Carriage of multidrug-resistant Gram-negative bacilli: duration and risk factors.

Identification of risk factors influencing the duration of carriage of multidrug-resistant Gram-negative bacilli (MDR-GNB) may be useful for infection control. The aim of this study is to estimate the impact of several factors collected for routine hospital surveillance on the duration of carriage of selected MDR-GNB. From January 2015 to July 2021, patients with at least two clinical/surveillance samples positive for MDR-GNB different from ESBL-producing E. coli or AmpC - exclusively producing Enterobacterales were assessed. Microorganisms, age, number of admissions, clinical or rectal sample, sex, and admission service were evaluated as risk factors. Multivariate analysis was performed by a Cox proportional hazard model. A total of 1981 episodes of colonization were included. Involved microorganisms were ESBL-Klebsiella pneumoniae (KP) in 1057 cases (53.4%), other ESBL-non-E. coli Enterobacterales in 91 (4.6%), OXA-48-KP in 263 (13.3%), KPC-KP in 90 (4.5%), VIM-KP in 29 (1.5%), carbapenemase-producing non-KP Enterobacterales (CP-non-KP) in 124 (6.3%), and MDR Pseudomonas aeruginosa (MDR-PAER) in 327 (16.5%). No differences in duration of colonization were observed among ESBL-KP (median colonization time 320 days), ESBL-non-E. coli Enterobacterales (226 days), OXA48-KP (305 days), and MDR-PAER (321 days). For each group, duration of colonization was significantly longer than that of KPC-KP (median colonization time 60 days), VIM-KP (138 days), and CP-non-KP (71 days). Male sex (HR = 0.88; 95% CI 0.78-0.99), detection in Hepatology-Gastroenterology (HR = 0.71; 95% CI 0.54-0.93), clinical sample (HR = 0.61; 95% CI 0.53-0.69), and > 2 admissions after first detection (HR = 0.47; 95% CI 0.42-0.52) were independent predictors of longer carriage, whereas VIM-KP (HR = 1.61; 95% CI 1.04-2.48), KPC-KP (HR = 1.85; 95% CI 1.49-2.3), and CP-non-KP (HR = 1.92; 95% CI 1.49-2.47) were associated with shorter colonization time. Duration of colonization was significantly longer for ESBL-KP, other ESBL-non-E. coli Enterobacterales, OXA-48-KP, and MDR-PAER. For these microorganisms, prolonging surveillance up to 2.5-3 years should be considered. Male sex, clinical sample, multiple readmissions, admission service, and type of microorganism are independent predictors of the duration of carriage.

Suicide among physicians: Major risk for women physicians.

INTRODUCTION: The risk of suicide is related to professional activity. Preliminary data suggest that being in the medical profession increases the risk of suicide in women. The objective of this nationwide study is to compare the death rate of physicians due to suicide with that of the general population and to assess the differences based on gender. MATERIALS AND METHODS: All physicians and the general population who died by suicide in Spain between 2005 and 2014, both inclusive, were studied. Between these years, the Spanish population grew from 43,662,613 to 46,455,123 persons and from 199,123 to 238,240 number of doctors. The data relating to the deaths of physicians were extracted from the databases of the General Council of Official Medical Associations (CGCOM) and data related to the general population were obtained from the National Institute of Statistics (INE). The variables included in the analyses are gender, age, specialty, place of residence and death, and causes of death according to the ICD-10. RESULTS: The annual mean of physician deaths was 918, with an annual crude rate of 4.8 per 1,000 registered physicians. It is confirmed that physicians have a significantly higher suicide rate (average of 1.3%) than the general population (average of 0.8%) (p = 0.003). The comparison of suicide between men and women doctors is significantly higher in women (X2= 53.068, p<0.001). In addition, if we separate by gender, female physicians have a suicide rate 7.5% higher than women from the general population, although the difference is not significant (X2 = 2.614, p = 0.107). CONCLUSIONS: . Suicide is higher among physicians than the general population and affects female physicians significantly more.

Accuracy of verbal fluency tests in the discrimination of mild cognitive impairment and probable Alzheimer's disease in older Spanish monolingual individuals.

