Estudio epidemiológico de los enterococos resistentes a la vancomicina en el hospital universitario de Canarias (2001-2009)

Las infecciones relacionadas con la asistencia sanitaria constituyen, uno de los problemas más importantes de Seguridad de los pacientes en los hospitales, habiendo además trascendido a otras instituciones especialmente centros de mayores así como a la propia comunidad. En EE.UU. y en algunos países de Europa los enterococos resistentes a la vancomicina (ERV ) particularmente Enterococcus faecium resistentes a la vancomicina (EfmRV) contituyen un grave problema que ha llevado incluso a la implantación obligatoria en algunos Estados Americanos de un Sistema de Vigilancia Activa. Objetivo: En nuestro estudio pretendemos precisar cual es la situación en el Hospital Universitario de Canarias de las infecciones asociadas a ERV y su evolución a lo largo de la década pasada (2001-2009). Así como conocer su epidemiología incluyendo la aplicación de marcadores moleculares.Material y método: El periodo de estudio se ha realizado desde el 1 de Enero de 2001 al 31 de Diciembre de 2009. Se estudiaron las infecciones por enterococos de todos los pacientes hospitalizados y específicamente aquellos en las que se aisló ERV en una muestra clínica o en una muestra de vigilancia epidemiológica (exudado perianal).En el periodo de estudio concretamente entre julio y octubre de 2005 se produjo en nuestro hospital el primer brote por Enterococcus faecium vanA en Canarias. El brote tuvo lugar en la planta de Nefrología con 16 pacientes implicados además de tres ERV aislados en otros dos hospitales de Canarias.Para la recogida de los datos demográficos y clínicos se revisaron las historias clínicas de todos los pacientes. Los aislamientos de ERV se realizaron a partir de su crecimiento en Agar Sangre y Agar Chocolate (bioMérieux). La identificación presuntiva se llevó a cabo mediante las pruebas clásicas (morfología, Gram y catalasa) y con las tarjetas de identificación para gram positivos por el Sistema automático Vitek2® (ID-GPC; bioMérieux). La Tipificación molecular de la resistencia a los glucopéptidos se realizó por PCR múltiple.. Para la determinación de la clonalidad de los aislados de ERV se utilizó la técnica de macrorrestricción y electroforesis de campo pulsado (PFGE) y MLST. Resultados: El número de ERV aislados en nuestro hospital es afortunadamente muy reducido ya que en este periodo de 9 años sólo hemos tenido 11 infecciones relacionadas con la asistencia sanitaria por ERV, de las cuales 10 fueron por E. faecium (4 EfmvanB y 6 EfmvanA) y sólo una por EfcvanB. Además tuvimos una infección extrahospitalaria por EfmvanA. Tuvimos 15 colonizaciones en el HUC, de las cuales 13 son perianales, obtenidas por búsqueda activa de portadores en relación al brote y 2 colonizaciones son de muestra clínica (exudado de herida y punta de catéter como se aprecia en la tabla 20). Mención aparte son las infecciones por E.gallinarum y E.casseliflavus que fueron 9 y 7 respectivamente. Ninguna otra especie de ERV fue aislada.Quisiéramos destacar que el primer aislamiento de EfmvanB que hicimos en el año 2001 representa el primer caso en España, al menos informado.. Si bien, hay que destacar que tuvimos un brote, 4 fueron infecciones entre julio y octubre del 2005, en el servicio de Nefrología de nuestro hospital, todos ellos en pacientes post-transplantados. Como consecuencia del brote en nuestro hospital iniciamos en octubre del 2005 un sistema de vigilancia activa para la detección de ERV a partir de tomas perianales a todos los pacientes hospitalizados en la planta de Nefrología.Todos los pacientes tanto infectados como colonizados responden a los perfiles de riesgo descritos que incluyen: hemodiálisis, hospitalizaciones frecuentes y prolongadas, enfermedades crónicas y subyacentes, multitratamiento con antibióticos incluyendo tratamientos previos con vancomicina y/o cefalosporinas.Todos los aislados se agruparon en el mismo PFGE, en tres subtipos: A1, A2, A3, estrechamente relacionados (2 o 3 bandas de diferencia entre ellos y más del 90% de similitud). Por lo que evidentemente forman parte de un mismo brote o cluster. Por otra parte

