Risk factors and clinical impact of multidrug resistance in healthcare-associated bacteraemic urinary tract infections: a post-hoc analysis of a multicentre prospective cohort in Spain.

BACKGROUND: The global burden associated with antimicrobial resistance is of increasing concern. AIM: To evaluate risk factors associated with multidrug-resistant (MDR) infection and its clinical impact in a cohort of patients with healthcare-associated bacteraemic urinary tract infections (BUTIs). METHODS: This was a prospective, multicentre, post-hoc analysis of patients with healthcare-associated-BUTI (ITUBRAS-2). The primary outcome was MDR profile. Secondary outcomes were clinical response (at 48-72 h and at hospital discharge) and length of hospital stay from onset of BUTI. Logistic regression was used to evaluate variables associated with MDR profile and clinical response. Length of hospital stay was evaluated using multivariate median regression. FINDINGS: In all, 443 episodes were included, of which 271 (61.17%) were classified as expressing an MDR profile. In univariate analysis, MDR profile was associated with E. coli episodes (odds ratio (OR): 3.13; 95% confidence interval (CI): 2.11-4.69, P < 0.001) and the extensively drug-resistant (XDR) pattern with P. aeruginosa aetiology (7.84; 2.37-25.95; P = 0.001). MDR was independently associated with prior use of fluoroquinolones (adjusted OR: 2.43; 95% CI: 1.25-4.69), cephalosporins (2.14; 1.35-3.41), and imipenem or meropenem (2.08; 1.03-4.20) but not with prior ertapenem. In terms of outcomes, MDR profile was not associated with lower frequency of clinical cure, but was associated with longer hospital stay. CONCLUSION: MDR profile was independently associated with prior use of fluoroquinolones, cephalosporins, imipenem, and meropenem, but not with prior ertapenem. MDR-BUTI episodes were not associated with worse clinical cure, although they were independently associated with longer duration of hospital stay.

Ceftolozane/tazobactam in the treatment of osteomyelitis and skin and soft-tissue infections due to extensively drug-resistant Pseudomonas aeruginosa: clinical and microbiological outcomes.

Infections due to multidrug-resistant bacteria (MDR) are currently a clinical challenge, mainly in elderly patients. The antimicrobial spectrum, safety and efficacy of ceftolozane/tazobactam (C/T) make it an attractive option for the treatment of MDR bacterial infections beyond the indications approved to date. Here we report our experience with C/T in four cases of osteomyelitis and three cases of skin and soft-tissue infections due to extensively-drug-resistant Pseudomonas aeruginosa.

Bacillus species pseudo-outbreak: construction works and collateral damage.

We describe the investigation and management of a pseudo-outbreak of Bacillus spp. bacteraemia associated with construction work in an emergency department (ED). During the pseudo-outbreak period 59 out of 3469 (1.7%) blood cultures yielded Bacillus spp. versus 24 out of 7628 (0.31%) in 2012. Material, surfaces, and air samples showed environmental contamination. Cases rapidly declined following the implementation of infection control measures and the end of construction. Construction works at the ED caused environmental contamination that most probably led to the pseudo-outbreak of Bacillus bacteraemia. In hospital settings, the lack of correctly implemented effective barriers during construction may place patients and healthcare providers at risk as well as lead to pseudo-outbreaks.

Switching to sirolimus in renal transplant recipients with hepatitis C virus: a safe option.

INTRODUCTION: The presence of hepatitis C virus (HCV) in renal transplant recipients is an independent risk factor for death and graft failure. Chronic allograft nephropathy (CAN) favored by the use of calcineurin inhibitors (CNI) is one of the main causes of graft loss, whereas sirolimus (SRL) has proven to maintain better graft function with lower rates of CAN. OBJECTIVES AND METHODS: We developed a protocol to evaluate the safety of SRL in transplant recipients with respect to HCV. We studied 5 patients (3 men) of mean age 52 +/- 9.2 years with HCV who had not received antiviral treatment. The viral genotypes were 1b in 4 cases and 2a/2c in 1 case. Basic immunosuppression was mycophenolate mofetil (MMF) and corticosteroids in all patients, cyclosporine (CsA) in 4 cases, and tacrolimus (Tac) in 1 case. Before the switch, a renal biopsy was performed and viral replication and cryoglobulins determined. RESULTS: Biopsy provided a diagnosis of CAN in 1 case, CNI toxicity-associated CAN in 2 cases, CNI toxicity in 1 case, and no renal damage in the remaining case. We observed a nonsignificant decrease in the number (log) of viral copies with a stabilization of renal function but with a slight to moderate increase in proteinuria. CONCLUSIONS: The switch seemed to be safe with no increase in viral copies. Graft renal function remained stable with increased proteinuria that must be supervised, even though it did not reach statistical significance.

