Azithromycin and moxifloxacin resistance determinants in Mycoplasma genitalium in Lleida, Spain.

OBJECTIVE: Mycoplasma genitalium (MG) is a microorganism related to sexually transmitted infections. Antibiotic resistance of MG leads to an increase in treatment failure rates and the persistence of the infection. The aim of this study was to describe the most frequent mutations associated with azithromycin and moxifloxacin resistance in our geographical area. METHODS: A prospective study from May 2019 to May 2023 was performed. MG-positive samples were collected. Real-time PCRs (AllplexTM MG-AziR Assay and AllplexTM MG-MoxiR Assay, Seegene) were performed in MG positive samples to detect mutations in 23S rRNA V domain and parC gene. RESULTS: A 37.1% of samples presented resistance determinants to azithromycin and the most common mutation detected was A2059G (57.9%). Resistance to moxifloxacin was studied in 72 azithromycin-resistant samples and 36.1% showed mutations, being G248T the most prevalent (73.1%). CONCLUSIONS: The resistance to different lines of treat ment suggests the need for a targeted therapy and the performing of a test of cure afterwards.

Hernia incisional umbilical (M3). ¿Son diferentes las hernias de trócar? Análisis comparativo del registro EVEREG / Umbilical incisional hernias (M3): Are trocar-site hernias different? Comparative analysis of the EVEREG Registry

Introducción La hernia incisional (HI) es una complicación frecuente. El objetivo principal de este estudio es comparar características, complicaciones y recurrencias de las HI producidas por la colocación de un trócar laparoscópico umbilical (M3T) con las de misma localización tras cirugía abierta (M3O); y de forma secundaria, la identificación de factores de riesgo. Método Estudio observacional transversal analizando al registro EVEREG durante el periodo entre julio del 2012 y junio del 2018. Las variables principales fueron recurrencias y complicaciones postoperatorias. Se compararon ambos grupos (M3T y M3O). Se realizó regresión logística múltiple para identificar los factores de riesgo de la cohorte completa. Resultados Se incluyeron un total de 882 casos. El grupo M3O presentó un ASA superior, HI con criterios de mayor complejidad para la reparación, mayor número de recurrencias a los 12 y 24 meses (8,6 vs. 2,5%; p < 0,0001 y 9,3 vs. 2,9%; p < 0,0001, respectivamente) y complicaciones postoperatorias (21,9 vs. 14,6%; p = 0,02). Se identificaron como factores de riesgo para la aparición de complicaciones postoperatorias, la reparación previa, la duración de la intervención y el requerimiento de procedimientos asociados, y para las recidivas: la ausencia de especialista de pared abdominal, la reparación previa y la aparición de complicaciones. El análisis por puntuación de propensión no detectó diferencias significativas en complicaciones y recurrencias. Conclusiones Las HI M3 de trócar umbilical son menos complejas que las originadas por cirugía abierta. La complejidad no se relaciona con el origen de la hernia, sino con sus características y las del paciente (AU)

Introduction Incisional hernia (HI), in open and laparoscopic surgery, is a very frequent complication. HI located in the umbilical region are called M3. The main aim of this study is to compare HI produced by the placement of an umbilical laparoscopic trocar (M3T) with those located in M3 in open surgery (M3O) in terms of basal characteristics, complications and recurrences; and secondarily the identification of risk factors. Method Cross-sectional observational study based on the national prospective registry EVEREG during the period of July 2012 - June 2018. The main variables were recurrences and postoperative complications. Both groups (M3T and M3O) were compared. Multiple logistic regression was performed to identify the risk factors of the entire cohort. Results 882 had a follow-up time longer than 12 months. M3O group presented superior ASA-Class, more complex HI and previous repair. It also presented a higher recurrence rate at 12 and 24 months (8.6 vs. 2.5%; p < 0,0001 and 9.3 vs. 2.9%; p < 0.0001) and higher postoperative complications rate (21.9 vs. 14.6%; p = 0.02). Previous repair, intervention length and associated procedures requirement were identified as risk factors for postoperative complications. Absence of a specialist present during surgery, previous repair, and the absence of complications were identified as risk factors for recurrence. In the PSM analysis no differences were detected in of complications and recurrences. Conclusions HI M3O is more complex than M3T. The complexity is not related to the origin of the hernia but to its characteristics and those of the patient (AU)

Linezolid-resistant MRSA-CC398 carrying the cfr gene, and MRSA-CC9 isolates from pigs with signs of infection in Spain.

