Plasmatic BRAF-V600E allele fraction as a prognostic factor in metastatic colorectal cancer treated with BRAF combinatorial treatments.

BACKGROUND: Combination of a BRAF inhibitor (BRAFi) and an anti-epidermal growth factor receptor (EGFR), with or without a MEK inhibitor (MEKi), improves survival in BRAF-V600E-mutant metastatic colorectal cancer (mCRC) over standard chemotherapy. However, responses are heterogeneous and there are no available biomarkers to assess patient prognosis or guide doublet- or triplet-based regimens. In order to better characterize the clinical heterogeneity observed, we assessed the prognostic and predictive role of the plasmatic BRAF allele fraction (AF) for these combinations. PATIENTS AND METHODS: A prospective discovery cohort including 47 BRAF-V600E-mutant patients treated with BRAFi-anti-EGFR ± MEKi in clinical trials and real-world practice was evaluated. Results were validated in an independent multicenter cohort (n= 29). Plasmatic BRAF-V600E AF cut-off at baseline was defined in the discovery cohort with droplet digital PCR (ddPCR). All patients had tissue-confirmed BRAF-V600E mutations. RESULTS: Patients with high AF have major frequency of liver metastases and more metastatic sites. In the discovery cohort, median progression-free survival (PFS) and overall survival (OS) were 4.4 and 10.1 months, respectively. Patients with high BRAF AF (≥2%, n = 23) showed worse PFS [hazard ratio (HR) 2.97, 95% confidence interval (CI) 1.55-5.69; P = 0.001] and worse OS (HR 3.28, 95% CI 1.58-6.81; P = 0.001) than low-BRAF AF patients (<2%, n = 24). In the multivariable analysis, BRAF AF levels maintained independent significance. In the validation cohort, high BRAF AF was associated with worse PFS (HR 3.83, 95% CI 1.60-9.17; P = 0.002) and a trend toward worse OS was observed (HR 1.86, 95% CI 0.80-4.34; P = 0.15). An exploratory analysis of predictive value showed that high-BRAF AF patients (n = 35) benefited more from triplet therapy than low-BRAF AF patients (n = 41; PFS and OS interaction tests, P < 0.01). CONCLUSIONS: Plasmatic BRAF AF determined by ddPCR is a reliable surrogate of tumor burden and aggressiveness in BRAF-V600E-mutant mCRC treated with a BRAFi plus an anti-EGFR with or without a MEKi and identifies patients who may benefit from treatment intensification. Our results warrant further validation of plasmatic BRAF AF to refine clinical stratification and guide treatment strategies.

Relación entre la edad y la aparición de acontecimientos adversos tras administrar la dosis de refuerzo frente a la COVID-19 / Relationship between age and the occurrence of adverse events after administration of the COVID-19 booster dose

JUSTIFICACIÓN: las vacunas frente a la COVID-19 y sus reacciones adversas han sido objeto de múltiples consultas durante los últimos meses en las farmacias comunitarias. La agilización de todos los trámites para su comercialización apresurada por la pandemia actual y la fuerte carga asistencial sanitaria que estamos sufriendo hacen que aún haya muchos aspectos que desconocemos, por eso debemos de prestar especial atención a todos los posibles acontecimientos adversos de estas vacunas.OBJETIVOS: evaluar si existe una mayor incidencia en la aparición de acontecimientos adversos en los pacientes con edades comprendidas entre los 18 y los 65 años frente a los mayores de 65 años.MATERIAL Y MÉTODOS: se realiza un estudio con carácter observacional descriptivo transversal retrospectivo mediante un cuestionario anónimo de recogida de datos con 11 ítems dirigido a usuarios de la farmacia comunitaria a los que hayan administrado una dosis de refuerzo de vacuna frente a la COVID-19. En el estudio participaron 16 farmacéuticos comunitarios ejercientes en Asturias. El cuestionario se realizó por los farmacéuticos comunitarios vía online a través de la plataforma SurveyMonkey. El análisis estadístico se llevó a cabo mediante IBM SPPS, utilizando como test estadístico Chi cuadrado de Pearson.RESULTADOS/DISCUSIÓN: al final del estudio se recogieron 347 respuestas, de las cuales 13 fueron invalidadas por diversos motivos, obteniendo un total de 334 respuestas válidas. El total de participantes que indico haber sufrido acontecimientos adversos tras la administración de la dosis de refuerzo frente a la COVID-19 es de 239 (71,5 5%). Del total de las respuestas, 249 (74.55 %) corresponden a personas de entre 18 y 65 años, mientras que 85 (25.45 %) son personas mayores de 65 años. (AU)

