440 --> 02:21:36.440
evolutionary thinking that could help us.
Great.

02:21:36.440 --> 02:21:39.080
And now, I suppose that in the four
minutes I have left, very briefly, I'm

02:21:39.080 --> 02:21:40.440
going to

02:21:40.440 --> 02:21:43.520
tell you what I do, because until now
I've told you what others do.

02:21:43.520 --> 02:21:45.600
Okay,

02:21:45.600 --> 02:21:49.600
So, as I was saying in the lab, we mainly
work on

02:21:49.600 --> 02:21:52.960
fundamental theory, we work on having an

02:21:52.960 --> 02:21:55.960
evolution with a fundamental approach.

02:21:55.960 --> 02:21:59.040
We want to understand how antibiotics
work.

02:21:59.280 --> 02:22:01.920
It's an applied case that interests us a
lot, but our real focus is on

02:22:01.920 --> 02:22:03.280
understanding

02:22:03.280 --> 02:22:07.400
the mechanisms and, above all, on
understanding this question that's here.

02:22:07.400 --> 02:22:11.720
Can we predict if we work on predicting
evolution?

02:22:11.720 --> 02:22:13.880
Can evolution be predicted or not?

02:22:13.880 --> 02:22:17.480
Is it a completely random process or are
there certain patterns that repeat?

02:22:18.280 --> 02:22:18.920
We don't know.

02:22:19.920 --> 02:22:23.920
So there's an experimental model where we
work

02:22:23.920 --> 02:22:27.320
a lot, it's the beta antibiotics, folks.

02:22:27.920 --> 02:22:30.920
Summary of this Beta figure.

02:22:31.400 --> 02:22:32.240
It's penicillin.

02:22:32.240 --> 02:22:35.200
Okay, here's Mr. Fleming once again with
his penicillin.

02:22:35.200 --> 02:22:36.240
OK.

02:22:36.240 --> 02:22:40.160
And you'll see that new and new compounds
have been discovered in this family over

02:22:40.160 --> 02:22:42.160
time. Okay. So.

02:22:42.160 --> 02:22:45.040
We have a very large family. Antibiotics.

02:22:45.040 --> 02:22:45.960
What's happening?

02:22:45.960 --> 02:22:48.960
In hospitals.

02:22:49.000 --> 02:22:51.520
Well, this is going to happen.

02:22:51.520 --> 02:22:54.320
Well, we have bacteria that are
resistant.

02:22:54.320 --> 02:22:58.240
Not because they have acquired a mutation
somewhere, but because they have acquired

02:22:58.240 --> 02:23:00.200
an enzyme that eats the antibiotic.

02:23:00.200 --> 02:23:04.200
These enzymes, called beta, have a
property that,

02:23:04.200 --> 02:23:08.680
in many cases, they also eat several
things at once.

02:23:08.680 --> 02:23:12.680
So, they're not just giving resistance to
one electronic beta,

02:23:12.680 --> 02:23:16.680
they're giving it to entire groups of
beta lactase, which is a problem,

02:23:16.680 --> 02:23:20.680
huh? I'm going to tell you about a
project we've done with PC2, which

02:23:20.680 --> 02:23:24.240
is the name we give it, but well, we
didn't come up with it.

02:23:24.760 --> 02:23:28.120
What can you see here? It's increasing,
okay?

02:23:28.160 --> 02:23:32.160
These are cases of bacteria that have
developed this

02:23:32.160 --> 02:23:36.160
type of resistance over time, from 2003
to 2013, and

02:23:36.160 --> 02:23:39.600
you can see that it's increasing a lot,
right?

02:23:39.600 --> 02:23:42.600
A lot of people are working on this.

02:23:42.600 --> 02:23:46.600
We know that there are a lot of mutants
that appear in hospitals when

02:23:46.600 --> 02:23:50.600
people sequence, and we already know what
little things are changing

02:23:50.600 --> 02:23:54.440
in those enzymes to make them more
efficient at eating the antibiotic.

02:23:54.800 --> 02:23:58.800
So, what we're proposing is, well, let's
imagine that we

02:23:58.800 --> 02:24:02.800
could take all those mutations and
recreate them in the

02:24:02.800 --> 02:24:06.800
lab, take the ancestral enzyme, put in
the mutations and

02:24:06.800 --> 02:24:10.360
then start combining them instead of the
ABC mutation.

02:24:10.520 --> 02:24:13.520
Then we have the double mutant A, B, a,
C, a D.

02:24:13.520 --> 02:24:13.840
Okay.

02:24:14.960 --> 02:24:17.280
And this is where Mr. Laplace comes in.

02:24:17.280 --> 02:24:18.680
It's a little late to introduce it.

02:24:18.680 --> 02:24:21.680
But hey, that's live TV for you.

02:24:21.760 --> 02:24:25.760
And now, Mr. Laplace, there was a
physicist and mathematician

02:24:25.760 --> 02:24:29.240
who said this thing in 1814 that is known
as him.

02:24:29.360 --> 02:24:31.800
This is the epitome of determinism, isn't
it?

02:24:31.800 --> 02:24:35.800
At that time, physicists were very proud
because they believed they

02:24:35.800 --> 02:24:39.800
understood the entire universe, and this
gentleman said the following:

02:24:39.800 --> 02:24:43.800
"If we were able to know the position and
momentum of every particle in

02:24:43.800 --> 02:24:47.000
the universe, if there were a being
capable of doing that."

02:24:47.000 --> 02:24:49.400
This is Laplace's famous demon.

02:24:49.400 --> 02:24:52.760
Could we predict the future and also
reconstruct the past?

02:24:53.200 --> 02:24:55.640
This idea that the universe is entirely
mechanical.

02:24:55.640 --> 02:24:57.760
Nothing escapes these kinds of rules.

02:24:58.960 --> 02:25:00.680
Okay, so let's do the same with
mutations.

02:25:00.680 --> 02:25:04.000
We're going to take the enzymes,
introduce the different mutations, and

02:25:04.000 --> 02:25:05.680
see their combinations.

02:25:05.680 --> 02:25:09.680
So, if the world were kind, if the
Universe were kind to

02:25:09.680 --> 02:25:13.040
people, we would expect things to be
simple and that.

02:25:13.040 --> 02:25:17.040
Well, maybe I have a mutation that is
very good, a bird that is a little

02:25:17.040 --> 02:25:20.680
worse, the C is regular, the B is so-so,
and when I combine them they more or less

02:25:20.680 --> 02:25:22.520
follow the logic.

02:25:22.520 --> 02:25:25.640
The best combination is a, B and so on.

02:25:26.960 --> 02:25:30.640
Okay, so these are the experimental data
we have with this enzyme.

02:25:31.480 --> 02:25:34.760
And well, okay, we found an enzyme, a
mutation that is very good and

02:25:34.760 --> 02:25:37.760
another that is very bad, which is B, and
then two intermediate ones.

02:25:38.600 --> 02:25:42.360
So, as I was saying, if the universe were
kind,

02:25:42.360 --> 02:25:45.360
this peace demon, uh, could succeed.

02:25:45.840 --> 02:25:46.600
What would we say?

02:25:48.160 --> 02:25:52.160
We would say, "Well, the best double
mutant is going to be the one

02:25:52.160 --> 02:25:56.160
that combines A, the one that's sure to
be there because A is the best,

02:25:56.160 --> 02:25:59.720
and then it would have to be combined
with C, the real one."

02:26:01.280 --> 02:26:05.280
Okay, so the way we do the experiments
turns out that no, it turns out

02:26:05.280 --> 02:26:09.280
that the best double mutant is BC, that
is, the worst mutation you

02:26:09.280 --> 02:26:12.760
could see at the beginning was combined
resistance with C.

02:26:14.000 --> 02:26:15.280
What's going on here?

02:26:15.280 --> 02:26:20.120
Okay, this is what is known as the
phenomenon in genetics.

02:26:20.120 --> 02:26:23.520
The clues are genetic interaction, as
I've put there.

02:26:23.640 --> 02:26:27.320
That's why the nearsighted demon can
really see very little.

02:26:28.800 --> 02:26:32.800
The reason for the clue transcends what I
can tell you in this talk,

02:26:32.800 --> 02:26:36.400
but we know because in the end you have
to think that these enzymes are

02:26:36.400 --> 02:26:38.240
dimensional entities.

02:26:38.480 --> 02:26:42.000
Any mutation you make here could be
interacting in a completely crazy way

02:26:42.000 --> 02:26:43.760
with something over there. Okay?

02:26:47.360 --> 02:26:49.600
Because this is interesting, because it's
important for the things we were talking

02:26:49.600 --> 02:26:50.760
about.

02:26:51.320 --> 02:26:55.320
If I measure the cross-resistance or
cross-sensitivity

02:26:55.320 --> 02:27:00.120
of these different mutants to inform
people who are in the clinic.

02:27:00.120 --> 02:27:04.520
Listen, when you have a patient with this
bug, give them this other antibiotic.

02:27:05.760 --> 02:27:09.760
If I let myself be guided by the
intuition that the best mutation

02:27:09.760 --> 02:27:13.760
will be the best of a mutant, it will be
the one that carries the

02:27:13.760 --> 02:27:17.120
mutation to, well I would say okay, this
is its profile

02:27:17.120 --> 02:27:20.120
which is very blue, come on CTX, let's
give it CTX.

02:27:20.120 --> 02:27:22.400
But be careful, because you can also go
this other way.

02:27:22.400 --> 02:27:26.400
We don't know, we can't do anything, we
don't know for this,

02:27:26.400 --> 02:27:30.720
for this case we couldn't tell anyone
what antibiotic to use.

02:27:30.720 --> 02:27:34.720
However, since we have this phenomenon,
it turns out that the

02:27:34.720 --> 02:27:38.360
predictions are not what we expected, and
we find an

02:27:38.360 --> 02:27:41.360
unexpected double mutant and this double
mutant.

02:27:41.360 --> 02:27:44.160
In this specific example, it turns out
that it would be very sensitive to

02:27:44.160 --> 02:27:45.600
acidity.

02:27:45.760 --> 02:27:49.760
Okay, this is just to illustrate, because
this

02:27:49.760 --> 02:27:53.440
unpredictability is ruining our promise
of

02:27:53.440 --> 02:27:56.440
being able to exploit cross-sensitivity.

02:27:58.040 --> 02:28:02.720
And the very, very last thing I'm going
to tell you is that all is not lost.

02:28:02.720 --> 02:28:05.720
Okay, all is not lost. Why?

02:28:05.720 --> 02:28:08.360
Because we have something called biases.

02:28:08.360 --> 02:28:10.440
Mutations and it means bias.

02:28:10.440 --> 02:28:15.440
Mutation means that some mutations are
more likely to happen than others.

02:28:16.160 --> 02:28:17.600
And why does this help us?

02:28:17.600 --> 02:28:20.600
Okay, first I want to tell you the
following.

02:28:21.320 --> 02:28:25.320
Imagine that the sequence, the key codons
are determining

02:28:25.320 --> 02:28:30.920
the resistance of your enzyme, well,
there is this sequence that is there.

