Impact of a focused antimicrobial stewardship program in adherence to antibiotic prophylaxis and antimicrobial consumption in appendectomies.

Antibiotic use in appendectomy constitutes a fundamental practice to achieve the clinical outcomes and the prevention of surgical site infection. A prospective interventional study was performed in a community hospital from January 2013 to December 2015 with the aim of determining the effect of a focused antimicrobial stewardship program in the compliance with antibiotic prophylaxis and the antimicrobial consumption in appendectomies. The compliance with the antibiotic prophylaxis was monitored for the timing of administration, the selection and dose and the discontinuation. The monitoring of antimicrobial consumption was performed by a pharmacist using ATC/DDD methodology. The stewardship program includes the education of the staff and the monitoring of the quality of antibiotic prophylaxis and consumption, and feedback. Comparison of the variables over the years was performed using student's t-test or chi-square test as required. In 603 appendectomies performed the compliance with timely administration was achieved in 72.9%, 99.6% and 100% during 2013, 2014 and 2015 respectively and the compliance with the discontinuation had an increase from 86.4% (2013) to 96.7% in 2015. Consumption of antimicrobial was 355.1 DDD/100 procedures (DDD) in flemonous, 447.3 DDD in suppurative, 892.8 DDD in gangrenous and 1162.7 DDD in perforated appendectomies. Reduction in consumption for cefuroxime (26.2%), metronidazole (12.6%) and ceftriaxone (18.1%) was observed. The consumption of antimicrobials in flemonous and suppurated appendectomies achieved the lowest figure in 2015. The focused antimicrobial stewardship program was effective to improve the timely administration and the proper discontinuation of prophylactic antibiotic, with an important reduction of antimicrobial consumption.

Lack of Association Between Elevated Urinary Levels of Interleukin-10 and Interferon Gamma With the Presence of Inflammation in Kidney Transplant Recipients.

INTRODUCTION: A lot of evidence has demonstrated the importance of different cytokines in acute renal rejection. Previous studies have examined the presence or absence of interleukin (IL)-10 in related immunopathologic rejection grafts as well as other interleukins. Studies in human transplantation show elevated levels of IL-10 and gamma interferon (INF-γ) in inflammation and rejection. OBJECTIVE: The objective of this study was to demonstrate the lack of association of elevated urinary levels of IL-10 and IFN in the presence of active inflammation. METHODS: An observational, descriptive, cross-sectional study conducted in transplant recipients at 12 months of follow-up after renal transplantation. In those who were held biopsy after renal transplantation at one year follow-up, or allograft dysfunction, we also measured IL-10 and INF-γ in the urine. The following were considered as variables: age, body mass index (BMI), gender, transplant type, creatinine, chronic kidney disease epidemiology collaboration equation, (CKD-EPI), modification of diet in renal disease study equation (MDRD), Banff classification, and levels of IL-10 and INF-γ. Statistical analysis was performed calculating a sample size of 25 patients, with an alpha bias of 0.05%, yielding measures of central tendency and determining no association between levels of IL-10 and INF-γ with the presence of rejection using SPSS 21.0 program. RESULTS: A total of 50 patients, 34 (68%) males, 16 (32%) females, with an average 31.7 ± 9.9 years, weight of 64.91 ± 13.84 kg, size 1.60 ± 0.10 m and 24.97 ± 4.07 BMI were included,39 (78%) living donor and 11 (22%) cadaveric. Twenty-six (52%) showed inflammation in the biopsy and 24 (48%) showed none. Mean creatinine was 1.81 ± 1.5, and the estimated glomerular filtration rate (eGFR) was 55.27 ± 22.46, 65.76 ± 26.7. (MDRD and CKD-EPI, respectively). No statistical difference was found in the levels of IL-10 and IFN-γ using analysis of variance. (ANOVA; P = .467 and P = .063, respectively) Based on Banff, the inflammation on biopsy score was 2.78 ± 2.84. There was statistical significance (P < .05) with respect to the Cr and eGFR by different equations. There were no significant interactions between cytokine levels and more than 1 factor. (as indicated by P < .2). DISCUSSION AND CONCLUSIONS: No significant differences were observed in the level of interleukins in patients with and without inflammation, denoting an adequate immunosuppression in most of these patients. Determination of inflammatory cytokines in urine could be used as a determinant of a good immunosuppression status, rather than as an early marker of rejection.

Highly Sensitive DNA Sensor Based on Upconversion Nanoparticles and Graphene Oxide.