Nocturnal ultrafiltration profiles in patients on APD: impact on fluid and solute transport.

In order to prevent morbidity and mortality in peritoneal dialysis (PD), sodium and water balance as well as a minimal level of small-solute clearances are needed. The impact of three nocturnal peritoneal ultrafiltration (UF) profiles on UF and small solute clearance in patients on automated PD (APD) was studied: constant glucose concentration of 1.36% (flat) or modifying the glucose concentration of the heater bag (descendant: 3.86-1.36%; ascendant: 1.36-3.86%). Sixty-two patients were enrolled in the study and received each profile within a four-month period, thus serving as their own controls. UF was lower with the flat profile (367+/-420ml; P<0.01), but no difference was seen between the two higher glucose concentration profiles. Peritoneal Kt/V (pKt/V) and peritoneal creatinine clearance (CrpC) showed statistically higher values from the descendant vs ascendant vs flat profiles (pKt/V: 1.54+/-0.30 vs 1.45+/-0.30 vs 1.38+/-0.27, and CrpC: 36.9+/-7.9 vs 33.5+/-7.48 vs 29.92+/-7.5 mlmin(-1)). Multivariate analysis showed statistical significance for the following: in the intrasubject comparisons, the profile for pKt/V (F=9.109, P<0.001) and CrpC (F=11.697, P<0.001), and in the intersubjects comparisons, the effects of both gender (F=14.334, P<0.01) for pKt/V and peritoneal permeability for both parameters (pKt/V: F=4.37, P<0.05; CrpC: F=11.697, P<0.001). In conclusion, the application of ascendant and descendant UF profiles in automated PD is feasible and results in better UF and small solute clearances, thus preventing inadequate dialysis and volume overload..

Diagnóstico molecular de la poliquistosis renal autosómica dominante en la Comunidad Autónoma de Canarias / Molecular diagnosis of adult dominant polycystic kidney disease in the Canary Islands

La poliquistosis renal autosómica dominante es una enfermedad hereditaria responsable del 6% de los casos de insuficiencia renal terminal en España. En la década de los 90 se identificaron los dos únicos genes relacionados con la enfermedad hasta el momento, en los cromosomas 16 y 4 (PKD1 y PKD2). El diagnóstico de esta enfermedad de desarrollo dependiente de la edad puede realizarse fácilmente mediante ecografía, pero el diagnóstico molecular mediante el análisis de ligamiento ofrece la ventaja de la detección precoz de individuos asintomáticos portadores del defecto genético, con vistas al seguimiento preventivo de estos individuos y al consejo genético. En este trabajo presentamos los resultados del análisis molecular de 30 familias con poliquistosis renal de la provincia de Las Palmas, realizado mediante análisis de ligamiento con dos series de marcadores polimórficos localizados en las inmediaciones de los genes PKD1 (D16S521, KG8, AC2.5, CW2, SM7) y PKD2 (D4S1538, D4S1534, D4S423, D4S414). Los objetivos del trabajo fueron: primero, comprobar el grado de informatividad y, por tanto, la utilidad de estos microsatélites para los estudios familiares de la PQRAD en nuestra población; y segundo, determinar la sensibilidad y especificidad del análisis genético en nuestra población. La mayoría de los marcadores mostró una alta heterocigosidad, comparable a la de otros estudios. Considerar los alelos de los distintos marcadores presentes en un mismo cromosoma conjuntamente, como un haplotipo, aumentó la informatividad de los marcadores y permitió la identificación inequívoca de los datos genéticos en el 97,7% de los pacientes y en el 88,7% de los individuos sanos. La sensibilidad y especificidad del análisis genético fueron del 90,7% (IC 95%: 85,7-95,7) y 86,8% (IC 95%: 80,6-93,0), respectivamente