Evaluación de los acontecimientos adversos producidos tras la administración de una dosis de refuerzo de la vacuna frente al SARS-COV-2 / Evaluation of adverse events following administration of a booster dose of SARS-COV-2 vaccine

JUSTIFICACIÓN: las pautas de vacunación heteróloga frente al Sars-Cov-2 han sido avaladas por diversos organismos tanto para completar la primovacunación como para administrar dosis de refuerzo, aunque no existen estudios que establezcan la intercambiabilidad de las vacunas disponibles.OBJETIVOS: evaluar la reactogenicidad a las vacunas cuando al paciente se le administra una pauta de vacunación heteróloga frente a una pauta homóloga. Cuantificar la intensidad de los acontecimientos adversos y compararlos según el esquema de vacunación seguido.MATERIAL Y MÉTODOS: se realiza un estudio observacional descriptivo transversal retrospectivo mediante un cuestionario anónimo con 11 ítems dirigido a usuarios de la farmacia comunitaria a los que hayan administrado una dosis de refuerzo de la vacuna frente al Sars-Cov-2. En el estudio participan 16 farmacéuticos comunitarios ejercientes en Asturias. El cuestionario se realiza por los farmacéuticos comunitarios a través de la plataforma SurveyMonkey.RESULTADOS/DISCUSIÓN: obtenemos 347 respuestas, de las que 13 fueron invalidadas, resultando un total de 334 respuestas. De estas, 239 (71.56%) sufrieron acontecimientos adversos tras la administración de la dosis de refuerzo, 11 (3,29%) tuvieron primovacunación homóloga y 313 (93,7%) primovacunación heteróloga. Analizando estos datos, 231 (69.16%) pacientes que habían sufrido acontecimientos adversos tras la administración de la tercera dosis, habían recibido una pauta de primovacunación homóloga, siendo 4 (1.20%) tan sólo las personas que refieren haber sufrido un acontecimiento adverso tras la dosis de refuerzo con una primovacunación heteróloga. (AU)

Fusobacterium nucleatum persistence and risk of recurrence after preoperative treatment in locally advanced rectal cancer.

BACKGROUND: Accumulating evidence has identified Fusobacterium as an important pathogenic gut bacterium associated with colorectal cancer. Nevertheless, only limited data exist about the role of this bacterium in locally advanced rectal cancer (LARC). In this study, we quantified Fusobacterium nucleatum in untreated and post-neoadjuvant chemoradiotherapy (nCRT) samples from LARC patients and investigated its association with therapy response and survival. PATIENTS AND METHODS: A total of 254 samples from 143 patients with rectal adenocarcinomas were analyzed for the presence and abundance of F. nucleatum using RNA in situ hybridization and digital image analysis. Assay accuracy was determined using infected cell lines and tumor samples with available quantitative PCR data. We studied the impact of F. nucleatum load on pathologic complete response and relapse-free survival. Treatment-induced changes were evaluated in paired pre- and post-nCRT samples (n = 71). Finally, tumor microenvironment changes during nCRT were assessed in paired samples (n = 45) by immune contexture analysis. RESULTS: F. nucleatum tissue levels by RNA in situ hybridization strongly correlated with quantitative PCR (r = 0.804, P < 0.001). F. nucleatum abundance was higher in untreated [median, 7.4; 95% confidence interval (3.7-16.2)] compared with treated [median, 1.6; 95% confidence interval (1.3-2.4)] tumors (P <0.001) with 58% (73/126) and 26% (22/85) positive tumors, respectively (P < 0.001). Baseline F. nucleatum levels were not associated with pathologic complete response. F. nucleatum positivity after nCRT, but not baseline status, significantly increased risk of relapse [hazard ratio = 7.5, 95% confidence interval (3.0-19.0); P < 0.001]. Tumors that turned F. nucleatum-negative after nCRT had a strong increase in CD8+ T cells post-nCRT (P < 0.001), while those that persisted F. nucleatum-positive after nCRT lacked CD8+ T cells induction in post-nCRT samples compared with baseline (P = 0.69). CONCLUSION: F. nucleatum persistence post-nCRT is associated with high relapse rates in LARC, potentially linked to suppression of immune cytotoxicity.

