Dynamics of Single-Chain Nanoparticles under Crowding: A Neutron Spin Echo Study.

We present a neutron spin echo (NSE) investigation to examine the impact of macromolecular crowding on the dynamics of single-chain nanoparticles (SCNPs), serving as synthetic models for biomacromolecules with flexibility and internal degrees of freedom, such as intrinsically disordered proteins (IDPs). In particular, we studied the dynamics of a medium-size poly(methyl methacrylate) (PMMA)-based SCNP (33 kDa) in solutions with low- (10 kDa) and high- (100 kDa) molecular weight analogous deuterated PMMA linear crowders. The dynamic structure factors of the SCNPs in dilute solution show certain degrees of freedom, yet the analysis in terms of the Zimm model reveals high internal friction that effectively stiffens the chain-a phenomenon also observed for IDPs. Under crowding conditions, the internal dynamics remains essentially unchanged, but the center-of-mass diffusion slows down. The effective viscosity felt by the SCNPs at the timescales probed by NSE is lower than the macroscopic viscosity of the crowder solution, and it does not depend significantly on the molecular weight.

Robot-assisted radical cystectomy and ileal conduit with Hugo™ RAS system: feasibility, setting and perioperative outcomes

ABSTRACT Introduction: Robotic approach has shown its feasibility and safety with respect to open approach for radical cystectomy (1). The performances of Hugo™ RAS system (Medtronic, Minneapolis, USA) have been demonstrated in several clinical scenarios (2-5). We report the feasibility and surgical settings of the first series of robot-assisted radical cystectomy (RARC) with intracorporeal ileal-conduit performed with Hugo™ RAS system. Methods: Two patients were submitted to RARC with ileal conduit at our institution. The trocar placement scheme and the operating room setting with docking angles of the four arms were already described (6). A 12-mm and a 5-mm trocar for the assistant were placed. In both cases, an ileal-conduit with a Wallace type-1 uretero-enteric derivation was performed intra-corporeally. Results: The first patient was a 71-year-old male with a very-high risk non-muscle invasive bladder cancer(BC), and the second patient was a 64-year-old male with a diagnosis of T2 high-grade BC. Operative times were 360 and 420 minutes with a docking time of 12 and 9 minutes, respectively. No intraoperative complications occurred. The estimated blood loss was 200ml and 400ml, respectively. The second patient developed an ileus on postoperative day 4 (Clavien-Dindo grade 2). No positive surgical margins were recorded. No recurrence nor progression occurred during follow-up. Conclusion: RARC with intracorporeal ileal conduit urinary diversion is feasible with Hugo™ RAS system. We provided insight into the surgical setting using this novel robotic platform to help new adopters to face this challenging procedure. These findings may help a wider distribution of robotic programs for BC treatment.

Structure of Single-Chain Nanoparticles under Crowding Conditions: A Random Phase Approximation Approach.

The conformation of poly(methyl methacrylate) (PMMA)-based single-chain nanoparticles (SCNPs) and their corresponding linear precursors in the presence of deuterated linear PMMA in deuterated dimethylformamide (DMF) solutions has been studied by small-angle neutron scattering (SANS). The SANS profiles were analyzed in terms of a three-component random phase approximation (RPA) model. The RPA approach described well the scattering profiles in dilute and crowded solutions. Considering all the contributions of the RPA leads to an accurate estimation of the single chain form factor parameters and the Flory-Huggins interaction parameter between PMMA and DMF. The value of the latter in the dilute regime indicates that the precursors and the SCNPs are in good solvent conditions, while in crowding conditions, the polymer becomes less soluble.

A new machine-learning model to predict long-term renal function impairment after minimally invasive partial nephrectomy: the Fundació Puigvert predictive model.

