[Efficacy, effectiveness and safety of the adjuvanted influenza vaccine in the population aged 65 or over]. / Eficacia, efectividad y seguridad de la vacuna antigripal adyuvada en población de 65 o más años de edad.

Most of the complications and deaths related to seasonal flu occur in the elderly population (≥65 years) with comorbidities, and the influenza vaccine is the most effective way to prevent them. Immunization is less effective in older adults due to immunosenescence. MF59-adjuvanted vaccines, designed to improve the magnitude, persistence and amplitude of the immune response in elderly people, have been used in clinical practice since 1997 in their trivalent formulation and, since 2020, in their tetravalent formulation. Data from various studies show that these vaccines are not only safe for all age groups, with a reactogenicity profile similar to that of the conventional vaccine, but also that they are especially effective in boosting the immune response in the population aged 65 or over by increasing antibody titers after vaccination and significantly reducing the risk of hospital admission. Adjuvanted vaccines have been shown to provide cross-protection against heterologous strains and to be as effective as the high-dose vaccine in the population aged 65 or over. In this review, the scientific evidence on the efficacy and effectiveness of the MF59-adjuvanted vaccine in real clinical practice in people ≥65 years of age is analyzed through a narrative and descriptive review of the literature with data from clinical trials, observational studies and systematic reviews or meta-analysis.

Descripción clínico-epidemiológica de los casos graves de gripe A en la temporada 2010/2011 en un hospital de tercer nivel en Canarias / No disponible

OBJETIVO: Describir las principales características clínico-epidemiológicas de los pacientes hospitalizados por gripe en el Hospital Universitario Nuestra Señora de Candelaria (HUNSC), durante la primera temporada pospandémica. MÉTODOS: Se trata de un estudio prospectivo mediante encuesta estandarizada donde se incluyó a todo aquel paciente que ingresaba o que desarrollaba un cuadro intrahospitalario de gripe (casopaciente) desde Enero hasta Marzo de 2011. Caso-grave se definió como aquellos casos-pacientes con gripe confirmada virológicamente y con neumonía, fallo multiorgánico, shock séptico o ingreso en Unidad de Cuidados Intensivos (UCI). RESULTADOS: Se identificaron 189 casos-pacientes y 49 casos-graves. De estos últimos, 27 fueron varones, 1 embarazada y 3 niños. La edad media fue de 45 años. El 34.7% (n=17) ingresó en UCI y 7 pacientes fallecieron durante la onda epidémica. La comorbilidad más frecuente presentada en los casos graves fue la hipertensión arterial y la obesidad. La mayoría de los pacientes fallecidos eran varones, con edades medias (excepto un lactante) y presentaban neumonía viral primaria. CONCLUSIÓN: La descripción clínico-epidemiológica de nuestros pacientes hospitalizados durante la temporada postpandémica es consistente con otros estudios

OBJECTIVE: To describe the clinical epidemiological characteristics of patients who were hospitalized in a tertiary hospital in the Canary Island (HUNSC), during the first post-pandemic influenza season. METHODS: Prospective study carried out with a validated questionnaire which included hospitalized patients or those who developed influenza in a hospital context (case-patient) between January and March 2011. Severe cases were described as those casepatients with laboratory-confirmed influenza and pneumonia, multiorganic failure, septic shock, or that who needed admission to intensive care unit (ICU). RESULTS: The total number of case-patients was 189, from which 49 were severe cases (27 patients were male, 1 pregnant woman and 3 kids). The median age was 45 years. Seventeen patients (34,7%) were admitted to the ICU and 7 patients died during the pandemic wave. The most frequent comorbility shown in severe influenza cases, were hypertension and obesity. Most of the patients who died, were males with normal average ages (except an unweaned baby) and presented primary-viral pneumonia. CONCLUSIÓN: The clinical epidemiological description of our hospitalized patients during the post-pandemic influenza season was consistent with other reports

Recomendaciones de vacunación antineumocócica en el adulto por indicación médica / No disponible

No disponible

Biofilm formation by five species of Candida on three clinical materials.

