Clinical and epidemiological characteristics of pyogenic liver abscess in people 65 years or older versus people under 65: a retrospective study.

BACKGROUND: To analyse the clinical, epidemiological, microbiological and prognostic differences of pyogenic liver abscess (PLA) in older (≥ 65 years of age) versus younger patients (< 65 years). METHODS: Multicentre, retrospective cohort study in all patients with PLA admitted to two Spanish hospitals from January 2000 to January 2014. Cases were divided into two age groups (< 65 years and ≥65 years) for comparison of clinical, epidemiological and microbiological characteristics as well as treatment. RESULTS: Of 98 patients analysed, 40 patients were younger than 65, and 58 were aged 65 or older. Significant associations in the older group were found with female sex (adjusted odds ratio [ORa] 9.0; 95% CI 1.4, 56), non-cryptogenic origin (ORa 14.5; 95% CI 1.6, 129), absence of chronic liver disease (ORa 14; 95% CI 1.3, 155), Escherichia coli infection (ORa 7.7; 95% CI 1.03, 58), and incidence of complications (ORa 2.3; 95% CI 1.04, 5.4). Mortality was 8.2% overall, although all deaths occurred in the older group (8/58; 13.8%) (p = 0.02). DISCUSSION: Our results are in consonance with other published studies. Older patients with PLA tend to present more anomalies in the biliary tract (Kai et. al, World J Gastroenterol 18: 2948-295, 2012, Rahimian et. al, Clin Infect Dis 39:1654-9, 2004, Seeto, Medicine (Baltimore) 75:99-113, 1996, Kao et.al, Aliment Pharmacol Ther 36:467-76, 2012, Lai et. al, Gastroenterology 146:129-37, 2014), while younger patients are more often male and present more commonly with previous liver disease (especially related to alcohol) and cryptogenic PLA. CONCLUSION: In patients aged 65 or older, PLA was more common in women and in those with a history of biliary disease, and E. coli was the most frequent bacterium. Mortality was also higher in the older group.

Stereoisomeric profiling of drugs of abuse and pharmaceuticals in wastewaters of Valencia (Spain).

The enantiomeric and diastereomeric profiling of chiral pharmaceuticals (ephedrine, norephedrine, atenolol and venlafaxine) and illicit drugs (amphetamine, methamphetamine, 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxy-N-methylamphetamine (MDMA) and 3,4-methylenedioxy-N-ethylamphetamine (MDEA)) was undertaken over a period of fourteen consecutive days in three wastewater treatment plants (WWTPs) in the city of Valencia, Spain. Degradation efficiency of WWTPs was found to be compound and enantiomer dependent. Selective enantiomer enrichment was observed for several target analytes. Amphetamine and MDMA were enriched with R(-)-enantiomers. 1S,2S(+)-pseudoephedrine was found to be more readily degradable during activated sludge treatment than its diastereomer 1R,2S(-)-ephedrine. Atenolol underwent enrichment with either S(-)- or R(+)-enantiomer in different WWTPs. This unexpected enantiomeric variation in the stereoselective degradation of atenolol could be attributed to different processes utilized during activated sludge treatment. The application of (enantiomeric) profiling of wastewater revealed usage patterns of chiral drugs in the Valencia region.

Screening of currently used pesticides in water, sediments and biota of the Guadalquivir River Basin (Spain).

The occurrence of 50 currently used pesticides and their transformation products in surface and waste waters, sediment and fish in the Guadalquivir River Basin was determined in 2010 and 2011. After selective sample extraction, pesticides were identified and quantified by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). The contamination profile in water and sediments is marked by the presence of organophosphorus and triazines. Transformation products were even at higher concentrations than parent pesticides. A wider range of pesticides was present in water than in sediments but none of them were detected in fish. The mean concentrations ranged from 0.2 to 13.0 ng/L in water and from 0.1 to 13.2 ng/g d.w. in sediment. The spatial distribution of most pesticides was consistent with the agricultural activities of the area or their urban applications. The waste water treatment plant effluents that impact the river are minor sources for few pesticides but for most of them run-off would be the most important contribution. The temporal distribution showed differences between both sampling campaigns related to the river flow. The low-flow produced a pesticide concentration effect, generating higher levels in water and accumulation in sediments. This forecasts a hazard in future scenarios if the current situation of the climate change and water scarcity evolves to more critical conditions highlighting the need of these monitoring studies.

