Epidemiology of Non-Tuberculous Mycobacteria isolated from clinical specimens in Madrid, Spain, from 2013 to 2017.

The epidemiology of non-tuberculous mycobacteria (NTM) in Spain is largely unknown because systematic reporting is not compulsory. The aim of our study was to describe the frequency and diversity of NTM species in our region and their distribution according to the source sample, gender, and age of the patients. We performed a multicenter study of all NTM isolated in 24 public hospitals in Madrid from 2013 to 2017. A total of 6.923 mycobacteria were isolated: 4535 (65.5%) NTM, and 2.388 (34.5%) Mycobacterium tuberculosis complex (MTB). Overall, 61 different NTM species were identified. The most frequently isolated species were Mycobacterium avium complex (47.7%), M. lentiflavum (12.2%), M. gordonae (9.2%), M. fortuitum (8.9%), and M. abscessus (3.9%). Whereas MTB cases were stable during the study period, the number of NTM isolates increased considerably from 930 isolates in 2013 to 1012 in 2017; a sharp increase occurred in the last year. The rise in NTM isolates was mostly due to M. lentiflavum, M. kansasii, and M. abscessus mainly isolated from respiratory specimens in patients older than 60. The increase in isolation rate of NTM in our region is consistent with the increasing rates reported worldwide in the last decades. The rise in NTM isolates was mainly attributed to M. lentiflavum but it also should be noted the increasing of species with high pathogenic potential such as M. kansasii and M. abscessus.

[Monophasic Salmonella Typhimurium outbreak due to the consumption of roast pork meat]. / Brote de Salmonella Typhimurium monofásica asociada al consumo de carne asada de cerdo.

This report presents an outbreak of monophasic Salmonella enteric serovar Typhimurium fagotipe 4, 5, 12: i:-, in a motorcycle concentration in Valladolid. Information was collected to one hundred and twelve affected from seven Spanish Autonomous Communities. The epidemiological investigation associated the outbreak with the consumption of roast pork with sauce sandwiches sold at a street market in that event.

Lectin-gated and glycan functionalized mesoporous silica nanocontainers for targeting cancer cells overexpressing Lewis X antigen.

Gated mesoporous silica nanoparticles can deliver payload upon the application of a predefined stimulus, and therefore are promising drug delivery systems. Despite their important role, relatively low emphasis has been placed on the design of gating systems that actively target carbohydrate tumor cell membrane receptors. We describe herein a new Lewis X (Lex) antigen-targeted delivery system comprising mesoporous silica nanoparticles (MSNs) loaded with ATTO 430LS dye, functionalized with a Lex derivative (1) and capped with a fucose-specific carbohydrate-binding protein (Aleuria aurantia lectin (AAL)). This design takes advantage of the affinity of AAL for Lex overexpressed receptors in certain cancer cells. In the proximity of the cells, AAL is detached from MSNs to bind Lex, and selectins in the cells bind Lex in the gated MSNs, thereby inducing cargo delivery. Gated MSNs are nontoxic to colon cancer DLD-1 cells, and ATTO 430LS dye delivered correlated with the amount of Lex antigen overexpressed at the DLD-1 cell surface. This is one of the few examples of MSNs using biologically relevant glycans for both capping (via interaction with AAL) and targeting (via interaction with overexpressed Lex at the cell membrane).

Niveles de 25-hidroxivitamina D en pacientes con melanoma y factores asociados con su insuficiencia / 25-hydroxyvitamin D in patients with melanoma and factors associated with inadequate levels

INTRODUCCIÓN Y OBJETIVOS: Los pacientes con melanoma parecen llevar al extremo las medidas de protección, lo que puede influir en los niveles de 25-hidroxivitamina D-25(OH)D-. El objetivo del estudio fue evaluar los niveles de 25(OH)D en pacientes con melanoma cutáneo e identificar factores relacionados con niveles inadecuados. MATERIAL Y MÉTODOS: Se midieron prospectivamente los niveles séricos de 25(OH)D en pacientes diagnosticados de melanoma cutáneo durante un periodo de seguimiento de un año. Se evaluaron qué factores ambientales, fenotípicos y genotípicos se relacionaban con niveles insuficientes y deficientes mediante regresión logística. RESULTADOS: De un total de 215 pacientes solo un 24,7% tenían valores normales de 25(OH)D y un 8,8% tenían valores deficientes (< 10 ng/ml). La obesidad (OR: 4,2; IC 95% OR: 1,3-13,3) y la extracción de sangre realizada en otoño/invierno (OR: 2,1; IC 95% OR: 1,1-4) se asociaron a niveles insuficientes (< 30 ng/ml). Los niveles deficitarios (< 10 ng/m) se asociaron a la obesidad (OR: 7,1; IC 95% OR: 1,1-46,9), la extracción de sangre realizada en otoño/invierno (OR: 9,0; IC 95% OR: 1,7-47,0), la ausencia de efélides (OR: 5,4; IC 95% OR: 1,2-23,4) y, marginalmente, a la presencia de tener < 2 polimorfismos no sinónimos en el receptor 1 de la melanocortina (MC1R) (OR: 5,0; IC 95% OR: 0,9-28,9). Limitaciones: No se han incluido en el análisis algunos factores, como la alimentación, relacionados con los niveles de 25(OH)D. CONCLUSIONES: Se deberían monitorizar los niveles de 25(OH)D en los pacientes con melanoma y valorar dar suplementos orales en los casos que lo precisen