02:28:30.920 --> 02:28:32.520
Okay?

02:28:32.520 --> 02:28:36.520
Well, I'm telling you that under certain
environmental conditions

02:28:36.520 --> 02:28:41.000
X where there is a mutagen, then changes
from tea to C will be beneficial.

02:28:41.920 --> 02:28:45.480
Well, I can tell that in this case, in
this sequence of my enzyme,

02:28:45.480 --> 02:28:48.480
I'm probably going to have this mutant,
the tea by faith.

02:28:49.440 --> 02:28:52.840
But if the environment changes, it turns
out that the mutations

02:28:52.840 --> 02:28:55.840
that are most likely to appear will be in
other places.

02:28:56.280 --> 02:29:00.000
They may be coding for different amino
acids and therefore for different

02:29:00.000 --> 02:29:01.880
enzymes.

02:29:02.080 --> 02:29:04.040
Because this is in our interest.

02:29:04.040 --> 02:29:08.040
Well, because we can go from a situation
where the clue is

02:29:08.040 --> 02:29:12.040
shrouded in a fog that we can't
understand, we can't predict

02:29:12.040 --> 02:29:16.040
anything, to a situation where we're
putting Laplace's

02:29:16.040 --> 02:29:20.040
demon glasses on and saying, look, it
turns out that these

02:29:20.040 --> 02:29:24.040
very powerful selection pressures, which
would be these

02:29:24.040 --> 02:29:28.040
lines that I'm putting in purple,
regardless of which

02:29:28.040 --> 02:29:32.040
mutation, which combination is better
than another, are

02:29:32.040 --> 02:29:36.040
driving evolution along different paths
and, for example,

02:29:36.040 --> 02:29:39.720
in this case, it would be leading us to a
solution, which would be B, which wasn't

02:29:39.720 --> 02:29:41.560
foreseen before.

02:29:41.600 --> 02:29:45.600
Okay, so we hope that understanding and

02:29:45.600 --> 02:29:49.600
mapping these computational biases will

02:29:49.600 --> 02:29:53.680
allow us to counteract this
unpredictability.

02:29:54.680 --> 02:29:56.920
And with this

02:29:56.920 --> 02:29:59.920
I am satisfied.

02:30:09.240 --> 02:30:12.760
You keep saying that pharmaceutical
companies don't want to invest because of

02:30:12.760 --> 02:30:14.560
the issue of antibiotics.

02:30:14.560 --> 02:30:16.240
But that's happening with vaccines.

02:30:16.240 --> 02:30:18.600
Vaccines are changing every year.

02:30:18.600 --> 02:30:22.600
Vaccines lose their effectiveness from
year to

02:30:22.600 --> 02:30:27.080
year, and antibiotics can last at least
five years.

02:30:27.160 --> 02:30:30.280
So I don't understand why pharmaceutical
companies invest in vaccines but not in

02:30:30.280 --> 02:30:31.880
antibiotics.

02:30:32.200 --> 02:30:34.520
It was a rather general question.

02:30:34.520 --> 02:30:38.040
I'm more certain that there's someone
here who knows more about these kinds of

02:30:38.040 --> 02:30:39.800
topics than I do.

02:30:39.800 --> 02:30:43.800
But I have a relatively easy answer:
producing antibiotics

02:30:43.800 --> 02:30:49.000
is much more costly in terms of time and
effort than producing a new vaccine.

02:30:49.600 --> 02:30:50.080
The vaccine.

02:30:50.080 --> 02:30:54.520
Is it enough for you to simply expose
your antigen to the model you use?

02:30:55.160 --> 02:30:56.600
Yes, that's good. We have to work.

02:30:56.600 --> 02:30:59.240
I'm not saying that making a vaccine is
incredibly easy, but finding new

02:30:59.240 --> 02:31:00.600
antibiotics

02:31:00.600 --> 02:31:03.240
is like searching for ants inside
volcanoes, literally, and it's difficult

02:31:03.240 --> 02:31:04.600
to

02:31:04.600 --> 02:31:07.240
find them because not only does it have
to be new, but it also has to be from a

02:31:07.240 --> 02:31:08.600
different

02:31:08.600 --> 02:31:11.880
family than the ones that already exist,
because there can be

02:31:11.880 --> 02:31:14.880
cross-resistance and they may not have
hepatotoxicity.

02:31:14.920 --> 02:31:17.920
Finding new antibiotics is much more
complicated.

02:31:22.840 --> 02:31:24.040
Thank you so much.

02:31:24.040 --> 02:31:28.040
I'm playing devil's advocate here,
because it's true that at the closing

02:31:28.040 --> 02:31:31.720
of Micromundo we have often invited
pharmaceutical companies to tell us their

02:31:31.720 --> 02:31:33.560
side of the story.

02:31:33.560 --> 02:31:37.240
And yes, it is true that of course it is
not worth it for them, and what they say

02:31:37.240 --> 02:31:39.120
is that they are not nuns.

02:31:39.120 --> 02:31:43.120
But for example, we, a large part of the
funding for Micromundo so that we can

02:31:43.120 --> 02:31:47.120
reach so many institutes comes from MSD,
and they have a social program, let's

02:31:47.120 --> 02:31:51.120
say, where they do allocate money to the
factory, to the production of new

02:31:51.120 --> 02:31:53.920
antibiotics, because obviously it is much
more profitable for them to do something

02:31:53.920 --> 02:31:55.360
else.

02:31:55.680 --> 02:31:59.680
But what the pharmaceutical companies are
asking for is a little support

02:31:59.680 --> 02:32:04.200
from the State to say, "Hey, let's do
combined programs where we can do that."

02:32:04.200 --> 02:32:07.480
So it's true that it's obviously a
company.

02:32:07.480 --> 02:32:11.480
Companies want to make money, but they
ask for some support in that

02:32:11.480 --> 02:32:15.480
regard, and they do have some special
programs, which are kind of

02:32:15.480 --> 02:32:18.960
a social purpose in order to develop new
antibiotics.

02:32:18.960 --> 02:32:21.000
But of course it's a business.

02:32:24.640 --> 02:32:27.640
If you ask me.

02:32:29.800 --> 02:32:33.800
Okay, so next up, to close the
presentations, we have Cristina

02:32:33.800 --> 02:32:37.800
Teixeira, Cristina Ballesteros, Laura
Villar and Luisa

02:32:37.800 --> 02:32:41.800
Botín, who are professionals involved in
the development

02:32:41.800 --> 02:32:47.640
and implementation of the National Plan
against the Antibiotic Resistance Front.

02:32:47.640 --> 02:32:51.640
The plan in the field of animal health in
Spain has been

02:32:51.640 --> 02:32:56.920
fundamental in the implementation of
surveillance strategies.

02:32:56.920 --> 02:33:00.920
Reduction in antibiotic use and awareness
in the

02:33:00.920 --> 02:33:04.920
veterinary sector have contributed to
positioning

02:33:04.920 --> 02:33:08.920
Spain as a leader in the application of
the integrated

02:33:08.920 --> 02:33:13.840
approach to health, human, animal and
environmental health.

02:33:14.400 --> 02:33:18.400
We were invited to reflect on
misconceptions and inappropriate

02:33:18.400 --> 02:33:22.400
practices in the use of antibiotics,
allowing us to recognize

02:33:22.400 --> 02:33:26.280
our role in this challenge and
understanding that we all

02:33:26.280 --> 02:33:29.280
influence both the problem and the
solution.

02:33:37.480 --> 02:33:40.240
Hello, everyone.

02:33:40.240 --> 02:33:43.560
Uh, well, I started saying, "How are you
all?"

02:33:45.080 --> 02:33:47.200
Are you excited?

02:33:47.200 --> 02:33:51.200
And I've noticed that you've already had
five

02:33:51.200 --> 02:33:54.520
talks and very few of you have slept.

02:33:55.120 --> 02:33:58.120
Some of you have even removed notes; you
haven't

02:33:58.120 --> 02:34:01.120
looked at your phones just to take
pictures.

02:34:01.120 --> 02:34:06.240
Does that mean you like this topic?

02:34:06.240 --> 02:34:09.840
Aren't you worried about antibiotic
resistance?

02:34:12.600 --> 02:34:17.080
She says no, that he's worried about
holding her hand.

02:34:20.200 --> 02:34:24.200
Aren't you worried about all those five,
uh,

02:34:24.200 --> 02:34:28.200
brilliant presentations you've had from

02:34:28.200 --> 02:34:32.160
scientists who've explained what this is
all about?

02:34:32.160 --> 02:34:34.560
They conduct their research.

02:34:34.560 --> 02:34:35.880
You're not worried.

02:34:35.880 --> 02:34:37.400
Are you using antibiotics correctly?

02:34:37.400 --> 02:34:40.040
Yes or no?

02:34:40.040 --> 02:34:43.040
Raise the hand you don't use.

02:34:45.000 --> 02:34:48.000
Someone who hasn't used antibiotics
properly.

02:34:53.440 --> 02:34:57.120
Well, but I see this is from the
microcosm.

02:34:57.360 --> 02:35:01.360
They're infecting you with this,

02:35:01.360 --> 02:35:05.360
uh, problem by explaining what it

02:35:05.360 --> 02:35:08.520
is, looking for solutions.

02:35:08.800 --> 02:35:12.240
And then that's already a little bit like

02:35:12.240 --> 02:35:15.240
messengers of what we want. That you
carry.

02:35:15.240 --> 02:35:17.080
Okay.

02:35:17.080 --> 02:35:18.760
Today we're going to have a chat.

02:35:18.760 --> 02:35:21.960
You've already had five. We've already
explained everything about antibiotic

02:35:21.960 --> 02:35:23.560
resistance.

02:35:23.560 --> 02:35:25.480
You already know everything.

02:35:25.480 --> 02:35:28.480
Now we're going to give you a test.

02:35:29.920 --> 02:35:31.480
Okay.

02:35:31.480 --> 02:35:33.880
Yes, yes, yes, yes.

02:35:33.880 --> 02:35:35.440
We need to know what it is.

02:35:35.440 --> 02:35:38.640
The messages you are taking from here

02:35:38.640 --> 02:35:41.640
today that we want you to spread.

02:35:42.240 --> 02:35:45.120
Why don't you use antibiotics properly?

02:35:45.120 --> 02:35:46.960
Okay,

02:35:46.960 --> 02:35:49.040
So, I don't have a remote.

02:35:49.040 --> 02:35:51.440
Sorry.

02:35:51.440 --> 02:35:54.160
First, I'm going to tell you what we do.

02:35:54.160 --> 02:35:57.160
Who we are.

02:35:58.800 --> 02:36:02.320
And to tell you who we are, I'm going to
explain it in this very simple way.

02:36:02.560 --> 02:36:05.600
So far you have had five people.