Adult dominant polycystic kidney disease is an hereditary condition responsible for 6% of end-stage renal failure in Spain. Two genes were located in chromosomes 16 and 4 as related to this age-dependent disease in the 90s (PKD1 and PKD2). The diagnosis can be easily achieved by sonographic study, but molecular analysis by means of linkage analysis has the advantage of an early diagnosis in asymptomatic genetic carriers, with a view to the preventive follow-up of these subjects and genetic counselling. In this paper we present the results of molecular analysis of 30 families with Adult Dominant Polycystic Kidney Disease (from the province of Las Palmas Spain), carried out linkage analysis with two series of microsatellite markers located within or in the vicinity of PKD1 (D16S521, KG8, AC2.5, CW2, SM7) and PKD2 (D4S1538, D4S1534, D4S423, D4S414) genes. The objectives of the study were: first, to verify the informativeness, and therefore, the usefulness of these markers for family studies in our population; and second, to assess the sensitivity and specificity of the genetic analysis in our population. Most of the markers showed a high heterozigosity, comparable to data in other studies. Considering the alleles of the different markers together in a chromosome as an haplotype increased the informativeness of the markers, and allowed the unequivocal identification of genetic data in 97.7% of patients and 88.7% of healthy subjects. The sensitivity and specificity of the genetic analysis were 90.7% (CI 95%: 85.7-95.7) and 86.8% (CI 95%: 80.6- 93.0), respectively

Steroids and bone density in patients with functioning kidney allografts.

INTRODUCTION: Osteopenia and osteoporosis after renal transplantation have been associated with factors related to the cause of end-stage renal disease, as well as to clinical events and therapeutic factors in the posttransplant period. We studied the prevalence of low bone density (LBD) according to WHO criteria. METHODS: A cross-sectional study was performed in a cohort of 106 patients (54 men and 52 women) with functioning renal allografts, who underwent bone densitometry (DEXA) of the lumbar spine and femoral neck. Patients were grouped according to DEXA into those with normal bone density (NBD) or LBD. We studied clinical, analytical, and therapeutic variables. RESULTS: Thirtysix patients (34%) had NBD and 70 patients (66%) LBD. Weight was the only parameter showing a significant difference (P = .034), namely, among NBD it was 80.44+/-15.13 versus LBD 73.94 +/- 14.54 kg, respectively. Creatinine clearance (CCr) tended to be lower among patients with LBD 59.62 +/- 22.73 versus 69.59 +/- 28.15 mL/min in patients with NBD (P = .052). PTHi levels were higher in patients with LBD (149.39 +/- 110.75) than those with NBD (110.94 +/- 82.61) (P = .069). In the multivariate analysis the important determinants were weight Exp(ss) = 0.967 [CI = 0.939 to 0.996] (P = .036); CCr Exp(ss) = 0.982 [CI = 0.965 to 1.000] (P = .055); and PTHi levels Exp(ss) = 1.003 [CI = 0.932 to 0.994] (P = .059). CONCLUSIONS: Osteopenia and osteoporosis are frequent among kidney transplant patients (66%), with a similar distribution between the lumbar spine and femoral neck. Excess weight and possibly better renal function may be protective factors. The cumulative steroid dose showed a significant effect on bone density. As expected, secondary hyperparathyroidism in patients with renal impairment seemed to be a risk factor for LBD.

[Molecular diagnosis of adult dominant polycystic kidney disease in the Canary Islands]. / Diagnóstico molecular de la Poliquistosis Renal Autosómica Dominante en la Comunidad Autónoma de Canarias.

Adult dominant polycystic kidney disease is an hereditary condition responsible for 6% of end-stage renal failure in Spain. Two genes were located in chromosomes 16 and 4 as related to this age-dependent disease in the 90s (PKD1 and PKD2). The diagnosis can be easily achieved by sonographic study, but molecular analysis by means of linkage analysis has the advantage of an early diagnosis in asymptomatic genetic carriers, with a view to the preventive follow-up of these subjects and genetic counselling. In this paper we present the results of molecular analysis of 30 families with Adult Dominant Polycystic Kidney Disease (from the province of Las Palmas Spain), carried out linkage analysis with two series of microsatellite markers located within or in the vicinity ofPKD1 (D16S521, KG8, AC2.5, CW2, SM7) and PKD2 (D4S1538, D4S1534, D4S423,D4S414) genes. The objectives of the study were: first, to verify the informativeness, and therefore, the usefulness of these markers for family studies in our population; and second,to assess the sensitivity and specificity of the genetic analysis in our population. Most of the markers showed a high heterozygosity, comparable to data in other studies. Considering the alleles of the different markers together in a chromosome as an haplotype increased the informativeness of the markers, and allowed the unequivocal identification of genetic data in 97.7% of patients and 88.7% of healthy subjects. The sensitivity and specificity of the genetic analysis were 90.7% (CI 95%: 85.7-95.7) and 86.8% (CI 95%: 80.6-93.0), respectively.

