Prestación sanitaria dental durante la pandemia de Covid-19 en un Centro de Salud urbano de Zaragoza del Servicio Aragonés de Salud / Dental health care during the Covid-19 pandemic in a Zaragoza urban Health Center of the Aragonese Health Service

The work carried out by all health professionals, including those who work in Primary Care, presents a transcendental role during the situation created by the Covid-19 pandemic. In Spain, after bending the contagion curve, the de-escalation process has begun, by which all productive work activities must be started again, after the forced cessation produced by the State of Alarm, while trying to preserve the security of all citizens in the face of the latent threat of Covid-19. In the Health Centers of the Autonomous Public Health Systems, the patient care services have been modified, in order to obtain a quality care service while trying to guarantee the health of both the clinical-care staff, as of patients. For this reason, the Oral Health Units of the Health Centers of the Autonomous Community of Aragon have had to adapt to the new situation, presenting in this study the characteristics of oral care in the Oral Health Unit of the Seminario Health Center Romareda de Zaragoza in the first month of the de-escalation.

La labor ejercida por todos los profesionales sanitarios, incluyendo los que ejercen su labor en la Atención Primaria, presenta un papel transcendental durante la situación creada por la pandemia por la Covid-19. En España, tras doblegar la curva de contagios, se ha iniciado el proceso de desescalada, por el cual todas las actividades laborales productivas deben volver a ponerse en marcha, tras el cese forzoso producido por el Estado de Alarma, procurando a la par preservar la seguridad de toda la ciudadanía ante la amenaza latente de la Covid-19. En los Centros de Salud de los Sistemas Sanitarios Públicos Autonómicos, se han modificado los servicios de atención a los pacientes, con el fin de obtener un servicio asistencial de calidad a la par que se procura garantizar la salud de tanto el personal clínico-asistencial, como de los pacientes. Por este motivo, las Unidades de Salud Bucodental de los Centros de Salud de la Comunidad Autónoma de Aragón han tenido que adaptarse a la nueva situación, presentándose en este estudio las características de la atención bucodental en la Unidad de Salud Bucodental del Centro de Salud El Seminario-Romareda de Zaragoza en el primer mes de la desescalada.

Benefits of applying organic amendments from recycled wastes for fungal community growth in restored soils of a limestone quarry in a semiarid environment.

Applying organic amendments to recover physical, chemical, and biological qualities of soil may enable recovery of soils degraded by mining in semiarid climates. This study's aim was to investigate the development and changes in the composition of fungal communities in restored soils with five different types of organic amendments (two types of vegetable compost and sewage sludge compost, and a mixture of both) compared with unamended soils and surrounding natural soils and to examine the relationships between the fungal taxa, the new physico-chemical and biological soil properties of technosoils after 18 months of restoration, and natural soils. Restoration improved soil quality and fungal diversity, placing these soils in an intermediate position between unrestored soils (with no fungi present) and undisturbed reference soils, which were the most fungal diverse. Sewage-treated soils and their mixtures showed high nitrogen and carbohydrate content as well as high basal respiration and fatty acid content, suggesting that they provided readily biodegradable organic matter. In contrast, greenhouse compost-treated soils showed high total organic carbon and polyphenol content, whereas garden compost-treated soils showed intermediate values. The biological soil properties of both composts showed were similar to those of the reference soils, suggesting that composts contained more resilient organic matter. Organic amendments of dissimilar origin caused significantly different fungal soil communities at the genus level among the restored soils. Results indicated that soil pH, electrical conductivity, total nitrogen content, soil basal respiration, fungi/bacteria-PLFA ratio, and dehydrogenase and ß-glucosidase activities, together with Pearson's correlations, revealed that these properties and nutrient content (total organic carbon, C/N ratio, carbohydrates, and polyphenols) influenced 40 soil fungal taxa. Therefore, the organic amendments led to changes in soil properties that favoured plant cover by promoting the soil fungal community growth beneficial to the carbon cycle and symbiotic with plants.

In vitro fertilization exacerbates stroke size and neurological disability in wildtype mice.

