Prevalence of mutations associated with macrolide and fluoroquinolone resistance in Neisseria gonorrhoeae with Allplex NG-DR Assay (Seegene) in a tertiary hospital from Madrid, Spain.

OBJECTIVE: The prevalence of drug-resistant Neisseria gonorrhoeae (NG) infections is increasing. Studies report the prevalence of NG strains presenting A2059G/C2611T (rRNA23S) and S91F (parC) mutations conferring resistance to azithromycin and ciprofloxacin. METHODS: We conducted a prospective cohort study evaluating first void-urine urines, rectal, and oropharyngeal swabs collected from a cohort of patients in a tertiary hospital in Madrid between October 2022 and January 2023. Samples were screened by Allplex 7-STI Essential Assay (Seegene). Drug resistances were performed by Allplex NG-DR Assay (Seegene). RESULTS: A total of 1,415 patients were included, of which 112 had a positive sample for NG infection. One patient had a C2611T mutation (0.9%) and neither patient showed A2059G mutation. We found 67 (59.8%) S91F-positive patients. Forty-four patients (39.3%) not had any mutations. CONCLUSIONS: We report a low-prevalence of mutations A2059G/C2611T to macrolides and a high-prevalence to S91F in NG infections. Molecular methods for the detection of NG resistance could be useful in direct non-culturable samples.

Epidemiology and prevalence of mutations associated with resistance to macrolides and fluoroquinolones in Mycoplasma genitalium in a tertiary hospital from Madrid, Spain.

OBJECTIVE: Mycoplasma genitalium causes persistent sexually transmitted infections. The aims of this study were to estimate the prevalence of resistances to macrolides and fluoroquinolones in M. genitalium and the sexually transmitted coinfections in patients at Hospital Universitario La Paz (Madrid, Spain). METHODS: Patients attended between January and October 2021 were studied. Screening for sexually transmitted pathogens and detection of 23S rRNA and parC genes mutations were performed by real-time PCR (Allplex,SeegeneTM). RESULTS: A total of 1,518 females and 1,136 males were studied. The prevalence of M. genitalium was 2.1%. The macrolides resistance rate was 51.8%. The mutations found were A2059G, A2058T and A2058G. The rate of resistance to fluoroquinolones was 17.8% being the G248T mutation (S83I) the most frequent. Seven males had some sexual transmitted coinfection. CONCLUSIONS: Although the percentage of M. genitalium infections is low, the high rate of resistance to macrolides makes it necessary to revise the protocols for diagnosis and empirical treatment of sexually transmitted infections. The use of fluoroquinolones is appropriate after screening of macrolide resistance profile.

Diseño de una intervención farmacéutica en farmacia comunitaria para mejorar la adherencia del paciente al tratamiento antibiótico / Design of a pharmaceutical intervention in community pharmacy to improve patient adherence to antibiotic therapy

JUSTIFICACIÓN: el buen uso de los antibióticos ha demostrado ser una de las medidas más efectivas para detener el incremento de las resistencias bacterianas. La farmacia comunitaria, por su proximidad y conocimiento del paciente, es un espacio ideal para la promoción de medidas para atajar este grave problema.OBJETIVOS: estudiar el efecto de la intervención del farmacéutico comunitario en el cumplimiento de los tratamientos antibióticos e identificar posibles factores asociados al uso incorrecto de los mismos.MATERIAL Y MÉTODOS: estudio cuasiexperimental prospectivo a realizar en 4 farmacias comunitarias (3 rurales y 1 urbana) aprobado por el CEIm (Tesis Doctoral).Sujetos del estudio: pacientes y cuidadores mayores de 18 años que acudan a las farmacias demandando antibiótico vía oral y deseen participar voluntariamente en el estudio. Tamaño muestral: para este estudio, en el que se compara un grupo control con un grupo intervención y variables mayoritariamente categóricas, se ha utilizado la fórmula de comparación de dos proporciones, siendo el tamaño muestral total de 72 participantes en cada uno de los grupos. Cuaderno de recogida de datos: incluye características de los participantes, prescripción médica, prescriptor del antibiótico y localización de infección así como los conocimientos del paciente-cuidador sobre antibióticos. Análisis del cumplimiento: se realizará el test de Morisky- Green-Levine y recuento de comprimidos.RESULTADOS ESPERADOS: la hipótesis que barajamos es que el refuerzo por parte del farmacéutico hará que los pacientes, mayoritariamente personas mayores en el caso de las farmacias rurales, mejoren su adherencia y por tanto completen adecuadamente el tratamiento. (AU)