The main objetive was to analyze the accuracy of different verbal fluency tests (VFTs) in discriminating cognitively healthy subjects from individuals with mild cognitive impairment (MCI) and probable Alzheimer's disease (AD) in a cohort of older Spanish speaking adults. As a result, we aimed to identify the VFT that best predicts conversion from MCI to probable AD. 287 subjects: 170 controls (HC), 90 stable MCI and 27 patients with MCI that evolved into probable AD (MCI-AD) were assessed with a neuropsychological battery test and five VFTs. The animal fluency test produced the best differentiation of HC from MCI (p < .001), of HC from MCI-AD (p < .001) and of MCI from MCI-AD converters (p < .001), with sensitivities 98.8%, 98.8% and 75.6%, respectively. Logistic regression showed that the animal fluency test (p < 0.001) appears to be the most useful and neuropsychological VFT to predict conversion to probable dementia.

An automated optofluidic biosensor platform combining interferometric sensors and injection moulded microfluidics.

A primary limitation preventing practical implementation of photonic biosensors within point-of-care platforms is their integration with fluidic automation subsystems. For most diagnostic applications, photonic biosensors require complex fluid handling protocols; this is especially prominent in the case of competitive immunoassays, commonly used for detection of low-concentration, low-molecular weight biomarkers. For this reason, complex automated microfluidic systems are needed to realise the full point-of-care potential of photonic biosensors. To fulfil this requirement, we propose an on-chip valve-based microfluidic automation module, capable of automating such complex fluid handling. This module is realised through application of a PDMS injection moulding fabrication technique, recently described in our previous work, which enables practical fabrication of normally closed pneumatically actuated elastomeric valves. In this work, these valves are configured to achieve multiplexed reagent addressing for an on-chip diaphragm pump, providing the sample and reagent processing capabilities required for automation of cyclic competitive immunoassays. Application of this technique simplifies fabrication and introduces the potential for mass production, bringing point-of-care integration of complex automated microfluidics into the realm of practicality. This module is integrated with a highly sensitive, label-free bimodal waveguide photonic biosensor, and is demonstrated in the context of a proof-of-concept biosensing assay, detecting the low-molecular weight antibiotic tetracycline.

Automated portable array biosensor for multisample microcystin analysis in freshwater samples.

An automated array biosensor based on evanescent-wave excitation has been developed for the detection of microcystins (MCs) in freshwater samples. The sensing surface consisted of microcystin-leucine-arginine (MCLR) covalently immobilized onto a planar waveguide (microscope slide). The binding of anti-MCLR monoclonal antibodies, spiked in the sample, to the immobilized MCLR was competitively inhibited by MCLR in solution and the amount of antibody bound to the patterned antigens was revealed using Cy5-labeled rabbit anti-mouse IgG. Surface chemistry has been optimized to improve biosensor performance in terms of sensitivity, regeneration ability and to avoid non specific binding for further application to environmental monitoring. The optimized biosensor assay presents an IC(50) value of 0.34 ± 0.01 µg/L, a detection limit of 16 ± 3 ng/L and a dynamic range from 0.06 to 1.5 µg/L MCLR, improving the performance of previously reported devices. Cross-reactivity to other related MCs, such as microcystin-RR (MCRR, 90%), microcystin-RR desmethylated (dm-MCRR, 95%) and microcystin-YR (MCYR, 91%), was also evaluated. The automated microarray can assay up to six different samples in parallel, with a total analysis time of about 60 min. The sensing surface was regenerated with 50mM NaOH and each chip was reused for, at least, 15 assay-regeneration cycles without significant binding capacity loss. The immunosensor has been successfully applied to the direct analysis of MCs in surface water samples and the results were in close agreement with those provided by LC-MS/MS.

Evolution of specific cognitive subprofiles of mild cognitive impairment in a three-year longitudinal study.

The present work addresses one of the currently most controversial aspects of early detection of Alzheimer's disease (AD) and other dementias; that is, the identification of the Mild Cognitive Impairment (MCI) syndrome-in some cases, prior to AD-in a sample of older subjects who are healthy from the cognitive viewpoint. In a three-year longitudinal study, we classified the participants between 58 and 90 years of age in different cognitive profiles: healthy and MCI (amnestic MCI, non-amnestic MCI, and multi-domain MCI). We followed the evolution of each one by means of the administration on three occasions of an extensive battery of neuropsychological tests. We have found a high percentage of MCI in our sample. Although some of them were amnestic MCIs, this group was not the most frequent. The multi-domain MCI is the one that evolves directly into AD, not the amnestic MCIs. We have found diverse evolutional trajectories over the past three years, some expected, others somewhat unexpected. We also point out the methodological difficulties posed by the administration of certain episodic memory tests, which is not the most appropriate to detect subclinical MCI, due to the effect of practice.

