The prognostic value of toxin B and binary toxin in Clostridioides difficile infection.

To study the association between detection of the Clostridioides difficile gene encoding the binary toxin (CDT) and direct detection of toxinB (TcdB) from feces with the appearance of serious disease, complications, or recurrence in a prospective series of cases. A total of 220 confirmed cases were included, using a two-step algorithm: an initial study to detect the enzyme, glutamate dehydrogenase (GDH), followed, in cases of positivity, by detection of the tcdB. tcdB-positive patients were investigated for the presence of CDT and TcdB. Outcome variables were severe disease, the modified Illinois C. difficile infection (CDI) prognostic risk index (ZAR score), the appearance of complications (need for colectomy, CDI-related death, or toxic megacolon) and recurrence. Patients who tested positive for the presence of TcdB in feces were found to have greater disease severity than those who tested negative, with a ZAR score of 35.4% vs. 23% (p = .048), a higher recurrence rate (14.6% vs. 5.9%, p = .032), and a tendency for higher number of complications (20.7% vs. 11.5%), although without reaching statistical significance (p = .053). When presence of CDT was analyzed, higher frequencies of severe disease (39.2% vs. 21.2%, p = .005), complications and recurrence (21.6% vs. 10.9%, p = .037 and 14.9% vs. 5.8%, p = .029; respectively) were observed in patients where CDT was detected. TcdB and CDT act as prognostic markers of the appearance of serious disease, complications or recurrence in cases of CDI. Simultaneous detection of both markers, TcdB and CDT, had a greater impact on the prognosis than when they were detected separately.

Quasiexperimental intervention study protocol to optimise the use of new antibiotics in Spain: the NEW_SAFE project.

INTRODUCTION: Ceftaroline, tedizolid, dalbavancin, ceftazidime-avibactam and ceftolozane-tazobactam are novel antibiotics used to treat infections caused by multidrug-resistant pathogens (MDR). Their use should be supervised and monitored as part of an antimicrobial stewardship programme (ASP). Appropriate use of the new antibiotics will be improved by including consensual indications for their use in local antibiotic guidelines, together with educational interventions providing advice to prescribers to ensure that the recommendations are clearly understood. METHODS AND ANALYSIS: This study will be implemented in two phases. First, a preliminary historical cohort (2017-2019) of patients from 13 Andalusian hospitals treated with novel antibiotics will be analysed. Second, a quasiexperimental intervention study will be developed with an interrupted time-series analysis (2020-2021). The intervention will consist of an educational interview between prescribers and ASP leaders at each hospital to reinforce the proper use of novel antibiotics. The educational intervention will be based on a consensus guideline designed and disseminated by leaders after the retrospective cohort data have been analysed. The outcomes will be acceptance of the intervention and appropriateness of prescription. Incidence of infection and colonisation with MDR organisms as well as incidence of Clostridioides difficile infection will also be analysed. Changes in prescription quality between periods and the safety profile of the antibiotics in terms of mortality rate and readmissions will also be measured. ETHICS AND DISSEMINATION: Ethical approval will be obtained from the Andalusian Coordinating Institutional Review Board. The study is being conducted in compliance with the protocol and regulatory requirements consistent with International Council of Harmonisation E6 Good Clinical Practice and the ethical principles of the latest version of the Declaration of Helsinki. The results will be published in peer-reviewed journals and disseminated at national and international conferences. TRIAL REGISTRATION NUMBER: NCT03941951; Pre-results.

Neisseria meningitidis Infecting a Prosthetic Knee Joint: A New Case of an Unusual Disease.

Primary meningococcal meningitis is an infrequent but known disease. However, the infection of a prosthetic joint with Neisseria meningitidis is rare. We hereby describe the second case of an arthroplasty infected with Neisseria meningitidis that responded favourably to prosthesis retention with surgical debridement, in combination with antibiotics treatment.

Effects of vacuum and modified atmosphere on textural parameters and structural proteins of cultured meagre (Argyrosomus regius) fillets.

