Successful outpatient conservative management of chyle leak after laparoscopic left hemicolectomy / Éxito de tratamiento conservador ambulatorio de paciente con ascitis quilosa tras hemicolectomía izquierda laparoscópica

Chyle leak is a pathological extravasation of chyle into the peritoneal cavity after a surgical injury. It is an uncom-mon complication in colorectal surgery. In most cases, conservative treatment is effective, although it often entails prolonged hospital stays.We present the case of a 60-year-old female with chyle leak after laparoscopic left hemicolectomy with complete mesocolic excision who underwent successful outpatient conservative management. We found no other cases of suc-cessful conservative outpatient treatment in the consulted literature. Adequate outpatient management may provide significant benefits by reducing hospital costs and improv-ing patient’s quality of life, while maintaining the possibility of starting adjuvant treatment if indicated (AU)

La ascitis quilosa es una acumulación patológica de quilo en la cavidad peritoneal tras una lesión quirúrgica. Es una complicación infrecuente de la cirugía colorrectal. En la mayoría de los casos, el tratamiento conservador suele ser eficaz, aunque conlleva estancias hospitalarias prolongadas.Se presenta el caso de una paciente de 60 años que de-sarrolló ascitis quilosa trasuna hemicolectomía izquierda laparoscópica, con escisión completa del mesocolon, que se resolvió con éxito mediante manejo conservador ambu-latorio. No se han encontrado casos exitosos de tratamien-to conservador ambulatorio en la bibliografía consultada. Un manejo ambulatorio como el propuesto puede aportar importantes beneficios en términos de reducción de costes hospitalarios y mejora de la calidad de vida del paciente, manteniendo la posibilidad de iniciar un tratamiento adyu-vante si está indicado (AU)

Successful outpatient conservative management of chyle leak after laparoscopic left hemicolectomy.

Chyle leak is a pathological extravasation of chyle into the peritoneal cavity after a surgical injury. It is an uncommon complication in colorectal surgery. In most cases, conservative treatment is effective, although it often entails prolonged hospital stays. We present the case of a 60-year-old female with chyle leak after laparoscopic left hemicolectomy with complete mesocolic excision who underwent successful outpatient conservative management. We found no other cases of successful conservative outpatient treatment in the consulted literature. Adequate outpatient management may provide significant benefits by reducing hospital costs and improving patient´s quality of life, while maintaining the possibility of starting adjuvant treatment if indicated.

Drivers of species knowledge across the tree of life.

Knowledge of biodiversity is unevenly distributed across the Tree of Life. In the long run, such disparity in awareness unbalances our understanding of life on Earth, influencing policy decisions and the allocation of research and conservation funding. We investigated how humans accumulate knowledge of biodiversity by searching for consistent relationships between scientific (number of publications) and societal (number of views in Wikipedia) interest, and species-level morphological, ecological, and sociocultural factors. Across a random selection of 3019 species spanning 29 Phyla/Divisions, we show that sociocultural factors are the most important correlates of scientific and societal interest in biodiversity, including the fact that a species is useful or harmful to humans, has a common name, and is listed in the International Union for Conservation of Nature Red List. Furthermore, large-bodied, broadly distributed, and taxonomically unique species receive more scientific and societal attention, whereas colorfulness and phylogenetic proximity to humans correlate exclusively with societal attention. These results highlight a favoritism toward limited branches of the Tree of Life, and that scientific and societal priorities in biodiversity research broadly align. This suggests that we may be missing out on key species in our research and conservation agenda simply because they are not on our cultural radar.

A bout of endurance and resistance exercise transiently decreases plasma levels of bile acids in young, sedentary adults.

