Emergency surgery in chronic intestinal pseudo-obstruction due to mitochondrial neurogastrointestinal encephalomyopathy: case reports

Chronic intestinal pseudo-obstruction (CIPO) is a syndrome characterized by recurrent clinical episodes of intestinal obstruction in the absence of any mechanical cause occluding the gut. There are multiple causes related to this rare syndrome. Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is one of the causes related to primary CIPO. MNGIE is caused by mutations in the gene encoding thymidine phosphorylase. These mutations lead to an accumulation of thymidine and deoxyuridine in blood and tissues of these patients. Toxic levels of these nucleosides induce mitochondrial DNA abnormalities leading to an abnormal intestinal motility

El problema de la compartimentación en contenidos teóricos y prácticos en el proceso de aprendizaje. Propuesta de diagramas arbóreos interactivos en las prácticas de Microbiología

[SPA] El estudio de la Microbiología a nivel de enseñanzas media y superior, se imparte clásicamente mediante clases magistrales teóricas y clases prácticas en el laboratorio. Esta compartimentación se ha visto agravada con la implantación de los Grados en los que los contenidos se distribuyen aún más entre una amplia variedad de actividades. El alumno debe sustituir la presencialidad por el trabajo personal, si bien los resultados observados son su preocupación por la materia objeto de evaluación de cada una de las partes y la dificultad en integrar y secuenciar los contenidos que asimila. Por otra parte, las condiciones de seguridad que requiere el trabajo con patógenos unido a la falta de tiempo, supone una reducción del programa práctico. En el presente estudio, financiado con un Proyecto de Innovación de la Universidad de Murcia suscrito con la CARM, se plantea como objetivo la resolución de este problema, común a ambos niveles de enseñanza, mediante diagramas arbóreos interactivos de fácil acceso. La finalidad es conseguir unos resultados en el proceso de enseñanza-aprendizaje de la Microbiología de la forma más parecida a la realidad, en las que el alumno debe tomar decisiones en base a los contenidos y destrezas adquiridos. [ENG] The study of Microbiology in secondary and higher education, was conventionally taught through theoretical lectures and practical laboratory classes. This compartmentalization has been exacerbated with the implementation of Grades in which content is distributed even more from a wide variety of activities. The student must replace presentiality for personal work, but the results observed are concerned about the subject matter of assessment of each of the parties and the difficulty in integrating and assimilating the content sequence. Moreover, the security that requires working with pathogens coupled with the lack of time, a reduction of practical program. In the present study, funded with Innovation Project of the University of Murcia signed with CARM, therefore seeks to solve this problem, common to both levels of education by interactive tree diagrams easily accessible. The aim is to achieve results in the teaching and learning of Microbiology shaped more like reality, in which the student must make decisions based on the content and skills acquired.Trabajo financiado por un proyecto dentro del PROGRAMA III: Centro de Formación y Desarrollo Profesional Universidad de Murcia (Proyectos conjuntos de investigación e innovación educativa 2013-14

Unidades didácticas de apoyo para prácticas de laboratorio: nuevos contenidos y usos para smartphones