Most recalcitrant infections are associated with colonization and microbial biofilm development. These biofilms are difficult to eliminate by the immune response mechanisms and the current antimicrobial. Fungi can form biofilms on biomaterials commonly used in clinical practice (intravascular catheters, dentures, heart valves, implanted devices, contact lenses and other devices) and are associated with infections. A variety of in vitro models using different substrates/devices have been described. These models have been used to investigate the effect of different variables, including flow, growth time, nutrients and physiological conditions on fungal biofilm formation, morphology and architecture. The purpose of our study is to analyze biofilm formation capacity by 84 strains of Candida spp. (23C. albicans, 23C. parapsilosis, 16C. tropicalis, 17C. glabrata and 5C. krusei) on three materials used in medical devices and its quantification using a method based on viable cell count. Under the conditions of our study, all assayed Candida strains have been able to form biofilms. All species showed greater biofilm formation capacity on Teflon™, with the exception of C. glabrata which displayed higher biofilm formation capacity on PVC. Biofilm formation by Candida spp. varies depending on the type of material on which it grows and on the species and strain of Candida. The method we propose could be of great use to deepen scientific knowledge on this subject of remarkable clinical significance, considering the absence of standard biofilm formation and quantification techniques on the catheters and the level of difficulty associated to those available.

Gripe humana y gripes animales: una convivencia forzada / Human and animal influenzas: forced coexistence

Influenza is a fascinating topic because of the nature of the causative agent and its presentation in the form of annual endemic cycles, epidemic outbreaks, and pandemics with great impact on public health due to direct morbidity and mortality or to the aggravation of other underlying diseases. Different variants of the influenza virus emerge every 1 to 2 years as the result of point mutations (antigenic drift) or major genetic reassortment (antigenic shift), which involves mixing animal and human viruses. These characteristics oblige the establishment of worldwide early warning systems so that the location of each new variant can be ascertained. The emergence of avian influenza viruses H5N1 and recently of the swine influenza virus H1N1 compel us to study the pathogenic mechanisms of these viruses and their propagation between animal species as well as to determine how the interspecies barrier is broken. A variety of clinical pictures areas sociated with influenzas of animal origin and in general an etiologic diagnosis is not obtained. However, such a diagnosis must be taken into consideration when the results will affect clinical, therapeutic, and epidemiologic decisions. Multiple approaches will be required if we are to cope with a future influenza pandemic, which will probably come from an animal source. Epidemiologic surveillance, antiviral therapy, vaccinations, and non-pharmacologic measures allbecome important public health tools for containing the impact of the virus on society as a whole and avoidings ustained transmission (AU)

La gripe posee un gran atractivo por las características que tiene su agente causal, por su forma de presentación mediante endemias anuales, brotes epidémicos y pandemias con gran repercusión en Salud Pública, ya que presentan una elevada morbilidad y mortalidad directa o por agravamiento de otras enfermedades de base. Las diferentes variantes del virus de la gripe surgen cada 1-2 años mediante mutaciones puntuales(deriva antigénica) o grandes reorganizaciones genéticas (cambios antigénicos mayores)que involucran mezcla de virus animales y humanos. Estas particularidades obligan a establecer sistemas de alerta temprana a nivel mundial para poder localizar cada nueva variante del virus. La aparición de gripes de origen aviar H5N1 y recientemente de origen porcino H1N1 nos obligan a estudiar de forma detenida los mecanismos de patogenicidad de este virus, su propagación entre las diferentes especies animales y cómo se produce el salto de la barrera interespecie. Los cuadros clínicos de estas formas de gripe de origen animal son muy variados y, de forma general, no se suele estudiar un diagnóstico etiológico en los cuadros clínicos que generan, pero sí es necesario planteárselos cuando los resultados vayan a afectar la toma de decisiones clínicas, terapéuticas y epidemiológicas. La mejor manera de afrontar una futura pandemia gripal (de propable origen animal) es hacerlo desde una perspectiva múltiple. La vigilancia epidemiológica,el tratamiento antiviral y las vacunas, así como el uso de medidas no farmacológicas, se convierten en importantes medidas de Salud Pública para contener el impacto de la misma sobre la sociedad en su conjunto y evitar la transmisión sostenida de la misma (AU)

Community-acquired pneumonia: aetiologic changes in a limited geographic area. An 11-year prospective study.

