MALDI-TOF/MS identification of species from the Acinetobacter baumannii (Ab) group revisited: inclusion of the novel A. seifertii and A. dijkshoorniae species.

OBJECTIVES: Rapid identification of Acinetobacter species is critical as members of the A. baumannii (Ab) group differ in antibiotic susceptibility and clinical outcomes. A. baumannii, A. pittii, and A. nosocomialis can be identified by MALDI-TOF/MS, while the novel species A. seifertii and A. dijkshoorniae cannot. Low identification rates for A. nosocomialis also have been reported. We evaluated the use of MALDI-TOF/MS to identify isolates of A. seifertii and A. dijkshoorniae and revisited the identification of A. nosocomialis to update the Bruker taxonomy database. METHODS: Species characterization was performed by rpoB-clustering and MLSA. MALDI-TOF/MS spectra were recovered from formic acid/acetonitrile bacterial extracts overlaid with α-cyano-4-hydroxy-cinnamic acid matrix on a MicroflexLT in linear positive mode and 2000-20 000 m/z range mass. Spectra were examined with the ClinProTools v2.2 software. Mean spectra (MSP) were created with the BioTyper software. RESULTS: Seventy-eight Acinetobacter isolates representative of the Ab group were used to calculate the average spectra/species and generate pattern recognition models. Species-specific peaks were identified for all species, and MSPs derived from three A. seifertii, two A. dijkshoorniae, and two A. nosocomialis strains were added to the Bruker taxonomy database, allowing successful identification of all isolates using spectra from either bacterial extracts or direct colonies, resulting in a positive predictive value (PPV) of 99.6% (777/780) and 96.8% (302/312), respectively. CONCLUSIONS: The use of post-processing data software identified statistically significant species-specific peaks to generate reference signatures for rapid accurate identification of species within the Ab group, providing relevant information for the clinical management of Acinetobacter infections.

Prevalence and predictors of vitamin D insufficiency in supplemented and non-supplemented women with systemic lupus erythematosus in the Mediterranean region.

It has been previously reported that vitamin D deficiency is more prevalent among SLE patients than in the general population. We sought to determine the prevalence of vitamin D insufficiency and deficiency and their related factors, its relationship to SLE symptoms and disease activity on a group of supplemented and non-supplemented female SLE patients from the Mediterranean region. We performed a cross-sectional study including female SLE patients who regularly attended the outpatient Lupus Unit at Parc de Salut Mar-IMAS in Barcelona, from January 2012 to May 2014. Collected data were sociodemographics, vitamin D supplementation, fatigue degree visual analog scale, pharmacological treatment, main SLE serological markers, indexes, scales and plasma levels of 25-hydroxyvitamin D. One hundred and two consecutive female SLE patients were included. Vitamin D overall insufficiency and deficiency were exhibited by 46 and 22.5 % of patients, respectively. Vitamin D insufficiency was found in 50 % of supplemented and 60 % of non-supplemented patients. Among non-supplemented female SLE patients, it was found that patients with vitamin D insufficiency showed more fatigue (p = 0.009) and received more oral corticosteroids (p = 0.02) than those with normal levels. Patients with vitamin D insufficiency (supplemented and non-supplemented) received more oral corticosteroids than those without insufficiency (p = 0.008). Vitamin D insufficiency is highly prevalent among female SLE patients, even in southern regions. Non-supplemented female SLE patients showed more fatigue and received more oral corticosteroids than those with normal levels of vitamin D. These data were not found in supplemented patients although having a high prevalence of vitamin D insufficiency (up to 50 %). Further studies with longer follow-up and larger population are needed to confirm our observations.