Mortality of women with ductal carcinoma in situ of the breast: a population-based study from the Girona province, Spain (1994-2013).

PURPOSE: We aim to comprehensively describe the incidence and mortality trends of ductal carcinoma in situ (DCIS) in the Girona province, Spain (1994-2013) and to estimate the all-cause mortality excess risk of diagnosed women. METHODS: Age-standardized rates of DCIS were estimated between 1994 and 2013. Standard mortality ratios (SMR) and absolute excess mortality were calculated overall and by tumor and patient characteristics. A sensitivity analysis was conducted excluding cases with a subsequent invasive breast cancer (sIBC). RESULTS: Of the 641 women included, 56 died (follow-up time: 8.4 person-years). Between 1994 and 2013, a significant increase in incidence and decrease in mortality was identified among women aged between 50 and 69 years old. Neoplasms and circulatory system disease were the most common causes of death. No excess risk of death was found overall, except for women aged < 50 years (SMR = 3.44, 95% CI 1.85; 6.40) and those with a sIBC (SMR = 2.51, 95% CI 1.26; 5.02), risk that lessened when cases with sIBC were excluded. Patients with sIBC also showed an excess risk (SMR = 2.29, 95% CI 1.03; 5.10). CONCLUSIONS: Among women aged 50-69 years old, incidence of DCIS has significantly increased yet mortality has decreased. Overall, the all-cause mortality risk of women diagnosed with DCIS remains similar to that of the general population except for women diagnosed before age 50 and those with sIBC, who showed a significant increased risk. Differential management of these patients should be considered.

Differences in Neisseria gonorrhoeae population structure and antimicrobial resistance pattern between men who have sex with men and heterosexuals.

This study compared the antimicrobial susceptibility and genotypes of strains of Neisseria gonorrhoeae isolated from men who have sex with men (MSM) and from heterosexuals. One hundred and eleven strains were characterized from 107 patients, comprising 57 strains from 54 heterosexuals and 54 strains from 53 MSM. Antimicrobial resistance rates were higher in strains from heterosexual patients, with resistance to cefixime (P = 0·0159) and ciprofloxacin (P = 0·002) being significantly higher. Typing by N. gonorrhoeae multi-antigen sequence typing (NG-MAST) showed that the most prevalent sequence types (ST) and genogroups (G) respectively were ST2400, ST2992, and ST5793, and G1407, G2992, and G2400. A statistically significant association was observed for MSM and genogroups G2400 (P = 0·0005) and G2992 (P = 0·0488), and G1407 with heterosexuals (P = 0·0002). We conclude that in our region distinct populations of gonococci are circulating among subjects with different sexual practices, with their corresponding transmission patterns. Furthermore, the high prevalence of genotype G2400 in MSM, has not to our knowledge been previously described.

Neisseria gonorrhoeae antimicrobial susceptibility in Barcelona: penA, ponA, mtrR, and porB mutations and NG-MAST sequence types associated with decreased susceptibility to cephalosporins.

The aims of this study were to determine the antimicrobial susceptibility of Neisseria gonorrhoeae (NG) in our area, to analyze the molecular mechanisms involved in cephalosporins resistance, and to undertake molecular typing of our NG strains. Antimicrobial susceptibility was determined using the Etest. The genes penA, mtrR, penB, and ponA were studied. Molecular typing was performed by N. gonorrhoeae multiantigen sequence typing. Of 329 strains analyzed in 2013, none showed high-level cephalosporin resistance, but 8.2 % had resistance to cefixime [minimum inhibitory concentration (MIC) > 0.125 µg/mL] and 0.6 % to ceftriaxone (MIC > 0.125 µg/mL). Azithromycin resistance was documented in 4.3 % and ciprofloxacin resistance in 49.2 %. Among 48 strains with an MIC ≥ 0.125 µg/mL to cefixime, 58.3 % showed the penA mosaic pattern XXXIV, 98 % a Leu → Pro substitution at position 421 of the ponA gene, 100 % amino acid changes at positions 101 and 102 of the PorB1b porin, and 87.5 % of strains an adenine deletion in the promoter region of the MtrC-D-E efflux pump. A significant difference between strains with and without decreased cephalosporin susceptibility (MIC ≥ 0.125 µg/mL) was observed for these four genes. Of the 48 strains with an MIC ≥ 0.125 µg/mL to cefixime, 43.8 % belonged to the genogroup G1407 and 27.1 % belonged to the genogroup G2400. A significant association of G1407 with decreased susceptibility (MIC ≥ 0.125 µg/mL) and G2992 with susceptibility was found, and also between G1407 and mosaic pattern XXXIV and between G2400 and A501T substitution in penA. The NG resistance rate in our area is higher than the median of Europe. We have detected the emergence of G2400, which may be a source of antimicrobial resistance.

