Nurses' preferences regarding MenACWY conjugate vaccines attributes: a discrete choice experiment in Spain.

OBJECTIVES: Immunisation against preventable diseases as meningitis is crucial from a public health perspective to face challenges posed by these infections. Nurses hold a great responsibility for these programs, which highlights the importance of understanding their preferences and needs to improve the success of campaigns. This study aimed to investigate nurses' preferences regarding Meningococcus A, C, W, and Y (MenACWY) conjugate vaccines commercialised in Spain. STUDY DESIGN: A national-level discrete choice experiment (DCE) was conducted. METHODS: A literature review and a focus group informed the DCE design. Six attributes were included: pharmaceutical form, coadministration evidence, shelf-life, package contents, single-doses per package, and package volume. Conditional logit models quantified preferences and relative importance (RI). RESULTS: Thirty experienced primary care nurses participated in this study. Evidence of coadministration with other vaccines was the most important attribute (RI = 43.78%), followed by package size (RI = 22.17%), pharmaceutical form (RI = 19.07%), and package content (RI = 11.80%). There was a preference for evidence of coadministration with routine vaccines (odds ratio [OR] = 2.579, 95% confidence interval [95%CI] = 2.210-3.002), smaller volumes (OR = 1.494, 95%CI = 1.264-1.767), liquid formulations (OR = 1.283, 95%CI = 1.108-1.486) and package contents including only vial/s (OR = 1.283, 95%CI = 1.108-1.486). No statistical evidence was found for the remaining attributes. CONCLUSIONS: Evidence of coadministration with routine vaccines, easy-to-store packages, and fully liquid formulations were drivers of nurses' preferences regarding MenACWY conjugate vaccines. These findings provide valuable insights for decision-makers to optimize current campaigns.

Fertility prediction in dairy goats from Murciano-Granadina breed: The role of sperm evaluation and female traits.

Fertility is one of the most economically important traits in farm animals, due to the direct and indirect costs associated to low pregnancy rates. Thus, one of the priority goals in animal reproduction is to predict the performance that the semen doses will have in vivo based on the quality values obtained in laboratory assays. Attempts have been made for getting a predictive model of fertility of frozen-thawed sperm in dairy goats, but similar studies have not been conducted for chilled goat buck sperm doses that are mostly used for artificial insemination in many countries including Spain. We study how parameters of in vitro sperm quality and characteristics of Murciano-Granadina dairy goats may affect the in vivo fertility obtained after artificial insemination with semen doses chilled at 4 °C. Moreover, this information was used for obtaining predictive models of the fertility. Sixty-three ejaculates from 13 males were used to prepare chilled doses for the insemination of 495 goats over 13 sessions. Fresh and chilled sperm were evaluated for motility and plasma membrane integrity with a computer-assisted sperm analysis system and flow cytometry, respectively. Fertility was determined at parturition, according to the kidding goats. Overall fertility was 59.6%. Pearson's correlation coefficients between in vivo fertility and quality variables of fresh sperm were not significant and were low (below 0.34 in absolute value) for chilled sperm. Females' characteristics had a low negative impact on fertility (correlation coefficients of -0.19 with age, -0.20 with parturitions and -0.11 with total milk yield obtained in the best lactation). Fixed and mixed logistic regression procedures were used trying to explain the fertility results. None of the models accurately predicted fertility, but the best models included the percentage of total motile sperm or average path velocity from fresh semen, age of the females and the session effect (uncontrolled environmental effects). These analyses showed that primiparous goats were 2.42 times more likely to get pregnant than goats that had kidded four or more times. Our field assay data on fertility in Murciano-Granadina dairy goats highlighted the importance of making quality controls of sperm, of choosing the doses presenting high percentages of motile sperm exhibiting regular trajectories and of selecting the youngest goats for AI, after their first kidding. Efforts should continue to obtain better predictive models for improving fertility in goat dairy herds.