Optimized identification of microorganisms directly from positive blood cultures by MALDI-TOF to improve antimicrobial treatment.

OBJECTIVE: Bacteriemia is a major cause of morbidity and mortality among hospitalized patients worldwide. Early identification of microorganisms from blood culture can lead to improvement of treatment and outcomes. METHODS: The study was divided into two phases. The first phase when a comparison of the methods was made to check the concordance between them, using as a reference the standard method implemented in the laboratory. In a second phase, both methods are combined. We used the rapid identification method and when it could not identify we used the standard method. The microorganisms that were not identified by either of the two methods were identified from colony at 24 hours. RESULTS: A total of 589 microbial positive blood cultures have been included in the present study. With the rapid method we obtained 96% and 88% identification results for Gram-negative bacilli (GNB) and Gram-positive cocci (GPC) respectively. In this study we observed that the combination of the rapid and standard method achieved identifications of 98% and 97% for GNB and GPC respectively. CONCLUSIONS: The data analysed shows that both methods combined perform better than individually. We achieved an optimization of the identification of microorganisms directly from positive blood cultures by MALDI-TOF. This combination identified 98% of the microorganisms in between ten minutes to one hour and a half since the blood culture flagged positive.

Follow-up with Telemedicine in Early Discharge for COPD Exacerbations: Randomized Clinical Trial (TELEMEDCOPD-Trial).

The results reported by different studies on telemonitoring in patients with chronic obstructive pulmonary disease (COPD) have been contradictory, without showing clear benefits to date. The objective of this study was to ascertain whether an early discharge and home hospitalization telehealth program for patients with COPD exacerbation is as effective as and more efficient than a traditional early discharge and home hospitalization program. A prospective experimental non-inferiority study, randomized into two groups (telemedicine/control) was conducted. The telemedicine group underwent monitoring and was required to transmit data on vital constants and ECGs twice per day, with a subsequent telephone call and 2 home visits by healthcare staff (intermediate and at discharge). The control group received daily visits. The main variable was time until first exacerbation. The secondary variables were: number of exacerbations; use of healthcare resources; satisfaction; quality of life; anxiety-depression; and therapeutic adherence, measured at one and 6 months of hospital discharge. A total of 116 patients were randomized (58 to each group) without significant differences in baseline characteristics or time until first exacerbation, i.e. median 48 days (pp. 25-75:23-120) in the control group, and 47 days (pp. 25-75:19-102) in the intervention group; p = 0.52). A significant decrease in the number of visits was observed in the intervention versus the control group, 3.8 ± 1 vs 5.1 ± 2(p = 0.001), without significant differences in the number of exacerbations. In conclusion follow-up via a telemedicine program in early discharge after hospitalization is as effective as conventional home follow up, being the cost of either strategy not significantly different.

