Endophthalmitis Caused by Fusarium proliferatum

Fusarium proliferatum caused endophthalmitis after cataract surgery. Diagnosis was established by classical microbiology and molecular biology methods (PCR and DNA typing). The treatment with local amphotericin B, oral ketoconazole, and topical natamycin was successfu

Polymerase chain reaction diagnosis in fungal keratitis caused by Alternaria alternata

PURPOSE: To contribute toward assessing the effectiveness of polymerase chain reaction as a rapid method in diagnosis of torpid keratitis caused by opportunistic fungi. METHODS: Interventional case report. A 50-year-old man with a corneal abscess in the right eye treated for a period of 6 months with different combinations of broad-spectrum antibiotics and steroids was referred to our center. Corneal scraping was taken for microbiological study, including classic cultures and polymerase chain reaction. Amplified DNA was sequenced to identify the pathogen. RESULTS: Polymerase chain reaction amplification was negative for Acanthamoeba species and positive for fungi. The sequence analysis showed Alternaria alternata as the causal agent in 24 hours. Cultures confirmed the identification in 10 days. CONCLUSION: Polymerase chain reaction amplification with subsequent DNA-typing was revealed to be a useful method for detection of ocular pathogens such as A. alternata involved in cases of torpid keratitis, even in the presence of broad-spectrum antimicrobial therap

Rapid Molecular Diagnosis of Posttraumatic Keratitis and Endophthalmitis Caused by Alternaria infectoria

The first case of Alternaria infectoria ocular infection is reported. Keratitis and endophthalmitis developed after eye-perforating trauma from a lemon tree branch. Two months after surgery and empirical steroid and antibiotic treatment, diagnosis by molecular methods was performed. PCR amplification was positive for a fungus after 4 h. Antifungal treatment with amphotericin B and fluconazole was initiated immediately. DNA sequence analysis showed Alternaria infectoria to be the causal agent. After topical and systemic administration of antifungal treatment, ocular inflammation disappeared and visual acuity improved. DNA typing was found to be a useful tool to achieve early identification of the causal agen

Efficacy of a brief multifactorial adherence-based intervention on reducing the blood pressure of patients with poor adherence: protocol for a randomized clinical trial

<p>Abstract</p> <p>Background</p> <p>Lowering of blood pressure by antihypertensive drugs reduces the risks of cardiovascular events, stroke, and total mortality. However, poor adherence to antihypertensive medications reduces their effectiveness and increases the risk of adverse events. In terms of relative risk reduction, an improvement in medication adherence could be as effective as the development of a new drug.</p> <p>Methods/Design</p> <p>The proposed randomized controlled trial will include patients with a low adherence to medication and uncontrolled blood pressure. The intervention group will receive a multifactorial intervention during the first, third, and ninth months, to improve adherence. This intervention will include motivational interviews, pill reminders, family support, blood pressure self-recording, and simplification of the dosing regimen.</p> <p>Measurement</p> <p>The primary outcome is systolic blood pressure. The secondary outcomes are diastolic blood pressure, proportion of patients with adequately controlled blood pressure, and total cost.</p> <p>Discussion</p> <p>The trial will evaluate the impact of a multifactorial adherence intervention in routine clinical practice. Ethical approval was given by the Ethical Committee on Human Research of Balearic islands, Spain (approval number IB 969/08 PI).</p> <p>Trial registration</p> <p>Current controlled trials ISRCTN21229328</p

Smoking cessation opportunities in severe mental illness (tobacco intensive motivational and estimate risk — TIMER—): study protocol for a randomized controlled trial

There is an increased risk of premature death in people with severe mental illness (SMI). Respiratory disorders and cardiovascular disease are leading causes of increased mortality rates in these patients, and tobacco consumption remains the most preventable risk factor involved. Developing new tools to motivate patients towards cessation of smoking is a high priority. Information on the motivational value of giving the lung age and prevention opportunities is unknown in this high-risk population. In the context of community care, screening and early detection of lung damage could potentially be used, together with mobile technology, in order to produce a prevention message, which may provide patients with SMI with a better chance of quitting smoking.This study receives funding by the Spanish Ministry of Economy, Industry and Competitiveness, Instituto Carlos III (FIS PI16/00802)

