A Study in a Regional Hospital of a Mid-Sized Spanish City Indicates a Major Increase in Infection/Colonization by Carbapenem-Resistant Bacteria, Coinciding with the COVID-19 Pandemic

Bacterial resistance to antibiotics has proven difficult to control over the past few decades. The large group of multidrug-resistant bacteria includes carbapenemase-producing bacteria (CPB), for which limited therapeutic options and infection control measures are available. Furthermore, carbapenemases associate with high-risk clones that are defined by the sequence type (ST) to which each bacterium belongs. The objectives of this cross-sectional and retrospective study were to describe the CPB population isolated in a third-level hospital in Southern Spain between 2015 and 2020 and to establish the relationship between the ST and the epidemiological situation defined by the hospital. CPB were microbiologically studied in all rectal and pharyngeal swabs and clinical samples received between January 2015 and December 2020, characterizing isolates using MicroScan and mass spectrometry. Carbapenemases were detected by PCR and Sanger sequencing, and STs were assigned by multilocus sequence typing (MLST). Isolates were genetically related by pulsedfield gel electrophoresis using Xbal, Spel, or Apal enzymes. The episodes in which each CPB was isolated were recorded and classified as involved or non-involved in an outbreak. There were 320 episodes with CPB during the study period: 18 with K. pneumoniae, 14 with Klebisella oxytoca, 9 with Citrobacter freundii, 11 with Escherichia coli, 46 with Enterobacter cloacae, 70 with Acinetobacter baumannii, and 52 with Pseudomonas aeruginosa. The carbapenemase groups detected were OXA, VIM, KPC, and NDM with various subgroups. Synchronous relationships were notified between episodes of K. pneumoniae and outbreaks for ST15, ST258, ST307, and ST45, but not for the other CPB. There was a major increase in infections with CPB over the years, most notably during 2020, coinciding with the COVID-19 pandemic. This study highlights the usefulness of gene sequencing techniques to control the spread of these microorganisms, especially in healthcare centers. These techniques offer faster results, and a reduction in their cost may make their real-time application more feasible. The combination of epidemiological data with real-time molecular sequencing techniques can provide a major advance in the transmission control of these CPB and in the management of infected patients. Real-time sequencing is essential to increase precision and thereby control outbreaks and target infection prevention measures in a more effective manner

Modelo computacional para la formación de clases de equivalencia

A computational model of neuronal net closely related with the formation of equivalence classes is developed. First the formal pattern of the neuronal net is presented and then its operation and its direct relationship with the phenomenon of the formation of the equivalence classes and with the derived relationships are explained. Later on, the validation of the pattern is described carrying out several simulations allowing verification of the pattern so it is able to generate relationships not explicitly trained, these results being adjusted to the basic results of this investigation line. These simulations were carried out using a training of classic conditioning and a test phase by means of conditional discriminations

Diseño de una nueva guía alimentaria para confeccionar menús saludables: Three Colour Method (3COME)

VIII Congreso Iberoamericano de Nutrición. ¿Nutrición basada en la videncia o en la evidencia

Inferior Alveolar Nerve Paresthesia After Overfilling of Endodontic Sealer Into the Mandibular Canal

The present study describes a case of endodontic sealer(AH Plus) penetration within and along the mandibular canal from the periapical zone of a lower second molar after endodontic treatment. The clinical manifestations comprised anesthesia of the left side of the lower lip, paresthesia and anesthesia of the gums in the third quadrant, and paresthesia and anesthesia of the leftmental nerve, appearing immediately after endodontic treatment. The paresthesia and anesthesia of the lip and gums were seen to decrease, but the mental nerve paresthesia and anesthesia persisted after 3.5 years. This case illustrates the need to expend great care with all endodontic techniques when performing nonsurgical root canal therapy, especially when the root apices are in close proximity to vital anatomic struc tures such as the inferior alveolar cana

Rescue surgery (surgical repositioning) of impacted lower second molars

La impactación de los segundos molares inferiores es una complicación de la erupción dentaria muy infrecuente, dado que su incidencia se cifra de un 0,03 a un 0,21 %. Se ha detectado en mayor frecuencia de forma unilateral que bilateral y es más usual en mandíbula que en maxilar. Presenta una ligera predicción por el sexo masculino, y la inclinación mesial es la más habitual. Se han publicado una amplia variedad de aproximaciones terapéuticas, fundamentalmente apelando a técnicas quirúrgicas únicas o ayudadas de técnicas ortodóncicas, con el objeto de llevar al diente a su correcta posición, y que se engloban bajo el concepto de cirugía de rescate. En los casos resueltos con una reubicación del diente impactado,la extracción profiláctica del germen se ha propugnado como obligatoria. Presentamos el caso de una paciente de 12 años y 6 meses derivado al Master de Cirugía Bucal de la Universidad de Sevilla por presentar falta de erupción del segundo molar inferior izquierdo. El paciente fue derivado por su ortodoncista, quien detecta la impactación del diente, antes de iniciar el tratamiento ortodóncico.Dicho compañero nos indica que, si es posible, no extraigamos el germen del tercer molar, pues prevé que será viable su erupción en el futuro (dispondrá de espacio en la arcada suficiente). Medidos los espacios de que disponemos, decidimos intentar la reubicación del diente impactado sin extraer el germen del cordal, que se llevó a cabo de forma exitosa.The impaction of lower second molars, given that its incidence is 0.03 to 0.21%, is a rare complication in tooth eruption. It has been detected more often in unilateral form than bilateral and is more common in the mandible than in the maxillary. It has a slight predilection for males, and mesial inclination ismore usual. A wide variety of therapeutic approaches have been published,basically referring to surgical techniques, independent or complemented by means of orthodontic technical aids, with the aim of placing the tooth in the correct position, and which are encompassed under the concept of surgical rescue.In cases resolved with repositioning of an impacted tooth, prophylactic root extraction has been proposed as obligatory.We present a case of a 12 and a half year old patient referred to the University of Seville due to non-eruption of the left lower second molar.The patient was referred by her orthodontist, who detected the impaction before starting orthodontic treatment. The orthodontist requested that, if it was possible, we did not extract the root of the third molar, because its eruption would be feasible in the future (there would be sufficient space in the arch). The spaces available were measured and we decided to attempt the repositioning of the impacted tooth without extracting the root of the wisdom tooth, which was carried out successfully

