Docencia de las enfermedades infecciosas, la resistencia a los antimicrobianos y su aplicación en la neumonía adquirida en la comunidad.

La historia de la humanidad en relación con las enfermedades infecciosas se ha basado en una lucha constante contra el desarrollo de nuevas enfermedades, los efectos de las ya existentes, el desarrollo de conocimientos en higiene y agentes antimicrobianos y la aparición de resistencias a estos últimos. En esta tesis por compendio de publicaciones se lleva a cabo una evaluación sobre los mecanismos y conocimientos humanos llevados a cabo en esta antigua y también actual contienda.En primer lugar se atiende a cómo los médicos estudian las enfermedades infecciosas, focalizando en los puntos fuertes y débiles de la docencia universitaria y hospitalaria (tiempo de la residencia), así como las percepciones de los alumnos sobre las mismas. El primer artículo evalúa estos supuestos en los estudiantes de medicina españoles y el segundo en los residentes europeos. Posteriormente la tesis se encamina hacia desgranar los conceptos de manejo de las enfermedades infecciosas, resistencia y uso de antibióticos en una enfermedad infecciosa en particular, la neumonía adquirida en la comunidad (NAC). El tercer artículo compara su manejo en residencias respecto al hospital, focalizando en los agentes etiológicos encontrados, su grado de resistencia a los antibióticos y el uso final de los mismos. El cuarto y último artículo trata sobre el manejo de la NAC en el contexto de la Hospitalización Domiciliaria, un elemento clave en el repertorio de medidas de la medicina del siglo XXI, focalizando nuevamente en el correcto uso de los antimicrobianos.<br /

Layer-by-layer technique to developing functional nanolaminate films with antifungal activity

The layer-by-layer (LbL) deposition method was used to build up alternating layers (five) of different polyelectrolyte solutions (alginate, zein-carvacrol nanocapsules, chitosan and chitosan-carvacrol emulsions) on an aminolysed/charged polyethylene terephthalate (A/C PET) film. These nanolaminated films were characterised by contact angle measurements and through the determination of water vapour (WVTR) and oxygen (O2TR) transmission rates. The effect of active nanolaminated films against the Alternaria sp. and Rhizopus stolonifer was also evaluated. This procedure allowed developing optically transparent nanolaminated films with tuneable water vapour and gas properties and antifungal activity. The water and oxygen transmission rate values for the multilayer films were lower than those previously reported for the neat alginate or chitosan films. The presence of carvacrol and zein nanocapsules significantly decreased the water transmission rate (up to 40 %) of the nanolaminated films. However, the O2TR behaved differently and was only improved (up to 45 %) when carvacrol was encapsulated, i.e. nanolaminated films prepared by alternating alginate with nanocapsules of zein-carvacrol layers showed better oxygen barrier properties than those prepared as an emulsion of chitosan and carvacrol. These films containing zein-carvacrol nanocapsules also showed the highest antifungal activity (30 %), which did not significantly differ from those obtained with the highest amount of carvacrol, probably due to the controlled release of the active agent (carvacrol) from the zein-carvacrol nanocapsules. Thus, this work shows that nanolaminated films prepared with alternating layers of alginate and zein-carvacrol nanocapsules can be considered to improve the shelf-life of foodstuffs.The authors acknowledge financial support from FP7 IP project BECOBIOCAP^. M. J. Fabra is recipients of a Juan de la Cierva contract from the Spanish Ministry of Economy and Competitivity. Maria L. Flores-López thanks Mexican Science and Technology Council (CONACyT, Mexico) for PhD fellowship support (CONACyT Grant Number 215499/310847). The author Miguel A. Cerqueira is a recipient of a fellowship (SFRH/BPD/72753/2010) supported by Fundação para a Ciência e Tecnologia, POPH-QREN and FSE (FCT, Portugal). The authors also thank the FCT Strategic Project of UID/ BIO/04469/2013 unit, the project RECI/BBB-EBI/0179/2012 (FCOMP- 01-0124-FEDER-027462) and the project BBioInd - Biotechnology and Bioengineering for improved Industrial and Agro-Food processes,^ REF. NORTE-07-0124-FEDER-000028 Co-funded by the Programa Operacional Regional do Norte (ON.2–O Novo Norte), QREN, FEDER. The support of EU Cost Action FA0904 is gratefully acknowledged

Manejo antibiótico en neumonía adquirida en la comunidad en la hospitalización a domicilio: ¿Hay margen de mejora?