El bajo peso al nacer es un factor de riesgo de diabetes mellitus tipo 1 / Low birth weight is a risk factor for type 1 diabetes

Introducción y objetivo: En los últimos años el aumento de la incidencia de diabetes mellitus tipo 1 (DM1) se ha relacionado con un incremento de la obesidad en la población infantil, entre otros factores. El objetivo del presente trabajo ha sido determinar de forma retrospectiva en la población española, en pacientes diagnosticados de DM1 de la Comunidad Autónoma de Madrid, la posible relación entre el peso del recién nacido, el incremento del índice de la masa corporal (IMC) en los 2 primeros años de vida y el IMC al comienzo de la enfermedad con la edad de presentación de la diabetes. Material y método: Participaron 100 niños diagnosticados de DM1 de ambos sexos (57 niños y 43 niñas), de raza caucásica, con una edad media de 84,45 meses (desviación estándar [DE] de 52,4). Se recogieron las siguientes variables: edad al comienzo de la enfermedad, edad gestacional, peso y talla de recién nacido, a los 2 años de vida y al comienzo de la enfermedad. Resultados: Los niños diagnosticados de DM1 tienen menor peso al nacer −0,288 (−0,51 a −0,066) y menor IMC (puntuación de DE) al nacer que la población sana −0,5 (−0,77 a −0,23). Además de un incremento mayor del IMC hasta los 2 años (4,58% frente a 2,17%; p<0,001). Los niños con menor IMC al nacer (12,77% frente a 13,06%; p<0,006) comienzan antes con la enfermedad. No se ha encontrado correlación entre el IMC al comienzo y el resto de las variables estudiadas. Conclusiones: El menor IMC al nacer de los pacientes con diabetes mellitus estudiados y el incremento de peso que se produce en los 2 primeros años de vida en esta población podría implicar a algunos factores durante la vida fetal como factor de riesgo de DM1 (AU)

Introduction and aim: Over recent years, the increasing incidence of type 1 diabetes mellitus (T1DM) has been associated with different factors, particularly increased obesity in childhood. The aim of this study was to find out if there was any relationship between birth weight, body mass index (BMI) increase during the first two 3 years of life, and BMI at diabetes onset with age at diagnosis, in a cohort of children diagnosed with T1DM. Material and method: Data from 100 Caucasian children with T1DM of both sexes (57 boys, 43 girls) between 10 months and 16 years of age, mean age 84.45 months (SD; 52.4), were studied. We analysed the following variables: age at diagnosis, gestational age, weight and height at birth, at two years of age and at diabetes diagnosis, expressed as SD scores (SDS). Results: All children were between 38–40 weeks of gestational age. Diabetic patients have lower birth weight (−2.88 ((−0.51)–(−0.066)) and lower BMI at birth compared with healthy children −0.5 ((−0.77)–(−0.23)). Diabetic children have a significant increase in BMI during the first two years of life (4.58 versus 2.17; P<0.001). Children with the lowest BMI at birth (12.77 versus 13.06; P<0.006) are the youngest at onset of the disease. BMI at diagnosis was not related to any of the variables studied. There were no gender differences either. Conclusions: The low BMI at birth and the later increase in the following years of life seem to be related to intrauterine environment as a risk factor for T1DM (AU)

[Low birth weight is a risk factor for type 1 diabetes]. / El bajo peso al nacer es un factor de riesgo de diabetes mellitus tipo 1.

