Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Spain: a multicentre prevalence study (2002).

A point-prevalence study, performed in 2002 in 143 Spanish hospitals, collected 439 isolates of Staphylococcus aureus. Of these, 134 (30.5%) were resistant to methicillin (i.e., MRSA). Susceptibility testing was performed by a microdilution method, and mecA was detected by PCR. The isolates were characterised by phage typing, pulsed-field gel electrophoresis (PFGE) after SmaI digestion, and SCCmec typing. The 134 MRSA isolates showed resistance to ciprofloxacin (93.3%), tobramycin (88.8%), erythromycin (67.9%), clindamycin (59.7%), gentamicin (42.5%), mupirocin (17.9%), rifampicin (5.2%) and trimethoprim-sulphamethoxazole (5.2%). All of the isolates were susceptible to glycopeptides. Twenty-five resistance patterns were found, of which four accounted for 66% of the isolates. Phage group III was the most frequent (41.1%). PFGE revealed 31 different patterns, with ten major clones (including two predominant clones with variable antibiotypes that accounted for 43.3% of the MRSA isolates) and 21 sporadic patterns. Two isolates belonged to two variants of the Iberian clone (ST247-MRSA-I), one to the Brazilian clone (ST239-MRSA-III), and seven to the EMRSA-16 clone (ST36-MRSA-II). SCCmecIV accounted for 70.2% of the isolates (73.9% were type IVA), while SCCmecI, SCCmecII and SCCmecIII accounted for 22.1%, 6.9% and 0.8% of isolates, respectively, with three non-typeable isolates. Isolates of SCCmecIV and SCCmecIVA were predominantly nosocomial (95.8% and 97.1%, respectively). None of the isolates produced Panton-Valentine leukocidin. Thus, two clones carrying SCCmecIV and SCCmecIVA, respectively, were predominant among nosocomial MRSA isolates throughout Spain.

Prevalence and evolution of methicillin-resistant Staphylococcus aureus in Spanish hospitals between 1996 and 2002.

Pulsed-field gel electrophoretic analysis of 2,144 methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from patients in Spanish hospitals over a 7-year period revealed 17 predominant profiles. Typing showed the replacement of Iberian clone E1 (ST247-MRSA-I) by two prevalent clones, E7 and E8, that are closely related to each other and have the same genetic background as ST125-MRSA-IV.

Child-onset growth hormone deficiency in adulthood. Transfer of patients from pediatric to adult endocrinology units.

Treatment with growth hormone (GH) in adult-onset GH deficiency (AO-GHD) reverses its many metabolic alterations, modifying body composition, bone mass, several cardiovascular risk factors, and improving quality of life. In adult patients with a previous diagnosis of child-onset GH deficiency (CO-GHD), the lack of treatment also produces similar alterations, reversed by GH treatment. In patients with multiple pituitary hormone deficiency, the lack of GH is considered definitive, but in isolated GHD, the need for re-evaluation of the deficit is mandatory. The 'gold standard' test is insulin-induced hypoglycemia, after a wash-out period, and the criterion for GH therapy should be a GH (polyclonal-RIA assay) response less than 3 ng/ml. The initial recommended GH dose is lover than in children, and the dosage must be adjusted to maintain IGF-I levels in the normal range. We propose that decisions about patient recruitment, assessment, confirmation or reevaluation, information about new perspectives, disadvantages and benefits of GH therapy, and the beginning of treatment should be made in cooperation by pediatric and adult endocrinologists, so the patient receives all information from both medical teams, before being transferred to the adult endocrinology department.

Deficiencia de GH, de origen infantil, en la edad adulta (COGHD). Transferencia de los pacientes desde endocrinología pediátrica a endocrinología de adultos / No disponible

No disponible

New large solar photocatalytic plant: set-up and preliminary results.

