Microbiota, probióticos y morbilidad en recién nacidos de muy bajo peso

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Pediatría. Fecha de lectura: 28-11-2019Introducción. La microbiota intestinal es un elemento clave en el mantenimiento de la homeostasis intestinal e inmunológica. Las bacterias intestinales pueden tener un papel protector o aumentar el riesgo de enfermedades. La adquisición de la microbiota intestinal se inicia en la etapa intrauterina y en las primeras semanas de vida, ésto es crucial para la salud. La adquisición de la microbiota, en el caso recién del nacido prematuro presenta una colonización retrasada y diferente respecto al recién nacido a término, con aumento de colonización de bacterias potencialmente patógenas y menor diversidad microbiana según avanza la estancia en las unidades de cuidados intensivos. La enterocolitis necrotizante y la sepsis son enfermedades graves en el pretérmino. Objetivos. Conocer el efecto del ambiente epidémico sobre la microbiota, el papel protector de determinados probióticos en prematuros extremos y conocer la interacción entre las bacterias probióticas y el huésped. Desarrollo del trabajo y metodología. 1. Análisis secuencial de la adquisición de la microbiota fecal en los recién nacidos prematuros de bajo peso durante las tres primeras semanas de vida en dos escenarios epidemiológicos diferentes en la misma unidad. 2. Estudio retrospectivo de una cohorte de prematuros extremos que explora los efectos de una mezcla de probióticos (InfloranÒ). 3. Estudio piloto para elucidar si la administración de dos cepas probióticas aisladas en leche humana se aíslan en las heces del recién nacido y la evolución de los distintos parámetros inmunológicos. Conclusiones. El establecimiento de la microbiota se ve influenciado por el ambiente epidemiológico hospitalario. La epidemia de Serratia spp. influye sobre la adquisición de microbiota. La administración de InfloranÒ se asocia con un aumento en la incidencia de enterocolitis. En todas las heces de los recién nacidos se aislaron las bacterias probióticas extraídas de la leche humana y se observó una disminución de calprotectina fecal

Ambient Media y Publicidad de Guerrilla: el espacio urbano como soporte

Este trabajo académico muestra la alternativa que nos ofrecen el Ambient Media y la Publicidad de Guerrilla frente a la crisis publicitaria que el sector está experimentando. Pero esta crisis ha de ser entendida más bien en términos de saturación y no tanto monetarios, ya que la publicidad convencional está sufriendo una pérdida de eficacia. Por ello, es necesario buscar caminos que nos lleven a captar la atención del consumidor de una manera diferente y no intrusiva.Grado en Publicidad y Relaciones Pública

Revisión y propuesta de técnicas alternativas a la evaluación por competencias para la certificación de Directores de Proyectos

[ES] La gestión y evaluación del desempeño por competencias cobra cada día más importancia, tanto en el ámbito académico como en el laboral. El presente Trabajo Fin de Máster presenta una revisión de cómo se realiza la evaluación por competencias en recursos humanos y, más concretamente, del sistema de evaluación por competencias en la certificación de directores de proyecto del organismo certificador de la International Project Management Association (IPMA). En este trabajo también se analizan las posibles restricciones que este sistema de evaluación presenta para aquellas competencias cuya medida de desempeño tiene gran parte de componente subjetiva, como ocurre en el caso de las competencias de comportamiento. Por último, trata de presentar varias técnicas novedosas utilizadas en recursos humanos y en educación que, en cierta manera, podrían ayudar al evaluador de IPMA a reducir estas limitaciones y de presentar una propuesta de evaluación por competencias de directores de proyecto basada en técnicas de simulación y neuromanagement, innovadoras en este campo.[EN] The management and evaluation of performance by competences is becoming more important, both in academic and work fields. The present Master’s Thesis presents a review of how the competency evaluation in human resources is carried out and, more specifically, the competency evaluation system in the certification of project managers of the certification body of the International Project Management Association (IPMA). This paper also analyzes the possible restrictions that this evaluation system presents for those competences whose performance measure has a great part of subjective component, as it happens in the case of behavioral competences. Finally, it tries to show several innovative techniques used in human resources and in education that, in a certain way, could help the IPMA evaluator to reduce these limitations and to present a proposal of evaluation by competences of project managers based on simulation techniques and neuromanagement, innovative in this field.Escribano Villajos, ME. (2017). Revisión y propuesta de técnicas alternativas a la evaluación por competencias para la certificación de Directores de Proyectos. http://hdl.handle.net/10251/81098.TFG

The Waning of BNT162b2 Vaccine Effectiveness for SARS-CoV-2 Infection Prevention over Time: A Test-Negative Study in Health Care Professionals of a Health Department from January 2021 to December 2021