Prescripción potencialmente inadecuada: utilidad de los criterios STOPP/START versión 2 a nivel poblacional en Cataluña / Potentially inappropriate prescribing: Usefulness of STOPP/START criteria version 2 in Catalonian elderly population

Objetivo: Analizar la prevalencia de la prescripción potencialmente inadecuada (PPI) en ancianos en Cataluña, utilizando los criterios Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) versión 2. Evaluar la asociación de la PPI con diversas variables (polimedicación, sexo, edad y características sociodemográficas). Material y métodos: Diseño: estudio descriptivo retrospectivo transversal. Emplazamiento: Ámbito de Atención Primaria. Cataluña, España. Participantes Se analizan los datos de la población de 70 años o más atendida en los Centros de Salud de Cataluña en 2014 (700.058 pacientes). Mediciones principales: Cincuenta y cinco indicadores STOPP, y 19 START. Se ajustan modelos de regresión logística para evaluar su asociación con diversas variables. Resultados: La edad media es de 79,2±6,5 años. El 58,5% son mujeres. El 38,7% tiene 7 o más fármacos prescritos, y más del 50% acumulan más de 10 visitas anuales. Los indicadores STOPP que acumulan una mayor PPI son los relacionados con el uso de antiinflamatorios no esteroideos, antiagregantes, anticoagulantes, y benzodiacepinas. En cuanto a los criterios START destaca la omisión de suplementos de vitamina D y calcio, antidepresivos, y fármacos relativos al sistema cardiovascular. La PPI es mayor en mujeres, pacientes institucionalizados y domiciliarios, y en aquellos con mayor número de fármacos y número de visitas. Conclusiones: Se detectó una PPI poblacional con una alta prevalencia (89,6%). La PPI se relaciona de forma más significativa con determinadas condiciones del paciente y grupos farmacológicos. El conocimiento de esta asociación es trascendental para la futura implementación de medidas de seguridad en prescripción farmacológica (AU)

Objective: To measure the prevalence of potentially inappropriate prescribing (PIP) among the elderly population in Catalonia using criteria Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) version 2. In addition, to evaluate the association between PIP and several factors (polypharmacy, gender, age and sociodemographic conditions). Materials and methods: Design: Retrospective cross sectional population study. Settings: Primary Health Care, Catalonia, Spain. Participants: The study population comprised of participants 70 years old and over, who attended primary health care centres in Catalonia in 2014 (700.058 patients). Main analysis: 55 STOPP and 19 START criteria are applied to analyse PIP prevalence. Logistic regression models are adjusted to determine PIP association with several factors. Results: The mean age is 79. 2±6.5. 58.5% being female. 38.7% of patients have 7 or more prescribed drugs, whereas 50% go to a primary care centre 10 or more times during one year. The most frequent PIP among STOPP criteria are related to nonsteroidal anti-inflammatory drug intake, antiplatelet and anticoagulants use, and benzodiazepines. According to START, the most frequent omissions are vitamin D and calcium supplements, antidepressants, and cardiovascular medications. Factors that increase PIP are: female gender, living in a nursing home, receiving home health care, polypharmacy and frequent visits to primary care centres. Conclusions: The overall prevalence of PIP is 89.6%. PPI is significantly related to certain drugs and patient's conditions. The knowledge of this association is important for the implementation of security measures for medical prescription (AU)

[Potentially inappropriate prescribing: Usefulness of STOPP/START criteria version 2 in Catalonian elderly population]. / Prescripción potencialmente inadecuada: utilidad de los criterios STOPP/START versión 2 a nivel poblacional en Cataluña.

OBJECTIVE: To measure the prevalence of potentially inappropriate prescribing (PIP) among the elderly population in Catalonia using criteria Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) version 2. In addition, to evaluate the association between PIP and several factors (polypharmacy, gender, age and sociodemographic conditions). MATERIALS AND METHODS: Design: Retrospective cross sectional population study. SETTINGS: Primary Health Care, Catalonia, Spain. PARTICIPANTS: The study population comprised of participants 70 years old and over, who attended primary health care centres in Catalonia in 2014 (700.058 patients). MAIN ANALYSIS: 55 STOPP and 19 START criteria are applied to analyse PIP prevalence. Logistic regression models are adjusted to determine PIP association with several factors. RESULTS: The mean age is 79. 2±6.5. 58.5% being female. 38.7% of patients have 7 or more prescribed drugs, whereas 50% go to a primary care centre 10 or more times during one year. The most frequent PIP among STOPP criteria are related to nonsteroidal anti-inflammatory drug intake, antiplatelet and anticoagulants use, and benzodiazepines. According to START, the most frequent omissions are vitamin D and calcium supplements, antidepressants, and cardiovascular medications. Factors that increase PIP are: female gender, living in a nursing home, receiving home health care, polypharmacy and frequent visits to primary care centres. CONCLUSIONS: The overall prevalence of PIP is 89.6%. PPI is significantly related to certain drugs and patient's conditions. The knowledge of this association is important for the implementation of security measures for medical prescription.

Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study.

Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. INTRODUCTION: There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. METHODS: We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. RESULTS: Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. CONCLUSION: The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.

Pathway towards an ideal and sustainable framework agreement for the public procurement of vaccines in Spain: a multi-criteria decision analysis.

Objective: To advance the development of an ideal and sustainable framework agreement for the public procurement of vaccines in Spain, and to agree on the desirable award criteria and their relative weight. Methods: A multidisciplinary committee of seven health-care professionals and managers developed a partial multi-criteria decision analysis to determine the award criteria that should be considered and their specific weights for the public procurement of routine vaccines and seasonal influenza vaccines, considering their legal viability. A re-test of the results was carried out. The current situation was analyzed through 118 tender specifications and compared to the ideal framework. Results: Price is the prevailing award criterion for the public procurement of both routine (weighting of 60% versus 40% for all other criteria) and influenza (36% versus 64%) vaccines. Ideally, 22 criteria should be considered for routine vaccines, grouped and weighted into five domains: efficacy (weighting of 29%), economic aspects (27%), vaccine characteristics (22%), presentation form and packaging (13%), and others (9%). Per criteria set, price was the most important criterion (22%), followed by effectiveness (9%), and composition/formulation (7%). Regarding influenza vaccines, 20 criteria were selected, grouped, and weighted: efficacy (29%), economic aspects (25%), vaccine characteristics (20%), presentation form and packaging (16%), and others (11%). Per criteria set, price was also the most relevant criterion (19%), followed by composition/formulation (8%), and effectiveness (8%). Conclusions: Contrary to the current approach, technical award criteria should prevail over economic criteria in an ideal and sustainable framework agreement for the public procurement of vaccines.

Mechanisms of interaction of chromium with Aspergillus niger var tubingensis strain Ed8.

Experiments were conducted to determine the mechanisms of interaction with chromium of Aspergillus niger var tubingensis strain Ed8 in batch culture and in bioreactor experiments. Results obtained in this work showed that the interaction of A. niger var tubingensis Ed8 with Cr(VI) is based mainly in a reduction process and also, secondly, in a sorption process. Using electron microscopy techniques the ultrathin sections obtained from the mycelium biomass produced by the fungus in batch cultures showed the ability to incorporate Cr intracellulary, into low electron-dense inclusions, but not extracellularly. On the other hand, cultures without Cr(VI) of A. niger var tubingensis Ed8, grown in a bubble column bioreactor, reduced Cr(VI) immediately after repeated addition of this oxyanion; after six loads, 460 mg Cr(VI) was reduced to Cr(III) in 60 h, corresponding to a reduction rate of 2.62 mg Cr(VI)g(-1) dry biomass h(-1).

Effect of copper and lead on two consortia of phototrophic microorganisms and their capacity to sequester metals.

The roles of consortia of phototrophic microorganisms have been investigated in this paper to determine their potential role to tolerate or resist metals and to capture them from polluted cultures. With this purpose, two consortia of microorganisms: on one hand, Geitlerinema sp. DE2011 (Ge) and Scenedesmus sp. DE2009 (Sc) (both identified in this paper by molecular biology methods) isolated from Ebro Delta microbial mats, and on the other, Spirulina sp. PCC 6313 (Sp) and Chroococcus sp. PCC 9106 (Ch), from Pasteur culture collection were polluted with copper and lead. In order to analyze the ability of these consortia to tolerate and capture metals, copper and lead were selected, because both have been detected in Ebro Delta microbial mats. The tolerance-resistance to copper and lead for both consortia was determined in vivo and at cellular level by Confocal Laser Scanning Microscopy (CLSM-λscan function). The results obtained demonstrate that both consortia are highly tolerant-resistant to lead and that the limits between the copper concentration having cytotoxic effect and that having an essential effect are very close in these microorganisms. The capacity of both consortia to capture extra- and intracellular copper and lead was determined by Scanning Electron Microscopy (SEM) and Transmission Electron Microscopy (TEM) respectively, coupled to an Energy Dispersive X-ray detector (EDX). The results showed that all the microorganisms assayed were able to capture copper extracellularly in the extrapolymeric substances, and lead extra- and intracellularly in polyphosphate inclusions. Moreover, the studied micro-organisms did not exert any inhibitory effect on each other's metal binding capacity. From the results obtained in this paper, it can be concluded that consortia of phototrophic microorganisms could play a very important role in biorepairing sediments polluted by metals, as a result of their ability to tolerate or resist high concentrations of metals and to bioaccumulate them, extra- and intracellulary.