In this work we demonstrate a DNA biosensor based on fluorescence resonance energy transfer (FRET) between NaYF4:Yb,Er nanoparticles and graphene oxide (GO). Monodisperse NaYF4:Yb,Er nanoparticles with a mean diameter of 29.1 ± 2.2 nm were synthesized and coated with a SiO2 shell of 11 nm, which allowed the attachment of single strands of DNA. When these DNA-functionalized NaYF4:Yb,Er@SiO2 nanoparticles were in the proximity of the GO surface, the π-π stacking interaction between the nucleobases of the DNA and the sp(2) carbons of the GO induced a FRET fluorescence quenching due to the overlap of the fluorescence emission of the NaYF4:Yb,Er@SiO2 and the absorption spectrum of GO. By contrast, in the presence of the complementary DNA strands, the hybridization leads to double-stranded DNA that does not interact with the GO surface, and thus the NaYF4:Yb,Er@SiO2 nanoparticles remain unquenched and fluorescent. The high sensitivity and specificity of this sensor introduces a new method for the detection of DNA with a detection limit of 5 pM.

Reproducible model to perform kidney transplantation in a low-resource population.

BACKGROUND: In several countries, organ transplantation is limited. We describe the implementation of a model to perform kidney transplantation in a low-resource population through a financial mechanism sharing public, patient, and private foundations funds. METHODS: This was a cohort study of 100 low-resource patients undergoing renal transplantation at the Hospital General of México. The mean age of the transplanted population was 30.07 ± 11.4 years, from which 84% reported an income <400 USD/month. Ninety percent of grafts were obtained from live donors. RESULTS: The survival rate at 1 year after the procedure was 98%. Patient rehabilitation after transplantation included the incorporation of individuals into productive life and work. The economically active population increased from 8% to 40% after the transplant procedure. The model was successfully implemented as the result of (i) adequate incorporation of medical staff with solid experience in organ transplantation; (ii) institutional public policy and collaboration between diverse services to support donors and receptors; and (iii) financial collaboration to attract resources and funds to guarantee access to immunosuppressants. CONCLUSIONS: Our results led toward an operational, reproducible model for transplanting patients in developing and financial crisis countries, reflecting beneficial long-lasting effects on the patient from the therapeutic, clinical, and economic points of view.

Synthesis and characterization of biocatalytic γ-Fe2O3@SiO2 particles as recoverable bioreactors.

In this work, we present a suitable methodology to produce magnetically recoverable bioreactors based on enzymes, which are covalently attached on the surface of iron oxide@silica nanoparticles. In order to produce this system, iron oxide clusters with a mean diameter of 68 nm were covered with silica. This strategy yields spherical γ-Fe2O3@SiO2 cluster@shell nanoparticles with a mean diameter of 200 nm which present magnetic responsiveness and enhanced stability. The surface of these nanoparticles was modified into two steps with the aim to obtain carboxylic functional groups, which were activated to react with the enzyme glucose oxidase (GOx) that was thus immobilized on the surface of the nanoparticles. The objective of this chemistry at the nanoparticles interface is to produce magnetic-responsive bioreactors. The enzymatic activity was evaluated by using the recoverable bioreactors as part of an amperometric biosensor. These measurements allowed determining the stability, catalytic activity and the amount of enzyme immobilized on the surface of the nanoparticles. Furthermore, the functionalized nanoparticles can be recovered by applying an external magnetic field, which allows them to be employed in chemical processes where the recovery of the biocatalyst is important.

Detection of a new variant of the mitochondrial glycerol-3-phosphate dehydrogenase gene in Spanish type 2 DM patients.

To evaluate if potential defects in the FAD-binding domain of the mitochondrial glycerol-3-phosphate dehydrogenase (mGPDH) gene could contribute to susceptibility to type 2 diabetes mellitus, we have screened 151 type 2 DM patients for mutations using PCR single-strand conformational polymorphism. Both a single substitution (T to A) at position 18 and a 6-base-pair deletion (TTTTAA) at position 26 of intron 3 have been detected in five type 2 DM patients and in one control subject. The evolution time of diabetes was longer in patients with these mutations than in patients without (24.2 +/- 11.1 vs 12.6 +/- 8.7 years, p < 0.02). These mutations generate a cryptic site that may have functional significance in the correct mechanism of the FAD-binding domain. In the process of PCR amplification of the mGPDH gene we also unexpectedly amplified the mGPDH retropseudogene. Subsequently, we decided to further characterize and completely sequence 2213 bp of this mGPDH retropseudogene. Our results suggest that two previously reported mGPDH pseudogene partial sequences may be identical copies of the mGPDH gene inserted in two different genomic locations and provide information about the alternative 5'- and 3'-untranslated regions. The data obtained are also important in order to avoid artifactual amplification of the mGPDH pseudogene in the process of screening for mGPDH mutations in diabetic patients.