Circulating bile acids (BA) are signaling molecules that control glucose and lipid metabolism. However, the effects of acute exercise on plasma levels of BA in humans remain poorly understood. Here, we evaluate the effects of a bout of maximal endurance exercise (EE) and resistance exercise (RE) on plasma levels of BA in young, sedentary adults. Concentration of eight plasma BA was measured by liquid chromatography-tandem mass spectrometry before and 3, 30, 60, and 120 min after each exercise bout. Cardiorespiratory fitness (CRF) was assessed in 14 young adults (21.8 ± 2.5 yo, 12 women); muscle strength was assessed in 17 young adults (22.4 ± 2.5 yo, 11 women). EE transiently decreased plasma levels of total, primary, and secondary BA at 3 and 30 min after exercise. RE exerted a prolonged reduction in plasma levels of secondary BA (p < 0.001) that lasted until 120 min. Primary BA levels of cholic acid (CA) and chenodeoxycholic acid (CDCA) were different across individuals with low/high CRF levels after EE (p ≤ 0.044); CA levels were different across individuals with low/high handgrip strength levels. High CRF individuals presented higher levels of CA and CDCA 120 min after exercise vs baseline (+77% and +65%) vs the low CRF group (-5% and -39%). High handgrip strength levels individuals presented higher levels of CA 120 min after exercise versus baseline (+63%) versus the low handgrip strength group (+6%). The study findings indicate that an individual's level of physical fitness can influence how circulating BA respond to both endurance and resistance exercise. Additionally, the study suggests that changes in plasma BA levels after exercising could be related to the control of glucose homeostasis in humans.

The relative abundance of fecal bacterial species belonging to the Firmicutes and Bacteroidetes phyla is related to plasma levels of bile acids in young adults.

BACKGROUND: Gut bacteria play a crucial role in the metabolism of bile acids (BA). Whether an association exists between the fecal microbiota composition and circulating BA levels in humans is poorly understood. Here, we investigated the relationship between fecal microbiota diversity and composition with plasma levels of BA in young adults. METHODS: Fecal microbiota diversity/composition was analyzed with 16S rRNA sequencing in 80 young adults (74% women; 21.9 ± 2.2 years old). Plasma levels of BA were measured using liquid chromatography-tandem mass spectrometry. PERMANOVA and Spearman correlation analyses were used to investigate the association between fecal microbiota parameters and plasma levels of BA. RESULTS: Fecal microbiota beta (P = 0.025) and alpha diversity indexes of evenness (rho = 0.237, P = 0.033), Shannon (rho = 0.313, P = 0.004), and inverse Simpson (rho = 0.283, P = 0.010) were positively associated with plasma levels of the secondary BA glycolithocholic acid (GLCA). The relative abundance of genera belonging to the Firmicutes and Bacteroidetes phyla was positively correlated with plasma levels of GLCA (all rho ≥ 0.225, P ≤ 0.049). However, the relative abundance of species from Firmicutes and Bacteroidetes phyla were negatively correlated with plasma levels of primary and secondary BA (all rho ≤ - 0.220, P ≤ 0.045), except for the relative abundance of Bacteroides vulgatus, Alistipes onderdonkii, and Bacteroides xylanisolvens species (Bacteroidetes phylum) that were positively correlated with the plasma levels of GLCA. CONCLUSIONS: The relative abundance of specific fecal bacteria species is associated with plasma levels of BA in young adults. However, further investigations are required to validate whether the composition of the gut microbiota can regulate the plasma concentrations of BA in humans.

Role of breathing training programs on quality of life in chronic kidney disease patients.

Background: Due to its chronic and progressive nature, chronic kidney disease (CKD) affects patients in many spheres including their perception of quality of life (QOL). Breathing training techniques have shown positive effects on health and QOL for different conditions. Objective: The aim of this study was to perform a scoping review to examine the characteristics related to the application of breathing training on patients with CKD, and to identify the relevant outcomes and target group for the application of breathing training. Methods: This scoping review was performed in accordance with PRISMA-SRc guidelines. We systematically searched three electronic databases for articles published before March 2022. The studies included patients with chronic kidney disease that received breathing training programs. The breathing training programs were compared to usual care or no treatment. Results: A total of four studies were included in this scoping review. The four studies had heterogeneous disease stages and breathing training programs. All the studies included reported positive effects of breathing training programs on QOL of CKD patients. Conclusion: The breathing training programs were able to improve the quality of life of patients with CKD undergoing hemodialysis treatment.