Nanometer-scale characterization of exceptionally preserved bacterial fossils in Paleocene phosphorites from Ouled Abdoun (Morocco).

Micrometer-sized spherical and rod-shaped forms have been reported in many phosphorites and often interpreted as microbes fossilized by apatite, based on their morphologic resemblance with modern bacteria inferred by scanning electron microscopy (SEM) observations. This interpretation supports models involving bacteria in the formation of phosphorites. Here, we studied a phosphatic coprolite of Paleocene age originating from the Ouled Abdoun phosphate basin (Morocco) down to the nanometer-scale using focused ion beam milling, transmission electron microscopy (TEM), and scanning transmission x-ray microscopy (STXM) coupled with x-ray absorption near-edge structure spectroscopy (XANES). The coprolite, exclusively composed of francolite (a carbonate-fluroapatite), is formed by the accumulation of spherical objects, delimited by a thin envelope, and whose apparent diameters are between 0.5 and 3 µm. The envelope of the spheres is composed of a continuous crown dense to electrons, which measures 20-40 nm in thickness. It is surrounded by two thinner layers that are more porous and transparent to electrons and enriched in organic carbon. The observed spherical objects are very similar with bacteria encrusting in hydroxyapatite as observed in laboratory experiments. We suggest that they are Gram-negative bacteria fossilized by francolite, the precipitation of which started within the periplasm of the cells. We discuss the role of bacteria in the fossilization mechanism and propose that they could have played an active role in the formation of francolite. This study shows that ancient phosphorites can contain fossil biological subcellular structures as fine as a bacterial periplasm. Moreover, we demonstrate that while morphological information provided by SEM analyses is valuable, the use of additional nanoscale analyses is a powerful approach to help inferring the biogenicity of biomorphs found in phosphorites. A more systematic use of this approach could considerably improve our knowledge and understanding of the microfossils present in the geological record.

The effect of copper on different phototrophic microorganisms determined in vivo and at cellular level by confocal laser microscopy.

Microbial mats are coastal ecosystems that consist mainly of cyanobacteria, primary producers in these habitats that play an important role in stabilising delta sediments. However, these ecosystems are subject to various kinds of pollution, including metal contamination, placing their survival at risk. Among heavy metals, copper is an essential metal at low doses and toxic at high doses. This metal is present in different pesticides used in rice production, a thriving agro-industry in the Ebro Delta (Spain). For several years, our group has been studying the Ebro Delta microbial mats and has developed a method for determining the effect that metals cause on cyanobacteria populations. This method is based on confocal laser microscopy coupled to a spectrofluorometer, which rapidly provides simultaneous three-dimensional information on photosynthetic microorganisms and their fluorescence spectra profiles. The current study determines the copper effect on different photosynthetic microorganisms from culture collection (Chroococcus sp. PCC 9106 and Spirulina sp. PCC 6313) and isolated from the environment (Microcoleus-like and the microalga DE2009). Comparing all results obtained it can be observed that the minimum dose of Cu that is capable of significantly altering chlorophyll a (chl a) fluorescence intensity were 1 × 10(-7) M in Chroococcus sp. PCC 9106; 1 × 10(-7) M in Spirulina sp. PCC 6313; 3 × 10(-7) M in Microcoleus and 5 × 10(-6) M in the microalga DE2009. Moreover, the sensitivity of the technique used was 1 × 10(-7) M.

Selection of bioindicators to detect lead pollution in Ebro delta microbial mats, using high-resolution microscopic techniques.