BACKGROUND AND PURPOSE: Assisted reproductive technologies (ART) induce premature vascular aging in human offspring. The related alterations are well-established risk factors for stroke and predictors of adverse stroke outcome. However, given the young age of the human ART population there is no information on the incidence and outcome of cerebrovascular complications in humans. In mice, ART alters the cardiovascular phenotype similarly to humans, thereby offering the possibility to study this problem. METHODS: We investigated the morphological and clinical outcome after ischemia/reperfusion brain injury induced by transient (45 min) middle cerebral artery occlusion in ART and control mice. RESULTS: We found that stroke volumes were almost 3-fold larger in ART than in control mice (P < 0.001). In line with these morphological differences, neurological performance assessed by the Bederson and RotaRod tests 24 and 48 h after artery occlusion was significantly worse in ART compared with control mice. Plasma levels of TNF-alpha, were also significantly increased in ART vs. control mice after stroke (P < 0.05). As potential underlying mechanisms, we identified increased blood-brain barrier permeability evidenced by increased IgG extravasation associated with decreased tight junctional protein claudin-5 and occludin expression, increased oxidative stress and decreased NO-bioactivity in ART compared with control mice. CONCLUSIONS: In wildtype mice, ART predisposes to significantly worse morphological and functional stroke outcomes, related at least in part to altered blood-brain barrier permeability. These findings demonstrate that ART, by inducing premature vascular aging, not only is a likely risk factor for stroke-occurrence, but also a mediator of adverse stroke-outcome. TRANSLATIONAL PERSPECTIVE: This study highlights that ART not only is a likely risk factor for stroke-occurrence, but also a mediator of adverse stroke-outcome. The findings should raise awareness in the ever-growing human ART population in whom these techniques cause similar alterations of the cardiovascular phenotype and encourage early preventive and diagnostic efforts.

Soil amendments from recycled waste differently affect CO2 soil emissions in restored mining soils under semiarid conditions.

Drylands affected by serious disturbances such as mining activities lose their vegetation cover and organic soil horizons, becoming CO2 emissions sources. Applications of organic amendments could be a good restoration solution that favours vegetation establishment and soil carbon sequestration; however, they are also associated with CO2 emissions. Experimental plots with different organic amendments (sewage sludge, garden and greenhouse vegetable composts, and mixtures of both) and unamended soils were installed in a quarry in southeast Spain. The aim of this study was: i) to evaluate the magnitude and changes of in situ CO2 emission from each experimental plot during a year and a half, and ii) to assess the effects of several physical-chemical (total organic carbon, total nitrogen, water retention, pH and electrical conductivity) and environmental parameters (moisture and temperature) in CO2 emissions. The results showed an initial CO2 emission (priming effect), produced from all restored plots just after the application of the organic amendment, which was significantly higher (P < 0.05) in soils with sewage sludge and their mixtures in comparison to vegetable compost. Garden compost had low emission rates, similar to soils without amendment and showed lower CO2 emission rates than the rest of the restoration treatments. Nevertheless, CO2 emissions decreased in each field campaign over time, showing that all restored soils had lower emissions than natural soils at the end of the sampled period. The different composition of organic amendments had a different effect on soil CO2 emissions. DistLM analysis showed that soil properties such as total organic carbon, total nitrogen, pH and soil moisture, associated with rainfall periods, strongly influenced CO2 emissions, whereas temperature did not affect the CO2 flow. In conclusion, the compost from plant remains could serve better as treatment to restore degraded soils in drylands than sewage sludge because of its lower CO2 emissions and concomitant effect on climate warming and carbon balance.

Quarry restoration treatments from recycled waste modify the physicochemical soil properties, composition and activity of bacterial communities and priming effect in semi-arid areas.

The selection of a suitable organic amendment for recovery of semi-arid soils degraded by mining is key to the success of an ecological restoration. The aim of this research is to study the short-term responses of physicochemical, biochemical and biological properties, as well as the changes of a soil bacterial community at the genus level after application of five types of organic amendments in a limestone quarry in Almería (SE, Spain). The relationship among bacterial taxa with biochemical and physicochemical properties and priming effect from restored soils was also analysed. Six months after the application of organic amendments, the values of different soil status, such as total organic carbon, total nitrogen, assimilable phosphorus and labile organic matter forms (carbohydrates and polyphenols), basal respiration (BR) and enzymatic activities increased significantly with respect to unrestored soils. Similarly, a positive priming effect of soil organic matter mineralisation was produced by all organic amendments, being significantly higher (p < 0.05) in sewage sludge-treated soils. Bacterial diversity was higher in restored than in control soils. The restoration caused changes in soil bacterial communities' composition at the phylum and genus levels. It was observed that soil bacterial communities were significantly related to several physical, chemical and biochemical soil properties, establishing two different co-occurrence patterns between restored and unrestored soils. A first bacterial co-occurrence pattern showed significant positive correlations to pH and C/N ratio and negativity with the rest of the soil properties. The second bacterial pattern was positively correlated with carbohydrates, µg of C, priming effect, BR, ß-glucosidase and phosphatase and negatively with pH and C/N ratio. It was concluded that soil bacterial communities are clearly influenced by the types of organic amendments applied. Bacterial taxa such as Taibaiella or Pseudomonas could perform key functions in the carbon cycle in restored soils.