Alucinaciones secundarias a tratamiento en paciente con Parkinson / Hallucinations after treatment in a patient with Parkinson’s

La enfermedad de Parkinson (EP) se puede considerar como la segunda enfermedad neurodegenerativa en cuanto a prevalencia se refiere. La EP es una enfermedad de carácter crónico que evoluciona en fases consecutivas, con un diagnóstico inicial insidioso y de manejo complejo para el médico de Atención Primaria. En este artículo presentamos un caso de una interacción medicamentosa poco estudiada entre fármacos antidepresivos y antiparkinsonianos. La paciente acudió a revisión de neurología y, en un ajuste de medicación realizado por el compañero de neurología, se añadió rasalagina a su tratamiento habitual (levodopa/carbidopa) y ello creó a la paciente un cuadro de alucinaciones. Tras un estudio pormenorizado del caso, se llegó a la conclusión de que la rasalagina debía ser retirada y el cuadro neurológico de alucinaciones remitió.

Parkinson's Disease (PD) can be deemed the second neurodegenerative disease in terms of prevalence. PD is a chronic disease that evolves in consecutive phases, with an insidious initial diagnosis and complex management for the primary care physician. In this paper we report a case of a poorly studied drug interaction between antidepressant and antiparkinsonian drugs. The patient went to a neurology review where, in a medication adjustment made by a neurology colleague, Rasalagin was added to her usual treatment (levodopa/carbidopa), which created hallucinations in the patient. After a minor case study, the conclusion was drawn that rasalagin should be withdrawn and the neurological picture of hallucinations remitted.(AU)

Intraoperative metabolic changes associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

BACKGROUND: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) causes considerable hemodynamic, respiratory, and metabolic changes during the perioperative period. OBJECTIVES: To evaluate metabolic changes associated with this procedure. Understanding perioperative factors and their association with morbidity may improve the perioperative management of patients undergoing this treatment. METHODS: A retrospective review of a prospectively maintained database was performed. All consecutive unselected patients who underwent CRS plus HIPEC between January 2018 and December 2020 (n = 219) were included. RESULTS: The mean age was 58 ± 11.7 years and 167 (76.3%) were female. The most frequent histology diagnosis was serous ovarian carcinoma 49.3% (n = 108) and colon carcinoma 36.1% (n = 79). Mean peritoneal cancer index was 14.07 ± 10.47. There were significant variations in pH, lactic acid, sodium, potassium, glycemia, bicarbonate, excess bases, and temperature (p < 0.05) between the pre-HIPEC and post-HIPEC periods. The closed HIPEC technique resulted in higher levels of temperature than the open technique (p < 0.05). Age, potassium level post-HIPEC potassium level, and pre-HIPEC glycemia were identified as prognostic factors for morbidity in multivariate analysis. CONCLUSION: The administration of HIPEC after CRS causes significant changes in internal homeostasis. Although the closed technique causes a greater increase in temperature, it is not related to higher morbidity rates. The patient's age, post-HIPEC potassium level, and pre-HIPEC glycemia are predictive factors for morbidity.

A hub-and-spoke model to deliver effective access to chimeric antigen receptor T-cell therapy in a public health network: the Catalan Blood and Tissue Bank experience.