Update Review and Clinical Presentation in Congenital Insensitivity to Pain and Anhidrosis

Introduction. Congenital insensitivity to pain and anhidrosis (CIPA) or hereditary sensory and autonomic neuropathy type IV is an extremely rare syndrome. Three clinical findings define the syndrome: insensitivity to pain, impossibility to sweat, and mental retardation. This pathology is caused by a genetic mutation in the NTRK1 gene, which encodes a tyrosine receptor (TrkA) for nerve growth factor (NGF). Methods. The consultation of a child female in our center with CIPA and a tibia fracture in pseudoarthrosis encouraged us to carefully review literature and examine the therapeutic possibilities. A thorough review of literature published in Pubmed was done about CIPA and other connected medical issues mentioned in the paper. Conclusions. The therapeutic approach of CIPA remains unclear. The preventive approach remains the only possible treatment of CIPA. We propose two new important concepts in the therapeutic approach for these patients: (1) early surgical treatment for long bone fractures to prevent pseudoarthrosis and to allow early weight bearing, decreasing the risk of further osteopenia, and (2) bisphosphonates to avoid the progression of osteopenia and to reduce the number of consecutive fractures

Evaluation of micronuclei in oral mucosa of individuals exposed to ionizing radiation: a pilot study from Celaya, México

Introduction: Occupational exposure to ionizing radiation can potentially lead to adverse health effects, including cancer and genetic defects. Genetic damage caused by radiation can be detected if micronuclei are observed. The objective of this pilot study was to detect the presence of micronuclei in cells of the oral mucosa in inidividuals occupationally exposed to ionizing radiation.Methods:  We implemented a pilot case-control study in which we compared oral mucosa micronuclei in 30 medical and nursing personnel in radiology centers in Celaya, Mexico, with 30 volunteers not exposed to ionizing radiation recruited from a public University. The oral mucosa was brushed and the amount of micronuclei was quantified. Chi-square test or t-test for two proportions were used to compared ionizing radiation and genetic damage between exposed and non-exposed groups.Results: The exposed group had an average of 5.37 ± 3.49 micronuclei and the non-exposed had 0.37 ± 0.61 (P<0.01). In the exposed group, 90% of participants exhibited genetic damage compared to 6.67% in the unexposed group (P<0.05).Conclusion: In this pilot study, medical and nursing staff from radiology centers presented with higher genetic damage compared to control group. Further studies are needed to identify the prevalence of genetic damage due to occupational radiation exposure in Mexico

Potential use of chemoprotectants against the toxic effects of cyanotoxins: A review

Cyanobacterial toxins, particularly microcystins (MCs) and cylindrospermopsin (CYN), are responsible for toxic effects in humans and wildlife. In order to counteract or prevent their toxicity, various strategies have been followed, such as the potential application of chemoprotectants. A review of the main substances evaluated for this aim, as well as the doses and their influence on cyanotoxin-induced toxicity, has been performed. A search of the literature shows that research on MCs is much more abundant than research on CYN. Among chemoprotectants, antioxidant compounds are the most extensively studied, probably because it is well known that oxidative stress is one of the toxic mechanisms common to both toxins. In this group, vitamin E seems to have the strongest protectant effect for both cyanotoxins. Transport inhibitors have also been studied in the case of MCs, as CYN cellular uptake is not yet fully elucidated. Further research is needed because systematic studies are lacking. Moreover, more realistic exposure scenarios, including cyanotoxin mixtures and the concomitant use of chemoprotectants, should be considered

Nursing students' perceptions on the use of clinical simulation in psychiatric and mental health nursing by means of objective structured clinical examination (OSCE)