Introducció del Design Thinking a l'aula

[cat] A la Formació Professional existeix una gran necessitat d’incorporar metodologies actives que ajudin als estudiants a aprendre d’una manera més dinàmica i activa. Hi ha cicles formatius que ja estan molt protocol·litzats com per exemple, Cuina o Electricitat, però hi ha molts altres cicles professionals que hi manca el principal avantatge d’aquests estudis que és poder aplicar la pràctica en totes les vessants dels seus ensenyaments, fet que es tradueix en un gran desinterès i en un gran augment d’abandonament escolar. És necessari una bona actualització de les programacions amb la introducció de metodologies innovadores, com és el cas del Design Thinking, principi bàsic d’estudi d’aquest treball. Primerament, analitzam els fonaments del Design Thinking als Estats Units, la seva evolució al llarg del temps, la seva internacionalització fins a arribar a Espanya i com ha sigut la seva implantació en el camp de la docència. Posteriorment, detallam la seva aplicació a diferents nivells educatius (Secundària, estudis universitaris i inclòs Primària) però sobretot, als cicles formatius de Formació Professional. Hem implantat el Design Thinking com a metodologia al nostre Treball Final de Màster, concretament en la programació anual del mòdul de Màrqueting Internacional, del cicle formatiu de grau superior de Comerç Internacional. A través de diverses sessions pràctiques, l’hem pogut treballar amb els alumnes de 1r del cicle formatiu de grau superior en Comerç Internacional de l’Institut Francesc de Borja Moll. A l’apartat de conclusions, les nostres principals aportacions s’han centrat que una bona aplicació d’aquesta estratègia juntament amb altres metodologies innovadores a escala transversal poden aportar grans resultats en l’àmbit acadèmic i d’inserció al món laboral, ja que les idees més engrescades i innovadores flueixen de la llibertat en les aportacions individuals i grupal

Molecular epidemiology of isolates of the Cryptococcus neoformans species complex from Spain

6 p. : il.To study genetic diversity of Cryptococcus neoformans species complex in Spain, 97 isolates of the yeast recovered from human, animal and environmental samples have been analysed using three molecular epidemiological techniques. One of these, URA5 gene fragment length polymorphism (RFLP) analysis, has been previously described as a molecular epidemiology tool. Thus, standard profiles and reference strains have been defined for it. In addition, 5S rDNA/IGS RFLP and [GACA]4 microsatellite PCR fingerprinting were also used. Our results show five of the previously defined URA5 genotypes with a high frequency (33%) of the VNI type, which is in concordance with other studies. The high presence of VNIII pattern (28.9%) among our strains is remarkable and could be a specific feature of the isolates from our country. 5S rDNA/IGS RFLP showed a low intra-species discriminative power. Three different molecular profiles (S1-3), which showed a good correlation with the different species, varieties and genotypes, were obtained. [GACA]4 microsatellite PCR-fingerprinting analysis showed a high variability of patterns among the studied strains. Molecular profiles represented in a dendrogram clustered strains in four main groups related with the source of the yeast and also in concordance with some of the described genotypes (VNI-IV and VGI). ____________________________________________________________________________________.RESUMEN - Para ampliar el conocimiento de la diversidad genética que presenta el complejo Cryptococcus neoformans en España, se analizaron 97 aislamientos de esta levadura obtenidos a partir de muestras ambientales, veterinarias y clínicas, utilizando 3 técnicas epidemiológicas moleculares diferentes. Uno de estos marcadores moleculares, el análisis del URA5 RFLP, se ha descrito previamente como herramienta epidemiológica, por lo que se dispone de perfiles estándar y cepas de referencia. Además, se utilizaron también el análisis del RFLP del 5S rDNA/IGS y la huella digital tras amplificación por PCR de la secuencia microsatélite [GACA]4. Nuestros resultados muestran 5 de los genotipos URA5 con una elevada frecuencia del tipo VNI (33%), lo que concuerda con otros estudios. Es de resaltar la elevada presencia del perfil VNIII entre nuestras cepas (28,9%), lo que podría ser el rasgo específico más destacable de los aislamientos de nuestro país. El marcador 5S rDNA/IGS mostró un bajo poder discriminativo intraespecie. Se obtuvieron 3 perfiles moleculares distintos (S1-3), que presentaron una buena correlación con las especies, variedades y genotipos. La obtención de perfiles de huella digital con [GACA]4, presentó una gran variabilidad entre las cepas estudiadas. La representación en dendrograma agrupó las cepas en 4 agrupamientos principales relacionados con el origen de las levaduras y también con cierta concordancia con los genotipos descritos (VNI-IV y VGI)

First report on mycetoma in Turkana County-North-western Kenya.

