The interaction between liver cirrhosis, infection by Streptococcus bovis, and colon cancer.

Whether cirrhotic patients with Streptococcus bovis bacteremia have an increased risk of colorectal neoplasm is uncertain. A multicentric retrospective cohort study was conducted investigating associations between S. bovis biotype and species, cirrhosis, and colorectal neoplasm. Out of 779 patients with S. bovis bacteremia, 69 (8.7%) had cirrhosis. No differences were found in the prevalence of colorectal neoplasm between cirrhotic and non-cirrhotic patients undergoing colonoscopy. Among cirrhotic patients, prevalence of colorectal neoplasms was higher in S. bovis biotype I (S. gallolyticus) bacteremia (80%) than in S. bovis biotype II (33.3%; p < 0.007). In conclusion, risk of colorectal neoplasm is high among cirrhotic patients with S. gallolyticus bacteremia.

Species and biotypes of Streptococcus bovis causing infective endocarditis / Especies y biotipos de Streptococcus bovis causantes de endocarditis infecciosa

Introduction: Streptococcus bovis/equinus complex (SBEC) is a major cause of infective endocarditis (IE), although its incidence varies greatly depending on the geographical area. The characteristics of IE caused by Streptococcus gallolyticus susp. gallolyticus are well known; there are hardly any descriptions of IE caused by other species or biotypes. Methods: Retrospective cohort study, from 1990 to 2019, of all SBEC IE in adults in three Spanish hospitals, Lugo (LH), Barcelona (BH) and Ferrol (FH) where the population is mainly rural, urban and mixed, respectively. The incidence of IE was analyzed in 3 areas. Clinical characteristics of IE (277 cases, 258 biotyped) were compared according to SBEC species and biotypes. Results: There are significant differences between the incidence of SBEC IE in HL (27.9/106) vs. HF and HB (8.8 and 7,1, respectively, p<0.001). We found significant differences (SbI vs. SbII) in mean age (68.5 vs. 73 years; p<0.01), duration of symptoms before diagnosis (46.9±46.5 vs. 30.4±40.9 days; p<0.01), presence of comorbidities: 39.1% (78) vs. 54.2% (32; p<0.04), predisposing heart illness:62.3% (124) vs. 81.3% (48; p<0.006), particularly, prosthetic or intravascular devices IE: 24.6% (49) vs. 52.4% (31; p<0.001), bi-valve involvement:23.6% (47) vs. 11.8% (7; p<0.05) and heart failure: 24.6% (49) vs. 38.9% (23; p<0.03). There were no significant differences in embolic events, need for surgery or mortality. The association with CRC was high in both groups: 77.7% vs. 66.6%. Conclusions: IE due to SBEC has geographical variations in incidence and different clinical characteristics among biotypes. The association with CRC was high.(AU)

Introducción: El complejo Streptococcus bovis/equinus (SBEC) es una de las principales causas de endocarditis infecciosa (EI), aunque su incidencia es muy variable según la zona geográfica. Las características de EI causada por Streptococcus gallolyticus subsp. gallolyticus son bien conocidas; apenas hay descripciones de EI causada por otras especies o biotipos. Métodos: Estudio de cohorte retrospectivo, desde 1990 hasta 2019, de todas las EI por SBEC en adultos en 3 hospitales españoles, Lugo (LH), Barcelona (BH) y Ferrol (FH) donde la población es mayoritariamente rural, urbana y mixta, respectivamente. Se analizó la incidencia de EI en 3 áreas. Se compararon las características clínicas de EI (277 casos, 258 biotipados) según las especies y biotipos de SBEC. Resultados: Existen diferencias significativas entre la incidencia de EI por SBEC en HL (27,9/106) vs. HF y HB (8,8 y 7,1, respectivamente, p<0,001). Encontramos diferencias significativas (SbI vs. SbII) en edad media (68,5 vs. 73 años; p<0,01), duración de los síntomas antes del diagnóstico (46,9±46,5 vs. 30,4±40,9 días; p<0,01); comorbilidades: 39,1 (78) vs. 54,2% (32; p<0,04); enfermedad cardíaca predisponente: 62,3 (124) vs. 81,3% (48; p<0,006), en particular, EI protésica o sobre dispositivos intravasculares: 24,6 (49) vs. 52,4% (31; p<0,001); afectación bivalva: 23,6 (47) vs. 11,8% (7; p<0,05) e insuficiencia cardiaca: 24,6 (49) vs. 38,9% (23; p<0,03). No hubo diferencias significativas en cuanto a eventos embólicos, necesidad de cirugía o mortalidad. La asociación con el CCR fue alta en ambos grupos: 77,7 vs. 66,6%. Conclusiones: La EI por SBEC tiene variaciones geográficas en la incidencia y diferentes características clínicas entre los biotipos. La asociación con el CCR fue elevada.(AU)

Species and biotypes of Streptococcus bovis causing infective endocarditis.