The aim of this study is to describe the changes in the aetiology of hospitalised patients with community-acquired pneumonia (CAP) during an 11-year observational period in a limited geographic area. Eight hundred and one (801) adult patients with CAP hospitalised were included. The patients were divided into three groups according to the time of presentation. Comprehensive microbiological laboratory tests were performed and differences in aetiology were analysed. In 228 patients (31%), a pathogen was detected, with Coxiella burnetii being the most common (20.1%). Significant variations in the prevalence of Chlamydophila pneumoniae were found between groups but not in other pathogens. In conclusion, long-term epidemiological studies may contribute to the knowledge of actual CAP aetiology.

Smoking and sickness absence among public health workers.

BACKGROUND: As well as causing sickness and death, smoking has high socio-economic costs. The aim of this paper was to examine how closely smoking is associated with sickness absence among healthcare workers. SUBJECTS AND METHODS: Cases and controls were paired by age, gender and occupation among primary healthcare workers in Tenerife, Canary Islands, Spain. Cases were selected from workers that had been absent from work due to sickness for 1 or more days in an entire year, regardless of the cause. Controls were those workers who were not absent due to sickness over the same period. Tobacco consumption was verified by telephone poll. Matched pairs analysis was performed. RESULTS: Among the 292 cases, 40% were smokers, compared with 31% of controls [odds ratio (OR)=1.51, 95% confidence intervals (CI)=1.06-2.14]. The association between smoking and sickness absence was stronger in those aged 30-45 years (OR=1.60, 95%CI=1.04-2.44) and among nurses (OR=2.08, 95%CI=1.05-4.14). When the cause of sickness absence was a respiratory disease, no association was found with smoking. However, an association was found with back pain (OR=5, 95%CI=1.45-17.27). Duration of tobacco consumption was higher in cases (a) when only current smokers were considered (P=0.002), and (b) when including the smoking duration of former smokers (P=0.0004). CONCLUSIONS: Smoking is associated with a higher risk of sickness absence among healthcare workers, particularly due to back pain. This could be used as an incentive to persuade healthcare workers to stop smoking and re-inforce the non-smoking message given to their patients.

Comparative evaluation of four commercial tests for presumptive identification of Candida albicans.

Four commercially available tests (Albicans ID2, Chromalbicans Agar, CHROMagar Candida, and BactiCard Candida) and the germ tube (GT) test for presumptive identification of Candida albicans were evaluated using clinical isolates of C. albicans (n=89) and of non-albicans yeasts (n=107). Sensitivities and specificities of all tests regarding the identification of C. albicans were greater than 92%, except for Chromalbicans Agar plates (88.7% after 48 h) and their specificity was 86%. Overall, the four commercial systems were easy to use and are good systems for the routine identification of C. albicans.

Recomendaciones en el abordaje diagnóstico y terapéutico del fumador. Documento de consenso / Recommendations on the diagnostic and therapeutic approach to smokers. Consensus document

No disponible

Recomendaciones en el abordaje diagnóstico y terapéutico del fumador. Documento de consenso / Recommendations in diagnosis and treatment of tobacco cessation. Consensus document

El tabaquismo es la principal causa de muerte evitable en los países desarrollados. Todos los profesionales sanitarios jugamos un papel clave en su control. Es fundamental realizar un correcto diagnóstico de las características de cada fumador para de esa forma ofertarle su tratamiento más adecuado. A lo largo de este documento de consenso entre las sociedades científicas que agrupan a los profesionales sanitarios más interesados en el tabaquismo, hemos definido un grupo de datos clínicos y analíticos que deben ser considerados para establecer el conjunto mínimo de datos diagnósticos en el fumador. Además recomendamos una actividad terapéutica adecuada a las características diagnósticas de cada fumador. Este conjunto mínimo de datos es la base imprescindible para establecer el tratamiento más adecuado a cada individuo con el objetivo de que el paciente progrese en el proceso de abandono del tabaco y consiga la abstinencia tabáquica en el más corto periodo de tiempo posible y con el menor coste personal. Así mismo este conjunto mínimo de datos permite racionalizar la intervención del profesional sanitario conforme a criterios de eficacia y eficiencia (AU)

Comparison of Albicans ID2 agar plate with the germ tube for presumptive identification of Candida albicans.

