[Clinical characteristics and prognosis of Staphylococcus aureus bacteremia]. / Características clínicas, pronóstico y factores asociados de la bacteriemia por Staphylococcus aureus en la actualidad.

OBJECTIVE: Staphylococcus aureus bacteremia patients characteristics at a tertiary hospital are described, and complications, mortality and associated factors are analyzed. METHODS: Data from patients with S. aureus bacteremia admitted between March 2020 and February2021 at Miguel Servet university hospital in Zaragoza were retrospectively analyzed. RESULTS: Results showed a 14 days mortality of 24.2% and an 30 days mortality of 40%. Overall survival decreased with complications appearance [HR 3.1 (1.2-8.05)] and age over 65 years [HR 3.1 (1.4-6.6)]. The adjusted analysis showed correlation between a higher mortality at 14 and 30 days with age over 65 years [OR 6.3 (1.7-23.1)], sepsis presence [OR 19.3 (5.4-68.7)] and number of positive (+) blood cultures ≥3 [OR 5.4 (0.8-34.1)]. Mortality at 14 days was associated with sepsis presence [OR 58.2 (5.7-592.9)], number of positive (+) blood cultures ≥3 [OR 14.1 (1.1-173.7)] and an older age [OR 1.1 (1.03-1.1)]. Analyzing time to positive blood cultures ≤12 hours and number of positive blood cultures ≥ 3 at the same time, frequency of sepsis increased [30 patients (66.6%) vs 15 patients (33.3%); OR 3.4 (IC95% 1.5-8)]. CONCLUSIONS: High 14- and 30-days mortality were found, as well as a worse evolution in older age patients, with sepsis presence, and with greater number of positive blood cultures and times to positive blood cultures ≤12 h.

[Impact of Staphylococcus aureus bacteremia in COVID-19 patients]. / Impacto de la bacteriemia por Staphylococcus aureus en pacientes con COVID-19.

OBJECTIVE: The disease caused by SARS-CoV-2 (COVID-19) has been a challenge for healthcare professionals since its appearance. Staphylococcus aureus has been described as one of the main pathogens causing bacterial infections in viral pandemics. However, co- infection with S. aureus causing bacteremia in patients with COVID-19 has yet to be well studied. METHODS: We performed a e study of S. aureus bacteremia (SAB) at Hospital Miguel Servet (Zaragoza) from March 2020 to February 2021. The clinical characteristics, mortality and risk factors of adults hospitalized patients with BSA associated COVID-19 compared to patients without COVID-19. RESULTS: A total of 95 patients with SAB were identified. 27.3% were positive for SARS-CoV-2. SAB represented 9.9% of bacteremia, being the second agent in frequency after E. coli. Nosocomial bacteremia was more frequent in the group of COVID-19 patients. The most frequent source of BSA in these patients was the respiratory source (26.9% vs 0%; P<0.001) followed by the skin (15.5% vs 15.9%; P=1). The development of sepsis was more frequent in COVID-19 patients (61,5% vs 7,8%; P=0,336) and among them, who received dexamethasone at doses > 6 mg/day (62.5% vs. 37.5%, P<0.05). CONCLUSIONS: Our data suggest that BSA has a negative impact on the evolution of patients with COVID-19. However, further and preferably prospective studies are required to obtain solid data on the impact of BSA on coronavirus patients.

Características clínicas de enfermedad vascular prematura en un área de salud / Clinical characteristics of premature cardiovascular disease in our health area

Introducción y objetivos La enfermedad cardiovascular sigue siendo la principal causa de mortalidad, pero se disponen de pocos datos en población joven. El objetivo de nuestro estudio fue conocer la incidencia y características clínicas de la enfermedad cardiovascular prematura en nuestra área de salud. Métodos Estudio trasversal de pacientes ingresados por episodio agudo de enfermedad cardiovascular prematura en un hospital de referencia durante 2018. Resultados Se detectó a 367 sujetos: 306 (83,4%) con enfermedad cardiovascular aterosclerótica. Casi la mitad (164, 44,7%) eran diabéticos, con hipercolesterolemia primaria o alto riesgo cardiovascular, y 84 (22,9%) tenían antecedentes personales de enfermedad cardiovascular. De entre aquellos con riesgo elevado o antecedentes (n=207), solo 47 sujetos tenían colesterol LDL en objetivo terapéutico. Conclusiones La mayoría de los sujetos con enfermedad cardiovascular prematura de nuestro estudio presentaron mayor riesgo cardiovascular del atribuible a su edad. El diagnóstico y el tratamiento intensivo de los factores de riesgo cardiovascular pueden prevenir la enfermedad cardiovascular en adultos jóvenes (AU)