INTRODUCTION: Streptococcus bovis/equinus complex (SBEC) is a major cause of infective endocarditis (IE), although its incidence varies greatly depending on the geographical area. The characteristics of IE caused by Streptococcus gallolyticus susp. gallolyticus are well known; there are hardly any descriptions of IE caused by other species or biotypes. METHODS: Retrospective cohort study, from 1990 to 2019, of all SBEC IE in adults in three Spanish hospitals, Lugo (LH), Barcelona (BH) and Ferrol (FH) where the population is mainly rural, urban and mixed, respectively. The incidence of IE was analyzed in 3 areas. Clinical characteristics of IE (277 cases, 258 biotyped) were compared according to SBEC species and biotypes. RESULTS: There are significant differences between the incidence of SBEC IE in HL (27.9/106) vs. HF and HB (8.8 and 7,1, respectively, p<0.001). We found significant differences (SbI vs. SbII) in mean age (68.5 vs. 73 years; p<0.01), duration of symptoms before diagnosis (46.9±46.5 vs. 30.4±40.9 days; p<0.01), presence of comorbidities: 39.1% (78) vs. 54.2% (32; p<0.04), predisposing heart illness:62.3% (124) vs. 81.3% (48; p<0.006), particularly, prosthetic or intravascular devices IE: 24.6% (49) vs. 52.4% (31; p<0.001), bi-valve involvement:23.6% (47) vs. 11.8% (7; p<0.05) and heart failure: 24.6% (49) vs. 38.9% (23; p<0.03). There were no significant differences in embolic events, need for surgery or mortality. The association with CRC was high in both groups: 77.7% vs. 66.6%. CONCLUSIONS: IE due to SBEC has geographical variations in incidence and different clinical characteristics among biotypes. The association with CRC was high.

Clinical characteristics of admission for mental illness in a Regional Psychiatric Hospitalization Unit. Descriptive study 2008-2018 / Características clínicas del ingreso por enfermedad mental en una Unidad de Hospitalización Psiquiátrica Comarcal. Estudio descriptivo 2008-2018.

Objective: To describe the admissions of patients diagnosed with severe mental illness (SMI) and anxiety disorder in a regional hospital; to explore factors related to the patient's referrer upon admission and prolonged stay. Materials and methods: Cross-sectional study of episodes of admission to the regional Psychiatric Hospitalization Unit over a period of 11 years with ICD-10 diagnostic codesF20-29, F30-39, F60-69 and F40-48. The data was extracted through the Admissions Unit and the information from the electronic medical record. For the statistical treatment, descriptive or inferential tests were used with a confidence level of 95%. Results: 961 patients were included (2,324 total discharges), aged 40.8±14.0 years. The most frequent reasons for admission were: positive symptoms (agitation, delusions and hallucinations), followed by suicidal ideation and attempt. The main remitting agent of the patients was the family itself. Approximately 1/5 of the cases were referred by the health system itself, and » of those admitted had self-excluded themselves from specialized supervision for more than a year. Conclusions: The problems that caused the admission and its origin, as well as its lack of follow-up, can be considered as a clear opportunity for improvement in the follow-up of patients with severe mental illness. An orientation towards proactivity, acting before the decompensation, would contribute to improving the care and quality of life of patients with severe mental illness and their environment.

Objetivo: Describir los ingresos de pacientes diagnosticados de enfermedad mental grave y trastorno de ansiedad en un hospital comarcal; explorar los factores relacionados con la derivación del paciente al ingreso y con estancia prolongada. Materiales y métodos: Estudio de corte transversal de los episodios de ingreso en la Unidad de Hospitalización Psiquiátrica comarcal en un periodo de 11 años con los códigos diagnósticos CIE-10 F20-29, F30-39, F60-69 y F40-48. Se extrajeron los datos a través de la Unidad de Admisión y la información de la historia clínica electrónica. Para el tratamiento estadístico se usaron pruebas descriptivas o inferenciales con nivel de confianza del 95%. Resultados: Se incluyeron 961 pacientes (2.324 altas totales), con edad de 40,8±14,0 años. Los motivos más frecuentes de ingreso fueron: síntomas positivos (agitación, delirios y alucinaciones), seguidos de ideación e intento de suicidio. El principal agente remisor de los pacientes fue la propia familia. Aproximadamente 1/5 de casos fue derivado por el propio sistema sanitario, y » de los ingresados se había autoexcluido de la supervisión especializada durante más de un año. Conclusiones: Los problemas causantes del ingreso y su procedencia, así como su falta de seguimiento, pueden considerarse como una oportunidad clara de mejora en el seguimiento del paciente con enfermedad mental grave. Una orientación hacia la proactividad, actuando antes de la descompensación, contribuiría a mejorar la asistencia y calidad de vida de los pacientes con enfermedad mental grave y su entorno.