02:36:06.680 --> 02:36:10.680
Super-enthusiastic scientists, those

02:36:10.680 --> 02:36:14.680
we call lab rats, who, as Gerónimo has so

02:36:14.680 --> 02:36:18.680
aptly put it, are opening up that
knowledge

02:36:18.680 --> 02:36:22.680
gap, lengthening it so that we can better

02:36:22.680 --> 02:36:26.680
understand this problem, find solutions,

02:36:26.680 --> 02:36:30.040
seek new therapies, and ensure that

02:36:30.040 --> 02:36:33.040
antibiotics continue to work.

02:36:33.520 --> 02:36:35.760
Us

02:36:35.760 --> 02:36:39.760
We are office mice and we are on the

02:36:39.760 --> 02:36:43.760
other side, in the administrative

02:36:43.760 --> 02:36:47.760
part of government entities,

02:36:47.760 --> 02:36:51.760
ministries to look for laws, measures,

02:36:51.760 --> 02:36:55.760
tools to be used better in practice,

02:36:55.760 --> 02:36:59.040
antibiotics less and better.

02:36:59.520 --> 02:37:00.880
Okay,

02:37:00.880 --> 02:37:02.800
We are the plan.

02:37:02.800 --> 02:37:06.720
I am a Christian, I am a veterinarian, I

02:37:06.720 --> 02:37:09.720
have my partner Cristina, who is.

02:37:10.800 --> 02:37:12.840
I am also a veterinarian.

02:37:12.840 --> 02:37:15.040
Laura.

02:37:15.040 --> 02:37:15.520
Hello.

02:37:15.520 --> 02:37:17.960
I'm a pharmacist. A pharmacist?

02:37:17.960 --> 02:37:19.000
And Luis?

02:37:19.000 --> 02:37:20.120
Or also known as Bubi?

02:37:20.120 --> 02:37:22.720
No. Come on.

02:37:22.720 --> 02:37:25.480
In other words, we are either three
veterinarians or a pharmacist.

02:37:25.480 --> 02:37:28.360
For every pharmacist, we need three
veterinarians.

02:37:28.360 --> 02:37:31.240
No, it's not like that.

02:37:31.240 --> 02:37:32.240
Well.

02:37:32.240 --> 02:37:36.200
And so we, on the administrative side,
are looking for solutions.

02:37:36.240 --> 02:37:36.880
Okay.

02:37:36.880 --> 02:37:40.360
Do you think the problem with resistors
has an easy solution?

02:37:40.720 --> 02:37:41.200
Yes or no?

02:37:45.000 --> 02:37:49.240
Come on, we need more cooperation. No.

02:37:51.120 --> 02:37:54.440
Actually, I'm going to tell you yes, it
has an easy solution.

02:37:54.880 --> 02:37:57.720
And Girona has already spoken.

02:37:57.720 --> 02:38:02.080
Yes. The problem is that we use
antibiotics too much.

02:38:02.080 --> 02:38:05.000
Well, they're used less and better.

02:38:05.000 --> 02:38:06.520
That's it.

02:38:06.520 --> 02:38:08.200
That's the solution.

02:38:08.200 --> 02:38:12.200
What we need is a change in behavior from

02:38:12.200 --> 02:38:17.960
everyone to use these medications less
and better.

02:38:18.160 --> 02:38:21.160
Okay, but

02:38:21.160 --> 02:38:24.000
That's not easy.

02:38:24.000 --> 02:38:28.200
The job is a.

02:38:29.280 --> 02:38:32.480
It's not easy because, as you've

02:38:32.480 --> 02:38:35.480
already seen from the previous talks

02:38:35.480 --> 02:38:37.120
first,

02:38:37.120 --> 02:38:42.760
The concept of resistance is not easy to
explain.

02:38:43.840 --> 02:38:47.840
It is not easy to understand, and

02:38:47.840 --> 02:38:51.840
then it is not easy to solve and

02:38:51.840 --> 02:38:55.840
implement, because as has already

02:38:55.840 --> 02:39:00.400
been said, bacteria do not find borders.

02:39:00.400 --> 02:39:04.400
This is not just a human problem; it is a
problem

02:39:04.400 --> 02:39:08.840
that involves animals and the
environment.

02:39:08.840 --> 02:39:12.480
So, in this thing we call the good Geoff,
where we are all connected, there is only

02:39:12.480 --> 02:39:14.320
one health.

02:39:14.440 --> 02:39:19.600
So, a priori, it's not useful or not

02:39:19.600 --> 02:39:22.600
It's the solution

02:39:22.880 --> 02:39:26.880
Implementing measures in only one area of
​​Los Angeles,

02:39:26.880 --> 02:39:29.920
when what we need to do is involve
everyone.

02:39:30.040 --> 02:39:33.080
And this implies forgiving

02:39:33.080 --> 02:39:36.080
redundancy to many people.

02:39:36.320 --> 02:39:39.320
It's worth working with a lot of people.

02:39:41.160 --> 02:39:42.400
Okay.

02:39:42.400 --> 02:39:44.760
So here's the plan.

02:39:44.760 --> 02:39:48.760
The plan has been in place in Spain since

02:39:48.760 --> 02:39:52.760
2014 and its aim is to implement measures

02:39:52.760 --> 02:39:56.760
to ensure that antibiotics continue to be

02:39:56.760 --> 02:39:59.960
effective or to curb this problem.

02:40:00.000 --> 02:40:01.760
Okay.

02:40:01.760 --> 02:40:04.040
We work.

02:40:04.040 --> 02:40:04.960
You've already seen.

02:40:04.960 --> 02:40:08.960
Veterinarian pharmacists work together on
the aspects of

02:40:08.960 --> 02:40:12.600
human health, animal health, and the
environment.

02:40:14.720 --> 02:40:17.240
And also

02:40:17.240 --> 02:40:21.240
From a small team that you see here in
the photo below, which

02:40:21.240 --> 02:40:25.240
works exclusively for this, within the
Spanish Agency

02:40:25.240 --> 02:40:30.760
for Medicines, within the Ministry of
Health, ten ministries collaborated.

02:40:31.800 --> 02:40:35.800
70 scientific associations or societies
and

02:40:35.800 --> 02:40:40.160
more than 300 expert collaborators in
this field.

02:40:40.480 --> 02:40:44.480
In other words, what we do is connect all

02:40:44.480 --> 02:40:48.480
these people, seek consensus, and put

02:40:48.480 --> 02:40:52.040
measures in place to use it less and
better.

02:40:52.040 --> 02:40:55.040
Antibiotics.

02:40:55.840 --> 02:40:56.320
Okay.

02:40:56.320 --> 02:40:59.920
We work on strategic lines.

02:40:59.920 --> 02:41:02.920
Okay. And I'm going to explain briefly.

02:41:02.920 --> 02:41:04.800
First, surveillance.

02:41:04.800 --> 02:41:08.800
It's important to understand the problem,
to

02:41:08.800 --> 02:41:11.880
know how much resistance there is.

02:41:12.400 --> 02:41:15.400
And to know how many antibiotics we
consume.

02:41:15.600 --> 02:41:17.800
That's what surveillance is for.

02:41:17.800 --> 02:41:21.520
After that, it's important to control the
problem.

02:41:21.520 --> 02:41:25.520
Controlling the problem involves
implementing

02:41:25.520 --> 02:41:29.680
measures, laws, signing agreements, and
documents.

02:41:30.200 --> 02:41:34.200
Prevention is important because part of

02:41:34.200 --> 02:41:38.440
the solution is not using the least
amount.

02:41:38.440 --> 02:41:42.400
Better to apologize is to use them less
and use them less.

02:41:42.760 --> 02:41:45.440
It's about prevention.

02:41:45.440 --> 02:41:47.640
Infections. Okay.

02:41:47.640 --> 02:41:50.280
It is very important.

02:41:50.280 --> 02:41:51.400
Then we did.

02:41:51.400 --> 02:41:54.640
It's a problem of social change, of
behavioral change.

02:41:54.640 --> 02:41:58.640
We need many communication campaigns, a
lot

02:41:58.640 --> 02:42:02.640
of training, and we need the five
scientists

02:42:02.640 --> 02:42:06.800
or university professors who have been
here.

02:42:07.200 --> 02:42:11.200
We need research, to better understand

02:42:11.200 --> 02:42:16.480
this phenomenon, and to find solutions to
it.

02:42:16.960 --> 02:42:19.960
The investigation.

02:42:20.440 --> 02:42:20.920
Okay.

02:42:20.920 --> 02:42:22.840
And now we're going to do the test.

02:42:22.840 --> 02:42:24.360
Okay.

02:42:24.360 --> 02:42:28.360
We're going to share a series of myths
about bad

02:42:28.360 --> 02:42:32.360
practices, how we misuse antibiotics on a
daily

02:42:32.360 --> 02:42:35.680
basis, and we're all going to discuss
them.

02:42:35.680 --> 02:42:36.960
Okay, so it's for you.

02:42:36.960 --> 02:42:42.120
So I really want you to raise your hands
and really participate.

02:42:42.160 --> 02:42:45.160
Okay. The first one.

02:42:45.280 --> 02:42:47.360
Let's see,

02:42:47.360 --> 02:42:50.320
This boy who tells us.

02:42:50.320 --> 02:42:54.320
I don't use antibiotics, so this problem
doesn't affect me.

02:42:55.080 --> 02:42:58.080
What do you think?

02:42:58.960 --> 02:43:01.960
He is wrong.

02:43:02.080 --> 02:43:05.840
I bet someone has already found a guy
like this.

02:43:06.480 --> 02:43:08.080
I, for example, have a brother-in-law.

02:43:08.080 --> 02:43:11.520
I have a brother-in-law who thinks this
doesn't apply to him because he takes

02:43:11.520 --> 02:43:13.240
antibiotics.

02:43:13.240 --> 02:43:13.640
Very good.

02:43:15.720 --> 02:43:18.720
What should we say to him?

02:43:19.680 --> 02:43:21.680
Anyone dare?

02:43:21.680 --> 02:43:23.120
Come on!

02:43:23.120 --> 02:43:24.520
I've woken you up.

02:43:24.520 --> 02:43:26.720
Look, nobody's asleep anymore.

02:43:26.720 --> 02:43:31.760
Does anyone dare to... we have here?

02:43:31.840 --> 02:43:33.040
What would you say to him/her?

02:43:33.040 --> 02:43:37.600
That antibiotics can learn to teach other
people.

02:43:38.560 --> 02:43:40.920
I mean, antibiotics first.

02:43:40.920 --> 02:43:43.920
Yes, you'll use them at some point in
your life. Yes.

02:43:43.920 --> 02:43:48.080
And you can always help others learn how
to use them.

02:43:48.400 --> 02:43:51.120
Sure, but. I mean, this.

02:43:51.120 --> 02:43:54.280
I don't use antibiotics, so this problem
isn't going to affect me.

02:44:01.520 --> 02:44:02.720
Exact.

02:44:02.720 --> 02:44:05.880
I mean, because we've already discussed
here that it's a problem.

02:44:05.880 --> 02:44:09.880
Wenger is a collective problem,

02:44:09.880 --> 02:44:13.640
and bacteria have no borders.

