Evolution of Salmonella spp. isolated compared to those of Campylobacter spp. in faecal samples for 12 years.

OBJECTIVE: The Autonomous Community of Galicia has adopted DECREE 216/2011 on health standards for poultry production, in addition to the Spanish national programs. However, no program has yet been implemented to eradicate campylobacteriosis, which shares the same reservoir. The aim of this study was to compare the evolution of Salmonella spp. isolates with respect to those of Campylobacter spp. in faecal samples received by the Microbiology Department. METHODS: A retrospective descriptive comparative study was conducted through the Laboratory Information System (SIL) of Salmonella spp. isolated against Campylobacter spp. in faeces between 2011 and 2022 at the Lucus Augusti University Hospital (HULA), Lugo, Spain. RESULTS: A total of 35,704 stool samples were analysed, of which 3,045 were positive. 751 Salmonella spp. were isolated. Statistical differences were observed in the annual distribution (p<0.01), with a clear turning point in 2018. Five hundred and five patients required hospital care, especially in 2014 with 72 patients (69%). On the other hand, 1,587 Campylobacter spp. were isolated. Required hospital care 1,002 patients during the study, with a peak in 2019 with 111 cases (62%). CONCLUSIONS: The reduction of salmonellosis cases and the maintenance of campylobacteriosis cases are directly related to the implementation of DECREE 216/2011. This, in turn, has reduced the pressure on hospitals in the HULA health area. Therefore, we believe that the ONE Health concept is being strengthened in the area studied.

[Comparison two blood culture bottles for the recovery of Enterobacteriaceae].

OBJECTIVE: The objective of the present study was to compare the suitability of the B BACTEC™ Lytic/10 Anaerobic/F versus B BACTEC™ Plus Aerobic/F vials at the time of both Enterobacteriaceae recovery rate and detection time. METHODS: Prospective observational study from September 2018 to January 2019 in which 150 bacteremia. The samples were incubated in the automated BD BACTEC ™ FX system (Becton Dickison). RESULTS: A total of 180 Enterobacteriaceae were isolated: 93 B BACTEC™ Plus Aerobic/F and 87 from B BACTEC™ Lytic/10 Anaerobic/F belonging to 106 patients The urinary focus was the most frequent origin. The average detection time in both cases was not more than 15 hours. CONCLUSIONS: The combination of both bottles seems to be the best diagnostic strategy, thus reducing the detection time as well as increasing the recovery of Enterobacteriaceae. The combination of both vials could be implemented especially in selected situation of special urgency such as the sepsis code or critical patients.

[Spontaneous bacterial peritonitis caused by Listeria monocytogenes: eight case reports (1992-2017) and literature review]. / Peritonitis bacteriana espontánea por Listeria monocytogenes: presentación de ocho casos (1992- 2017) y revisión de la literatura.

OBJECTIVE: Spontaneous bacterial peritonitis (SBP) is a frequent and severe entity in patients with cirrhosis or ascites due to other causes. However, Listeria monocytogenes is a microorganism that has been scarcely identified as a causative agent of SBP. METHODS: In this study, a descriptive analysis of cases of L. monocytogenes SBP was carried out in our center for 26 years (1992-2017). RESULTS: A total of eight patients were diagnosed, with an average age of 58 years, with no differences in sex distribution and all of them were community acquired cases. Half of the patients had underlying liver disease, two of them active malignancies; one was undergoing continuous ambulatory peritoneal dialysis and the last one with hypertensive heart disease. Six (75%) of the patients received a third-generation cephalosporin as empirical treatment. The clinical course was favorable after receiving directed antibiotic treatment in five (62.5%) of the patients. However, three of them, under the age of 59, died. Serotyping of L. monocytogenes isolates revealed that half of them were serovar 4, two 1 / 2a and the remaining one 1 / 2c. All strains were susceptible to ampicillin, meropenem, erythromycin and cotrimoxazole. CONCLUSIONS: We conclude by emphasizing the importance of taking this etiology into account in patients with underlying liver disease and with clinical or laboratory data suggesting SBP, mainly due to the need for specific antibiotic treatment different from conventionally empirically used.