Background: In view of the rising incidence and prevalence of mental disorders, and the stigma often attached to persons with these pathologies, the question of specific, appropriate training for nursing students is one of great importance. Objective structured clinical examination (OSCE) and clinical simulation may provide a useful means of introducing the student to this environment. Objectives: To examine the perceptions and satisfaction of nursing students after their participation in a targeted mental health course in which the main specialist skills were acquired via clinical simulation. Design: A quantitative, descriptive, transversal study was conducted, in which the participants in a mental health course completed a questionnaire on their satisfaction with the experience. Participants: The study population consisted of 141 nursing students enrolled in a mental health course and currently in the third year of their Nursing Degree studies at the University of M ́alaga (Spain). Results: The overall satisfaction expressed was more than 8 out of 10 (mean score = 8.43, SD = 1.25) and the students’ satisfaction with specific aspects of the procedure exceeded 4 out of 5. The study results show that these nursing students considered the methodology in question to be useful preparation for clinical practice (mean score = 4.78, SD = 0.45), that they appreciated the participation of an expert (mean score = 4.72, SD = 0.60) and that receiving the opinions of their peers about their performance was an enriching part of the experience (mean score = 4.54, SD = 0.64). Conclusions: The participants reported a high degree of satisfaction with the OSCE procedure and observed that this method should be implemented more frequently. Debriefing is viewed as a vital contribution to the learning process and to the participants’ satisfaction. However, further research is needed to study the impact of stress and anxiety on the acquisition of skills via OSCEsFunding for open access charge: Universidad de Málaga / CBU

Evaluation of micronuclei in oral mucosa of individuals exposed to ionizing radiation: a pilot study from Celaya, México

Introduction: Occupational exposure to ionizing radiation can potentially lead to adverse health effects, including cancer and genetic defects. Genetic damage caused by radiation can be detected if micronuclei are observed. The objective of this pilot study was to detect the presence of micronuclei in cells of the oral mucosa in inidividuals occupationally exposed to ionizing radiation. Methods:  We implemented a pilot case-control study in which we compared oral mucosa micronuclei in 30 medical and nursing personnel in radiology centers in Celaya, Mexico, with 30 volunteers not exposed to ionizing radiation recruited from a public University. The oral mucosa was brushed and the amount of micronuclei was quantified. Chi-square test or t-test for two proportions were used to compared ionizing radiation and genetic damage between exposed and non-exposed groups. Results: The exposed group had an average of 5.37 ± 3.49 micronuclei and the non-exposed had 0.37 ± 0.61 (P<0.01). In the exposed group, 90% of participants exhibited genetic damage compared to 6.67% in the unexposed group (P<0.05). Conclusion: In this pilot study, medical and nursing staff from radiology centers presented with higher genetic damage compared to control group. Further studies are needed to identify the prevalence of genetic damage due to occupational radiation exposure in Mexico

Spanish validation of the national league for nursing questionnaires for clinical simulation

Introduction Learning by clinical simulation enables students to experience the nuances often encountered in clinical settings before experiencing actual real-world patient scenarios. Valid and reliable assessment tools are required to measure clinical competence. The aim of this study was to validate the National League for Nursing satisfaction instruments for its use in the Spanish context. Methods Psychometric and cultural adaptation study. Student Satisfaction and Self-Confidence in Learning Scale, the Simulation Design Scale and the Educational Practices Questionnaire were adapted culturally, and their psychometric properties were tested empirically. Results Fourth-year undergraduate nursing students participated in the study (n = 173). The Cronbach's alpha scores obtained ranged from 0.90 to 0.95. Confirmatory factor analysis revealed adequate goodness of fit values (RMSEA: 0.04 to 0.08). Conclusions The Spanish-language version of the National League of Nursing instruments obtains satisfactory results. Further study is needed to determine the factorial invariance and whether any modifications in the instruments are needed.This research was supported in part by the University of Malaga within the framework of the financing program of educational innovation projects under number PIE 144-2015

