El efluente hospitalario como fuente de enterococos vancomicina resistentes

We would like to acknowledge César Criado Sánchez, Laboratory Technician of the Department of Preventive Medicine and Public Health, Faculty of Pharmacy, University of Granada, Spain, for his invaluable help in making this study possible. We also thank Jean Louise Sanders for translating and editing the manuscript.Objetivos: Las especies de enterococos son intrínsecamente resistentes a varios antibióticos, adquieren resistencia con relativa facilidad, y difunden estos genes de resistencia a otras especies. La resistencia a los antibióticos en enterococos está asociada al uso de los mismos en la clínica médica y también a la diseminación de clones resistentes en el mundo. El objetivo de este trabajo fue comparar las características de las cepas de enterococos resistentes a vancomicina (ERV) aisladas en efluentes hospitalarios y aguas residuales urbanas. Métodos: Se obtuvieron muestras de los efluentes del Hospital Universitario José de San Martín (Buenos Aires) y muestras de aguas residuales urbanas de la ciudad de Buenos Aires. Resultados: Los recuentos de ERV fueron mayores en los efluentes hospitalarios, siendo la odds ratio 36.4 (IC95%: 26.0-50.8; p<0.0001). Los ERV aislados se identificaron principalmente como E. faecium. Los resultados indicaron una alta prevalencia de enterococos resistentes al resto de los antibióticos ensayados. Conclusión: Podemos concluir que los efluentes de los centros hospitalarios constituyen una fuente de enterococos de resistencia múltiple a antibióticos.Objectives: Enterococci are intrinsically resistant to many commonly used antimicrobial agents. They are able to acquire resistance with relative ease and can spread these genes to other species. Enterococci resistant to antibiotics are associated with the use of these in clinical practice and also the spread of resistant clones in the world. The aim of this work was to compare the characteristics of the strains of vancomycin-resistant enterococci (VRE) isolated from municipal wastewater and hospital effluent. Methods: Samples were obtained from the effluent of the Hospital Universitario José de San Martín (Buenos Aires) and the municipal wastewater of the city of Buenos Aires. Results: The bacterial counts of VRE were greater in the hospital effluent, with an odds ratio of 36.4 (95% CI: 26.0-50.8; p<0.0001). The VRE isolated were mainly identified as E. faecium. The results indicate a high prevalence of enterococci resistant to the antibiotics tested. Conclusion: We may conclude that the effluents of hospitals constitute a source of VRE showing multiple resistance to antibiotics.The authors declare that they have no fundin

A Silent Corticotroph Pituitary Carcinoma: Lessons From an Exceptional Case Report

Nowadays, neither imaging nor pathology evaluation can accurately predict the aggressiveness or treatment resistance of pituitary tumors at diagnosis. However, histological examination can provide useful information that might alert clinicians about the nature of pituitary tumors. Here, we describe our experience with a silent corticothoph tumor with unusual pathology, aggressive local invasion and metastatic dissemination during follow-up. We present a 61-year-old man with third cranial nerve palsy at presentation due to invasive pituitary tumor. Subtotal surgical approach was performed with a diagnosis of silent corticotroph tumor but with unusual histological features (nuclear atypia, frequent multinucleation and mitotic figures, and Ki-67 labeling index up to 70%). After a rapid regrowth, a second surgical intervention achieved successful debulking. Temozolomide treatment followed by stereotactic fractionated radiotherapy associated with temozolomide successfully managed the primary tumor. However, sacral metastasis showed up 6 months after radiotherapy treatment. Due to aggressive distant behavior, a carboplatine-etoposide scheme was decided but the patient died of urinary sepsis 31 months after the first symptoms. Our case report shows how the presentation of a pituitary tumor with aggressive features should raise a suspicion of malignancy and the need of follow up by multidisciplinary team with experience in its management. Metastases may occur even if the primary tumor is well controlled.This work was supported by grants from the ISCIII-Subdirección General de Evaluación y Fomento de la Investigación co-funded with Fondos FEDER (PI16/00175 to AS-M and DC) and the Sistema Andaluz de Salud (A-0003-2016 and A-0006-2017 to AS-M, C-0015-2014 and RC-0006-2018 to DC)

Individual and environmental factors associated with death of cyclists involved in road crashes in Spain: a cohort study