PURPOSE: To provide a new model to predict long-term renal function impairment after partial nephrectomy (PN). METHODS: Data of consecutive patients who underwent minimally invasive PN from 2005 to 2022 were analyzed. A minimum of 12 months of follow-up was required. We relied on a machine-learning algorithm, namely classification and regression tree (CART), to identify the predictors and associated clusters of chronic kidney disease (CKD) stage migration during follow-up. RESULTS: 568 patients underwent minimally invasive PN at our center. A total of 381 patients met our inclusion criteria. The median follow-up was 69 (IQR 38-99) months. A total of 103 (27%) patients experienced CKD stage migration at last follow-up. Progression of CKD stage after surgery, ACCI and baseline CKD stage were selected as the most informative risk factors to predict CKD progression, leading to the creation of four clusters. The progression of CKD stage rates for cluster #1 (no progression of CKD stage after surgery, baseline CKD stage 1-2, ACCI 1-4), #2 (no progression of CKD stage after surgery, baseline CKD stage 1-2, ACCI ≥ 5), #3 (no progression of CKD stage after surgery and baseline CKD stage 3-4-5) and #4 (progression of CKD stage after surgery) were 6.9%, 28.2%, 37.1%, and 69.6%, respectively. The c-index of the model was 0.75. CONCLUSION: We developed a new model to predict long-term renal function impairment after PN where the perioperative loss of renal function plays a pivotal role to predict lack of functional recovery. This model could help identify patients in whom functional follow-up should be intensified to minimize possible worsening factors of renal function.

Robot-assisted radical cystectomy and ileal conduit with HugoTM RAS system: feasibility, setting and perioperative outcomes.

INTRODUCTION: Robotic approach has shown its feasibility and safety with respect to open approach for radical cystectomy (1). The performances of HugoTM RAS system (Medtronic, Minneapolis, USA) have been demonstrated in several clinical scenarios (2-5). We report the feasibility and surgical settings of the first series of robot-assisted radical cystectomy (RARC) with intracorporeal ileal-conduit performed with HugoTM RAS system. METHODS: Two patients were submitted to RARC with ileal conduit at our institution. The trocar placement scheme and the operating room setting with docking angles of the four arms were already described (6). A 12-mm and a 5-mm trocar for the assistant were placed. In both cases, an ileal-conduit with a Wallace type-1 uretero-enteric derivation was performed intra-corporeally. RESULTS: The first patient was a 71-year-old male with a very-high risk non-muscle invasive bladder cancer(BC), and the second patient was a 64-year-old male with a diagnosis of T2 high-grade BC. Operative times were 360 and 420 minutes with a docking time of 12 and 9 minutes, respectively. No intraoperative complications occurred. The estimated blood loss was 200ml and 400ml, respectively. The second patient developed an ileus on postoperative day 4 (Clavien-Dindo grade 2). No positive surgical margins were recorded. No recurrence nor progression occurred during follow-up. CONCLUSION: RARC with intracorporeal ileal conduit urinary diversion is feasible with HugoTM RAS system. We provided insight into the surgical setting using this novel robotic platform to help new adopters to face this challenging procedure. These findings may help a wider distribution of robotic programs for BC treatment.

Intra- vs Intermolecular Cross-Links in Poly(methyl methacrylate) Networks Containing Enamine Bonds.

The molecular dynamics of a copolymer composed of methyl methacrylate (MMA) and (2-acetoacetoxy)ethyl methacrylate (AEMA) monomers and the influence on it of intra- to intermolecular cross-links of AEMA units with ethylenediamine (EDA) was studied by combining dielectric relaxation experiments and thermal investigations. The dielectric spectra of the non-cross-linked copolymer show three dynamical processes: a slow relaxation (α) and a faster (ß), both dominated by the MMA dynamics, and an even faster secondary relaxation (γ) reflecting the AEMA dynamics. Already for low cross-linking densities, the γ process is very much affected and eventually disappears, increasing the cross-linking density. The secondary ß relaxation however was nearly unaffected by cross-linking. The effect of cross-linking on the α relaxation was very pronounced with an important increasing of the glass transition temperature T g. There was also an increase of the dynamic heterogeneity and the relaxation intensity when increasing the cross-linking density (up to the maximum explored, 9 mol % EDA). The quality of the average time scale and T g value have similarities in behavior for intra- and intermolecular cross-linking, but clear differences in the dynamic heterogeneities where observed. These differences can be interpreted in connection with the sparse internal structure of the collapsed single chains obtained by intramolecular cross-linking.

A method to estimate the size of single-chain nanoparticles under severe crowding conditions.