[Correlation between MALDI-TOF Vitek-MSTM system and conventional identification methods of gastrointestinal infection causing bacteria]. / Correlación entre el sistema de MALDI-TOF Vitek-MSTM y los métodos convencionales de identificación de bacterias causantes de infección gastrointestinal.

OBJECTIVE: Rapid identification of pathogens is essential for the diagnosis of gastrointestinal infections. Matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometry has shown to be effective and fast for the identification of microorganisms. The objective of this study was to evaluate the correlation between Vitek-MSTM and conventional methods for bacterial identification causing gastrointestinal infection. METHODS: A total of 329 gastrointestinal pathogens were identified using Vitek-MSTM (v2 SARAMIS MS -ID, bioMérieux, Marcy-I´Étoile, France) and routine diagnostic methods simultaneously. In cases of discrepancy 16SrRNA gene sequencing was performed. RESULTS: The correlation between Vitek-MSTM and diagnostic methods was 100% except for Yersinia enterocolitica (94.1%), Helicobacter pylori (10%) and Aeromonas veronii (0 %). CONCLUSIONS: Vitek-MSTM is a quick and useful method for identification of enterophatogenic bacteria. It is necessary to improve the performance of the system for the identification of H. pylori and A. veronii.

Arsenic levels in immigrant children from countries at risk of consuming arsenic polluted water compared to children from Barcelona.

Arsenic is a highly toxic element that pollutes groundwater, being a major environmental problem worldwide, especially in the Bengal Basin. About 40% of patients in our outpatient clinics come from those countries, and there is no published data about their arsenic exposure. This study compares arsenic exposure between immigrant and native children. A total of 114 children (57 natives, 57 immigrants), aged 2 months to 16 years, were recruited and sociodemographic and environmental exposure data were recorded. Total arsenic in urine, hair, and nails and arsenic-speciated compounds in urine were determined. We did not find significant differences in total and inorganic arsenic levels in urine and hair, but in organic arsenic monomethylarsenic acid (MMA) and dimethylarsinous acid (DMA) in urine and in total arsenic in nails. However, these values were not in the toxic range. There were significant differences between longer than 5 years exposure and less than 5 years exposure (consumption of water from tube wells), with respect to inorganic and organic MMA arsenic in urine and total arsenic in nails. There was partial correlation between the duration of exposure and inorganic arsenic levels in urine. Immigrant children have higher arsenic levels than native children, but they are not toxic. At present, there is no need for specific arsenic screening or follow-up in immigrant children recently arrived in Spain from exposure high-risk countries.

High-level quinolone resistance is associated with the overexpression of smeVWX in Stenotrophomonas maltophilia clinical isolates.

Stenotrophomonas maltophilia is the only known bacterium in which quinolone-resistant isolates do not present mutations in the genes encoding bacterial topoisomerases. The expression of the intrinsic quinolone resistance elements smeDEF, smeVWX and Smqnr was analysed in 31 clinical S. maltophilia isolates presenting a minimum inhibitory concentration (MIC) range to ciprofloxacin between 0.5 and > 32 µg/mL; 11 (35.5%) overexpressed smeDEF, 2 (6.5%) presenting the highest quinolone MICs overexpressed smeVWX and 1 (3.2%) overexpressed Smqnr. Both strains overexpressing smeVWX presented changes at the Gly266 position of SmeRv, the repressor of smeVWX. Changes at the same position were previously observed in in vitro selected S. maltophilia quinolone-resistant mutants, indicating this amino acid is highly relevant for the activity of SmeRv in repressing smeVWX expression. For the first time SmeVWX overexpression is associated with quinolone resistance of S. maltophilia clinical isolates.

Management of regional lymph nodes in the elderly melanoma patient: patient selection, accuracy and prognostic implications.