Objective To quantify the magnitude of associations between cyclist fatalities and both cyclist and environment related characteristics in Spain during the first 24 hours after a crash. Results Non-use of a helmet was directly associated with death (IDR 1.43, 95% CI 1.25 to 1.64). Among other cyclist characteristics, age after the third decade of life was also directly associated with death, especially in older cyclists (‘over 74’ category, IDR 4.61, 95% CI 3.49 to 6.08). The association with death did not differ between work-related cycling and other reasons for cycling. There was an inverse association with death for crashes in urban areas and on community roads. Any adverse meteorological condition also showed a direct association with death, whereas altered road surfaces showed an inverse association. Crashes during nighttime were directly associated with death, with a peak between 3:00 and 5:59 am (IDR 1.58, 95% CI 1.03 to 2.41). Conclusions We found strong direct and inverse associations between several cyclist and environment related variables and death. These variables should be considered in efforts to prioritise public health measures aimed at reducing the number of cycling-related fatalities.This work was partially supported by the National Council of Science and Technology of Mexico [doctorate grant number 410668]

Prevalence of Multi-Resistant Microorganisms and Antibiotic Stewardship among Hospitalized Patients Living in Residential Care Homes in Spain: A Cross-Sectional Study

Antimicrobial resistance is a growing global health problem. Patients living in care homes are a vulnerable high-risk population colonized by multidrug-resistant organisms (MDRO). We identified a case series of 116 residents of care homes from a cohort of 540 consecutive patients admitted to the internal medicine service of our hospital. We performed early diagnostic tests of MDRO through anal exudates in our sample. The prevalence of MDRO colonization was 34.5% of residents and 70% of them had not been previously identified in the clinical records. Previous hospitalizations and in-hospital antibiotic administration were significantly associated with the presence of MDRO. Our results emphasize the need to consider care homes in the planning of regional and national infection control measures and for implementing surveillance systems that monitor the spread of antimicrobial resistance in Spain. Systematic early testing upon admission to hospital services with a high prevalence of patients with MDRO colonization (e.g., internal medicine) could contribute to the adoption of adequate prevention measures. Specific educational programs for care home staff should also be implemented to address this increasing problem.Catedra de Docencia e Investigacion SEMERGEN-Medicina de Familia, University of Granada, Spai

Sex Hormone Receptor Expression in Craniopharyngiomas and Association with Tumor Aggressiveness Characteristics

Craniopharyngiomas (CPs) are rare tumors of the sellar and suprasellar regions of embryonic origin. The primary treatment for CPs is surgery but it is often unsuccessful. Although CPs are considered benign tumors, they display a relatively high recurrence rate that might compromise quality of life. Previous studies have reported that CPs express sex hormone receptors, including estrogen and progesterone receptors. Here, we systematically analyzed estrogen receptor α (ERα) and progesterone receptor (PR) expression by immunohistochemistry in a well-characterized series of patients with CP (n = 41) and analyzed their potential association with tumor aggressiveness features. A substantial proportion of CPs displayed a marked expression of PR. However, most CPs expressed low levels of ERα. No major association between PR and ERα expression and clinical aggressiveness features was observed in CPs. Additionally, in our series, β-catenin accumulation was not related to tumor recurrence. View Full-TextThis work was supported by grants from the ISCIII-Subdirección General de Evaluación y Fomento de la Investigación co-funded with Fondos FEDER (PI16/00175 to A.S-M. and D.A.C.) and the Sistema Andaluz de Salud (A-0006-2017 and A-0055-2018 to A.S-M, RC-0006-2018 to D.A.C.)

Quality criteria of physiotherapy grade (diploma): report provided by the Spanish Association and Physiotherapists

[Resumen] El informe sobre criterios de calidad específicos de recursos materiales y profesorado para el título de grado de Fisioterapia ha sido elaborado por la Asociación Española de Fisioterapeutas que convocó, con tal finalidad, a una comisión de expertos en Educación en Fisioterapia. El documento, realizado a propuesta de la Dirección General de Universidades en diciembre de 2004, tiene por objetivo el establecer los criterios mínimos de recursos materiales y humanos derivados de la especificidad de la titulación de Fisioterapia, que permita cubrir las nuevas demandas de la sociedad. En relación a los recursos materiales, se ha procurado darle un suficiente grado de especificación cuantitativa y cualitativa a los instrumentos que constituyen los recursos materiales específicos. La intención es, así mismo, facilitar su valoración en el momento de acreditar la titulación. Se abordan, por una parte, los recursos específicos de la titulación para la docencia teórico-práctica en el centro, dentro de los laboratorios destinados a tal efecto. Por otra parte, se definen las características o perfil de los centros sociosanitarios donde debe impartirse la formación clínica del alumno. En relación a los recursos humanos, se hace especial hincapié en el perfil y la experiencia del profesorado para la docencia, así como en el ratio profesor-alumno en la formación práctica y en la formación clínica.[Abstract] The report about specific quality criteria of resources material (items) and teaching profession to obtain the Physiotherapy Grade, has been elaborated by the Spanish Association of Physiotherapists, which aimed to convoke a Physiotherapy Education experts commission. The document was carried out on Universities General Chairmene’s proposal, aiming to establish the minimum criteria of human and Material (Items) resources, derived from the specific Physical Therapy Grade (Diploma), Which may cover the latest Society requirements. According to the Material resources, there has been a serious attempt to give the instruments, which constitute the specific material resources, an appropriate degree, quantitative and qualitative specification. The main intention by itself, consists of providing its assessment when the time to accredit the title comes. On the one hand the specific resources of the Physiotherapy Grade for the Theoric-practical Teaching in the Centre are taken up even in the laboratories aimed to get such goal. On the other hand we define the characteristics or the profile of the social. Health centres, where Pupils’ Clinical Education, must be carried out. Relating to the Human Resources, we do underline the Teaching Profession experience and profile, as well as the rate Teacher-Pupil, both in the practical Training and the Clinical Education, too

