Low Sensitivity of Conventional Fungal Agars in Fungemia by Rhodotorula Mucilaginosa: Description of Two Cases

Background Although most bloodstream yeast infections are caused by Candida spp., infections by rare or less common species have increased in recent years. Diagnosis of infections caused by these species is difficult due to the lack of specific symptoms and adequate diagnostic tools. Cases presentation We describe two cases of fungemia by Rhodotorula mucilaginosa within a few months of each other, in a secondary Spanish hospital. In both cases, diagnosis was challenging. Blood subcultures in conventional fungal media were persistently negatives and the use of non-conventional fungal media was essential for isolating the yeasts and achieving a correct diagnosis. 1-3 beta-d-glucan detection and a panfungal PCR assay were helpful techniques to confirm the diagnosis Conclusion It is highly important to establish an early diagnosis for fungemia. The process is challenging because often non-specific symptoms are presents. When yeasts grow in blood cultures other genera than Candida spp. could be the cause of infection. Patient risk factors should be assessed to incorporate alternative culture media and the available rapid diagnostic test, in order to provide an early recognition of the pathogenThis work was supported by research project PI17CIII/00033 from the Spanish Fondo de Investigaciones Sanitarias of the Instituto de Salud Carlos III, and IT913-16 from the Consejeria de Educacion, Universidades e Investigacion of Gobierno Vasco-Eusko Jaurlaritz

Spanish experts consensus on emergency psychiatric care in hospital emergency departments

Delphi technique; Emergency services; PsychiatricTècnica Delphi; Serveis d'emergència; PsiquiatriaTécnica Delphi; Servicios d'emergencia; PsiquiatríaBackground The demand for urgent psychiatric care is increasing, but in Spain there are no clear recommendations for emergency departments (ED) on how to optimize care for patients with psychiatric emergencies. We aimed to provide expert consensus recommendations on the requirements for general hospitals´ emergency departments to treat patients with urgent psychiatric symptoms. Methods We used a modified Delphi technique. A scientific committee compiled 36 statements based on literature search and clinical experience. The statements covered the organizational model, facilities, staffing, safety, patient interventions, and staff training. A panel of 38 psychiatry specialists with expertise in psychiatric emergencies evaluated the questionnaire in two rounds. Results After two rounds of voting, 30 out of 36 proposed items (83%) were agreed upon. The panel agreed that psychiatric emergencies should be managed in a general hospital, with dedicated facilities for patient assessment, direct supervision of patients at risk, and an observation unit run by the psychiatric service. In addition to the psychiatrist, the ED should have specialist nurses and security staff available 24/7. Social workers should also be readily available. ED and consulting rooms should be designed to ensure patient and staff safety. A triage system should be established for patients with psychiatric symptoms, with medical evaluation preceding psychiatric evaluation. Guidance on supplies, equipment, and staff training is also provided. Conclusion All ED in general hospitals should have adequate resources to handle any psychiatric emergency. This paper provides recommendations on the minimum requirements to achieve this goal.This work was funded by Janssen

Cómo hacer una evaluación sensible al género y al enfoque basado en derechos humanos para el desarrollo

Depto. de Ciencia Política y de la AdministraciónFac. de Ciencias Políticas y SociologíaTRUEpu

Prevalence, clinical characteristics and outcome of severe primary HIV-1 infection: a prospective cohort study

Background: Severe cases of primary HIV infection have been described in patients presenting with neurological involvement, AIDS defining events or other life-threatening events. These severe forms have not been fully studied. Objectives: To determine the prevalence and characteristics of severe PHI in a hospital-based cohort of primary HIV infection, and the response to the early initiation of antiretroviral therapy (ART) at 12 months. Methods: Every patient with PHI attending Hospital Clínic of Barcelona (1997-2015) was evaluated. Severe PHI was defined using clinical, analytical and immunological criteria. Chi-squared test was used for categorical variables and Student's t-test for quantitative variables. Results: 33% of 224 PHI patients (95% CI: 26.84%-39.16%) had a severe PHI. These patients had more symptoms, abnormal analytical parameters and hospital admissions. The severe PHI group had a significantly higher viral load although no differences were observed at 12 months in terms of viral suppression or CD4 count recovery. None died during PHI. Conclusions: Up to one third of patients in our cohort presented with a severe PHI, which was associated with higher hospitalization rates and higher plasma HIV RNA viral load. However, severe forms were not associated to a worse clinical, immunological or virological outcome at 12 months

Hemolytic Anemia After Surgical Mitral Valve Repair Treated With Transcatheter Edge-to-Edge Device

An 80-year-old woman with mitral valve repair failure was admitted with hemolytic anemia secondary to the impact of a regurgitant jet on the annuloplasty ring. Transcatheter repair to treat both mitral regurgitation and hemolysis was favored because of surgical risk. Transcatheter edge-to-edge repair represents an alternative for treating hemolysis associated with mitral regurgitation. (Level of Difficulty: Advanced.

