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

Procedimiento para el aislamiento y crecimiento de bacterias capaces de utilizar el manitol como fuente de carbono

Número de publicación: 2 164 536 Número de solcitud: 009901455Procedimiento para el aislamiento y crecimiento de bacterias capaces de utilizar el manitol como fuente de carbono, en muestras de procedencia humana, animal, vegetal, industrial o medioambiental y, en general, de cualquier tipo de muestras. Comprende las etapas de (i) sembrar un medio de cultivo que incluye: manitol, fosfato monopotásico, fosfato dipotásico, extracto de levadura, triptona, sales minerales, vitaminas, bien con una suspensión densa de la muestra o bien directamente con la propia muestra o con una colonia bacteriana aislada de dicha muestra; e ii) incubar el medio de cultivo así sembrado a la temperatura óptima de crecimiento para cada cepa bacteriana a estudiar.Universidad de Granad

Laboratorio virtual para la enseñanza y aprendizaje de la identificación de microorganismos

El trabajo, de momento, no ha sido publicadoEl proyecto ha sido llevado a cabo por un grupo de cinco profesores del departamento de Microbiología y Genética de la Universidad de Salamanca. El objetivo del proyecto ha sido la elaboración de tutoriales multimedia sobre la identificación de microorganismos tanto de forma aislada como integrantes de muestras clínicas o sanitarias, con ejercicios basados en la interpretación de casos reales, distribuibles a través de internet y con suministro de información feedback. Básicamente el proyecto ha consistido en la realización y filmación de los análisis microbiológicos implicados, la digitalización de las imágenes tanto estáticas como dinámicas (vídeo digital), la elaboración de las tablas de datos (morfológicos, bioquímico y fisiológico...) de microorganismos necesarios para conseguir la identificación de los mismos, la elaboración de las páginas web de los tutoriales multimedia, la prueba piloto de ensayo de los tutoriales con un grupo reducido de alumnos y la prueba masiva de utilización por un grupo grande de alumnos. Las actividades desarrolladas, así como los resultados obtenidos se resumen en los siguientes apartados: enseñanza-aprendizaje de la identificación de microorganismos. Como se explica en la memoria, los recursos docentes elaborados pueden consultarse en las siguientes direcciones web: http://virus.usal.es/web/microAli/LabV/Gram/gram.html http://edicion-micro.usal.es/web/identificacion/AyudaPruebas.html http://edicion-micro.usal.es/web/educativo/entrada.html http://193.146.205.151:591/identificacion98/EleccionGrupos.htm Análisis microbiológico de muestras: los tutoriales multimedia sobre los análisis microbiológicos de muestras y la identificación de los microorganismos contenidos en las mismas se encuentra en la siguiente URL: http://virus.usal.es/web/analisis-micro/anmicro.html La citada página incluye los enlaces a los tutoriales de: análisis microbiológico de muestras clínicas, Urinocultivo ; análisismicrobiológico de muestras de agua, potabilidad; Análisis microbiológico de muestras de alimentos, recuento de enterobacterias y aislamiento e identificación del patógeno Salmonella. Integración en la enseñanza aprendizaje en una asignatura: por último los recursos elaborados se han integrado en la docencia reglada de las asignaturas 'Microbiología' y 'Análisis Biológicos y Diagnóstico de Laboratorio' de la Licenciatura de Farmacia y de la asignatura 'Métodos Biológicos de Análisis y Corrección' de la licenciatura de Ciencias Ambientales. Se concluye que con el sistema diseñado para la enseñanza-aprendizaje de la identificación de microorganismos y los tutoriales multimedia sobre análisis microbiológicos de muestras se consiguen los objetivos educativos propuestos. Los alumnos aceptan gratamente el sistema que se les ofrece y lo valoran positivamente.Junta de Castilla y León. Consejería de Educación y CulturaCastilla y LeónES

Stable low molecular weight RNA profiling showed variations within Sinorhizobium meliloti and Sinorhizobium medicae nodulating different legumes from the alfalfa cross-inoculation group

