Integrando el aprendizaje activo de la Microbiología en el Grado de Medicina: evolución de la implicación de los estudiantes / Introducing inquiry-based learning in Microbiology into the medical degree course: outcome of student involvement

OBJETIVO: Se ha planteado como objetivo la mejora de la calidad de la docencia de la Microbiología General en el Grado de Medicina mediante la actualización de la metodología docente, introduciendo el aprendizaje activo basado en preguntas (inquiry-based learning [IBL]) para conseguir mejorar las competencias que deberán adquirir los estudiantes como parte de su formación integral. MATERIAL Y MÉTODO: En este estudio han participado 92 alumnos de Segundo Curso del Grado de Medicina (Curso 2015-2016), y se ha calculado el porcentaje de alumnos que participaron en las diferentes tandas de preguntas, y los que no participaron en ninguna y posteriormente se relacionó con las calificaciones obtenidas en la asignatura de Microbiología. Se incluyeron las preguntas IBL que se realizaron en clase en el campus virtual de la asignatura, pero incluyendo la corrección de las mismas. Al finalizar la actividad se realizó un estudio transversal a través de un cuestionario autocumplimentado en el que se valoraba la opinión de los alumnos sobre el aprendizaje activo mediante IBL. RESULTADOS: En los alumnos que realizaron alguna prueba IBL se obtuvieron calificaciones mejores que en aquellos que no habían participado presencialmente en ninguna. Los alumnos valoraron positivamente esta actividad para medir el aprendizaje y mejorar la preparación del examen. CONCLUSIONES: El uso del campus virtual unido a la actualización en la metodología docente puede mejorar el rendimiento académico de los estudiantes de Microbiología en el Grado de Medicina, consiguiendo un incremento de la implicación y adhesión de los alumnos en el aprendizaje activo

OBJECTIVE: The aim of this article is the improvement in the quality of the teaching in General Microbiology in the Medical Degree by updating the teaching practices. These practices included inquiry-based learning (IBL) in which students are actively engaged in the learning process for improving the skills to be acquired as part of their integrated training. MATERIAL AND METHOD: This study included 92 Microbiology students in the Second Year of the Medical Degree (Academic Year 2015-2016). The percentage of students who used IBL resources and those that did not use any were calculated and subsequently compared with the student performance in the Microbiology exam. The IBL questions were included that were asked in class in the virtual campus, but with their correct answer. In order to assess the perceived impact of the active learning, the students were asked to fill out a questionnaire evaluating IBL. RESULTS: Students who prepared with IBL scored higher in the examination, thus evaluating IBL positively, considering that this activity can measure learning and improve preparation for exams. CONCLUSION: The use of the virtual campus together with the updating in the teaching methodology can improve the academic performance of Microbiology students in the Medical Degree, obtaining an increase of the implication and adhesion of the students in the active learning

Efficacy of preoperative and intraoperative skin and nail surgical preparation of the foot in reducing bacterial load.

BACKGROUND: A common problem associated with toenail removal surgery is the accompanying bacterial infection that often ensues. The foot has a particularly difficult anatomy to prepare antiseptically for surgery, which contributes to this wide-spread problem. OBJECTIVE: To compare the antiseptic efficacy of two skin pretreatment methods before toenail avulsion surgery. METHODS: Two presurgical methods were performed on 24 patients each (48 patients total). Swab samples were taken from each patient at five distinct stages (pretreatment, post-treatment, after surgery, after saline solution irrigation of the nail bed, and after phenol application) throughout the surgical procedure, and bacterial culture analysis was performed (total inocula count and identification of specific microorganisms). RESULTS: We found both methods to be effective at reducing the initial bacterial load when used at pretreatment, but the reduction in bacterial load was lost after the nail avulsion surgery, achieving values similar to the initial bacterial load before the presurgical scrub, from 5.17 and 5.04 log(10) colony-forming units (CFU)/cm(2) to 4.86 and 5.07 log(10) CFU/cm(2), respectively. An interoperative irrigation step was effective in reducing the bacterial load by 95.2% and 95.3%, respectively. STUDY LIMITATIONS: Our patients underwent phenol-based nail avulsion, resulting in no bacterial load after complete nail removal because of the intrinsic antiseptic nature of the phenol. CONCLUSIONS: Incorporation of intraoperative irrigation of sterile saline solution after nail avulsion surgery reduces potential bacterial load. Every effort should be made to lower the risk of contamination after nail plate avulsion.

Preoperative skin and nail preparation of the foot: comparison of the efficacy of 4 different methods in reducing bacterial load.

