Seasonal and Spatial Variations of Indoor Pollen in a Hospital

The airborne indoor pollen in a hospital of Badajoz (Spain) was monitored over two years using a personal Burkard sampler. The air was sampled in four places indoors—one closed room and one open ward on each of the ground and the third floors—and one place outdoors at the entrance to the hospital. The results were compared with data from a continuous volumetric sampler. While 32 pollen types were identified, nearly 75% of the total counts were represented by just five of them. These were: Quercus, Cupressaceae, Poaceae, Olea, and Plantago. The average indoor concentration was 25.2 grains/m3, and the average indoor/outdoor ratio was 0.27. A strong seasonal pattern was found, with the highest levels in spring and winter, and the indoor concentrations were correlated with the outdoor one. Indoor air movement led to great homogeneity in the airborne pollen presence: the indoor results were not influenced by whether or not the room was isolated, the floor level, or the number of people in or transiting the site during sampling. The presence of ornamental vegetation in the area surrounding the building affected the indoor counts directly as sources of the pollen

Producing Urban Aerobiological Risk Map for Cupressaceae Family in the SW Iberian Peninsula from LiDAR Technology

Given the rise in the global population and the consequently high levels of pollution, urban green areas, such as those that include plants in the Cupressaceae family, are suitable to reduce the pollution levels, improving the air quality. However, some species with ornamental value are also very allergenic species whose planting should be regulated and their pollen production reduced by suitable pruning. The Aerobiological Index to create Risk maps for Ornamental Trees (AIROT), in its previous version, already included parameters that other indexes did not consider, such as the width of the streets, the height of buildings and the geographical characteristics of cities. It can be considered by working with LiDAR (Light Detection and Ranging) data from five urban areas, which were used to create the DEM and DSM (digital elevation and surface models) needed to create one of the parameters. Pollen production is proposed as a parameter (α) based on characteristics and uses in the forms of hedges or trees that will be incorporated into the index. It will allow the comparison of different species for the evaluation of the pruning effect when aerobiological risks are established