Efecto del Valsartán sobre la presión arterial y función renal en pacientes con hipertensión arterial y diabetes mellitus tipo 2. Estudio Lapaval / Valsartan in patients with arterial hypertension and type 2 diabetes mellitus. The lapaval study

La hipertensión arterial junto a la diabetes mellitus son importantes determinantesde la aparición y evolución de la nefropatía diabética, y a la vez situación de elevadoriesgo cardiovascular. La renoprotección mediante el bloqueo del sistema reninaangiotensinaes una alternativa válida para este tipo de pacientes. Objetivo: Evaluar el efecto de valsartán, un antagonista específico de los receptorestipo 1 de la angiotensina II sobre la presión arterial y función renal en pacientesdiabéticos tipo 2 con albuminuria e hipertensión arterial.Pacientes y método: Se trata de un estudio prospectivo observacional, llevado acabo en dos hospitales con pacientes procedentes de las diferentes unidades deAtención Primaria. Se analizaron 74 pacientes diabéticos tipo 2 con cifras de presiónarterial de 140/90 mm Hg, con presencia de micro o macroalbuminuria y a) cifras decreatinina en sangre inferiores a 1,5 mg/dl (grupo 1) o b) cifras de creatinina en sangreentre 1,5 y 2 mg/dl (grupo 2), seguidos durante 12 semanas. El tratamiento seinició con valsartán 80 mg/día, incrementando a 160 mg/día y añadiendo posteriormentetorasemida a dosis de 5 mg/día si no se lograban alcanzar las cifras diana depresión arterial. El grado de reducción de la presión arterial fue analizado comparativamentecon un esfigmomanómetro de mercurio y un monitor semiautomáticoOmron HEM 705 CP.Resultados: En todos los pacientes objeto de estudio la presión arterial sistólica(PAS) y diastólica (PAD), pero no la presión de pulso, disminuyeron significativamente(p < 0,001) a lo largo del periodo analizado, pasando de 150,7 ± 12,8 a130,8 ± 9,6 y de 94,7 ± 7,7 a 76,8 ± 6,3 mm Hg respectivamente. En el grupo 2 sólose halló una reducción significativa de la presión arterial diastólica (101,4 ± 8,8 a79,4 ± 5,6; p < 0,001). Los valores más bajos de presión arterial se obtuvieron siemprecon el monitor semiautomático. Al final del estudio, el 9,5% de los pacientes semantenía con valsartán 80 mg/día, al 48,6% de los pacientes se le dobló la dosis yel 36,5% de los pacientes necesitó la adición de un segundo o tercer fármaco al valsartán160 mg/día para alcanzar la diana terapéutica de presión arterial. Hubo unareducción significativa de la microalbuminuria (75,5 ± 9,5 a 54,7 ± 7,3 µg/min; p < 0,001) y macroalbuminuria (n = 20; 0,93 ± 0,4 a 0,68 ± 0,4 g/d; p < 0,001) entodos los pacientes analizados respecto a sus valores basales.Conclusión: El valsartán disminuye significativamente las cifras de PAS y PAD, alcanzándoseen todos los casos el objetivo establecido, precisándo para ello los tresregímenes terapéuticos. El valsartán a dosis de 160 mg/día alcanzó un significativo ymayor efecto en la reducción de la micro y macroalbuminuria. No se encontraronmodificaciones en las cifras de creatinina en sangre, aclaramiento de creatinina,HbA1c y potasio sérico. Los valores de HDL-colesterol aumentaron significativamente.La tasa de acontecimientos adversos fue mínima