02:44:13.720 --> 02:44:17.720
In other words, even though I'm doing
very

02:44:17.720 --> 02:44:21.720
well, a bacterium from someone who I know

02:44:21.720 --> 02:44:25.720
thinks I take them badly can affect me
through

02:44:25.720 --> 02:44:29.720
direct contact, or through contact in

02:44:29.720 --> 02:44:33.720
hospitals, the community, or through
food,

02:44:33.720 --> 02:44:37.680
or through contact with animals or the
environment.

02:44:38.560 --> 02:44:42.560
Even if you take it well, you can come
into

02:44:42.560 --> 02:44:47.920
contact with that bacteria and that
becomes a problem.

02:44:47.960 --> 02:44:51.960
In other words, resistance is like

02:44:51.960 --> 02:44:56.560
infectious diseases are social diseases.

02:44:58.360 --> 02:44:59.560
We already know what's going on.

02:44:59.560 --> 02:45:02.560
COVID doesn't count.

02:45:03.000 --> 02:45:05.920
So this is the message you need to
convey.

02:45:05.920 --> 02:45:10.360
It's not just what you do, but what we
all do.

02:45:10.840 --> 02:45:12.120
Okay.

02:45:12.120 --> 02:45:15.120
I'm going to pass the word on to my
colleagues.

02:45:16.760 --> 02:45:19.760
Okay, I'll continue with this.

02:45:24.760 --> 02:45:27.280
Okay, let's move on to the next case.

02:45:27.280 --> 02:45:31.280
Okay, now that we've warmed up with the
first one,

02:45:31.280 --> 02:45:34.320
let's see what you think of the next

02:45:34.320 --> 02:45:37.320
case we have to discuss together.

02:45:37.440 --> 02:45:42.280
Okay, so imagine that we have a process
or we are sick.

02:45:42.280 --> 02:45:46.280
We went to the doctor and the doctor
prescribed antibiotics

02:45:46.280 --> 02:45:50.280
because we have an infection, and well,
we have to take

02:45:50.280 --> 02:45:53.440
the treatment for ten, 15, or 21 days.

02:45:53.440 --> 02:45:56.080
As you know, as has already been
discussed here, it depends somewhat on

02:45:56.080 --> 02:45:57.440
the process

02:45:57.440 --> 02:46:00.880
we have, on the type of bacteria where
the infection is located.

02:46:01.680 --> 02:46:05.680
But what happens is that when we start
antibiotic

02:46:05.680 --> 02:46:09.680
treatment, after a few days we start to
feel better and

02:46:09.680 --> 02:46:13.680
then we might start thinking, well, since
I already

02:46:13.680 --> 02:46:17.680
feel better, maybe I don't need to take
it until I finish,

02:46:17.680 --> 02:46:21.520
or we might even be tempted to stop the
treatment and think, well, that's it,

02:46:21.520 --> 02:46:23.440
huh?

02:46:23.560 --> 02:46:27.560
So, my body won't get used to the
antibiotic,

02:46:27.560 --> 02:46:31.560
or I won't have side effects from
stopping

02:46:31.560 --> 02:46:37.040
it, huh? It seems like that's not the
case.

02:46:39.800 --> 02:46:41.320
Huh? So what?

02:46:41.320 --> 02:46:45.200
So we would have two options, huh?

02:46:46.320 --> 02:46:47.440
We could.

02:46:47.440 --> 02:46:51.440
We would have the option of taking it
until the end, or since I'm already

02:46:51.440 --> 02:46:55.320
feeling well, not stopping taking it, and
that way I'm taking only

02:46:55.320 --> 02:46:58.320
what's strictly necessary because I'm
already well.

02:46:58.920 --> 02:47:04.240
So the question we have now is what do
you think, huh?

02:47:07.080 --> 02:47:09.160
Huh? What do you think we should do?

02:47:09.160 --> 02:47:13.160
We can stop without problems because I
already feel well, or would you

02:47:13.160 --> 02:47:16.440
continue, uh, taking the treatment
following the guidelines prescribed by

02:47:16.440 --> 02:47:18.080
the doctor?

02:47:18.920 --> 02:47:20.880
Eva explained this to us very well.

02:47:23.920 --> 02:47:25.360
Yes of course.

02:47:25.360 --> 02:47:28.360
Very good, very good.

02:47:35.040 --> 02:47:37.680
What's your name?

02:47:37.680 --> 02:47:40.680
Well, as it already is.

02:47:48.000 --> 02:47:52.000
What happens, what happens when the
treatment begins, is that

02:47:52.000 --> 02:47:56.920
the antibiotic starts killing those
bacteria that are most sensitive.

02:47:57.240 --> 02:48:01.240
But if I interrupt it before finishing
it, resistant bacteria will

02:48:01.240 --> 02:48:05.240
remain, and when the treatment is
completely stopped, those are the

02:48:05.240 --> 02:48:08.800
ones that will stay, and then we have
already created a problem.

02:48:09.360 --> 02:48:13.360
And this connects with a very important
concept that we have encountered

02:48:13.360 --> 02:48:17.360
many times, which is that, uh, there are
many people who think that by

02:48:17.360 --> 02:48:21.360
taking the antibiotic it is the person
who becomes resistant, but it

02:48:21.360 --> 02:48:25.320
must be emphasized that it is not we who
become resistant to the antibiotic, but

02:48:25.320 --> 02:48:27.320
our bacteria, uh?

02:48:27.640 --> 02:48:30.200
And those bacteria, as we have already
seen, can be transmitted.

02:48:30.200 --> 02:48:34.800
So it's important, uh, to follow the
treatment plan.

02:48:35.200 --> 02:48:36.640
If they have to leave, I don't know.

02:48:36.640 --> 02:48:38.240
In other words, we can continue, it's no
big deal.

02:48:52.000 --> 02:48:53.920
Hey?

02:48:53.920 --> 02:48:56.160
Well, that's all for now. Nice to meet
you.

02:48:56.160 --> 02:49:00.000
Well, you all got top marks, because I
can see you were all paying close

02:49:00.000 --> 02:49:01.960
attention.

02:49:02.680 --> 02:49:04.120
No, nothing happened. Don't worry.

02:49:04.120 --> 02:49:06.240
If it was just because it wasn't like
this one.

02:49:06.240 --> 02:49:08.360
I'm saying something very boring.

02:49:08.360 --> 02:49:09.880
It's okay, it's okay.

02:49:09.880 --> 02:49:12.880
Peaceful.

02:49:13.920 --> 02:49:15.360
Okay, that gives them time.

02:49:15.360 --> 02:49:18.360
And now we move on to the next case.

02:49:30.000 --> 02:49:33.000
This has been antibiotic resistance.

02:49:35.560 --> 02:49:37.520
The exams have this at the end.

02:49:37.520 --> 02:49:37.880
Clear.

02:49:37.880 --> 02:49:41.200
Let's put on the pressure and move on to
the

02:49:41.200 --> 02:49:44.200
next case, which is social pressure.

02:49:45.320 --> 02:49:49.760
Okay, so another typical case is when I
go.

02:49:49.760 --> 02:49:52.040
Okay, I'm going to the doctor. I think I
have an infection.

02:49:52.040 --> 02:49:55.480
Okay, it may happen that I have an
important event or not, but I think I do.

02:49:55.960 --> 02:49:58.600
I think that because of the symptoms I
have, I have identified it with something

02:49:58.600 --> 02:49:59.960
that has

02:49:59.960 --> 02:50:02.400
happened to me before, that I have had
before and I was prescribed an

02:50:02.400 --> 02:50:03.640
antibiotic.

02:50:03.640 --> 02:50:07.640
I am waiting for the doctor, after the
examination and after I

02:50:07.640 --> 02:50:11.640
tell him a little about my history, to
prescribe me an antibiotic,

02:50:11.640 --> 02:50:16.080
and in this case we have also told him
that I have an important event.

02:50:16.080 --> 02:50:19.840
What I want is to feel better as soon as
possible, okay?

02:50:20.240 --> 02:50:21.520
And then I go to the doctor.

02:50:21.520 --> 02:50:25.520
What he tells me is that, based on the
symptoms and the

02:50:25.520 --> 02:50:29.520
medical history, he or she considers that
I have a viral

02:50:29.520 --> 02:50:33.240
infection and that I do not need
antibiotics.

02:50:33.640 --> 02:50:34.440
And then?

02:50:34.440 --> 02:50:38.440
Well, that's where it connects a bit with
needing to feel better as

02:50:38.440 --> 02:50:42.440
soon as possible, and also in this case,
well, I went to my father, my

02:50:42.440 --> 02:50:45.760
mother, I heard them and I said, but
aren't you going to prescribe me an

02:50:45.760 --> 02:50:47.440
antibiotic?

02:50:47.760 --> 02:50:53.040
I think I'm sick enough without needing a
prescription.

02:50:53.040 --> 02:50:57.040
And also I think I've had a bit

02:50:57.040 --> 02:51:01.600
of a fever, etc. And so here we are.

02:51:01.960 --> 02:51:02.960
The question was a little...

02:51:02.960 --> 02:51:06.960
We know that in this case, if the doctor
tells me it's viral, then based

02:51:06.960 --> 02:51:10.960
on everything we've seen, an antibiotic
shouldn't be prescribed, but

02:51:10.960 --> 02:51:14.560
the question is whether you think it's
worth it just in case.

02:51:14.560 --> 02:51:17.440
But I also think, okay, even if they tell
me it's viral, I know I might have a

02:51:17.440 --> 02:51:20.320
bacteria, because I think so because of
the symptoms and all.

02:51:20.320 --> 02:51:24.280
And then, uh, I put a little pressure on
the doctor to prescribe

02:51:24.280 --> 02:51:27.280
that antibiotic because I really think I
need it.

02:51:27.520 --> 02:51:30.520
I don't know if anyone has been through
that situation or not.

02:51:32.120 --> 02:51:37.160
Yes, tell me. Yes

02:51:38.680 --> 02:51:41.680
preventively.

02:51:59.040 --> 02:52:02.240
Yes, but there are reasons for that.

02:52:03.040 --> 02:52:07.040
In other words, there are high-risk
clinical cases when you go into

02:52:07.040 --> 02:52:10.560
surgery where they open you up with an
incision in the operating room; that's a

02:52:10.560 --> 02:52:12.360
lot of risk.

02:52:12.400 --> 02:52:13.440
You have to have one.

02:52:13.440 --> 02:52:16.440
A preventative antibiotic.

02:52:21.840 --> 02:52:24.840
But.

02:52:30.080 --> 02:52:35.440
That's a common clinical practice that
many dentists have.

02:52:35.960 --> 02:52:38.480
But anyway, I'm speaking on behalf of
Human Health.

02:52:38.480 --> 02:52:42.480
Do we have guidelines for prescribing
antimicrobial treatment in the

02:52:42.480 --> 02:52:46.480
community that include oral and dental
infections, because, as Cristiana

02:52:46.480 --> 02:52:49.680
says, there are infections where
antibiotic prophylaxis

02:52:49.680 --> 02:52:52.680
is necessary due to the risk of the
infection itself, right?