Single-chain nanoparticles (SCNPs) result from the folding of isolated polymer chains via intramolecular interactions. Currently, there is no theory able to rationalize the astonishing conformational behaviour of SCNPs under severe crowding conditions (e.g., highly concentrated solutions, all-polymer nanocomposites) and, specifically, the significant size reduction observed in highly crowded solutions of covalent-bonded SCNPs and all-polymer nanocomposites containing SCNPs. Herein, we propose a valuable method to estimate the size of SCNPs under crowding. The method - which is based on combining MD simulations results with scaling concepts - is also useful for ring polymers and nanostructured Janus-shaped SCNPs.

Disentangling Component Dynamics in an All-Polymer Nanocomposite Based on Single-Chain Nanoparticles by Quasielastic Neutron Scattering.

We have investigated an all-polymer nanocomposite (NC) consisting of single-chain nanoparticles (SCNPs) immersed in a matrix of linear chains of their precursors (25/75% composition in weight). The SCNPs were previously synthesized via "click" chemistry, which induces intramolecular cross-links in the individual macromolecules accompanied by a slight shift (5-8 K) of the glass transition temperature toward higher values and a broadening of the dynamic response with respect to the raw precursor material. The selective investigation of the dynamics of the NC components has been possible by using properly isotopically labeled materials and applying quasielastic neutron scattering techniques. Results have been analyzed in the momentum transfer range where the coherent scattering contribution is minimal, as determined by complementary neutron diffraction experiments with polarization analysis. We observe the development of dynamic heterogeneity in the intermediate scattering function of the NC components, which grows with increasing time. Local motions in the precursor matrix of the NC are accelerated with respect to the reference bulk behavior, while the displacements of SCNPs' hydrogens show enhanced deviations from Gaussian and exponential behavior compared with the pure melt of SCNPs. The resulting averaged behavior in the NC coincides with that of the pure precursor, in accordance with the macroscopic observations by differential scanning calorimetry (DSC) experiments.

Experiencia de la vacunación antigripal con la vacuna de alta carga antigénica en residencias geriátricas en la temporada 2020-21 / Experience of influenza vaccination with the high antigenic load vaccine in geriatric residences in the 2020-21 season

La vacuna antigripal es una de las estrategias más efectivas de prevenir la infección por el virus de la gripe y sus complicaciones, especialmente entre las personas mayores. Ante la coincidencia de la epidemia de gripe y la pandemia de COVID19 durante la temporada 202021, una situación particularmente grave debido al aumento del riesgo de coinfección y muerte, desde el Ministerio de Sanidad se acordó el uso de vacunas antigripales de alta carga antigénica en residencias geriátricas. La experiencia puntual con esta estrategia en dos residencias adscritas al Centro de Salud de Isla de Oza de Madrid ha sido exitosa, con un alto grado de aceptación y satisfacción por parte de los residentes y un nivel de seguridad óptimo.(AU)

Influenza vaccine is the most effective way to prevent influenza virus infection and its complications, particularly among the elderly. Given the coincidence of the influenza epidemic and the COVID19 pandemic during the 202021 season, an extremely serious situation due to the increased risk of coinfection and mortality, the Ministry of Health agreed to use a high-dose influenza vaccine in nursing home residents. The specific experience with this strategy in two residences ascribed to the Isla de Oza Health Center in Madrid has been successful, with a high degree of acceptance and satisfaction among residents, as well as an optimal safety profile.(AU)

Dynamic Processes and Mechanisms Involved in Relaxations of Single-Chain Nano-Particle Melts.

We present a combined study by quasielastic neutron scattering (QENS), dielectric and mechanical spectroscopy, calorimetry and wide-angle X-ray diffraction on single-chain nano-particles (SCNPs), using the corresponding linear precursor chains as reference, to elucidate the impact of internal bonds involving bulky cross-links on the properties of polymer melts. Internal cross-links do not appreciably alter local properties and fast dynamics. This is the case of the average inter-molecular distances, the ß-relaxation and the extent of the atomic displacements at timescales faster than some picoseconds. Contrarily, the α-relaxation is slowed down with respect to the linear precursor, as detected by DSC, dielectric spectroscopy and QENS. QENS has also resolved broader response functions and stronger deviations from Gaussian behavior in the SCNPs melt, hinting at additional heterogeneities. The rheological properties are also clearly affected by internal cross-links. We discuss these results together with those previously reported on the deuterated counterpart samples and on SCNPs obtained through a different synthesis route to discern the effect of the nature of the cross-links on the modification of the diverse properties of the melts.