AIMS: To perform the molecular characterization of 23 Staphylococcus aureus isolates from pigs with signs of infections recovered in Spanish farms during 2018-2019. METHODS AND RESULTS: The antimicrobial resistance pattern and virulence profile were determined. The molecular typing was performed by different molecular techniques. The transferability of the cfr gene was assessed by conjugation and its genetic environment was determined by PCR mapping. In all, 21 isolates were methicillin-resistant S. aureus (MRSA) carrying the mecA gene (SCCmecV or non-typeable SCCmec), whereas the remaining two were methicillin-susceptible (MSSA). All but one MRSA isolates (n = 20) belonged to the CC398, being the spa t011 the most prevalent (n = 11). The remaining MRSA and the two MSSA isolates were ascribed to ST9/CC9. The S. aureus isolates exhibited resistance to (number of resistant isolates): ß-lactamics (21), erythromycin and/or clindamycin (20), aminoglycosides (7), tetracycline (22), fluoroquinolones (14), chloramphenicol (5) and linezolid (1). The S. aureus isolates did not carry any of the virulence genes studied. One MRSA belonging to the CC398 showed linezolid resistance mediated by the cfr gene. The cfr gene was co-located with fexA in the Tn558 variant previously reported in the S. aureus plasmid pSCFS7. CONCLUSIONS: Two major livestock-associated genetic lineages were detected among pigs with signs of infection in Spain. The presence of the cfr gene among LA-MRSA-CC398 is of great concern not only for veterinary medicine, but also for humans in close contact. SIGNIFICANCE AND IMPACT OF THE STUDY: This work describes the molecular characterization of S. aureus isolates recovered from pigs with signs of infection and we report, as far as we know, the first description of MRSA-CC9 from pigs in Spain. Moreover, the detection of a MRSA-CC398 isolate carrying the multiresistance cfr gene highlights the need for continuous surveillance and awareness of LA-MRSA.

Implications of grey zone results for routine hepatitis C virus screening with the ARCHITECT HCV-Ag assay.

AIMS: Hepatitis C virus antigen (HCV-Ag) detection requires retesting for samples with grey zone results (GzR), adding cost and time and decreasing reliability. Our aim in this study was to evaluate the frequency and significance of GzR during the use of the automated Architect HCV-Ag assay in routine clinical practice. METHODS AND RESULTS: We studied HCV-Ag levels in 952 serum samples using the ARCHITECT HCV-Ag assay. GzR were detected in 33 samples; 25 were reactive on retesting and 19 were anti-HCV positive. Seventeen of these 19 samples were tested for HCV-RNA and were all reactive (viral loads <104  IU ml-1 ). The remaining six samples were anti-HCV nonreactive and had undetectable HCV-RNA. Eight GzR samples were nonreactive on retesting, seven were anti-HCV nonreactive (three underwent HCV-RNA quantification and were all nonreactive), and one was anti-HCV reactive (HCV-RNA nonreactive). No significant differences were found on comparing HCV-Ag values. CONCLUSIONS: Grey zone results found to be negative on retesting do not need additional technique testing, except in donor screening scenarios, where the use of molecular methods would be advisable. SIGNIFICANCE AND IMPACT OF THE STUDY:  The proposed diagnostic algorithm confirms that, eventhough GzR occur, hepatitis C virus antigen is a robust alternative to HCV-RNA detection in the active detection of infections.

Assessment of the treatment efficiency of an urban stormwater pond and its impact on the natural downstream watercourse.

During the last few decades, stormwater ponds have become an alternative management practice in order to avoid flooding and to contain rainwater and runoff in urban areas where impervious land cover has increased. A second purpose of stormwater ponds is to improve the quality of runoff water that is usually contaminated with nitrogen, phosphorus, metals and organic micropollutants. Processes used are based on natural methods such as settlement and contribute to minimize the impact of these inputs to the natural aquatic system. This study aims to better understand the behavior of a wet stormwater pond, Heron Lake (33 ha) located in the city of Villeneuve d'Ascq in northern France through various indicators [trace metals, PAHs, PCBs, caffeine (CAF), carbamazepine (CBZ), nutrients and pathogens]. For that purpose, water quality was monitored for 1 year, mainly at the entrance and at the outlet of the lake. Sampling have also been done in the downstream aquatic environment, the Marque River. Sediments were sampled in the lake to evaluate the pollution trapped during sedimentation. Our results of both water and sediment sampling highlight: (i) the wastewater input into the Heron Lake is estimated to be equivalent to that of roughly 3800 inhabitants; (ii) the removal rates observed at the outlet, relative to concentrations at the entrance channel, vary as follows for these dissolved species: 24% for NO3- and PO43-, 28% for CBZ, 35% for Cu, 63% for Pb, 78% for CAF, 84% for Zn and up to 93% for NH4+; (iii) there are high levels of sediment contamination with metals, PAHs and PCBs at the entrance channel; (iv) the eutrophication of this pond is attributed to persistent high nutrient concentrations in both water and sediment, and has contributed to the development of an invasive macrophyte, the Elodea nuttallii; and (v) there appears to be only a negligible impact of the discharge from the lake to the natural watercourse, contributing annual loads of <2 up to 6% of the total amount of Cu, Pb, Zn, CAF, CBZ and nutrients measured in the Marque River, and having a slight diluting effect on concentrations in the Marque River.