Introducción: La neumonía adquirida en la comunidad (NAC) es una enfermedad frecuente que puede serabordada en hospitalización a domicilio (HAD). En el presente trabajo evaluamos el margen de mejoracon el uso de antibióticos en la NAC en HAD. Métodos: Se reclutaron retrospectivamente todos los pacientes con NAC en dos hospitales españolesdesde el 01 de enero de 2018 al 30 de octubre de 2019. Se registraron variables demográficas, clínicas y sobre calidad de prescripción antibiótica. Posteriormente se construyó una variable que recogía seis indi-cadores de calidad asistencial, categorizando y comparando a los pacientes en dos grupos: buena calidadasistencial (cuatro o más indicadores realizados) o mala calidad asistencial (tres o menos indicadoresrealizados). Resultados: Obtuvimos una muestra de 260 pacientes. La solicitud de pruebas diagnósticas y la adecuacióna las guías de práctica clínica fue del 85, 4 y 85, 8%, respectivamente. Los porcentajes de realización dedesescalada (53, 7%) y terapia secuencial (57, 7%) cuando estaban indicadas fueron bajos. La duraciónmedia del tratamiento fue de 7, 3 días para el intravenoso y 9, 5 días para el total. La calidad de prescripciónfue buena en 134 (63, 2%) pacientes, siendo más frecuente en aquellos que ingresaron directamente enHAD desde urgencias. También se asoció a menor reingreso a 30 días. Conclusión: Existe un amplio margen de mejora en algunos aspectos con el uso de antimicrobianos enHAD, que podría motivar la implementación de programas de optimización del uso de antibióticos. Introduction: Community Acquired Pneumonia (CAP) is common disease that can be treated in Hospital At Home (HAH). In this paper we evaluate the room of improvement in the use of antibiotics in CAP in HH. Methods: Patients with CAP were retrospectively recruited in two Spanish hospitals from 1/1/18 to 10/30/19. Demographic, clinical and quality of antibiotic prescription variables were recorded. Subsequently, we created a new variable that collected six quality of care indicator, categorizing and comparing patients into two groups: good quality of care (4 or more indicators performed) or poor quality of care (3 or less indicators performed). Results: We recruited 260 patients. The request for diagnostic tests and the adequacy to Clinical Practice Guidelines were 85.4% and 85.8% respectively. Percentages of de-escalation (53.7%) and sequential therapy (57.7%) when indicated were low. The average length of treatment was 7.3 days for intravenous and 9.5 days for total. Quality of prescription was good in 134 (63.2%) patients, being more frequent in those who were admitted directly to HAD from the emergency room. It was also associated with less readmission at 30 days. Conclusion: There is a wide room for improvement in some fields of antimicrobials use in HAH that could stimulate the implementation of Antimicrobial Stewardship Programs

Role of the 4Kscore test as a predictor of reclassification in prostate cancer active surveillance

Background: Management of active surveillance (AS) in low-risk prostate cancer (PCa) patients could be improved with new biomarkers, such as the 4Kscore test. We analyze its ability to predict tumor reclassification by upgrading at the confirmatory biopsy at 6 months. Methods: Observational, prospective, blinded, and non-randomized study, within the Spanish National Registry on AS (AEU/PIEM/2014/0001; NCT02865330) with 181 patients included after initial Bx and inclusion criteria: PSA =10 ng/mL, cT1c-T2a, Grade group 1, =2 cores, and =5 mm/50% length core involved. Central pathological review of initial and confirmatory Bx was performed on all biopsy specimens. Plasma was collected 6 months after initial Bx and just before confirmatory Bx to determine 4Kscore result. In order to predict reclassification defined as Grade group =2, we analyzed 4Kscore, percent free to total (%f/t) PSA ratio, prostate volume, PSA density, family history, body mass index, initial Bx, total cores, initial Bx positive cores, initial Bx % of positive cores, initial Bx maximum cancer core length and initial Bx cancer % involvement. Wilcoxon rank-sum test, non-parametric trend test or Fisher’s exact test, as appropriate established differences between groups of reclassification. Results: A total of 137 patients met inclusion criteria. Eighteen patients (13.1%) were reclassified at confirmatory Bx. The %f/t PSA ratio and 4Kscore showed differences between the groups of reclassification (Yes/No). Using 7.5% as cutoff for the 4Kscore, we found a sensitivity of 89% and a specificity of 29%, with no reclassifications to Grade group 3 for patients with 4Kscore below 7.5% and 2 (6%) missed Grade group 2 reclassified patients. Using this threshold value there is a biopsy reduction of 27%. Additionally, 4Kscore was also associated with changes in tumor volume. Conclusions: Our preliminary findings suggest that the 4Kscore may be a useful tool in the decision-making process to perform a confirmatory Bx in active surveillance management

