The combination of MDPV and ethanol results in decreased cathinone and increased alcohol levels. Study of such pharmacological interaction.

Methylenedioxypyrovalerone (MDPV) is a new psychostimulant cathinone acting as a selective dopamine transporter blocker. Due to the concomitant consumption of ethanol (EtOH) and new psychoactive substances, it is of interest to explore a possible pharmacological interaction between MDPV and EtOH. In locomotor activity assays, EtOH (1g/kg i.p.) elicited a reduction in the stimulant effect induced by low doses of MDPV (0.1-0.3mg/kg, s.c.) in rats, jointly with a decrease in blood and brain MDPV concentrations. Experiments in rat liver microsomes showed different effects depending on the [MDPV]/[EtOH] relationship, evidencing, at certain concentrations, the enhancing effect of EtOH on MDPV metabolism. These suggest that EtOH interacts with MDPV at microsomal level, increasing its metabolic rate. The interaction between both substances was also supported by results in plasma EtOH concentration, which were significantly increased by MDPV, in such a manner that EtOH elimination rate was significantly reduced. The possible toxicological impact of this phenomenon deserves further investigation. In contrast, the rewarding properties of MDPV were unaltered by EtOH. Microdialysis experiments verified that, in the NAcc, both substances could also act synergistically, in such a manner that extracellular dopamine concentrations are maintained. Finally, if the psychostimulant effect induced by MDPV decreased with EtOH, it could favor the boosting and re-dosing in search of the desired effects. However, as the rewarding effect of each dose of the substance would not decrease, the addictive liability could increase considerably. Moreover, we must warn about the increase in EtOH concentrations when consumed concomitantly with MDPV.

Sustainability Assessment of indicators for integrated water resources management.

The scientific community strongly recommends the adoption of indicators for the evaluation and monitoring of progress towards sustainable development. Furthermore, international organizations consider that indicators are powerful decision-making tools. Nevertheless, the quality and reliability of the indicators depends on the application of adequate and appropriate criteria to assess them. The general objective of this study was to evaluate how indicators related to water use and management perform against a set of sustainability criteria. Our research identified 170 indicators related to water use and management. These indicators were assessed by an international panel of experts that evaluated whether they fulfil the four sustainability criteria: social, economic, environmental, and institutional. We employed an evaluation matrix that classified all indicators according to the DPSIR (Driving Forces, Pressures, States, Impacts and Responses) framework. A pilot study served to test and approve the research methodology before carrying out the full implementation. The findings of the study show that 24 indicators comply with the majority of the sustainability criteria; 59 indicators are bi-dimensional (meaning that they comply with two sustainability criteria); 86 are one-dimensional indicators (fulfilling just one of the four sustainability criteria) and one indicator do not fulfil any of the sustainability criteria.

An antimicrobial stewardship program reduces antimicrobial therapy duration and hospital stay in surgical wards.

We report a quasi-experimental study of the implementation of an antimicrobial stewardship program in two surgical wards, with a pre-intervention period with just assessment of prescription and an intervention period with a prospective audit on antibiotic prescription model. There was a significant reduction of length of stay and the total days of antimicrobial administration. There were no differences in mortality between groups. The antimicrobial stewardship program led to the early detection of inappropriate empirical antibiotic treatment and was associated with a significant reduction in length of stay and the total duration of antimicrobial therapy.

Microbial communities from different types of natural wastewater treatment systems: vertical and horizontal flow constructed wetlands and biofilters.

The prokaryotic microbial communities (Bacteria and Archaea) of three different systems operating in Denmark for the treatment of domestic wastewater (horizontal flow constructed wetlands (HFCW), vertical flow constructed wetlands (VFCW) and biofilters (BF)) was analysed using endpoint PCR followed by Denaturing Gradient Gel Electrophoresis (DGGE). Further sequencing of the most representative bacterial bands revealed that diverse and distinct bacterial communities were found in each system unit, being γ-Proteobacteria and Bacteroidetes present mainly in all of them, while Firmicutes was observed in HFCW and BF. Members of the Actinobacteria group, although found in HFCW and VFCW, seemed to be more abundant in BF units. Finally, some representatives of α, ß and δ-Proteobacteria, Acidobacteria and Chloroflexi were also retrieved from some samples. On the other hand, a lower archaeal diversity was found in comparison with the bacterial population. Cluster analysis of the DGGE bacterial band patterns showed that community structure was related to the design of the treatment system and the organic matter load, while no clear relation was established between the microbial assemblage and the wastewater influent.