Albicans ID2 (bioMérieux, France) is a commercially available chromogenic medium that allows rapid and specific macroscopic identification of Candida albicans and facilitates the differentiation of species in mixed cultures. We compared it with the standard method for the identification of yeast species, the germ tube test (GT). This study involved 423 clinical isolates, including 163 C. albicans and 260 non-albicans yeasts. Sensitivity of Albicans ID2 agar plates regarding the identification of C. albicans were 98.2% after 48 h of incubation and specificity of 96.6%. This method using rapid enzymatic method shows the same similar sensitivity than the GT test The false negative rate (1.8%) for the GT test is consistent with that previously reported. None tests discriminated between C. albicans and C. dubliniensis isolates.

[Usefulness of a gene amplification technique (LCx MTB) in the diagnosis of tuberculosis: preliminary results with different sputum samples]. / Utilidad de una técnica de amplificación genética (LCx MTB) para el diagnóstico de tuberculosis: resultados preliminares con muestras diferentes al esputo.

OBJECTIVE: To evaluate the use in non-sputum samples of a commercial molecular amplification kit (LCx MTB, Abbott Diagnostica) (LCx) for the diagnosis of tuberculosis. MATERIAL AND METHOD: Ninety-nine non-sputum samples from the same number of patients (bronchoalveolar, pleural and ascitic fluid, fecal samples, blood cultures, biopsies from different sites, cerebrospinal fluid, urine and gastric juices) and 14 sputum samples (10 from patients clinically suspected of having tuberculosis and 4 from patients diagnosed of tuberculosis and undergoing appropriate treatment for at least one month). All samples were LCx processed according to the manufacturer's instructions. The reference diagnosis was obtained by the Löwestein-jensen method and when results were inconsistent, we took into account the degree of clinical suspicion, response to treatment and histology. RESULTS: Seven of the 99 samples were positive by the LCx technique, and 6 of the 7 were also LJ positive; 1 could not be evaluated because of culture contamination. One LJ positive culture was LCx negative. Only one sample was positive by Ziehl-Neelsen (ZN) staining. Ninety-two samples were LCx negative, with 91 showing no growth at all. Sensitivity was 86% and specificity 98%. Atypical mycobacteria were detected in 4 cases, all of which were LCx negative. CONCLUSIONS: Diagnosis of tuberculosis by applying the LCx system to various types of samples other than sputum is simple, rapid, sensitive and specific.

Risk factors for surgical site infections diagnosed after hospital discharge.

A prospective cohort study on 1103 consecutive patients undergoing general surgery with a follow-up of up to 30 days was undertaken to analyse the risk factors for surgical-site infection (SSI). Relative risks (RRs), crude and multiple-risk factors adjusted for by logistic regression analysis, and their 95% confidence intervals were calculated. One hundred and four patients (9.4%) developed infection, 81 in hospital and 23 at home. Predictors for in-hospital SSI differed from those for post-discharge SSI. In a crude analysis, an increased risk of post-discharge SSI occurred after clean-contaminated surgery (but not contaminated surgery). Stepwise logistic regression failed to identify any significant predictor for post-discharge SSI.

[Smoking habit among workers of the public health system in Tenerife]. / Hábito tabaáquico en los trabajadores del sistema sanitario público de Tenerife.

OBJECTIVE: To find the prevalence of tobacco use among workers in the Public Health system and to assess their own attitudes to the possibility of giving up smoking. DESIGN: A descriptive study of a crossover type was carried out using a self-filled closed-answer questionnaire. SETTING: The Public Health system on the island of Tenerife. PARTICIPANTS: After stratified random sampling, a sample of 1,282 workers was obtained, of whom 770 (60%) answered the questionnaire. Later a reply was obtained from 10% of those who did not at first reply, without any differences from the other participants being apparent. MEASUREMENTS AND MAIN RESULTS: Overall prevalence is 43% of smokers, 13% ex-smokers and 44% non-smokers. 20% of the smokers have an important physical dependency and only 30.76% are highly motivated to stop smoking. 56% of smokers feel home pressure to stop smoking, while only 29.5% of smokers feel pressured at work. We elaborated a scale, which was useful in measuring peoples' motivation to abandon the habit. CONCLUSIONS: Almost half these workers are smokers at present. Despite belonging to the Health system, they are no more motivated than the general population they look after.