Collective Motions and Mechanical Response of a Bulk of Single-Chain Nano-Particles Synthesized by Click-Chemistry.

We investigate the effect of intra-molecular cross-links on the properties of polymer bulks. To do this, we apply a combination of thermal, rheological, diffraction, and neutron spin echo experiments covering the inter-molecular as well as the intermediate length scales to melts of single-chain nano-particles (SCNPs) obtained through 'click' chemistry. The comparison with the results obtained in a bulk of the corresponding linear precursor chains (prior to intra-molecular reaction) and in a bulk of SCNPs obtained through azide photodecomposition process shows that internal cross-links do not influence the average inter-molecular distances in the melt, but have a profound impact at intermediate length scales. This manifests in the structure, through the emergence of heterogeneities at nanometric scale, and also in the dynamics, leading to a more complex relaxation behavior including processes that allow relaxation of the internal domains. The influence of the nature of the internal bonds is reflected in the structural relaxation that is slowed down if bulky cross-linking agents are used. We also found that any residual amount of cross-links is critical for the rheological behavior, which can vary from an almost entanglement-free polymer bulk to a gel. The presence of such inter-molecular cross-links additionally hinders the decay of density fluctuations at intermediate length scales.

Valuable structure-size relationships for tadpole-shaped single-chain nanoparticles with long and short flexible tails unveiled.

Tadpole-shaped single-chain nanoparticles (TSCNPs) are useful soft building blocks for nanotechnology composed of a flexible polymer chain tethered to an intramolecularly folded single-chain nanoparticle. We disclose herein valuable structure-size relationships for a priori TSCNP design depending on tail length, which are validated by experimental data from multiple TSCNP systems, allowing, for the first time, the prediction of TSCNP size before synthesis.

Evolución de la incidencia de pacientes con colonización e infección por bacterias productoras de carbapenemasas VIM en un hospital pediátrico en España / Evolution of the incidence of colonized and infected patients by VIM carbapenemase-producing bacteria in a pediatric hospital in Spain

Introducción: El objetivo del estudio es describir la evolución de la incidencia de infecciones y colonizaciones por bacterias productoras de carbapenemasas de tipo VIM (BPC-VIM) en pacientes ingresados en un hospital pediátrico de tercer nivel en Madrid entre 2012 y 2015. Material y métodos: Estudio descriptivo de vigilancia epidemiológica. El sistema de vigilancia incluyó detección de casos (cribado de colonización por BPC de todos los pacientes ingresados con periodicidad variable según unidad de ingreso) y medidas de control (precauciones de contacto, identificación al ingreso de pacientes colonizados previamente, limpieza, formación, observación de adherencia a precauciones de contacto, cohortes). Se incluyeron los pacientes ingresados con primera muestra microbiológica positiva para BPC-VIM entre 2012 y 2015. Se realizó seguimiento de pacientes con colonización para detectar infección a través de historia clínica. Resultados: Se detectaron 239 pacientes con colonización y 51 con infección por BPC-VIM (49,3% mujeres, 47,6% edad igual o menor a 5 meses, 52,1% ingresado en UCI). Las incidencias de infección y de colonización fueron, respectivamente, 2,6 y 6,7 casos por mil pacientes ingresados en 2012, 1,8 y 10,0 en 2014 y 0,3 y 5,0 en 2015. El 84,4% compartía unidad con paciente con muestra previa positiva. El 13,0% (31/239) de pacientes colonizados tuvieron infección posterior. Conclusiones: La incidencia de pacientes pediátricos colonizados o infectados por BPC-VIM ha sido variable entre 2012 y 2015, con una clara disminución tras un periodo epidémico. La intensificación de las medidas de vigilancia y control de la transmisión y la coordinación entre los servicios fueron claves en la reducción de casos afectados