Structure and dsRNA-binding activity of the Birnavirus Drosophila X Virus VP3 protein.

The Birnavirus multifunctional protein VP3 plays an essential role coordinating the virus life cycle, interacting with the capsid protein VP2, with the RNA-dependent RNA polymerase VP1 and with the dsRNA genome. Furthermore, the role of this protein in controlling host cell responses triggered by dsRNA and preventing gene silencing has been recently demonstrated. Here we report the X-ray structure and dsRNA-binding activity of the N-terminal domain of Drosophila X virus (DXV) VP3. The domain folds in a bundle of three α-helices and arranges as a dimer, exposing to the surface a well-defined cluster of basic residues. Site directed mutagenesis combined with Electrophoretic Mobility Shift Assays (EMSA) and Surface Plasmon Resonance (SPR) revealed that this cluster, as well as a flexible and positively charged region linking the first and second globular domains of DXV VP3, are essential for dsRNA-binding. Also, RNA silencing studies performed in insect cell cultures confirmed the crucial role of this VP3 domain for the silencing suppression activity of the protein.IMPORTANCE The Birnavirus moonlighting protein VP3 plays crucial roles interacting with the dsRNA genome segments to form stable ribonucleoprotein complexes and controlling host cell immune responses, presumably by binding to and shielding the dsRNA from recognition by the host silencing machinery. The structural, biophysical and functional data presented in this work has identified the N-terminal domain of VP3 as responsible for the dsRNA-binding and silencing suppression activities of the protein in Drosophila X virus.

Long-Term Carbapenems Antimicrobial Stewardship Program.

OBJECTIVE: To evaluate clinical and antibiotic resistance impact of carbapenems stewardship programs. METHODS: descriptive study, pre-post-intervention, between January 2012 and December 2019; 350-bed teaching hospital. Prospective audit and feedback to prescribers was carried out between January 2015 and December 2019. We evaluate adequacy of carbapenems prescription to local guidelines and compare results between cases with accepted or rejected intervention. Analysis of antibiotic-consumption and hospital-acquired multidrug-resistant (MDR) bloodstream infections (BSIs) was performed. RESULTS: 1432 patients were followed. Adequacy of carbapenems prescription improved from 49.7% in 2015 to 80.9% in 2019 (p < 0.001). Interventions on prescription were performed in 448 (31.3%) patients without carbapenem-justified treatment, in 371 intervention was accepted, in 77 it was not. Intervention acceptance was associated with shorter duration of all antibiotic treatment and inpatient days (p < 0.05), without differences in outcome. During the period 2015-2019, compared with 2012-2014, decreased meropenem consumption (Rate Ratio 0.58; 95%CI: 0.55-0.63), candidemia and hospital-acquired MDR BSIs rate (RR 0.62; 95%CI: 0.41-0.92, p = 0.02), and increased cefepime (RR 2; 95%CI: 1.77-2.26) and piperacillin-tazobactam consumption (RR 1.17; 95%CI: 1.11-1.24), p < 0.001. CONCLUSIONS: the decrease and better use of carbapenems achieved could have clinical and ecological impact over five years, reduce inpatient days, hospital-acquired MDR BSIs, and candidemia, despite the increase in other antibiotic-consumption.

Characterization of Coxsackievirus B4 virus-like particles VLP produced by the recombinant baculovirus-insect cell system expressing the major capsid protein.

Coxsackievirus B4 (CV-B4) is suspected to be an environmental factor that has the intrinsic capacity to damage the pancreatic beta cells and therefore causes insulitis and type 1 diabetes (T1D). Although vaccination against CV-B4 could reduce the incidence of this chronic auto-immune disease, there is currently no therapeutic reagent or vaccine in clinical use. By the employment of the Bac-to-Bac® vector system to express the major viral capsid protein, we contributed towards the development of a CV-B4 vaccine by producing CV-B4 virus-like particles (VLPs) from recombinant baculovirus in infected insect cells. In fact Western blot and Immunofluorescence analysis detected the viral protein 1 (VP1) in the cells resulting from the construction of a recombinant bacmid DNA carrying the key immunogenic protein then transfected in the insect cells. Sucrose gradient ultracentrifugation fractions of the infected cell lysates contained the recombinant protein and the electron microscopy demonstrated the presence of VLPs in these sucrose fractions. This study clearly shows for the first time the expression of CVB4 VP1 structure protein alone can form VLPs in the baculovirus-infected insect cell keeping conserved both characteristics and morphology.