Estacionalidade do Aspergillus no ar exterior em Badajoz

The airborne presence of Aspergillus in both outdoor and indoor air is important from the point of view of environmental and public health. The aim of this work was to study the seasonal presence of Aspergillus in outdoor air using viable methods. The exterior atmosphere of the city of Badajoz (SW Spain) was sampled at the University of Extremadura for two years from March 25, 2009, to March 25, 2011, using 3 types of viable portable volumetric samplers: two Burkard samplers–one provided with a device having a conical structure (Bd) and another one fitted with a sieve (Bs)– and one Sampl’air sampler (AES). The aspiration flow rate was 20 liters per minute for the Burkard samplers and 100 liters per minute for the AES sampler. Two kinds of culture media were used: Agar Dextrose Sabouraud (SDA) and Agar Extract Malt (MEA). During the first sampling period (March 25, 2009 - March 26, 2010) sampling was done with Bd and Bs and with SDA, whereas during the second sampling period (March 30, 2010 - March 25, 2011) AES and Bs and MEA were used. Data are provided in colony-forming units per cubic meter (CFU/m3). A total of 610 colonies of Aspergillus were counted during the overall period. The daily average concentration was 17 CFU/m3 throughout the period. A total of 15 Aspergillus species were identified, the most frequent being, in descending order: A. niger, A. candidus, A. fumigatus, A. niveus and A. versicolor. Some species were characterized by marked seasonality, predominating during autumn or winter or being absent in the summer. Others showed no marked seasonality. On average, Aspergillus concentration was highest in autumn and lowest in spring; the values in summer and winter were intermediate. Significant differences were found considering the three samplers used (χ2=28.491, p<0.001).La presencia de Aspergillus en el aire exterior e interior es importante para la salud pública. El objetivo de este trabajo fue estudiar la presencia estacional de Aspergillus en el aire exterior. Se muestreó la atmósfera exterior de Badajoz (SO España) en la Universidad de Extremadura durante dos años, desde el 25 de marzo de 2009 hasta el 25 de marzo de 2011, utilizando 3 tipos de captadores volumétricos portátiles viables: dos captadores Burkard, uno con un dispositivo con estructura cónica (Bc) y otro con un tamiz (Bt), y un captador Sampl’air (AES). La velocidad de flujo de aspiración fue 20 L/min. para los captadores Burkard y 100 para AES. Se emplearon dos tipos de medio de cultivo Agar Sabouraud Dextrosa (SDA) y Agar Extracto de Malta (MEA). En un primer periodo (25/03/2009-26/03/2010) se muestreó con Bc y Bt y con SDA, mientras que en el segundo (30/03/2010-25/03/2011) se muestreó con AES y Bt y con MEA. Los datos se proporcionan en unidades formadoras de colonias por metro cúbico (CFU/m3). Se contabilizaron un total de 610 colonias de Aspergillus en el periodo total estudiado. La concentración promedio diaria fue de 17 CFU/m3 en todo el periodo. Se identificaron 15 especies de Aspergillus siendo las más frecuentes: A. niger, A. candidus, A. fumigatus, A. niveus y A. versicolor. Algunas especies se caracterizaron por una marcada estacionalidad, con predominancia en otoño o invierno, o ausencia en verano. Otras no mostraron estacionalidad predominante. En promedio la concentración de Aspergillus fue máxima en otoño y mínima en primavera; en verano e invierno los valores fueron intermedios. Se han encontrado diferencias significativas teniendo en cuenta los tres captadores empleados (χ2=28,491, p<0,001).A presença do Aspergillus no ar exterior e interior é importante do ponto de vista da saúde pública. O objetivo do presente trabalho é estudar a abundância sazonal do Aspergillus no ar exterior. Recolheram-se amostras da atmosfera exterior de Badajoz (SO Espanha), na Universidade de Extremadura, durante dois anos, a partir de 25 de março de 2009 até 25 de março de 2011. Foram utilizados três tipos de sensores volumétricos portáteis viáveis: dois sensores Burkard, um com um dispositivo de estrutura cónica (Bc) e outro com uma peneira (Bt), e Sampl’air (AES). O caudal de aspiração foi de 20 litros/minuto para os sensores Burkard e 100 litros/minuto para o AES. Foram utilizados dois tipos de meio de cultura Sabouraud Dextrose Agar (SDA) e extrato de malte Agar (MEA). No primeiro período de amostragem (2009-03-25 a 2010-03-26) operou-se com Bc e Bp e SDA, enquanto no segundo período de amostragem (2010-03-30 a 2011-03-25) operou-se com AES e Bp e MEA. Os dados são fornecidos em unidades formadoras de colônias por metro cúbico (UFC/m3). Foi contabilizado um total de 610 colónias de Aspergillus. A concentração média foi de 17 UFC/m3.Foram identificadas 15 espécies do Aspergillus. As mais frequentes por ordem decrescente foram A. niger, A. candidus, A. fumigatus, A. niveus e A. versicolor. Algumas das espécies são caracterizadas por uma assinalada estacionariedade, com predomínio no outono ou no inverno, ou ausência no verão. Outras não mostraram estacionariedade predominante. Em média a concentração do Aspergillus foi máxima no outono e mínima na primavera, no verão e no inverno os valores foram intermédios. Registaram-se diferenças significativas tendo em conta os três captadores usados (χ2=28.491, p<0.001)

Urban aerobiological risk mapping of ornamental trees using a new index based on LiDAR and Kriging: A case study of plane trees

Ornamental trees bring benefits for human health, including reducing urban pollution. However, some species, such as plane trees (Platanus sp.), produce allergenic pollen. Consequently, urban maps are a valuable tool for allergic patients and allergists, but they often fail to include variables that contribute to the “building downwash effect”, such as the width and shape of streets and the height of buildings. Other factors that directly influence pollen dispersion (slopes and other geographical features) also have not traditionally been discussed. The LiDAR (Laser Imaging Detection and Ranging) technique enables one to consider these variables with high accuracy. This work proposes an Aerobiological Index to create Risk maps for Ornamental Trees (AIROT) and the establishment of potential areas of risk of exposure to Platanus pollen. LiDAR data from five urban areas were used to create the DEM and DSM (Digital Elevation and Surface Models) needed to perform further analysis. GIS software was used to map the points for each city and to create risk maps by Kriging, with stable (3 cases) and exponential function (2 cases) as the optimal models. In short, the AIROT index was a useful tool to map possible biological risks in cities. Since AIROT allows each city to consider its own characteristics, including geographical specifications, by using remote sensing and geostatistics techniques, the establishment of risk maps and healthy itineraries is valuable for allergic patients, allergists, architects and urban planners. This new aerobiological index provides a new decision-making tool related to urban planning and allergenicity assessment

Relationship of NDVI and oak (Quercus)pollen including a predictive model in the SW Mediterranean region