Inicio y continuidad de la lactancia materna en relación con la asistencia a un programa educativo para madres jóvenes / Beginning and continuity of breastfeeding according to the attendance to a specific intervention for a young mothers

OBJETIVO: Determinar si las gestantes de hasta 22 años de edad que participaron en el programa Mares Joves (Madres Jóvenes [MJ]) y que recibieron una intervención específica para el fomento de la lactancia materna aumentaron la duración de la lactancia materna y la asistencia al programa de educación prenatal (EPN) y posnatal (EPP) con respecto a las que no participaron, así como la relación entre la duración de la LM, la asistencia a EPN y EPP y otras variables socioeconómicas, demográficas, obstétricas y familiares. METODOLOGÍA: Estudio cuasi experimental, con grupo de intervención y grupo control, comparando la duración de la lactancia materna (LM) en función de la participación en el programa de MJ (grupo de intervención) o no (grupo control). Otras variables de estudio: edad, nivel socioeconómico, hijos previos, presencia de pareja afectiva en el momento del parto, apoyo familiar y asistencia a EPN y EPP. Análisis estadístico: descriptivo, mediante porcentajes, medias y desviación estándar. Prueba de la t de Student o ANOVA y el test de la ji al cuadrado (Chi²) como estadística bivariada. Paquete estadístico SPSS, versión 16.0. RESULTADOS: Mujeres participantes: 242 (grupo de intervención: 131; grupo control: 111). Las participantes en el programa MJ lactaron más tiempo que las del grupo control y asistieron con más frecuencia a los grupos específicos de madres jóvenes de preparación para el parto. La asistencia a EPN y EPP se asoció a un incremento significativo de la duración de la LM. Las mujeres de América del Sur son las que más tiempo lactaron, y las españolas las que menos. No se encontraron diferencias significativas en función de la edad, el nivel socioeconómico, los hijos previos, la presencia o no de pareja afectiva o el apoyo familiar. CONCLUSIONES: La participación en el programa MJ y la asistencia a los grupos de EPN y EPP específicos para madres jóvenes se asociaron a un incremento de la duración de la LM

AIM: To determine whether pregnant women up to 22 years who participated in the program Young Mothers (YM), receiving a specific intervention for the promotion of breastfeeding (BR), increased the duration of BR and the attendance at prenatal education program (EPN) and postnatal (EPP) in comparison with the non-attendants, and the relationship between duration of BR and assistance to EPN and EPP, and socio-economic, demographic, obstetric and family variables. METHODOLOGY: A quasi-experimental study, non-randomized, control group, comparing the length of BR depending on the participation or not in the YM program. Other study variables: age, socioeconomic status, previous children, the presence of affective partner at the time of birth, family support, and assistance to EPN and EPP. Statistical analysis: descriptive, using percentages, means and standard deviation. T Student's test or ANOVA and the Chi² and bivariate statistics. SPSS version 16.0. RESULTS: 242 female participants (131 intervention group, control group 111). The program participants YM breastfed longer than the control group and attended more frequently to specific groups of young mothers in preparation for the birth. The EPN and EPP support was associated with a significant increase in the duration of breastfeeding. Latin American women are the longest breastfed and Spanish the least. No significant differences in terms of age, socio- economic status, previous children, couple or family support affective found. CONCLUSIONS: Participation in the YM program and assistance to specific EPN and EPP groups for young mothers, was associated with an increased duration of BR

Increased serum IgG and IgA in overweight children relate to a less favourable metabolic phenotype.

BACKGROUND: The adaptive immune system has emerged as an unexpected modulator of insulin resistance. B lymphocytes accumulate in adipose tissue and produce pathogenic antibodies that cause insulin resistance. OBJECTIVE: We studied whether circulating immunoglobulins (IgG, IgA and IgM) were related to metabolic risk markers in pre-pubertal children with and without overweight. DESIGN AND METHODS: Subjects were 270 asymptomatic pre-pubertal Caucasian children (145 lean, 125 overweight) recruited in a primary care setting. Assessments included serum IgG, IgA and IgM concentrations (nephelometry), insulin resistance (HOMA-IR) and fasting lipids (triacylglycerol and high-density lipoprotein [HDL]-cholesterol). RESULTS: Overweight children had higher IgG and IgA serum levels than lean children (P ≤ 0.01). Increasing serum IgG and IgA, but not IgM, were associated with a less favourable metabolic phenotype, consisting of higher HOMA-IR and triacylglycerol and lower HDL-cholesterol, particularly in obese children, in whom serum IgG and IgA were both independently associated with HOMA-IR (ß = 0.308, P = 0.017, r2 = 9.5% and ß = 0.361, P = 0.005, r2 = 13.0%, respectively) and triacylglycerol (ß = 0.343, P = 0.006, r2 = 11.1% and ß = 0.354, P = 0.003, r2 = 12.2%, respectively). CONCLUSIONS: Increased circulating IgG and IgA in overweight children are associated with a less favourable metabolic phenotype, particularly in obese children. These results suggest a relationship between adaptive immunity and insulin resistance in childhood obesity.