Parental ancestry and risk of early pregnancy loss at high altitude.

High altitude pregnancy is associated with increased frequency of low birth weight infants and neonatal complications, the risks of which are higher in women of low-altitude ancestry. Does ancestry also influence the risk of miscarriage (pregnancy loss <20 weeks) in high-altitude pregnancy? To answer this, 5386 women from La Paz, Bolivia (3300-4150 m) with ≥1 live-born infant were identified. Data were extracted from medical records including maternal and paternal ancestry, demographic factors, and reproductive history. The risk of miscarriage by ancestry was assessed using multivariate logistic regression, adjusting for parity, and maternal age. Andean women experienced first live-births younger than Mestizo or European women (21.7 ± 4.6 vs 23.4 ± 8.0 vs 24.1 ± 5.1, P < .001). Andeans experienced more pregnancies per year of reproductive life (P < .001) and had significantly higher ratios of live-births to miscarriages than women of Mestizo or European ancestry (P < .001). Andean women were 24% less likely to have ever experienced a miscarriage compared to European women (OR:0.76; CI:0.62-0.90, P < .001). The woman's partner's ancestry wasn't a significant independent predictor of miscarriage. In conclusion, the risk of miscarriage at high altitude is lower in Andean women. The lack of a paternal ancestry effect suggests underlying mechanisms relate more to differential maternal adaptation in early pregnancy than fetal genetics.

Effect of biocrusts on bacterial community composition at different soil depths in Mediterranean semi-arid ecosystems.

This study analyzed the influence of biocrusts on the chemical properties and bacterial diversity and community composition in the underlying soils along a depth gradient (the biocrust (C1), middle (S2) and deep (S3) soil layers) in two semi-arid Mediterranean ecosystems. Organic carbon, pH, electric conductivity and calcium carbonate content were estimated by wet oxidation, potentiometrically (pHmeter), with a conductivity-meter and volumetrically with a Bernard calcimeter, respectively. Bacterial diversity and community composition were estimated by 16S rRNA gene high-throughput amplicon sequencing. Chemical properties in C1 were significantly different from the other soil layers, showing higher organic carbon content and lower pH (p < 0.05). The relative abundance of several bacterial taxa, such as Bryocella, Methylobacterium, Segitebacter and Actinomycetospora showed significant positive correlations with organic carbon (r = 0.53 to 0.75) and negative with pH (r = -0.72 to -0.84), and were also highly correlated with each other (p < 0.01), suggesting a bacterial co-occurrence pattern associated with the biocrust. On the contrary, other bacterial taxa, such as Euzebyaceae, Truepera, Alphaproteobacteria and Caldinilaceae, showed positive correlations with electrical conductivity and calcium carbonate and were also correlated with each other (p < 0.01), in a second type of co-occurrence pattern associated with bare soil. The C1 and S2 layers had several taxa in common, while S3 layers had taxa common to bare soil, suggesting that the effect of biocrusts was limited to the first centimeters of soil and progressively decreased in depth. Bacterial diversity was lower in C1 than in the underlying layers and increased progressively from biocrust to deeper soil layers. The results suggest that the diversity and composition of soil microbial communities in biologically crusted sites in Mediterranean semi-arid environments are mainly controlled by chemical properties which in turn are modified by the biocrust along a depth gradient.