INTRODUCTION AND AIM: Over recent years, the increasing incidence of type 1 diabetes mellitus (T1DM) has been associated with different factors, particularly increased obesity in childhood. The aim of this study was to find out if there was any relationship between birth weight, body mass index (BMI) increase during the first two 3 years of life, and BMI at diabetes onset with age at diagnosis, in a cohort of children diagnosed with T1DM. MATERIAL AND METHOD: Data from 100 Caucasian children with T1DM of both sexes (57 boys, 43 girls) between 10 months and 16 years of age, mean age 84.45 months (SD; 52.4), were studied. We analysed the following variables: age at diagnosis, gestational age, weight and height at birth, at two years of age and at diabetes diagnosis, expressed as SD scores (SDS). RESULTS: All children were between 38-40 weeks of gestational age. Diabetic patients have lower birth weight (-2.88 ((-0.51)-(-0.066)) and lower BMI at birth compared with healthy children -0.5 ((-0.77)-(-0.23)). Diabetic children have a significant increase in BMI during the first two years of life (4.58 versus 2.17; P<0.001). Children with the lowest BMI at birth (12.77 versus 13.06; P<0.006) are the youngest at onset of the disease. BMI at diagnosis was not related to any of the variables studied. There were no gender differences either. CONCLUSIONS: The low BMI at birth and the later increase in the following years of life seem to be related to intrauterine environment as a risk factor for T1DM.

Fiebre en Atención Primaria / No disponible

La fiebre es un motivo frecuente en las consultas de Atención Primaria que plantea un amplio diagnóstico diferencial, la mayoría de las veces debida a procesos víricos o bacterianos autolimitados y de corta duración, pero también puede ser la expresión de procesos más graves que pueden poner en peligro la vida del paciente. Un estudio protocolizado y racional desde la consulta puede ahorrar pruebas complementarias costosas, innecesarias e incluso ingresos hospitalarios. La mayoría de los protocolos consultados recomiendan la secuencia de estudios que exponemos en el protocolo recogido en la figura 1

Fever is a frequent reason for consultation in Primary Health Care that entails a wide range of differential diagnoses, most of the times due to self-limited viral or bacterial conditions of short duration. However, it may also be the expression of more serious life-threatening conditions. A protocolize and rational study made from the consultation may avoid expensive and unnecessary complementary studies and even hospital admissions. Most of the protocols consulted recommend a sequence of studies

A propósito de un caso de fiebre por picadura de garrapata africana / A case report of African tick bite fever

Durante muchos años, la única rickettsiosis conocida en España del grupo de las fiebres manchadas ha sido la fiebre botonosa mediterránea. Sin embargo, la existencia de viajes a países cada vez más lejanos por turismo y el continuo incremento de la inmigración ha dado lugar a un aumento de los casos de las rickettsiosis adquiridas de otros países. Presentamos el caso clínico de un paciente con fiebre por picadura de la garrapata africana (Rickettsia africae)

For many years, the only rickettsiosis known in Spain from the spotted fever group was Mediterranean boutonneuse fever. However, the existence of tourist trips to increasingly far away countries and the continuous increase of immigration have given rise to an increase in the cases of rickettsiosis acquired from other countries. We present the clinical case of a patient with African tick bite fever (Rickettsia africae)

Escorbuto: una causa inusual de púrpura, equimosis y artralgias / Scurvy: an unusual cause of purpura, ecchymosis and arthralgias

No disponible

Development of a new sample pretreatment procedure based on pressurized liquid extraction for the determination of fluoroquinolone residues in table eggs.

A new method for the simultaneous determination of three fluoroquinolones (FQs) enrofloxacin (ENRO) ciprofloxacin (CIPRO) and sarafloxacin (SARA) in table eggs has been developed, applying pressurized liquid extraction (PLE) and liquid chromatography (LC) with fluorescence detection (LC-FLD). The influence of several extraction parameters (e.g. solvent mixture, temperature and extraction time) on FQs extraction efficiency and coextracted matrix interferents was evaluated using fortified control eggs and matrix matched standard curves. The results showed that FQs extraction efficiency depends mainly on solvent composition and the optimum extraction mixture was found to be phosphate 50mM, pH 3.0/acetonitrile (50:50, v/v). The optimized procedure employed 50% flush volume, 5min of static time and three extraction cycles at 70 degrees C and 1500psi. Method validation was performed according to the guidelines of the Directive 96/23/EC, using control egg samples, fortified with the target FQs in the range 50-1000ngg(-1) and applying the optimized extraction conditions on three different days, providing recoveries between 67-90% with RSDs lower than 11% in all cases. The decision limit (CCalpha) and detection capability (CCbeta) of the analytical method were found to be within the range 17-24ngg(-1) and 30-41ngg(-1), respectively. The method was successfully applied to the determination of ENRO and its metabolite CIPRO in incurred egg samples from ENRO-treated hens and LC-MS has been used and for confirmatory purposes.