Repair of erosions in patients with rheumatoid arthritis treated with etanercept: magnetic resonance imaging findings after 1 year of follow-up.

OBJECTIVES: To monitor repair of bone erosions using magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA) during etanercept combination therapy. METHOD: The study population comprised 29 RA patients [biologic-naïve, 28-joint Disease Activity Score (DAS28) ≥ 3.2] starting etanercept combination therapy with disease-modifying anti-rheumatic drugs (DMARDs) and completing the 1-year study period with the same treatment. Clinical and laboratory assessments and MRI of the hand were performed at baseline and at 1 year. MRI findings were scored by two readers using the Rheumatoid Arthritis MRI Scoring System (RAMRIS). Both readers were blind to the chronological order of the MRI scans, the identity of the patients, and clinical and other imaging data. Tenosynovitis was also scored. The intra- and inter-reader intraclass correlation coefficients (ICCs) were calculated, along with the sensitivity to change with the smallest detectable difference (SDD). Repair of erosions was defined as a RAMRIS score of at least 1 point lower than baseline. RESULTS: The mean RAMRIS score for erosions did not change but all other inflammatory MRI parameters decreased significantly. In 19 patients, the RAMRIS score for erosions remained unchanged after 1 year. In five patients the score decreased after 1 year, although the decrease exceeded the SDD in only one patient (3.4%). CONCLUSIONS: Etanercept combined with DMARDs stopped the progression of erosions, as measured by the RAMRIS, in 82.8% of our RA patients and occasional repair of bone erosions occurred after 1 year of treatment.

Alopecia areata as another immune-mediated disease developed in patients treated with tumour necrosis factor-α blocker agents: Report of five cases and review of the literature.

BACKGROUND: Tumour necrosis factor antagonists (anti-TNF-α) have demonstrated the efficacy in different chronic immune inflammatory disorders. Within the spectrum of adverse events, autoimmune diseases have been observed, including cases of alopecia areata (AA). OBJECTIVES: The objective of the study is to characterize AA developed during anti-TNF-α therapy. METHODS: We present five new cases and review all the cases reported in the literature (eleven). RESULTS: One third of the cases had a positive (personal or family) history of AA. Most of them presented with rapid extensive AA, usually involving the ophiasis area. Prognosis was usually poor, with slight response to treatments. In the cases where anti-TNF-α therapy was maintained, the course did not seem to change. CONCLUSIONS: Although rare, AA developed during anti-TNF-α therapy might be more frequent than suggested by reports of isolated cases. Personal and family history of autoimmune disease might alert clinicians to their possible development or relapse once the anti-TNF-α therapy is started.

Feasibility study of the anaerobic digestion of dewatered pig slurry by means of polyacrylamide.

Liquid livestock waste can be managed by separating liquid and solid fractions then treating each separately by applying best available technology, such as anaerobic digestion for the solid fraction. There is an increasing use of polyacrylamide (PAM) as a flocculant agent to improve solid-liquid separation. In the present work, the anaerobic toxicity of PAM residues and the optimal range of total solids concentration for maximum methane production were studied as a function of PAM dosage. Results showed that dry matter and its volatile solids content increased significantly with increasing PAM dosage. Batch anaerobic tests showed that methane yield decreased linearly with increasing total solids, while the methane production per unit of raw substrate reached a maximum at 16.4% total solids. No PAM toxicity was measured for PAM concentrations below 415 g/kg total solids, but some indirect inhibitory phenomena were observed, such as a limited hydrolysis rate due to particle aggregation, and inhibition of methanogenesis by high ammonia concentration.