A European industrial consortium called SOLARDETOX has been created as the result of an EC-DGXII BRITE-EURAM-III-financed project on solar photocatalytic detoxification of water. The project objective was to develop a simple, efficient and commercially competitive water-treatment technology, based on compound parabolic collectors (CPCs) solar collectors and TiO2 photocatalysis, to make possible easy design and installation. The design, set-up and preliminary results of the main project deliverable, the first European industrial solar detoxification treatment plant, is presented. This plant has been designed for the batch treatment of 2 m3 of water with a 100 m2 collector-aperture area and aqueous aerated suspensions of polycrystalline TiO2 irradiated by sunlight. Fully automatic control reduces operation and maintenance manpower. Plant behaviour has been compared (using dichloroacetic acid and cyanide at 50 mg l(-1) initial concentration as model compounds) with the small CPC pilot plants installed at the Plataforma Solar de Almería several years ago. The first results with high-content cyanide (1 g l(-1)) waste water are presented and plant treatment capacity is calculated.

[Prevalence of the 185Ag deletion of the BRCA1 gene in Chilean women with breast neoplasm]. / Prevalencia de la deleción 185AG del gen BRCA1 en mujeres chilenas con cáncer de mama.

BACKGROUND: The most important identified pathogenic factor for breast cancer is the presence of mutations in BRCA1 gene. These are associated with familial breast cancer in up to 80% of cases. The most frequent mutation of BRCA1 gene in Caucasian populations is the exon 2 185AG deletion. AIM: To study the presence of 185AG deletion in Chilean women with sporadic or familial breast cancer. PATIENTS AND METHODS: We studied 15 women with familial breast cancer, in whom at least one close relative was affected, and 40 women with sporadic breast cancer. In genomic DNA obtained from a blood sample, an allele specific polymerase chain reaction was done. This reaction allows the identification of 185AG deletion and uses two pairs of primers. One for the native form that renders a 118 base pairs product and one for the deletion that renders a 170 base pairs product, both with a respective 280 base pairs internal control. RESULTS: The diagnosis of breast cancer was done at 40 +/- 5 and 65 +/- 10 years old in women with familial and sporadic breast cancer, respectively. In none of the samples, the amplification of the 170 base pairs band that corresponds to 185AG deletion, was obtained. In both groups, the product of the amplification was the 118 base pairs band, that corresponds to the native form of BRCA1 gene. The polymerase chain reaction was optimized for a duration of 90 minutes. CONCLUSIONS: 185AG deletion of BRCA1 gene was not detected in this group of Chilean women with sporadic or familial breast cancer.

[The prevalence of methicillin-resistant Staphylococcus aureus phagotype 95 in the Hospitales Vall d'Hebron of Barcelona]. / Prevalencia de Staphylococcus aureus resistentes a meticilina fagotipo 95 en los Hospitales Vall d'Hebron de Barcelona.

BACKGROUND: In our hospital endemic methicillin resistant Staphylococcus aureus (MRSA) has been documented since 1971, with epidemic and interepidemic periods. During these years phage groups I, I-III, and non-typable were found by the international set of phages Phage group 95 (F95) was unusual between 1986 (when phage typing was first available) and 1991, with prevalence of 5.2% (mean), and 100% of sensibility to methicillin. In November 1991 appeared the first MRSA F95 strain, and its prevalence has been increasing until 1997. MATERIAL AND METHODS: We have studied 133 strains of MRSA F95 isolated from 87 patients, 39 of them hospitalized in the General Hospital (HG), 38 in Traumatology Hospital (HT) and 8 in the Children's Hospital (HI). Two of these patients had successive stancies in HG and HT. Antimicrobial susceptibility was determined by the disk diffusion method and microdilution to check oxacillin resistance. Moreover these method we have maked: detection of mecA, phage typing with the international set of phages and study of the PGFE patterns by digestion of chromosomic DNA with Smal. RESULTS: The percentage of methicillin resistance in F95 strains was increased since the appear of the first strain between 8.3% in 1991 to a maximum of 76.9% in 1995, we had a descens to 13.7% in 1996 but 1997 can back to augment it to 72.5%. MICs for oxacillin of these strains were low (< or = 64 mg/l to 87.4% of strains), and all of them were mecA positive, 78.1% of them were resistant to macrolides, 96.5% to tobramycin and 84.9% to quinolones, but only 10.5% to gentamicin, 4.7% were resistant to cotrimoxazol, 1.2% to fosfomycin and 2.5% to rifampin. All of them were sensible to doxycycline, and vancomycin. The pulse field gel electrophoresis showed 7 restriction patterns in MRSA F95, 73.8% of strains correspond to one of them (B), spreading from the spinal cord injury unit and prevalent in HT; and 10.8% to another (C), the first that appear, spreading from the neurosurgical unit and with high prevalence in HG. 6.9% has pattern J a B subtype that appear in broth HG and HT. Pattern E is prevalent in HI it was spread from neonatology unit. CONCLUSIONS: The emergence in a Center with endemic resistance of new strains of MRSA, not all of them of the same clone, with characteristic resistance pattern to antibiotics and in convivence with other phage groups is one demonstration of genetic variability of SAMR in our entorn.