Deep water running and general practice in primary care for non-specific low back pain versus general practice alone: randomized controlled trial.

There is equivocal evidence regarding the benefits of aquatic aerobic exercise for non-specific chronic low back pain (NSCLBP) in addition to standard care in general practice consisting of education and advice. The purpose of this study was to compare the addition of deep water running (DWR) to standard general practice (GP) on NSCLBP versus GP care alone on pain, physical and mental health and disability. In this single-blind randomised controlled trial, 58 subjects with NSCLBP were recruited from primary care. The control group received GP care consisting of a physician's consultation and educational booklet only. The experimental group received additional 30-min sessions of DWR three times a week for 15 weeks at the individualized aerobic threshold. Measurements were made pre- and post-intervention and at 1-year follow-up. Both groups showed improvement. The difference between treatment effects at longest follow-up of 1 year was -26.0 (-40.9 to -11.1) mm on the VAS (p < 0.05), -2.5 (-5.7 to -0.2) points in RMQ for disability (p < 0.05), 3.3 (10.0 to 24.7) points on physical health in the physical summary component of the Spanish Short Form 12 (SF-12; p < 0.05) and 5.8 (8.6 to 34.7) points on the mental summary component of the SF-12 (p < 0.05), in favour of the DWR group. For patients with NSCLBP, the addition of DWR to GP was more effective in reducing pain and disability than standard GP alone, suggesting the effectiveness and acceptability of this approach with this group of patients.

[The radiology demand in primary care]. / Estudio de la demanda radiológica en asistencia primaria.

AIM: To contribute a preliminary study, which allows the best use of the demand criteria and acceptance mechanisms of radiological explorations at the primary care level. DESIGN: Retrospective and observational study. SITE. Public Health Care Center Poblenou, in the Barcelona area. PATIENTS: A random sample of patients covering 15,000 X-Ray explorations. MEASUREMENTS AND MAIN RESULTS: The parameters evaluated were: the type of x-ray; the existence of otherwise of pathology; the physician requesting the x-ray; and the patient's age and sex. Results show greater use by the feminine sex (56%), with statistically significant differences (p less than 0.0008) (1 degree of freedom). The overall pathology rate was 43%, also with significant differences between different groups of doctors (p less than 0.0001) (3 degrees of freedom). 52% of the investigations were on patients over 50. CONCLUSIONS: In general, the high percentage in primary care of pathological explorations should be noted; as should the variation in pathology rates between different groups of doctors, which suggests possible differences of criteria in the use of radiological indicators. The high percentage of patients of an advanced age will have to be considered in the planning of radiological services.

Motorcycle helmets--medical costs and the law.

Since 1975, 26 states have repealed or modified their motorcycle (M/C) helmet laws. Louisiana (LA) reinstated the M/C helmet law in 1982. The medical and financial impact of repeal in Kansas (KS), reinstatement in LA (accident, fatality, and critical injury rates) have been studied through 1987. Current FARS data and studies from KS, LA, 10 states and 5 countries are compared and reported. Without M/C helmet legislation, the user rate drops from 99% to 50%. With reinstatement, the user rate rises to greater than 95%. Average hospital stay (days) for helmeted (H) riders is 5.8, non-helmeted (NH), 11.8. Fatality rate/1,000 M/C registrations is 6.2 NH, 1.6 H. Changes effected through M/C helmet legislation: fatality rate was 1.17 (1981), falling to 0.44 (1987) with legislation (62% decrease) (LA); 66% change Colorado, 42% Oklahoma; fatality rate/1,000 accidents changed 28% from 42.68 NH to 30.81 H; injury accidents 84% to 73%, critical injury reduction 44% (1981 to 1987). Risk of head injury: NH 2.07 greater than H. Risk of a fatal accident: NH 1.44 greater than H. Accident rate is less with M/C helmet legislation than without (19% KS, 48% LA). The medical costs (LA 1981 to 1987) decreased 48.8%. Length of stay decreased 37%. The major impact hospital stay greater than 20 days: 80% decline. Cost of long-term disability greater than 30 days: 81.2% decrease (LA). Average disability was 26.7 vs. 51.1 days (KS); 25.5 H required hospitalization per 100 accidents vs. 41.6 NH. Medical costs: NH 306% greater than H (KS). Based on 1989 dollars, $120.8 million of additional medical care and rehabilitation expenses/per year were due directly to non-use of helmets (U.S.); 60-82% of NH riders have no insurance; $4.9 billion was absorbed by the public in the form of increased taxation, higher insurance costs, and lost taxes. M/C helmet legislation decreases medical costs. In this era of spiraling health care costs, legislation mandating the use of protective helmets should be considered as a viable alternative to raising taxes.