Risk assessment on the presence of pharmaceuticals in sediments, soils and waters of the Pego-Oliva Marshlands (Valencia, eastern Spain).

This study is focused on the occurrence of 17 pharmaceuticals in waters (34 samples), sediments (16 samples) and soils (23 samples, at two different depths) in a typical Mediterranean coastal wetland (Pego-Oliva marsh, Spain). Soil and sediment samples were extracted by pressurized liquid extraction (PLE). Aqueous extracts from PLE and water samples were concentrated by solid-phase extraction (SPE) and determined by liquid-chromatography tandem mass spectrometry (LC-MS/MS). Pharmaceuticals were detected in concentrations up to 112 ng/L in water samples, up to 15.1 ng/g sediments and up to 8.4 ng/g in soil. In surface waters, ibuprofen and codeine were the compounds more frequently detected (up to 59 ng/L and 63 ng/L, respectively). Ground and tap water samples analyzed were also contaminated with pharmaceuticals. The 94% of sediments and the 80% of agricultural soils were polluted (mostly by carbamazepine and acetaminophen). Diffusion of codeine and fluoroquinolones to deeper soil horizons was observed. Possible relationships between variables were established by Pearson correlations and principal components analysis (PCA). An environmental risk assessment based on the available long-term data was performed. Results showed actual risk for the lowest trophic level, and for fishes, due to the presence of fluoroquinolones and ibuprofen. Nevertheless, the presence of pharmaceuticals in the environment is not limited only to an ecological problem since contamination also affects drinking water, being a potential risk to human health.

Spatial distribution of illicit drugs in surface waters of the natural park of Pego-Oliva Marsh (Valencia, Spain).

BACKGROUND, AIM AND SCOPE: The Pego-Oliva Marsh is the second most important wetland in the Valencian Community (Spain). It is included in the RAMSAR agreement and represents one key point for migratory birds. Emerging contaminants from the human pressure, such as pharmaceuticals, illicit drugs and personal care product, are not included in the list of priority contaminants of the Water Framework Directive yet, and are neither monitored nor controlled. However, pollution of emerging contaminants can threaten the environment and even human health. In order to understand the status of the emerging contamination and recommend future rationalization of countermeasures, the occurrence of illicit drugs was investigated. MATERIAL AND METHODS: Samples were collected at 23 sites from the main irrigation channels and the marsh. Illicit drugs were extracted using solid phase extraction and determined by liquid chromatography tandem mass spectrometry. The method detection limits ranged from 0.01 to 1.54 ng l(-1) and the recoveries from 57% to 120%. RESULTS AND DISCUSSION: 3,4-Methylenedioxymethamphetamine, ketamine, morphine, benzoylecgonine, cocaine, methadone, 6-acetylmorphine and nor-9-carboxy-tetrahydrocannabinol were detected. The mean concentrations were 0.62, 21.33, 1.30, 1.92, 2.25, 0.32, 0.04 and 0.07 ng l(-1), respectively. The highest concentrations were in the north of Pego-Oliva Marsh. CONCLUSIONS: The pollution status by illicit drugs of the Pego-Oliva Marsh has been established. However, contamination levels in all the area of the natural park were low compared with those reported in other superficial waters.

Assessment of the occurrence and distribution of pharmaceuticals in a Mediterranean wetland (L'Albufera, Valencia, Spain) by LC-MS/MS.