Lead (Pb) is a metal that is non-essential to any metabolic process and, moreover, highly deleterious to life. In microbial mats - benthic stratified ecosystems - located in coastal areas, phototrophic microorganisms (algae and oxygenic phototrophic bacteria) are the primary producers and they are exposed to pollution by metals. In this paper we describe the search for bioindicators among phototrophic populations of Ebro delta microbial mats, using high-resolution microscopic techniques that we have optimized in previous studies. Confocal laser scanning microscopy coupled to a spectrofluorometric detector (CLSM-λscan) to determine in vivo sensitivity of different cyanobacteria to lead, and scanning electron microscopy (SEM) and transmission electron microscopy (TEM), both coupled to energy dispersive X-ray microanalysis (EDX), to determine the extra- and intracellular sequestration of this metal in cells, were the techniques used for this purpose. Oscillatoria sp. PCC 7515, Chroococcus sp. PCC 9106 and Spirulina sp. PCC 6313 tested in this paper could be considered bioindicators for lead pollution, because all of these microorganisms are indigenous, have high tolerance to high concentrations of lead and are able to accumulate this metal externally in extracellular polymeric substances (EPS) and intracellularly in polyphosphate (PP) inclusions. Experiments made with microcosms demonstrated that Phormidium-like and Lyngbya-like organisms selected themselves at the highest concentrations of lead assayed. In the present study it is shown that all cyanobacteria studied (both in culture and in microcosms) present PP inclusions in their cytoplasm and that these increase in number in lead polluted cultures and microcosms. We believe that the application of these microscopic techniques open up broad prospects for future studies of metal ecotoxicity.

Encuesta sobre el conocimiento y manejo de los pacientes con ataque isquémico transitorio entre médicos y enfermería de Atención Primaria / Survey of the knowledge and management of transient ischemic attacks among primary care physicians and nurses

Introducción: La principal fuente de consulta de los pacientes con ataque isquémico transitorio (AIT) agudo en nuestra área sanitaria son los centros de salud de Atención Primaria. Existen muy pocos estudios sobre el conocimiento del AIT y su manejo entre profesionales de la medicina comunitaria y de familia.Objetivo: Estimar el conocimiento del AIT, su manejo y las pruebas complementarias necesarias entre médicos y personal de enfermería de Atención Primaria de nuestra área de influencia. Para ello se envió una encuesta electrónica cerrada a 640 profesionales con 7 preguntas sobre el AIT.Resultados: Se obtuvo una alta tasa de respuestas: 285 (46,7% médicos). 239 (83,9%) participantes mostraron un conocimiento adecuado de la duración del AIT. Sólo 40 (14%) de la sintomatología. Mientras que el 67% contestó adecuadamente que es necesaria una prueba de neuroimagen urgente. Sólo el 42,5% reconoció la necesidad una exploración con dúplex de troncos supraórticos precoz. Únicamente, el 35,4% conocía qué es un doppler transcraneal, mientras que el 78,2% supo que era más adecuado enviar a estos pacientes a urgencias hospitalarias. El predictor independiente de mejor conocimiento fue ser un médico de Atención Primaria (MAP) (odds ratio [OR]: 2,138; IC 95%: 1,124-4,067; p = 0,021) pero no hubo diferencias entre MAP y enfermería en el conocimiento del manejo de estos pacientes. En enfermería fue peor el conocimiento en el ámbito rural (OR: 0,410; IC 95%: 0,189-0,891; p = 0,024). Conclusión: El conocimiento de la actitud ante un AIT es correcto en la mayoría de casos, sin embargo es necesario mejorar el conocimiento de la sintomatología de los AIT (AU)

Introduction: Transient ischaemic attack (TIA) patients often report that Primary Care physicians(PCPs) and nurses are their main medical contacts after onset of symptoms in our healtharea. There are few studies on the knowledge and management of TIA among Community andFamily Medicine professionals.Material and methods: Our aim was to study the current knowledge and practice in the managementof TIA patients among Primary Care physicians and nurses. A cross-sectional survey withseven questions about TIA was conducted among 640 PCPs and nurses from Primary Care centresin our health area.Results: In total, 285 (46.7% PCPs) took participate in the study. Of these, 239 (83.9%) participantsknew the duration of a TIA. However only 40 (14%) recognised all clinical symptoms.An urgent neuroimaging was preferred by 67%. Only 42.5% agreed that an urgent cervicalduplex would be useful in these patients. Transcranial Doppler was recognised by only 35.4%.A majority (78.2%) of participants agreed that TIA patients must be admitted to hospital. PCPshad the best knowledge of TIA (odds ratio [OR] 2.138; 95% CI 1.124-4.067; P = 0.021) but therewere no differences between physicians and nurses on the management of these patients.Nurses from rural Primary Care centers had the worst level of knowledge (OR 0.410; 95% CI0.189-0.891; P = 0.024).Conclusion: TIA was well recognized as a medical emergency. However, knowledge of clinicalsymptoms of TIA must be improved (AU)

Survey of the knowledge and management of transient ischemic attacks among primary care physicians and nurses.