Arterial hypertension and diabetes mellitus give rise to a situation of high cardiovascularrisk. The potential renoprotection from inhibition of the renin-angiotensinsystem is a valid option in this type of patient.Objective: Evaluate the effect of valsartan on blood pressure (BP) and renal functionin albuminuric patients with type 2 diabetes and arterial hypertension.Patients and methods: This was a prospective, observational study. Seventy-fourdiabetic patients with a blood pressure of 140/90 mmHg, with micro or macroalbuminuriaand a) blood creatinine levels lower 1.5 mg/dl (group 1) or b) blood creatininelevels between 1.5 and 2 mg/dl (group 2), were studied and followed up fora 12-week period. Treatment was started with valsartan 80 mg/d, increasing to 160mg/d, adding torasemide at a dose of 5 mg/d if the target blood pressure of 130/85mmHg has not been achieved. The degree of BP reduction was analyzed comparativelyusing a mercury sphygmomanometer and a semi-automatic monitor, the OmronHEM 705 CP.Results: All patients showed a significant reduction of the systolic (SBP) anddiastolic (DBP) blood pressures (p< 0.001) over the study period, decreasingfrom 150.7 ± 12.8 to 130.8 ± 9.6 and from 94.7 ± 7.7 to 76.8 ± 6.3 mmHg, respectively.A significant reduction was observed only for diastolic blood pressure(101.4 ± 8.8 to 79.4 ± 5.6; p < 0.001) in the group 2 of patients. Lowest BP valueswere always obtained with the semiautomatic device. At the end of the study,9.5% maintained valsartan 80 mg/d and 36.5% required the addition of a secondor third drug to valsartan 160 mg in order to achieve the therapeutic target BP. Asignificant reduction was observed in the microalbuminuria (75.5 ± 9.5 to 54.7 ±7.3 µg/min; p < 0.001) and macroalbuminuria (n = 20; 0.93 ± 0.4 to 0.68 ± 0.4g/day; p < 0.001).Conclusion: Valsartan significantly reduced SBP and DBP. Valsartan at 160 mg/dhad a significantly greater effect in reducing micro and macroalbuminuria. No changeswere observed in renal function, HbA1c or serum potassium. The rate of adverseevents was very low

[Valsartan in patients with arterial hypertension and type 2 diabetes mellitus. The lapaval study]. / Efecto del valsartin sobre la presión arterial y función renal en pacientes con hipertensión arterial y diabetes mellitus tipo 2. Estudio Lapaval.

UNLABELLED: Arterial hypertension and diabetes mellitus give rise to a situation of high cardiovascular risk. The potential renoprotection from inhibition of the renin-angiotensin system is a valid option in this type of patient. OBJECTIVE: Evaluate the effect of valsartan on blood pressure (BP) and renal function in albuminuric patients with type 2 diabetes and arterial hypertension. PATIENTS AND METHODS: This was a prospective, observational study. Seventy-four diabetic patients with a blood pressure of > or = 140/90 mmHg, with micro or macroalbuminuria and a) blood creatinine levels lower 1.5 mg/dl (group 1) or b) blood creatinine levels between 1.5 and 2 mg/dl (group 2), were studied and followed up for a 12-week period. Treatment was started with valsartan 80 mg/d, increasing to 160 mg/d, adding torasemide at a dose of 5 mg/d if the target blood pressure of 130/85 mmHg has not been achieved. The degree of BP reduction was analyzed comparatively using a mercury sphygmomanometer and a semi-automatic monitor, the Omron HEM 705 CP. RESULTS: All patients showed a significant reduction of the systolic (SBP) and diastolic (DBP) blood pressures (p< 0.001) over the study period, decreasing from 150.7 +/- 12.8 to 130.8 +/- 9.6 and from 94.7 +/- 7.7 to 76.8 +/- 6.3 mmHg, respectively. A significant reduction was observed only for diastolic blood pressure (101.4 +/- 8.8 to 79.4 +/- 5.6; p < 0.001) in the group 2 of patients. Lowest BP values were always obtained with the semiautomatic device. At the end of the study, 9.5% maintained valsartan 80 mg/d and 36.5% reqcuired the addition of a second or third drug to valsartan 160 mg in order to achieve the therapeutic target BP A significant reduction was observed in the microalbuminuria (75.5 +/- 9.5 to 54.7 +/- 7.3 microg/min; p < 0.001) and macroalbuminuria (n = 20; 0.93 +/- 0.4 to 0.68 +/- 0.4 g/day; p < 0.001). CONCLUSION: Valsartan significantly reduced SBP and DBP Valsartan at 160 mg/d had a significantly greater effect in reducing micro and macroalbuminuria. No changes were observed in renal function, HbA1c or serum potassium. The rate of adverse events was very low.