BACKGROUND: Orthopedic surgical procedures involving the foot and ankle are associated with high rates of infection. The optimal method of preparing the skin and nails for foot and ankle surgery remains unknown. OBJECTIVE: This study was conducted to compare the efficacy of 4 different methods of skin and nail preparation of the foot using various antiseptic solutions. METHODS: In this prospective, randomized study, 4 methods of skin and nail preparation were compared in terms of their efficacy in eliminating bacteria from the hallux nailfold and first web space of the normal foot in 28 healthy adult volunteers. Efficacy was determined by evaluating the difference in the total bacterial load before and after skin preparation. The foot-preparation solutions evaluated were 4% chlorhexidine gluconate, 70% isopropyl alcohol, and 7.5% to 10% povidone-iodine. RESULTS: The addition of alcohol to povidone-iodine was found to increase the efficacy of the preparation method. The nailfold remained contaminated after any of the preoperative skin- and nail-preparation methods studied. LIMITATIONS: This study did not measure clinically relevant infections, and the results may not correlate with decreased rates of infection after surgery. CONCLUSION: Incorporation of alcohol and povidone-iodine into the preoperative skin- and nail-preparation process may help reduce the bacterial load. Every effort should be made to lower the risk of contamination from the nail.

Tratamiento antimicrobiano de la enfermedad pulmonar obstructiva crónica en el anciano / No disponible

No disponible

Tratamiento antimicrobiano de la enfermedad pulmonar obstructiva crónica en el anciano / Antimicrobial therapy of chronic obstructive pulmonary disease in the elderly

No disponible

Consensus statement on antimicrobial treatment of odontogenic bacterial infections.

The infection of the oral cavity is a common public health problem and constant cause for antibiotic prescription, with 10% of antibiotics used to treat this problem. However, few studies have so far aimed to determine its incidence. Added to this, its relationship with certain sytemic diseases (cardiac, endocrine, etc) confers this pathology vital importance. In spite of the frequency and importance of odontogenic infection, the current dispersion in criteria regarding key aspects in classification, terminology and therapeutic recommendations is noticeable. The main objective of this document, compiled as a consensus statement by specialists in microbiology and odontology, is to establish useful recommendations for all of those involved in the clinical management of this pathology. Special attention has been placed on the rise in bacterial resistance observed over the last years, specifically the proliferation of betalactamase producing strains. Another important factor causing the resistance to appear is lack of therapeutic compliance, specially what regards dosage and treatment duration. Therefore, this pathology constitutes a complex problem which requires the instauration of broad spectrum antimicrobials, well tolerated and a convenient posology so that patients receive the adequate dose over the necessary period. High doses of amoxicillin/clavulanate (2000 mg/125 mg) have showed good results and power to overcome resistance. Other agents such as metronidazole and clindamycin, followed by de claritromycin and azithromycin have also proved to be active against most of microorganisms responsible for odontogenic infection.

Microbiological basis of oral infections and sensitivity to antibiotics.

Because oral infections are common, the physician must understand the underlying etiology, pathogeny, and other variables that determine how these processes evolve in order to choose the most appropriate antibiotic drug. The special characteristics of the oral cavity determine the make-up of the microflora that lives there. Different anaerobic species belonging to the Peptostreptococcus, Prevotella, Fusobacterium, Gemella, and Porphyromonas genera are of particular interest, as are the aerobic species Streptococcus, Staphylococcus, and Corynebacterium. Each of these microorganisms occupies a different microniche within the oral cavity, and the prevailing balance is upset when conditions become modified as a result of illness or due to dental interventions such as tooth extraction or tooth scaling and polishing. Pathogenic or opportunistic bacteria (Actinomyces, Prevotella intermedia species, etc.) can develop in these conditions, as can yeasts (Candida sp., Histoplasma capsulatum), virus (herpes simplex, papilomavirus), and parasites (Entamoeba gingivalis, Trichomonas tenax). When infection occurs, the patients s immune system reacts by means of inborn immunity (non-specific) and acquired immunity (specific). Empirical treatment is administered that should be based on etiological data and on the antimicrobial sensitivity of the pathogen that is causing the infection. However, oral microflora sensitivity to different antibiotics is currently declining and there is a noticeable trend towards resistances. As a consequence of all this, the treatment of oral infections must also aim to restore the ecological balance of the oral cavity and to minimize the emergence of resistance in the microorganisms present in the mouth. Hence, epidemiological oral pathogen sensitivity studies must be conducted, fostering the administration of appropriate antibiotics at proper doses and keeping specialists abreast of the latest trends. In recent decades, oral infections comprise one of the most common pathologies in the general population, due in large part to infectious complications associated with poor oral hygiene. This in turn, translates into an increased need and demand for dental care, while at the same time, it requires that the professional accurately understand the etiological factors involved, as well as the pathogeny and different variables that determine the specificity of these kinds of infections, so as to be able to choose the appropriate antimicrobial drugs for proper treatment.