Cinco especies vegetales antiinflamatorias del Libellus de Medicinalibus Indorum Herbis de México, 1552: Una revisión botánica, química y farmacológica

Background and Aims: The Libellus de Medicinalibus Indorum Herbis (Little Book of the Medicinal Herbs of the Indians) includes 185 beautifully illustrated plants, 131 interpreted to species. Only some have been investigated regarding their attributed properties. Therefore, we selected six plants used as anti-inflammatories. The objectives of this work were to corroborate their botanical identity and to determine if contemporary chemical and pharmacological information supports their ancient therapeutic applications.Methods: The illustrations of the chosen plants were compared with specimens from the MEXU Herbarium to propose their possible taxonomic identity. The phytochemistry and anti-inflammatory activity of these species were reviewed in databases.Key results: The six plants selected from the Codex correspond to five species, since we consider that tetzmitl (Folium 13r) and texiyotl (Folium 22v) plants are the same species: Sedum dendroideum. Extracts from the leaves of S. dendroideum have shown anti-inflammatory activity in different pharmacological models due to derivatives of the flavonoid kaempferol, which supports its ancient medical applications to treat swollen face, eyes, and mouth. In Folium 48v, tzihuac copalli and tlacoecapatli are prescribed when “the vein punctured by the phlebotomy swells.” We agree they are Bursera bipinnata and Litsea glaucescens, respectively. To date, their possible anti-inflammatory properties have not been investigated, but other related species do present these. The Folium 22v recommends tememetla and tequixquiçacatl to relieve inflamed mouth. We corroborate that they are Echeveria gibbiflora and Distichlis spicata, respectively. These species do not have chemical-pharmacological studies.Conclusions: The bibliographic review suggests that anti-inflammatory properties attributed to S. dendroideum in the Codex have chemical and pharmacological support. Chemotaxonomic and pharmacological information suggests that B. bipinnata and L. glaucescens could bear these attributes and should be investigated experimentally. These three species are still used as anti-inflammatory in contemporary traditional medicine.Antecedentes y Objetivos: El Libellus de Medicinalibus Indorum Herbis (Librito de las Hierbas Medicinales de los Indios) incluye 185 plantas bellamente ilustradas, 131 interpretadas a especie. Solo algunas se han investigado respecto a las propiedades que ahí se les atribuyen. Por ello, seleccionamos seis plantas utilizadas como antiinflamatorias. Los objetivos de este trabajo fueron corroborar su identidad botánica y determinar si la información química y farmacológica contemporánea respalda sus antiguas aplicaciones terapéuticas.Métodos: Para proponer las especies a las cuales posiblemente corresponden las ilustraciones de las plantas elegidas, estas se compararon con especímenes del Herbario MEXU. Se revisó en bases de datos la fitoquímica y actividad antiinflamatoria de dichas especies.Resultados clave: Las seis plantas seleccionadas del códice corresponden a cinco especies, pues consideramos que las plantas tetzmitl (Folium 13r) y texiyotl (Folium 22v) son la misma especie: Sedum dendroideum. Los extractos de las hojas de S. dendroideum han presentado actividad antiinflamatoria en diferentes modelos farmacológicos debido a derivados del flavonoide kaempferol, lo cual respalda sus antiguas aplicaciones médicas para tratar la cara, ojos y boca hinchados. En el Folium 48v se prescriben tzihuac copalli y tlacoecapatli cuando “se hincha la vena pinchada por la flebotomía”. Concordamos en que son Bursera bipinnata y Litsea glaucescens, respectivamente. A la fecha, no se han investigado sus posibles propiedades antiinflamatorias, pero sí las presentan otras especies relacionadas. El Folium 22v recomienda tememetla y tequixquiçacatl para aliviar la boca inflamada. Corroboramos que son Echeveria gibbiflora y Distichlis spicata, respectivamente. Dichas especies no cuentan con estudios químico-farmacológicos.Conclusiones: La revisión bibliográfica sugiere que las propiedades antiinflamatorias atribuidas en el Códice para S. dendroideum tienen sustento químico y farmacológico. La información quimiotaxonómica y farmacológica sugiere que B. bipinnata y L. glaucescens podrían presentarlas y deben investigarse experimentalmente. Estas tres especies aún se emplean como antiinflamatorias en la medicina tradicional contemporánea

Identification of recent tuberculosis exposure using QuantiFERON-TB Gold Plus, a multicenter study.

