Información de medicamentos a la población desde el Servicio de Farmacia a través de Internet

Objectives: To describe and discuss the work of a Pharmacy Department for the health-care portal www.viatusalud.com. Methods: Using a web portal, a Pharmacy Department develops and updates a vademecum on drugs, and answers enquiries by end-users. Results: On December 31, 2002 more than 750 records on drugs were available, and 3030 enquiries had been answered. Conclusions: With this drug information and online enquiry service, our Pharmacy Department helps meet the demand of health-care information posed by the community and by patients previously seen at Clínica Universitaria. In addition, it allows areas of improvement to be detected in the information to be offered to patients fron a Pharmacy Department, and represents a tertiary source of information for health-care professionals

Phenotypic and genotypic characteristics of Escherichia coli strains isolated during a longitudinal follow-up study of chronic urinary tract infections

Worldwide, Urinary Tract Infections (UTIs) are an important health problem with many cases reported annually, women being the most affected. UTIs are relevant because they can become a recurrent condition, associated with different factors that contribute to the chronicity of the disease (cUTI). cUTI can be classified as persistent (peUTI) when the causative agent is the same each time the infection occurs or as reinfection (reUTI) when the associated microorganism is different. The purpose of this work was to characterize Escherichia coli isolates obtained in two prospective studies of patients with cUTI, to define which of them corresponded to peUTI and which to reUTI. A total of 394 isolates of E. coli were analyzed by agglutination with specific sera, antimicrobial susceptibility by diffusion disc test, and the phylogroups and presence of genes associated with virulence by PCR assays. Additionally, in some characterized strains adherence, invasiveness, and biofilm formation were analyzed by in vitro assays. The results showed that the peUTI strains belonged mainly to the classical UPEC serogroups (O25, O75, O6), were included in the B2 phylogroup, carried a great number of virulence genes, and were adherent, invasive, and biofilm-forming. Meanwhile, reUTI strains showed great diversity of serogroups, belonged mainly in the A phylogroup, and carried fewer virulence genes. Both peUTI and reUTI strains showed extensively drug-resistant (XDR) and multidrug-resistant (MDR) profiles in the antimicrobial susceptibility test. In conclusion, it appears that peUTIs are caused principally by classical UPEC strains, while reUTIs are caused by strains that appear to be a part of the common E. coli intestinal biota. Moreover, although both peUTI and reUTI strains presented different serotypes and phylogroups, their antimicrobial resistance profile (XDR and MDR) was similar, confirming the importance of regulating prophylactic treatments and seeking alternatives for the treatment and control of cUTI. Finally, it was possible to establish the features of the E. coli strains responsible for peUTI and reUTI which could be helpful to develop a fast diagnostic methodology

Effects of lng Mutations on LngA Expression, Processing, and CS21 Assembly in Enterotoxigenic Escherichia coli E9034A

Enterotoxigenic Escherichia coli (ETEC) is a major cause of morbidity in children under 5 years of age in low- and middle-income countries and a leading cause of traveler's diarrhea worldwide. The ability of ETEC to colonize the intestinal epithelium is mediated by fimbrial adhesins, such as CS21 (Longus). This adhesin is a type IVb pilus involved in adherence to intestinal cells in vitro and bacterial self-aggregation. Fourteen open reading frames have been proposed to be involved in CS21 assembly, hitherto only the lngA and lngB genes, coding for the major (LngA) and minor (LngB) structural subunit, have been characterized. In this study, we investigated the role of the LngA, LngB, LngC, LngD, LngH, and LngP proteins in the assembly of CS21 in ETEC strain E9034A. The deletion of the lngA, lngB, lngC, lngD, lngH, or lngP genes, abolished CS21 assembly in ETEC strain E9034A and adherence to HT-29 cells was reduced 90%, compared to wild-type strain. Subcellular localization prediction of CS21 proteins was similar to other well-known type IV pili homologues. We showed that LngP is the prepilin peptidase of LngA, and that ETEC strain E9034A has another peptidase capable of processing LngA, although with less efficiency. Additionally, we present immuno-electron microscopy imagens to show that the LngB protein could be localized at the tip of CS21, and probably helps to control CS21 length. In conclusion, our results demonstrate that the LngA, LngB, LngC, LngD, LngH, and LngP proteins are essential for CS21 assembly, as well as for bacterial aggregation and adherence to HT-29 cells