Introduction and objectives Cardiovascular disease continues to be the main cause of mortality, but few data are available in the young population. The aim of our study was to know the incidence and clinical characteristics of premature cardiovascular disease in our health area. Methods Cross-sectional study of patients admitted for acute episode of premature cardiovascular disease in a referral hospital during 2018. Results We detected 367 subjects: 306 (83.4%) with atherosclerotic cardiovascular disease. Almost half (164, 44.7%) were diabetic, with primary hypercholesterolaemia or high cardiovascular risk, and 84 (22.9%) had a personal history of cardiovascular disease. Among those with elevated risk or history (n=207) only 47 subjects had LDL cholesterol at therapeutic target. Conclusions Most of the subjects with premature cardiovascular disease in our study had higher cardiovascular risk than attributable to their age. Intensive diagnosis and treatment of cardiovascular risk factors may prevent cardiovascular disease in young adults (AU)

Clinical characteristics of premature cardiovascular disease in our health area.

INTRODUCTION AND OBJECTIVES: Cardiovascular disease continues to be the main cause of mortality, but few data are available in the young population. The aim of our study was to know the incidence and clinical characteristics of premature cardiovascular disease in our health area. METHODS: Cross-sectional study of patients admitted for acute episode of premature cardiovascular disease in a referral hospital during 2018. RESULTS: We detected 367 subjects: 306 (83.4%) with atherosclerotic cardiovascular disease. Almost half (164, 44.7%) were diabetic, with primary hypercholesterolaemia or high cardiovascular risk, and 84 (22.9%) had a personal history of cardiovascular disease. Among those with elevated risk or history (n = 207) only 47 subjects had LDL cholesterol at therapeutic target. CONCLUSIONS: Most of the subjects with premature cardiovascular disease in our study had higher cardiovascular risk than attributable to their age. Intensive diagnosis and treatment of cardiovascular risk factors may prevent cardiovascular disease in young adults.

Clinical management of cUTI, cIAI, and HABP/VABP attributable to carbapenem-resistant Gram-negative infections in Spain.

OBJECTIVE: Carbapenem-resistant Gram-negative (CRGN) infections are a major public health problem in Spain, often implicated in complicated, healthcare-associated infections that require the use of potentially toxic antibacterial agents of last resort. The objective of this study was to assess the clinical management of complicated infections caused by CRGN bacteria in Spanish hospitals. METHODS: The study included: 1) a survey assessing the GN infection and antibacterial susceptibility profile in five participating Spanish hospitals and 2) a non-interventional, retrospective single cohort chart review of 100 patients with complicated urinary tract infection (cUTI), complicated intra-abdominal infection (cIAI), or hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia (HABP/VABP) attributable to CRGN pathogens. RESULTS: In the participating hospitals CRGN prevalence was 9.3% amongst complicated infections. In the retrospective cohort, 92% of infections were healthcare-associated, and Klebsiella pneumoniae and Pseudomonas aeruginosa were the most common pathogens. OXA was the most frequently detected carbapenemase type (71.4%). We found that carbapenems were frequently used to treat cUTI, cIAI, HABP/VABP caused by CRGN pathogens. Carbapenem use, particularly in combination with other agents, persisted after confirmation of carbapenem resistance. Clinical cure was 66.0%, mortality during hospitalization 35.0%, mortality at the time of chart review 62.0%, and 6-months-post-discharge readmission 47.7%. CONCLUSIONS: Our results reflect the high burden and unmet needs associated with the management of complicated infections attributable to CRGN pathogens in Spain and highlight the urgent need for enhanced clinical management of these difficult-to-treat infections.