The influence of two preservation strategies (vacuum package and modified atmosphere package) on the post-mortem changes of textural parameters, pH, water holding capacity, sarcoplasmic and myofibrillar proteins, and collagen content of meagre (Argyrosomus regius) fillets was studied. Fillets were stored in a cold room in aerobic (control, C), vacuum (V) and modified atmosphere (MA) package. Samples were withdrawn at six sampling points throughout 15-day storage, and post-mortem changes were assessed. The textural parameters were significantly enhanced in V and MA compared to C. Both V and MA treatments reduced the intensity of a group of myofibrillar protein fractions (140-195 kDa) and increased insoluble collagen compared to C. Consequently, the post-mortem flesh softening in C was attributed to increased proteolysis in both intracellular and extracellular structural proteins. The preservation of the textural and biochemical characteristics of meagre fillets subjected to V and MA treatments makes these two treatments highly recommendable for the commercialization of meagre fillets.

The 5S rDNA high dynamism in Diplodus sargus is a transposon-mediated mechanism. Comparison with other multigene families and Sparidae species.

There has been considerable discussion in recent years on the evolution of the tandemly repeated multigene families, since some organisms show a concerted model whereas others show a birth-and-death model. This controversial subject extends to several species of fish. In this study, three species of the Sparidae family (Pagrus pagrus, P. auriga and Diplodus sargus) and an interspecific hybrid (P. pagrus (♀) × P. auriga (♂)) have been studied at both molecular and cytogenetic level, taking three different multigene families (5S rDNA, 45S rDNA and U2 snDNA). Results obtained with the 5S rDNA in P. pagrus and P. auriga are characterized by a considerable degree of conservation at the two levels; however, an extraordinary variation was observed in D. sargus at the two levels, which has never been found in other fishes studied to date. As a consequence of this, the evolutionary model of the multigene families is discussed considering the results obtained and others from the bibliography. The result obtained in the hybrid allowed the recombination frequency in each multigene family to be estimated.

Infección de partes blandas por Stenotrophomonas maltophilia de adquisición comunitaria en paciente previamente sano / Community acquired Stenotrophomonas maltophilia soft-tissue infection in a previously healthy patient

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Proceso de cambio para el diseño de grado en Enfermería / The process of change for designing the Nursing degree

El camino hacia la Convergencia Europea de la Enseñanza Superior obliga a las instituciones a reformar los planes de estudios, teniendo en cuenta que se avanza hacia un nuevo paradigma docente centrado en el aprendizaje donde el estudiante debe tomar la responsabilidad de su propia enseñanza, desarrollando estrategias que encuentra efectivas para cumplir sus objetivos. Este proceso de cambio obliga a los profesores a explorar metodologías que favorezca la integración y el aprendizaje de por vida. El artículo presenta las acciones del proceso de cambio que la Escuela de Enfermería de la Universitat de Lleida ha llevado a cabo durante los dos últimos años para innovar el plan de estudios acorde al proceso Bolonia, en colaboración con las Universidades Rovira i Virgili (Tarragona) y Girona, con el asesoramiento de la Oficina de Educación en Ciencias de la Salud de la Universidad de La Frontera (Temuco, Chile)

The road to the European Convergence in Higher Education compels institutions to modify academic curricula, taking into account that advances made towards a new academic paradigm that focuses on a type of learning where the students must assume responsibility for their own learning, developing effective strategies to meet objectives. This process of change compels academic staff to explore methodologies that foster integration and learning for life. This paper presents the actions integrated in the change process that the Nursing School at the University of Lleida has carried out in the last two years to innovate their academic curricular, in accordance with the Bologna process and in collaboration with the University of Rovira i Virgili (Tarragona) and the University of Girona, under the guidance of the Education Office in Health Science from the University of La Frontera (Temuco, Chile)

Intercepción poscoital hormonal en un servicio de planificación familiar / Postcoital hormonal contraception in a family planning service

Objetivo. Conocer las características de la población atendida en el Servicio de Planificación Familiar de Lleida que demanda la intercepción poscoital, y conocer su uso y efectos en dicha población. Método. Se planteó un estudio epidemiológico observacional transversal, que fue realizado durante 3 años, entre 1999 y 2001. Se estudió a todas las mujeres que acudieron durante los 3 años al mencionado servicio de planificación familiar y que solicitaron la intercepción poscoital, a las que se aplicó una encuesta estructurada que fue cumplimentada por una enfermera del mismo servicio. Se recogieron variables relativas a aspectos sociodemográficos de las mujeres y al uso y a los efectos de la intercepción poscoital. Resultados. Las 2.813 mujeres estudiadas tenían una media de edad de 21,5 años. El 92,3% (2.577) conocía la existencia de la intercepción poscoital, pero 2.018 (72,3%) de ellas la demandaban por primera vez. El motivo principal de la demanda era la rotura del preservativo, con una frecuencia de 1.741 (62,1%). Las mujeres tardaban 33,7 h de promedio en solicitar el tratamiento. La menstruación apareció en el 98,6% de las mujeres que acudieron al control poscoital. Conclusiones. Los resultados encontrados en el presente estudio coinciden bastante con los de la bibliografía especializada. Creemos que es necesario potenciar la educación sexual de la juventud