La formación de grado en enfermedades infecciosas, resistencia y uso de antibióticos desde la perspectiva de los estudiantes de Medicina

Introducción: Una de las principales herramientas para optimizar el uso de los antibióticos es la formación de los prescriptores. El objetivo de este trabajo es conocer la opinión de los estudiantes de Medicina españoles sobre la formación en enfermedades infecciosas. Material y métodos: Se distribuyó un cuestionario on line anonimizado entre estudiantes de sexto curso a través de distintos canales. El cuestionario incluyó 45 preguntas sobre conocimientos, actitudes y percepciones sobre el diagnóstico, resistencia antimicrobiana, uso de antibióticos y la formación de pregrado en enfermedades infecciosas. Resultados: Se recibieron un total de 441 encuestas de 21 facultades. Se obtuvieron 374 respuestas (84, 8%) de las 8 facultades más representadas, con una tasa de respuesta del 28, 9%. La mayoría de los alumnos se sentían preparados para identificar los signos clínicos de infección (418; 94, 8%) y para interpretar correctamente las pruebas de laboratorio (382; 86, 6%). Reconocieron saber elegir un antibiótico con seguridad sin consultar libros ni guías (178; 40, 4%). Solo 107 alumnos (24, 3%) consideraron haber recibido suficiente formación en el uso prudente de los antimicrobianos. Respecto a los métodos de aprendizaje, se percibieron como más útiles la discusión de casos clínicos, los rotatorios en servicios o unidades de enfermedades infecciosas y los talleres de pequeños grupos: se evaluaron favorablemente en un 76, 9; en un 76 y en un 68, 8% de los casos, respectivamente. Conclusión: Los estudiantes de Medicina se encuentran más seguros en el diagnóstico de enfermedades infecciosas que en el tratamiento antibiótico. Asimismo, sienten la necesidad de recibir mayor formación en antibioterapia y uso prudente en antibióticos. Introduction: One of the main tools to optimize antibiotics use is education of prescribers. The aim of this article is to study undergraduate education in the field of infectious diseases, antimicrobial resistance and antibiotic stewardship from the perspective of Spanish medical students. Material and methods: An anonymous online questionnaire was distributed among sixth grade students using different channels in Europe, within the ESGAP Student-Prepare survey. The questionnaire included 45 questions about knowledge, attitudes and perceptions about diagnosis, bacterial resistance, use of antibiotics and undergraduate training in infectious diseases. We present here the Spanish results. Results: A total of 441 surveys were received from 21 medical schools. A total of 374 responses (84.8%) were obtained from the 8 most represented faculties, with a response rate of 28.9%. Most students felt adequately prepared to identify clinical signs of infection (418; 94.8%) and to accurately interpret laboratory tests (382; 86.6%). A total of 178 (40.4%) acknowledged being able to choose an antibiotic with confidence without consulting books or guidelines. Only 107 (24.3%) students considered that they had received sufficient training in judicious use of antibiotics. Regarding learning methods, the discussion of clinical cases, infectious diseases units rotatories and small group workshops were considered the most useful, being evaluated favorably in 76.9%, 76% and 68.8% of the cases. Conclusion: Medical students feel more confident in the diagnosis of infectious diseases than in antibiotic treatment. They also feel the need to receive more training in antibiotics and judicious antibiotic use

Bioactive extracts from persimmon waste: influence of extraction conditions and ripeness