Introduction: The aim of this study is to describe the evolution of the incidence of infected and colonized patients with carbapenemase VIM-producing bacteria (CPB-VIM) at a national referral pediatric center in Madrid, Spain, between 2012 and 2015. Material and methods: Descriptive epidemiological surveillance study. The surveillance system included case detection (screening for BPC colonization in all admitted patients, with periodicity according to the ward) and control measures (contact precautions, identification of previously colonized patients at admission, environmental cleaning, education, supervision of contact precautions, and patient cohort). All hospitalized patients with first positive microbiological sample for CPB-VIM in 2012-2015 were included. Colonized patients were followed through clinical history to evaluate later infection. Results: We found 239 colonized and 51 infected patients with CPB-VIM (49.3% women, 47.6% were 5 months old or younger, 52.1% admitted at Intensive Care Unit). Infection and colonization incidence were, respectively, 2.6 and 6.7 cases per one thousand hospitalized patients in 2012, 1.8 and 10.0 in 2014 and 0.3 and 5.0 in 2015. Within these patients, 84.4% shared ward with other patient with previous positive sample. 13.0% (31/239) of colonized patients had a subsequent infection. Conclusions: We have shown data of pediatric patients affected by BPC-VIM, collected from an epidemiological surveillance system that included systematic screening at a national referral center. After an epidemic period, the incidence of cases went down. The surveillance and infection control measures intensification, as well as coordination with involved departments, were key in the handling of the situation

Effect of vaccination, comorbidities and age on mortality and severe disease associated with influenza during the season 2016-2017 in a Spanish tertiary hospital.

BACKGROUND: Identifying risk factors for complications or death associated with influenza remains crucial to target preventive interventions. Scores like the Charlson comorbidity index (CCI) may be of help. The aims of this study were to assess the effect of vaccination and comorbidities on severe influenza disease and influenza-related death among hospitalized patients during the season 2016/17; and to evaluate the validity of the CCI to predict death among these patients. METHODS: Data from adult patients (≥18 years old) with influenza infection admitted to La Paz University Hospital (LPUH) were recorded during the 2016/17 epidemic. The effect of influenza vaccine to prevent severe influenza or death was evaluated using multivariate logistic regression models. The area under the curve of the CCI and the age-adjusted CCI were compared to assess the predictive effect on mortality. RESULTS: A total of 342 adult patients with influenza infection were admitted, of which 83 developed severe influenza and 25 died during hospitalization. There were no differences between patients who survived and those who died concerning the CCI, but the age-adjusted CCI was higher in fatal cases (p-value=0.005). Influenza vaccine had no statistically significant effect on the risk of mortality (p-value=0.162) while age (OR: 1.12, p-value<0.001) and dementia (OR: 3.05, p-value=0.016) proved to be independent predictors for mortality. The seasonal vaccine was found to be protective for severe infection (OR: 0.54, p-value=0.019). The age-adjusted CCI was a better predictor of mortality than the crude CCI. CONCLUSIONS: Age and dementia are significant independent risk factors for mortality associated with influenza among hospitalized patients. The age-adjusted CCI seems to be a better predictor of mortality than the crude CCI. Influenza vaccine has shown to be effective in preventing severe influenza in the season 2016/17 among hospitalized patients and should be promoted in population at risk.

Serratia marcescens outbreak in a neonatology unit of a Spanish tertiary hospital: Risk factors and control measures.

BACKGROUND: We describe the investigation undertaken and the measures adopted to control a Serratia marcescens outbreak in the neonatology unit of La Paz University Hospital in Madrid, Spain. METHODS: Weekly rectal and pharyngeal screenings for S marcescens were performed in the neonates starting after detection of the outbreak. Environmental samples and samples from health care workers (HCWs) were obtained for microbiological analysis. An unmatched case-control study was carried out to investigate risk factors for infection/colonization. RESULTS: The outbreak began in June 2016 and ended in March 2017, affecting a total of 59 neonates. Twenty-five (42.37%) neonates sustained an infection, most frequently conjunctivitis and sepsis. Multivariate logistic regression identified the following risk factors: parenteral nutrition (odds ratio [OR], 103.4; 95% confidence interval [CI], 11.9-894.8), history of previous radiography (OR, 15.3; 95% CI, 2.4-95.6), and prematurity (OR, 5.65; 95% CI, 1.5-21.8). Various measures were adopted to control the outbreak, such as strict contact precautions, daily multidisciplinary team meetings, cohorting, allocation of dedicated staff, unit disinfection, and partial closure. Hands of HCWs were the main suspected mechanism of transmission, based on the inconclusive results of the environmental investigation and the high number of HCWs and procedures performed in the unit. CONCLUSIONS: S marcescens spreads easily in neonatology units, mainly in neonatal intensive care units, and is often difficult to control, requiring a multidisciplinary approach. Strict measures, including cohorting and medical attention by exclusive staff, are often needed to get these outbreaks under control.