[SPA] Esta comunicación describe fundamentalmente la parte de desarrollo de herramientas, realizado por profesoras y profesores de la Facultad de Bellas de Artes y de la Facultad de Veterinaria, ambas de la Universidad de Murcia. El trabajo se enmarca en el proyecto de Innovación docente “Realización de prácticas en Microbiología mediante la utilización de recursos audiovisuales y nuevas tecnologías” en el Marco del Programa III del Convenio de Cooperación en Materia de Formación Inicial y Permanente del Profesorado que ejerce en los Niveles Anteriores a la Universidad, suscrito por la Universidad de Murcia y la Comunidad Autónoma de la Región de Murcia. Esta comunicación está vinculada a la comunicación titulada “El problema de la compartimentación en contenidos teóricos y prácticos en el proceso de aprendizaje. Propuesta de diagramas arbóreos interactivos en las prácticas de Microbiología”, tratando cuestiones complementarias de un mismo proyecto. Nos centraremos en la explicación del funcionamiento de la web app que ha sido concebida para que estudiantes de Microbiología puedan mejorar y afirmar los conocimientos que se adquieren en las prácticas de laboratorio. Esta aplicación es accesible desde el navegador del ordenador (online y offline) y está adaptada para teléfonos móviles (online), incluyendo material multimedia (imágenes, texto, audios y vídeos). Este material ha sido grabado íntegramente en los laboratorios de Microbiología de la Facultad de Veterinaria con la colaboración de profesoras/es y alumnas/os. [ENG] This paper describes a part of the work of teachers from the Faculty of Fine Arts and the Faculty of Veterinary Science, both from the University of Murcia. This work has been created in the context of an innovation learning project titled "Performing Microbiology practices using audiovisual resources and new technologies". This communication is linked to the communication entitled "The problem of compartmentalization in theory and practice for learning contents. Interactive tree diagrams for Microbiology practices", both of them explain subjects of the same project. We will focus on explaining the web app that has been designed by the teachers from de Fine Arts faculty and that integrates content created by veterinary teachers The main goal of this app is to improve and affirm the knowledge acquired by students of microbiology in the labs (practice exercises). This app works for web (online and offline) and mobile phones (online) and includes multimedia material (images, text, audio and video). This material has been recorded entirely in the Microbiology Laboratories of the Faculty of Veterinary, in collaboration with teachers and students.Trabajo financiado por un proyecto dentro del PROGRAMA III: Centro de Formación y Desarrollo Profesional Universidad de Murcia (Proyectos conjuntos de investigación e innovación educativa 2013-14

Combination of Tocilizumab and Steroids to Improve Mortality in Patients with Severe COVID-19 Infection : A Spanish, Multicenter, Cohort Study

We aimed to determine the impact of tocilizumab use on severe COVID-19 (coronavirus disease 19) pneumonia mortality. We performed a multicentre retrospective cohort study in 18 tertiary hospitals in Spain from March to April 2020. Consecutive patients admitted with severe COVID-19 treated with tocilizumab were compared to patients not treated with tocilizumab, adjusting by inverse probability of the treatment weights (IPTW). Tocilizumab's effect in patients receiving steroids during the 48 h following inclusion was analysed. During the study period, 506 patients with severe COVID-19 fulfilled the inclusion criteria. Among them, 268 were treated with tocilizumab and 238 patients were not. Median time to tocilizumab treatment from onset of symptoms was 11 days [interquartile range (IQR) 8-14]. Global mortality was 23.7%. Mortality was lower in patients treated with tocilizumab than in controls: 16.8% versus 31.5%, hazard ratio (HR) 0.514 [95% confidence interval (95% CI) 0.355-0.744], p < 0.001; weighted HR 0.741 (95% CI 0.619-0.887), p = 0.001. Tocilizumab treatment reduced mortality by 14.7% relative to no tocilizumab treatment [relative risk reduction (RRR) 46.7%]. We calculated a number necessary to treat of 7. Among patients treated with steroids, mortality was lower in those treated with tocilizumab than in those treated with steroids alone [10.9% versus 40.2%, HR 0.511 (95% CI 0.352-0.741), p = 0.036; weighted HR 0.6 (95% CI 0.449-0.804), p < 0.001] (interaction p = 0.094). These results show that survival of patients with severe COVID-19 is higher in those treated with tocilizumab than in those not treated and that tocilizumab's effect adds to that of steroids administered to non-intubated patients with COVID-19 during the first 48 h of presenting with respiratory failure despite oxygen therapy. Randomised controlled studies are needed to confirm these results. European Union electronic Register of Post-Authorization Studies (EU PAS Register) identifier, EUPAS34415 The online version of this article (10.1007/s40121-020-00373-8) contains supplementary material, which is available to authorized users

Risk factors for infections caused by carbapenem-resistant Enterobacterales: an international matched case-control-control study (EURECA)

Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors. Findings Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-beta-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74-15.53; <0.001), urinary catheter (1.78; 1.03-3.07; 0.038) and exposure to broad spectrum antibiotics, as categorical (2.20; 1.25-3.88; 0.006) and time-dependent (1.04 per day; 1.00-1.07; 0.014); chronic renal failure (2.81; 1.40-5.64; 0.004) and admission from home (0.44; 0.23-0.85; 0.014) were significant only for CSE controls. Subgroup analyses provided similar results. Interpretation The main risk factors for CRE infections in hospitals with high incidence included previous coloni-zation, urinary catheter and exposure to broad spectrum antibiotics