Tratamiento farmacológico de la COVID-19 / Pharmacological treatment of COVID-19

Los datos clínicos que disponemos de la COVID-19 y la investigación llevada a cabo hasta la fecha han generado una amplia lista de medicamentos que potencialmente podrían emplearse o que se están empleando ya. Se han planteado diferentes dianas terapéuticas para combatir la enfermedad; según esto, podemos hablar de agentes antivirales, cuando actúan sobre el propio microorganismo; o bien inmunosupresores e inmunomoduladores, cuando el objetivo de tratamiento va dirigido fundamentalmente a prevenir o tratar la inflamación generada como consecuencia de esta infección. En este momento, solo hay dos fármacos que han mostrado algún efecto en los ensayos clínicos, el antiviral remdesivir y el tratamiento con corticoide sistémico. Sin embargo, solo el corticoide sistémico ha demostrado mejorar el pronóstico de la enfermedad. Resulta prioritario seguir realizando ensayos clínicos controlados y de calidad, que nos permitan obtener respuestas para las múltiples interrogantes que se han generado a lo largo de esta pandemia. En espera de mayor evidencia científica, se recomienda seguir los protocolos de manejo clínico establecidos por cada centro de hospitalario

The clinical data available on COVID-19 and the research carried out to date have generated an extensive list of drugs that could potentially be used or are already being used. Different therapeutic targets have been proposed to combat the disease; According to this, we can speak of antiviral agents, when they act on the microorganism itself; or immunosuppressants and immunomodulators, when the treatment objective is preventing or treating the inflammation generated as a consequence of this infection. At this time, there are only two drugs that have shown an effect in clinical trials, the antiviral remdesivir and systemic corticosteroid treatment. However, only systemic corticosteroids have shown to improve the prognosis of the disease. It is a priority to continue conducting controlled and quality clinical trials, which will provide us with answers to the many questions that have been generated throughout this pandemic. Pending more scientific evidence, it is recommended to follow the clinical management protocols established by each health care center

Imaging the optical properties of turbid media with single-pixel detection based on the Kubelka-Munk model.

We present a diffuse optical imaging system with structured illumination and integrated detection based on the Kubelka-Munk light propagation model for the spatial characterization of scattering and absorption properties of turbid media. The proposed system is based on the application of single-pixel imaging techniques. Our strategy allows us to retrieve images of the absorption and scattering properties of a turbid media slab by using integrating spheres with photodiodes as bucket detectors. We validate our idea by imaging the absorption and scattering coefficients of a spatially heterogeneous phantom.

Modulation of mtDNA copy number ameliorates the pathological consequences of a heteroplasmic mtDNA mutation in the mouse.

Heteroplasmic mtDNA mutations typically act in a recessive way and cause mitochondrial disease only if present above a certain threshold level. We have experimentally investigated to what extent the absolute levels of wild-type (WT) mtDNA influence disease manifestations by manipulating TFAM levels in mice with a heteroplasmic mtDNA mutation in the tRNAAla gene. Increase of total mtDNA levels ameliorated pathology in multiple tissues, although the levels of heteroplasmy remained the same. A reduction in mtDNA levels worsened the phenotype in postmitotic tissues, such as heart, whereas there was an unexpected beneficial effect in rapidly proliferating tissues, such as colon, because of enhanced clonal expansion and selective elimination of mutated mtDNA. The absolute levels of WT mtDNA are thus an important determinant of the pathological manifestations, suggesting that pharmacological or gene therapy approaches to selectively increase mtDNA copy number provide a potential treatment strategy for human mtDNA mutation disease.

Single-pixel imaging with Fourier filtering: application to vision through scattering media.

We present a novel approach for imaging through scattering media that combines the principles of Fourier spatial filtering and single-pixel imaging. We compare the performance of our single-pixel imaging setup with that of a conventional system. First, we show that a single-pixel camera does not reduce the frequency content of the object, when a small pinhole is used as a low-pass filter at the detection side. Second, we show that the introduction of Fourier gating improves the contrast of imaging through scattering media in both optical systems. We conclude that single-pixel imaging fits better than conventional imaging on imaging through scattering media by the Fourier gating.

Signal-to-noise ratio of single-pixel cameras based on photodiodes.