Pancoast's syndrome secondary to lung infection with cutaneous fistulisation caused by Staphylococcus aureus.

Apical bronchial carcinoma is the most common cause of Pancoast's syndrome. Of the many other causes reported, infection is a rare one. A literature review is presented and a case of Pancoast's syndrome, secondary to apical lung pneumonia with bronchocutaneous fistulisation caused by Staphylococcus aureus infection, is reported. Clinical and radiological resolution was achieved after treatment with antibiotics.

Factores clínicos y biológicos que influyen en la medición de la grasa corporal mediante bioimpedanciometría con el monitor OMRON BF 300 / Biological and clinical factors influencing bioelectrical impedance analysis measurements with the OMRON BF 300 monitor

Fundamento. La estimación de la grasa corporal tiene una importancia creciente a escala clínica. El objetivo de este estudio es evaluar la influencia de factores clínicos y biológicos en la medición de grasa corporal por bioimpedanciometría (IB) con el monitor OMRON BF 300.Material y métodos. Estudio descriptivo transversal. Los factores analizados son: ingesta sólida y líquida, ejercicio, influencia de la ropa, posición de las piernas y del monitor, ciclo menstrual, errores en la medición de peso y talla y evacuación de esfínteres. En conjunto participaron 135 personas, 87 mujeres y 48 varones de 14 a 69 años de edad. Resultados. Diferentes factores influyen en el resultado: posición del monitor (p < 0,001), comida (p < 0,001), ingesta líquida (p < 0,001), paseo durante 1-2 h (p < 0,001), evacuación de esfínteres (p < 0,001) y precisión del peso (p < 0,01-p < 0,001) y de la talla (p < 0,001). Sin embargo, no influyen la posición de las piernas, la ropa y, en las mujeres, la fase del ciclo menstrual. El peso de grasa corporal aumenta durante el día, y recupera los valores basales durante la noche. Conclusiones. Múltiples factores influyen en la determinación de la grasa corporal por IB con el monitor OMRON BF 300. Recomendamos medir correctamente y con precisión la talla (1 mm) y el peso (0,1 kg), realizar las determinaciones por la mañana en ayunas, con la vejiga vacía, en ropa interior, sin haber realizado ejercicio y con una posición del monitor de 90° respecto a la vertical del cuerpo para obtener medidas fiables y reproducibles. La dieta preestablecida y el consumo líquido controlado pueden ser necesarios en algunas situaciones (AU)

[Validation of the OMRON BF 300 monitor for measuring body fat by bioelectric impedance]. / Validación del monitor de medición de la grasa corporal por impedancia bioeléctrica OMRON BF 300.

OBJECTIVES: To assess the accuracy of the OMRON BF 300 body fat monitor using bioelectric impedance and to validate its measurement of body fat percentage (BF%) against the Siri equation. DESIGN: Cross-sectional descriptive study. SETTING: Primary care. Coronel de Palma and San Fernando Health Centres, Móstoles. PARTICIPANTS: 88 people took part in the assessment of the accuracy of the monitor, and 91 in the validation. MEASUREMENTS AND MAIN RESULTS: The BF% were recorded in triplicate, with the mean being the figure noted. Precision was evaluated through the intra-class correlation coefficient (ICC) and the coefficient of variation (CV); validity, through technical error, the ICC and the Bland-Altman method. In the Siri equation, body density was calculated through the Durnin-Womersley equation. Precision: ICC was 0.999 and CV 0.4 +/- 0.03. VALIDATION: the difference between the BF% monitor (26.6 +/- 9.1%) and the Siri equation (27.8 +/- 8.2%) was -1.27% (p < 0.01; 95% CI -1.97 to -0.57); the technical error of the monitor was 2.2% and of the ICC 0.956 (95% CI, 0.9335-0.9710). Thus, 80.2% of the monitor-equation differences were below 5%, with a concordance interval under the Bland-Altman method of +5.45 to -7.99%. CONCLUSIONS: The OMRON BF 300 monitor satisfies the precision criteria (ICC > 0.95 and low CV) and validation (excellent technical error, ICC > 0.75 and clinically acceptable differences) and is a valid alternative to cutaneous folds as a method of assessing nutrition of the patient.