[Acute lower massive digestive hemorrhage due to a jejunal angiomatoid hamartoma. Case report]. / Hemorragia digestiva baja aguda masiva debida a hamartoma angiomatoide yeyunal. Aportación de un caso.

Acute hemorrhage of the lower digestive tract is massive in 20% of the cases, requiring emergency surgery. In such cases, a preoperative diagnosis of the point of bleeding is essential. In order to determine this, any combination of oral panendoscopy, rectal sigmoidoscopy, colonoscopy, arteriography and isotopic studies should be used. The most frequent causes are right colonic angiodysplasia and colonic diverticulosis. The authors present a case of lower digestive bleeding due to an angiomatoid hamartoma located in the first jejunal segments, a rare pathology as a cause of hemorrhage. The diagnosis was obtained by selective arteriography. Oral panendoscopy and colonoscopy were also performed.

Carriage of Neisseria meningitidis and Neisseria lactamica in a school population during an epidemic period in Spain.

A study was made of the incidence of Neisseria meningitidis and N. lactamica in a school population; 2470 children aged between 5 and 7 years were studied from four schools in Alcala de Henares (Madrid). Nasopharyngeal swabs were taken in June, November and March, between 1979 and 1983. In all the surveys except one, the proportion of carriers of N. lactamica was higher than that of N. meningitidis, reaching a ratio of about 2:1 in the complete study. The predominant serogroup of meningococcus found was B (41%), with nongroupable strains reaching 43%. A study of serotypes within group B showed a predominance of nontypable strains (48.5%), while those strains considered to be most virulent (types 2 and 1, 8, 15) reached 40%. Eighteen per cent of N. lactamica strains were observed to agglutinate with antimeningococcal sera whilst the remainder of the strains were rough. When these strains were studied with the antiserum-agar technique, using antimeningococcal sera, a high percentage of strains cross-reacted with the meningococci. The susceptibility of strains to sulphadiazine, penicillin, ampicillin, chloramphenicol, rifampicin and spiramycin was determined. Finally an analysis was made of the effect that an elevated colonization rate of N. lactamica might have on colonization by meningococci. The necessity of using fine epidemiological markers in tracing virulent strains in a population at risk is stressed. Selective prophylactic measures are also necessary.

[The cost of measles in Spain]. / Contribución al estudio de costos del sarampión en España.

With the purpose of obtaining information useful to plan massive measles vaccination campaigns in this country two retrospective surveys were carried out to evaluate cost of care as well as age and seasonal distribution of measles in Spain. Two samples made of 1.781 and 701 school-children, living in a 137.000 inhabitants city and representative of the industrial, construction and services sectors of the spanish population (81.920 of it), were interviewed. The mean cost of care per case was of 8.252 pts. Before six years of age 92% of the individuals studied had had measles, 51% of them between March and May. Between 20 and 24% of patients were 24 months old or less; among the latter group age distribution was the following 50% below 12 months, 35% between 12 and 18 months and 15% between 18 and 24 months.

[Pharyngeal carriers of Neisseria meningitidis and N. lactamica in childhood]. / Portadores faríngeos de "Neisseria meningitidis" y N. lactámica en el niño.

A prospective study was undertaken with the purpose of finding out the proportion of pharyngeal carriers of N. meningitidis and N. lactamica among our infantile school population. Seven groups constituted by, approximately, 200 infants each, were studied along two years. Samples were taken in two different schools, for each each group, at a period of average incidence (February, April, June and October). Infants were between five and six years of age and made a total of 1,315 individuals, which we consider representative of our school infantile population. Positivity for N. lactamica was around 20%, whereas 10% of infants were carriers of N. meningitidis. Among the latter 56% were group B, 15% group Y, 5% group A and 20% agglutinated spontaneously. The remainder fell into several serogroups (10 unclassifiable, six 29E and one each, X, W135 and Z). Concerning group B serotypes, except for 22 not typable cases, most carriers were serotype 2, while the remainder were distributed in seven other serotypes. These findings are comparable to those seen in the population with clinical disease. However the number of carriers remained constant and, in contrast to what happened with clinical patients, was unrelated to seasonal variations. Resistance of N. meningitidis to chemotherapy was the following: sulfadiazine 100%, ampicillin 19%, rifampicin 20% and penicillin 0%. The latter can not be considered a good choice in prophylaxis.