Whole-body diffusion-weighted magnetic resonance imaging (WB-DW-MRI) vs choline-positron emission tomography-computed tomography (choline-PET/CT) for selecting treatments in recurrent prostate cancer

Objective. To determine the effectiveness of whole-body diffusion-weighted magnetic resonance imaging (WB-DW-MRI) in detecting metastases by comparing the results with those from choline-positron emission tomography-computed tomography (choline-PET/CT) in patients with biochemical relapse after primary treatment, and no metastases in bone scintigraphy, CT and/or pelvic MRI, or metastatic/oligometastatic prostate cancer (PCa). Patients with this disease profile who could benefit from treatment with stereotactic body radiation therapy (SBRT) were selected and their responses to these techniques were rated. Materials and methods. This was a prospective, controlled, unicentric study, involving 46 consecutive patients from our centre who presented biochemical relapse after adjuvant, salvage or radical treatment with external beam radiotherapy, or brachytherapy. After initial tests (bone scintigraphy, CT, pelvic MRI), 35 patients with oligometastases or without them were selected. 11 patients with multiple metastases were excluded from the study. WB-DW-MRI and choline-PET/CT was then performed on each patient within 1 week. The results were interpreted by specialists in nuclear medicine and MRI. If they were candidates for treatment with ablative SBRT (SABR), they were then evaluated every three months with both tests. Results. Choline-PET/CT detected lesions in 16 patients that were not observable using WB-DW-MRI. The results were consistent in seven patients and in three cases, a lesion was observed using WB-DW-MRI that was not detected with choline-PET/CT. The Kappa value obtained was 0.133 (p = 0.089); the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of WB-DW-MRI were estimated at 44.93, 64.29, 86.11, and 19.15%, respectively. For choline-PET/CT patients, the sensitivity, specificity, PPV, and NPV were 97.10, 58.33, 93.06, and 77.78%, respectively. Conclusions. Choline-PET/CT has a high global sensitivity while WB-DW-MRI has a high specificity, and so they are complementary techniques. Future studies with more enrolled patients and a longer follow-up period will be required to confirm these data. The initial data show that the best technique for evaluating response after SBRT is choline-PET/CT (AU)

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Whole-body diffusion-weighted magnetic resonance imaging (WB-DW-MRI) vs choline-positron emission tomography-computed tomography (choline-PET/CT) for selecting treatments in recurrent prostate cancer.

OBJECTIVE: To determine the effectiveness of whole-body diffusion-weighted magnetic resonance imaging (WB-DW-MRI) in detecting metastases by comparing the results with those from choline-positron emission tomography-computed tomography (choline-PET/CT) in patients with biochemical relapse after primary treatment, and no metastases in bone scintigraphy, CT and/or pelvic MRI, or metastatic/oligometastatic prostate cancer (PCa). Patients with this disease profile who could benefit from treatment with stereotactic body radiation therapy (SBRT) were selected and their responses to these techniques were rated. MATERIALS AND METHODS: This was a prospective, controlled, unicentric study, involving 46 consecutive patients from our centre who presented biochemical relapse after adjuvant, salvage or radical treatment with external beam radiotherapy, or brachytherapy. After initial tests (bone scintigraphy, CT, pelvic MRI), 35 patients with oligometastases or without them were selected. 11 patients with multiple metastases were excluded from the study. WB-DW-MRI and choline-PET/CT was then performed on each patient within 1 week. The results were interpreted by specialists in nuclear medicine and MRI. If they were candidates for treatment with ablative SBRT (SABR), they were then evaluated every three months with both tests. RESULTS: Choline-PET/CT detected lesions in 16 patients that were not observable using WB-DW-MRI. The results were consistent in seven patients and in three cases, a lesion was observed using WB-DW-MRI that was not detected with choline-PET/CT. The Kappa value obtained was 0.133 (p = 0.089); the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of WB-DW-MRI were estimated at 44.93, 64.29, 86.11, and 19.15%, respectively. For choline-PET/CT patients, the sensitivity, specificity, PPV, and NPV were 97.10, 58.33, 93.06, and 77.78%, respectively. CONCLUSIONS: Choline-PET/CT has a high global sensitivity while WB-DW-MRI has a high specificity, and so they are complementary techniques. Future studies with more enrolled patients and a longer follow-up period will be required to confirm these data. The initial data show that the best technique for evaluating response after SBRT is choline-PET/CT. Trial registration number NCT02858128.

A mass of less than 15 solar masses for the black hole in an ultraluminous X-ray source.