INTRODUCTION: Transient ischaemic attack (TIA) patients often report that Primary Care physicians (PCPs) and nurses are their main medical contacts after onset of symptoms in our health area. There are few studies on the knowledge and management of TIA among Community and Family Medicine professionals. MATERIAL AND METHODS: Our aim was to study the current knowledge and practice in the management of TIA patients among Primary Care physicians and nurses. A cross-sectional survey with seven questions about TIA was conducted among 640 PCPs and nurses from Primary Care centres in our health area. RESULTS: In total, 285 (46.7% PCPs) took participate in the study. Of these, 239 (83.9%) participants knew the duration of a TIA. However only 40 (14%) recognised all clinical symptoms. An urgent neuroimaging was preferred by 67%. Only 42.5% agreed that an urgent cervical duplex would be useful in these patients. Transcranial Doppler was recognised by only 35.4%. A majority (78.2%) of participants agreed that TIA patients must be admitted to hospital. PCPs had the best knowledge of TIA (odds ratio [OR] 2.138; 95% CI 1.124-4.067; P = 0.021) but there were no differences between physicians and nurses on the management of these patients. Nurses from rural Primary Care centers had the worst level of knowledge (OR 0.410; 95% CI 0.189-0.891; P = 0.024). CONCLUSION: TIA was well recognized as a medical emergency. However, knowledge of clinical symptoms of TIA must be improved.

Confocal laser scanning microscopy image analysis for cyanobacterial biomass determined at microscale level in different microbial mats.

We recently published a new method based on determining cyanobacterial biomass by confocal laser scanning microscopy image analysis (CLSM-IA) (Solé et al., Ultramicrosc 107:669-673, 2007). CLSM-IA allows biomass calculation for microorganisms of a small size, since the limit of the technique's resolution is that generated by a voxel, the smallest unit of a three-dimensional digital image, equivalent to 1.183 x 10(-3) mgC/cm(3) of sediment. This method is especially suitable for the quantitative analysis of a large number of CLSM images generated from benthic sediments in which complex populations of cyanobacteria are abundant, such as microbial mats. In order to validate the new CLSM approach, mats with varying structural characteristics were studied. We have grouped them into three types: Microcoleus mats (laminated), sandy mats (nonlaminated and composed of well-sorted quartz sands), and oil-polluted mats. In this work, we applied CLSM-IA in natural [the Ebro delta and Sant Jordi colony (Spain), Salins-de-Giraud and Etang de Berre (France), and Orkney Islands (Scotland)] and artificial [mesocosms (Israel)] microbial mats. A total of 4,103 confocal images were obtained in order to determine total and individual cyanobacteria biomass profiles, at microscale level. The data presented in this paper show the efficacy of the method, as it can be applied to highly diverse mat samples.

A randomized comparison of levobupivacaine, bupivacaine and ropivacaine with fentanyl, for labor analgesia.

BACKGROUND: To compare the analgesic efficacy of epidural infusions of levobupivacaine, bupivacaine and ropivacaine in labor. METHODS: 102 nulliparous parturients in early labor were enrolled in this randomized, double-blind clinical trial. They were randomly assigned to receive one of three continuous epidural infusion regimens: levobupivacaine 0.125%, bupivacaine 0.125% or ropivacaine 0.2%, all with fentanyl 1 microg/mL at 8 mL/h. Supplementary analgesia was provided with an 8-mL epidural bolus of the study solution if visual analogue scale (VAS) score for pain was 40 (0-100 mm). Pain and motor and sensory block were measured at 0, 15 and 30 min, 1, 2, 3 and 4h and full cervical dilatation. RESULTS: Analgesia was satisfactory in all three groups, with VAS score <40 mm at all measurements. VAS scores were greater in those receiving levobupivacaine (P<0.005). Motor block was greater with bupivacaine than levobupivacaine (P<0.01). There were no differences in motor block between levobupivacaine and ropivacaine. There were no other differences between groups. CONCLUSION: All three regimens were effective during first stage of labor although pain scores were higher in those receiving levobupivacaine. Motor block was greater with bupivacaine than with levobupivacaine.