Polyphasic study of the genetic diversity of lactobacilli associated with 'Almagro' eggplants spontaneous fermentation, based on combined numerical analysis of randomly amplified polymorphic DNA and pulsed-field gel electrophoresis patterns.

AIMS: The goal of this study was to assess the genetic diversity of lactic acid bacteria (LAB) from the complex natural ecosystem present in the spontaneous fermentation of 'Almagro' eggplants by a polyphasic approach based on molecular techniques. METHODS AND RESULTS: Randomly amplified polymorphic DNA (RAPD) and pulsed-field gel electrophoresis (PFGE) were applied to 149 Lactobacillus isolates obtained from that fermentation process. Two random primers, OPL-05 and ArgDei-For, and two rare-cutting enzymes, SfiI and SmaI, chosen after preliminary testing on the basis of band intensity and distribution, were used. RAPD and PFGE generated electrophoretic patterns suitable for strain discrimination, but further discrimination was achieved when combined numerical analysis of the results from both methods and the results previously obtained by SDS-PAGE whole cell protein analysis, was carried out. The findings indicated a considerable degree of genomic diversity in the LAB microbiota studied and especially in the Lactobacillus plantarum isolates. In terms of species assignment, the polyphasic study allowed a definite and well-founded identification of 98.7% of the isolates. CONCLUSIONS: The combined numerical analysis of RAPD and PFGE patterns represented a useful tool to discriminate the diversity of the Lactobacillus strains responsible for the spontaneous fermentation of this pickle. The species identification and strain typing results from the polyphasic study were regarded as the most exact compromise yielding the fewest contradictions based on the available data. SIGNIFICANCE AND IMPACT OF THE STUDY: Combined numerical analysis of RAPD-PCR and PFGE patterns has not yet been employed to study the genetic diversity of LAB from an ecosystem like that found in fermenting vegetables.

Contribution of starter culture to the sensory characteristics of fermented Almagro eggplants.

Trial fermentations were performed using three experimental starter cultures with a view to selecting the most appropriate starter for use in the manufacture of Almagro eggplants. The lactic acid bacterial strains used in the starters had previously been isolated from spontaneous fermentations. The combined action of the obligate heterofermentative species Lactobacillus brevis and the facultative heterofermentative species L. plantarum yielded Almagro eggplants with sensory properties preferred by panelists. Conversely, another obligate heterofermentative species, namely, L. fermentum, present in certain starter formulations tested, appeared to encounter difficulty growing during fermentation and exerted little influence on the sensory characteristics of the eggplants produced.

Terapia renoprotectora en la nefropatía diabética. Evidencias disponibles / Renal protective therapy in diabetic nephropathy. Available evidence

No disponible

No disponible

Biochemical characterization of lactic acid bacteria isolated from spontaneous fermentation of 'Almagro' eggplants.

A total of 149 strains of lactic acid bacteria isolated from the spontaneous fermentation of 'Almagro' eggplants were characterized and identified. Of the isolates, 148 were determined as belonging to the genus Lactobacillus. A coccoid, gram-positive database-negative isolate was obtained in the early stages of fermentation. The Lactobacillus strains were divided into six groups based on sugar fermentation patterns and other physiological and morphological characteristics, and were identified as Lactobacillus plantarum biotype 1 (54.4%), Lactobacillus brevis biotype 2 (19.5%), Lactobacillus fermentum (9.4%), Lactobacillus brevis biotype 3 (5.4%), Lactobacillus pentosus (4.7%) and nine strains, which were not included in the previous species, were grouped as Lactobacillus spp. (6.0%). Fermentation was initiated by Lactobacillus brevis biotype 2 and Lactobacillus fermentum. During the fermentation Lactobacillus plantarum became the predominant species.

[Epidemiologic study of infection by hepatitis C virus in a hemodialysis unit]. / Estudio epidemiológico de la infección por el virus de la hepatitis C en una Unidad de Hemodiálisis.