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 &lt; 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

CARB-ES-19 Multicenter Study of Carbapenemase-Producing Klebsiella pneumoniae and Escherichia coli From All Spanish Provinces Reveals Interregional Spread of High-Risk Clones Such as ST307/OXA-48 and ST512/KPC-3

ObjectivesCARB-ES-19 is a comprehensive, multicenter, nationwide study integrating whole-genome sequencing (WGS) in the surveillance of carbapenemase-producing K. pneumoniae (CP-Kpn) and E. coli (CP-Eco) to determine their incidence, geographical distribution, phylogeny, and resistance mechanisms in Spain.MethodsIn total, 71 hospitals, representing all 50 Spanish provinces, collected the first 10 isolates per hospital (February to May 2019); CPE isolates were first identified according to EUCAST (meropenem MIC &gt; 0.12 mg/L with immunochromatography, colorimetric tests, carbapenem inactivation, or carbapenem hydrolysis with MALDI-TOF). Prevalence and incidence were calculated according to population denominators. Antibiotic susceptibility testing was performed using the microdilution method (EUCAST). All 403 isolates collected were sequenced for high-resolution single-nucleotide polymorphism (SNP) typing, core genome multilocus sequence typing (cgMLST), and resistome analysis.ResultsIn total, 377 (93.5%) CP-Kpn and 26 (6.5%) CP-Eco isolates were collected from 62 (87.3%) hospitals in 46 (92%) provinces. CP-Kpn was more prevalent in the blood (5.8%, 50/853) than in the urine (1.4%, 201/14,464). The cumulative incidence for both CP-Kpn and CP-Eco was 0.05 per 100 admitted patients. The main carbapenemase genes identified in CP-Kpn were blaOXA–48 (263/377), blaKPC–3 (62/377), blaVIM–1 (28/377), and blaNDM–1 (12/377). All isolates were susceptible to at least two antibiotics. Interregional dissemination of eight high-risk CP-Kpn clones was detected, mainly ST307/OXA-48 (16.4%), ST11/OXA-48 (16.4%), and ST512-ST258/KPC (13.8%). ST512/KPC and ST15/OXA-48 were the most frequent bacteremia-causative clones. The average number of acquired resistance genes was higher in CP-Kpn (7.9) than in CP-Eco (5.5).ConclusionThis study serves as a first step toward WGS integration in the surveillance of carbapenemase-producing Enterobacterales in Spain. We detected important epidemiological changes, including increased CP-Kpn and CP-Eco prevalence and incidence compared to previous studies, wide interregional dissemination, and increased dissemination of high-risk clones, such as ST307/OXA-48 and ST512/KPC-3

RIE : revista de investigación educativa

Estudio de casos de dos mujeres. La finalidad es identificar las estrategias cognitivas que utilizan cuando toman decisiones al realizar tareas cotidianas en contextos no formales. Al analizar las entrevistas en profundidad y los videos realizados se identificaron las estrategias empleadas en estas situaciones.CataluñaUniversitat de Barcelona. Biblioteca de Ciències de l'Educació; Passeig de la Vall d'Hebron, 171; 08035 Barcelona; +34934021035; +34934021034;ES

Estrategias cognitivas que utilizan hombres y mujeres para tomar decisiones en contexto cotidianos

Este es un estudio de casos de dos mujeres. La finalidad del mismo es identificar las estrategias cognitivas que utilizan cuando toman decisiones, al realizar "tareas cotidianas", en contextos no formales. Tuvimos en cuenta dos aspectos; por un lado las características de los casos seleccionados que difieren en aspectos personales y académicos, y por otro, las decisiones que toman en la tarea cotidiana de "hacer la compra". Analizadas las entrevistas en profundidad y los videos realizados, se identificaron las estrategias empleadas en estas situacionesThis is a case study of two women and two man. Its objective is to identify the cognitive strategies used doing "daily tasks" when they have to take a decision in non-formal contexts. We took two aspects into account; on one side, the two selected cases' characteristics are different in terms of personal and academic aspects and, on the other side, the decisiones they take when carrying out the daily task of "doing the shopping". Once the interviews and the videos were deeply analyzed, we identified the strategies used in these situations