In this work, a bioactive persimmon extract was produced from discarded fruits. A central composite design was used to evaluate the effect of different extraction parameters and ripeness stages of persimmon fruits on the total phenolic content and antioxidant activity of the resulting extracts. Significantly greater phenolic contents were obtained from immature persimmon (IP) fruits. The optimum IP extract with the conditions set by the experimental design was industrially up-scaled and its composition and functional properties were evaluated and compared with those obtained under lab-scale conditions. Both extracts contained significant protein (>20%) and phenolic contents (similar to 11-27 mg GA/g dry extract) and displayed significant antiviral activity against murine norovirus and hepatitis A virus. Moreover, the extract showed no toxicity and significantly reduced the fat content and the cellular ageing of Caenorhabditis elegans (C. elegans) without affecting the worm development. These effects were mediated by down-regulation of fat-7, suggesting an anti-lipogenic activity of this extract

Perspectives on utilization of edible coatings and nano-laminate coatings for extension of postharvest storage of fruits and vegetables

It is known that in developing countries, a large quantity of fruit and vegetable losses results at postharvest and processing stages due to poor or scarce storage technology and mishandling during harvest. The use of new and innovative technologies for reducing postharvest losses is a requirement that has not been fully covered. The use of edible coatings (mainly based on biopolymers) as a postharvest technique for agricultural commodities has offered biodegradable alternatives in order to solve problems (e.g., microbiological growth) during produce storage. However, biopolymer-based coatings can present some disadvantages such as: poor mechanical properties (e.g., lipids) or poor water vapor barrier properties (e.g., polysaccharides), thus requiring the development of new alternatives to solve these drawbacks. Recently, nanotechnology has emerged as a promising tool in the food processing industry, providing new insights about postharvest technologies on produce storage. Nanotechnological approaches can contribute through the design of functional packing materials with lower amounts of bioactive ingredients, better gas and mechanical properties and with reduced impact on the sensorial qualities of the fruits and vegetables. This work reviews some of the main factors involved in postharvest losses and new technologies for extension of postharvest storage of fruits and vegetables, focused on perspective uses of edible coatings and nano-laminate coatings.María L. Flores-López thanks Mexican Science and Technology Council (CONACYT, Mexico) for PhD fellowship support (CONACYT Grant Number: 215499/310847). Miguel A. Cerqueira (SFRH/BPD/72753/2010) is recipient of a fellowship from the Fundação para a Ciência e Tecnologia (FCT, POPH-QREN and FSE Portugal). The authors also thank the FCT Strategic Project of UID/ BIO/04469/2013 unit, the project RECI/BBB-EBI/0179/2012 (FCOMP-01-0124-FEDER-027462) and the project ‘‘BioInd Biotechnology and Bioengineering for improved Industrial and AgroFood processes,’’ REF. NORTE-07-0124-FEDER-000028 Co-funded by the Programa Operacional Regional do Norte (ON.2 – O Novo Norte), QREN, FEDER. Fundação Cearense de Apoio ao Desenvolvimento Científico e Tecnológico – FUNCAP, CE Brazil (CI10080-00055.01.00/13)

Detection of hollow heart disorder in watermelons using vibrational test and machine learning

The presence of internal voids in watermelons has an impact on the costs of producers and on consumer confidence. Various studies have shown that the vibrational parameters of the fruit are related to maturity, quality and the existence of internal defects. A method for the detection of internal voids in seedless watermelons based on vibrational parameters obtained in impact hammer tests and machine learning is presented. After a statistical study of the test results, the frequency of the first peak of the vibrational response and the density of the watermelon are selected as predictors to be used in the classification algorithms. The accuracy of detecting hollow watermelons increases if firmness estimator is introduced as a predictor. Probabilities of success above 89% in the detection of internal voids have been achieved using different classification algorithm

Neumonía adquirida en la comunidad en un hospital terciario español: ¿cómo se comporta en pacientes provenientes de residencia?

Con 4,63 casos por cada 1.000 personas/año y 1,64 hospitalizaciones por cada 1.000 personas/año la neumonía adquirida en la comunidad (NAC) es una enfermedad frecuente en España. Varias guías de práctica clínica resumen el abordaje más adecuado para su manejo. Sin embargo, existe cierto debate sobre cómo se comportan los pacientes provenientes de residencia. En el presente artículo analizamos las características de un grupo de pacientes hospitalizados por NAC, comparando aquellos provenientes de residencia con los que no