Objective. To determine the characteristics of the population seeking postcoital hormonal contraception in the family planning service of Lleida (Spain) and to determine the use and effects of this form of contraception in this population. Method. We performed an epidemiological, observational, cross-sectional study over a 3-year period (1999-2001). All women who attended the family planning service in the study period and who requested postcoital hormonal contraception were included. In all subjects a structured interview was performed by a nurse from the family planning service. Variables relating to sociodemographic factors and the use and effects of this form of contraception were gathered. Results. A total of 2813 women were studied. The mean age was 21.5 years. Nearly all the women (92.3% [2577]) knew about postcoital hormonal contraception but 2018 (72.3%) had not requested it previously. The main reason for seeking this form of contraception was condom rupture, with a frequency of 1741 (62.1%). The mean interval before requesting postcoital hormonal contraception was 33.7 hours. Menstruation occurred in 98.6% of the women who sought emergency contraception. Conclusions. The results of the present study are in fairly close agreement with those reported in the specialist literature. We believe that sex education should be increased among young peopleObjective. To determine the characteristics of the population seeking postcoital hormonal contraception in the family planning service of Lleida (Spain) and to determine the use and effects of this form of contraception in this population. Method. We performed an epidemiological, observational, cross-sectional study over a 3-year period (1999-2001). All women who attended the family planning service in the study period and who requested postcoital hormonal contraception were included. In all subjects a structured interview was performed by a nurse from the family planning service. Variables relating to sociodemographic factors and the use and effects of this form of contraception were gathered. Results. A total of 2813 women were studied. The mean age was 21.5 years. Nearly all the women (92.3% [2577]) knew about postcoital hormonal contraception but 2018 (72.3%) had not requested it previously. The main reason for seeking this form of contraception was condom rupture, with a frequency of 1741 (62.1%). The mean interval before requesting postcoital hormonal contraception was 33.7 hours. Menstruation occurred in 98.6% of the women who sought emergency contraception. Conclusions. The results of the present study are in fairly close agreement with those reported in the specialist literature. We believe that sex education should be increased among young people

Intercepción postcoital y uso de anticonceptivos en la población joven / Postcoital interception and the use of contraceptives in the young population

Objetivo: conocer la relación entre el Conocimientode la Intercepción Postcoital (IPC) y eluso de anticonceptivos habituales entre las jóvenesatendidas por demanda de IPC en el Centro de PlanificaciónFamiliar de Lleida.Material y métodos: se realizó un estudio observacionaltransversal mediante una encuesta estructuradallevada a cabo mediante entrevista personala todas las mujeres menores de veinte añosatendidas entre 1999 y 2001 en el centro, siendoen total 1.164.Resultados: un 19,3% de las jóvenes realizabancoitos sin protección y un 64,4% expresó utilizarun método anticonceptivo seguro, pero habían tenidoun accidente con el preservativo.El 65,3% tenían conocimiento previo de la IPC perono la habían usado, seguido del 27,1% que yala habían empleado con anterioridad. El conocimientoprevio de la IPC no mostró relación con eluso de anticonceptivos habituales.Conclusiones: el estudio sugiere reflexiones tantoacerca de la finalidad de la IPC como de la necesidadde más educación sexual en los jóvenes

Objective: To determine the relationship betweenpostcoital interception (PCI) and the use ofcommon contraceptives among young females thatdemand PCI at Family Planning Centre in Lleida.Material and methods: A cross-sectional observationalstudy was performed by using astructure survey by interviewing all females underthe age of 20, treated between 1999 and 2002in the centre, amounting to a total of 1.164 youngwomen.Results: 19,3% of the girls had sex withoutprotection and 64,4% wanted to use a safecontraceptive method, but had had an accidentwith the condom.65,3% knew previously about PCI but had neverused it, followed by 27,1% that had already usedthe method before. The previous knowledge of thePCI did not show any relationship with the use ofcommon contraceptives.Conclusions: This study suggests that somereflection is needed regarding the finality of PCI aswell as the need for a stronger sexual educationamong the young