Single-pixel cameras have been successfully used in different imaging applications in the last years. One of the key elements affecting the quality of these cameras is the photodetector. Here, we develop a numerical model of a single-pixel camera, which takes into account not only the characteristics of the incident light but also the physical properties of the detector. In particular, our model considers the photocurrent, the dark current, the photocurrent shot noise, the dark-current shot noise, and the Johnson-Nyquist (thermal) noise of the photodiode used as a light detector. The model establishes a clear relationship between the electric signal and the quality of the final image. This allows us to perform a systematic study of the quality of the image obtained with single-pixel cameras in different contexts. In particular, we study the signal-to-noise ratio as a function of the optical power of the incident light, the wavelength, and the photodiode temperature. The results of the model are compared with those obtained experimentally with a single-pixel camera.

Computational imaging with a balanced detector.

Single-pixel cameras allow to obtain images in a wide range of challenging scenarios, including broad regions of the electromagnetic spectrum and through scattering media. However, there still exist several drawbacks that single-pixel architectures must address, such as acquisition speed and imaging in the presence of ambient light. In this work we introduce balanced detection in combination with simultaneous complementary illumination in a single-pixel camera. This approach enables to acquire information even when the power of the parasite signal is higher than the signal itself. Furthermore, this novel detection scheme increases both the frame rate and the signal-to-noise ratio of the system. By means of a fast digital micromirror device together with a low numerical aperture collecting system, we are able to produce a live-feed video with a resolution of 64 × 64 pixels at 5 Hz. With advanced undersampling techniques, such as compressive sensing, we can acquire information at rates of 25 Hz. By using this strategy, we foresee real-time biological imaging with large area detectors in conditions where array sensors are unable to operate properly, such as infrared imaging and dealing with objects embedded in turbid media.

High-resolution adaptive imaging with a single photodiode.

During the past few years, the emergence of spatial light modulators operating at the tens of kHz has enabled new imaging modalities based on single-pixel photodetectors. The nature of single-pixel imaging enforces a reciprocal relationship between frame rate and image size. Compressive imaging methods allow images to be reconstructed from a number of projections that is only a fraction of the number of pixels. In microscopy, single-pixel imaging is capable of producing images with a moderate size of 128 × 128 pixels at frame rates under one Hz. Recently, there has been considerable interest in the development of advanced techniques for high-resolution real-time operation in applications such as biological microscopy. Here, we introduce an adaptive compressive technique based on wavelet trees within this framework. In our adaptive approach, the resolution of the projecting patterns remains deliberately small, which is crucial to avoid the demanding memory requirements of compressive sensing algorithms. At pattern projection rates of 22.7 kHz, our technique would enable to obtain 128 × 128 pixel images at frame rates around 3 Hz. In our experiments, we have demonstrated a cost-effective solution employing a commercial projection display.

Compressive imaging in scattering media.

One challenge that has long held the attention of scientists is that of clearly seeing objects hidden by turbid media, as smoke, fog or biological tissue, which has major implications in fields such as remote sensing or early diagnosis of diseases. Here, we combine structured incoherent illumination and bucket detection for imaging an absorbing object completely embedded in a scattering medium. A sequence of low-intensity microstructured light patterns is launched onto the object, whose image is accurately reconstructed through the light fluctuations measured by a single-pixel detector. Our technique is noninvasive, does not require coherent sources, raster scanning nor time-gated detection and benefits from the compressive sensing strategy. As a proof of concept, we experimentally retrieve the image of a transilluminated target both sandwiched between two holographic diffusers and embedded in a 6mm-thick sample of chicken breast.

Resolution analysis in computational imaging with patterned illumination and bucket detection.

In computational imaging by pattern projection, a sequence of microstructured light patterns codified onto a programmable spatial light modulator is used to sample an object. The patterns are used as generalized measurement modes where the object information is expressed. In this Letter, we show that the resolution of the recovered image is only limited by the numerical aperture of the projecting optics regardless of the quality of the collection optics. We provide proof-of-principle experiments where the single-pixel detection strategy outperforms the resolution achieved using a conventional optical array detector for optical imaging. It is advantageous in the presence of real-world conditions, such as optical aberrations and optical imperfections in between the sample and the sensor. We provide experimental verification of image retrieval even when an optical diffuser prevents imaging with a megapixel array camera.