BACKGROUND AIMS: To describe and analyze whether a hub-and-spoke organizational model could efficiently provide access to chimeric antigen receptor (CAR) T-cell therapy within a network of academic hospitals and address the growing demands of this complex and specialized activity. METHODS: The authors performed a retrospective evaluation of activity within the Catalan Blood and Tissue Bank network, which was established for hematopoietic stem cell transplantation to serve six CAR T-cell programs in academic hospitals of the Catalan Health Service. Procedures at six hospitals were followed from 2016 to 2021. Collection shipments of starting materials, CAR T-cell returns for storage and infusions for either clinical trials or commercial use were evaluated. RESULTS: A total of 348 leukocytapheresis procedures were performed, 39% of which were delivered fresh and 61% of which were cryopreserved. The network was linked to seven advanced therapy medicinal product manufacturers. After production, 313 CAR T-cell products were shipped back to the central cryogenic medicine warehouse located in the hub. Of the units received, 90% were eventually administered to patients. A total of 281 patients were treated during this period, 45% in clinical trials and the rest with commercially available CAR T-cell therapies. CONCLUSIONS: A hub-and-spoke organizational model based on an existing hematopoietic stem cell transplantation program is efficient in incorporating CAR T-cell therapy into a public health hospital network. Rapid access and support of growing activity enabled 281 patients to receive CAR T cells during the study period.

Los Centros de Desarrollo Infantil del MIES, una realidad para el futuro de la sociedad / The MIES child development centers, a reality for the future of society

El desarrollo neurológico constituye un objetivo prioritario en Ecuador. Existen Centros de Desarrollo Infantil que persiguen lograr un adecuado desarrollo neurológico en la edad infantil. El objetivo de la presente investigación fue caracterizar el estado de los Centros de Desarrollo Infantil de la provincia Chimborazo, teniendo en cuenta la organización administrativa, situación del talento humano, infraestructura y equipamiento. Para esto se realizó una investigación básica, de campo y descriptiva consistente en la evaluación de estos elementos en cada centro visitado. Del total de 93 instituciones en la provincia, se identificaron 6 que se consideraron emblemáticos. Como principales resultados se puede señalar que las instituciones cuentan con una adecuada infraestructura, equipamiento y gestión administrativa y del talento humano para cumplir sus funciones; sin embargo, se carece de áreas específicas de fisioterapia y de profesionales de esta especialidad. Se concluye que, dentro del marco del convenio macro de cooperación interinstitucional, la Universidad Nacional de Chimborazo podrá proveer el recurso humano calificado para las actividades de fisioterapia orientadas a la estimulación del equilibrio, la coordinación y el área sensomotriz; de esta forma se estará consolidando el desarrollo neurológico de los niños que asisten a los Centros de Desarrollo Infantil(AU)

Neurological development is a priority objective in Ecuador. There are Child Development Centers that seek to achieve adequate neurological development in childhood. The objective of the present investigation was to characterize the state of the Child Development Centers of the Chimborazo province, taking into account the administrative organization, the situation of human talent, infrastructure and equipment. For this, a basic, field and descriptive investigation was carried out consisting of the evaluation of the elements previously described in each center visited. Of the total of 93 institutions in the province, 6 were identified as emblematic. As main results, it can be pointed out that the institutions have adequate infrastructure, equipment and administrative management and human talent to fulfill their functions; however, specific areas of physiotherapy and professionals in this specialty are lacking. It is concluded that, within the framework of the inter-institutional cooperation macro agreement, the National University of Chimborazo will be able to provide qualified human resources for physiotherapy activities aimed at stimulating balance, coordination and the sensorimotor area; In this way, the neurological development of the children who attend the Child Development Centers will be consolidated(AU)

Técnicas fisioterapéuticas de entrenamiento muscular inspiratorio y Buteyko en niños con asma bronquial / Inspiratory and Buteyko muscular training physiotherapeutic techniques in children with bronchial asthma