Infartos medulares óseos / Bone marrow infarcts

Objetivo: Conocer las características clínicas, evolución y etiología de los infartos medulares óseos (IMO). Métodos: Tras la detección de un caso centinela se revisa la base de datos de los últimos 5 años de nuestro centro, y se detectó a 5 pacientes con las características prefijadas, de un total de 8.200 exploraciones osteoarticulares realizadas. Resultados: Caso 1: varón de 41 años con antecedentes de hipercolesterolemia, trasplante renal e inmunosupresión posterior, clínica de coxalgia bilateral y resonancia magnética (RM) que presenta imágenes compatibles en cabezas y cuellos femorales; caso 2: varón de 44 años con antecedentes de síndrome de Raynaud y asma bronquial con corticoterapia en las descompensaciones, clínica de gonalgia bilateral y RM que muestra lesiones compatibles en ambos fémures y tibias; caso 3: varón de 43 años con antecedentes de infección por el VIH y enfermedad pulmonar obstructiva crónica (EPOC) con corticoterapia, clínica de dolor mecánico en tobillo izquierdo y RM que presenta múltiples lesiones compatibles en la tibia, astrágalo, calcáneo y escafoides; caso 4: mujer de 59 años sin antecedentes relacionados ni clínica, con RM que evidencia lesión compatible en cuello femoral derecho; caso 5: varón de 42 años con antecedentes de enolismo y osteonecrosis (ON) de cabeza femoral izquierda, clínica de gonalgia mecánica y RM que presenta lesiones compatibles en tibia y cóndilo femoral interno. Discusión: Los IMO son una entidad infrecuente y poco descrita, cuya imagen en RM es la de una lesión ósea intramedular de contornos serpiginosos, hipo o isointensa en T1 e hiperintensa en T2. Aparecen como lesiones segmentarias, sin afección cortical y normalmente múltiples. Difieren de la típica ON pero pueden asociarse a ella, intuyendo un posible origen Infartos medulares óseos común. A las causas reconocidas en nuestro centro, la revisión bibliográfica permite añadir otras enfermedades causales. Se cita la posible malignización de la lesión a sarcomas óseos. (AU)

Prevalence of anti-human papillomavirus type 16, 18, 31, and 58 virus-like particles in women in the general population and in prostitutes.

Genital human papillomavirus (HPV) infection is sexually transmitted. The aim of the study was to characterize serological responses to HPV types 16, 18, 31, and 58 by exploring type-specific virus-like particles (VLPs) in two groups of women with very distinct sexual behaviors. Anti-VLP antibodies for types 16, 18, 31, and 58 and HPV DNA in cervical cells were investigated with 177 prostitutes and 283 age-matched controls from the female general population in Spain. Anti-VLP positivity increased with number of lifetime sexual partners in women from the general population, and no seroresponse was found in virgins. However, in prostitutes HPV infection was characterized by higher multireactivity to three or four VLPs (25%) than the general population (3%) and by a more frequent antibody response to HPV-58 than in the general population. About 75% of the women seropositive for type 58 had been born in a Latin American country. Seroprevalence of HPV and cervical HPV DNA in prostitutes were 14 and 10 times higher than observed in women in the general population (prevalence odds ratio [POR] of HPV seropositivity, 14.04 [95%; CI = 8.4 to 23.6] and POR for HPV DNA, 10.4 [95% CI = 3.9 to 27.6). Our results indicate that prostitutes are at an increased risk of oncogenic HPV infections, and they confirm the validity of anti-VLPs as markers of present or past HPV infection, that the number of sexual partners is the major determinant in acquisition of oncogenic HPV, and that anti-VLPs could be used as a marker of repeated infection in prostitutes.