Long-term efficacy of 6-month therapy with isoniazid and rifampin compared with isoniazid, rifampin, and pyrazinamide treatment for pleural tuberculosis.

Research into anti-tuberculosis treatment has mainly focused on pulmonary tuberculosis (TB), with few studies on pleural-TB. The aim of the study is to compare the long-term efficacy of a 6-month treatment regimen with isoniazid and rifampicin (6HR) with treatment regimen of isoniazid, rifampicin, and pyrazinamide (6HR2Z) for pleural-TB. A case-control study of 200 HIV-negative patients with pleural-TB prospectively followed in our TB-unit from 1995 to 2018. The primary resistance to isoniazid is < 4% in our geographic area. Pleural-TB diagnosis was based on a positive culture for M. tuberculosis (84 patients), presence of caseating granulomas in pleural biopsy (28), or characteristics of pleural fluid (88). A comparative study of demographic and clinical characteristics between the treatment groups was carried out. Out of the 200 patients followed, (112 males, 88 females; mean age 32.9 ± 18.4 years), 99 patients were treated with 6HR regimen and 101 with 6HR2Z. The groups were comparable, except the 6HR2Z had larger size of pleural effusion. All patients completed the treatment. The group treated with 6HR presented fewer adverse effects (15.3%) than 6HR2Z group (33%), p = 0.005, and lower frequency of severe hepatic toxicity (5% vs 10.9%). Four patients died from causes other than TB during treatment with 6HR2Z, and all other patients were cured during a monitoring period for 8.4 years (IQRs, 3.3-14.3). Six patients in 6HR and 10 in 6HR2Z developed residual pachypleuritis. 6HR is as effective as 6HR2Z treatment for pleural-TB, with fewer adverse effects.

Manejo quirúrgico abierto de la disección de aorta abdominal / Open Surgical Management of the Abdominal Aortic Dissection

RESUMEN La disección aórtica ocurre cuando las capas de la pared aortica se separan como resultado de la entrada de sangre a través de un desgarro en la íntima. El promedio reportado para la disección primaria de la aorta abdominal es menor al 2 por ciento, comparado con el de la aorta ascendente (70 por ciento), aorta descendente (20 por ciento) y el arco aórtico (7 por ciento). Se reporta el caso de un paciente masculino de 74 años de edad que inició su padecimiento con dolor lumbar y abdominal súbito e intenso. Se le realizó una angiotomografía que mostró una disección de la aorta abdominal infrarrenal con extensión a ambas arterias iliacas primitivas hasta antes de su bifurcación. Se le realizó un bypass aortobifemoral con injerto bifurcado de Dacron obteniendo un buen resultado posoperatorio. La disección aórtica abdominal primaria es una rara patología que en pacientes sintomáticos se puede tratar mediante la reparación abierta o endovascular, si se decide realizar la técnica abierta se puede realizar la escisión más bypass aortobifemoral obteniendo buenos resultados como en este caso(AU)

ABSTRACT Aortic dissection occurs when the layers of the aortic wall separate as a result of the entry of blood through a tear in the intima. The average figure reported for primary dissection of the abdominal aorta is less than 2 percent, compared with that of the ascending aorta (70 percent), descending aorta (20 percent), and aortic arch (7 percent). We report the case of a 74-year-old male patient who began his disease with sudden and intense abdominal and back pain. An angiotomography was performed that showed a dissection of the infrarenal abdominal aorta with extension to both primitive iliac arteries until before its bifurcation. An aortobifemoral bypass with a bifurcated Dacron graft was performed, obtaining a good postoperative result. Primary abdominal aortic dissection is a rare pathology that, in symptomatic patients, can be treated by open or endovascular repair. If it is decided to perform the open technique, excision can be performed plus aortobifemoral bypass, obtaining good results as in this case(AU)