[Evolution and spatial analysis of leishmaniasis cases in a rural area bordering a community outbreak in Madrid: 2001-2017]. / Evolución y análisis espacial de los casos de leishmaniasis en una zona rural colindante al brote comunitario de Madrid: 2001-2017.

OBJECTIVE: Leishmaniasis is a zoonotic disease, widely spread all over the world, and an endemic disease in some Spanish regions. Within the Autonomous Region of Madrid, some south populations were affected by an outbreak from 2009. This outbreak had special features and implications related to epidemiology, reservoir and environment intervention. An increased rate in rural areas bordering the outbreak area was detected by epidemiological surveillance. This area has the same environment characteristics. The objective of this study was to research and analyze the evolution of leishmaniasis cases declared in a rural area and their comparison with the cases of the outbreak area. METHODS: The cases declared to Epidemiology Surveillance Network have been used. Kulldorff´s tools were used for the cluster analysis. A hot spot analysis (Getis-Ord Gi*) was made. Leporidae and vector information of the area was related to the location of cases. RESULTS: The number of observed cases exceeded the number of expected cases in this area (epidemic index 7.8 in 2013), after the outbreak. This showed a relation between both incidence rates. It seemed to be spatial correlation when the number of cases was analyzed by census sections and grids (Moran´s I 0,208; z= 9,336). Using the hot-spot analysis, a higher incidence of the study area could be observed, and within Health Basic Area of Griñón after the outbreak years. A spatial relation between cases and a greater presence of vectors and leporidae was found. CONCLUSIONS: The distribution of leishmaniasis cases, in the period and study area suggests a link between the community outbreak and the increase of cases in the study area last years, overall in the rural area. It would be useful to strengthen surveillance and it should apply effective measures used in the bordering area if they were necessary. These measures can help to control the spread of the outbreak.

OBJETIVO: La leishmaniasis en una enfermedad zoonótica muy extendida a nivel mundial y es endémica en algunas regiones de España. Desde 2009 un brote de leishmaniasis ha afectado a algunos municipios del sur de Madrid con características e implicaciones especiales en cuanto a epidemiología, reservorio e intervención medioambiental. Se ha observado un aumento de casos en las zonas rurales adyacentes con características ambientales similares. El objetivo de este trabajo fue estudiar y analizar la evolución de los casos de leishmaniasis declarados en una zona rural colindante y compararlos con el brote comunitario. METODOS: Se utilizó la información de los casos declarados a la Red de Vigilancia Epidemiológica de la Comunidad de Madrid en la zona de estudio desde 2001-2017 y se compararon las tasas de incidencia con las del área del brote. Se realizó un análisis espacial de los casos y de los conglomerados para cuatro unidades espaciales. Se realizó análisis de conglomerados según la técnica de Kulldorff y análisis de puntos calientes según Gi* de Getis-Ord. Se relacionó la información disponible de lepóridos y vectores con la ubicación de los casos. RESULTADOS: Los casos observados en el área de estudio superaron a los esperados tras al inicio del brote (índice epidémico 7,8 en 2013) mostrándose una relación gráfica entre las tasas de incidencia. Existió una autocorrelación espacial cuando se analizaron el número de casos por secciones censales y por cuadrículas (índice de Moran de 0,208; z= 9,336). En el análisis de puntos calientes se pudo apreciar una mayor incidencia en el área de estudio en el periodo posterior al brote, en particular en la Zona Básica de Salud de Griñón. Se constató una relación espacial entre casos y zonas de mayor presencia de lepóridos y vectores. CONCLUSIONES: La distribución de casos de leishmaniasis en el periodo y área de estudio sugiere que puede existir una asociación entre el brote comunitario y el aumento de casos de los últimos años en el área de estudio, específicamente en la zona rural, por lo que sería necesario reforzar la vigilancia y aplicar medidas de control ambiental en caso necesario, lo cual puede contribuir a limitar la extensión del brote.