INTRODUCTION AND OBJECTIVES: Patients with melanoma appear to take extreme sun-protection measures, which could influence 25-hydroxyvitamin D [25(OH)D] levels. The aim of this study was to measure 25(OH)D levels in patients with cutaneous melanoma and identify factors associated with inadequate levels. MATERIAL AND METHODS: Over a period of 1 year, we prospectively measured serum 25(OH)D in patients with cutaneous melanoma and used logistic regression analysis to identify environmental, phenotypic, and genotypic factors that were associated with insufficient and deficient levels. RESULTS: Of 215 patients analyzed, 8.8% had deficient 25(OH)D levels (< 10 ng/mL) and just 24.7% had normal levels. Insufficient levels (< 30 ng/mL) were associated with obesity (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.3-13.3) and blood sampling in autumn/winter (OR, 2.1; 95% CI, 1.1-4). Deficient levels (< 10 ng/mL) were associated with obesity (OR, 7.1; 95% CI, 1.1-46.9), blood sampling in autumn/winter (OR, 9.0; 95% CI, 1.7-47.0), absence of freckles (OR, 5.4; 95% CI, 1.2-23.4), and, with marginal significance, the presence of fewer than 2 nonsynonymous melanocortin-1 receptor (MC1R) polymorphisms (OR, 5.0; 95% CI, 0.9-28.9). Limitations: Some factors related to 25(OH)D levels, such as food, were not included in the analyses. CONCLUSIONS: 25(OH)D levels should be monitored in patients with melanoma and the need for oral supplements should be contemplated where appropriate

25-Hydroxyvitamin D in Patients With Melanoma and Factors Associated With Inadequate Levels. / Niveles de 25-hidroxivitamina D en pacientes con melanoma y factores asociados con su insuficiencia.

INTRODUCTION AND OBJECTIVES: Patients with melanoma appear to take extreme sun-protection measures, which could influence 25-hydroxyvitamin D [25(OH)D] levels. The aim of this study was to measure 25(OH)D levels in patients with cutaneous melanoma and identify factors associated with inadequate levels. MATERIAL AND METHODS: Over a period of 1 year, we prospectively measured serum 25(OH)D in patients with cutaneous melanoma and used logistic regression analysis to identify environmental, phenotypic, and genotypic factors that were associated with insufficient and deficient levels. RESULTS: Of 215 patients analyzed, 8.8% had deficient 25(OH)D levels (<10ng/mL) and just 24.7% had normal levels. Insufficient levels (<30ng/mL) were associated with obesity (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.3-13.3) and blood sampling in autumn/winter (OR, 2.1; 95% CI, 1.1-4). Deficient levels (<10ng/mL) were associated with obesity (OR, 7.1; 95% CI, 1.1-46.9), blood sampling in autumn/winter (OR, 9.0; 95% CI, 1.7-47.0), absence of freckles (OR, 5.4; 95% CI, 1.2-23.4), and, with marginal significance, the presence of fewer than 2 nonsynonymous melanocortin-1 receptor (MC1R) polymorphisms (OR, 5.0; 95% CI, 0.9-28.9). LIMITATIONS: Some factors related to 25(OH)D levels, such as food, were not included in the analyses. CONCLUSIONS: 25(OH)D levels should be monitored in patients with melanoma and the need for oral supplements should be contemplated where appropriate.