Dolor de espalda

Guía de actuación clínica en Atención Primaria que contiene los siguientes apartados : dolor de espalda : generalidades, patología cervical, dorsal y lumbar : cuadros clínicos, puntos clave y algoritmos. También incluye una guía de consulta rápida.

A new method based on image analysis for determining cyanobacterial biomass by CLSM in stratified benthic sediments.

Cyanobacteria are the dominant primary producers in microbial mats, which are stratified benthic microbial ecosystems found in coastal environments. Some cyanobacteria form long filaments, which make difficult to apply classical methods to estimate their biomass because they establish strong interactions with detritic particles. In a previous study, we described a method for determining cyanobacterial biomass by means of confocal laser scanning microscopy (CLSM). However, the manual method used, based on summa projection images, was difficult to apply when analyzing a large number of samples. In this paper, we described a new automated method, based on stacks and applying the plugin voxel counter in the ImageJ analysis system, more adequate for obtaining biomass data quickly from a large number of CLSM images.

Evaluación médico-deportiva antes del inicio del ejercicio / Medical and physical condition evaluation before beginning of exercise

La práctica de ejercicio físico es importante para gozar de una buena salud. Sin embargo, no todas las actividades físicas y deportes son adecuados para los pacientes con diabetes. Las actividades con cargas de fuerza máxima que provocan la activación de la glucólisis, no se aconsejan en los pacientes con diabetes por inducir hiperglucemia y aumento de la presión arterial. Por el contrario, las actividades de larga duración pueden causar hipoglucemias si no se toman precauciones, como la ingestión de alimentos antes y durante el ejercicio. También debe tenerse en cuenta el tipo de actividad física y su duración. Además, es importante valorar el nivel de glucemia del paciente antes del ejercicio, dado que este factor es determinante para evaluar el esfuerzo y la carga soportable por aquél. En conclusión, se aconsejan ejercicios aeróbicos de larga duración (>1 hora) y ejercicios de fuerza-resistencia con cargas menores o iguales al 60% sobre una repetición máxima

Physical exercise is important for maintaining a good health status. However, not all the physical activities and sports are appropriate for people with diabetes. Activities requiring bursts of maximum effort that result in the activation of the glycolytic system are not recommended for type 1 diabetic patients because they induce hyperglycemia and increase blood pressure. On the other hand, prolonged activity can cause hypoglycemia if no preventive measures, such as food ingestion, are taken just before and during exercise. The type of exercise and its duration should also be taken into account. The capillary blood glucose level should be tested prior to exercise in type 1 diabetic patients because this factor is determinant to ascertain the effort and load they can withstand. In conclusion, a long session (>1 hour) of aerobic exercise and strength and resistance exercise with loads less than or equal to 60% and an established maximal repetition are recommended

Morphological and ultrastructural characterization of an unusual purple sulfur bacterium from a marine microbial-mat community.

An unusual purple sulfur bacterium present in the pink layer of the Ebro Delta microbial mats has been identified through the study of its ultrastructural features. As pure cultures of this bacterium have not been obtained, due to its inability to grow in axenic conditions, only enrichment cultures where it reached at least 90% of total biomass have been considered. In enrichment cultures, the cells are rods that are 5.4+/-0.6 microm wide and 11.0+/-2.1 microm long. The color of the cell suspensions is pink to pinkish-red. Cells are motile by means of a polar tuft of flagella and multiply by binary fission. This bacterium possesses an extensive internal photosynthetic membrane system consisting of stacks of lamellae, contains bacteriochlorophyll a and carotenoids of normal spirilloxanthin series and deposits sulfur intracellularly. In natural samples, the most abundant phototrophic purple sulfur bacterium developing in this ecosystem has the same kind of intracytoplasmic membrane system, but the cells differ slightly in size and arrangement, in that they are ovoid, 4.2+/-0.5 microm wide and 6.0+/-1.4 microm long, and can be seen forming irregular non-motile clumps which are embedded in slime. Differences observed between field samples and enrichment cultures suggest that environmental conditions may bring about changes in the phenotypic characteristics of the cells. The morphological characteristics of the described bacterium resemble those of large Chromatia. However, this bacterium differs from known species in this group, particularly in terms of its photosynthetic membrane system and in its light absorption properties.