Estudio comparativo de medición entre lecturas visuales y espectrofotométricas en pruebas de susceptibilidad in vitrode aislamientos de candida

Se realizó un estudio de susceptibilidad in vitrofrente a itraconazol, ketoconazol y clotrimazol de 144 cepas de Candida, conservadas y previamente identificadas, aisladas de la cavidad oral de pacientes infectados por elvirus de inmunodeficiencia humana (VIH) con cuadros clínicos de candidiasis orofaríngea (COF). El estudio se llevó a cabo mediante dos metodologías; la primera, utilizando los requerimientos del Clinical and Laboratory Standard Institute (CLSI), en el cual está establecida la lectura visual para determinar los patrones de susceptibilidad; y la segunda, mediante la propuesta de la European Committee on Antibiotic Susceptibility Testing, el cual tiene fijado la lectura espectrofotométrica para eliminar las posibles subjetividades de la metodología del CLSI. Los resultados obtenidos mediante ambas lecturas no mostraron diferencias mayores a dos diluciones en los valores de concentración mínima inhibitoria, y demostraron que ambos métodos se correlacionan y es importante para aquellos laboratorios de pocos recursos económicos.Palabras clave: Susceptibilidad in vitr,; Candida, lectura visual, CLSI, lectura espectrofotométrica, EUCAST azoles, VIH/sida.</p

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Gestantes con antígeno de superficie positivo: resultado de su pesquisaje en 5 837 casos

Se realiza un estudio observacional, analítico, con un modelo de diseño del tipo casos y controles; en un total de 5 837 gestantes, pesquisadas en los municipios Guanabacoa y Regla desde el 1 de junio de 1990 hasta el 1 de junio de 1994. Se detectaron 20 casos con antígeno de superficie positivo para la hepatitis B, lo que aporta una prevalencia de 0,3 % y constituyen el grupo estudio. El grupo control se formó mediante un muestreo estratificado de los 4 policlínicos que conforman ambos municipios, se reunieron 120 mujeres en las cuales la prueba de pesquisaje ELISA había sido negativa. Como instrumento epidemiológico se aplicó el riesgo relativo y su intervalo de confianza. En el grupo estudio tuvieron significación estadística las variables siguientes entre los factores de riesgo identificables: las enfermedades de transmisión sexual, la promiscuidad, el antecedente de intervenciones quirúrgicas, la situación económica mala, la soltería, el nivel universitario, el antecedente de hemoterapia, la comprobación de urosepsis, el haber tenido un recién nacido pretérmino o con un peso inferior a los 2 500 g y la referencia de niños con estas características en embarazos anteriores.An observational and analytical case-control study was conducted among 5 837 women that were screened in the municipalities of Guanabacoa and Regla from June 1, 1990, to June 1, 1994. 20 cases with positive surface antigens for heapatits B that constituted the study group were detected, accounting for a prevalence of 0.3 %. The control group was formed by a stratified sampling of 4 polyclinics of both municipalities. 120 women who underwent an ELISA and had negative results were grouped. The relative risk and its confidence interval were used as an epidemiological instrument. In the study group the following variables were statistically significant amog the identifiable risk factors: sexually transmitted diseases, promiscuity, previous surgical procedures, bad economic situation, celibacy, university level, hemotherapy history, urosepsis checking, having a preterm newborn with a birth weight lowere than 2 500 g, and report of children with these characteristics in prior pregnancies

Molecular determinants of interactions between the N-terminal domain and the transmembrane core that modulate hERG K + channel gating

A conserved eag domain in the cytoplasmic amino terminus of the human ether-a-go-go-related gene (hERG) potassium channel is critical for its slow deactivation gating. Introduction of gene fragments encoding the eag domain are able to restore normal deactivation properties of channels from which most of the amino terminus has been deleted, and also those lacking exclusively the eag domain or carrying a single point mutation in the initial residues of the N-terminus. Deactivation slowing in the presence of the recombinant domain is not observed with channels carrying a specific Y542C point mutation in the S4–S5 linker. On the other hand, mutations in some initial positions of the recombinant fragment als

Actitud ante la muerte en los Médicos de Familia

Se realizó un estudio descriptivo para caracterizar las actitudes ante la muerte en una muestra de 50 Médicos de Familia del Policlínico "Plaza". Se utilizó una versión cubana de un instrumento diseñado anteriormente para estudiar las actitudes ante la muerte. Se intentaba a su vez, establecer los primeros indicadores de validez y confiabilidad de esta versión denominada convencionalmente: cuestionario de actitudes ante la muerte (CAM), que incluía 33 reactivos, agrupados para su interpretación en 6 subescalas: evitación, aceptación, temor, pasaje, salida y perspectiva profesional. El procesamiento de las respuestas incluyó estadísticas descriptivas y pruebas de decisión con ayuda del sistema SSPS-PC+. Las actitudes prevalentes en los médicos eran de evitación y temor, en un contexto ambivalente dado por las actitudes positivas de aceptación de la muerte como un hecho natural, que se traduce en afrontamiento profesional no consecuente. En general, se encuentran actitudes que revelan la insuficiente preparación de los Médicos de Familia investigados para la aproximación realista a la muerte.<br>A descriptive study of attitudes to death was carried out in a sample of 50 family physicians from "Plaza" polyclinics. A Cuban version of a previously designed instrument to study attitudes to death was used. At the same time, it was intended to establish the first indicators of validation and reliability of this version which is conventionally called: Questionnaire of Attitudes to Death (QAD) that includes 33 reactions grouped into 6 subclasses for the purpose of interpretation: avoidance, acceptance, fear, passage, exit and professional perspective. The processing of responses covered descriptive statistics and decision-making tests assisted by the SSPS-PC+ system. The prevailing attitudes to death found in the physicians were: avoidance and fear in an ambivalent environment given by positive attitudes of death acceptance as a natural fact of life, which means an inconsistent professional facing up to death. Generally speaking, the attitudes found revealed a poor preparation of the studied family physicians for a realistic approach to death

Inhibidores de la enzima conversora de angiotensina: Revisión de estudios multicéntricos

Se realizó una revisión bibliográfica de los inhibidores de angiotensina. Se hizo una breve reseña histórica, se revisaron sus mecanismos de acción, sus efectos a diferentes niveles y sus reacciones secundarias. Se analizaron los diferentes estudios multicéntricos que se han realizado con este grupo de medicamentos, y encontramos que los mismos influyen de forma favorable en la morbilidad y la mortalidad de los pacientes con insuficiencia cardíaca, que sus efectos son superiores en aquellos con grados más avanzados de insuficiencia y que deben ser empleadas dosis altas según la tolerancia a los mismos. Aunque se plantea que estos inhibidores no son intercambiables, en la literatura revisada no se halló la superioridad de uno sobre otro para determinada enfermedad y/o grupos de pacientes.A literature review of the angiotensin inhibitors was made. A brief historical review was made and the mechanisms of actions, the effects at different levels and the secondary reactions of these inhibitors were reviewed. Different multicenter studies that have been carried out with this group of drugs were analyzed, in which we found out that such drugs favorably affect morbidity and mortality of patients with heart failure, their effects are higher in those patients with advanced degree of heart failure and that high doses should be used according to tolerance. Although it is said that these inhibitors are not exchangeable, the reviewed literature did not show the superiority of one drug over the others for certain disease and/or group of patients

Intervención sobre hipertensión arterial en un consultorio médico Blood hypertension intervention in a physician´s office

Se realizó un estudio de intervención sobre HTA en un grupo de pacientes hipertensos del Consultorio No. 3, correspondiente al Policlínico "Luis Galván Soca", del municipio Centro Habana, en el que, de un total de 75 pacientes para un 13,3 %, se aplicó el estudio a 60 hipertensos, con el fin de saber el nivel de conocimiento que tenían sobre su enfermedad de base, en cuanto a conceptos, definiciones y complicaciones, entre otros aspectos. Después de realizada la investigación, se obtuvo como resultado de las encuestas aplicadas, en primera instancia, que los pacientes conocían muy poco sobre su enfermedad de base, y que después de impartido el curso, que contó de 4 intervenciones, se observó un aumento del conocimiento de la enfermedad que padecen en sentido general, por lo cual vemos cumplido el objetivo trazado en esta investigación.<br>An intervention study on hypertension was carried out in a group of hypertensive patients from the physician´s office no.3 from "Luis Galván Soca" polyclinics in Centro Havana municipality. Of 75 in all, the study was applied to 60 hypertensives to find out their level of knowledge about their underlying disease in terms of concepts, definitions and complications, among other things. After the research, the result of the applied surveys yielded that the patients knew veryllittle about their underlying disease and that, after the training comprising 4 interventions, increased knowledge about their disease in general was observed, so we believe that the objective of this research study has been achieved