[Diffuse sclerosing papillary thyroid carcinoma. Report of two cases]. / Carcinoma papilar esclerosante difuso del tiroides. Comunicación de dos casos.

Unlike classical papillary carcinoma, diffuse sclerosing papillary thyroid carcinoma presents as a diffuse goiter with a discretely irregular surface, associated to hypo or hyperthyroidism, specially in young women. We report two women aged 41 and 23 years old with this disease, one with normal thyroid function and the other with hyperthyroidism. It is concluded that diffuse sclerosing papillary thyroid carcinoma must be suspected in patients with rapidly growing goiter with irregular surface or diffuse minute calcifications, specially in the presence of hypo or hyperthyroidism. Fine needle aspiration is a good diagnostic procedure.

[Functioning and non-functioning parathyroid cysts: entities with different origin and clinical characteristics in 2 cases]. / Quistes paratiroideos funcionantes y no funcionantes: entidades con origen y clínica diferente en dos casos.

We report two women presenting with parathyroid cysts. A 20 years old woman presented with goiter and a cystic lesion in the left thyroid lobe was identified on ultrasound examination and CAT scan. The patient had hypercalcemia and elevated PTH levels. The content of the cyst, obtained by needle aspiration, had an extremely high PTH concentration. The patient was operated, removing the cyst and a remaining thymus. Pathological study confirmed the diagnosis of a parathyroid cyst. An 11 years old girl presented with a mass in the left thyroid lobe. An ultrasound examination disclosed the presence of a cystic nodule. The patient was otherwise asymptomatic and laboratory work up was normal. The patient was operated and pathological examination of the surgical piece revealed a parathyroid cyst.

[Thyroid neoplasm of mid follicular-medullary type; an uncommon, particular and aggressive form: report of 3 cases]. / Cáncer tiroídeo tipo intermedio folicular-medular; una forma inhabitual, particular y agresiva. Comunicación de tres casos.

Mixed medullary and follicular carcinoma of the thyroid shares secretory and immunohistochemical features of both follicular and parafollicular thyroidal cells. We report three women, aged 34, 63 and 61 old with this type of tumor. Its diagnosis must be bore in mind in patients with thyroidal tumors and a histological appearance of a medullary or undifferentiated carcinoma. An early diagnosis of a mixed medullary and follicular carcinoma of the thyroid is important, considering its special treatment and negative prognosis.

Adrenal failure due to metastasis both to the hypothalamic-pituitary area and the adrenals.

A 61-year-old white male was admitted to our hospital with a big-cell bronchogenic carcinoma whose first clinical manifestation was diabetes insipidus (DI) secondary to metastasis to the hypothalamic-pituitary area (MHP). In three months, and progressively, he developed anterior pituitary failure, as well as primary adrenal insufficiency (PAI) due to metastasis in both adrenals. Panhypopituitarism or PAI due to both MHP and adrenals has been rarely reported in the literature. A thorough examination of the oncologic patient led us to diagnose hormone insufficiency properly. The absence of reported cases might be due to the fact that the symptoms resulting from hormone insufficiency are veiled by the severe condition of the patients suffering from disseminated cancer.

An additional set of phages to characterize epidemic methicillin-resistant Staphylococcus aureus strains from Spain (1989-92).