Evolución y análisis espacial de los casos de leishmaniasis en una zona rural colindante al brote comunitario de Madrid: 2001-2017 / Evolution and spatial analysis of leishmaniasis cases in a rural area bordering a community outbreak in Madrid: 2001-2017

Fundamentos: La leishmaniasis en una enfermedad zoonótica muy extendida a nivel mundial y es endémica en algunas regiones de España. Desde 2009 un brote de leishmaniasis ha afectado a algunos municipios del sur de Madrid con características e implicaciones especiales en cuanto a epidemiología, reservorio e intervención medioambiental. Se ha observado un aumento de casos en las zonas rurales adyacentes con características ambientales similares. El objetivo de este trabajo fue estudiar y analizar la evolución de los casos de leishmaniasis declarados en una zona rural colindante y compararlos con el brote comunitario. Métodos: Se utilizó la información de los casos declarados a la Red de Vigilancia Epidemiológica de la Comunidad de Madrid en la zona de estudio desde 2001-2017 y se compararon las tasas de incidencia con las del área del brote. Se realizó un análisis espacial de los casos y de los conglomerados para cuatro unidades espaciales. Se realizó análisis de conglomerados según la técnica de Kulldorff y análisis de puntos calientes según Gi* de Getis-Ord. Se relacionó la información disponible de lepóridos y vectores con la ubicación de los casos. Resultados: Los casos observados en el área de estudio superaron a los esperados tras al inicio del brote (índice epidémico 7,8 en 2013) mostrándose una relación gráfica entre las tasas de incidencia. Existió una auto-correlación espacial cuando se analizaron el número de casos por secciones censales y por cuadrículas (índice de Moran de 0,208; z= 9,336). En el análisis de puntos calientes se pudo apreciar una mayor incidencia en el área de estudio en el periodo posterior al brote, en particular en la Zona Básica de Salud de Griñón. Se constató una relación espacial entre casos y zonas de mayor presencia de lepóridos y vectores. Conclusión: La distribución de casos de leishmaniasis en el periodo y área de estudio sugiere que puede existir una asociación entre el brote comunitario y el aumento de casos de los últimos años en el área de estudio, específicamente en la zona rural, por lo que sería necesario reforzar la vigilancia y aplicar medidas de control ambiental en caso necesario, lo cual puede contribuir a limitar la extensión del brote

Background: Leishmaniasis is a zoonotic disease, widely spread all over the world, and an endemic disease in some Spanish regions. Within the Autonomous Region of Madrid, some south populations were affected by an outbreak from 2009. This outbreak had special features and implications related to epidemiology, reservoir and environment intervention. An increased rate in rural areas bordering the outbreak area was detected by epidemiological surveillance. This area has the same environment characteristics. The objective of this study was to research and analyze the evolution of leishmaniasis cases declared in a rural area and their comparison with the cases of the outbreak area. Methods: The cases declared to Epidemiology Surveillance Network have been used. Kulldorff's tools were used for the cluster analysis. A hot spot analysis (Getis-Ord Gi*) was made. Leporidae and vector information of the area was related to the location of cases. Results: The number of observed cases exceeded the number of expected cases in this area (epidemic index 7.8 in 2013), after the outbreak. This showed a relation between both incidence rates. It seemed to be spatial correlation when the number of cases was analyzed by census sections and grids (Moran's I 0,208; z= 9,336). Using the hot-spot analysis, a higher incidence of the study area could be observed, and within Health Basic Area of Griñón after the outbreak years. A spatial relation between cases and a greater presence of vectors and leporidae was found. Conclusion: The distribution of leishmaniasis cases, in the period and study area suggests a link between the community outbreak and the increase of cases in the study area last years, overall in the rural area. It would be useful to strengthen surveillance and it should apply effective measures used in the bordering area if they were necessary. These measures can help to control the spread of the outbreak

Consenso sobre la vacunación anti-neumocócica en el adulto por riesgo de edad y patología de base. Actualización 2017 / Consensus document on pneumococcal vaccination in adults at risk by age and underlying clinical conditions. 2017 Update