A Practical Environment to Apply Model-Driven Web Engineering

The application of a model-driven paradigm in the development of Web Systems has yielded very good research results. Several research groups are defining metamodels, transformations, and tools which offer a suitable environment, known as model-driven Web engineering (MDWE). However, there are very few practical experiences in real Web system developments using real development teams. This chapter presents a practical environment of MDWE based on the use of NDT (navigational development techniques) and Java Web systems, and it provides a practical evaluation of its application within a real project: specialized Diraya.Ministerio de Educación y Ciencia TIN2007-67843-C06-03Ministerio de Educación y Ciencia TIN2007-30391-

Crown Walls in Mass and Reinforced Concrete: The Way to Aesthetics in Maritime Works

Maritime works are characterized by their remarkable size, length, depth and extraordinarily great demand for natural or artificial materials. To this effect, despite functional designs or the ultimate limit state, a breakwater crown wall can increase the overall effectiveness of the structure in limiting wave overtopping. It will contribute to a reduction of volume of material required and hence the cost to achieve a given level of performance depending on the precautions to be taken on the basis of the critical discharges for functional safety (vehicles, pedestrian and buildings) and structural safety (embankment and revetment seawalls), amongst others. In many cases, bulky mass-concrete elements are designed without any steel reinforcement. Sometimes this effect causes cracking problems in large volumes. The step to slender reinforced concrete elements may take a leap to the aesthetic factor and visual landscape integration in maritime works. In addition, the use of other materials, shapes and colours can bring breakwaters and crown walls to life by creating new functions for maritime works such as a promenade, relaxation or visual enjoyment areas. The aim of this article is to reflect on the issue of bulky mass concrete elements or rebars in slender reinforced concrete crown walls and how the use of these slender elements can bring with it excellent artistic developments as well as the use of other materials in mass concrete sloping, vertical and composite breakwaters and their crown walls. Some breakwaters are no longer just mere defence works but are becoming pieces of art

Dietary fatty acids and lipoproteins on progression of age-related macular degeneration

Age-related macular degeneration (AMD) is a medical condition of central loss vision and blindness. Numerous studies have revealed that changes on certain dietary fatty acids (FAs) could have useful for AMD management. This review summarizes the effects of dietary omega-3 long-chain PUFAs, MUFAs, and SFAs, and lipoproteins on AMD. Findings are consistent with the beneficial role of dietary omega-3 long-chain PUFAs, while the effects of dietary MUFAs and SFAs appeared to be ambiguous with respect to the possible protection from MUFAs and to the possible adverse impact from SFAs on AMD. Some of the pathological mechanisms associated with lipoproteins on AMD share those observed previously in cardiovascular diseases. It was also noticed that the effects of FAs in the diet and lipoprotein on AMD could be modulated by genetic variants. From a population health perspective, the findings of this review are in favour of omega-3 long-chain FAs recommendations in a preventive and therapeutic regimen to attain lower AMD occurrence and progression rates. Additional long-term and short-term nutrigenomic studies are required to clearly establish the role and the relevance of interaction of dietary FAs, lipoproteins, and genes in the genesis and progression of AMD

Peligro de aludes con vientos muy fuertes y copiosas nevadas en la borrasca Hugo (Mar 2018)

Entre finales de otoño y principios de primavera, existe un peligro inherente asociado a la nieve debido a la inestabilidad que el manto nivoso puede alcanzar por factores meteorológicos y del propio terreno en que se deposita. En la mayor parte de las ocasiones, se ven afectadas únicamente las actividades de los montañeros. En casos excepcionales el fenómeno puede tener un impacto considerable en la población por afectar a la vialidad y a las infraestructuras. Durante el fin de semana del 23 al 25 de marzo de 2018 la borrasca Hugo motivó la emisión de numerosos avisos por fenómenos meteorológicos adversos debido a las nevadas, los vientos fuertes y el oleaje en buena parte de España, principalmente el norte y el noroeste. En Picos de Europa cayeron importantes cantidades de nieve, lo que motivó también la emisión de avisos, donde el peligro llegó a estimarse como fuerte (4) en la Escala Europea, que va de 1 a 5. En este capítulo se analiza el proceso operativo en AEMET de estimación del nivel de peligro de aludes que, a día de hoy, se realiza en base a criterios que siguen siendo fundamentalmente cualitativos, y cómo la incertidumbre de una predicción a tres días añade dificultad a este hecho

Peligro de aludes en el Parque Nacional de Picos de Europa y sierras de Cordel y Peña Labra durante la borrasca Hugo. 23-25 de marzo de 2018 [Presentación]

Presentación realizada en el VI Simposio Nacional de Predicción "Memorial Antonio Mestre", celebrado en la sede central de AEMET en Madrid del 17 al 19 de septiembre de 2018