Monitorización continua de un protocolo: parálisis facial a frigore / Continuous monitoring of a guideline: Bell's palsy

Introducción: La elaboración y revisión de protocolos de actuación neuropediátrica permite reducir la variabilidad de nuestra práctica médica, mejorando la asistencia. Se presenta la monitorización de nuestro protocolo de parálisis facial a frigore (PFP). Material y métodos: Se revisan los informes de urgencias e historias clínicas de los niños valorados en consulta de Neuropediatría por PFP entre julio de 2006 y agosto de 2009 (grupo 2), para conocer el grado de cumplimiento vigente de los criterios de calidad del protocolo y compararlos con los de la revisión previa (grupo 1, de marzo de 2003 a junio de 2006). También se actualizan las evidencias científicas surgidas sobre el tema. Resultados: El porcentaje de cumplimiento del grupo 1 con respecto al 2ha pasado de 85,1 a 100% en constancia de descripción de la mímica facial, de 11,1 a 31,6% en descripción de existencia o no de vesículas sugestivas de herpes zóster, de 77,7 a 84,2% en constancia de fundoscopia, y de 77,7 a 86,8% en describir la normalidad del resto de los pares craneales. Se recoge por primera vez en grupo 2 la entrega de hoja informativa para padres y pediatras, con el 21,1%. Discusión: El audit médico permite evaluar nuestra actuación y establecer líneas de mejora según las deficiencias encontradas. Se insiste en seguir mejorando la constancia escrita de los datos más relevantes y recordar la importancia de entrega de la hoja informativa para padres y pediatras, como forma de asegurar el continuum asistencial (AU)

Introduction: The preparation and review of child neurology guidelines can reduce the variability of our medical practice, thus improving health care. We present the continuous monitoring of our Bell's palsy guideline. Material and methods: Emergency and medical reports of the children seen in Child Neurology surgery from July 2006 to August 2009 (group 2) are reviewed for the purpose of finding out the present level of compliance with guideline quality criteria and compare it with the previously reviewed period (group 1, from March 2003 to June 2006). Scientific evidence on this topic is also updated. Results: Comparing the compliance rate in group 1 with group 2 shows a rise in group 2 from 85.1% to 100% in facial expression description, from 11.1% to 31.6% on whether or not there is evidence of Herpes Zoster vesicles, from 77.7% to 84.2% whether or not there is evidence fundoscopic examination, and from 77.7% to 86.8% as regards cranial nerve function remaining normal. The rate of fact sheet issue, recorded for the first time in group 2, is 21.1%. Discussion: Medical auditing allows us to evaluate our medical practice and set up ways for improvement according to the deficiencies found. We insist on striving to improve the written record of the most relevant data and never overlook the importance of issuing the fact sheets to parents and paediatricians, to ensure continuity of medical care (AU)

[Continuous monitoring of a guideline: Bell's palsy]. / Monitorización continua de un protocolo: parálisis facial a frigore.

INTRODUCTION: The preparation and review of child neurology guidelines can reduce the variability of our medical practice, thus improving health care. We present the continuous monitoring of our Bell's palsy guideline. MATERIAL AND METHODS: Emergency and medical reports of the children seen in Child Neurology surgery from July 2006 to August 2009 (group 2) are reviewed for the purpose of finding out the present level of compliance with guideline quality criteria and compare it with the previously reviewed period (group 1, from March 2003 to June 2006). Scientific evidence on this topic is also updated. RESULTS: Comparing the compliance rate in group 1 with group 2 shows a rise in group 2 from 85.1% to 100% in facial expression description, from 11.1% to 31.6% on whether or not there is evidence of Herpes Zoster vesicles, from 77.7% to 84.2% whether or not there is evidence fundoscopic examination, and from 77.7% to 86.8% as regards cranial nerve function remaining normal. The rate of fact sheet issue, recorded for the first time in group 2, is 21.1%. DISCUSSION: Medical auditing allows us to evaluate our medical practice and set up ways for improvement according to the deficiencies found. We insist on striving to improve the written record of the most relevant data and never overlook the importance of issuing the fact sheets to parents and paediatricians, to ensure continuity of medical care.

Repression of Puma by scratch2 is required for neuronal survival during embryonic development.

Although Snail factors promote cell survival in development and cancer, the tumor-suppressor p53 promotes apoptosis in response to stress. p53 and Snail2 act antagonistically to regulate p53 upregulated modulator of apoptosis (Puma) and cell death in hematopoietic progenitors following DNA damage. Here, we show that this relationship is conserved in the developing nervous system in which Snail genes are excluded from vertebrate neurons and they are substituted by Scratch, a related but independent neural-specific factor. The transcription of scratch2 is induced directly by p53 after DNA damage to repress puma, thereby antagonizing p53-mediated apoptosis. In addition, we show that scratch2 is required for newly differentiated neurons to survive by maintaining Puma levels low during normal embryonic development in the absence of damage. scratch2 knockdown in zebrafish embryos leads to neuronal death through the activation of the intrinsic and extrinsic apoptotic pathways. To compensate for neuronal loss, the proliferation of neuronal precursors increases in scratch2-deficient embryos, reminiscent of the activation of progenitor/stem cell proliferation after damage-induced apoptosis. Our data indicate that the regulatory loop linking p53/Puma with Scratch is active in the vertebrate nervous system, not only controlling cell death in response to damage but also during normal embryonic development.