[Community-acquired pneumonia: impact of the use of a therapeutic strategy based on probability of short-term mortality]. / Neumonía adquirida en la comunidad: impacto de la utilización de una estrategia terapéutica basada en la mortalidad a corto plazo.

BACKGROUND: To assess the impact of the use of a therapeutic strategy based on classifying patients with community-acquired pneumonia (CAP) according to the probability of short-term mortality. PATIENTS AND METHODS: During one year, all patients admitted to the Emergency Department with diagnosis of CAP were included. Clinicians were invited to treat patients according to a recently published protocol that stratifies patients into five categories (from low to high-risk mortality): patients assigned to class 1 were managed at home; patients included in classes 2 and 3 were assigned to a short-time period at emergency department before managed at home; and patients assigned to classes 4 and 5 were hospitalized. RESULTS: The final population analyzed included 101 patients. The rate of acceptability among clinicians was 96.7%. Patients were classified by the following terms: risk-class 1: 17 (16.8%); risk-classes 2 and 3: 40 (39.7%); risk-classes 4 and 5: 44 (43.6%). During follow-up, of the 57 non-hospitalized patients, 3 (5.2%) were subsequently admitted to hospital and 7 (12.2%) patients initially assigned to a short-time period at emergency department were hospitalized, and 1 (1.7%) of them died. By this program, the reduction of the hospitalization rate was 23.8%. CONCLUSION: A strategy of management of CAP based on a prognostic classification has a good safety and acceptability among clinicians, and reduces the rate of hospitalizations.

Effect of inclusion of sugar beet pulp, pelleting and season on laying hen performance.

1. The effect of three metabolisable energy (ME) concentrations 12.2, 11.3 and 10.5 MJ ME/kg and two forms of diet (mash and pellet) on egg production in summer and winter were studied. The different ME values were obtained by diluting the 12.2 MJ ME/kg diet with sugar beet pulp of 2.88 MJ/kg DM. In a 3rd summer experiment the water intake of hens on these diets was examined. Data were analysed by factorial analysis of variance, and the relationship between performance and dietary energy concentration was examined by regression analysis. 2. The use of low energy diets (10.5 to 11.3 MJ ME/kg) decreased egg production in both seasons, but pelleting diets improved egg production and egg weight in summer. Egg weight was not affected by energy density in winter, but decreased in the summer when energy density increased. 3. In winter, food consumption was not affected by the dietary ME, while in summer food consumption increased when the dietary ME increased. Therefore, energy intake was not the same at all energy densities, but tended to increase as the energy density increased. 4. In summer, pelleting improved food efficiency and egg production and increased water consumption and the ratio of water to food intake. Water intake and water: food ratio decreased with increasing dietary energy concentration.

Effect of d-limonene, alpha-pinene and cineole on in vitro transdermal human skin penetration of chlorpromazine and haloperidol.

The aim of this research is to carry out a comparative study of the ability to cross human skin of two neuroleptic drugs: chlorpromazine (CAS 50-53-3) and haloperidol (CAS 52-86-8), in the absence and in the presence of three terpenes (cineole, d-limonene and alpha-pinene) with the purpose of considering the possibility of improving their transdermal penetration profile. Franz diffusion cells were used, in conjunction with human skin as permeation membrane. The permeation parameters calculated were permeability constant (Kp), flux (J) and lag time (Tl) in the presence and in the absence of enhancers. None of the three enhancers assayed improved the penetration profile of chlorpromazine, and d-limonene even reduced the transdermal permeability (enhancement index, EI = 0.67) since its coefficient of relative activity was reduced, (Xr = 0.73). Cineole and d-limonene increased the permeation profile of haloperidol, giving EI values of 1.95 and 4.21, respectively, and leading to a fourfold increase in the flux value for both enhancers. alpha-Pinene did not modify the permeation profile of haloperidol. None of the three terpenes assayed had a significant effect on the lag time of chlorpromazine or haloperidol. In these experimental conditions the concentration values predicted at steady state of chlorpromazine formulated without enhancers are within the therapeutic range. In contrast, therapeutic levels of haloperidol cannot be predicted in the absence of enhancers such as d-limonene or cineole.