Four different low molecular weight (LMW) RNA profiles, designated I-IV, among 179 isolates from Medicago, Melilotus and Trigonella species growing in a field site in Northern Spain were identified. From sequence analysis of the 16S rRNA, atpD and recA genes as well as DNA-DNA hybridization analysis with representatives of each LMW RNA profile it was evident that isolates with LMW RNA profiles I and II belonged to Sinorhizobium meliloti and those displaying profiles III and IV to Sinorhizobium medicae. Therefore, two distinct LMW RNA electrophoretic mobility profiles were found within each of these two species. Collectively, LMW RNA profiles I and II (identified as S. meliloti) were predominant in Melilotus alba, Melilotus officinalis and Medicago sativa. Profiles III and IV (identified as S. medicae) were predominant in Melilotus parviflora, Medicago sphaerocarpa, Medicago lupulina and Trigonella foenum-graecum. All the four LMW RNA profiles were identified among isolates from Trigonella monspelliaca nodules. These results revealed a different specificity by the hosts of the alfalfa cross-inoculation group towards the two bacterial species found in this study.Peer Reviewe

Role of Rhizobium endoglucanase CelC2 in cellulose biosynthesis and biofilm formation on plant roots and abiotic surfaces

Abstract Background The synthesis of cellulose is among the most important but poorly understood biochemical processes, especially in bacteria, due to its complexity and high degree of regulation. In this study, we analyzed both the production of cellulose by all known members of the Rhizobiaceae and the diversity of Rhizobium celABC operon predicted to be involved in cellulose biosynthesis. We also investigated the involvement in cellulose production and biofilm formation of celC gene encoding an endoglucanase (CelC2) that is required for canonical symbiotic root hair infection by Rhizobium leguminosarum bv. trifolii. Results ANU843 celC mutants lacking (ANU843ΔC2) or overproducing cellulase (ANU843C2+) produced greatly increased or reduced amounts of external cellulose micro fibrils, respectively. Calcofluor-stained cellulose micro fibrils were considerably longer when formed by ANU843ΔC2 bacteria rather than by the wild-type strain, in correlation with a significant increase in their flocculation in batch culture. In contrast, neither calcofluor-stained extracellular micro fibrils nor flocculation was detectable in ANU843C2+ cells. To clarify the role of cellulose synthesis in Rhizobium cell aggregation and attachment, we analyzed the ability of these mutants to produce biofilms on different surfaces. Alteration of wild-type CelC2 levels resulted in a reduced ability of bacteria to form biofilms both in abiotic surfaces and in planta. Conclusions Our results support a key role of the CelC2 cellulase in cellulose biosynthesis by modulating the length of the cellulose fibrils that mediate firm adhesion among Rhizobium bacteria leading to biofilm formation. Rhizobium cellulose is an essential component of the biofilm polysaccharidic matrix architecture and either an excess or a defect of this “building material” seem to collapse the biofilm structure. These results position cellulose hydrolytic enzymes as excellent anti-biofilm candidates.We thank Nancy Fujishige and Peter De Hoff for help in the biofilm assays. This work was supported by Junta de Castilla y León Grant GR49 and MICINN Grants AGL2008-03360 and AGL2011-29227. M.R. and L.R. were supported by a PhD fellowship from the Spanish governmentPeer Reviewe

Has Micromonospora an influence on the development and the structure of Medicago root nodules?

Trabajo presentado en el 20th International Congress on Nitrogen Fixation, celebrado en Granada (España), del 3 al 7 de septiembre de 2017In addition to rhizobia, legume root nodules are inhabited by a large number of bacteria of different genera and belonging to three different Phyla (1). We now know that many of these bacteria have plant growth promoting properties, or antifungal activity (2-4). But until now we thought that these microorganisms did not have the capacity to induce or modify the nodulation process. In this study we analyzed the influence of Micromonospora on alfalfa nodulation. The first conclusion of this study is that Micromonospora can induce nodules in alfalfa roots and interestingly, these nodules show a shape similar to that of the nodules induced by Frankia. The nodules induced in alfalfa roots when Micromonospora is inoculated alone are few in number, they appear in one third of the inoculated plants and are large, coraloid and their cells are full of starch granules and no structure is observed that remembers to those of the typical legume roots nodules induced by Rhizobia. Micromonospora could not be detected within these nodules using any of the microscopy techniques available: LM, TEM and SEM. Co-inoculation of Micromonospora with Ensifer meliloti. In plants coinoculated with the two microorganisms coraloid nodules appear together with typical nodules, the later being more abundant. Microscopic observation showed no differences in nodular structure between the two types of nodules. The infected cells of nodules from co-inoculation treatments contain the typical symbiosomes and also clearly different elongated structures were observed. These structures are only observed in the coinoculation treatments with E. meliloti and Micromonospora under axenic conditions in mesocosmos experiments. In addition, this type of new structure is repeated in the observations made with optical microscopy as well as TEM and SEM, therefore we suspect that these new structures were due to the presence of Micromonospora in the nodule. Immunolocalization with the antimicromonospora antibody in nodule sections showed the presence of fluorescence-positive elongated micelar forms, isolated bacteria and putative spores. It can be concluded that these new structures appear due to the presence of Micromonospora inside the nodules of Medicago roots. (1) Martínez-Hidalgo and Hirsch. 2017. Phytobiomes (Accepted) (2) Martínez-Hidalgo, P. et al. 2014. Sci rep, 4. (3) Martínez-Hidalgo, P., et al. 2015. Front microbiol. 6. (4) Maymon, et al. 2015. Front plant. sci. 6 PMH is a postdoctoral fellow from JCyL-FEDER (Ref. SA058U16). and grant to MFP AGL2013-40758-R (Ministerio de Economía y Competitividad)PMH is a postdoctoral fellow from JCyL-FEDER (Ref. SA058U16). and grant to MFP AGL2013-40758-R (Ministerio de Economía y Competitividad