The duration of protection of vaccines against SARS-CoV-2 infection has been evaluated in previous studies, but uncertainty remains about the persistence of effectiveness over time and the ideal timing for booster doses. Therefore, the aim of this study was to evaluate BNT162b2 vaccine effectiveness against SARS-CoV-2 infection in health care workers (HCWs) at a tertiary hospital depending on time elapsed since the completion of a two-dose vaccination regimen. We conducted a case–control with negative test study between 25 January and 12 December 2021 that included 1,404 HCWs who underwent an active infection diagnostic test (AIDT) to rule out SARS-CoV-2 infection due to COVID-19 suspicion or prior close contact with patients diagnosed with COVID-19. The adjusted vaccine effectiveness (aVE) for the prevention of SARS-CoV-2 infection 12 to 120 days after completing the full two-dose vaccination regimen was 91.9%. Then, aVE decreased to 63.7% between 121 to 240 days after completing the full two-dose regimen and to 37.2% after 241 days since the second dose. Vaccination against SARS-CoV-2 infection in HCWs remains highly effective after 12 to 120 days have elapsed since the administration of two doses of the BNT162b2 vaccine; however, effectiveness decreases as time elapses since its administration

Genomics of Serratia marcescens isolates causing outbreaks in the same pediatric unit 47 years apart: Position in an updated phylogeny of the species

The first documented nosocomial outbreak caused by Serratia marcescens in Spain occurred in 1969 at the neonatal intensive care unit (NICU) of the tertiary La Paz Children’s Hospital in Madrid, Spain, and based on the available phenotyping techniques at this time, it was considered as a monoclonal outbreak. Only 47 years later, another S. marcescens outbreak of an equivalent dimension occurred at the same NICU. The aim of the present study was to study isolates from these historical and contemporary outbreaks by phenotypic analysis and whole-genome sequencing techniques and to position these strains along with 444 publicly available S. marcescens genomes, separately comparing core genome and accessory genome contents. Clades inferred by both approaches showed high correlation, indicating that core and accessory genomes seem to evolve in the same manner for S. marcescens. Nine S. marcescens clusters were identified, and isolates were grouped in two of them according to sampling year. One exception was isolate 13F-69, the most genetically distant strain, located in a different cluster. Categorical functions in the annotated accessory genes of both collections were preserved among all isolates. No significant differences in frequency of insertion sequences in historical (0.18–0.20)—excluding the outlier strain—versus contemporary isolates (0.11–0.19) were found despite the expected resting effect. The most dissimilar isolate, 13F-69, contains a highly preserved plasmid previously described in Bordetella bronchiseptica. This strain exhibited a few antibiotic resistance genes not resulting in a resistant phenotype, suggesting the value of gene down expression in adaptation to long-term starvation.CS was supported by “Fundación Mutua Madrileña” grant to RC achieved in 2017 call with reference number AP165902017. MP-A was supported by the Programa Operativo de Empleo Juvenil, cofinanced by the European Social Fund Investing in your future (ESF) and ERDF (PEJD-2018-PRE/BMD-8237). BP-V was funded by H2020 FTIPilot 2016 project no. 730713 “FAST-bact “A novel fast and automated test for antibiotic susceptibility testing for Gram positive and negative bacteria” and co-funded by Instituto de Salud Carlos III and the European Regional Development Fund (ERDF, “A way to achieve Europe”). FB was supported by grants from the Madrid Regional Government (InGEMICS-C; S2017/BMD-3691) and CIBER (CIBER in Epidemiology and Public Health, CIBERESP; CB06/02/0053), co-funded by Instituto de Salud Carlos III and the European Regional Development Fund (ERDF, “A way to achieve Europe”). This work was supported by the Instituto de Salud Carlos III, PI17/00115 (RC), and REIPI (RD16/0016/0011) actions, cofinanced by the European Development Regional Fund “A way to achieve Europe” (ERDF

Relationship between the Sensory-Determined Astringency and the Flavanolic Composition of Red Wines

[EN] The relationship between the proanthocyanidin profile and the perceived astringency was assessed in 13 commercial Tempranillo red wines. The concentration and compositional information were obtained by liquid chromatography with diode array detection coupled to electrospray ionization mass spectrometry after acid-catalyzed depolymerization of wine proanthocyanidins in the presence of excess phloroglucinol. Statistical analysis of the results showed significant correlations between sensory and chemical determinations. Astringency was more affected by the subunit composition than by the total concentration or the average degree of polymerization of wine proanthocyanidins. Higher proportions of epicatechin (EC) subunits in extension positions and gallocatechin (GC) subunits in terminal positions were shown to increase astringency. On the contrary, the amount of epigallocatechin (EGC) in both extension and terminal positions was negatively correlated with the perceived astringency

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Administration of Bifidobacterium breve PS12929 and Lactobacillus salivarius PS12934, Two Strains Isolated from Human Milk, to Very Low and Extremely Low Birth Weight Preterm Infants: A Pilot Study

The preterm infant gut has been described as immature and colonized by an aberrant microbiota. Therefore, the use of probiotics is an attractive practice in hospitals to try to reduce morbidity and mortality in this population. The objective of this pilot study was to elucidate if administration of two probiotic strains isolated from human milk to preterm infants led to their presence in feces. In addition, the evolution of a wide spectrum of immunological compounds, including the inflammatory biomarker calprotectin, in both blood and fecal samples was also assessed. For this purpose, five preterm infants received two daily doses (~109 CFU) of a 1 : 1 mixture of Bifidobacterium breve PS12929 and Lactobacillus salivarius PS12934. Bacterial growth was detected by culture-dependent techniques in all the fecal samples. The phylum Firmicutes dominated in nearly all fecal samples while L. salivarius PS12934 was detected in all the infants at numerous sample collection points and B. breve PS12929 appeared in five fecal samples. Finally, a noticeable decrease in the fecal calprotectin levels was observed along time

Influence of a Serratia marcescens outbreak on the gut microbiota establishment process in low-weight preterm neonates.