A new microtitre plate screening method for evaluating the viability of aerobic respiring bacteria in high surface biofilms.

AIMS: It is difficult to determine the effects of bactericidal compounds against bacteria in a biofilm because classical procedures for determining cell viability require several working days, multiple complicated steps and are frequently only applicable to cells in suspension. We attempt to develop a compact, inexpensive and versatile system to measure directly the extent of biofilm formation from water systems and to determine the viability of respiring bacteria in high surface biofilms. METHODS AND RESULTS: It has been reported that the reduction of tetrazolium sodium salts, such as XTT (sodium 3,3'-[1-[(phenylamino)carbonyl]-3,4-tetrazolium]Bis(4-methoxy)-6-nitro)benzene sulfonic acid hydrate), during active bacterial metabolism can be incorporated into a colorimetric method for quantifying cell viability. XTT is reduced to a soluble formazan compound during bacterial aerobic metabolism such that the amount of formazan generated is proportional to the bacterial biomass. CONCLUSIONS: We show here, for the first time, that this colorimetric approach can be used to determine the metabolic activity of adherent aerobic bacteria in a biofilm as a measure of cell viability. This technique has been used to estimate viability and proliferation of bacteria in suspension, but this is the first application to microbial communities in a real undisturbed biofilm. SIGNIFICANCE AND IMPACT OF THE STUDY: This simple new system can be used to evaluate the complex biofilm community without separating the bacteria from their support. Thus, the results obtained by this practice may be more representative of the circumstances in a natural system, opening the possibility to multiple potential applications.

[Cellulase treatment in 3 cases of large phytobezoars]. / Tratamiento con celulasa en 3 casos de fitobezoares de gran tamaño.

INTRODUCTION: A bezoar is a hard mass of undigested foreign matter found in the gastrointestinal system. The most common type is the phytobezoar, which is composed of vegetable fibres. There is no current consensus as to its treatment. Three cases of phytobezoars treated with cellulase are described. PATIENTS AND METHOD: Case 1: patient with large gastric phytobezoar. Initial treatment with nasogastric cola drink lavages was ineffective. Subsequent treatment with cellulase was successful. Case 2: patient with gastric phytobezoar who was treated with cellulase and metoclopramide. Definitive fragmentation was performed with the endoscopy technique. Case 3: patient with large intestinal phytobezoar. The patient was treated by endoscopic lysis with partial success. Subsequent treatment with cellulase led to complete disintegration. In all the cases, cellulase was administered in pure form by nasogastric tube, and none of the patients suffered adverse effects. CONCLUSIONS: Treatment with cellulase is based on the enzymatic degradation of the bezoar. It has been shown to be effective as the treatment of choice in earlier studies with few patients. This agent seems to be a good alternative for patients with large phytobezoars.

Tratamiento con celulasa en 3 casos de fitobezoares de gran tamaño / Cellulase treatment in 3 cases of large phytobezoars

Introducción: Los bezoares son concreciones de material extraño no digerido localizadas en el tracto gastrointestinal. Los más comunes son los fitobezoares, formados por restos vegetales. Actualmente no hay consenso sobre su tratamiento. Se describen 3 casos de fitobezoares tratados con celulasa. Pacientes y método: El caso 1 es un paciente con fitobezoar gástrico de grandes dimensiones. Se trató inicialmente con lavados de bebida de cola por sonda nasogástrica, pero resultó inefectivo. El tratamiento posterior con celulasa tuvo éxito. El caso 2 es un paciente con fitobezoar gástrico que se trató con celulasa y metoclopramida. La fragmentación definitiva se realizó mediante técnica endoscópica. Y el caso 3 es un paciente con un gran fitobezoar intestinal. Se trató mediante lisis endoscópica, que tuvo un éxito parcial. Posteriormente recibió celulasa y la disgregación fue completa. En todos los casos se administró celulasa como sustancia pura por sonda nasogástrica y ningún paciente presentó efectos adversos. Conclusiones: La terapia con celulasa se basa en la degradación enzimática del bezoar. Ha demostrado eficacia como tratamiento de primera elección en estudios previos de pocos pacientes. Este agente parece una buena alternativa en pacientes con fitobezoares de gran tamaño (AU)