Quality evaluation of banana skin extract jellies.

Due to the great volume of banana skin resulting from the industrialization of banana and to their high pectin content, the objectives of the present study were to evaluate the effect of the following factors: extract/sugar, pectin and citric acid on the chemical, physical and sensory qualities of the jellies obtained. A complete factorial experimental design was used (2(3)) with 3 central points to evaluate the influence of the factors on the dependent variables, testing the linear models. The chemical properties underwent few alterations and the instrumental and sensory texture attributes were mainly affected by the extract/sugar ratio and the pectin level. The brittleness, elasticity and gumminess increased with increases in the extract/ sugar ratio and pectin level. According to the sensory analysis and the purchasing intention, the best formulations were those obtained using a higher extract/sugar ratio (60/40) and lower pectin level (0.5 g/ 100), combined with the highest (20 mL) or lowest volumes of citric acid (15 mL), with scores for all the attributes in the range from 'I liked slightly' to 'I liked moderately'.

[Feminisation and nephrology]. / Feminización y ejercicio de la nefrología.

Feminisation in nephrology is very high and their consequence in clinical research appears as an interesting focus. Nephrologist women participate to working groups and research projects of the "Sociedad Española de Nefrología" in similar percentage than they contribute to society, more or less 40 %. Nephrologist women are half of medicine PhD. However, nephrologists women are represented the fifth part in advanced projects within clinical research. If the nephrology is a speciality which will be able to keep up with the increasing of the assistance demand, the participation of the women in the clinical research is basic. Without looking down on the other topics, the clinical research within epidemiology and quality about the renal health could be particularly attractive for the women in nephrology.

Avisos médicos domiciliarios en un centro de salud urbano. Estudio de la demanda y estrategias para su optimización / Medical domiciliary care requests in an urban health center. A study of the demand and strategies for its improvement

OBJETIVO. Conocer el perfil del solicitante de atención domiciliaria en nuestra área de salud, como primer paso para intentar aplicar soluciones que mejoren la calidad de la asistencia sanitaria en nuestro centro y, posiblemente, en otros centros de similares características. MATERIAL Y MÉTODOS. Se realiza un estudio transversal analítico. Se incluyeron todas las llamadas recibidas para atención médica domiciliaria en nuestro centro de salud durante los 3 primeros meses del año 2007. Los avisos domiciliarios son divididos en urgentes y demorables. Se incluyeron distintas variables de filiación, datación, diagnóstico y tratamiento. La fuente de información fue la historia clínica informatizada y el libro de registro de urgencias de nuestro centro. Los datos se trataron estadísticamente. RESULTADOS. Durante el período de estudio se realizaron 1.665 avisos a domicilio, de los cuales el 48% se atendieron como urgentes. La edad media fue de 68 años, con un rango de edad de 1 a 101 años. La mayoría de los avisos fue demandada por mujeres (64%). En el 80% de los casos no era la primera vez que el paciente solicitaba la atención domiciliaria. Los diagnósticos varían en función de si el paciente es visto de urgencias o en forma de domicilio a demanda. Se consideró que el aviso no estaba justificado en el 40% de las ocasiones. CONCLUSIONES. Creemos que existe una sobreutilización de la atención domiciliaria, tanto urgente como de demanda, malgastando recursos en actos médicos innecesarios, existiendo múltiples factores involucrados. La educación sanitaria, la recepción telefónica del aviso por el médico, la modulación de la dependencia por su médico y un buen programa de atención al paciente inmovilizado y crónico-dependiente son medidas propuestas para optimizar la atención domiciliaria (AU)