OBJECTIVE: To analyze the prevalence of infection, the frequency of HCV genotypes and the epidemiology characteristics among the patients in hemodialysis treatment in one 25 years old hospital hemodialysis center and one 15 years old secondary unit by a transversal cross-section study in 1998. PATIENTS AND METHODS: 171 hemodialyzed-patients were studied. Patients sera were analyzed by the presence of HCV antibodies anti-VHC by a enzymoimmunoassay (Abbott Cientifica) and the presence of antibodies was confirmed by a line immunoassay (Inno-LIA HCV AbIII) and by the presence of VHC-RNA by reverse transcriptase PCR (Cobas Amplicor HCV). Genotypes were determinate by reverse hybridization (Inno-LIA HCV III). RESULTS: Fifty (29.2%) of the patients were HCV antibody positive. Forty-five (26.3%) were HCV-RNA positive, all of them with antibodies positive. The distribution of genotypes was: 1b, 34 (75.5%); 4f, 4 (8.9%); 1a, 3 (6.7%); 1, 3 (6.7%) and 1 case could not be typed (2.2%). In 14 patients (28.0%), seroconversions were documented Twenty-one patients (42.0%) were diagnosed when the routine tests were available and 15 patients (30.0%) were diagnosed pre-dialysis. The multivariate analysis showed that the risk of HCV infection was greater for patients who had been more 8 years on dialysis (OR: 6.22; 95% CI: 1.24-31.07). CONCLUSIONS: Data presented indicate that the prevalence of HCV infections in our hemodialysis units and the number of seroconversions were high and the HCV subtype 1b was more frequent; because of this, the screening by both serological and molecular methods is necessary, at least twice a year, to identify all the infected patients. Besides, we think that is necessary to increase the control of the completion of the Universal Precautions.

Influence of sodium chloride concentration on the controlled lactic acid fermentation of "Almagro" eggplants.

The effect of a commercial Lactobacillus starter and sodium chloride concentration on the fermentation of "Almagro" eggplants (Solanum melongena L. var. esculentum depressum) was studied. The results of fermentation using added starter and varying salt concentrations (4, 6, and 10% w/v) in brine were compared with the results of spontaneous fermentation taking place in brine with a salt concentration of 4%. Fresh fruits, medium in size (34-44 g), were used in all cases; all fruits were blanched under identical conditions. Temperature in the fermenters was 32+/-2 degrees C. The results obtained indicate that addition of a suitable starter shortened the fermentation process, provided the salt concentration in the brine did not exceed 6%. In the conditions tested, the eggplants obtained after fermentation were found to be of good quality though somewhat bitter which may explained by the starter employed.

Effects of the novel multiple-action agent carvedilol on severe nephrosclerosis in renal ablated rats.

Antihypertensive drugs have differing effects on renal hemodynamics and morphology. We analyzed whether the use of a new beta adrenoceptor antagonist and vasodilator, carvedilol (CVD), slows the progression of nephrosclerosis and whether the renoprotective effect as well as reduction in cardiac hypertrophy is dependent on the degree of blood pressure reduction. Fifty-four adult male Sprague-Dawley rats were distributed among five groups: group I served as untreated controls with 5/6 nephrectomy (Nx); group II, sham (no renal ablation or drug treatment); group III, CVD 5 (5/6 Nx and treatment with oral CVD at 5 mg/kg/day); group IV, CVD 10 (5/6 Nx and treatment with oral CVD at 10 mg/kg/day); and group V, CVD 20 (5/6 Nx and treatment with oral CVD at 20 mg/kg/day). Tail-cuff blood pressure and 24-hr urine samples were obtained before and at 3, 5 and 11 weeks of treatment with CVD. At the end of the study period, blood was taken to measure serum creatinine, plasma renin activity and CVD levels, as well as the remnant kidney and heart for morphological studies. There was a significant reduction in 24-hr U(ProtV) in all the CVD-treated groups, and it was increasingly evident with the highest dose used. However, only rats receiving doses of 10 and 20 mg/kg/day of CVD exhibited significant decreases in blood pressure. Elevated serum creatinine levels seen in untreated controls were significantly decreased by CVD in treated rats (P < .01), indicating that glomerular filtration rate was improved by this drug. This was associated with a significant increase in U(NaV). Concomitant and significant (P < .01) decreases in plasma renin activity were observed in sham and CVD-treated rats. CVD-treated animals had considerably reduced renal damage (P < .01) and cardiac hypertrophy (P < .01) compared with untreated controls. These data indicate that CVD is effective in delaying progression of renal damage and provides beneficial effects in the remnant kidney and cardiac hypertrophy, even at nonhypotensive doses.