BACKGROUND: Among older melanoma patients, lymphatic mapping failure, lower rates of SLN positivity and poor prognosis are reported reasons for omission of sentinel lymph node biopsy (SLNB). We investigated reasons for non-compliance with guidelines, sensitivity and prognostic significance of SLNB and completion lymphadenectomy (CLND) for elderly melanoma patients. METHODS: Retrospective review of patients ≥65 years with ≥1 mm thick melanoma treated at a single Institution. Wilcoxon, chi-square and Fisher's exact tests were used for analysis as appropriate. Univariable and multivariable Cox regressions were used to analyze time-to-event variables. RESULTS: 72 of 358 patients (20%) did not undergo SLNB. Reasons for omission included selective neck dissection in 26 (7%), patient refusal in 11 (3%), physician recommendation in 15 (4%) and significant comorbidities in 8 (2%). Of the 286 patients undergoing SLNB, only 5 (1.7%) had lymphatic mapping failures. 76 patients (26.6%) were SLN-positive. The sensitivity of SLNB was 90.5%, the negative predictive value was 96.3% and the false negative rate was 3.8%. Sixty-seven (88%) SLN-positive patients underwent CLND and 10 (15%) had positive non-SLNs. Reasons for omission of CLND included patient refusal in 3 (4%), surgeon recommendation in 5 (7%) and postoperative complication in 1 (1%). SLN and non-SLN status were independently associated with disease-free survival. SLN status was independently associated with melanoma-specific survival. CONCLUSIONS: SLNB was successful in 98.7% of elderly patients with high sensitivity and a low false negative rate. Only 2% of our elderly patients appeared too frail for SLNB. Age alone should not be a contraindication to SLNB and CLND for melanoma.

Clinical guide SEOM on venous thromboembolism in cancer patients

Venous thromboembolism (VTE) is a common event in cancer patients and one of the major causes of cancer-associated mortality and a leading cause of morbidity. In recent years, the incidence rates of VTE have notably increased; however, VTE is still commonly underestimated by oncologists. VTE is considered an adverse prognostic factor in cancer patients in all settings. In 2011 the Spanish Society of Medical Oncology (SEOM) first published a clinical guideline of prophylaxis and treatment of VTE in cancer patients. In an effort to incorporate evidence obtained since the original publication, SEOM presents an update of the guideline for thrombosis and cancer in order to improve the prevention and management of VTE (AU)

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Clinical guide SEOM on venous thromboembolism in cancer patients.

Venous thromboembolism (VTE) is a common event in cancer patients and one of the major causes of cancer-associated mortality and a leading cause of morbidity. In recent years, the incidence rates of VTE have notably increased; however, VTE is still commonly underestimated by oncologists. VTE is considered an adverse prognostic factor in cancer patients in all settings. In 2011 the Spanish Society of Medical Oncology (SEOM) first published a clinical guideline of prophylaxis and treatment of VTE in cancer patients. In an effort to incorporate evidence obtained since the original publication, SEOM presents an update of the guideline for thrombosis and cancer in order to improve the prevention and management of VTE.

Estudio descriptivo del consumo de alcohol en los adolescentes de Gandía / Descriptive study of alcohol consumption in adolescents of Gandia

Introducción. La morbimortalidad en los países desarrollados se relaciona con hábitos adquiridos en la adolescencia. El alcohol es la droga más consumida por los adolescentes españoles, planteando su uso abusivo un problema preocupante para la salud pública. Objetivo. Valorar el patrón de consumo de bebidas alcohólicas de los jóvenes estudiantes de 4.o de ESO de la ciudad de Gandía y las características que definen a esta población y al entorno en el que se realiza. Metodología. Se trata de un estudio descriptivo transversal del consumo de alcohol en los adolescentes de entre 15 y 18 años de Gandía, que se lleva a cabo mediante una encuesta con diferentes cuestiones relacionadas con los hábitos de salud de las cuales 9 se refieren al consumo de alcohol. Resultados. De los 346 encuestados, el 98% son menores de edad. El 93,3% ha probado alguna vez una bebida alcohólica, haciendo botellón habitualmente el 48,5% y habiéndose emborrachado alguna vez el 45,5%, concentrándose el consumo en el fin de semana. Un 76,6% tuvo el primer contacto con el alcohol en el entorno familiar. Conclusión. El consumo de alcohol en el adolescente es muy elevado, es un consumo mayoritariamente de fin de semana con una alta prevalencia en las intoxicaciones etílicas, consumo que se realiza en espacios públicos y con los amigos (AU)