Comportamiento de la otitis media aguda / Behavior of acute otitis media

Introducción: la otitis media aguda es una complicación de las infecciones respiratorias agudas altas, frecuente en los niños menores de 5 años. Objetivos: caracterizar su comportamiento, según edad y sexo, e identificar algunos factores de riesgo en este grupo de edad. Métodos: se realizó un estudio descriptivo retrospectivo de 554 niños ingresados en el hospital Pediátrico de Centro Habana con el diagnóstico de otitis media aguda, durante los años 2006-2010. Los datos se recogieron de las historias clínicas. Resultados: la otitis media aguda fue más frecuente en el sexo masculino (58,7 por ciento) y en los menores de 1 año (53,1 por ciento) . El antecedente de bajo peso (33,9 por ciento) y la prematuridad (27,5 por ciento), la asistencia a círculos infantiles (43,5 por ciento) y el hábito de fumar de los padres (58,4 por ciento), además del antecedente de ingresos hospitalarios por otitis media en el mes previo a la aparición del episodio actual (59,0 por ciento), constituyeron los principales factores de riesgo en el presente estudio. Conclusiones: la otitis media es una causa frecuente de ingresos hospitalarios, y se identifican como principales factores de riesgo la asistencia a círculos infantiles y el tabaquismo de algunos de los padres(AU)

Introduction: acute otitis media is a complication from acute upper respiratory tract infections and is frequent in the under 5 years-old children. Objectives: to characterize the behavior by sex and age and to identify some risk factors in this age group. Methods: a retrospective and descriptive study was conducted in 554 children admitted to Centro Habana pediatric hospital and diagnosed as acute otitis media patients during the years 2006 through 2010. Data were collected from the medical histories. Results: acute otitis media was more common in boys (58.7 percent) and under one-year old infants (53.1 percent). A history of low birthweight (33.9 percent) and prematurity (27.5 percent), attending daycare centers (43.5 percent) and smoking parents (58.4 percent)in addition to a history of admissions at hospital due to otitis media a month prior to the onset of the current event (59 percent) were the main risk factors seen in this study. Conclusions: otitis media is a frequent cause of admission at hospital and the main risk factors are attending the daycare centers, and smoking parents(AU)

Comportamiento de la otitis media aguda / Behavior of acute otitis media

Introducción: la otitis media aguda es una complicación de las infecciones respiratorias agudas altas, frecuente en los niños menores de 5 años.Objetivos: caracterizar su comportamiento, según edad y sexo, e identificar algunos factores de riesgo en este grupo de edad.Métodos: se realizó un estudio descriptivo retrospectivo de 554 niños ingresados en el hospital Pediátrico de Centro Habana con el diagnóstico de otitis media aguda, durante los años 2006-2010. Los datos se recogieron de las historias clínicas.Resultados: la otitis media aguda fue más frecuente en el sexo masculino (58,7 por ciento) y en los menores de 1 año (53,1 por ciento). El antecedente de bajo peso (33,9 por ciento) y la prematuridad (27,5 por ciento), la asistencia a círculos infantiles (43,5 por ciento) y el hábito de fumar de los padres (58,4 por ciento), además del antecedente de ingresos hospitalarios por otitis media en el mes previo a la aparición del episodio actual (59,0 por ciento), constituyeron los principales factores de riesgo en el presente estudio.Conclusiones: la otitis media es una causa frecuente de ingresos hospitalarios, y se identifican como principales factores de riesgo la asistencia a círculos infantiles y el tabaquismo de algunos de los padres(AU)

Introduction: acute otitis media is a complication from acute upper respiratory tract infections and is frequent in the under 5 years-old children.Objectives: to characterize the behavior by sex and age and to identify some risk factors in this age group.Methods: a retrospective and descriptive study was conducted in 554 children admitted to Centro Habana pediatric hospital and diagnosed as acute otitis media patients during the years 2006 through 2010. Data were collected from the medical histories.Results: acute otitis media was more common in boys (58.7percent) and under one-year old infants (53.1 percent). A history of low birthweight (33.9 percent) and prematurity (27.5 percent), attending daycare centers (43.5 percent) and smoking parents (58.4 percent), in addition to a history of admissions at hospital due to otitis media a month prior to the onset of the current event (59 percent) were the main risk factors seen in this study.Conclusions: otitis media is a frequent cause of admission at hospital and the main risk factors are attending the daycare centers, and smoking parents(AU)

Comportamiento de la otitis media aguda / Behavior of acute otitis media

Introducción: la otitis media aguda es una complicación de las infecciones respiratorias agudas altas, frecuente en los niños menores de 5 años. Objetivos: caracterizar su comportamiento, según edad y sexo, e identificar algunos factores de riesgo en este grupo de edad. Métodos: se realizó un estudio descriptivo retrospectivo de 554 niños ingresados en el hospital Pediátrico de Centro Habana con el diagnóstico de otitis media aguda, durante los años 2006-2010. Los datos se recogieron de las historias clínicas. Resultados: la otitis media aguda fue más frecuente en el sexo masculino (58,7 por ciento) y en los menores de 1 año (53,1 por ciento) . El antecedente de bajo peso (33,9 por ciento) y la prematuridad (27,5 por ciento), la asistencia a círculos infantiles (43,5 por ciento) y el hábito de fumar de los padres (58,4 por ciento), además del antecedente de ingresos hospitalarios por otitis media en el mes previo a la aparición del episodio actual (59,0 por ciento), constituyeron los principales factores de riesgo en el presente estudio. Conclusiones: la otitis media es una causa frecuente de ingresos hospitalarios, y se identifican como principales factores de riesgo la asistencia a círculos infantiles y el tabaquismo de algunos de los padres