Maternal Serum Meteorin Levels and the Risk of Preeclampsia

BACKGROUND: Meteorin (METRN) is a recently described neutrophic factor with angiogenic properties. This is a nested case-control study in a longitudinal cohort study that describes the serum profile of METRN during different periods of gestation in healthy and preeclamptic pregnant women. Moreover, we explore the possible application of METRN as a biomarker. METHODS AND FINDINGS: Serum METRN was measured by ELISA in a longitudinal prospective cohort study in 37 healthy pregnant women, 16 mild preeclamptic women, and 20 healthy non-pregnant women during the menstrual cycle with the aim of assessing serum METRN levels and its correlations with other metabolic parameters. Immunostaining for METRN protein was performed in placenta. A multivariate logistic regression model was proposed and a classifier model was formulated for predicting preeclampsia in early and middle pregnancy. The performance in classification was evaluated using measures such as sensitivity, specificity, and the receiver operating characteristic (ROC) curve. In healthy pregnant women, serum METRN levels were significantly elevated in early pregnancy compared to middle and late pregnancy. METRN levels are significantly lower only in early pregnancy in preeclamptic women when compared to healthy pregnant women. Decision trees that did not include METRN levels in the first trimester had a reduced sensitivity of 56% in the detection of preeclamptic women, compared to a sensitivity of 69% when METRN was included. CONCLUSIONS: The joint measurements of circulating METRN levels in the first trimester and systolic blood pressure and weight in the second trimester significantly increase the probabilities of predicting preeclampsia

Análisis filogenético de cepas de Escherichia coli aisladas de crías de alpacas (Vicugna pacos) con diarrea en la sierra central del Perú

The aim of this study was to determine the phylogenetic groups of Escherichia coli isolated from alpacas with diarrhoea. The presence of E. coli was determined in 150 samples of diarrheal faeces collected from young alpacas from the central highlands of Peru, and the distribution of phylogenetic groups was determined by the Clermont method. E. coli was present in 79.3% (119/150) of animals with diarrhoea. The strains were classified into phylogenetic groups A, B1, B2 and D, which showed a frequency of 13.5% (16/119), 65.5% (78/119), 1.68% (2/119) and 19.33% (11/23), respectively. Moreover, 21% (25/119) of isolated strains of E. coli belonged to phylogenetic groups B2 and D, mainly extraintestinal pathogenic strains, and 79% (94/119) to groups B1 and A, which are mainly commensal strains.El objetivo del presente estudio fue la determinación de grupos filogenéticos de Escherichia coli obtenidos de alpacas con diarrea. Se determinó la presencia de E. coli en 150 muestras de heces diarreicas recolectadas de crías de alpaca de la sierra central del Perú, y se determinó la distribución de los grupos filogenéticos mediante el método de Clermont. E. coli estuvo presente en el 79.3% (119/150) de los animales con diarrea, pudiendo clasificarse en los grupos filogenéticos A, B1, B2 y D, los cuales mostraron una frecuencia de 13.5% (16/119), 65.5% (78/119), 1.68% (2/119) y 19.33% (23/119), respectivamente. El 21% (25/119) de cepas aisladas de E. coli pertenecen a los grupos filogenéticos B2 y D, principalmente cepas patógenas extraintestinales, y el 79% (94/119) a los grupos B1 y A, que son principalmente cepas comensales

The Hemorrhagic Coli Pilus (HCP) of Escherichia coli O157:H7 Is an Inducer of Proinflammatory Cytokine Secretion in Intestinal Epithelial Cells