Introduction: A bezoar is a hard mass of undigested foreign matter found in the gastrointestinal system. The most common type is the phytobezoar, which is composed of vegetable fibres. There is no current consensus as to its treatment. Three cases of phytobezoars treated with cellulase are described. Patients and method: Case 1: patient with large gastric phytobezoar. Initial treatment with nasogastric cola drink lavages was ineffective. Subsequent treatment with cellulase was successful. Case 2: patient with gastric phytobezoar who was treated with cellulase and metoclopramide. Definitive fragmentation was performed with the endoscopy technique. Case 3: patient with large intestinal phytobezoar. The patient was treated by endoscopic lysis with partial success. Subsequent treatment with cellulase led to complete disintegration. In all the cases, cellulase was administered in pure form by nasogastric tube, and none of the patients suffered adverse effects. Conclusions: Treatment with cellulase is based on the enzymatic degradation of the bezoar. It has been shown to be effective as the treatment of choice in earlier studies with few patients. This agent seems to be a good alternative for patients with large phytobezoars (AU)

Effects of glucocorticoids in ventilated piglets with severe pneumonia.

There is clinical evidence suggesting that glucocorticoids may be useful in severe pneumonia, but the pathogenic mechanisms explaining these beneficial effects are unknown. The aim of the present study was to determine the effects of adding glucocorticoids to antibiotic treatment in an experimental model of severe pneumonia. In total, 15 Lagerwhite-Landrace piglets were ventilated for 96 h. After intubation, a 75 mL solution containing Pseudomonas aeruginosa (10(6) cfu x mL(-1)) was bronchoscopically inoculated. The animals were randomised into three groups 12 h after inoculation: 1) untreated; 2) treated with ciprofloxacin; and 3) treated with ciprofloxacin plus methylprednisolone. Physiological and laboratory parameters were monitored throughout the study. Pro-inflammatory cytokines were measured in serum and bronchoalveolar lavage (BAL). Histopathology of the lungs and cultures from blood, BAL and lungs were performed. At the end of the study, piglets receiving the antibiotic plus glucocorticoids showed: 1) a decrease in the concentration of interleukin-6 in BAL; and 2) a decrease in the global bacterial burden both in BAL and lung tissue. In conclusion, in this experimental model of pneumonia, the association of glucocorticoids with antibiotics attenuates local inflammatory response and decreases bacterial burden in the lung.

Experimental Pseudomonas aeruginosa pneumonia: evaluation of the associated inflammatory response.

An abnormal inflammatory response (IR) in pneumonia is associated with poor outcomes and high mortality. Animal models could help to better understand the relationship between the pulmonary infection and the associated IR. The aims of the present study were to validate an experimental model of pneumonia induced by the inoculation of Pseudomonas aeruginosa in ventilated piglets and to study the associated IR over a long period of time (96 h). Five Lagerwhite-Landrace piglets were ventilated for 4 days. After intubation, a solution containing 75 mL of P. aeruginosa (10(6) colony-forming units.mL(-1)) was bronchoscopically inoculated. Physiological and laboratory parameters were monitored throughout the study. Pro-inflammatory cytokines were measured in serum and in bronchoalveolar lavage (BAL). Histopathology of the lungs and cultures from blood, BAL and lungs were performed. All the animals developed histopathological evidence of pneumonia. Microbiological studies of both BAL and lung confirmed the presence of P. aeruginosa in all the samples. Throughout the study, an increase in interleukin-6 was observed in serum and in BAL. In conclusion, the experimental model of pneumonia induced by the inoculation of high concentrations of Pseudomonas aeruginosa in ventilated piglets is feasible and could be appropriate for the evaluation of different aspects of the associated inflammatory response.

[Cardiovascular risk and glucose metabolism: agreements and discrepancies between the WHO-85 and ADA-97 classifications]. / Riesgo cardiovascular y metabolismo de la glucosa: acuerdos y discrepancias entre las clasificaciones OMS-85 y ADA-97.

UNLABELLED: AIM. To identify the differences between coronary heart disease risk in patients with altered basal glucemia (ABG), oral glucose intolerance (OGI) and type II diabetes mellitus according to the WHO-85 and ADA-97 diagnostic classifications, in an adult population at high risk for diabetes mellitus. DESIGN: Descriptive, cross-sectional, multicenter study.Setting. Seven primary health care centers in Spain.Patient. 970 persons considered the population at risk for type II diabetes mellitus. MEASURES: Participants were classified according to the criteria of the WHO-85 (normal, OGI, diabetes) and the ADA-97 system (normal, ABG, diabetes). The following variables were recorded: age, sex, smoking habit, body mass index, systolic blood pressure, diastolic blood pressure, basal glucemia, glucemia 2 h after an oral glucose tolerance test, HbA1c, microalbmuniuria, total cholesterol, HDL, LDL and triglycerides. Coronary heart disease risk was calculated with the 1998 table developed by Wilson et al. on the basis of the Framingham study. RESULTS: A total of 970 participants were studied. Mean age was 58.6 #+ 12.4 years; 453 were men (46.7%) and 517 were women (53.3%). Our analysis showed that cardiovascular disease risk factors were less frequent in normal subjects, and that their prevalence was higher in persons with diabetes (according to both WHO and ADA classifications). There were no significant differences in coronary heart disease risk or different risk factors between analogous groups in the two classification systems (normal, OGI/ABG or diabetes). Coronary heart disease risk in persons with different types of alterations in glucose metabolism was 11.3% in normal subjects, 14% in persons with OGI and 27.3% in persons with diabetes according to the WHO-85 system, and 11.4% in normal subjects, 15.7% in persons with ABG and 29.5% in persons with diabetes according to the ADA-97 system. CONCLUSIONS: The greater the alteration in carbohydrate metabolism, the greater the coexistence of risk factors and the estimated risk of coronary heart disease. There were no significant differences in the presence of cardiovascular risk factors, or in the relationship between carbohydrate metabolism and coronary heart disease risk, between analogous stages identified with one classification system or the other.

Riesgo cardiovascular y metabolismo de la glucosa: acuerdos y discrepancias entre las clasificaciones OMS-85 y ADA-97 / Cardiovascular disease risk and glucose metabolism: agreement and discrepancies between the WHO-85 and ADA-97 classifications