The distribution of 17 pharmaceuticals between water and the solid phase (sediments and soils) was studied by utilizing solid-phase extraction (SPE) and liquid chromatography-tandem mass spectrometry (LC-MS/MS). Two extraction procedures for soils and sediments, prior to the SPE, one based on pressurized liquid extraction (PLE) with hot water and the other on methanol/water ultrasonic extraction, were compared. Absolute recoveries were 71.2-99.3% [relative standard deviation (RSD) <21.4%)] for water, and the method detection limits (MDLs) ranged from 0.3 to 10 ng L(-1). Recoveries were 35.4-105.3% (RSDs <19.1%) and 42.1-97.8% (RSDs <14%) for soil and sediment samples, respectively, using PLE and 20.2-86.5% (RSDs <25.1%) and 30.3-97.4% (RSDs <19.1%) using ultrasonic extraction. Fifteen of the 17 pharmaceuticals were present in the L'Albufera water at concentrations up to 17 µg L(-1). Oxytetracycline and tetracycline were not detected. In sediments, only tetracycline, norfloxacin and diclofenac were not found. The other studied pharmaceuticals were present in the range from less than the method quantification limit (MQL) to 35.83 ng g(-1). Among the 17 target compounds, ofloxacin, ciprofloxacin, norfloxacin, trimethoprim, clofibric acid and diclofenac were not detected in soil samples. The average concentrations ranged from less than the MQL for ibuprofen to 34.91 ng g(-1) for tetracycline. These results indicate that pharmaceuticals could survive the wastewater treatment processes, which could lead to their dissemination in water environments.

Analysis of insecticides in honey by liquid chromatography-ion trap-mass spectrometry: comparison of different extraction procedures.

The feasibility of different extraction procedures was tested and compared for the determination of 12 organophosphorus and carbamates insecticides in honey samples. In this sense, once the samples were pre-treated - essentially dissolved in hot water by stirring - and before they could be analyzed by liquid chromatography-ion trap-second stage mass spectrometry (LC-MS(2)), four different approaches were studied for the extraction step: QuEChERS, solid-phase extraction (SPE), pressurized liquid extraction (PLE) and solid-phase microextraction (SPME). The main aim of this work was to maximise the sensitivity of pesticides and to minimise the presence of interfering compounds in the extract. All pesticides were linear in the range from CC(ß) to 1000× CC(ß) for the four extraction methods (three orders of magnitude). Detection capabilities (CC(ß)) were 0.024-1.155 mg kg(-1) with QuEChERS, 0.010-0.646 mg kg(-1) with SPE, 0.007-0.595 mg kg(-1) with PLE, and 0.001-0.060 mg kg(-1) with SPME. All the target compounds could be recovered by any of the methods, at a CC(ß) fortification level ranged from 28 to 90% for the SPME. In comparison, the PLE method was the most efficient extraction method with recoveries from 82 to 104%. It was followed by the QuEChERS method with recoveries between 78 and 101% and the SPE method with recoveries between 72 and 100%. The repeatability expressed as relative standard deviation (RSDs) was below 20% for all the pesticides by any of the tested extraction methods. Results obtained applying the four extraction techniques to real honey samples are analogous.

SPE and LC-MS/MS determination of 14 illicit drugs in surface waters from the Natural Park of L'Albufera (València, Spain).

A simple and robust method using solid-phase extraction (SPE) and liquid chromatography tandem mass spectrometry (LC-MS/MS) for the simultaneous determination of 14 drugs of abuse and their metabolites (cocainics, amphetamine-like compounds, cannabinoids, and opiates) in surface waters has been developed. Seven SPE adsorbents (Oasis HLB, Oasis MCX, Oasis Wax, Supelselect HLB, Strata-X, Strata-XCW), amount of sorbent bed, water volume, and pH were investigated. The highest recoveries, as well as the simplest protocol, were obtained for Oasis HLB cartridges (6 mL/200 mg) using 250 mL of water. The proposed method was linear in a concentration range from 0.03-6 to 300-60,000 ng/L depending on the compound, with correlation coefficients higher than 0.998. Matrix effects have been studied in surface water samples, and several isotope-labeled internal standards have been evaluated as a way to compensate the signal suppression observed. Limits of detection (LODs) and quantification (LOQs) ranged from 0.01 to 1.54 ng/L and from 0.03 to 5.13 ng/L, respectively. Recoveries were 71-102% at the LOQ level and 77-104 at 50 ng/L. The intra-day and intermediate precisions were from 1% to 8% and from 2% to 11%, respectively. The present work reports for the first time the occurrence of drugs of abuse residues in surface water samples from the Natural Park of L'Albufera (Valencia, Spain). Codeine, cocaine, benzoylecgonine, ecgonine methylester, amphetamine, 3,4-methylendioxy methamphetamine, morphine, and methadone were quantified with median values of 11.10, 0.02, 5.59, 0.08, 0.21, 0.75 and 0.14 ng/L respectively, and 11-nor-9-carboxy-Delta9-tetrahydrocannabinol was detected in one sample at levels

Determination of pharmaceuticals in soils and sediments by pressurized liquid extraction and liquid chromatography tandem mass spectrometry.