Introduction: acute otitis media is a complication from acute upper respiratory tract infections and is frequent in the under 5 years-old children. Objectives: to characterize the behavior by sex and age and to identify some risk factors in this age group. Methods: a retrospective and descriptive study was conducted in 554 children admitted to Centro Habana pediatric hospital and diagnosed as acute otitis media patients during the years 2006 through 2010. Data were collected from the medical histories. Results: acute otitis media was more common in boys (58.7 percent) and under one-year old infants (53.1 percent). A history of low birthweight (33.9 percent) and prematurity (27.5 percent), attending daycare centers (43.5 percent) and smoking parents (58.4 percent)in addition to a history of admissions at hospital due to otitis media a month prior to the onset of the current event (59 percent) were the main risk factors seen in this study. Conclusions: otitis media is a frequent cause of admission at hospital and the main risk factors are attending the daycare centers, and smoking parents

Epidemiology and impact of a multifaceted approach in controlling central venous catheter associated blood stream infections outside the intensive care unit.

BACKGROUND: Outside ICUs, CVC-ABSIs epidemiology and the results of strategies for their prevention are not well known. The aim of this study was to investigate the epidemiology and the impact of a multifaceted "bundle" approach in controlling CVC-ABSIs outside ICU. METHODS: From 1991 we performed prevalence studies of device and parenteral nutrition use, and prospective surveillance of all episodes of CVC-ABSIs in a 350-bed teaching hospital. CVC-ABSIs incidence/1,000 inpatient-days was calculated. An estimated CVC-ABSIs incidence/1,000 catheter-days was calculated based on the prevalence rates of catheter use and the total number of inpatient-days in each year. On november 2008, an education programme was instituted for care of catheter lines: reinforcing instructions in aseptic insertion technique, after care and hand-washing; in order to assess the adherence to these measures the quantity of alcohol-based hand-rub consumption/1,000 patient-days was quoted in litres. From January 2009, a checklist intervention for CVC insertion in ICU was started: hand hygiene, using full barrier precautions, cleaning the skin with alcoholic chlorhexidine, avoiding femoral access and removing unnecessary catheters. Compliance with the central line insertion checklist was measured by real-time audits and was achieved in 80% of cases. RESULTS: Prevalence of use of CVC and parenteral nutrition was similar throughout the study. We followed-up 309 CVC-ABSIs cases. Estimated CVC-ABSIs rate progressively increased to 15.1/1,000 catheter-days in 2008 (0.36/1,000 inpatient-days). After the intervention, the alcohol-based hand-rub consumption increased slightly and estimated CVC-ABSIs rate fell to 10.1 /1,000 catheter-days in last three years (0.19/1,000 inpatient-days), showing a 32.9% decrease. The infection rates achieved were lower in Internal Medicine wards: decreased from 14.1/1,000 catheter-days (0.17/patient-days) in 2008 to 5.2/1,000 catheter-days (0.05/1,000 inpatient-days) in last three years, showing a 63.1% decrease. In 2009, the estimated CVC-ABSIs incidence rate was significantly lower in the Internal Medicine ward compared to the Surgery ward: rate ratio (RR) = 0.14, 95%CI: 0.03-0.60), and within the Internal Medicine ward, the estimated CVC-ABSIs incidence rate was significantly lower in 2009 compared to 2008 (RR = 0.20, 95%CI: 0.04-0.91). CONCLUSION: The rate of CVC-ABSIs increased outside-ICU, and the implementation of multifaceted infection control programme decreased their clinical impact.

ANCA-positive vasculitis induced by levamisole-adulterated cocaine and nephrotic syndrome: The kidney as an unusual target.