Introduction: The morbidity and mortality in developed countries is related to habits acquired in adolescence. Alcohol is the drug most consumed by Spanish adolescents, making its abuse a concern for public health. Objective: To evaluate the pattern of alcohol consumption of 4 th year secondary school pupils in the city of Gandia, the defining characteristics of this population and the environment in which this takes place. Methodology: This is a descriptive study of alcohol use in adolescents aged 15 to 18 years of Gandia, which was carried out through a survey of different issues related to health habits, nine of which relate to consumption alcohol. Results: Of the 346 adolescents surveyed, 98% were minors, 93.3% had tried an alcoholic drink. Just under half (48.5%) took part in street binge-drinking, and 45.5% had got drunk at least once. Consumption was mainly during the weekend. More than three-quarters (76.6%) had their first contact with alcohol in the family. Conclusion: Alcohol use among adolescents is high, with consumption is mostly at weekends and with a high prevalence of alcohol intoxication, drinking in public places, and with friends (AU)

[Descriptive study of alcohol consumption in adolescents of Gandia]. / Estudio descriptivo del consumo de alcohol en los adolescentes de Gandía.

INTRODUCTION: The morbidity and mortality in developed countries is related to habits acquired in adolescence. Alcohol is the drug most consumed by Spanish adolescents, making its abuse a concern for public health. OBJECTIVE: To evaluate the pattern of alcohol consumption of 4th year secondary school pupils in the city of Gandia, the defining characteristics of this population and the environment in which this takes place. METHODOLOGY: This is a descriptive study of alcohol use in adolescents aged 15 to 18 years of Gandia, which was carried out through a survey of different issues related to health habits, nine of which relate to consumption alcohol. RESULTS: Of the 346 adolescents surveyed, 98% were minors, 93.3% had tried an alcoholic drink. Just under half (48.5%) took part in street binge-drinking, and 45.5% had got drunk at least once. Consumption was mainly during the weekend. More than three-quarters (76.6%) had their first contact with alcohol in the family. CONCLUSION: Alcohol use among adolescents is high, with consumption is mostly at weekends and with a high prevalence of alcohol intoxication, drinking in public places, and with friends.

Hábitos de sueño de la población infantil del Grau de Gandía. Un estudio descriptivo / Sleep habits of the children in the Grau de Gandia. A descriptive study

El insomnio es es trastorno de sueño infantil más frecuente y puede aparecer en la edad lactante o en la etapa preescolar, siendo de utilidad para la detección precoz el uso de cuestionarios de sueño, como la versión española del Pediatric Sleep Questionnaire (PSQ). Nos planteamos conocer la prevalencia de los trastornos de sueño en una población de 3 a 6 años del Grau de Gandía, utilizando para ello la versión española del PSQ mediante una encuesta autocumplimentada por los padres de los alumnos de los diferentes colegios. Se ha realizado un estudio descriptivo de corte transversal, recogiéndose 144 encuestas válidas, realizándose la entrada de los datos en una base de datos EXCEL para su posterior descripción. Un 23,4% de los niños presentan insomnio en función de las respuestas dadas, siendo importante la presencia de otras parasomnias como somniloquias (70%), ronquidos (7.2%), bruxismo (22.3%), trastornos por movimientos rítmicos (7.1%) y un 4.1% de los niños presentan síntomas desatencionales independientemente de que se presente o no síntomas de hiperactividad, un 2.08% de las encuestas respondían a un TDHA combinado y un 6.25% sintomatología de hiperactividad-impulsividad. Nuestro estudio proporcióna datos similares a otros estudios poblacionales realizados en el medio escolar, tanto en este rango de edad como en superiores, respecto al insomnio, parasomnias, hábitos de sueño y los TDHA, siendo la etiología más frecuente la falta de educación del hábito de sueño, por lo que el papel de la enfermera es fundamental en la orientación y formación a los padres (AU)