CES1 genetic variation affects the activation of angiotensin-converting enzyme inhibitors.

The aim of the study was to determine the effect of carboxylesterase 1 (CES1) genetic variation on the activation of angiotensin-converting enzyme inhibitor (ACEI) prodrugs. In vitro incubation study of human liver, intestine and kidney s9 fractions demonstrated that the ACEI prodrugs enalapril, ramipril, perindopril, moexipril and fosinopril are selectively activated by CES1 in the liver. The impact of CES1/CES1VAR and CES1P1/CES1P1VAR genotypes and diplotypes on CES1 expression and activity on enalapril activation was investigated in 102 normal human liver samples. Neither the genotypes nor the diplotypes affected hepatic CES1 expression and activity. Moreover, among several CES1 nonsynonymous variants studied in transfected cell lines, the G143E (rs71647871) was a loss-of-function variant for the activation of all ACEIs tested. The CES1 activity on enalapril activation in human livers with the 143G/E genotype was approximately one-third of that carrying the 143G/G. Thus, some functional CES1 genetic variants (for example, G143E) may impair ACEI activation, and consequently affect therapeutic outcomes of ACEI prodrugs.

Fascitis necrosante por Staphylococcus aureus resistente a la meticilina adquirido en la comunidad productor de leucocidina de Panton-Valentine / Necrotizing fasciitis due to community-acquired panton-valentine leukocidin methicillin resistant Staphylococcus aureus

El Staphylococcus aureus resistente a la meticilina adquirido en la comunidad (SARM-AC) es actualmente un microorganismo emergente en todo el mundo, que puede producir infecciones cutáneas y de partes blandas, algunas de éstas graves, como la fascitis necrosante, además de neumonía y osteomielitis. A continuación se presenta un caso de fascitis necrosante en un niño de 14 meses de edad, que se confirmó mediante resonancia magnética, producido por SARM-AC productor de leucocidina de Panton-Valentine. La evolución clínica fue buena después del tratamiento quirúrgico precoz y de la administración de clindamicina por vía intravenosa durante 2 semanas. En este trabajo se revisan los aspectos microbiológicos y las pautas de tratamiento de estas infecciones (AU)

Community-Acquired Methicillin-Resistant Staphylococcus aureus (CA-MRSA) is a worldwide emerging pathogen that is able to produce serious skin and soft- tissue infections such as necrotizing fasciitis, as well as pneumonia and osteomyelitis. We present a 14 month child with necrotizing fasciitis, confirmed by magnetic resonance imaging, produced by CA-MRSA Panton-Valentine leukocidin producer. The clinical outcome was good after early surgical treatment and the administration of intravenous clindamycin for two weeks. We review microbiological aspects and treatment guidelines of these infections (AU)

[Necrotizing fasciitis due to community-acquired panton-valentine leukocidin methicillin resistant Staphylococcus aureus]. / Fascitis necrosante por Staphylococcus aureus resistente a la meticilina adquirido en la comunidad productor de leucocidina de Panton-Valentine.

Community-Acquired Methicillin-Resistant Staphylococcus aureus (CA-MRSA) is a worldwide emerging pathogen that is able to produce serious skin and soft- tissue infections such as necrotizing fasciitis, as well as pneumonia and osteomyelitis. We present a 14 month child with necrotizing fasciitis, confirmed by magnetic resonance imaging, produced by CA-MRSA Panton-Valentine leukocidin producer. The clinical outcome was good after early surgical treatment and the administration of intravenous clindamycin for two weeks. We review microbiological aspects and treatment guidelines of these infections.

[Intake of fermented milk containing Lactobacillus casei DN-114 001 and its effect on gut flora]. / Efecto de la ingesta de leche fermentada con Lactobacillus casei DN-114 001 sobre la flora intestinal.