Paenibacillus hispanicus sp. Nov. isolated from triticum aestivum roots

A bacterial strain designated AMTAE16 was isolated from a root of wheat in Spain. Phylogenetic analyses based on 16S rRNA gene sequences placed the isolate in the genus Paenibacilluswith its closest relative being Paenibacillus daejeonensis AP-20 with 99.0 % 16S rRNA gene sequence similarity. DNA–DNA hybridization studies showed a mean of 30 % DNADNA relatedness between strain AMTAE16 and the type strain of P. daejeonensis. The isolate was a Gram-stainvariable, motile and sporulating rod. Catalase and oxidase activities were positive. Gelatin and starch were hydrolysed but not casein. Growth was supported by many carbohydrates and organic acids as carbon source. MK-7 was the only menaquinone detected and anteiso-C, C and iso-C were the major fatty acids. The major polar lipids were diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, two unidentified aminophospholipids, four unidentified phospholipids and two unidentified lipids. meso- Diaminopimelic acid was detected in the peptidoglycan. The DNA G+C content was 55.4 mol%. Phylogenetic, chemotaxonomic and phenotypic analyses showed that strain AMTAE16represents a novel species of the genus Paenibacillus, for which the name Paenibacillus hispanicus sp. nov. is proposed. The type strain is AMTAE16(=LMG 29501=CECT 9124).This work was supported by MINECO (Spanish Central Government) Grants AGL2013-48098-P and AGL2013-40758-R. EM is granted by a postdoctoral contract of this project

Entorno virtual para la formación tecnológica en ciencias experimentales : aprendizaje basado en casos reales

Realizado en la Facultad de Farmacia, de Salamanca, por 6 profesores del centro, para la asignatura de tercer curso: Análisis Microbiológicos y Diagnóstico de Laboratorio (Microbiología). El objetivo era crear un entorno virtual para la formación tecnológica mediante el diseño y la elaboración de módulos de simulación distribuidos por la web que simulen equipos y técnicas de laboratorio reales. También, se elaboraron tutoriales para la interpretación de resultados obtenidos en protocolos de análisis y experimentos con o sin simulación. Para lograr el objetivo, se han elaborado documentos audiovisuales sobre técnicas moleculares y microbiológicas, páginas web para tutoriales y protocolos, simuladores mediante javascripts, bases de datos interrogables. Los materiales se ofertan vía Internet desde un servidor web. Este método de enseñanza se aplicó con una prueba piloto a 18 alumnos y, más adelante, masiva, a 202 alumnos y se ha encontrado buena adaptación por parte de los alumnos y alta eficacia docente. Los modelos diseñados pueden aplicarse en la enseñanza de cualquier asignatura con contenidos en microbiología.Junta de Castilla y León. Consejería de Educación y CulturaCastilla y LeónJunta de Castilla y León. Consejería de Educación y Cultura; Monasterio de Nuestra Señora de Prado. Autovía Puente Colgante, s. n.; 47071 Valladolid; Tel. +34983411881; Fax +34983411939; [email protected]

Analysis of rhizobial endosymbionts of Vicia, Lathyrus and Trifolium species used to maintain mountain firewalls in Sierra Nevada National Park (South Spain)