Objetivo. Conocer las diferencias entre el riesgo coronario de los sujetos con glucemia basal alterada (GBA), intolerancia oral a la glucosa (ITG) y diabetes mellitus tipo 2 según las clasificaciones diagnósticas de la OMS-85 y ADA-97 en una población adulta con un riesgo alto de presentar diabetes mellitus. Diseño. Estudio descriptivo, transversal, multicéntrico. Emplazamiento. Atención primaria, 7 centros de salud. Pacientes. Un total de 970 sujetos considerados población de riesgo para diabetes mellitus tipo 2.Mediciones. Se clasificaron los sujetos según los criterios OMS-85 (normales, ITG, diabetes) y según la ADA-97 (normales, GBA y diabetes). Se recogieron las siguientes variables: edad, sexo, consumo de tabaco, índice de masa corporal, tensión arterial sistólica, tensión arterial diastólica, glucemia basal, glucemia a las 2 horas de la PTOG, HbA1c, microalbuminuria, colesterol total, cHDL, cLDL, triglicéridos y se estimó el cálculo del riesgo coronario mediante la tabla de Wilson et al de 1998, basada en el estudio Framingham. Resultados. Se evaluó a 970 sujetos con una edad media de 58,6 ñ 12,4 años, 453 varones (46,7 por ciento) y 517 mujeres (53,3 por ciento). En el análisis de la presencia de factores de riesgo cardiovascular se observa que éstos son menos frecuentes en los sujetos normales y que su prevalencia es más elevada en los diabéticos (OMS y ADA). No existen diferencias significativas entre el riesgo coronario y los diversos factores de riesgo cuando se analizan grupos homónimos OMS-ADA (normales, ITG-GBA o diabéticos). Según la clasificación de la OMS-85, el riesgo coronario en los distintos tipos de alteraciones del metabolismo de la glucosa fue un 11,3 por ciento en sujetos normales, un 14 por ciento en ITG y un 27,3 por ciento en diabéticos, y según la ADA-97 un 11,4 por ciento en sujetos normales, un 15,7 por ciento en GBA y un 29,5 por ciento en diabéticos. Conclusiones. A mayor grado de patología hidrocarbonada, mayor coexistencia de factores de riesgo y mayor estimación del riesgo coronario. No hay diferencias importantes entre los estadios de las clasificaciones OMS y ADA ni en la presencia de factores de riesgo cardiovascular ni en relación al riesgo coronario (AU)

[Prevention of thromboembolic disease in patients with heart disease]. / Profilaxis de la enfermedad tromboembólica en enfermos con cardiopatía.

OBJECTIVE: To evaluate the adequacy to thromboembolic disease prophylaxis protocol in patients with heart disease. DESIGN: Cross-sectional study. SUBJECTS: Patients older than 14 years affected of heart disease in a semi-urban health primary-care clinic with a population of 10,610 persons and 5582 clinical records. METHODS: Data about age, sex, cardiovascular risk factors, heart disease, prophylactic treatment and its adequacy to the protocol of the "thromboembolic disease commission" of the reference hospital were analysed. RESULTS: Age 67 +/- 13 years (mean +/- SD). Cardiovascular risk factors: hypertension 40%, diabetes 33%, dyslipemia 15%, smoking 21%. Heart disease: ischemic cardiopathy 48%, atrial fibrillation 15%, valvulopathy 19%, dilated myocardiopathy 4% and other 14%. In 20% of cases had two different affections (80% with atrial fibrillation). Prophylactic therapy: 52% of patients were under prophylactic treatment (35% antiaggregation, 18% anticoagulation). Among antiaggregants, drugs used were acetylsalicylic acid 73.5%, triflusal 14.7%, dipyridamole, 8.8% and ticlopidine 3%. In 53% of people without prophylactic treatment antiaggregation criteria were present. 15% of patient under antiaggregation therapy did not meet antiaggregation criteria, and 6% fulfilled anticoagulation criteria. 67% treatments accorded the reference protocol, without significant differences between kind of heart disease or sex. The only statistically significant difference was found in age: 46% of patients older than 80 year were correctly treated, in front 75% adequacy in younger people. CONCLUSION: Prophylactic antithrombotic therapy was according the reference protocol in 67% of cases. In older patients, with greater risk of thromboembolic disease, the adequacy is worse.

Profilaxis de la enfermedad tromboembólica en enfermos con cardiopatía / Thromboembolic disease prophylaxis in patients with heart disease