OBJECTIVE: To study the gut flora in infants who received fermented milk containing Lactobacillus casei and Streptococcus termophilus and its effect on secretory immunoglobulin levels. MATERIAL AND METHODS: An experimental, randomized, prospective, parallel group study was carried out. Thirty-five infants were included (18 in the treatment group and 17 in the control group) with a mean age of 2 years (SD: 0.6 years; range: 1-3 years). The experimental group received both fermented milk (0.5 l/day) containing L. casei and S. termophilus for 6 weeks and standard cow's milk for the following 6 weeks. The control group received standard cow's milk (0.5 l/day) for 12 weeks. Secretory IgA levels in saliva were evaluated in the experimental group at the start of the study (baseline levels) and 6 weeks later. In both groups, stools were collected to study gut flora at 0, 6 and 12 week. RESULTS: Secretory IgA levels significantly increased (p =0.0063) from a mean baseline value of 2.5 mg/dl to a mean of 3.4 mg/dl at 6 weeks. Gram-negative aerobic flora were decreased in the experimental group after 6 weeks compared with the control group (p =0.0203). The number of infants with Lactobacillus spp in their gut flora was greater in the experimental group than in the control group at week 6 and this difference was statistically significant (p =0.028) at week 12. Conclusion The present study provides evidence of L. casei survival in the gastrointestinal tract and of its effect of increasing secretory IgA.

Efecto de la ingesta de leche fermentada con Lactobacillus casei DN-114 001 sobre la flora intestinal / Intake of fermented milk containing Lactobacillus casei DN-114 001 and its effect on gut flora

Objetivo Estudiar las características de la flora microbiana intestinal de niños que recibieron en su dieta leche fermentada con Lactobacillus casei y Streptococcus termophilus y su repercusión en los valores de inmunoglobulinas secretoras. Material y métodos Estudio experimental aleatorizado, prospectivo, con 2 grupos paralelos. Se incluyeron un total de 35 niños (18 en el grupo experimental y 17 en el grupo control), con una edad media de 2 años (DE: 0,6 años; rango: 1-3 años). El grupo experimental recibió en su dieta leche fermentada (500 ml/día) con L. casei y S. termophilus durante 6 semanas y leche de vaca normal estándar durante 6 semanas más. El grupo control recibió leche de vaca normal estándar (500 ml/día) a lo largo de todo el estudio. Se evaluaron los valores de IgA secretora en saliva del grupo experimental al inicio y a las 6 semanas del estudio. Se recogieron heces para el estudio de la flora intestinal a las 0, 6 y 12 semanas en ambos grupos. Resultados Se observó un aumento estadísticamente significativo (p 5 0,0063) de un valor medio basal de 2,5 mg/dl al inicio hasta una media de 3,4 mg/dl a las 6 semanas. Así mismo, se observó un descenso de la flora aeróbica gramnegativa a la semana 6 en comparación con el grupo control (p 5 0,0203). La proporción de niños en los que se les aisló Lactobacillus spp. en la flora intestinal fue superior en el grupo experimental a partir de la semana 6 y llegando a ser estadísticamente significativa (p 5 0,028) a las 12 semanas. Conclusión El presente estudio aporta evidencia sobre la supervivencia de L. casei en el tracto intestinal y su efecto inmunoestimulante en un incremento significativo del la IgA secretora

Objective To study the gut flora in infants who received fermented milk containing Lactobacillus casei and Streptococcus termophilus and its effect on secretory immunoglobulin levels. Material and methods An experimental, randomized, prospective, parallel group study was carried out. Thirty-five infants were included (18 in the treatment group and 17 in the control group) with a mean age of 2 years (SD: 0.6 years; range: 1-3 years). The experimental group received both fermented milk (0.5 l/day) containing L. casei and S. termophilus for 6 weeks and standard cow's milk for the following 6 weeks. The control group received standard cow's milk (0.5 l/day) for 12 weeks. Secretory IgA levels in saliva were evaluated in the experimental group at the start of the study (baseline levels) and 6 weeks later. In both groups, stools were collected to study gut flora at 0, 6 and 12 week. Results Secretory IgA levels significantly increased (p 5 0.0063) from a mean baseline value of 2.5 mg/dl to a mean of 3.4 mg/dl at 6 weeks. Gram-negative aerobic flora were decreased in the experimental group after 6 weeks compared with the control group (p 5 0.0203). The number of infants with Lactobacillus spp in their gut flora was greater in the experimental group than in the control group at week 6 and this difference was statistically significant (p 5 0.028) at week 12. Conclusion The present study provides evidence of L. casei survival in the gastrointestinal tract and of its effect of increasing secretory IgA