Link between cognitive polygenic risk scores and clinical progression after a first-psychotic episode

Background Clinical intervention in early stages of psychotic disorders is crucial for the prevention of severe symptomatology trajectories and poor outcomes. Genetic variability is studied as a promising modulator of prognosis, thus novel approaches considering the polygenic nature of these complex phenotypes are required to unravel the mechanisms underlying the early progression of the disorder. Methods The sample comprised of 233 first-episode psychosis (FEP) subjects with clinical and cognitive data assessed periodically for a 2-year period and 150 matched controls. Polygenic risk scores (PRSs) for schizophrenia, bipolar disorder, depression, education attainment and cognitive performance were used to assess the genetic risk of FEP and to characterize their association with premorbid, baseline and progression of clinical and cognitive status. Results Schizophrenia, bipolar disorder and cognitive performance PRSs were associated with an increased risk of FEP [false discovery rate (FDR) ⩽ 0.027]. In FEP patients, increased cognitive PRSs were found for FEP patients with more cognitive reserve (FDR ⩽ 0.037). PRSs reflecting a genetic liability for improved cognition were associated with a better course of symptoms, functionality and working memory (FDR ⩽ 0.039). Moreover, the PRS of depression was associated with a worse trajectory of the executive function and the general cognitive status (FDR ⩽ 0.001). Conclusions Our study provides novel evidence of the polygenic bases of psychosis and its clinical manifestation in its first stage. The consistent effect of cognitive PRSs on the early clinical progression suggests that the mechanisms underlying the psychotic episode and its severity could be partially independent

Estudio para la mejora de la calidad del grado en Trabajo Social en atención a las necesidades de nuestros egresados y sus empleadores

Mediante este proyecto la Facultad de Trabajo Social de la UCM pretende conocer cuáles son las necesidades formativas de nuestros alumnos con el principal objetivo de hacer una modificación en la titulación que pueda dar respuesta a las necesidades de conocimiento de nuestros profesionales así como conocer las condiciones esenciales en las que nuestros egresado acceden al mercado laboral

Analysis of vitamin C content of fruits from five pepper varieties showing different pungency levels and antimicrobial potentiality of capsaicin

In this work, the nutritional properties and antimicrobial activity of five pepper varieties, including dulce italiano (bell pepper), boiro (a Padron-type pepper), green jalapeño, red chilli, and habanero, have been investigated. The dry matter provided by each of these varieties was analyzed, and their caloric content were withdrawn from searches in databases. Thus, it was found the following caloric contents: Habanero and red chilli provided 40 kcal/100 g; jalapeño green, 29 kcal/100 g; dulce italiano, 23 kcal/100 g; and boiro (padrón), 21 kcal/100 g. On the other hand, an easy and simple method was set up to determine vitamin C (ascorbic acid, ascorbate) in crops, using lugol and starch. The data provided by the application of this method indicated that red chili was the variety with the highest vitamin C content, and boiro the one with the lowest. The antimicrobial activity of both crude extracts from pepper fruits and pure capsaicin was probed against five bacterial species: Escherichia coli, Bacillus subtilis, Xanthomonas campestris, Dickeya dadantii and Ralstonia solanacearum. Solid (Petri dishes with agar) and liquid media were used for the assays. Our data indicated that capsaicin is able to inhibit the growth of B. subtilis, but not that of E. coli, perhaps this latter case due to the great adaptation of this species to environmental conditions.Peer reviewe