Validación del monitor de medición de la grasa corporal por impedancia bioeléctrica Omron BF 300 / Validation of the Omron BF 300 monitor for measuring body fat by bioelectric impedance

Objetivos. Valorar la precisión del monitor de grasa corporal por impedancia bioeléctrica OMRON BF 300 y validar su medición del porcentaje de grasa corporal ( por cientoGC) frente a la ecuación de Siri. Diseño. Estudio descriptivo, transversal. Emplazamiento. Atención primaria. Centros de Salud Coronel de Palma y San Fernando, Móstoles. Participantes. En la valoración de la precisión del monitor participaron 88 personas y 91 en la validación. Mediciones y resultados principales. Las determinaciones de por cientoGC se realizaron por triplicado, anotándose la media. La precisión se evaluó mediante el coeficiente de correlación intraclase (CCI) y el coeficiente de variación (CV). La validez, mediante el error técnico, el CCI y el método de BlandAltman. En la ecuación de Siri la densidad corporal se calculó con la ecuación de Durnin-Womersley. Precisión: el CCI fue de 0,999 y el CV de 0,4 ñ 0,03. Validación: la diferencia de por cientoGC monitor (26,6 ñ 9,1 por ciento) - ecuación de Siri (27,8 ñ 8,2 por ciento) fue de -1,27 por ciento (p 0,95 y CV bajo) y validación (error técnico excelente, CCI > 0,75 y diferencias clínicamente aceptables) y supone una alternativa válida a los pliegues cutáneos en la valoración nutricional del paciente (AU)

Neoplasia of plasma cells with atypical presentation and infection by the human immunodeficiency virus. A presentation of two cases.

Neoplasia of plasma cells acquires special clinical characteristics in patients infected by human immunodeficiency virus (HIV). These patients are much younger at the time of diagnosis, and when they are compared with the general population they show an atypical clinical evolution, with a greater frequency of solitary plasmacytomas, less evidence of a monoclonal plasmatic component, or greater aggressiveness of the neoplastic process. This paper provides the most significant data on two patients infected by HIV and diagnosed for plasma cell neoplasia. Recent pathogenetic hypotheses for plasma cell neoplasias that include immune alterations, chronic viral infections, and hyperexpression of cytokines exist in patients infected by HIV, and this could suggest that this type of neoplasia is another malignant haematological process associated with AIDS.

[Antitetanus vaccination: noncompliance with doses]. / Vacunación antitetánica. Ausencias en la cumplimentación.

The objectives of this article are to estimate the percentage of people who fail to receive their second and third dose of the antitetanus vaccination, find a relation between public health information and the reason for administering the vaccine with the percentage of non-compliers, and to estimate the percentage of patients who fail to receive their third dose after a six month waiting period. This study was designed with a multiple follow-up. This study took place at a Primary Health care center: E.A.P. Barcelona II in Móstoles, Madrid. Patients included all those people who met the requirements for the vaccination; in this study there were 452 persons. STATISTICS AND MAIN RESULTS INCLUDE: The percentage of noncompliance with second and third doses was 59.7% (195% (54.4%-65.0%)) There was a higher percentage of noncompliance in the group which received sanitary information, 61.8% while the group which received basic information registered a 54% rate (p > 0.05). The percentage who failed to continue their doses if first administered for a cut was 60.3% against a 59.0% rate for those caught in doctors check-ups, (p > 0.05). The proportion of noncompliance due to the 6 month waiting period was 46.9% (IC95 (37.8-56%)). CONCLUSION: This study did not demonstrate that greater sanitary information coupled with a cut contributed to a higher compliance to the convention vaccination pattern. We note the percentage of noncompliance for the third dose following a 12 month pattern was 55.3% against 46.9% in the six month pattern; this leads us to plan a further study. One can include that more than half the people do not comply when they should for the administration of the antitetanus vaccine. We feel it is necessary to improve the means through which people remember they need to take their antitetanus vaccine's doses.