Insomnia is the most common sleep disorder in chilhood and it may occur to unweaned babies or during the infant period. In order to be able to detect as early as possible this disease, it is useful to make sleep questionnaires, such as the Spanish Version of the Pediatric Sleep Questionnaire (PSQ). We considered to know the prevalence of sleep disorders in a population from 3 to 6 years old from the "Grau de Gandia", using de Spanish Version of PSQ by means of an autofilled survey answered by the parents of the students from the different schools. We performed a cross sectional study, collecting 144 valid surveys, performing data entry in a EXCEL database for further description. A 23.4% of the children have insomnia based on the responses and it is significant the presence of other parasomnias such as somniloquy (70%), snoring (7.2%), bruxism (22.3%), rhythmic movement disorders (7.1% ) and a 4.1% of the children have symptoms of attention deficit regardless of havingr or not symptoms of hyperactivity. A 2.08% of the survey responded to a combined ADHD and a 6.25% of the children had symptoms of hyperactivity-impulsivity. Our study provides similar data to other population studies carried out at schools at this age range and also in higher, with regard to insomnia, parasomnias, sleep habits and ADHD, being the lack of education of the habit of sleep the most common etiology, so the role of the nurse is fundamental in the orientation and training for parents (AU)

Programa nacional de bocio nodular (PRONBONO): Estudio multicéntrico de bocio nodular único palpable / National Program for Nodular Goiter (PRONBONO): Multicenter study of single palpable thyroid nodules

Introducción: La presencia de nódulos tiroideos palpables en la población general, es uno de los signos clínicos tiroideos más frecuentes en la práctica diaria. Objetivos: 1) establecer la prevalencia de las distintas patologías en bocio nodular único palpable y analizar sus características y su relación con los resultados citológicos. 2) analizar la existencia de diferencias regionales en Argentina. Pacientes y Métodos: Estudio prospectivo de 739 pacientes con bocio nodular único palpable evaluados entre el 1/1/2000 y el 31/12/2001 en Centros de Buenos Aires, Bahía Blanca, Mendoza y La Pampa. Se recabaron datos de examen clínico, ecografía tiroidea, TSH, ATPO y citología por punción con aguja fina. (PAAF). Fue utilizado para el análisis estadístico Correlación de Pearson, X2 y Test de Fisher. Resultados: la edad (X ± DS) fue 46,3 ± 14 años, 93,1 % eran de sexo femenino. El 1,6 % tenía historia de radiación en cuello y el 29,9 % antecedentes familiares de patología tiroidea. Hallazgos clínicos: disfagia en el 7,9 %, disfonía 3,5 %, crecimiento nodular en los últimos 6 meses 19,2 %, consistencia dura el 24,7 %, fijeza a estructuras adyacentes 1,5 % y adenopatías en el 3 %. Hallazgos bioquímicos: TSH normal en el 81,2 % y ATPO positivos en el 30,3 % de los casos. Características Ecográficas: nódulos sólidos: 53,1 %, hipoecoicos: 63,8 %, microcalcificaciones 10,3 %, halo incompleto: 15 %, multinodular: 30,5 %, tiroides heterogénea: 60,2 % y adenopatías: 3,8 %. Hallazgos citológicos: En el 86,8 % de los casos fue necesario solo una punción para llegar al diagnóstico. Insatisfactorio (excluyendo quiste): 3,2 %: benignos: 77,3 %; sospechosos: 12,6 % y cáncer: 7 % (42 papilar, 2 medular y 3 sin especificar). Una correlación significativa (p<0,02) fue observada entre citología maligna y crecimiento rápido, dureza, fijeza a estructuras vecinas, nódulo sólido, halo incompleto y adenopatías aunque estos parámetros son más frecuentes en números absolutos en nódulos benignos. La mayoría de las cirugías fueron indicadas en base al hallazgo citológico. El diagnóstico histológico de los 96 pacientes que fueron operados mostró 51 carcinomas, de los cuales solo dos tenían citología benigna y 31 adenomas. Conclusión: Los nódulos palpables únicos fueron más frecuentes en mujeres eutiroideas en la edad media de la vida. Un tercio tenía historia familiar de patología tiroidea, similar al porcentaje hallado de ATPO positivos. Por ecografía los nódulos fueron predominantemente sólidos, hipoecoicos, únicos con resto de la glándula tiroides heterogénea. La PAAF fue predominantemente benigna. El crecimiento rápido, la dureza, la fijeza a estructuras adyacentes, el halo incompleto y la presencia de adenopatías fueron relacionados con malignidad, pero la benignidad fue más frecuente. En la mayoría de los pacientes la cirugía fue recomendada por los hallazgos citológicos. Nuestros resultados son similares a los reportados en otras áreas geográficas.