Techniques of remote sensing are being used to develop phenological studies. Our goal is to study the correlation among the Normalized Difference Vegetation Index (NDVI) related with oak trees included in three set data polygons (15, 25 and 50 km to aerobiological sampling point as NDVI-15, 25 and 50), and oak (Quercus) daily average pollen counts from 1994 to 2013. The study was developed in the SW Mediterranean region with continuous pollen recording within the mean pollen season of each studied year. These pollen concentrations were compared with NDVI values in the locations containing the vegetation under a study based on two cartographic sources: the Extremadura Forest Map (MFEx) of Spain and the Fifth National Forest Inventory (IFN5) from Portugal. The importance of this work is to propose the relationship among data related in space and time by Spearman and Granger causality tests. 9 out of 20 studied years have shown significant results with the Granger causality test between NDVI and pollen concentration, and in 12 years, significant values were obtained by Spearman test. The distances of influence on the contribution of Quercus pollen to the sampler showed statistically significant results depending on the year. Moreover, a predictive model by using Artificial Neural Network (ANN) was applied with better results in NDVI25 than for NDVI15 or NDVI50. The addition of NDVI25 with the lag of 5 days and some weather parameters in the model was applied with a RMSE of 4.26 (Spearman coefficient r = 0.77) between observed and predicted values. Based on these results, NDVI seems to be a useful parameter to predict airborne pollen

EVALUATING FUNGI INDOOR PRESENCE IN HOMES THROUGH VIABLE AND NON-VIABLE SAMPLING

Moulds are common and important allergens. They are more abundant outdoors but patients affected by mould allergy stay indoors much longer than outdoors. So, indoor sampling could help to assess the influence of the concentration of allergens in allergic symptoms. The aim of this study was to assess the relative efficiencies of two air sampling methods, viable and non viable, for the quantification of airborne indoor fungi in the homes of patients sensitized to Alternaria. Furthermore, outdoor sampling was carried out to compare results. Samples were taken over six months in Badajoz (SW Spain). Two houses were selected according to the presence of allergic patients to Alternaria. They were sampled once a month using both viable and non viable personal samplers at solar noon. A Burkard personal sampler was used to record spores and a Sampl’air AES Chemunex sampler was used for colonies. Three rooms were selected in each home: living room, kitchen and bathroom. Temperature and relative humidity were registered at each sample. Outdoor sampling was performed one day per week at the Faculty of Science, using a seven day Burkard sampler for spores and the same personal sampler for colonies. On average, 200-300 CFU/ m3 were found from more than 40 taxa identified. The highest number of colonies was recorded in the kitchen, then in the bathroom and finally in the living room. Nevertheless, there were minor differences between rooms. The houses studied showed a similar temporal pattern, with maximum values in December and minimum in January. Cladosporium colonies showed statistical differences between homes, but these differences were not found with Alternaria, Aspergillus or Penicillium colonies. Differences between rooms appeared for Alternaria colonies and Cladosporium herbarium spores. Temperature was positively correlated in most cases and relative humidity negatively with Alternaria spores. The number of spores collected was as twice as that of colonies, with an average concentration between 600-700 colonies/m3 , and nearly 1400 spores/m3 as maximum concentration. The temporal pattern of spores was similar to that found for colonies. Comparing colonies to spores, Alternaria and AspergillusPenicillium showed similar values. Notwithstanding, Cladosporium spores were nearly five times more abundant than colonies. The advantage of viable methods is the identification to species level, but they have the disadvantage that spores from some ubiquitous species, as Cladosporium, do not always grow in those media, which raises the interest to use additional non-viable methods