OBJECTIVE. To know the profile of the person requesting domiciliary care in our health care area as a first step to try to apply solutions that improve the quality of the health care in our center and possibly, in other centers of similar characteristics. MATERIAL AND METHODS. A cross-sectional, analytical study was conducted. All the calls received for medical domiciliary care in our Health Care Center during the first 3 months of the year 2007 were included. The domiciliary care requests were divided into urgent and with possibility of delay. Different personal data, dates, diagnosis and treatment variables were included. The information was obtained from the computerized clinical records and registry book of emergencies of our center. The data were processed statistically. RESULTS. During the study period, 1665 patients were attended at home, 48% of whom were seen as emergencies. Mean age was 68 years, with an age range going 1 to 101 years. Most of the domiciliary care was demanded by women (64%). In 80% of the cases, it was not the first time that the patient had requested domiciliary care. The diagnoses varied based on whether the patient was seen as an emergency visit or home care on demand. The demand was considered unjustified in 40% of the cases. CONCLUSIONS. We believe that there is overuse of urgent and on demand domiciliary care, wasting resources for unnecessary medical acts, and that there are many factors involved. Health care education, telephonic reception of the notice by the doctor, modulation of the dependence by the doctor and a good program of care of the immobilized and chronic-dependent patient are measures proposed to improve domiciliary care (AU)

Use of polar decomposition of Mueller matrices for optimizing the phase response of a liquid-crystal-on-silicon display.

We provide experimental measurement of the Mueller matrices corresponding to an on-state liquid-crystal-on-silicon display as a function of the addressed voltage. The polar decomposition of the Mueller matrices determines the polarization properties of the device in terms of a diattenuation, a retardance and a depolarization effect. Although the diattenuation effect is shown to be negligible for the display, the behavior of the degree of polarization as a function of the input polarization state shows a maximum coupling of linearly polarized light into unpolarized light of about 10%. Concerning the retardation effect, we find that the display behaves as a retarder with a fast-axis orientation and a retardance angle that are voltage-dependent. The above decomposition provides a convenient framework to optimize the optical response of the display for achieving a phase-mostly modulation regime. To this end, the display is sandwiched between a polarization state generator and a polarization state analyzer. Laboratory results for a commercial panel show a phase modulation depth of 360 masculine at 633 nm with a residual intensity variation lower than 6 %.

[Analysis of factors associated with extremity ulceration in diabetic subjects with peripheral neuropathy]. / Análise de fatores associados à ulceração de extremidades em indivíduos diabéticos com neuropatia periférica.

Peripheral neuropathy is the main risk factor for foot ulceration in diabetic subjects. This study examined the association of peripheral arterial disease (PAD) with foot ulceration in a sample of diabetic subjects with peripheral neuropathy, and also if inflammatory markers would be associated with this event. We evaluated 32 type 2 diabetic individuals with abnormal 10-g monofilament exam, who were stratified in 2 groups according to history or presence of lower extremities ulcer. The group "with ulcer" (n = 18) included the ones that had active or cicatrized ulcer, or some lower-extremity amputation due to ulcer complications. In addition to the neurological examination and monofilament test, they were submitted to biothesiometry, lower extremity vascular assessment with Doppler, and laboratory determinations. No difference between the groups was found concerning sex distribution, mean age, and duration of diabetes diagnosis. The group with ulcer showed higher mean values of height (1.70 +/- 0.06 vs. 1.63 +/- 0.11 m, p = 0.044), vibration perception threshold measured in medial malleolli (40.9 +/- 13.0 vs. 30.6 +/-12.3 V, p = 0.040) than the group without ulcer. The groups did not differ regarding the mean values of the inflammatory markers. Response to patellae reflex was worse in the group with ulcer (p = 0.047), in which a higher proportion of individuals with abnormal toe-brachial index (p = 0.030) was observed as compared to those without ulcer. We concluded that PAD is associated with the presence of ulcer in neuropathic subjects. The assessment of digital arteries flow in lower limbs (in great toe) contributed to detect such association. Association of diabetic foot ulcers and inflammatory markers was not observed, but cannot be excluded due to limitations of sample size. Prospective studies should examine the sensitivity of the toe-brachial index to identify PAD in diabetic individual at risk of ulceration.