El asma bronquial es una enfermedad respiratoria crónica que genera elevados índices de discapacidad, sobre todo en la población infantil. La aplicación de fisioterapia respiratoria constituye un coadyuvante en los esquemas terapéuticos de la enfermedad; en este sentido el entrenamiento muscular inspiratorio y el método Buteyko constituyen técnicas respiratorias que han sido reportadas como útiles en el tratamiento del asma bronquial. La presente investigación tuvo como objetivo describir las ventajas que ofrecen ambos métodos como esquemas terapéuticos de niños con asma bronquial. Como principales resultados se describen una serie de estudios que muestran las ventajas de la implementación de estos métodos para mejorar distintos componentes de la patogenia y manifestaciones clínicas del asma bronquial. Estos estudios muestran que la aplicación indistinta de uno o ambos métodos mejora diversos aspectos entre los que sobresalen mejorar volúmenes y capacidades pulmonares, función pulmonar, fuerza muscular ventilatoria y la mecánica respiratoria. Adicionalmente, mejoran algunos elementos relacionados con la mecánica respiratoria como es el uso de la respiración bucal. Se concluye que la realización de la fisioterapia respiratoria en niños con asma bronquial constituye una alternativa viable y eficaz en el mejoramiento de varios parámetros relacionados con esta enfermedad. Diversos estudios demuestran que la aplicación de estas técnicas respiratorias mejora la capacidad respiratoria, el tono y trofismo de músculos respiratorios y la mecánica respiratoria. Los resultados positivos evidencian la necesidad de aumentar la implementación del entrenamiento muscular inspiratorio y el método Buteyko como esquema terapéutico en niños con asma bronquial en unidades de atención pública y privada(AU)

Bronchial asthma is a chronic respiratory disease that generates high rates of disability, especially in children. The application of respiratory physiotherapy constitutes an adjunct in the therapeutic schemes of the disease; in this sense, inspiratory muscle training and the Buteyko method constitute respiratory techniques that have been reported as useful in the treatment of bronchial asthma. The present investigation aimed to describe the advantages offered by both methods as therapeutic regimens for children with bronchial asthma. The main results are a series of studies that show the advantages of the implementation of these methods to improve different components of the etiopathogenesis and clinical manifestations of bronchial asthma. These studies show that the indistinct application of one or both methods improves different aspects, among which the improvement of lung volumes and capacities, lung function, ventilatory muscle strength and respiratory mechanics stand out. Additionally, they improve some elements related to respiratory mechanics such as the use of mouth breathing. It is concluded that the performance of respiratory physiotherapy in children with bronchial asthma constitutes a viable and effective alternative in the improvement of various parameters related to this disease. Several studies show that the use of these respiratory techniques improves respiratory capacity, tone and trophism of respiratory muscles, and respiratory mechanics. The positive results demonstrate the need to increase the implementation of inspiratory muscle training and the Buteyko method as a therapeutic scheme in children with bronchial asthma in public and private care units(AU)

Leukocytapheresis variables and transit time for allogeneic cryopreserved hpc: better safe than sorry.

Cryopreservation was recommended to ensure continuity in allogeneic hematopoietic progenitor cells (HPC) transplantation during the COVID-19 pandemic. Several groups have shown no impact on clinical outcomes for patients who underwent HPC transplantation with cryopreserved products during the first months of this pandemic. However, concerns about quality control attributes after cryopreservation have been raised. We investigated, in 155 allogeneic peripheral blood cryopreserved HPC, leukocytapheresis characteristics influencing viable CD34+ and CD3+ cells, and CFU-GM recoveries after thawing. Collection characteristics such as volume, nucleated cells (NC)/mL and hematocrit correlated with viable CD34+ and CD3+ cells recoveries after thawing in univariate analysis but only CD3+ cells remained statistically significant in multivariate analysis (r2 = 0.376; P = < 0.001). Additionally, transit time also showed correlation with viable CD34+ (r2 = 0.186), CD3+ (r2 = 0.376) and CFU-GM recoveries (r2 = 0.212) in multivariate analysis. Thus, diluting leukocytapheresis below 200 × 106 NC/mL, avoiding red cells contamination above 2%, cryopreserving below 250 × 106 NC/mL and minimizing transit time below 36 h, prevented poor viable CD34+ and CD3+ cells, and CFU-GM recoveries. In summary, optimizing leukocytapheresis practices and minimizing transportation time may better preserve the quality attributes of HPC when cryopreservation is indicated.

Plasma Levels of Bile Acids Are Related to Cardiometabolic Risk Factors in Young Adults.