We investigated whether the difference of antigen tube 2 (TB2) minus antigen tube 1 (TB1) (TB22TB1) of the QuantiFERON-TB gold plus test, which has been postulated as a surrogate for the CD81 T-cell response, could be useful in identifying recent tuberculosis (TB) exposure. We looked at the interferon gamma (IFN-g) responses and differences in TB2 and TB1 tubes for 686 adults with QFT-plus positive test results. These results were compared among groups with high (368 TB contacts), low (229 patients with immune-mediated inflammatory diseases [IMID]), and indeterminate (89 asylum seekers or people from abroad [ASPFA]) risks of recent TB exposure. A TB22TB1 value .0.6 IU ml21 was deemed to indicate a true difference between tubes. In the whole cohort, 13.6%, 10.9%, and 11.2% of cases had a TB2.TB1 result in the contact, IMID, and ASPFA groups, respectively (P = 0.591). The adjusted odds ratios (aORs) for an association between a TB22TB1 result of .0.6 IU ml21 and risk of recent exposure versus contacts were 0.71 (95% confidence interval [CI], 0.31 to 1.61) for the IMID group and 0.86 (95% CI, 0.49 to 1.52) for the ASPFA group. In TB contact subgroups, 11.4%, 5.4%, and 17.7% with close, frequent, and sporadic contact had a TB2.TB1 result (P = 0.362). The aORs versus the close subgroup were 1.29 (95% CI, 0.63 to 2.62) for the frequent subgroup and 1.55 (95% CI, 0.67 to 3.60) for the sporadic subgroup. A TB22TB1 difference of .0.6 IU ml21 was not associated with increased risk of recent TB exposure, which puts into question the clinical potential as a proxy marker for recently acquired TB infection

Tetrahymena Metallothioneins Fall into Two Discrete Subfamilies

BACKGROUND: Metallothioneins are ubiquitous small, cysteine-rich, multifunctional proteins which can bind heavy metals. METHODOLOGY/PRINCIPAL FINDINGS: We report the results of phylogenetic and gene expression analyses that include two new Tetrahymena thermophila metallothionein genes (MTT3 and MTT5). Sequence alignments of all known Tetrahymena metallothioneins have allowed us to rationalize the structure of these proteins. We now formally subdivide the known metallothioneins from the ciliate genus Tetrahymena into two well defined subfamilies, 7a and 7b, based on phylogenetic analysis, on the pattern of clustering of Cys residues, and on the pattern of inducibility by the heavy metals Cd and Cu. Sequence alignment also reveals a remarkably regular, conserved and hierarchical modular structure of all five subfamily 7a MTs, which include MTT3 and MTT5. The former has three modules, while the latter has only two. Induction levels of the three T. thermophila genes were determined using quantitative real time RT-PCR. Various stressors (including heavy metals) brought about dramatically different fold-inductions for each gene; MTT5 showed the highest fold-induction. Conserved DNA motifs with potential regulatory significance were identified, in an unbiased way, upstream of the start codons of subfamily 7a MTs. EST evidence for alternative splicing in the 3′ UTR of the MTT5 mRNA with potential regulatory activity is reported. CONCLUSION/SIGNIFICANCE: The small number and remarkably regular structure of Tetrahymena MTs, coupled with the experimental tractability of this model organism for studies of in vivo function, make it an attractive system for the experimental dissection of the roles, structure/function relationships, regulation of gene expression, and adaptive evolution of these proteins, as well as for the development of biotechnological applications for the environmental monitoring of toxic substances