Most ultraluminous X-ray sources have a typical set of properties not seen in Galactic stellar-mass black holes. They have luminosities of more than 3 × 10(39) ergs per second, unusually soft X-ray components (with a typical temperature of less than about 0.3 kiloelectronvolts) and a characteristic downturn in their spectra above about 5 kiloelectronvolts. Such puzzling properties have been interpreted either as evidence of intermediate-mass black holes or as emission from stellar-mass black holes accreting above their Eddington limit, analogous to some Galactic black holes at peak luminosity. Recently, a very soft X-ray spectrum was observed in a rare and transient stellar-mass black hole. Here we report that the X-ray source P13 in the galaxy NGC 7793 is in a binary system with a period of about 64 days and exhibits all three canonical properties of ultraluminous sources. By modelling the strong optical and ultraviolet modulations arising from X-ray heating of the B9Ia donor star, we constrain the black hole mass to be less than 15 solar masses. Our results demonstrate that in P13, soft thermal emission and spectral curvature are indeed signatures of supercritical accretion. By analogy, ultraluminous X-ray sources with similar X-ray spectra and luminosities of up to a few times 10(40) ergs per second can be explained by supercritical accretion onto massive stellar-mass black holes.

Super-Eddington mechanical power of an accreting black hole in M83.

Mass accretion onto black holes releases energy in the form of radiation and outflows. Although the radiative flux cannot substantially exceed the Eddington limit, at which the outgoing radiation pressure impedes the inflow of matter, it remains unclear whether the kinetic energy flux is bounded by this same limit. Here, we present the detection of a radio-optical structure, powered by outflows from a non-nuclear black hole. Its accretion disk properties indicate that this black hole is less than 100 solar masses. The optical-infrared line emission implies an average kinetic power of 3 × 10(40) erg second(-1), higher than the Eddington luminosity of the black hole. These results demonstrate kinetic power exceeding the Eddington limit over a sustained period, which implies greater ability to influence the evolution of the black hole's environment.

[Hypoglycemia]. / Hipoglucemia.

Hypoglycemia is the acute complications occur more often, people with diabetes mellitus, especially those treated with insulin and/or certain oral hypoglycemic agents. Studies such as The Diabetes Control and Complications Trial (DCCT) in type 1 diabetes mellitus or the United Kingdom Prospective Diabetes Study (UKPDS) in type 2 have shown that improvement in metabolic control, expressed in the reduction of HbA1c (glycated hemoglobin) decreases the risk of chronic complications associated with diabetes. However this reduction is associated with an increased incidence of hypoglycemia, especially in people with aggressive therapy Although in recent years the treatment of diabetes with new drugs (like insulin, new oral agents), it remains difficult to reproduce the endogenous insulin secretion and fear of patients have episodes of hypoglycemia is the strongest difficulty in optimizing the treatment of diabetes, and that adversely affects their quality of life.

Hipoglucemia / Hypoglycemia

La hipoglucemia constituye la complicación aguda que presentan con más frecuencia las personas con diabetes mellitus, especialmente las tratadas con insulina y/o con algunos hipoglucemiantes orales. Estudios como el The Diabetes Control and Complications Trial (DCCT) en diabetes mellitus tipo 1 o el United Kingdom Prospective Diabetes Study (UKPDS) en tipo 2 han demostrado que la mejoría en el control metabólico, expresada en la reducción de la HbA1c (hemoglobina glicosilada), disminuye el riesgo de complicaciones crónicas asociadas. Sin embargo, esta reducción se relaciona con una mayor incidencia de episodios de hipoglucemia, principalmente en personas con tratamiento intensivo. A pesar de que en los últimos años el tratamiento de la diabetes cuenta con nuevos fármacos (análogos de insulina, nuevos antidiabéticos orales), sigue siendo difícil reproducir la secreción endógena de insulina y el temor de los pacientes a presentar episodios de hipoglucemia supone la mayor dificultad en la optimización del tratamiento de la diabetes, ya que afecta negativamente a su calidad de vida(AU)

Hypoglycemia is the acute complications occur more often, people with diabetes mellitus, especially those treated with insulin and / or certain oral hypoglycemic agents. Studies such as The Diabetes Control and Complications Trial (DCCT) in type 1 diabetes mellitus or the United Kingdom Prospective Diabetes Study (UKPDS) in type 2 have shown that improvement in metabolic control, expressed in the reduction of HbA1c (glycated hemoglobin) decreases the risk of chronic complications associated with diabetes. However, this reduction is associated with an increased incidence of hypoglycemia, especially in people with aggressive therapy. Although in recent years the treatment of diabetes with new drugs (like insulin, new oral agents), it remains difficult to reproduce the endogenous insulin secretion and fear of patients have episodes of hypoglycemia is the strongest difficulty in optimizing the treatment of diabetes, and that adversely affects their quality of life(AU)