Hipertensión secundaria y síndrome metabólico / Secondary hypertension and metabolic syndrome

Mujer de 67 años en programa de obesidad desde hace 5 años. Se detecta hipercolesterolemia hace dos años, con colesterol total: 245 mg/dl, colesterol ligado a lipoproteínas de alta densidad (c-HDL): 50 mg/dl, colesterol ligado a lipoproteínas de baja densidad (c-LDL): 165 mg/dl, y triglicéridos: 149 mg/dl, en tratamiento con dieta. Ingresa por cuadro de abdomen agudo en el servicio de Cirugía General, siendo sometida a apendicectomía incidental tras analítica, ecografía y tomografía computarizada (TC) abdominal sugerentes de apendicitis aguda. Reingresa dos días después en Medicina Interna por persistencia del dolor abdominal y febrícula. Se detecta hipertensión arterial (HTA) y tras estudio exhaustivo el diagnóstico es dolor de origen genitourinario con buena resolución. En el informe de alta, aunque descartan la HTA secundaria vásculo-renal, no se valoran alteraciones analíticas: glucemia: 140 mg/dl, fósforo: 2,4 mg/dl, calcio en orina de 24 horas: 333,2 mg/24 horas y microalbuminuria que podrían sugerir otro origen. Ante la persistencia de alteraciones del metabolismo fosfocálcico se solicitan valores de hormona parotiroidea (PTH) que resultan elevados: 310 pg/ml. Se diagnostica de HTA secundaria a hiperparatiroidismo y síndrome metabólico

A 67 year old woman who has been included in an obesity program for 5 years with hypercholesterolemia detected 2 years ago. Total cholesterol is: 245 mg/dl, HDL-C: 50 mg/dl, LDL-c: 165 mg/dl and triglycerides: 149 mg/dl. She was following a treatment with diet. She was admitted in the General Surgery Department due to acute abdomen and underwent an appendectomy as a result of a blood test, abdominal ultrasonography and abdominal CT suggesting acute appendicitis. She was readmitted two days later in the Internal Medicine Department due to persistence of abdominal pain and low fever. High blood pressure was detected. After a thorough study, genitourinary pain with good outcome was diagnosed. In the discharge report, no blood tests abnormalities were assessed, although vasculo-renal secondary hypertension was ruled out: glycemia: 140 mg/dl, phosphorus: 2.4 mg/dl, 24 hour urine calcium: 333.2 mg/24 h and positive microalbuminuria that could suggest a different etiology. Given the persistence of phosphorus-calcium metabolism disorders, PTH values, which were elevated, were assessed: 310 pg/ml. The diagnosis was hyperparathyroidism with secondary hypertension and metabolic syndrome

[Evaluation of three rapid methods for intrapartum detection of group B streptococcus]. / Evaluación de tres técnicas rápidas para la detección intraparto del estreptococo del grupo B.

OBJECTIVE: The goal of this study was to evaluate three methods for rapid group B streptococcus (GBS) intrapartum vaginal detection. MATERIALS AND METHODS: In 330 women, at risk of delivering an infant with GBS disease, vaginal exudates were collected and a culture performed. The following rapid tests were also performed: 1) Equate Strep B immunoassay in 133 samples. 2) Icon Strep B immunoassay in 192 samples. 3) Co-agglutination with Phadebact Strep B, with a previous incubation (> 4 hours) of the vaginal swabs in Lim Group B Strep broth, in 88 samples. In some patients, two of these methods were performed simultaneously. RESULTS: GBS was detected in 37 women (11.2%) by culture. The sensitivity of Equate Strep B was 47%, Icon Strep B was 35% and co-agglutination with Phadebact Strep B was 38%. The specificity was 91%, 99% and 100% for each one of these methods. PPV 44%, 90% and 100%, respectively and NPV 92%, 91% and 90%, respectively. CONCLUSION: In conclusion, none of these methods was shown sensitive enough to be used for the routine detection of GBS. Therefore, in order to know the GBS carrier status and prevent its vertical transmission, the practice of vaginal culture during late pregnancy is mandatory.

[Characteristics of group b streptococcus vertical transmission]. / Características de la transmisión vertical madrefeto del estreptococo del grupo B.