Spanish and Portuguese Societies of Internal Medicine consensus guideline about best practice in end-of-life care.

AIM: To develop consensus recommendations about good clinical practice rules for caring end-of-life patients. METHODS: A steering committee of 12 Spanish and Portuguese experts proposed 37 recommendations. A two rounds Delphi method was performed, with participation of 105 panelists including internists, other clinicians, nurses, patients, lawyers, bioethicians, health managers, politicians and journalists. We sent a questionnaire with 5 Likert-type answers for each recommendation. Strong consensus was defined when >95% answers were completely agree or >90% were agree or completely agree; and weak consensus when >90% answers were completely agree or >80% were agree or completely agree. RESULTS: The panel addressed 7 specific areas for 37 recommendations spanning: identification of patients; knowledge of the disease, values and preferences of the patient; information; patient's needs; support and care; palliative sedation, and after death care. CONCLUSIONS: The panel formulated and provided the rationale for recommendations on good clinical practice rules for caring end-of-life patients.

Guía de práctica clínica de consenso sobre buenas prácticas en los cuidados al final de la vida de las Sociedades Española y Portuguesa de Medicina Interna / Spanish and Portuguese Societies of Internal Medicine consensus guideline about best practice in end-of-life care

Objetivo Establecer recomendaciones de consenso sobre normas de buena práctica clínica en la atención a los pacientes al final de la vida. Métodos Un comité de 12 expertos españoles y portugueses propuso 37 recomendaciones. Se realizó un Proceso Delphi a dos rondas, con participación de 105 panelistas incluyendo internistas, otros médicos clínicos, enfermeras, enfermos, juristas, expertos en bioética, gestores sanitarios, políticos y periodistas. Para cada recomendación se envió un cuestionario con cinco respuestas tipo Likert. Se definió consenso fuerte cuando > 95% de las respuestas estaban totalmente de acuerdo o > 90% estaban de acuerdo y totalmente de acuerdo; consenso débil cuando > 90% estaban totalmente de acuerdo o > 80% estaban de acuerdo y totalmente de acuerdo. Resultados El panel abordó siete áreas específicas con 37 recomendaciones que abarcaban: Identificación de los pacientes; Conocimiento, valores y preferencias del paciente; Información; Necesidades del paciente; Atención y cuidados; Sedación paliativa y Atención tras la muerte. Conclusiones Un Proceso Delphi con participación multidisciplinar ha permitido establecer normas de buena práctica clínica en la atención al final de la vida con consenso de enfermos, agentes sociales y profesionales sanitarios (AU)

Aim To develop consensus recommendations about good clinical practice rules for caring end-of-life patients. Methods A steering committee of 12 Spanish and Portuguese experts proposed 37 recommendations. A two rounds Delphi method was performed, with participation of 105 panelists including internists, other clinicians, nurses, patients, lawyers, bioethicians, health managers, politicians and journalists. We sent a questionnaire with 5 Likert-type answers for each recommendation. Strong consensus was defined when > 95% answers were completely agree or > 90% were agree or completely agree; and weak consensus when > 90% answers were completely agree or > 80% were agree or completely agree. Results The panel addressed 7 specific areas for 37 recommendations spanning: identification of patients; knowledge of the disease, values and preferences of the patient; information; patient's needs; support and care; palliative sedation, and after death care Conclusions The panel formulated and provided the rationale for recommendations on good clinical practice rules for caring end-of-life patients (AU)

Spanish and Portuguese Societies of Internal Medicine consensus guideline about best practice in end-of-life care. / Guía de práctica clínica de consenso sobre buenas prácticas en los cuidados al final de la vida de las Sociedades Española y Portuguesa de Medicina Interna.

AIM: To develop consensus recommendations about good clinical practice rules for caring end-of-life patients. METHODS: A steering committee of 12 Spanish and Portuguese experts proposed 37 recommendations. A two rounds Delphi method was performed, with participation of 105 panelists including internists, other clinicians, nurses, patients, lawyers, bioethicians, health managers, politicians and journalists. We sent a questionnaire with 5 Likert-type answers for each recommendation. Strong consensus was defined when > 95% answers were completely agree or > 90% were agree or completely agree; and weak consensus when > 90% answers were completely agree or > 80% were agree or completely agree. RESULTS: The panel addressed 7 specific areas for 37 recommendations spanning: identification of patients; knowledge of the disease, values and preferences of the patient; information; patient's needs; support and care; palliative sedation, and after death care. CONCLUSIONS: The panel formulated and provided the rationale for recommendations on good clinical practice rules for caring end-of-life patients.