Neumonía de la comunidad por Acinetobacter baumannii / Community-acquired Acinetobacter baumannii pneumonia

Fundamento. Describir dos casos de neumonía adquirida en la comunidad por Acinetobacter baumannii. Pacientes y métodos. Se trata de dos pacientes, uno con antecedentes de diabetes mellitus tipo 2 y tromboembolismo pulmonar dos años antes, y el segundo sin factores de riesgo conocidos salvo la edad, ingresados por neumonía adquirida en la comunidad por A. baumannii, que desarrollaron cavitación, con evolución final favorable. Conclusión. El A. baumannii es una causa infrecuente de neumonía de la comunidad, aunque debe ser tomado en consideración en pacientes con situaciones de base debilitantes y que no evolucionan de forma favorable en los primeros días del ingreso con tratamiento convencional (AU)

[Community-acquired Acinetobacter baumannii pneumonia]. / Neumonía de la comunidad por Acinetobacter baumannii.

OBJECTIVES: Description of two cases of community-acquired Acinetobacter baumannii pneumonia. PATIENTS AND METHODS: Two patients, one with a history of diabetes mellitus type 2 and pulmonary thromboembolism 2 years earlier and the second without known risk factors except for the age, were admitted to hospital because of community-acquired A. baumannii pneumonia with cavitation and with favorable final evolution. CONCLUSION: A. baumannii is an infrequent cause of community-acquired pneumonia, although it should be suspected in patients with debilitating illness and in patients who do not evolve favorably on the first days of the admission with conventional treatment.

[Nosocomial infection/colonization of the respiratory tract caused by Acinetobacter baumannii in an Internal Medicine ward]. / Infección/colonización nosocomial de las vías respiratorias por Acinetobacter baumannii en una planta de Medicina Interna.

BACKGROUND: To present the epidemiology of the outbreak and the description of patients with infection or colonization of the respiratory tract caused by A. baumannii in an Internal Medicine ward. METHODS: 20 consecutively patients hospitalized in the Internal Medicine ward were studied during 18 months with isolation of multiresistant A. baumanni in respiratory tract specimens with or without clinical signs of infection. RESULTS: Starting on an index case, that was a patient coming from other hospital with diagnosis of nosocomial Acinetobacter pneumonia, we detected 20 patients. The age of the patients ranged from 48 to 95 years, with a mean of 71.4 years. Eighty percent were males. The clinical features were similar: advanced age, with chronic diseases (35 percent diabetics, 45 percent with chronic lung diseases), and use of broad-spectrum antibiotics agents, fundamentally third generation cephalosporin (70 percent), clarithromycin (55 percent) and quinolones (30 percent). 75 percent of patients were in the same ward. Eight (40 percent) of the patients with chronic lung diseases were subjects with COPD, two with asthma and chronic glucocorticoids treatment, and one with a sleep apnea. In four cases the isolation was considered a colonization. The mean stay was 26.15 days, and the mortality 40 percent. CONCLUSIONS: The nosocomial infection caused by Acinetobacter baumannii is responsible of a high morbi-mortality between the patients hospitalized in an Internal Medicine ward, and produce an increase in length of stay. It is necessary a combination of control measures to prevent the transmission in the hospital and the outbreak of new multiresistant strains.

Absceso submentoniano por lactobacillus acidophilus/jensenii / Submental abscess by lactobacillus acidophilus/jensenii

Las diferentes especies del género Lactobacillus constituyen unas bacterias de bajo poder patógeno que se encuentran sobre todo en el tracto gastrointestinal, en el aparato genital femenino, y también formando parte de la flora anaerobia de la cavidad bucal. Debido a este bajo poder patógeno suelen estar implicadas en infecciones junto a otros microorganismos más virulentos, o en enfermos inmunocomprometidos. En este caso, Lactobacillus aparece de forma solitaria como agente productor de un absceso submentoniano en un paciente inmunocompetente (AU)