La enfermedad neumocócica invasiva (ENI) y la neumonía neumocócica (NN) suponen un grave problema de salud entre los adultos de mayor edad y aquellos con determinadas condiciones y patologías de base, entre los que destacan los inmunodeprimidos y algunos inmunocompetentes, que les hacen más susceptibles a la infección y favorecen cuadros de mayor gravedad y peor evolución. Entre las estrategias para prevenir la ENI y la NN se encuentra la vacunación, aunque las coberturas vacunales son más bajas de lo deseable. Actualmente, existen 2 vacunas disponibles para el adulto. La vacuna polisacárida (VNP23), que se emplea en mayores de 2 años de edad desde hace décadas, es la que mayor número de serotipos (23) incluye, pero no genera memoria inmunitaria, los niveles de anticuerpos disminuyen con el tiempo, provoca un fenómeno de tolerancia inmunitaria y no actúa sobre la colonización nasofaríngea. La vacuna conjugada (VNC13) puede emplearse a cualquier edad de la vida a partir de las 6 semanas de vida y genera una respuesta inmunitaria más potente que la VNP23 frente a la mayoría de los 13 serotipos en ella incluidos. En el año 2013 las 16 Sociedades Científicas más directamente relacionadas con los grupos de riesgo para padecer ENI publicamos un documento de Consenso con una serie de recomendaciones basadas en las evidencias científicas respecto a la vacunación antineumocócica en el adulto con condiciones especiales y patología de base. Se estableció un compromiso de discusión y actualización ante la aparición de nuevas evidencias. Fruto de este trabajo de revisión, presentamos una actualización del anterior documento junto a otras nuevas Sociedades Científicas donde destaca la recomendación por edad (AU)

Invasive pneumococcal disease (IPD) and pneumococcal pneumonia (PP) represent an important health problem among aging adults and those with certain underlying pathologies and some diseases, especially immunosuppressed and some immunocompetent subjects, who are more susceptible to infections and present greater severity and worse evolution. Among the strategies to prevent IPD and PP, vaccination has its place, although vaccination coverage in this group is lower than desirable. Nowadays, there are 2 vaccines available for adults. Polysacharide vaccine (PPV23), used in patients aged 2 and older since decades ago, includes a greater number of serotypes (23), but it does not generate immune memory, antibody levels decrease with time, causes an immune tolerance phenomenon, and have no effect on nasopharyngeal colonization. PCV13 can be used from children 6 weeks of age to elderly and generates an immune response more powerful than PPV23 against most of the 13 serotypes included in it. In the year 2013 the 16 most directly related to groups of risk of presenting IPD publised a series of vaccine recommendations based on scientific evidence regarding antipneumococcal vaccination in adults with underlying pathologies and special conditions. A commitment was made about updating it if new scientific evidence became available. We present an exhaustive revised document focusing mainly in recommendation by age in which some more Scientific Societies have been involved (AU)

Effect of amoxicillin exposure on brain, gill, liver, and kidney of common carp (Cyprinus carpio): The role of amoxicilloic acid.

Amoxicillin (AMX) is one of the most commonly prescribed antibiotics around the world due to its broad-spectrum activity against different bacterial strains as well as its use as a growth promoter in animal husbandry. Although residues of this antibacterial agent have been found in water bodies in diverse countries, there is not enough information on its potential toxicity to aquatic organisms such as the common carp Cyprinus carpio. This study aimed to evaluate AMX-induced oxidative stress in brain, gill, liver and kidney of C. carpio. Carp were exposed to three different concentrations of AMX (10 ng/L, 10 µg/L, 10 mg/L) for 12, 24, 48, 72, and 96 h, and the following biomarkers were evaluated: lipid peroxidation (LPX), hydroperoxide content (HPC), protein carbonyl content (PCC) and activity of the antioxidant enzymes superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx). Amoxicillin and its main degradation product amoxicilloic acid (AMA) were determined by high performance liquid chromatography coupled with electrochemical detection and UV detection (HPLC-EC-UV). Significant increases in LPX, HPC, and PCC (P < 0.05) were found in all study organs, particularly kidney, as well as significant changes in antioxidant enzymes activity. Amoxicilloic acid in water is concluded to induce oxidative stress in C. carpio, this damage being highest in kidney. The biomarkers used are effective for the assessment of the environmental impact of this agent on aquatic species. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 1102-1120, 2017.