Introduction: the presence of palpable thyroid nodules in the general population is one of the most common clinical signs of thyroid disease in daily practice. Objectives: 1) To assess the prevalence of pathologies, clinical and cytological findings of single palpable thyroid nodules (SPTN) in Argentina. 2) Analyze the regional differences in Argentina. Methods: Prospective study of 739 patients with STPN were evaluated at centres in Buenos Aires, Bahía Blanca, Mendoza, and La Pampa between 1/1/00 and 12/31/01. Clinical examination, thyroid ultrasound scan (US), TSH, TPOAb and fine needle aspirations (FNA) were performed. Statistics: Pearson Correlation, X2 & Fisher Tests. Results: Age (X ± SD) 46 ± 14ys: 93.1 % were women. Previous history of neck radiation & familial thyroid disease were found in 1.6 and 29.9 % respectively. Clinical findings: dysphagia: 7.9 %; dysphonia: 3.5%; nodule growth: 19.2 %; hard consistence: 24.7 %; fixation to adjacent structure: 1.5 % and lymphadenopathies (ADP): 3 %. Biochemical findings: TSH was normal in 81.2 % & TPOAb+ in 30.3 %. US features: solid: 53.1 %; hypoechoic: 63.8 %; microcalcifications: 10.3 %; incomplete halo: 15 %; more than 1 nodule: 30.5 %; thyroid heterogeneity: 60.2 % and ADP: 3.8 %. Cytology: Only 1 FNA was needed in 86.8%. Unsatisfactory (excluding cysts): 3.2 %; benign: 77.2%; suspicious: 12.6 % and cancer: 7 % (42 papillary, 2 medullary and 3 non specified). A significant correlation (p<0.02) was established between malignant nodules and rapid growth, hard, fixed, solid nodule, incomplete halo and ADP, though these parameters were more frequent (in absolute number) in benign nodules. Surgery was mainly indicated based on FNA results. Histological diagnosis of 96 patients who underwent surgery showed 51 carcinomas, of which only 2 were cytologically benign and 31 adenomas. Conclusion: Palpable single nodules were more frequent in middle aged euthyroid women. One third had familial thyroid pathology, similar to the presence of TPOAb. On US, nodules were predominantly solid, hypoechoic, single with heterogeneous thyroid gland. FNA was predominantly benign. Rapid growth, hard, fixed, solid nodule, incomplete halo and ADP were associated with malignancy, but benignity was more common. In most of the patients surgery was recommended based on cytological findings. Our results are similar to those reported in other geographic areas.

Hiponatremia, hipopotasemia e insuficiencia renal aguda prerrenal como presentación de fibrosisquística / No disponible

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