PATIENT: Male, 36 FINAL DIAGNOSIS: Levamisole-induced vasculopathy Symptoms: Purpuric skin lesions Medication: Levamisole Clinical Procedure: - Specialty: Internal Medicine. OBJECTIVE: Unusual clinical course. BACKGROUND: Levamisole has been detected in seized cocaine samples and a levamisole-induced vasculopathy (LIV) has been described, mainly focused on skin. CASE REPORT: A 36-year-old Caucasian man with history of antibodies to hepatitis C infection (negative hepatitis C virus RNA and negative HIV serology), smoking, and intravenous use of cocaine and brown heroin, presented to the hospital with purpuric skin lesions on extremities and earlobes. One month before the current presentation, a skin punch biopsy of one of these lesions was performed, showing histopathologic findings suggestive of mixed cryoglobulinemia. Laboratory testing revealed leukopenia, renal failure, and nephrotic syndrome. Antimyeloperoxidase antineutrophil cytoplasmic antibodies (MPO-ANCA) were positive. The previous skin punch biopsy was revised and demonstrated pathologic findings consistent with leukocytoclastic vasculitis. An analysis of a cocaine sample for personal use, provided by the patient, was performed using mass spectrometry-gas chromatography and levamisole was detected. Three boluses of intravenous methylprednisolone were administered, followed by oral prednisone 1 mg/Kg per day. Skin lesions and renal function improved. CONCLUSIONS: To our knowledge, this is the first report of nephrotic syndrome induced by levamisole-adulterated cocaine, proven by cocaine sample toxicology. Lack of renal biopsy is a limitation of this report.

The VP3 factor from viruses of Birnaviridae family suppresses RNA silencing by binding both long and small RNA duplexes.

RNA silencing is directly involved in antiviral defense in a wide variety of eukaryotic organisms, including plants, fungi, invertebrates, and presumably vertebrate animals. The study of RNA silencing-mediated antiviral defences in vertebrates is hampered by the overlap with other antiviral mechanisms; thus, heterologous systems are often used to study the interplay between RNA silencing and vertebrate-infecting viruses. In this report we show that the VP3 protein of the avian birnavirus Infectious bursal disease virus (IBDV) displays, in addition to its capacity to bind long double-stranded RNA, the ability to interact with double-stranded small RNA molecules. We also demonstrate that IBDV VP3 prevents the silencing mediated degradation of a reporter mRNA, and that this silencing suppression activity depends on its RNA binding ability. Furthermore, we find that the anti-silencing activity of IBDV VP3 is shared with the homologous proteins expressed by both insect- and fish-infecting birnaviruses. Finally, we show that IBDV VP3 can functionally replace the well-characterized HCPro silencing suppressor of Plum pox virus, a potyvirus that is unable to infect plants in the absence of an active silencing suppressor. Altogether, our results support the idea that VP3 protects the viral genome from host sentinels, including those of the RNA silencing machinery.

Extrapulmonary tuberculosis: epidemiology and risk factors

Objetivo: Conocer la epidemiología y los factores de riesgo asociados con la tuberculosis extrapulmonar(EPTB).Método: Los casos de tuberculosis (TB) diagnosticadas entre 1991-2008 en una población caucásica fueron clasificados como EPTB o TB pulmonar (PTB). De todos los casos, 63,7% fueron seguidos en una consulta monográfica de TB. Se utilizó un protocolo estandarizado para la recogida de los datos, incluyendo: sexo, edad, vacunación con BCG, contacto con algún paciente con PTB, tabaquismo, alcoholismo, diabetes mellitus, corticoides/fármacos inmunosupresores e infección por el VIH. Se compararon las variables entre los grupos de EPTB y de PTB. El análisis estadístico se basó en un estudio de regresión logística. Se calcularon los odds ratio (OR) y sus intervalos de confianza (IC) del 95%.Resultados: Entre 2.161 casos diagnosticados, 1.186 fueron PTB y 705 EPTB. La incidencia global de TB disminuyó desde 79.9/100.000 en 1992 hasta 27.1/100.000 en 2008, p<0,05. El número de casos de EPTB disminuyó de forma más lenta que el de PTB. La proporción de EPTB aumentó desde 30,6% de los casos en 1991-1996 hasta 37,6% en 2003-2008 (la localización ganglionar aumentó un 27%), p<0,05 en un ji al cuadrado de tendencia. En el estudio multivariante, ser mujer (OR 2,04; IC 95%: 1,56-2,66) y la edad (OR1,02; IC 95%: 1,01-1,022) se asociaron con EPTB mientras que el alcoholismo (OR 0,33; IC 95%: 0,20-0,52),

Objective To describe the epidemiology and risk factors associated with extra-pulmonary tuberculosis (EPTB).Method Cases of tuberculosis (TB) diagnosed from 1991 to 2008 in a Caucasian population were classified as EPTB or pulmonary TB (PTB). Of all cases, 63.7% were followed up in a specialist TB unit. A standardised protocol for data collection was used, including: gender, age, BCG vaccination, contact with PTB patient, smoking habit, alcohol abuse, diabetes mellitus, immunosuppressive drugs/steroids and HIV-status. These variables were compared between EPTB and PTB groups. Statistical analysis was based on logistic regression. Odds ratios (OR) and their 95% confidence intervals (CI) were calculated. Results Among the 2,161 cases diagnosed, 1,186 were PTB and 705 EPTB. The overall TB incidence had fallen from 79.9/100,000 in 1992 to 27.1/100,000 in 2008, P<.05. The number of EPTB cases decreased more slowly than PTB. EPTB increased from 30.6% of cases in 1991-1996 to 37.6% in 2003-2008 (lymphatic site increased 27%), by trend test P<.05. At multivariate level, being female (OR 2.04; 95% CI: 1.56-2.66) and age (OR 1.02; 95% CI: 1.01-1.022) were associated with EPTB, while alcohol abuse (OR 0.33; 95% CI: 0.20-0.52), smoking habit (OR 0.45; 95%CI: 0.34-0.59), contact with PTB patients (OR 0.57; 95% CI: 0.44-0.76) and BCG vaccination (OR 0.64; 95% CI: 0.44-0.92) had a protective effect. The proportion of female gender and age of patients increased over time, whilst there was a decrease in BCG vaccinated patients. Conclusions Whilst there has been a reduction in the overall incidence of TB, the proportion of EPTB increased. The proportional increase in EPTB could be explained by an increase in life expectancy and the predominance of women in the population, and by a decline in BCG vaccinated patients(AU) el tabaquismo (OR 0,45; IC 95%: (..) (AU)

Non-cirrhotic portal hypertension in human immunodeficiency virus-infected patients: a new challenge in antiretroviral therapy era.

Non-cirrhotic portal hypertension (NCPH) has been recently reported as a liver disease in Human Immunodeficiency Virus (HIV)-infected patients under antiretroviral therapy (ART). Combination of non-exclusive mechanisms has been described: primary endothelial damage of terminal portal veins induced by HIV or immunologic disorders, mitochondrial toxicity by didanosine and prothrombotic state. It is characterized by heterogeneous liver histological findings, frequently identified as nodular regenerative hyperplasia and clinical manifestations of portal hypertension with well-preserved liver function. We describe herein two HIV-infected patients with clinical picture suggestive of NCPH. Besides the case reports, we briefly address questions to apply to patient care in clinical practice.

Extrapulmonary tuberculosis: epidemiology and risk factors.

OBJECTIVE: To describe the epidemiology and risk factors associated with extra-pulmonary tuberculosis (EPTB). METHOD: Cases of tuberculosis (TB) diagnosed from 1991 to 2008 in a Caucasian population were classified as EPTB or pulmonary TB (PTB). Of all cases, 63.7% were followed up in a specialist TB unit. A standardised protocol for data collection was used, including: gender, age, BCG vaccination, contact with PTB patient, smoking habit, alcohol abuse, diabetes mellitus, immunosuppressive drugs/steroids and HIV-status. These variables were compared between EPTB and PTB groups. Statistical analysis was based on logistic regression. Odds ratios (OR) and their 95% confidence intervals (CI) were calculated. RESULTS: Among the 2,161 cases diagnosed, 1,186 were PTB and 705 EPTB. The overall TB incidence had fallen from 79.9/100,000 in 1992 to 27.1/100,000 in 2008, P<.05. The number of EPTB cases decreased more slowly than PTB. EPTB increased from 30.6% of cases in 1991-1996 to 37.6% in 2003-2008 (lymphatic site increased 27%), by trend test P<.05. At multivariate level, being female (OR 2.04; 95% CI: 1.56-2.66) and age (OR 1.02; 95% CI: 1.01-1.022) were associated with EPTB, while alcohol abuse (OR 0.33; 95% CI: 0.20-0.52), smoking habit (OR 0.45; 95%CI: 0.34-0.59), contact with PTB patients (OR 0.57; 95% CI: 0.44-0.76) and BCG vaccination (OR 0.64; 95% CI: 0.44-0.92) had a protective effect. The proportion of female gender and age of patients increased over time, whilst there was a decrease in BCG vaccinated patients. CONCLUSIONS: Whilst there has been a reduction in the overall incidence of TB, the proportion of EPTB increased. The proportional increase in EPTB could be explained by an increase in life expectancy and the predominance of women in the population, and by a decline in BCG vaccinated patients.

Non-hospital-associated methicillin-resistant Staphylococcus aureus and MRSA chronic carrier patients in infection control.

This study reports research on methicillin-resistant Staphylococcus aureus (MRSA) colonized-infected patients who were admitted to a 320-bed hospital. Specifically, we report on the difficulties related to MRSA infection control as a consequence of the increasing incidence of non-hospital-associated MRSA acquisition and patients as chronic carriers who are frequently readmitted to the hospital.