The different species of Lactobacillus genus are bacteria of a low pathogenicity. They are found in the gastrointestinal tract, the female genitourinary tract, and also as part of the anaerobic flora in the mouth. Due to this low pathogenicity, they are generally related with infections together with other with more virulent microorganisms, or in immunocompromised patients. In our case, Lactobacillus appears alone as an etiological agent in an immunocompetent patient with a submental abscess (AU)

Infección/colonización nosocomial de las vías respiratorias por Acinetobacter baumannii en una planta de Medicina Interna / Nosocomial Infection/Colonization of the respiratory tract caused by Acinetobacter baumannii in an Internal Medicine Ward

Fundamento: Presentar la epidemiología del brote y la descripción de los pacientes con infección o colonización de las vías respiratorias por Acinetobacter baumannii en el área de hospitalización de Medicina Interna. Métodos: Estudio de 20 pacientes consecutivos ingresados en la planta de hospitalización de Medicina Interna durante 18 meses, en los que se aisló en esputo A. baumannii multirresistente, acompañado o no de signos clínicos de infección. Resultados: A raíz de un caso índice, que fue un paciente trasladado de otro centro hospitalario con el diagnóstico de neumonía nosocomial por A. baumannii, se han detectado 20 pacientes, cuya edad media es de 71.4 años (48-95). El perfil de los pacientes fue similar: edad avanzada, con patología crónica de base (35% diabéticos, 45% con enfermedad respiratoria crónica), con ingresos previos en Medicina Interna (35%), y con antecedente de consumo en el mes previo de antibióticos, fundamentalmente cefalosporinas de tercera generación (70% de los casos), claritromicina (55%) y quinolonas (30%). El 75% de los casos aconteció en el mismo área de hospitalización. De los pacientes con enfermedad pulmonar crónica, 8 (40%) cumplían criterios de EPOC, 2 eran asmáticos corticodependientes y 1 paciente estaba diagnosticado de SAOS. En 4 casos el aislamiento se consideró colonización. La estancia media fue de 26.15 días, con un porcentaje de exitus del 40%. Conclusiones: La infección nosocomial por Acinetobacter baumannii es responsable de una elevada morbimortalidad entre los pacientes ingresados en la planta de Medicina Interna. Es fundamental la adopción de medidas para el control de su transmisión intrahospitalaria y evitar la aparición de nuevas cepas multirresistentes (AU)

Background: To present the epidemiology of the outbreak and the description of patients with infection or colonization of the respiratory tract caused by A. baumannii in an Internal Medicine ward. Methods: 20 consecutively patients hospitalized in the Internal Medicine ward were studied during 18 months with isolation of multiresistant A. baumanni in respiratory tract specimens with or without clinical signs of infection. Results: starting on an index case, that was a patient coming from other hospital with diagnosis of nosocomial Acinetobacter pneumonia, we detected 20 patients. The age of the patients ranged from 48 to 95 years, with a mean of 71.4 years. Eighty percent were males. The clinical features were similar: advanced age, with chronic diseases (35 percent diabetics, 45 percent with chronic lung diseases), and use of broad-spectrum antibiotics agents, fundamentally third generation cephalosporin (70 percent), clarithromycin (55 percent) and quinolones (30 percent). 75 percent of patients were in the same ward. Eight (40 percent) of the patients with chronic lung diseases were subjects with COPD, two with asthma and chronic glucocorticoids treatment, and one with a sleep apnea. In four cases the isolation was considered a colonization. The mean stay was 26.15 days, and the mortality 40 percent. Conclusions: The nosocomial infection caused by Acinetobacter baumannii is responsible of a high morbi-mortality between the patients hospitalized in an Internal Medicine ward, and produce an increase in length of stay. It is necessary a combination of control measures to prevent the transmission in the hospital and the outbreak of new multiresistant strains (AU)

[Submental abscess by Lactobacillus acidophilus/jensenii]. / Absceso submentoniano por Lactobacillus acidophilus/jensenii.

The different species of Lactobacillus genus are bacteria of a low pathogenicity. They are found in the gastrointestinal tract, the female genitourinary tract, and also as part of the anaerobic flora in the mouth. Due to this low pathogenicity, they are generally related with infections together with other with more virulent microorganisms, or in immunocompromised patients. In our case, Lactobacillus appears alone as an etiological agent in an immunocompetent patient with a submental abscess.