Adequate gut microbiota establishment is important for lifelong health. The aim was to sequentially analyze the gut microbiota establishment in low-birth-weight preterm neonates admitted to a single neonatal intensive care unit during their first 3 weeks of life, comparing two epidemiological scenarios. Seven control infants were recruited, and another 12 during a severe S. marcescens outbreak. Meconium and feces from days 7, 14, and 21 of life were collected. Gut microbiota composition was determined by 16S rDNA massive sequencing. Cultivable isolates were genotyped by pulsed-field gel electrophoresis, with four S. marcescens submitted for whole-genome sequencing. The expected bacterial ecosystem expansion after birth is delayed, possibly related to antibiotic exposure. The Proteobacteria phylum dominates, although with marked interindividual variability. The outbreak group considerably differed from the control group, with higher densities of Escherichia coli and Serratia to the detriment of Enterococcus and other Firmicutes. Curiously, obligate predators were only detected in meconium and at very low concentrations. Genotyping of cultivable bacteria demonstrated the high bacterial horizontal transmission rate that was confirmed with whole-genome sequencing for S. marcescens. Preterm infants admitted at NICU are initially colonized by homogeneous microbial communities, most of them from the nosocomial environment, which subsequently evolve according to the individual conditions. Our results demonstrate the hospital epidemiology pressure, particularly during outbreak situations, on the gut microbiota establishing process

Cocina y oficios. Información de Prevención de Riesgos Laborales

Este documento ha sido realizado en cooperación entre la Escuela Nacional de Medicina del Trabajo (ENMT) del Instituto de Salud Carlos III y el Servicio de Prevención de Riesgos Laborales del Hospital Universitario Ramón y Cajal, contando además con la revisión de los contenidos por parte de la Asociación Nacional de Medicina del Trabajo en el Ámbito Sanitario.Esta monografía ha sido elaborada dentro del Programa Editorial de 2019 del Instituto de Salud Carlos III (Ministerio de Ciencia, Innovación y Universidades).La Ley 31/1995 de Prevención de Riesgos Laborales establece la obligatoriedad de que todos los trabajadores, independientemente del tipo de contrato que tengan, reciban información suficiente y adecuada, sobre los riesgos para la seguridad y sa-lud que pueden tener al desempeñar su trabajo y sobre cómo prevenirlos.Este derecho de información de los trabajadores supone a su vez una obligación que el empresario, con frecuencia, delega en el servicio de prevención de riesgos laborales. Los servicios de prevención deben trabajar con criterios de eficiencia por lo que este documento, realizado desde nuestra experiencia en el ámbito sanitario, pretende facilitar a estos servicios la elaboración de la información preventiva en re-lación con los riesgos para los trabajadores de cocina y de oficios. En él se incluyen:— Los riesgos generales que suelen tener los trabajadores de los centros sanita-rios, junto con algunas medidas generales de emergencia y evacuación.— Los riesgos más habituales de los trabajadores de cocina y los trabajadores de oficios y las medidas de prevención y protección aplicables, entre los que se incluyen los que se derivan de la manipulación manual de cargas.— La gestión de los residuos.— Recomendaciones para el mantenimiento de la forma física.No pretende ser un documento ni cerrado ni completo, ya que esta información puede ser modificada o complementada con la obtenida de la evaluación de riesgos de cada lugar y puesto de trabajo concreto, en relación con las tareas asignadas.En algunas situaciones es conveniente disponer también de procedimientos, nor-mas o instrucciones de trabajo, sobre todo en aquellas tareas que supongan mayor riesgo. La prevención debe estar integrada en todos los niveles jerárquicos y activi-dades de la empresa, por lo que estas instrucciones se elaborarán en cada servicio o unidad y tendrán siempre en cuenta el punto de vista de la prevención, incluyendo la información recogida en manuales de instrucciones de equipos y máquinas, fichas de datos de seguridad de productos químicos utilizados y reglamentación aplicable. Los responsables de cada unidad deberán transmitir a sus trabajadores estas normas, en especial cuando se incorporen nuevos miembros a su equipo y recordarlas de manera periódica, asegurándose de que el trabajo se realiza conforme a las mismas.PRESENTACIÓN 7 INTRODUCCIÓN 8 INFORMACIÓN GENERAL12 MANIPULACIÓN MANUAL DE CARGAS 60 GESTIÓN DE RESIDUOS 67 MANTENIMIENTO DE LA FORMA FÍSICA 7