OBJECTIVE: The goal of this study was to compare the characteristics of group B streptococcus (GBS) or Streptococcus agalactiae vertical transmission in woman, receiving or not intrapartum. antimicrobial prophylaxis, at risk of delivering an infant with GRS disease. MATERIALS AND METHODS: The study included 330 women, with risk factors for delivering an infant with GBS disease. The vaginal GBS colonization was studied by conventional culture. A clinical and microbiological follow-up was done in both women and neonates. RESULTS: GHS was detected in 37 women (11.2%). Among these, 21 (56.8%) received intrapartum antibiotics and 16 (43.2%) did not. Forty-one neonates were born from these 37 women. Of these, 11 showed signs of infection (3 with positive blood culture and 8 with blood culture negative for GBS) and 2 presented an asymptomatic bacteremia A GBS neonatal infection (with positive blood culture) was produced in 4.8% of newborns from mothers who received intrapartum antibiotics versus 25% of newborns from mothers who did not receive intrapartum antibiotics. However, this difference was not significant nor was the difference between external colonization by GBS between these two groups of newborns. On the contrary, significant differences were found in the percentage of clinically suspected sepsis (with negative blood cultures), which was more frequent among newborns from mothers without intrapartum antibiotics (30.4% vs 5.6%). A good correlation between the intensity of vaginal colonization and the incidence of microbiologically demonstrated sepsis, suspected sepsis an asymptomatic bacteremia in the newborn was found. CONCLUSION: In conclusion, in order to minimize the vertical transmission of GBS, the most efficient strategy seems to be to offer antibiotic prophylaxis to women identified as GBS carriers, since the antibiotic administration to women with "obstetric risks" often means that it is impossible that two hours elapse between antibiotic administration and delivery, resulting in the loss of efficacy of this second strategy.

La docencia nefrológica en Cuba. Experiencia en 15 años / Nephrologic teaching in Cuba. Experience in 15 years

La enseñanza nefrológica en Cuba se inicia a finales de 1966 con la fundación del Instituto de Nefrología. Se realiza a tres niveles diferentes: pregrado, posgrado y a técnicos medios, en especial a los dos últimos. Desde 1970 a 1982 se graduaron 51 especialístas. En la actualidad hay 3 centros con categoría docente en el país. En cursos de adiestramiento, jornadas de actualización y talleres se han beneficiado con este tipo de actividad 279 profesionales de diversas especialidades, 88 enfermeras de cursos posbásicos, 473 enfermeras de otros perfiles y 63 técnicos medios. Se describe el programa de especialización en nefrología y se dan las pautas para el desarrollo en los próximos años (AU)

La docencia nefrologica en Cuba.Experiencia en 15 anos. / Nephrologic teaching in Cuba. Experience in 15 years

La ensenanza nefrologica en Cuba se inicia a finales de 1966 con la fundacion del Instituto de Nefrologia. Se realiza a tres niveles diferentes: pregrado posgrado y a tecnicos medios, en especial en los dos ultimos. Desde 1970 a 1982 se graduaron 51 especialistas. En la actualidad hay 3 centros con categoria docente en el pais. En cursos de adiestramiento, jornadas de actualizacion y talleres se han beneficiado con este tipo de actividad 279 profesionales de diversas especialidades, 88 enfermeras de cursos posbasicos, 473 enfermeras de otros perfiles y 63 tecnicos medios. Se describe el programa de especializacion en Nefrologia y se dan las pautas para el desarrollo en los proximos anos

La docencia nefrologica en Cuba.Experiencia en 15 anos. / Nephrologic teaching in Cuba. Experience in 15 years

La ensenanza nefrologica en Cuba se inicia a finales de 1966 con la fundacion del Instituto de Nefrologia. Se realiza a tres niveles diferentes: pregrado posgrado y a tecnicos medios, en especial en los dos ultimos. Desde 1970 a 1982 se graduaron 51 especialistas. En la actualidad hay 3 centros con categoria docente en el pais. En cursos de adiestramiento, jornadas de actualizacion y talleres se han beneficiado con este tipo de actividad 279 profesionales de diversas especialidades, 88 enfermeras de cursos posbasicos, 473 enfermeras de otros perfiles y 63 tecnicos medios. Se describe el programa de especializacion en Nefrologia y se dan las pautas para el desarrollo en los proximos anos