02:52:52.720 --> 02:52:56.720
I don't know if you're familiar with
endocarditis caused by dental procedures,

02:52:56.720 --> 02:53:00.640
but there are many others that you're
not, but what the general public

02:53:00.640 --> 02:53:02.640
remembers is that we need an antibiotic.

02:53:02.640 --> 02:53:03.960
If you have a tooth pulled.

02:53:03.960 --> 02:53:05.800
So what we're trying to do here.

02:53:05.800 --> 02:53:09.800
The talk was also somewhat focused on the
topic of students, awareness,

02:53:09.800 --> 02:53:13.800
but we work a lot on raising awareness
among the population, because

02:53:13.800 --> 02:53:17.800
it's not just what professionals do or
don't do, what we investigate

02:53:17.800 --> 02:53:21.240
or don't investigate, it's also what the
population already has in its DNA as a

02:53:21.240 --> 02:53:22.960
society.

02:53:22.960 --> 02:53:24.200
This is what is being talked about and
done.

02:53:24.200 --> 02:53:27.280
And if you don't send it to me because
he's a bad

02:53:27.280 --> 02:53:30.280
professional, then we're also trying to
change that.

02:53:30.320 --> 02:53:32.200
Another problem, yes.

02:53:33.480 --> 02:53:42.040
Yes. Our dad, look.

02:53:43.120 --> 02:53:48.920
When the port arrives, I see him, I thank
him because he has no antibiotics left.

02:53:49.200 --> 02:53:52.200
I'll see if it works for me.

02:53:52.480 --> 02:53:55.400
I believe.

02:53:55.400 --> 02:53:58.360
Another question.

02:53:58.360 --> 02:54:00.400
In the end.

02:54:00.400 --> 02:54:04.400
So it seems that no matter how much I
tell them everything

02:54:04.400 --> 02:54:07.600
since Monday last time, I think there is
a.

02:54:08.160 --> 02:54:12.160
There is pressure and I think there is a
lack of conceptual understanding

02:54:12.160 --> 02:54:16.160
that we should already have that person
vaccinated so that we know we are

02:54:16.160 --> 02:54:19.920
there, because if you are not asking for
a sacrifice that also has to do with

02:54:19.920 --> 02:54:21.840
yourself, well, okay.

02:54:21.840 --> 02:54:25.040
But we get nervous around small children,
right?

02:54:25.400 --> 02:54:26.600
It's inexplicable.

02:54:26.600 --> 02:54:30.600
In fact, that's what I was going to say,
that this problem of

02:54:30.600 --> 02:54:34.600
pressure is especially pronounced in
children, because

02:54:34.600 --> 02:54:38.600
there is greater pressure to prescribe
antibiotics, and for

02:54:38.600 --> 02:54:42.600
that reason one of the lines we are
working on in the plan is to

02:54:42.600 --> 02:54:46.600
develop guidelines in which the doctor
has a clear decision

02:54:46.600 --> 02:54:50.520
tree to see when to prescribe antibiotics
and when not to, having a ten-year basis

02:54:50.520 --> 02:54:52.480
to rely on.

02:54:52.560 --> 02:54:55.440
When you have these questions that I'm
talking about.

02:55:05.080 --> 02:55:09.120
Well, we also have campaigns in the plan.

02:55:20.640 --> 02:55:24.640
Of course, the pressure to prescribe is
one of the

02:55:24.640 --> 02:55:28.120
problems because more antibiotics are
prescribed

02:55:28.120 --> 02:55:31.120
than should actually be prescribed.

02:55:32.080 --> 02:55:35.080
Okay.

02:55:58.000 --> 02:56:02.800
That's all that's left.

02:56:08.520 --> 02:56:11.520
Now.

02:56:12.720 --> 02:56:15.000
We're doing something right with the
plan.

02:56:15.000 --> 02:56:15.880
We're doing something.

02:56:15.880 --> 02:56:18.880
TRUE.

02:56:47.600 --> 02:56:51.520
Yes. Yes, there are.

02:56:51.520 --> 02:56:54.200
There is another measure that is not yet
implemented because it is very difficult

02:56:54.200 --> 02:56:56.920
to implement, which is called deferred
prescription.

02:56:57.280 --> 02:57:00.840
Delayed prescription means that the
doctor prescribes an antibiotic

02:57:00.840 --> 02:57:03.840
and you leave it to your responsibility
to take it.

02:57:03.840 --> 02:57:07.720
The system kind of unlocks it for you
after a few days so you can get it.

02:57:07.720 --> 02:57:08.760
The problem?

02:57:08.760 --> 02:57:12.760
There is no rapid test for all bacteria
in the office, so of

02:57:12.760 --> 02:57:16.320
course, but a culture is not viable in
many situations

02:57:16.320 --> 02:57:19.320
because you don't know which bacteria you
have.

02:57:19.320 --> 02:57:23.320
It will probably take longer to take him
to the hospital, the

02:57:23.320 --> 02:57:27.320
culture, the return and the result than
to give an empirical

02:57:27.320 --> 02:57:30.720
therapy that charges you in case it is
suspected to be bacterial and not viral

02:57:30.720 --> 02:57:32.440
as well.

02:57:32.440 --> 02:57:36.320
What we do have are more rapid viral
tests, but for what?

02:57:36.320 --> 02:57:40.000
To confirm it, to say, "Hey, look, I
haven't confirmed that it's bacterial,

02:57:40.000 --> 02:57:43.000
but I have confirmed that it's viral, so
you can't take it."

02:57:43.000 --> 02:57:47.000
And then there's also an environment
where the sampling is different,

02:57:47.000 --> 02:57:51.000
there may be more contamination, you take
it to the lab, a thousand

02:57:51.000 --> 02:57:54.840
things grow and you don't know if you
want to, if not, what to do.

02:57:54.840 --> 02:57:58.600
You give a person who is in the community
with a crop that you believe

02:57:58.600 --> 02:58:01.600
has contamination, a 4th generation
cephalosporin.

02:58:01.600 --> 02:58:04.840
Well, it's a little bit uncertain.

02:58:04.840 --> 02:58:08.120
Of course, if it gets worse, if it goes
further, that's when we have to go to the

02:58:08.120 --> 02:58:09.760
hospital.

02:58:09.760 --> 02:58:13.000
Are there also clinical criteria in the
pathways where the primary care physician

02:58:13.000 --> 02:58:14.640
refers you to the hospital, and why?

02:58:14.640 --> 02:58:18.440
Because that infection is considered to
no longer be treatable in the community

02:58:18.440 --> 02:58:20.360
with community resources.

02:58:20.680 --> 02:58:24.680
If you need to have a bronchial wash or
any other more invasive procedure, you

02:58:24.680 --> 02:58:27.360
need to be taken to the hospital so that
you can be treated in the best possible

02:58:27.360 --> 02:58:28.720
way.

02:58:28.720 --> 02:58:32.120
That's why there's a middle ground, and
also delayed prescription, but I'm

02:58:32.120 --> 02:58:35.120
telling you it's very complicated because
it depends a lot on the patient.

02:58:35.200 --> 02:58:38.280
I also have an 18-month-old baby and it's
extremely difficult.

02:58:38.280 --> 02:58:41.440
In other words, I've managed to stick
with the three-in-one recipe for four

02:58:41.440 --> 02:58:43.040
days.

02:58:43.040 --> 02:58:43.560
Because?

02:58:43.560 --> 02:58:46.040
Because I say, I don't know if it's
conjunctivitis in my son; in three days

02:58:46.040 --> 02:58:47.320
he hasn't improved. They give

02:58:47.320 --> 02:58:49.320
it to my poor son and he wakes up with so
much eye discharge that he can't open his

02:58:49.320 --> 02:58:50.320
eyes.

02:58:50.320 --> 02:58:53.720
And I say, well now it does cost, it
costs a lot, it costs a fortune.

02:58:57.760 --> 02:59:01.760
No, I mean, I don't know if there's been
more

02:59:01.760 --> 02:59:05.760
awareness in recent years, but doctors

02:59:05.760 --> 02:59:09.640
themselves weren't as up-to-date a few
years ago.

02:59:09.640 --> 02:59:11.320
With all the problems surrounding
antibiotics.

02:59:11.320 --> 02:59:15.320
And yes, the doctors themselves end up
not raising awareness

02:59:15.320 --> 02:59:19.320
properly because they are not up-to-date,
the population cannot

02:59:19.320 --> 02:59:23.320
keep up-to-date either, and in the end
the population depends a

02:59:23.320 --> 02:59:27.000
lot on the opinion of a doctor or what a
doctor says, sorry, a doctor, a nurse, a

02:59:27.000 --> 02:59:28.840
specialist.

02:59:28.840 --> 02:59:32.560
And if the specialist is not informed,
that's one thing, and then another.

02:59:33.040 --> 02:59:35.200
the topic of

02:59:35.200 --> 02:59:36.800
of the crops and such.

02:59:36.800 --> 02:59:39.640
So I think it takes a long time for a day
to grow.

02:59:39.640 --> 02:59:40.960
What grows.

02:59:40.960 --> 02:59:45.440
Choose a colony, identify it, and see if
it is resistant.

02:59:45.440 --> 02:59:47.760
It takes another day, and by the time you
want to see it, you're already in very

02:59:47.760 --> 02:59:48.960
bad shape.

02:59:49.120 --> 02:59:53.120
And the time it takes to get the remedy
they can give you isn't worth it, because

02:59:53.120 --> 02:59:56.120
the antibiotic will be the same, the one
they'll be giving you until the culture

02:59:56.120 --> 02:59:57.640
comes back.

02:59:57.640 --> 03:00:00.280
So in the end, sometimes if you were
quick to get strep throat for

03:00:00.280 --> 03:00:01.640
tonsillitis, it's

03:00:01.640 --> 03:00:05.160
worth it, because it's proven to be the
bacteria that most commonly causes

03:00:05.160 --> 03:00:06.960
tonsillitis in the community.

03:00:07.240 --> 03:00:09.800
So there are certain things that we do
know and others that escape us, besides

03:00:09.800 --> 03:00:11.080
the

03:00:11.080 --> 03:00:14.080
fact that many bacterial infections are
also self-limiting.

03:00:14.120 --> 03:00:19.640
I mean, it's not that they all,
absolutely all, need anti-therapy.

03:00:19.640 --> 03:00:22.560
That's why there's also the level of
observation time.

03:00:22.560 --> 03:00:24.240
You have what everyone has.

03:00:24.240 --> 03:00:27.560
Well, let's see, let's wait and see, it's
not about delaying it just for the sake

03:00:27.560 --> 03:00:29.240
of delaying it.

03:00:29.240 --> 03:00:33.240
My husband often tells me, "I take it
just in case, you know, 'the shoemaker's

03:00:33.240 --> 03:00:36.960
children go barefoot,' but I take it just
in case, because what harm can it do?"