Intrahepatic arteriovenous fistula resulting from needle biopsy

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Hematemesis y vómitos persistentes en paciente anticoagulada / Hematemesis and persistent vomiting in an anticoagulated patient

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Hallazgos endoscópicos del tumor mucinoso de páncreas / Endoscopic signs of mucinous tumor of the pancreas

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Prevalencia y conocimientos de tabaquismo en estudiantes de Ciencias de la Salud, de la Educación y Estudios Sociales / Prevalence and knowledge of the smoking habit in students of Sciences of Health, Education and Social Studies

Objetivo: Conocer la prevalencia y actitudes sobre el consumo de tabaco en estudiantes universitarios de las diplomaturas de Ciencias dela Salud (CS), Ciencias de la Educación (CE) y Estudios Sociales (ES) de la Universidad de Zaragoza, todas ellas con repercusión como modelo social a imitar. Pacientes y método: Estudio descriptivo transversal mediante cuestionario anónimo, voluntario y autoadministrado que recogía datos personales y preguntas sobre actitudes y conocimientos de los efectos del tabaco. La población diana estuvo compuesta por los estudiantes con asignaturas de primer y tercer curso de las diplomaturas previamente citadas. Resultados: Se recogieron 450 encuestas válidas (180 alumnos de Ciencias de la Educación y Estudios Sociales respectivamente) y 90 de Ciencias de la Educación, con una distribución por cursos al 50% entre 1º y 3º. Por género, el 82,4% eran mujeres y el 17,5% hombres, con una edad media global de 21,42 ± 4,8 años. Se observó que el 45,3% eran fumadores (35,4% en hombres y 47,4% en mujeres), 9,1% exfumadores y el 45,6% nunca habían fumado. Ciencias de la Salud es la carrera donde menos fumadores encontramos 31,1%, seguido de Ciencias de la Educación con un 46,7% y Estudios Sociales con un 51,1%. Conclusiones: Los universitarios encuestados presentan cifras similares de fumadores que la población de su edad. Mayor prevalencia del hábito tabáquico en mujeres que en hombres como se viene observando en los últimos estudios. Menor consumo de tabaco en los estudiantes de Ciencias de la Salud que en los de Ciencias de la Educación y Estudios Sociales (AU)

Objective: Know the prevalence and attitudes and the consumption of tobacco in university students in the Sciences of Health (SH) careers, Sciences of Education (SE) and Social Studies (SS) of the University of Zaragoza, all of them with a repercussion as a social model to imitate. Patients and methods: Descriptive, cross-sectional study using an anonymous, voluntary and self-applied questionnaire that collected personal data and asked about attitudes and knowledge on the effects of tobacco.The target population was made up of the students in the subject staught in the first and third year of the previously mentioned careers. Results: A total of 450 valid surveys were collected (180 students from Sciences of Education and Social Studies, respectively) and 90 from Sciences of Education, with the distribution per course at 50% between the first and third year. By gender, 82.4% were women and 17.5% men with a mean global age of 21.42 ± 4.8 years. It was observed that 45.3% smoked (35.4% in men and 47.4% in women), 9.1% ex-smokers and 45.6% had never smoked. Sciences of Health is the career having the least number of smokers, there being 31.1%, followed by Sciences of Education with 46.7% and Social Studies with 51.1%. Conclusions: The university students who were surveyed had similar values of being smokers as the population of their age. There was greater prevalence of the smoking habit in women than in men as has been observed in recent studies and less consumption of tobacco in the students from Sciences of Health than in those from Sciences of Education and Social Studies (AU)

Abdomen agudo en la enfermedad celiaca: yeyunoileítis ulcerativa / Acute abdomen in celiac disease: Ulcerative jejunoileitis

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Detection of decreased susceptibility to fluoroquinolones in Salmonella spp. by five different methods including real-time polymerase chain reaction (PCR).

Detection of Salmonella spp. isolates showing decreased susceptibility to fluoroquinolones has become important owing to the increasing prevalence of these strains and their association with treatment failure. Nalidixic acid agar dilution, nalidixic acid disk diffusion, MicroScan automated system and real-time polymerase chain reaction (PCR) (LightCycler) followed by melting temperature (Tm) analysis are compared with ciprofloxacin agar dilution as suitable methods to detect decreased susceptibility to fluoroquinolones in 100 Salmonella spp. isolates. Three minor discrepancies were found for nalidixic acid disk diffusion, one minor discrepancy was found for nalidixic acid agar dilution and Tm analysis, and one major discrepancy was found for MicroScan. Nalidixic acid disk diffusion was confirmed as a good screening method. Tm analysis is a rapid and accurate method for detecting decreased susceptibility to fluoroquinolones due to gyrA mutations in Salmonella spp.