Documento de consenso sobre el tratamiento antimicrobiano de las infecciones bacterianas odontogénicas / Consensus statement on antimicrobial treatment of odontogenic bacterial infections

Las infecciones de la cavidad bucal son un problema de salud pública frecuente y motivo constante de prescripción antibiótica; el 10% de los antibióticos se emplean para tratar este problema. Sin embargo, hasta la fecha son pocos los estudios realizados para determinar su incidencia. Asímismo, su relación con ciertas enfermedades sistémicas (cardiacas, endocrinas, etc...) confiere a estas patologías una importancia vital. A pesar de la reconocida frecuencia e importancia de las infecciones odontogénicas, llama la atención la actual dispersión de criterio en varios aspectos referentes a su clasificación, terminología y recomendaciones terapéuticas. El objetivo principal de este documento, realizado con el consenso de especialistas en microbiología y odontología, es establecer unas recomendaciones útiles para todos los profesionales implicados en el manejo clínico de estas patologías. Recibe especial atención el aumento de la prevalencia de resistencias bacterianas observado durante los últimos años y, en concreto, la proliferación de cepas productoras de betalactamasas. Otro factor causal importante de la aparición de resistencias es la falta de cumplimiento terapéutico, en especial en lo que respecta a la dosis y a la duración del tratamiento. Así pues, estas patologías constituyen un problema complejo cuyo abordaje requiere la instauración de antimicrobianos de amplio espectro, con adecuados parámetros farmacocinéticos, con buena tolerancia y una posología cómoda que permita que el paciente reciba la dosis adecuada durante el tiempo necesario. Amoxicilina/ácido clavulánico a dosis altas (2000mg/ 125mg) ha demostrado buenos resultados y capacidad para superar resistencias. Otros agentes como metronidazol y clindamicina, seguidos de claritromicina y azitromicina han demostrado también ser activos frente a la mayoría de los microorganismos responsables de las infecciones odontogénicas (AU)

The infection of the oral cavity is a common public health problem and constant cause for antibiotic prescription, with 10% of antibiotics used to treat this problem. However, few studies have so far aimed to determine its incidence. Added to this, its relationship with certain sytemic diseases (cardiac, endocrine, etc…) confers this pathology vital importance. In spite of the frequency and importance of odontogenic infection, the current dispersion in criteria regarding key aspects in classification, terminology and therapeutic recommendations is noticeable. The main objective of this document, compiled as a consensus statement by specialists in microbiology and odontology, is to establish useful recommendations for all of those involved in the clinical management of this pathology. Special attention has been placed on the rise in bacterial resistance observed over the last years, specifically the proliferation of betalactamase producing strains. Another important factor causing the resistance to appear is lack of therapeutic compliance, specially what regards dosage and treatment duration. Therefore, this pathology constitutes a complex problem which requires the instauration of broad spectrum antimicrobials, well tolerated and a convenient posology so that patients receive the adequate dose over the necessary period. High doses of amoxicillin/clavulanate (2000 mg / 125 mg) have showed good results and power to overcome resistance. Other agents such as metronidazole and clindamycin, followed by de claritromycin and azithromycin have also proved to be active against most of microorganisms responsible for odontogenic infection (AU)

Plasma fibronectin as a marker of sepsis.

OBJECTIVES: To evaluate the value of plasma fibronectin (pFN) as a diagnostic marker of sepsis. SUBJECTS AND METHODS: Plasma FN was determined in patients showing sepsis-related symptoms who had blood cultures performed. These patients were assigned to one of two groups according to their clinical situation: (1) Clinical Septic Group: patients with sepsis according to American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) criteria; (2) Fever Peak Group: patients who did not fulfil sufficient ACCP/SCCM criteria for sepsis. Two additional control groups were also established: (3) Non-infectious Diseases Control Group and (4) Healthy Control Group. RESULTS: Plasma FN levels, microbiological and clinical data were compared among the different patient groups. For each group, the number of patients, median and mean pFN levels and the 95% confidence interval of the mean were: (1) n = 43, 102 mg/l, 122 mg/l (100-144); (2) n = 70, 185 mg/l, 207 mg/l (184-231); (3) n = 22, 175 mg/l, 181 mg/l (151-211); and (4) n = 22, 256 mg/l, 261 mg/l (229-292). Bonferroni's test of multiple comparisons was able to detect a significant difference between pFN concentrations corresponding to the septic group, compared to the remaining groups (pANOVA < 0.001 ). CONCLUSION: Plasma FN appears to act as a marker of sepsis in that patients showed diminished pFN levels. Along with other clinical and laboratory variables, the use of this marker would allow a rapid diagnosis of sepsis and limit the number of blood cultures to be processed and the number of antibiotic prescriptions, particularly when symptoms are insidious and diagnosis is doubtful. We propose further and more complex studies using a higher number of patients.