In recent years, methicillin-resistant Staphylococcus aureus (MRSA) isolates in Spain have increased dramatically; in 1986 there were only 1.2% MRSA amongst all nosocomial Staphylococcus aureus (SA) isolates, by 1989 this percentage had risen to 44% in some hospital causing a very serious epidemic situation in the country. We have characterized these isolates by direct, reverse and Fisk phage typing and we have also looked for an additional local set of phages to help us to differentiate these strains. We have been able to differentiate an epidemic strain from other MRSA strains which cause sporadic hospital outbreaks, and we have also distinguished between some variants of the epidemic strain.

Hospital infections in Spain. I. Staphylococcus aureus (1978-91).

This study was undertaken to determine the distribution of phage types of Staphylococcus aureus isolates from hospital outbreaks or sporadic cases received in our laboratory during the past 14 years. The records for 15,803 isolates from 55 Spanish hospitals have been analysed. In relation to sporadic isolates we have been able to detect the predominance of phage group I and non-typable staphylococcal strains. Since 1989, we have observed a considerable increase in hospital infection caused by methicillin-resistant S. aureus strains which we could differentiate in to two groups; one belonging to phage group III (6/47/54/75/77/84/85) and other groups of nontypable strains which could be classified as phage group I-III after heat treatment (29/77/84) and with similar patterns by reverse typing (6/47/53/54/75/83A/84/85/W57/1030/18042). During 1990 and 1991, these strains have extended widely to at least six different autonomous regions creating an epidemic situation in Spain.

[Prevalence of serotype 0:12 among strains of P. aeruginosa causing nosocomial infection in Spain (1980-1991)]. / Prevalencia del serotipo 0:12 de cepas de P. aeruginosa productoras de infección nosocomial en España (1980-1991).

BACKGROUND: The aim of the present study was to characterize P. aeruginosa strains causing nosocomial infection in Spain between 1980-1990 with special emphasis on the incidence of serotype 0:12 strains. METHODS: 11,411 strains of P. aeruginosa from hospital-acquired infections were studied and epidemiologically characterized by phage-typing, serotyping and sensitivity to antimicrobial agents. The strains of the 0:12 serotype were analyzed by isoenzyme analysis. RESULTS: Although the major serotypes throughout the period studied were: 0:1, 0:6 and 0:11, the existence of serotype 0:12 strains (6%) were detected which had produced nosocomial outbreaks in surrounding countries. This serotype is homogeneous in that the epidemiologic markers and patterns of sensitivity to antibiotics and the multienzyme analysis demonstrate uniformity in the electrophoretic patterns of all the strains studied. CONCLUSIONS: The 0:12 serotype is in Spain indistinguishable by phage typing and studies of antibiotic sensitivity. It may be considered as being of clonal origin and is probably equal to that existing elsewhere in Europe.

[Spontaneous expression of class II (HLA-DR) molecules in thyroid pathology]. / Expresión espontánea de moléculas de clase II (HLA-DR) en patología tiroidea.

The spontaneous expression of Class II molecules (HLA-DR) was studied in cultured thyrocytes obtained from patients with Graves Disease (n = 7), Hashimoto's Thyroiditis (n = 5), euthyroid nodular goiter, (n = 12), papillary carcinoma (n = 5), and laryngeal carcinoma (3 normal thyroid glands). If nodular goiters and papillary carcinoma are of autoimmune origin, as Graves Disease and Hashimoto's Thyroiditis, they should spontaneously express HLA-DR antigen on their cell surface as this has been considered one of the initial steps of autoimmunity. The study was performed using the cytotoxicity assay. Immediately after the thyroid glands were obtained, thyrocytes were labelled with 51-Cr and incubated overnight; the cells were destroyed by adding monoclonal antiHLA-DR antibody and rabbit complement. The cytotoxicity index (CI% + SD) which reflects 51-Cr release from lyzed cells was used to measure antigen expression. While Graves Disease's and Hashimoto's Disease's thyrocytes expressed HLA-DR in high proportion, normal thyrocytes and thyroid cells from other diseases did so in minimal proportion (28.12 +/- 10.71 vs 2.26 +/- 2.32, p < 0.001). These findings strongly suggest that nodular goiters and papillary carcinoma are not of autoimmune origin since they are unable to express HLA-DR on their cell surface. It is postulated that HLA-DR expression is the result of the influence of T lymphocytes previously sensitized to thyroid antigens.