The differences in intestinal viscosity produced by barley and beta-glucanase alter digesta enzyme activities and ileal nutrient digestibilities more in broiler chicks than in cocks.

The objectives of this study were to determine whether intestinal viscosity caused by mixed linked barley beta-glucan depresses ileal nutrient digestibility and digestive enzyme activities and to determine the interaction of intestinal viscosity, digestive enzyme activities and ileal nutrient digestibility in different ages of poultry. In Experiments 1 and 2, 1-d-old broiler chicks and 1-y-old cocks, respectively, were fed diets with 60% corn, low and high viscosity barley with or without beta-glucanase, for 3 wk. A 3 x 2 factorial design was used. Comparisons were made only within the same age group. In Experiment 3, 1-d-old broiler chicks were fed high viscosity barley with and without beta-glucanase to measure fecal nutrient and ileal and fecal amino acid digestibility. Broiler chicks fed barley ate less and gained less weight than those fed corn; added beta-glucanase resulted in increases in both food consumption and weight gain for the barley-fed chicks (P < 0.05). Relative pancreas weight was higher (P < 0.05) in chicks fed barley than in those fed corn, and lower with beta-glucanase (P < 0.05). Digesta from barley-fed birds had the highest viscosities, which were decreased (P < 0.05) by beta-glucanase. Amylase and lipase were lower in broiler chicks fed high viscosity barley compared with corn (P < 0.05), and beta-glucanase increased both activities and that of trypsin as well (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Rate of passage of barley diets with chromium oxide: influence of age and poultry strain and effect of beta-glucanase supplementation.

Three-week-old broiler chicks and 1-yr-old Leghorn cocks were used to determine the effect of beta-glucanase addition (experimental product from Trichoderma longibrachiatum) to a 60% barley-based diet on rate of feed passage, transit time, and mean retention time. Fecal chromium oxide content was used to calculate cumulated and noncumulated excretion data. A Hill equation was chosen to test the goodness of fit of cumulative excretion curves. Time of 50% (T50) and 1% (T1) chromium excretion, calculated from cumulative excretion curves, were affected by beta-glucanase addition, but this effect also was influenced by age or strain. In broiler chicks, T50 (P < .02) and T1 (P < .06) decreased with beta-glucanase addition. In cocks, T50 (P < .04) and T1 (P < .05) increased with beta-glucanase addition. Noncumulative excretion data yielded similar results. In the absence of beta-glucanase, peak chromium excretion occurred 1 h later in broiler chicks than in cocks. These differences in feed passage rate may explain why intestinal viscosity caused by the presence of beta-glucan did not act in the same manner in broiler chicks as in cocks. When beta-glucanase was added, the age-related difference was removed and rates become similar. In broiler chicks, the rate of feed passage is related to feed intake. Thus, this could explain the different effects in terms of feed utilization.

Bioavailability of fluorine in sepiolite for laying hens.

The purpose of the present work was to compare the bioavailability of structural fluorine contained in sepiolite and in sodium fluoride for laying hens. Three hundred 27-wk-old laying hens were fed one of three diets: 1) a control based on corn, barley, and soybean meal containing 21 mg/kg of fluorine; 2) a sepiolite diet in which 2% sepiolite replaced 2% barley in the control diet and which contained 217 mg/kg of fluorine; and 3) a NaF diet, consisting of the same control diet to which NaF was added to contain 217 mg/kg of fluorine (the same level of F- as the sepiolite diet). The experiment ended when hens were 64 wk old. Fluorine concentration in the tibial bone of hens fed the NaF diet was four times higher than in the control, and twice as high in eggshell. In contrast, hens fed sepiolite had fluorine concentrations in tibial bone and eggshell not significantly higher than fluorine concentrations in the controls. These results indicate that fluorine from sepiolite was not available. The effects of the different diets on egg production, feed intake, feed conversion, egg weight, shell and interior egg quality, dry matter of feces, and body weight gain were also determined but no significant differences due to the dietary treatment were observed.