03:00:36.960 --> 03:00:38.840
Well, all this, all this.

03:00:38.840 --> 03:00:41.920
We have to explain what happens because
when you experience

03:00:41.920 --> 03:00:44.920
it firsthand, it's very complicated, very
complicated.

03:00:45.520 --> 03:00:46.960
Just a quick thing.

03:00:46.960 --> 03:00:50.960
When I was in the UK they had something
that sounds familiar to me, this

03:00:50.960 --> 03:00:54.960
delayed prescription thing, because you'd
go in with a urinary tract

03:00:54.960 --> 03:00:58.960
infection and they'd give you a generic
thing and take the samples and

03:00:58.960 --> 03:01:02.480
two days later they'd call you and say
take this or take this other thing and

03:01:02.480 --> 03:01:04.240
we'd put it on your card.

03:01:04.840 --> 03:01:07.480
I mean, I don't know if it was at the
level of the entire health system, if it

03:01:07.480 --> 03:01:08.840
was a pilot

03:01:08.840 --> 03:01:12.520
program, but I remember when they were
doing it in Sweden and here they are

03:01:12.520 --> 03:01:14.360
really trying to fine-tune it, right?

03:01:15.880 --> 03:01:19.880
And now that we're here, the university
working sector, there's

03:01:19.880 --> 03:01:23.880
something very important: when you affect
the pockets of the

03:01:23.880 --> 03:01:27.880
State, those in charge, then a delayed
prescription has proven

03:01:27.880 --> 03:01:31.640
to be one of the most cost-effective
measures, along with prevention, to

03:01:31.640 --> 03:01:33.560
prevent resistance.

03:01:33.560 --> 03:01:36.920
So, all that stuff he does, hey, I want
this deferred prescription.

03:01:36.920 --> 03:01:40.920
In fact, deferred prescription is within
the basic portfolio of

03:01:40.920 --> 03:01:44.560
the National Health System, that is, it
is included as a service,

03:01:44.560 --> 03:01:47.560
but it is very difficult to implement
systems.

03:01:47.560 --> 03:01:50.400
I'm going to tell you about our troubles
because we're going to cry at the

03:01:50.400 --> 03:01:53.240
bookstore, but it's very complicated in
many ways.

03:01:55.400 --> 03:02:00.880
There is no risk, there is no risk with
that type of prescription that it is.

03:02:00.960 --> 03:02:04.520
So after four days, if the person is not
feeling well and then feels well, they

03:02:04.520 --> 03:02:06.320
also take antibiotics to have at home.

03:02:06.320 --> 03:02:10.360
Given the obsession that exists, I'll
take it anyway.

03:02:10.360 --> 03:02:11.960
Yes, there is, absolutely.

03:02:11.960 --> 03:02:15.960
Ultimately, it's like offering the option
of having a backup

03:02:15.960 --> 03:02:19.960
antibiotic, but the difference is that in
this case, you leave the

03:02:19.960 --> 03:02:24.480
consultation with a delayed prescription
or with a prescription already written.

03:02:24.880 --> 03:02:27.840
So, with delayed prescription, there are
a lot of studies.

03:02:27.840 --> 03:02:31.840
In fact, a few years ago we sent it to
the Health Technology Assessment Network

03:02:31.840 --> 03:02:35.600
to do a literature review of all the
scientific evidence that exists for the

03:02:35.600 --> 03:02:37.480
use of delayed prescribing.

03:02:37.800 --> 03:02:41.800
And there is a percentage that improves,
that improves, not all, obviously,

03:02:41.800 --> 03:02:45.800
because in the end many relapse, but
compared to going out with the prescribed

03:02:45.800 --> 03:02:49.800
antibiotic, well, going out with it is
not comparing it with not prescribing

03:02:49.800 --> 03:02:53.120
because not prescribing is because you
firmly believe that it would not be.

03:02:57.160 --> 03:02:58.560
Of course, I'll return it too.

03:02:58.560 --> 03:03:01.560
That's where we introduce a factor which
is the burden on the health system.

03:03:04.960 --> 03:03:08.960
Sure, but that's why all of this is going
to be together because, as Cristian

03:03:08.960 --> 03:03:12.520
mentioned, in the end we have many lines
that run in parallel. They run absolutely

03:03:12.520 --> 03:03:14.320
in parallel because we can't.

03:03:14.320 --> 03:03:18.320
Well, the truth is that I don't know how
to continue

03:03:18.320 --> 03:03:22.320
the talk because it was planned for
something else,

03:03:22.320 --> 03:03:26.440
but what we can do is also show you the,
the, the.

03:03:26.520 --> 03:03:29.160
What is the name of the campaign we have
for the population, because it is

03:03:29.160 --> 03:03:30.520
something

03:03:30.520 --> 03:03:33.160
very important that we also do from the
plan and also, of course, from the

03:03:33.160 --> 03:03:34.520
veterinary

03:03:34.520 --> 03:03:38.480
side, which I understand is what escapes
us all a little, and I include myself.

03:03:38.480 --> 03:03:42.000
In case you were interested in us telling
you a little bit about this part and

03:03:42.000 --> 03:03:43.760
continuing like this.

03:03:43.760 --> 03:03:48.200
And of course, then leave it open for
debate until you want it to be.

03:03:48.200 --> 03:03:49.960
I feel a bit bad for all the kids.

03:03:55.240 --> 03:03:57.240
We present the latest case.

03:03:57.240 --> 03:03:58.880
Okay, then, the last case.

03:03:58.880 --> 03:04:02.880
As you have seen, we work from a
perspective or angle that includes

03:04:02.880 --> 03:04:06.880
Veterinary Medicine, Environment, Public
Health, and Medicine,

03:04:06.880 --> 03:04:11.440
and we want to present this case where we
know that the meat contains antibiotics.

03:04:12.000 --> 03:04:15.640
The meat we eat is full of antibiotics;
in the end, we are ingesting them, and

03:04:15.640 --> 03:04:17.480
that is why there is resistance.

03:04:17.920 --> 03:04:20.920
How many of you here have ever heard
that?

03:04:23.600 --> 03:04:25.000
Many.

03:04:25.000 --> 03:04:27.600
Okay. What?

03:04:27.600 --> 03:04:27.840
That?

03:04:27.840 --> 03:04:32.280
What percentage of plausibility do you
think that has?

03:04:34.600 --> 03:04:37.600
That statement?

03:04:39.000 --> 03:04:41.200
It depends on where you live.

03:04:41.200 --> 03:04:44.200
In Spain, in Spain?

03:04:45.960 --> 03:04:48.200
Okay.

03:04:48.200 --> 03:04:52.000
Well, as we told you about antibiotics.

03:04:52.000 --> 03:04:55.400
Of course they are used in animals, but
only when the animals

03:04:55.400 --> 03:04:58.400
need them, when they have a bacterial
infection.

03:04:58.400 --> 03:04:59.200
Okay.

03:04:59.200 --> 03:05:02.840
And also because they could be used a
long time ago to help them grow better.

03:05:02.840 --> 03:05:06.280
But the use of antibiotics as growth
promoters has been banned in the European

03:05:06.280 --> 03:05:08.000
Union for more than 20 years.

03:05:08.000 --> 03:05:12.160
Therefore, antibiotics are not used in
Europe to make animals grow.

03:05:12.160 --> 03:05:16.160
But also, when we use an antibiotic to
treat an animal,

03:05:16.160 --> 03:05:20.160
all antibiotics, all medications, have
what is called

03:05:20.160 --> 03:05:24.160
a waiting period, which is a minimum time
that must

03:05:24.160 --> 03:05:28.160
elapse between when you apply the last
application of

03:05:28.160 --> 03:05:33.520
antibiotic to that animal and when you
can take food from those animals.

03:05:33.760 --> 03:05:36.520
Okay, and this includes all breeds of
animals raised for consumption,

03:05:36.520 --> 03:05:37.920
including, for example, bees.

03:05:39.000 --> 03:05:42.840
There may also be treatments for certain
infestations, and honey is taken.

03:05:43.280 --> 03:05:44.800
Okay.

03:05:44.800 --> 03:05:46.720
Therefore, in addition.

03:05:46.720 --> 03:05:48.200
In addition, there are controls.

03:05:48.200 --> 03:05:50.760
Okay, there are controls in
slaughterhouses, there are controls in

03:05:50.760 --> 03:05:52.080
the food chain.

03:05:52.080 --> 03:05:54.160
So this isn't just about it being written
on a piece of paper.

03:05:54.160 --> 03:05:55.480
This is under control.

03:05:55.480 --> 03:05:58.480
Therefore, the food we eat does

03:05:58.480 --> 03:06:01.480
not have to contain antibiotics.

03:06:08.120 --> 03:06:11.120
There would be.

03:06:11.320 --> 03:06:13.960
If outside the European Union there is no
such control and a person goes on a trip

03:06:13.960 --> 03:06:15.320
or

03:06:15.320 --> 03:06:18.720
all the people who go on a trip eat meat
outside the European Union and then come

03:06:18.720 --> 03:06:20.440
back to the European Union.

03:06:20.440 --> 03:06:24.080
In the end, the controls, that is, they
can also bring bacteria, their controls,

03:06:24.080 --> 03:06:25.920
there are border controls.

03:06:25.920 --> 03:06:28.520
And this is something else, as I told you
at the beginning.

03:06:28.520 --> 03:06:30.680
That's why, well, I didn't want to get
too involved, but I do think it's

03:06:30.680 --> 03:06:31.800
important to differentiate between them.

03:06:31.800 --> 03:06:34.800
Using antibiotics as growth promoters is
one thing.

03:06:34.800 --> 03:06:38.800
There are countries where they can be
used, and another thing is that

03:06:38.800 --> 03:06:42.800
the waiting time doesn't have to be
respected. The waiting time always

03:06:42.800 --> 03:06:46.800
has to be respected, okay. And when food
comes from other countries

03:06:46.800 --> 03:06:51.280
there are border controls, there are
inspection points where checks are done.

03:06:51.280 --> 03:06:53.920
Obviously, it is not possible to inspect
all carcasses, all honeys, all food

03:06:53.920 --> 03:06:55.280
products

03:06:55.280 --> 03:06:58.800
that arrive from other countries, but
checks and controls are carried out at

03:06:58.800 --> 03:07:00.600
the level of the entire European Union.

03:07:06.080 --> 03:07:09.080
I mean.

03:07:12.440 --> 03:07:15.320
Homes.

03:07:15.320 --> 03:07:16.960
But not just meat.

03:07:16.960 --> 03:07:19.440
Directly from being in a hotel or a
place.

03:07:19.440 --> 03:07:23.440
In other words, there are studies done on
people who have traveled in less than

03:07:23.440 --> 03:07:26.840
24 hours and simply by being in one
country and another place you are

03:07:26.840 --> 03:07:29.840
exposed to other resistances, and that's
just to add up.