Mycetoma is one of the six Neglected Tropical Diseases that are prevalent in Turkana County (northwest Kenya). The aim of the study was to estimate the prevalence of mycetoma in the county, as well as to describe the main causative agents involved in the disease using methods affordable locally. Based on the data collected by the team of cooperative medicine Cirugia en Turkana (Surgery in Turkana), a specific study for mycetoma was started during the 16th humanitarian medicine campaign in February 2019. Patients with suspected mycetoma were studied at the Lodwar County Referral Hospital (LCRH). After informing the patient and getting their consent, the lesions were examined and sampled (mainly by biopsy) and clinical data were recorded. Samples were washed in sterile saline solution and cut in fragments. Some of these were inoculated on Sabouraud Dextrose Agar, Malt Extract Agar, and diluted Nutrient Agar plates. One fragment of each sample was used for DNA extraction. The DNA and the rest of the fragments of samples were kept at -20°C. All cultures were incubated at room temperature at the LCRH laboratory. The DNA obtained from clinical samples was submitted to PCR amplification of the ITS-5.8S and the V4-V5 16S rRNA gene region, for the detection and identification of fungi and bacteria respectively. From February 2019 till February 2022, 60 patients were studied. Most of them were men (43, 74,1%) between 13 and 78 y.o. (mean age 37). Half of the patients were herdsmen but, among women 40% (6) were housewives and 26.7% (4) charcoal burners. Lesions were mainly located at the feet (87.9%) and most of the patients (54; 93.1%) reported discharge of grains in the exudate, being 27 (46.6%) yellow or pale colored and 19 (32.8%) of them dark grains. Culture of clinical samples yielded 35 fungal and bacterial putative causative agents. Culture and molecular methods allowed the identification of a total of 21 causative agents of mycetoma (39.6% of cases studied). Most of them (17) corresponded to fungi causing eumycetoma (80.9%) being the most prevalent the genus Madurella (7; 41.2%), with two species involved (M. mycetomatis and M. fahalii), followed by Aspergillus (2; 11.8%). Other minority genera detected were Cladosporium, Fusarium, Acremonium, Penicillium, and Trichophyton (5.9% each of them). Actinobacteria were detected in 19.1% of samples, but only Streptomyces somaliensis was identified as a known agent of mycetoma, the rest being actinobacteria not previously described as causative agents of the disease, such as Cellulosimicrobium cellulans detected in two of the patients. Although Kenya is geographically located in the mycetoma belt, to our knowledge this is the first report on mycetoma in this country from 1973, and the first one for Turkana County

The Domestic Environment and the Lung Mycobiome

This study analyzes the relationship between the mycobiome of the Lower Respiratory Tract (LRT) and the fungi in the domestic environment. Samples studied consisted of Broncho-Alveolar Lavage (BAL) from 45 patients who underwent bronchoscopy for different diagnostic purposes, and dust and air from the houses (ENV) of 20 of them (44.4%). Additionally, five bronchoscopes (BS) were also analyzed and negative controls were included for every procedure. All samples were processed for DNA extraction and cultures, which were performed in Sabouraud Dextrose and Potato Dextrose Agar. The fungal Internal Transcribed Spacer (ITS2) was sequenced by the Solexa/Illumina system and sequences were analyzed by QIIME 1.8.0 and compared with the UNITE Database for identification. The similarity between the two fungal communities (BAL and ENV) for a specific patient was assessed via the percentage of coincidence in the detection of specific operational taxonomic units (OTUs), and about 75% of co-occurrence was detected between the mycobiome of the LRT and the houses. Cultures confirmed the presence of the core mycobiome species. However, the low rate of isolation from BAL suggests that most of its mycobiome corresponds to non-culturable cells. This likely depends on the patient’s immune system activity and inflammatory status.This research was funded by the Spanish Association for Respiratory Diseases (SEPAR) through their grant program RESPIRA with number PII026/2016. E. Revelles (2015-16) and J. Adsuar (2018) received a grant from the Spanish Ministry of Education for their contribution in this work. E. Gómez-Imbernon received a grant from the University Miguel Hernandez for his contribution to this work (2017)

S1 Fig -

Size of lesions in relation to: A) type of mycetoma, B) color of grains and C) time of evolution. (PPTX)</p