Enterohemorrhagic Escherichia coli (EHEC) O157:H7, the causative agent of hemorrhagic colitis and the hemolytic uremic syndrome (HUS), produces long bundles of type IV pili (TFP) called hemorrhagic coli pili (HCP). HCP are capable of mediating several phenomena associated with pathogenicity: i) adherence to human and bovine epithelial cells; ii) invasion of epithelial cells; iii) hemagglutination of rabbit erythrocytes; iv) biofilm formation; v) twitching motility; and vi) specific binding to laminin and fibronectin. HCP are composed of a 19 kDa pilin subunit (HcpA) encoded by the hcpA chromosomal gene (called prepilin peptidase-dependent gene [ppdD] in E. coli K-12).In this study we investigated the potential role of HCP of E. coli O157:H7 strain EDL933 in activating the release of pro- and anti-inflammatory cytokines from a variety of host epithelial cells. We found that purified HCP and a recombinant HcpA protein induced significant release of IL-8 and TNF-alpha, from cultured polarized intestinal cells (T84 and HT-29 cells) and non-intestinal HeLa cells. Levels of proinflammatory IL-8 and TNF-alpha, but not IL-2, IL6, or IL-10 cytokines, were increased in the presence of HCP and recombinant HcpA after 6 h of incubation with >or=50 ng/ml of protein, suggesting that stimulation of IL-8 and TNF-alpha are dose and time-dependent. In addition, we also demonstrated that flagella are potent inducers of cytokine production. Furthermore, MAPK activation kinetics studies showed that EHEC induces p38 phosphorylation under HCP-producing conditions, and ERK1/2 and JNK activation was detectable after 3 h of EHEC infection. HT-29 cells were stimulated with epidermal growth factor stimulation of HT-29 cells for 30 min leading to activation of three MAPKs.The HcpA pilin monomer of the HCP produced by EHEC O157:H7 is a potent inducer of IL-8 and TNF-alpha release, an event which could play a significant role in the pathogenesis of hemorrhagic colitis caused by this pathogen

Errores de medicación: evaluación de un sistema de notificación y análisis de los errores en un hospital universitario

Reporting systems are a valuable tool for detecting errors, analysing them, and for designing initiatives to promote patient safety. The aims of this study were: to describe the design and implementation of a medication error reporting system in the clinical practice context and included in a hospital quality plan, to evaluate the reporting system as an improvement tool, and to analyse notified medication errors in order to propose measures to increase patient safety. We retrospectively analysed all medication errors reported since the introduction of the system, the root cause analyses carried out, and the proposed and implemented improvement actions. We evaluated the tool validity and utility analysing the congruence between narrative descriptions and options selected from pull-down menus on the medication errors forms, and between information on the report and reality, as well as analysing the possibility of classifying medication errors based on the information included in the tool and concordance between different evaluators. We evaluated user satisfaction through a questionnaire given to nurses and doctors. In addition, we used two multivariable logistic regression models to determine independent factors associated with errors reaching the patient and with errors causing harm, respectively. A total of 2,578 medication errors were reported from May 2004 to December 2014. Of these, 94.0% caused no harm, 2.7% caused harm and 1.7% were potential errors. Nurses reported 71.3% of errors, 24.8% were notified by pharmacists and 3.9% by doctors. Regarding the process involved, 44.6% were prescription errors, 33.5% were related to preparation/dispensing and 17.6% to preparation/administration. After the root cause analyses some improvement actions affecting different processes were proposed, 69% of them were implemented. At least one discrepancy between narrative text and options selected from pull-down menus on the reporting form was present in almost 50% of the analysed reports. In those medication errors followed in depth, some discrepancy with reality existed in 40% of the reports. Concordance between evaluators was lower in recurrence probability, severity and identification of causes or contributing factors. However, discrepancies were not critical and did not hindered medication errors classification. Professionals consider the tool easy to use but tend to underreport. Multivariable models indicated that medication errors with higher odds of reaching the patient were: incorrect dose or drug, omission of a dose or a drug, wrong patient, wrong administration technique, medication errors in preparation/manipulation/packaging, those with various persons involved, errors in preparation/administration, and those with anticancer or anti-infective drugs. Therefore, the medication errors reporting system was successfully implemented, in addition, improvement actions were also introduced. Simple medication error reporting tools, as the one presented and analysed here, are valid and useful. Adding more pull-down menus and helping tools will increase identification of medication error causes and contributing factors. Narrative section in the reporting form is useful. Increasing hospital personnel training and offering more feed-back information would motivate reporting. Additional safety measures are necessary to check the right drug, dose and administration technique