03:07:30.400 --> 03:07:34.400
I, for example, have worked on a project
in Argentina that we

03:07:34.400 --> 03:07:37.640
called resistances, also a research
project and in

03:07:37.640 --> 03:07:40.640
Argentina, for example, regulatory, the
export.

03:07:40.720 --> 03:07:44.720
In other words, there are different rules
if the meat is going to be exported

03:07:44.720 --> 03:07:48.480
to Europe; some products cannot use
growth promoters and have applicable

03:07:48.480 --> 03:07:50.360
legislation for those products.

03:07:50.360 --> 03:07:53.160
Okay, not everything fits in the same
way.

03:07:53.160 --> 03:07:56.280
In other words, they have to comply with
certain regulations in order to export to

03:07:56.280 --> 03:07:57.840
the European Union.

03:08:02.480 --> 03:08:06.480
There are many researchers who have been
looking at that too, and

03:08:06.480 --> 03:08:10.160
we're going to talk about what there are
actually published studies of a trip of

03:08:10.160 --> 03:08:12.040
less than a day.

03:08:12.200 --> 03:08:15.520
And when you return, what do you bring
back from other places?

03:08:15.760 --> 03:08:17.840
Simply because you're exposed to a
different environment?

03:08:17.840 --> 03:08:20.440
Okay.

03:08:20.440 --> 03:08:23.440
Therefore, yes.

03:08:27.440 --> 03:08:29.320
Now I'm going to take advantage of the
fact that you all know a lot about that.

03:08:29.320 --> 03:08:33.320
And I also see a lot of veterinarians
around here because it's a

03:08:33.320 --> 03:08:37.640
very basic thing, but why are antibiotics
used as growth promoters?

03:08:38.040 --> 03:08:38.920
So, what does it do?

03:08:38.920 --> 03:08:42.920
In other words, animals simply have fewer
infections and that's why they grow more,

03:08:42.920 --> 03:08:45.480
because it's something I've always
wondered about, but I'm never going to

03:08:45.480 --> 03:08:46.800
ask about it.

03:08:48.080 --> 03:08:49.760
Well, there are several reasons.

03:08:49.760 --> 03:08:52.120
In other words, the thing is that
empirically it was seen that they grew

03:08:52.120 --> 03:08:53.320
more.

03:08:53.480 --> 03:08:57.480
The explanations are varied because, in
addition, the doses used are

03:08:57.480 --> 03:09:01.480
worse because the growth promoters are
actually being used at

03:09:01.480 --> 03:09:05.720
therapeutic doses, which further
encourages the emergence of resistance.

03:09:05.960 --> 03:09:09.960
So let's say they might be eliminating
some infections,

03:09:09.960 --> 03:09:13.120
interacting with the immune system, and
that makes

03:09:13.120 --> 03:09:16.120
the animal grow faster, just like there
are others.

03:09:16.120 --> 03:09:19.840
In other words, let's say that among
those that promote growth, there are also

03:09:19.840 --> 03:09:22.840
other compounds that have been used that
are not antibiotics.

03:09:23.560 --> 03:09:26.000
But come on, that would be a bit of what
underlies it.

03:09:26.000 --> 03:09:28.920
And of course, they are used massively.

03:09:28.920 --> 03:09:32.800
So let's say it's because they are used
with the feed that the animals

03:09:32.800 --> 03:09:35.800
are treated with, so this is one of the
reasons.

03:09:35.960 --> 03:09:36.840
I don't know if it's because he says
that.

03:09:40.080 --> 03:09:42.960
Like, like.

03:09:42.960 --> 03:09:46.960
Let's just say it was seen, uh, within
the complex relationship that

03:09:46.960 --> 03:09:50.480
exists between use and resistance, which
is not all as straightforward as we might

03:09:50.480 --> 03:09:52.240
think.

03:09:52.240 --> 03:09:56.240
Obviously, I use higher pressure, uh,
resistance, but there are

03:09:56.240 --> 03:10:00.240
many factors that are there, and one of
the things that was seen is

03:10:00.240 --> 03:10:04.240
the relationship that when it decreased,
of course, since it was a

03:10:04.240 --> 03:10:08.240
massive use, when it was withdrawn, the
effects began to be noticeable

03:10:08.240 --> 03:10:12.240
that all those profiles no longer
appeared because the biggest

03:10:12.240 --> 03:10:16.240
problem that existed was that it wasn't
the antibiotics exactly,

03:10:16.240 --> 03:10:19.560
but it was the version that was seen that
way, the most

03:10:19.560 --> 03:10:22.560
evident was Virginia Medicine, which is a
clear sense.

03:10:22.720 --> 03:10:26.720
And there we have vancomycin, and
vancomycin is the last resort

03:10:26.720 --> 03:10:30.080
antibiotic used to treat nosocomial
valvular endocarditis

03:10:30.080 --> 03:10:33.080
infections in hospitals caused by
staphylococci.

03:10:33.080 --> 03:10:35.960
But of course, the bacteria that carries
it is the whole organism and there can be

03:10:35.960 --> 03:10:37.400
transfer between one and the other.

03:10:37.400 --> 03:10:40.040
Then, uh, that's when it became clear
that there was a relationship, when it

03:10:40.040 --> 03:10:41.400
became clear

03:10:41.400 --> 03:10:44.040
what was happening with the corner, it
became clear that it was a problem that

03:10:44.040 --> 03:10:45.400
of course

03:10:45.400 --> 03:10:48.680
there were people who were dying because
you could no longer treat them with the

03:10:48.680 --> 03:10:50.320
antibiotic that was reserved.

03:10:54.640 --> 03:10:57.640
Any other questions?

03:10:58.600 --> 03:11:01.600
Correct.

03:11:01.600 --> 03:11:03.440
Well, that's the message.

03:11:03.440 --> 03:11:04.760
The meat we eat is safe.

03:11:04.760 --> 03:11:07.160
It does not contain antibiotics.

03:11:07.160 --> 03:11:09.520
If you don't want to eat meat, that's
another matter.

03:11:09.520 --> 03:11:12.960
And above all, you should always get your
information from reliable sources.

03:11:13.400 --> 03:11:17.240
It's useful for avoiding hoaxes, because,
as in all areas of life, there are a lot

03:11:17.240 --> 03:11:19.160
of hoaxes going around.

03:11:19.160 --> 03:11:23.160
And I think that to conclude, I found
this useful and especially

03:11:23.160 --> 03:11:27.000
helpful, in case you want to use it in
one of your sessions.

03:11:27.400 --> 03:11:28.360
But we're going for it.

03:11:28.360 --> 03:11:31.640
I really wanted to do the performance
because we were going to tell all the

03:11:31.640 --> 03:11:33.280
kids to hold hands with so-and-so.

03:11:33.280 --> 03:11:33.880
And why?

03:11:33.880 --> 03:11:35.080
Because I studied in 2013.

03:11:35.080 --> 03:11:38.960
He said that only 5% of people wash their
hands properly.

03:11:39.520 --> 03:11:43.520
The study is old, from 2013, total 5%,
that is, 5% do not

03:11:43.520 --> 03:11:47.520
wash their hands well, 33% advertise
soap, 10% do not

03:11:47.520 --> 03:11:50.720
even wash them after going to the
bathroom.

03:11:51.320 --> 03:11:55.320
In a more recent study, in 2025, with the
data on the

03:11:55.320 --> 03:11:59.280
left, 48% did not wash their hands
directly, 62% knew that they had to do

03:11:59.280 --> 03:12:01.280
it.

03:12:01.280 --> 03:12:06.240
During it puts less, but it is more than
20 seconds and 30%.

03:12:06.240 --> 03:12:11.320
This slipped my mind, but 30% weren't
washing their hands.

03:12:11.320 --> 03:12:12.920
After this, you will sneeze.

03:12:12.920 --> 03:12:15.560
But anyway, if you want to use it for a
future conversation, it's something like

03:12:15.560 --> 03:12:16.920
how shocking it is to shake

03:12:16.920 --> 03:12:19.120
someone's hand and not know if they've
been to the bathroom before and now it's

03:12:19.120 --> 03:12:20.240
your turn.

03:12:20.480 --> 03:12:22.640
It doesn't do anything either.

03:12:22.640 --> 03:12:26.640
The key phrases that you all already
know, and

03:12:26.640 --> 03:12:30.880
above all we wanted to show you this
year's campaign.

03:12:30.880 --> 03:12:33.200
Let's see if there's any mention of
Fleming's healthcare, which has barely

03:12:33.200 --> 03:12:34.360
been heard today.

03:12:34.880 --> 03:12:38.880
Well, people like the campaign about
Fleming, the discoverer of the first

03:12:38.880 --> 03:12:42.720
antibiotic, and this is his face when he
has to use them incorrectly because he

03:12:42.720 --> 03:12:44.640
takes them without a prescription.

03:12:44.640 --> 03:12:48.000
You don't finish the treatment or you

03:12:48.000 --> 03:12:51.000
use them against pain, fever or flu.

03:12:51.360 --> 03:12:55.480
Antibiotics are ceasing to work in people
and animals due to misuse.

03:12:55.480 --> 03:12:58.680
Using antibiotics properly means going to
the Ministry of Health.

03:12:58.680 --> 03:13:01.680
The government of Spain.

03:13:04.960 --> 03:13:08.960
And I don't know, for younger people, to
debunk

03:13:08.960 --> 03:13:12.960
all the myths that we have and are going
to talk

03:13:12.960 --> 03:13:16.960
about today, well, this was this year's
campaign

03:13:16.960 --> 03:13:19.960
that we are going to repeat next year.

03:13:20.640 --> 03:13:24.640
And of course, you probably haven't seen

03:13:24.640 --> 03:13:29.960
it and you're not, but it's for a general
audience.

03:13:29.960 --> 03:13:31.240
For more.

03:13:31.240 --> 03:13:35.240
We launched more during Antibiotic

03:13:35.240 --> 03:13:40.120
Awareness Week 18 throughout the month of
November.

03:13:40.880 --> 03:13:41.960
But it doesn't reach everyone.

03:13:41.960 --> 03:13:43.000
That's right.

03:13:43.000 --> 03:13:45.520
The plan also includes a communications
team.

03:13:45.520 --> 03:13:48.160
Dale, with whom we work on all these
messages, and they are the ones who help

03:13:48.160 --> 03:13:49.520
us,

03:13:49.520 --> 03:13:53.080
well, to reach the younger population
without having to say anything

03:13:53.080 --> 03:13:56.080
and without having to seem like we're
doing anything.

03:13:56.080 --> 03:13:58.240
Our parents were like that when we were
young.

03:13:58.240 --> 03:14:03.360
So if you need any resources, know that
you can contact us because we have them.

03:14:03.360 --> 03:14:07.360
Furthermore, we have them in a thousand
languages, including Basque; we can make

03:14:07.360 --> 03:14:10.240
them in English, Catalan, Galician, and
we can distribute them without any

03:14:10.240 --> 03:14:11.720
hassle.

03:14:11.720 --> 03:14:15.000
Then we were going to ask them what they
could do better, since it was their

03:14:15.000 --> 03:14:16.640
responsibility.