Forest fires lead to the annual disappearance of many natural formations that require the creation of firewall areas. They can be maintained by enriching their pastures with attractive plants for grazing livestock, mainly legumes, which have a high protein content and low dependence on N fertilizers due to their ability to establish nitrogen-fixing symbiosis with rhizobia. In this study, the rhizobia isolated from the nodules of six legumes from the genera Vicia, Lathyrus and Trifolium were analysed in a firewall zone established in Lanjarón (Granada) close to the Sierra Nevada National Park (Spain). The results showed a high genetic diversity of the isolated strains that had 3, 16, 14 and 13 different types of rrs, recA, atpD and glnII genes, respectively. All strains were phylogenetically close to the species from the Rhizobium leguminosarum group, although they were not identified as any of them. The isolated strains belonged to the symbiovars viciae and trifolii but high phylogenetic diversity was found within both symbiovars, since there were 16 and 14 nodC gene types, respectively. Some of these strains clustered with strains isolated in other countries and continents, but others formed atpD, recA, glnII and nodC clusters and lineages only found to date in this study.This work was supported by research grants including ERDF (European Regional Development Funds): OAPN 748/2012 from the Organismo Autónomo Parques Nacionales (Spanish Ministry of Environment) and 20134R069—RECUPERA2020 from the Spanish Ministerio de Economía y Competitividad. AVL was awarded a contract from RECUPERA2020 and an FPU fellowship from the Spanish Ministerio de Educación, Cultura y Deporte

Anales de Edafología y Agrobiología Tomo 42 Número 5-6

Suelos. Retención de Parathión en Bentonitas Homoiónicas. II. Isotermas de retención y magnitudes termodinámicas relacionadas, por F. del Rey Bueno, E. González Pradas, C. Valenzuela Calahorro y J. D. López González.-- Formaciones edáficas de la región de Ocaña (Toletlo ). l. Entisoles., por José Gumuzzio Fernández y José B. Alvarez Martín.-- Caracterización hidrodinámica de un suelo de olivar. Fundamento teórico y métodos experimentales, por F. Moreno, G. Vachaud y J. Martín Aranda.-- Niveles de influencia de la vegetación en los horizontes superficiales de los suelos. II. Características morfológicas, análisis granulométrico, por Hoyos de Castro, A., Hernando Costa, J., Egido Rodríguez, J. A. y de la Cruz Caravaca, M. T.-- Estudio geológico e identificación de minerales interestratificados clorita-esmectita, mediante sorción interlaminar de aminas. Triásico de la cordillera iberia. l. por M. Doval, M. Rodas, A. Ruiz Amil y F. Aragón.—Fertilidad del Suelo. Niveles foliares de las plantaciones de aguacates de las Islas Canarias occidentales, por V. García, A. Díaz, M. Altares, J. J. Bravo Rodríguez y M. Fernández.-- Caracterización y valor fertilizante de los purines de vacuno en Galicia.t. por M. C. Leiros de la Peña, M. C. Villar Celorio, A. Cabaneiro, T. Carballas, F. Díaz-Fierros, F. Gil Sotres y C. Gómez lbarlucea.—Nutrición y Fisiología Vegetal. Efecto del azufre, nitrógeno y Rhizobium sobre la cosecha, nodulación y contenido de nutrientes en Phaseolus Vulgaris, por Lluch, C., Campos, J.A. y Ligero, F.-- Influencia de la presión osmótica sobre podredumbre apical del tomate (Lycopersicum esculentum), por Ma P. Sánchez Conde.-- Efecto de las giberelinas producidas por Rhizobium Meliloti en la nodulación de alfalfa (Medicago sativa L.), por Lluc, C., Ligero, F. y Olivares, J.-- Bases para el diagnóstico del exceso de boro en limonero, por A. León, A. Torrecillas, F. del Amor y M.a R. Monllor.-- Influencia del hospedador en la infección de las raíces de leguminosas por Rhizobium por M. A. Herrera, L. Mejías, E. Martínez-Molina y J. Olivares.-- Efectos de la irradiación con UV cercano sobre la evolución del contenido de apigenina y quercetol en ononis spinosa L., por J. Baztan.-- Composición mineral y estudio estructural de los tejidos sanos y afectados de podredumbre apical en dos variedades de tomate, (Lycopersicum Esculentum L.), por Ma P. Sánchez Conde y Ma R. de Felipe.—Trabajos recapitulativos. Aplicación de la isoterma de langmuir al estudio de las interacciones sólido-disolución en suelo, por M. Suárez y J. Sánchez-Andreu .-- Evaluación de la erosión hídrica de los suelos, por P. Sanroque, J. L. Rubio y J. Sánchez.-- Nota prioritaria. Criterios ecológicos en el uso de plaguicidas, por Eugenio Laborda.-- NotasPeer reviewe