Rede de Aerobiologia da Extremadura

The development of aerobiological networks in Spain has been made at the level of the autonomous communities. In Extremadura the sampling is conducted by the University of Extremadura. It began in 1993 with a station in Badajoz (BA). Two towns have had sampling on a temporary basis: Cáceres (CC 1996-2001) and Merida (ME 1996-1998). Currently there are 3 more sampling stations, which have been running since 2011: Plasencia (PL), Don Benito (DB) and Zafra (ZA), and CC again recently. The Annual Pollen Index (annual daily amounts) has shown an average of more than 50.000 pollen grains/m3 (23.532-92.655). In Badajoz (23 years) the results show a downward trend. The maximum daily concentration peaks were reached in 1997, with values of 6.102 grains/ m3 (CC 21/3) and 5.041 grains/m3 (BA 23/3). The five most important pollen types represent 78% of all the pollen registered. Their importance varies from one station to another. Quercus, Poaceae, Olea, Cupressaceae and Platanus, in this order, are the most abundant pollen types in all stations, except Platanus, which is the second most abundant in DB, and Olea, which is second in ZA. The data have been available on the research group’s website (www.aerouex.es) since 2006, and the record of visitors to the site shows a signi cant correlation with the concentration of pollen. Extremadura stands out for its high pollen concentrations of Poaceae and Quercus, due to its wide expanses of oak and cork trees. Pollen from ornamental sources –Cupressaceae and Platanus— shows a strong dependence on their abundance and distribution.El desarrollo de redes aerobiológicas en España se ha realizado a nivel de las comunidades autónomas. En Extremadura el muestreo llevado a cabo por la Universidad de Extremadura comenzó en 1993 con la estación de Badajoz (BA). Dos localidades han tenido muestreo de forma temporal, Cáceres (CC 1996-2001) y Mérida (ME 1996-1998). En la actualidad se cuenta con 3 estaciones de muestreo más, funcionando desde 2011: Plasencia (PL), Don Benito (DB) y Zafra (ZA) y, de forma reciente, nuevamente CC. El Índice Polínico Anual (la suma de las concentraciones de polen diarias para un año) ha mostrado un promedio de más de 50.000 granos/m3 (23.532-92.655). Para Badajoz (23 años) se aprecia una tendencia a la reducción. Los picos de concentración diaria máxima se alcanzaron en 1997 con valores de 6.102 granos/m3 (CC 21/3) y 5.041 granos/m3 (BA 23/3). Los cinco tipos polínicos más relevantes representan el 78% del total de polen registrado. Su importancia varía de una estación a otra. Quercus, Poaceae, Olea, Cupressaceae y Platanus, en este orden, son los tipos más abundantes en todas las estaciones, excepto Platanus que es el segundo en DB y Olea que es el segundo en ZA. Desde 2006 los datos están disponibles a través de la página web del grupo de investigación (www.aerouex.es) y el registro de los accesos a dicho sitio muestra una correlación significativa con la concentración de polen. Extremadura se destaca por los altos valores de concentración de polen de Quercus y Poaceae, debido a la gran extensión de encinares y alcornocales. El polen de fuentes ornamentales, Cupressaceae y Platanus, muestra una importante dependencia de su abundancia y distribución en las localidades estudiadas.O desenvolvimento das redes de aerobiologia em Espanha foi realizado ao nível das comunidades autónomas. Na Extremadura a amostragem levada a cabo pela Universidade de Extremadura começou em 1993 com a estação de Badajoz (BA). Duas localidades foram temporariamente estudadas como pontos de amostragem, Cáceres (CC 1996-2001) e Mérida (ME 1996-1998). Existem, atualmente, em execução desde 2011, mais 3 estações de amostragem: Plasencia (PL), Don Benito (DB) e Zafra (ZA) e, recentemente, de novo CC. O Índice Polínico Anual (somas diárias anuais) mostrou uma média de mais de 50.000 grãos/m3 (23.532-92.655). Em Badajoz (23 anos) verifica-se uma tendência para a redução da concentração. Os picos de concentração máximos diários foram alcançados em 1997 com os valores de 6.102 grãos/m3 (CC 21/3) e 5.041 grãos/m3 (BA 23/3). Os cinco tipos polínicos mais importantes representam 78% de pólen total registrado. A sua importância varia de uma estação para outra. Quercus, Poaceae, Olea, Cupressaceae e Platanus, nesta ordem, são os tipos mais abundantes em todas as estações, exceto Platanus que é o segundo em DB e Olea que é o segundo em ZA. Os dados estão disponíveis desde 2006 através do site do grupo de investigação (www. aerouex.es) e o registro de acessos mostra uma correlação significativa com a concentração de pólen. A Extremadura destaca-se pelos valores elevados de concentração de pólen de Poaceae e de Quercus, devido à grande extensão de azinheiras e sobreiros. O pólen de origens ornamentais, Cupressaceae e Platanus, mostra uma dependência significativa de sua abundância e distribuição nas localidades estudadas

Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections

IMPORTANCE The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. OBJECTIVE To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. DESIGN, SETTING, AND PARTICIPANTS This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. INTERVENTIONS Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or pa renteral ertapenem for the comparator group after 4 days. MAIN OUTCOMES AND MEASURES The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. RESULTS Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to infinity percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI. -infinity to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). CONCLUSIONS AND RELEVANCE This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p < 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics