Vibrio parahaemolyticus en los productos marinos

Vibrio parahaemolyticus es la principal causa a nivel mundial de enfermedades diarreicas transmitidas por los alimentos de origen marino. Los factores de virulencia han sido profundamente estudiados pero siguen existiendo muchas dudas acerca de su rol en la patogenicidad y en los desencadenantes que determinan su activación. Se sabe que los factores climáticos y ambientales influyen en el desarrollo de la patogenicidad así como en su expansión a lugares donde previamente no se habían reportado casos. De hecho, el calentamiento global asociado al cambio climático se ha relacionado con dicha expansión. La aparición de cepas multirresistentes a antibióticos de uso habitual en medicina humana acompañado de la expansión global mencionada, ha levantado un mayor interés a nivel mundial en la vigilancia epidemiológica de su distribución y en el estudio y desarrollo de diferentes estrategias para su prevención y control.Abstract. Vibrio parahaemolyticus is the major cause of seafood-borne diarrheal disease in humans worldwide. The virulence factors have been thoroughly studied although many doubts remain about their role in pathogenicity and in the mechanisms that determine their activation. It is known that climatic and environmental factors influence the development of pathogenicity as well as its spread to places where previously no cases have been reported. In fact, global warming associated with climate change has been associated to this expansion. The emergence of multiresistant strains of antibiotics commonly used in human medicine accompanied by the global expansion mentioned, has raised greater interest worldwide in epidemiological surveillance of their distribution and in the study and development of different strategies for their prevention and control

Patients Discharged with Home Enteral Nutrition from a Third-Level Hospital in 2018

Patients who, during admission, begin to use enteral nutrition (EN) and do not recover adequate oral intake need proper planning prior to discharge. The present study is a descriptive analysis of patients discharged with EN from our hospital in 2018. In all, the study included 141 patients (50.3% male) with an average age of 76.18 14 years with the most frequent reasons for enteral support being neurological disease (71.3%) and ear, nose, and throat (ENT) and maxillofacial surgery (17.02%) (others accounted for 11.68%). In these two groups, di erences were observed in both the average age (77 vs. 70.5 years) and sex of patients—mostly women (58%) in the first group and men (70%) in the second. Overall, the access routes used were nasogastric tube (76.4%), and percutaneous endoscopic gastrostomy (18.4%); 67.1% of the episodes ended by 30 June, 60.6% of patients died (47% of neurological patients), and 39.3% patients recovered function of the oral passage (85% of surgical/head and neck tumor). The duration of support was as follows: 1–3 months, 32%; 6–12 months, 26.9%; more than 12 months, 18.5%. This indicated some frequent and clearly di erentiated profiles in the patients studied, which may contribute to better care and support in order to maintain long-term treatment

Evaluation of non-financial information and its contribution to advancing the sustainable development goals within the Spanish banking sector

Non-financial information and its contribution to the achievement of each Sustainable Development Goal (SDG) are assuming great relevance in the business world, in which it is not enough to be economically sustainable without also being sustainable from ethical, environmental, and social points of view. An analysis of how the financial sector contributes to the achievement of the SDGs is crucial in two ways. Firstly, due to the relevance and the magnitude of this sector itself; secondly, and more importantly in our view, because of the financial leverage of the banking sector that has a mandate to facilitate the transition of all economic sectors towards sustainability, guided by the 2030 Agenda. However, despite the expectations placed on banking entities, there is a research gap on their disclosure practices and on the SDG-related information that they report. In addition, the academic literature centered on the analysis of SDG-related disclosures through artificial intelligence is very scarce. To fill this gap, the objective of our study is, on the one hand, to analyze whether there is greater homogeneity in the disclosure of non-financial information in the Spanish banking sector following the transposition of Directive 2014/95/EU into Spanish Law. On the other hand, it is to evaluate the contribution of banking entities to the SDGs. To do so, the non-financial information reports of 12 Spanish banks are analyzed, completing a comparative evaluation and using artificial intelligence to identify mentions of each SDG and its targets. The Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) was also used to rank the banking entities in accordance with their contribution to each SDG. The results reflected the plurality, in both breadth and quality, in the disclosure of non-financial information and in the contribution to the SDGs. The only point in common between all the entities that were studied was the use of the GRI disclosure framework and the identification of the priority SDGs, positioning SDGs 8, 13, and 4 in priority positions. The banks with higher bank capitalization levels occupied the top of the ranking of contributions to the SDGs. Differences were presented for all other aspects, even to the point of highlighting that some entities or independent verifiers had not offered all the information. In conclusion, greater efforts to improve the quality of non-financial reporting and further development of the common regulatory framework will be fundamental for better comparability between the reports from banking entities. Furthermore, this study shows that natural language processing can be applied to better measure companies’ alignment with the SDGs based on the text of their non-financial report

Anticoagulantes orales directos frente a antagonistas de la vitamina K en pacientes del «mundo real» con fibrilación auricular no valvular: estudio FANTASIIA

Observational study[Abstract] Introduction and objectives: To compare the long-term results of direct oral anticoagulants (DOAC) vs vitamin K antagonists (VKA) in real-world-patients with nonvalvular atrial fibrillation (NVAF) in a nationwide, prospective study. Methods: The FANTASIIA registry prospectively included outpatients with AF anticoagulated with DOAC or VKA (per protocol, proportion of VKA and DOAC 4:1), consecutively recruited from June 2013 to October 2014 in Spain. The incidence of major events was analyzed and compared according to the anticoagulant treatment received. Results: A total of 2178 patients were included in the study (mean age 73.8±9.4 years), and 43.8% were women. Of these, 533 (24.5%) received DOAC and 1645 (75.5%) VKA. After a median follow up of 32.4 months, patients receiving DOAC vs those receiving VKA had lower rates of stroke-0.40 (95%CI, 0.17-0.97) vs 1.07 (95%CI,0.79-1.46) patients/y, P=.032-, severe bleedings-2.13 (95%CI, 1.45-3.13) vs 3.28 (95%CI, 2.75-3.93) patients/y; P = .044-, cardiovascular death-1.20 (95%CI, 0.72-1.99) vs 2.45 (95%CI, 2.00-3.00) patients/y; P = .009-, and all-cause death-3.77 (95%CI, 2.83-5.01) vs 5.54 (95%CI, 4.83-6.34) patients/y; P = .016-. In a modified Cox regression model by the Andersen-Gill method for multiple events, hazard ratios for patients receiving DOAC were: 0.42 (0.16-1.07) for stroke; 0.47 (0.20-1.16) for total embolisms; 0.76 (0.50-1.15) for severe bleedings; 0.67 (0.39-1.18) for cardiovascular death; 0.86 (0.62-1.19) for all-cause death, and 0.82 (0.64-1.05) for the combined event consisting of stroke, embolism, severe bleeding, and all-cause death. Conclusions: Compared with VKA, DOAC is associated with a trend to a lower incidence of all major events, including death, in patients with NVAF in Spain.[Resumen] Introducción y objetivos. Comparar los resultados a largo plazo de los anticoagulantes orales directos (ACOD) frente a los antagonistas de la vitamina K (AVK) en pacientes del mundo real con fibrilación auricular no valvular (FANV) en un estudio nacional prospectivo. Métodos. El estudio FANTASIIA incluyó consecutivamente a pacientes ambulatorios con FANV anticoagulados con ACOD o AVK desde junio de 2013 hasta octubre de 2014. Se compararon las tasas de eventos según el anticoagulante administrado. Resultados. Se incluyó a 2.178 pacientes (edad, 73,8 ± 9,4 años; el 43,8% mujeres); de ellos, 533 (24,5%) recibían ACOD y 1.645 (75,5%), AVK. Tras una mediana de seguimiento de 32,4 meses, los pacientes con ACOD tuvieron tasas más bajas de ictus —0,40 (IC95%, 0,17-0,97) frente a 1,07 (IC95%, 0,79-1,46) pacientes/año; p = 0,032—, hemorragias mayores —2,13 (IC95%, 1,45-3,13) frente a 3,28 (IC95%, 2,75-3,93) pacientes/año; p = 0,044—, muerte cardiovascular —1,20 (IC95%, 0,72-1,99) frente a 2,45 (IC95%, 2,00-3,00) pacientes/año; p = 0,009— y muerte total —3,77 (IC95%, 2,83-5,01) frente a 5,54 (IC95%, 4,83-6,34) pacientes/año; p = 0,016—. En el análisis de Cox modificado según el método de Andersen-Gill para datos con múltiples eventos, las razones de riesgos instantáneos para los pacientes con ACOD fueron 0,42 (0,16-1,07) para el ictus; 0,47 (0,20-1,16) para la embolia sistémica en general; 0,76 (0,50-1,15) para las hemorragias mayores; 0,67 (0,39-1,18) para la muerte cardiovascular; 0,86 (0,62-1,19) para la mortalidad total y 0,82 (0,64-1,05) para el combinado de ictus, embolias, hemorragias mayores y muerte. Conclusiones. El tratamiento con ACOD se asocia con una tendencia a una menor tasa de todos los eventos graves, incluida la mortalidad, en relación con los AVK en pacientes con FANV en España

Prevalence of submicroscopic malaria infection in immigrants living in Spain

BACKGROUND: The importance of submicroscopic malaria infections in high-transmission areas could contribute to maintain the parasite cycle. Regarding non-endemic areas, its importance remains barely understood because parasitaemia in these afebrile patients is usually below the detection limits for microscopy, hence molecular techniques are often needed for its diagnosis. In addition to this, the lack of standardized protocols for the screening of submicroscopic malaria in immigrants from endemic areas may underestimate the infection with Plasmodium spp. The aim of this study was to assess the prevalence of submicroscopic malaria in afebrile immigrants living in a non-endemic area. METHODS: A prospective, observational, multicentre study was conducted. Afebrile immigrants were included, microscopic observation of Giemsa-stained thin and thick blood smears, and two different molecular techniques detecting Plasmodium spp. were performed. Patients with submicroscopic malaria were defined as patients with negative blood smears and detection of DNA of Plasmodium spp. with one or both molecular techniques. Demographic, clinical, analytical and microbiological features were recorded and univariate analysis by subgroups was carried out with STATA v15. RESULTS: A total of 244 afebrile immigrants were included in the study. Of them, 14 had a submicroscopic malaria infection, yielding a prevalence of 5.7% (95% confidence interval 3.45-9.40). In 71.4% of the positive PCR/negative microscopy cases, Plasmodium falciparum alone was the main detected species (10 out of the 14 patients) and in 4 cases (28.6%) Plasmodium vivax or Plasmodium ovale were detected. One patient had a mixed infection including three different species. CONCLUSIONS: The prevalence of submicroscopic malaria in afebrile immigrants was similar to that previously described in Spain. Plasmodium vivax and P. ovale were detected in almost a third of the submicroscopic infections. Screening protocols for afebrile immigrants with molecular techniques could be useful for a proper management of these patients.This work was funded by projects PI14/01671, PI17/01791 and PI14CIII/00014, from the Instituto de Salud Carlos III (Ministry of Economy, Industry and Competitiveness) and cofounded by the European Regional Development Fund, and approved by the Ethics Committee of our Institution. There was no funding from the PCR manufacturers; they did not play any role in data analysis or in the reporting of the results.S

Influence of sex on long-term prognosis in patients with atrial fibrillation treated with oral anticoagulants. Results from the prospective, nationwide FANTASIIA study

[Abstract] Background: While many risk factors for Atrial Fibrillation (AF) have been identified, there are important differences in their relative impact between sexes. The aim of our study was to investigate the influence of sex as a long-term predictor of adverse events in “real world” AF patients treated with direct oral anticoagulants. Methods: The FANTASIIA registry is a prospective, national and multicentric study including outpatients with anticoagulated AF patients. Baseline characteristics and adverse events at 3 years of follow-up were collected and classified by sex. Cox multivariate analysis was performed to investigate the role of sex in major events and composite outcomes. Results: A total of 1956 patients were included in the study. 43.9% of them were women, with a mean age of 73.8 ± 9.4 years (women were older 76.5 ± 7.9 vs 71.7 ± 10.1, p<0.001). Women had higher rate of cardiovascular risk factors and higher mean of CHA2DS2-VASc (4.4 ± 1.4 vs 3.7 ± 1.6, p<0.001) and HAS-BLED (2.1 ± 1.0 vs 1.9 ± 1.1, p<0.001) than men. After 3 years of follow-up, rates of major events were similar in both groups with limit difference for all-cause mortality (4.4%/year in women vs 5.6%/year in men; p = 0.056). However, all the composite events were more frequent in women. We observed in the non-adjusted adverse events lower rate of all-cause mortality (HR 0.62, 95%CI 0.47–0.81; p<0.001), composite 1 outcomes (HR 0.80, 95%CI 0.65–0.98; p = 0.029) and composite 2 (HR 0.77, 95%CI 0.64–0.94; p = 0.010) in women compared with men. In multivariate Cox regression analysis observed that female sex was an independently protector factor for all-cause mortality and for the composite outcomes 1 and 2. Conclusions: In this “real world” study of anticoagulated AF patients, women could have a protective role against development of adverse events, mainly on all-cause mortality and combined events.Instituto de Salud Carlos III; RD12/0042/0068Instituto de Salud Carlos III; RD12/0042/0010Instituto de Salud Carlos III; RD12/0042/0069Instituto de Salud Carlos III; RD12/0042/006

Conocimiento, conducta y actitud ante el Código europeo contra el cáncer por parte de los profesionales sanitarios de atención primaria

Objetivo: Determinar si los profesionales de atención primaria (AP) conocen el Código europeo contra el cáncer (CECC) y si ello se relaciona con que practiquen sus recomendaciones. Diseño: Observacional descriptivo. Emplazamiento: Centros de AP españoles. Participantes: Profesionales de AP. Intervenciones: Cuestionario autoadministrado. Mediciones principales: Factores de riesgo y protectores del cáncer, pruebas de cribado y conocimiento del CECC. Resultados: Respondieron 1.734 profesionales (10, 5%), edad media de 48, 5 años (DT: 9, 2), el 71, 5% mujeres. El 50, 0% desconoce el CECC; los tutores (OR = 1, 61), adscritos al PAPPS (OR = 1, 51) y que llevan más tiempo trabajando en AP (OR = 2, 62) son los que más lo conocen. El 7, 2% fuma y el 79, 1% bebe alcohol. El 64, 1% presenta normopeso y el 19% realiza actividad física. Evita exponerse al sol el 52, 7% y usa protectores el 53, 8%. El 85, 2% nunca se ha realizado un cribado colorrectal, el 11% nunca una citología y el 12% una mamografía. Existe relación entre conocer el CECC y el tabaquismo (p < 0, 001), sobrepeso/obesidad (p = 0, 024), actividad física (p = 0, 003), ingesta de carnes (p < 0, 001), mamografía (p < 0, 001), citología (p = 0, 022), PSA (p = 0, 045), así como el fomento de sus consejos entre los pacientes. Conclusiones: El CECC es desconocido por la mitad de los profesionales de AP. La práctica de sus recomendaciones es desigual, siendo la prevalencia de tabaquismo baja, y la protección solar una conducta poco extendida. Los que lo conocen son los que más practican sus recomendaciones. Objective: To decide if Primary Care (PC) professionals know the European Code against Cancer (CECC) and if this relates to practice the recommendations with themselves and with their patients. Design: descriptive, observational study. Setting: Spanish Health Centers. Participants: Health professionals. Interventions: self-administered questionnaire. Main measurements: cancer protective and risk factors, screening for colorectal, breast, cervix and prostate cancer, level of knowledge of the ECAC. Results: 1734 participants (10.5%), mean age 47.4 years (SD: 8.6), 71.5% female. 50.0% do not know the CECC; tutors (OR = 1.61), assigned to the PAPPS (OR = 1.51) and who have been working in AP for more time (OR = 2.62) are the ones who know it most. 7.2% smoke and 79.1% drink alcohol. 64.1% presented normal weight and 19% performed physical activity. They avoid exposing themselves to the sun 52.7% and use protectors 53.8%. 85.2% have never had a colorectal screening, 11% never had a cytology, and 12% had a mammogram. There is a relationship between knowing the CECC and smoking (P <.001), overweight/obesity (P =.024), physical activity (P =.003), meat intake (P <.001), mammography (P <.001), cytology (P =.022), PSA (P =.045), as well as the promotion of their advice among patients. Conclusions: The CECC is unknown by half of the AP professionals. The practice of its recommendations is uneven, with the prevalence of low smoking, and sun protection a little extended behavior. Those who know him are the ones who most practice his recommendations

A multicentre analysis of Nocardia pneumonia in Spain: 2010-2016

Objective: To analyse all cases of Nocardia pneumonia occurring between 2010 and 2016 in five Spanish hospitals. Methods: This was a retrospective observational analysis of clinical and microbiological data collected from 55 cases of Nocardia pneumonia. Results: There were one to 20 cases per hospital and six to nine cases per year. Chronic obstructive pulmonary disease, bronchiectasis, and asthma were the main predisposing underlying respiratory conditions. Thirty-four patients were receiving systemic and/or inhaled corticosteroids prior to infection, eight had neoplasia, and six had haematological malignancies. Clinical and radiological findings were common to pneumonia of other infectious aetiologies, except for the frequent presence of nodules and cavitation. Overall, the 1-year mortality was high (38.2%), and mortality was directly related to the pulmonary disease in 15 patients (27.3%). The most frequently identified species were N. cyriacigeorgica (n = 21), N. abscessus (n = 8), and N. farcinica (n = 5). All Nocardia isolates were susceptible to linezolid and all but two were susceptible to amikacin and trimethoprim-sulfamethoxazole. Conclusions: Nocardia pneumonia-associated mortality remains high, probably because of the debilitated status of patients in whom this pathogen is able to cause pulmonary infection

Peripheral artery disease and clinical outcomes in patients with atrial fibrillation: A report from the FANTASIIA registry

Observational study[Abstract] Background: Atrial fibrillation (AF) and peripheral artery disease (PAD) are common conditions that increase cardiovascular risk. We determined the association between PAD and prognosis in a cohort of real-world patients receiving oral anticoagulant therapy for nonvalvular AF. Methods: We prospectively included 1956 patients (mean age 73.8 ± 9.5 years, 44.0% women) receiving oral anticoagulant therapy for AF. Clinical characteristics were collected at baseline. Patients were followed for a period of 3 years. Survival analysis and multivariable regression analyses were performed to assess variables related to death, stroke, bleeding, myocardial infarction and major adverse cardiovascular events (MACE). Results: Patients with PAD (n = 118; 6%) exhibited higher rates of cardiovascular risk factors and cardiovascular diseases. After 3 years of follow-up, there were a total of 255 deaths (no PAD 233, vs PAD 22), 45 strokes (43 vs 2), 146 major bleedings (136 vs 10) and 168 MACE (148 vs 20). On univariate analysis, there was a higher risk of cardiovascular mortality (2.02%/year no PAD vs 4.08%/year PAD, P = .02), myocardial infarction (0.99%/year no PAD vs 2.43%/year PAD, P = .02) and MACE (3.18%/year no PAD vs 6.99%/year PAD, P < .01). There was no statistically significant association with these events after multivariable adjustment. Conclusions: In a large cohort of anticoagulated patients with AF, the presence of PAD represents a higher risk subgroup and is associated with worse crude outcomes. The exact contribution of the PAD independently of other cardiovascular diseases or risk factors requires further investigation.Instituto de Salud Carlos III; RD16/11/00420Instituto de Salud Carlos III; RD12/0042/0068Instituto de Salud Carlos III; RD12/0042/0010Instituto de Salud Carlos III; RD12/0042/0069Instituto de Salud Carlos III; RD12/0042/006

Diagnóstico precoz del VIH en atención primaria en España. Resultados de una prueba piloto de cribado dirigido basado en condiciones indicadoras, criterios conductuales y de origen

Estimar la prevalencia de la infección por VIH en pacientes diagnosticados con una condición indicadora (CI) para el VIH y/o que habían tenido una conducta de riesgo para su adquisición y/o que provenían de países con elevada prevalencia. Determinar la aceptabilidad y viabilidad de ofrecer la prueba del VIH basada en CI y criterios conductuales y de origen en atención primaria (AP). Estudio transversal en una muestra de conveniencia. Seis centros de AP en España. Los criterios de inclusión fueron: pacientes entre 16 y 65 años que presentaban al menos una de las CI propuestas y/o al menos uno de los criterios conductuales y/o de origen propuestos. Participaron 388 pacientes. Se ofreció la serología del VIH a todos los pacientes que cumplían con los criterios de inclusión. Descripción de la frecuencia de CI, criterios conductuales y de origen. Prevalencia de infección por VIH. Nivel de aceptabilidad y viabilidad de la oferta de la prueba del VIH basada en criterios conductuales y de origen y CI. Un total de 174 pacientes presentaron una CI (44,84%). El criterio conductual más común fue: haber mantenido relaciones sexuales desprotegidas alguna vez en la vida con personas que desconocían su estado serológico para el VIH (298; 76,8%). Se diagnosticaron 4 pacientes VIH+ (1,03%). Todos presentaban una CI y eran hombres que mantenían sexo con hombres. El nivel de aceptabilidad en AP fue elevada. Ofrecer la prueba del VIH a pacientes con CI y criterios conductuales es viable y efectiva en AP