The present work describes the development of a sensitive analytical method based on pressurized liquid extraction (PLE) and pre-concentration by solid-phase extraction (SPE), followed by liquid chromatography-electrospray tandem mass spectrometry (LC-ESI-MS/MS) for the determination of seventeen pharmaceuticals in soils and sediments. The method is based on sample homogenisation using Na(2)-EDTA washed sand and extraction with water at 90 degrees C. Special emphasis was placed on the optimization of the extraction procedure to develop a green method that reduces, at a maximum, the use of organic solvents in order to eliminate matrix components during the clean-up. The proposed method was linear in a concentration range from 0.3 to 333ngg(-1), with correlation coefficients higher than 0.993. Method detection (MDLs) and quantification (MQLs) limits ranged from 0.1 to 6.8ngg(-1) and from 0.25 to 23ngg(-1), respectively. Absolute recoveries were analyte dependent, varying between 50% and 105% at the MQL level, except for fenofibrate (40%) and diclofenac (34%). The intra-day and inter-day precision was given by RSD values from 0.7% to 7.9% and from 1.6% to 14.5%, respectively. Acetaminophen, carbamazepine, ciprofloxacin, clofibric acid, codeine, diazepam, fenofibrate, metropolol, ofloxacin and propanolol were detected at concentrations from MDL to 35.62ngg(-1) in soils and sediments from marsh areas. Due to the low recoveries, results for fenofibrate and diclofenac can only be considered as semi-quantitative. The method was fully suitable for the other 15 pharmaceuticals.

Determination of tetracycline residues in soil by pressurized liquid extraction and liquid chromatography tandem mass spectrometry.

An optimized extraction and cleanup method for the analysis of chlortetracycline (CTC), doxycycline (DC), oxytetracycline (OTC) and tetracycline (TC) in soil is presented. Soil extraction in a pressurized liquid extraction system, followed by extract clean up using solid-phase extraction (SPE) and tetracycline determination by liquid chromatography tandem mass spectrometry (LC-MS/MS) provided appropriate efficiency and reproducibility. Different dispersing agents and solvents for soil extraction and several SPE cartridges for cleanup were compared. The best extraction results were obtained using ethylenediamine tetraacetic acid-treated sand as dispersing agent, and water at 70 degrees C. The most effective cleanup was obtained using Strata-X sorbent in combination with a strong anion exchange cartridge. Recoveries ranged from 71% to 96% and precision, as indicated by the relative standard deviations, was within the range of 8-15%. The limits of quantification (LOQs) by using LC-MS/MS, based on signal-to-noise ratio (S/N) of 10, ranged from 1 microg kg(-1) for TC to 5 microg kg(-1) for CTC. These results pointed out that this technique is appropriate to determine tetracyclines in soils. Analysis of 100 samples taken in the Valencian Community revealed that, in soil, up to 5 microg kg(-1) CTC, 15 microg kg(-1) OTC, 18 microg kg(-1) TC, and 12 microg kg(-1) DC could be detected. Detection of the analytes in several samples, which typify great part of the Spanish agricultural soils, should be outlined as most important result of this study.

A comparative study of bacteremic and non-bacteremic pneumococcal pneumonia.

BACKGROUND: Few attempts have been made to compare bacteremic and non-bacteremic pneumococcal pneumonia, mainly because it is difficult to gain agreement on which cases represent non-bacteremic pneumococcal pneumonia. Recently, an immunochromatographic assay for the detection of Streptococcus pneumoniae urinary antigen has been successfully evaluated for the diagnosis of pneumococcal pneumonia. The aim of our study was to examine and compare clinical and radiological features, risk factors, and outcome associated with bacteremic and non-bacteremic groups. METHODS: A retrospective study (1995-2003) analyzing the clinical records of patients diagnosed with pneumococcal pneumonia in our institution was performed. S. pneumoniae were identified by blood cultures (bacteremic group) and detection of urinary antigen (non-bacteremic group). RESULTS: There were 82 patients (57 bacteremic and 25 non-bacteremic). In seven non-bacteremic cases, another etiology was detected, i.e., Legionella (n=1) and Chlamydia pneumoniae (n=6). Bacteremic patients were significantly younger (p=<0.001), more likely to have liver disease (p=0.028), current smokers (p=0.024), alcohol and intravenous drug abusers (p=0.014 and p<0.001, respectively), and infected with HIV (p<0.001). Non-bacteremic patients were more likely to have congestive heart failure (p=0.004), chronic obstructive pulmonary disease (p=0.033) and to be former smokers (p=0.004). Bacteremic cases needed more prolonged intravenous antibiotic treatment (6 days vs. 4.5 days; p=0.006) than non-bacteremic cases and their length of stay was also longer. CONCLUSION: In our study, smoking was the leading risk factor for pneumococcal pneumonia. However, current smokers have an increased risk of bacteremic forms and former smokers and patients with COPD developed non-bacteremic forms more frequently. Bacteremic patients need more prolonged intravenous antibiotic treatment than non-bacteremic patients.

Criptococosis meníngea como manifestación de síndrome de reconstitución inmunitaria / Meningeal cryptococcosis as a sign of immune

No disponible

Efavirenz-associated gynecomastia: report of five cases and review of the literature.

The prognosis of HIV infection has improved dramatically since the introduction of highly active antiretroviral therapy (HAART). However, numerous adverse effects and limitations regarding tolerability remain a concern. Lipomastia (pseudogynecomastia), a breast enlargement due to central adiposity, may occur as part of a fat redistribution syndrome which has been associated with HAART regimens and several pathogenic mechanisms have been advocated in its development. Here we report an observational longitudinal study of five patients diagnosed of gynecomastia associated with efavirenz-based HAART regimens. All cases reached successful immunologic and virologic responses to HAART. The delay of appearance of gynecomastia from the beginning of HAART ranged between 4 to 15 months. In all five cases, gynecomastia regressed after efavirenz withdrawal (mean period of 5 months). In summary, we think that HAART induced gynecomastia should be suspected in HIV patients receiving efavirenz-containing regimens. Although pathogenesis is unclear, this study and a review of the English literature implicates two possible mechanisms: (a) immune restoration processes and (b) efavirenz mediated estradiol-like effects.

Endocarditis aguda por Staphylococcus lugdunensis con émbolos sépticos cerebrales y pulmonares de buena evolución / Acute Staphilococcus lugdunensis endocarditis with septic cerebral and pulmonary emboli, showing favorable evolution

No disponible

Orquiepididimitis tuberculosa en pacientes con infección por el VIH. Presentación de tres casos / Tuberculous orchiepididymitis in parents with HIV infection. Presentation of three cases

No disponible

Necrosis avascular en pacientes con infección por el VIH / Avascular esteonecrosis in HIV infected patients

La necrosis avascular ósea u osteonecrosis era una rara entidad en pacientes con infección por el VIH. La incidencia de esta asociación está aumentando en los últimos años, especialmente en pacientes que reciben tratamiento antirretroviral de alta eficacia con inhibidores de la proteasa. Presentamos tres casos (dos varones y una mujer) de osteonecrosis en pacientes con infección por el VIH. En dos casos, la osteonecrosis afectó a rodillas y el tercero a la cadera. Los tres pacientes recibían tratamiento antirretroviral de alta eficacia desde hacía más de un año, en ningún caso se detectó hiperlipemia, anticuerpos antifosfolipídicos, ni ningún otro factor clásico de riesgo para la osteonecrosis. Creemos que la osteonecrosis debe ser una complicación a tener en cuenta en los pacientes con VIH especialmente aquellos con tratamiento antirretroviral de alta eficacia. (AU)