Objetivo. Evaluar la adecuación de la profilaxis de la enfermedad tromboembólica en los pacientes diagnosticados de cardiopatía. Diseño. Estudio transversal. Emplazamiento. Área básica de salud semiurbana con una población adscrita de 10.610 habitantes y 5.582 historias clínicas abiertas. Pacientes. Pacientes mayores de 14 años diagnosticados de enfermedad cardíaca (n = 100). Mediciones. Edad, sexo, factores de riesgo cardiovascular, tipo de cardiopatía, tratamiento, y su adecuación a los criterios de la 'comisión de enfermedad tromboembólica' del hospital de referencia. Resultados. Edad media: 67 ñ 13 años. Factores de riesgo: hipertensión, 40 por ciento; diabetes, 33 por ciento; dislipemia, 15 por ciento; tabaquismo, 21 por ciento. Tipos de cardiopatía: cardiopatía isquémica, 48 por ciento; fibrilación auricular aislada, 15 por ciento; valvulopatías, 19 por ciento; miocardiopatía dilatada, 4 por ciento; otras, 14 por ciento. Un 20 por ciento presentaba 2 cardiopatías asociadas (80 por ciento a fibrilación auricular). Seguían tratamiento profiláctico un 52 por ciento de los pacientes (34 por ciento antiagregación, 18 por ciento anticoagulación). Antiagregantes: ácido acetilsalicílico (73,5 por ciento), triflusal (14,7 por ciento), dipiridamol (8,8 por ciento), ticlopidina (3 por ciento). Un 53 por ciento de los casos que no realizaban profilaxis cumplía criterios de antiagregación. El 15 por ciento de los pacientes en tratamiento antiagregante no lo precisaba y un 6 por ciento era candidato a anticoagulación. Se adecuaba al protocolo un 67 por ciento de los casos, sin detectarse diferencias significativas entre distintos tipos de cardiopatías ni sexos. La peor adecuación correspondió a los mayores de 80 años (46 frente a 75 por ciento), diferencia estadísticamente significativa. Conclusiones. La terapia profiláctica antitrombótica se ajusta al protocolo del hospital de referencia en el 67 por ciento de los pacientes. En el anciano, paciente con mayor riesgo de enfermedad tromboembólica, se da la peor adecuación (AU)

Impact of the American Diabetes Association diagnosis criteria on high-risk Spanish population. IGT Research Group. Impaired glucose tolerance.

To research into the impact of the new American Diabetes Association (ADA) diagnostic criteria on high risk Spanish population, two cross-sectional studies involving seven primary health care centers in Catalonia (Spain) were revised. Individuals aged > 40 years with any major risk factor for diabetes were screened according to the World Health Organization (WHO) rules using a 75 g oral glucose tolerance test to measure fasting plasma glucose (FPG) and 2 h plasma glucose. The changes on diabetes prevalence and on epidemiological characteristics were evaluated applying the ADA criteria on the basis of FPG alone. A total of 970 individuals, 453 males (46.7%), mean age 59 years and mean body mass index (BMI) 30.6 kg/m2 were screened. Among the 459 diabetic subjects according to either the WHO or the ADA criteria, 314 (68.4%) were classified as having diabetes with respect to both sets of criteria (WHO and ADA). The overlap between impaired glucose tolerance (WHO) and impaired fasting glucose (ADA) diagnoses was 20.7%. Using the ADA criteria results in a decrease of the prevalence of diabetes by 1.5% (95% confidence interval (CI) = -2.2 to -0.8%). No changes in the diabetic phenotype (age, sex and BMI) were found. Impaired fasting glucose prevalence was 18.4% (95% CI = 16-21%). Overall concordance in terms of crude and weighted kappa-value was only acceptable (kappa = 0.51 and kappa = 0.61, respectively). To apply the new ADA diagnostic criteria on high risk Spanish population evidenced a decrease on diabetes prevalence. Nevertheless, the change of criteria undervalued the risk of postprandial hyperglycaemia related to impaired glucose tolerance.

Resistance to chlorine of freshwater bacterial strains.

The disinfectant properties of chlorine have been known for centuries but in the last few years water chlorination has attracted some criticism due to its secondary effects and the increased resistance of bacterial strains to chlorine inactivation. In this paper the kinetics of inactivation by chlorine of different Gram-positive and Gram-negative bacterial strains isolated from chlorinated water is studied. The Gram-positive strains were more resistant to chlorine and the behaviour of some of them in the presence of chloramphenicol suggests either the synthesis of unique proteins or aggregation of the bacteria as mechanisms of resistance to inactivation. The concept of Ki, the inactivation rate constant, by comparison with Ks in Michaelis-Menten enzyme kinetics (considering enzymic saturation), or with Ks in Monod growth kinetics (considering limiting rates of transport and metabolism of substrates), may be an interesting parameter to define microbial resistance to disinfectants and toxics.