CONTEXT: Bile acids (BA) are known for their role in intestinal lipid absorption and can also play a role as signaling molecules to control energy metabolism. Prior evidence suggests that alterations in circulating BA levels and in the pool of circulating BA are linked to an increased risk of obesity and a higher incidence of type 2 diabetes in middle-aged adults. OBJECTIVE: We aimed to investigate the association between plasma levels of BA with cardiometabolic risk factors in a cohort of well-phenotyped, relatively healthy young adults. METHODS: Body composition, brown adipose tissue, serum classical cardiometabolic risk factors, and a set of 8 plasma BA (including glyco-conjugated forms) in 136 young adults (age 22.1 ± 2.2 years, 67% women) were measured. RESULTS: Plasma levels of chenodeoxycholic acid (CDCA) and glycoursodeoxycholic acid (GUDCA) were higher in men than in women, although these differences disappeared after adjusting for body fat percentage. Furthermore, cholic acid (CA), CDCA, deoxycholic acid (DCA), and glycodeoxycholic acid (GDCA) levels were positively, yet weakly associated, with lean body mass (LBM) levels, while GDCA and glycolithocholic acid (GLCA) levels were negatively associated with 18F-fluorodeoxyglucose uptake by brown adipose tissue. Interestingly, glycocholic acid (GCA), glycochenodeoxycholic acid (GCDCA), and GUDCA were positively associated with glucose and insulin serum levels, HOMA index, low-density lipoprotein cholesterol, tumor necrosis factor alpha, interleukin (IL)-2, and IL-8 levels, but negatively associated with high-density lipoprotein cholesterol, ApoA1, and adiponectin levels, yet these significant correlations partially disappeared after the inclusion of LBM as a confounder. CONCLUSION: Our findings indicate that plasma levels of BA might be sex dependent and are associated with cardiometabolic and inflammatory risk factors in young and relatively healthy adults.

Neurodinámica del nervio mediano como tratamiento del dolor cervical radicular / Neurodynamics of the median nerve as a treatment for radicular neck pain

Introducción: La radiculopatía cervical es una de las afecciones que con mayor frecuencia se presenta en la población joven. La irradiación del dolor a los miembros superiores causa afectación a la calidad de vida. La neurodinámica ofrece ventajas en el tratamiento de esta afección. Objetivo: Identificar los efectos de la movilización neural mediante neurodinámica en los síntomas irradiados del dolor cervical radicular. Métodos: Investigación aplicada, cuasi experimental, descriptiva y longitudinal aplicada en 28 trabajadores de la Universidad Nacional de Chimborazo diagnosticados de cervicalgia de origen neural. Se aplicaron varios exámenes entre los que destaca el test de tensión neurodinámico del nervio mediano para el diagnóstico del dolor cervical radicular. Se procedió a realizar 6 sesiones de neurodinámica que cambiaron la evolución de la afección diagnosticada. Se aplicó la prueba de McNemar para identificar cambios en la intensidad del dolor. Resultados: Promedio de edad de 46,28 años con predominio de trabajadores entre 40 y 49 años (39,29 por ciento) y del sexo femenino (67,86 por ciento). El 39,28 por ciento de los trabajadores refirió comorbilidades asociadas: el hipotiroidismo (45,45 por ciento) y la hipertensión arterial (36,36 por ciento) fueron las más referidas. Después de aplicada la técnica, solo el 3,57 por ciento de los trabajadores continuó con dolor irradiado y con intensidad moderada, el 60,72 por ciento presentó un dolor leve y el 35,71 por ciento se autoidentificó sin dolor. Conclusiones: La aplicación de la movilización neural mediante neurodinámica provocó cambios estadísticamente significativos en la disminución de la intensidad del dolor cervical y también mejoró la irradiación del dolor a los miembros superiores(AU)