Effect of the aeration system on the levels of airborne microorganisms generated at wastewater treatment plants.

Six different wastewater treatment plants were monitored in order to identify the main bioaerosol sources and to evaluate the effect of the aeration system used in the biological treatment (air diffusion, horizontal rotors and surface turbine aerators) on the airborne microorganism levels to which workers may be exposed. Air samples were collected by using a single stage impactor. Total count of mesophilic bacteria was used as the monitoring parameter to compare the impact of the aeration system on generic bacterial bioaerosols rather than a quantitative estimation for pathogens or fecal indicator microbes. In this study, pre-treatment, biological treatment and sludge thickening were the processes that generated the highest amount of bioaerosols. Aeration systems involving mechanical agitation of the wastewater, such as horizontal rotors and surface turbines, generated a larger amount of bioaerosols (between 450 and 4580CFU/m(3)) than air diffuser aerators (between 22 and 57CFU/m(3)). The levels of airborne bacteria generated by air diffusers were very similar to those registered at the background locations (lower than 50CFU/m(3)), unaffected by the activities taking place in the wastewater treatment plant. The use of air diffusers as an aeration system for the biological treatment would significantly minimise the potential biological hazard that wastewater treatment plant workers may be exposed to.

Pattern of arborization of the motor nerve terminals in the fast and slow mammalian muscles.

A silver impregnation method and a morphometric approach were used to define differences existing in the motor nerve terminal branching pattern between a fast-twitch muscle (extensor digitorum longus) and a slow-twitch one (soleus) of the normal adult rat. Because no single measure can describe precisely all geometrical properties (ie both topology and metrics) of the nerve terminals, we evaluated morphologic parameters defining length and angular characteristics in the different terminal segments classified according to their centrifugal order. The main results indicate that the distal free-end segments in the extensor digitorum longus muscle are shorter and less divergent than in the soleus nerve terminals. The endings in the two muscles have different fractal dimensions. Findings are discussed in the context of the hypothetical mechanisms governing motor nerve terminal size and complexity.

Branching pattern of the motor nerve endings in a skeletal muscle of the adult rat.

We have performed a morphometric analysis of the branching pattern of the rat sternomastoid motor nerve terminals in normal and regenerated singly-innervated synaptic areas, in junctions with an accessory ending and also in dually-innervated synaptic areas. We tried to seek measurable differences related to the terminal complexity and size in these different situations. The number of sole-plate nuclei is always significantly correlated with the nerve terminal parameters and unrelated to the muscle cell diameter. A significant correlation between the terminal complexity and the postsynaptic size is found only in the smallest endings whereas correlation is lost with the increase in nerve terminal complexity. In normal singly-innervated areas, the mean length of the distal free-end segments of the terminal arborisation becomes reduced with the increase in complexity of the terminals, whereas the mean length of the segments between branching points and the mean angle of branch emergence is, on average, constant. Whereas the accessory endings show the same branching pattern as the endings during the initial days of regeneration, the parent ending can be considered as a miniature version of the endings in normal singly-innervated junctions. In dually-innervated areas, the smallest endings show a similar branching pattern to the accessory endings and the endings during the initial process of reinnervation, whereas the larger endings show a significant reduction in the length of the distally placed segments compared to the normal endings in singly-innervated areas. Results indicate that the terminal branching pattern is not haphazard but, on the contrary, general rules and tendencies can be measured.

Motor nerve terminal morphologic plasticity induced by small changes in the locomotor activity of the adult rat.

The possible existence of plastic changes in the branching pattern and the complexity of silver-impregnated motor nerve terminals was studied in the extensor digitorum longus muscle of adult rats housed in metabolic cages or trained to walk. Results indicate a precise inverse relation between the amount of locomotor activity and the complexity finally attained by the motor nerve terminals.