Barriers to health care services for migrants living with HIV in Spain

BACKGROUND: In Spain, migrants are disproportionately affected by HIV and experience high rates of late diagnosis. We investigated barriers to health care access among migrants living with HIV (MLWH) in Spain. METHODS: Cross sectional electronic survey of 765 adult HIV-positive migrants recruited within 18 health care settings between July 2013 and July 2015. We collected epidemiological, demographic, behavioral and clinical data. We estimated the prevalence and risk factors of self-reported barriers to health care using multivariable logistic regression. RESULTS: Of those surveyed, 672 (88%) had information on health care access barriers: 23% were women, 63% from Latin America and Caribbean, 14% from Sub-Saharan Africa and 15% had an irregular immigration status. Men were more likely to report barriers than women (24% vs. 14%, P = 0.009). The main barriers were: lengthy waiting times for an appointment (9%) or in the clinic (7%) and lack of a health card (7%). Having an irregular immigration status was a risk factor for experiencing barriers for both men (OR: (4.0 [95%CI: 2.2–7.2]) and women (OR: 10.5 [95%CI: 3.1–34.8]). Men who experienced racial stigma (OR: 3.1 [95%CI: 1.9–5.1]) or food insecurity (OR: 2.1 [95%CI: 1.2–3.4]) were more likely to report barriers. Women who delayed treatment due to medication costs (6.3 [95%CI: 1.3–30.8]) or had a university degree (OR: 5.8 [95%CI: 1.3–25.1]) were more likely to report barriers. CONCLUSION: Health care barriers were present in one in five5 MLWH, were more common in men and were associated to legal entitlement to access care, perceived stigma and financial constraints

Disseny de mobiliari per a Caribe S.L.

[ES] En este proyecto se va a realizar un diseño para Caribe S.L., una panadería-pastelería de Almuñécar (Granada) para su nueva tienda. Este mobiliario se centrará en el diseño de un mostrador con vitrina neutra. El cliente quiere modernizar el aspecto de las tiendas manteniendo la estética que han seguido hasta ahora. Contará con un diseño de unión entre lo moderno y la esencia de la panadería, así como una alta funcionalidad para los/las trabajador/as de las tiendas y las necesidades del producto a poner en venta.[EN] In this project a design will be made for Caribe S.L., a bakery-pastry shop in Almuñécar (Granada) for their new shop. This furniture will focus on the design of a neutral showcase with a counter. The client wants to modernise the appearances of the shops while maintaining the aesthetics they have followed until now. It will have a design that will unify the new modern aspects and the essence of the bakery it-self until now, as well as a high functionality for the workers of the store and the needs of the product on sell.Fajardo Ligero, C. (2023). Diseño de mobiliario para Caribe S.L. Universitat Politècnica de València. http://hdl.handle.net/10251/19582

LA ORIENTACION VOCACIONAL Y LAS PREFERENCIAS POR LAS LICENCIATURAS DEL CAMPO DE LAS CIENCIAS SOCIALES SOBRE LAS DEL AMBITO DE LAS CIENCIAS EXACTAS POR PARTE DE LOS EDUCANDOS DEL 6° SEMESTRE DEL COLEGIO DE BACHILLERES DE TABASCO PLANTEL N° 7 DE HUIMANGUILLO, TABASCO

Licenciatura en Ciencias de la Educació

Diurnal variation in nodule nitrogen metabolism in faba bean (Vicia faba L.)

Diurnal variations in acetylene reduction is shown in nitro gen-fixing faba bean. The highest values for ARA occurred during the light period, while the lowest values were recorded during the dark periodo However, the glutamate synthase cycle enzymes (GS and NADH-GOGAT) and NADH-GDH show rhythmic behaviour on a cycle of 16 h, with maximum and minimum activities both being observed during the photoperiod as well the dark periodoLa reducción de acetileno en plantas de haba fijadoras de nitrógeno, mostró diferencias entre el día y la noche. Los mayores valores de ARA se detectaron durante el periodo de luz, mientras que en periodo de oscuridad los valores fueron inferiores. Por otra parte, las enzimas del ciclo de la glutamato sintasa (GS y NADH-GOGAT) y la NADH-GDH mostraron un comportamiento cíclico de 16 horas, observándose actividades máximas y mínimas tanto en el periodo de luz como en el de oscuridad

Performance of and biomass characterisation in a UASB reactor treating domestic waste water at ambient temperature

[Abstract] Domestic waste water from the city of A Coruña (NW Spain) was treated anaerobically in a laboratory-scale upflow anaerobic sludge blanket (UASB) digester, at 20°C, at hydraulic retention times (HRTs) of longer than 24 h, the COD and SS removal efficiencies remained practically constant and higher than 85%. When reducing the HRT from 24 to 5 h, the COD removal decreased from 85% to 53% and the SS removal from 89% to 63%. The methane recovered in the biogas ranged from 25% to 30% of the influent COD, increasing slightly with the operational time. Methanogenic activities greater than 0.1 g CH4-COD·g-1VSS·d-1 were found for the sludge from the lower part of the UASB digester. The average methanogenic activity of the sludge decreased from 0.32 at the start-up to about 0.03 g CH4-COD·g-1VSS·d-1 at the end of operation, while the average sludge concentration was in the range of 8 to 10 g VSS·l-1. The amount and the methanogenic activity of the developed anaerobic sludge appeared to be the main efficiency-limiting factor of the UASB performance. The removal efficiencies were increased by about 5% when the UASB digester was used in combination with a completely mixed sludge digester (CMSD) system for the external digestion and stabilisation of the accumulated solids into the UASB. This also led to the increase of the biomass concentration and uniformisation of the UASB sludge bed, but the average methanogenic activity remained low