Introduction: Cervical radiculopathy is one of the conditions that occurs most frequently in the young population. The radiation of pain to the upper limbs affects quality of life. Neurodynamics offers advantages in the treatment of this condition. Objective: To identify the effects of neural mobilization by neurodynamics in the radiated symptoms of radicular neck pain. Methods: Applied, quasi-experimental, descriptive and longitudinal research applied to 28 workers from the National University of Chimborazo diagnosed with neck pain of neural origin. Several tests were applied, among which the neurodynamic tension test of the median nerve stands out for the diagnosis of radicular neck pain. 6 neurodynamic sessions were carried out, which changed the evolution of the diagnosed condition. The McNemar test was applied to identify changes in pain intensity. Results: Average age of 46.28 years with a predominance of workers between 40 and 49 years old (39.29 percent) and female (67.86 percent). 39.28 percent of the workers referred associated comorbidities, hypothyroidism (45.45 percent) and arterial hypertension (36.36 percent) were the most referred. After applying the technique, only 3.57 percent of the workers continued with radiating pain and with moderate intensity, 60.72 percent presented mild pain and 35.71 percent self-identified as pain-free. Conclusions: The application of neural mobilization through neurodynamics caused statistically significant changes in the decrease in the intensity of neck pain and also improved the radiation of pain to the upper limbs(AU)

Eosinophilic appendicitis due to Strongyloides stercoralis: a challenging differential diagnosis for clinicians.

A 45-year-old man presents with 48-hour status of high temperature, cough and dyspnoea. In the context of pandemic, the patient is initially diagnosed with COVID-19 syndrome. Later, the laboratory and ultrasound study supported acute appendicitis diagnosis. Appendicectomy was performed. The histopathology study confirmed eosinophilic appendicitis and that a parasitic infection was suspected. The stool sample was positive for Strongyloides stercoralis The diagnosis of a S stercoralis is a rare finding in Spain. S. stercoralis simulates clinical findings of inflammatory bowel disease or eosinophilic gastroenteritis, which may lead to the wrong therapeutic choice. Since in inflammatory diseases corticosteroid treatments are considered the initial choice in many cases, in the case of S. stercoralis infection, the administration of this therapy can be fatal. In Spain, the number of diagnoses is much lower than in the past decade, although it is highly probable that the infection has been underdiagnosed due to low clinical awareness among Spanish population.

Invasive Streptococcus pyogenes disease in Spain: a microbiological and epidemiological study covering the period 2007-2019.

The aim of this study is to present the first nationwide microbiological and epidemiological study of invasive group A Streptococcus (iGAS) disease in Spain. One thousand eight hundred ninety-three iGAS isolates were analyzed over 2007-2019. emm typing was performed by sequencing the gene's variable 5' end, exotoxin genes were identified by PCR, and antimicrobial susceptibility explored via the E test and disk diffusion. Five hundred twenty-three isolates were associated with sepsis, 292 with cellulitis, 232 with scarlet fever, 153 with pneumonia, 141 with streptococcal toxic shock syndrome, and 94 with necrotizing fasciitis. The most prevalent emm types were emm1 (449/1893 isolates), emm89 (210/1893), emm3 (208/1893), emm4 (150/1893), emm12 (112/1893) emm6 (107/1893), emm87 (89/1893), emm28 (88/1893), emm75 (78/1893), emm77 (78/1893), emm11 (58/1893), and emm22 (35/1893). emm1, emm3, emm4, and emm6 were the predominant types affecting children (mostly respiratory infections), while emm11, emm77, and emm89 prevailed in the elderly (mostly skin infections). Each emm type was associated with one or more exotoxin gene (spe, sme, and ssa) profiles. speA was detected in 660 isolates, speB in 1829, speC in 1014, speF in 1826, speG in 1651, speJ in 716, speH in 331, smeZ in 720, and ssa in 512. Isolates with speA were associated with the most severe infections. Penicillin susceptibility was universal. Two hundred twenty-four isolates were resistant to tetracycline, 169 to erythromycin, and 81 to clindamycin. Tetracycline, erythromycin, and clindamycin resistance rates declined over the study period. The above information could serve as the basis for continued surveillance efforts designed to control disease cause by this bacterium.