03:14:16.640 --> 03:14:18.760
And finally, we are all for each other.

03:14:27.040 --> 03:14:29.680
I don't know if you have any questions
that have come up for discussion, I don't

03:14:29.680 --> 03:14:31.040
know how long we can

03:14:31.040 --> 03:14:34.080
have another round, because there has
already been a lot of discussion, eh?

03:14:34.240 --> 03:14:37.560
Or we can leave it here for whatever
reason you prefer.

03:14:42.600 --> 03:14:45.600
Well, many.

03:15:01.880 --> 03:15:05.880
If we also fail to raise awareness among
healthcare professionals

03:15:05.880 --> 03:15:09.760
and not just place the blame on the
population, we're doing it wrong.

03:15:09.760 --> 03:15:10.960
Everyone at some point.

03:15:10.960 --> 03:15:13.600
So it's simply a matter of focusing on
all sectors, seeing what's being done

03:15:13.600 --> 03:15:14.960
wrong,

03:15:14.960 --> 03:15:18.960
what's being done right, without pointing
fingers, without blaming, simply with

03:15:18.960 --> 03:15:21.840
the sole objective of improving and
ensuring that everything is for the sake

03:15:21.840 --> 03:15:23.320
of public health.

03:15:27.280 --> 03:15:31.280
But one of the things we always talked
about, and Cristina has also

03:15:31.280 --> 03:15:35.280
come to our class, was the microworld,
and that's what's being done

03:15:35.280 --> 03:15:38.600
now for the environmental health sector,
because I think it's the most important

03:15:38.600 --> 03:15:40.280
thing.

03:15:40.960 --> 03:15:43.960
It's very difficult in general, but
environmental health is very broad, isn't

03:15:43.960 --> 03:15:45.480
it?

03:15:45.840 --> 03:15:47.520
What is being done now, or what are you
doing?

03:15:48.960 --> 03:15:52.960
Well, first it seems that we don't put it
first, it seems not, but they

03:15:52.960 --> 03:15:56.960
are still finishing defining what the
environment is, where things

03:15:56.960 --> 03:16:00.960
are, where to look for it, because in the
end the medicines that reach

03:16:00.960 --> 03:16:04.880
the environment, which we were also going
to talk about, the point of

03:16:04.880 --> 03:16:07.880
taking all the surplus medicines, not
just antibiotics.

03:16:07.880 --> 03:16:09.800
He continues to the point, eh.

03:16:09.800 --> 03:16:13.800
Then they have a transformation in the
environment, for example

03:16:13.800 --> 03:16:16.840
in multidisciplinarity it is the most
consumed.

03:16:16.840 --> 03:16:18.520
It's good for the environment.

03:16:18.520 --> 03:16:21.280
It immediately degrades into an inactive
form.

03:16:21.280 --> 03:16:22.880
So it's the most consumed.

03:16:22.880 --> 03:16:25.560
Okay, but that's not the main problem in
the environment.

03:16:25.560 --> 03:16:29.560
So right now we're still going to be
reviewing the third

03:16:29.560 --> 03:16:33.160
document internally and externally,
because the first

03:16:33.160 --> 03:16:36.160
one was what to look for, which was an
analysis.

03:16:36.160 --> 03:16:40.160
Furthermore, it's very methodical at a
chemical level,

03:16:40.160 --> 03:16:44.160
looking at what is released in the
environment, what we can

03:16:44.160 --> 03:16:48.160
find, and therefore, what metabolites we
need to look for

03:16:48.160 --> 03:16:52.160
that can generate resistance in the
bacteria of the

03:16:52.160 --> 03:16:56.160
environment and that can therefore be
transferred to wild

03:16:56.160 --> 03:17:00.160
animals, livestock, and people in
recreational waters,

03:17:00.160 --> 03:17:03.680
because this summer we're all going to
swim there,

03:17:03.680 --> 03:17:06.680
but we have to look for everything, all
of that.

03:17:06.680 --> 03:17:09.880
So those were the emission sources,
right?

03:17:10.200 --> 03:17:13.280
The only ones searching for the source of
that emission are the hospitals.

03:17:13.520 --> 03:17:17.520
If 80% of consumption is in the
community, in fact there are a lot of

03:17:17.520 --> 03:17:21.520
studies that also look at socioeconomic
levels, showing the

03:17:21.520 --> 03:17:25.800
different neighborhoods where antibiotic
consumption is higher or lower.

03:17:25.800 --> 03:17:29.960
In the end, there are many factors out
there that aren't in our report.

03:17:29.960 --> 03:17:32.680
This is a separate study, but it is the
second report and this is the third

03:17:32.680 --> 03:17:34.040
report.

03:17:34.480 --> 03:17:38.480
I'm not sure if that was why, uh, what to
look

03:17:38.480 --> 03:17:42.080
for, uh, this is where it came from.

03:17:42.080 --> 03:17:46.080
And this is when I'm not sure because we
haven't reviewed it yet, but

03:17:46.080 --> 03:17:50.080
the environmental colleagues are on it,
apart from that there are a

03:17:50.080 --> 03:17:54.080
lot of initiatives now the environment
and not as understood as a

03:17:54.080 --> 03:17:57.800
hospital environment or the environment
as climate change, but as the

03:17:57.800 --> 03:17:59.680
environment, as surroundings.

03:18:00.040 --> 03:18:04.040
It's on everyone's lips in Europe, and
Spain is quite a pioneer

03:18:04.040 --> 03:18:08.040
in the field of environmental work, which
is why the colleagues

03:18:08.040 --> 03:18:12.040
from the agency and from Paraná are
working on both sides, they

03:18:12.040 --> 03:18:16.720
are very active with everything, of
course, that's all I'm going to add.

03:18:16.960 --> 03:18:20.960
The environment was the guiding principle
of the

03:18:20.960 --> 03:18:24.960
plan that started later, it came together
in 2019,

03:18:24.960 --> 03:18:28.960
uh, and the truth is that it began as a
working group

03:18:28.960 --> 03:18:32.960
where they tried to find consensus, to
understand

03:18:32.960 --> 03:18:36.960
a little more about all this
environmental problem,

03:18:36.960 --> 03:18:40.960
they were going to look for where to
look, how, how,

03:18:40.960 --> 03:18:44.960
how the active principles of the
environment

03:18:44.960 --> 03:18:48.960
acted, that is, and it was also starting
to work on

03:18:48.960 --> 03:18:52.960
monitoring methodologies, to draw up
environmental

03:18:52.960 --> 03:18:57.760
monitoring systems by doing pilot
projects.

03:18:57.960 --> 03:19:01.960
But of course, it does not yet have a
structure of six

03:19:01.960 --> 03:19:06.520
strategic lines, such as in human
medicine or animal health.

03:19:08.160 --> 03:19:10.000
Since we have a plan.

03:19:10.000 --> 03:19:14.000
But it is a very active group and the
truth is that

03:19:14.000 --> 03:19:19.480
it is doing some very pioneering things
that are an example in Europe

03:19:19.480 --> 03:19:22.480
and in the world.

03:19:23.920 --> 03:19:27.920
We've more or less closed the book, but I
just wanted to

03:19:27.920 --> 03:19:31.920
comment that if they're still working on
that environmental

03:19:31.920 --> 03:19:35.000
document, I think they should focus very,
very

03:19:35.000 --> 03:19:38.000
heavily on wastewater treatment plants.

03:19:38.520 --> 03:19:42.520
The wastewater treatment plants are
completely obsolete;

03:19:42.520 --> 03:19:46.520
they are using treatments from 50 years
ago, and with the

03:19:46.520 --> 03:19:50.520
new medications, nanoparticles, and
antibiotics, I

03:19:50.520 --> 03:19:54.480
am sure that resistance is one of the
main causes.

03:19:54.480 --> 03:19:57.880
Perhaps the treatment of natural waters
is not being done

03:19:57.880 --> 03:20:00.880
properly because these plants are
completely obsolete.

03:20:00.880 --> 03:20:04.880
So if you can influence them to be
legally obligated to regeneration

03:20:04.880 --> 03:20:09.280
and modernization, then I think that
would be an important step forward.

03:20:09.480 --> 03:20:10.000
Thank you.

03:20:10.000 --> 03:20:14.000
In fact, I'm just going to complement
what we've been talking about,

03:20:14.000 --> 03:20:18.000
which of course, as the environment is
such a broad thing, but one of the

03:20:18.000 --> 03:20:21.400
things they're going to start focusing on
is wastewater.

03:20:21.400 --> 03:20:22.120
Okay, so what for?

03:20:22.120 --> 03:20:25.160
Because obviously there has to be a
consensus on what we're going to look at

03:20:25.160 --> 03:20:26.680
and where.

03:20:26.680 --> 03:20:30.680
So it's one of the things they're working
on, to have a

03:20:30.680 --> 03:20:35.360
monitoring system, uh, of what is being
found in wastewater.

03:20:36.400 --> 03:20:39.720
Furthermore, it's not just about the
medicines we don't throw down the well.

03:20:39.720 --> 03:20:43.720
If it's because in the end we give the
medications,

03:20:43.720 --> 03:20:47.720
urine, feces, in the end everything
there, even if we

03:20:47.720 --> 03:20:51.400
do it very lightly, but they are indeed
their focus.

03:20:51.400 --> 03:20:55.400
There are many studies, based not only on
wastewater from hospital and

03:20:55.400 --> 03:20:59.040
pharmaceutical industry treatment plants,
but also on community wastewater

03:20:59.040 --> 03:21:00.880
treatment plants.

03:21:01.720 --> 03:21:06.200
Well, then, to the last ones, the
irrepressible ones, whoever you want, eh?

03:21:06.320 --> 03:21:10.320
We want to thank the entire organization
for your attendance,

03:21:10.320 --> 03:21:14.320
the attendees, the speakers, and thank
you all, and especially,

03:21:14.320 --> 03:21:17.360
well, the students who have already left.

03:21:17.360 --> 03:21:22.520
That's great, because I think this
microworld project has been a success.

03:21:22.520 --> 03:21:26.520
This was supposed to be the closing and
closing of this project

03:21:26.520 --> 03:21:30.520
and it has been a complete success due to
the profile of speakers

03:21:30.520 --> 03:21:33.800
we have managed to bring thanks to your
availability

03:21:33.800 --> 03:21:36.800
and I hope we have your emails and
contacts.

03:21:37.160 --> 03:21:39.880
Uh, I want to make a little channel, we
want to make a little channel.

03:21:39.880 --> 03:21:43.880
If we have any questions about young
people who want to make

03:21:43.880 --> 03:21:47.880
contact with you at the level of
institutes that want to do

03:21:47.880 --> 03:21:51.880
more projects or that want to do external
internships,

03:21:51.880 --> 03:21:55.880
CFGS, etc., then I will try, we will try
to get in touch with

03:21:55.880 --> 03:21:59.920
the speakers and we will consider this
first day closed.

03:22:01.080 --> 03:22:02.040
Thank you all very much.