Estudio de la etiología y factores asociados a la infección del sitio quirúrgico y la evolución de las resistencias a los antibióticos de los microorganismos causantes

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid. Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 14 de Julio de 201

Epidemiología y clínica de las infecciones y colonizaciones causadas por enterobacterias productoras de carbapenemasas en un hospital de tercer nivel

Objective. To describe the epidemiology of Enterobactera-les producing carbapenemases (EPC) in a tertiary hospital. Material and methods. A retrospective observational study, all patients with a positive sample for EPC treated in hospitalization or in the Emergency Department were included, between January 1, 2014 and December 31, 2016. Results. A total of 272 patients (316 samples) were in-cluded: 155 (57%) male. Mean age of 70.4 years (95% CI 68.2-72.7). Mean Charlson index was 3.6 (95% CI 3.4-3.8). In 63.2% the acquisition was nosocomial, in 35.3% it was health-care associated (HA). 55.1% presented infection, the most frequent infection was urinary tract infection (UTI) (58.7%). The most frequent species were Klebsiella pneumoniae (62.7%) and Enterobacter cloacae (10.1%). The most frequent types of carbapenemase were OXA-48 (53.8%) and VIM (43%). The nosocomial acquisition was associated with the male gender, transplantation, immunosuppression, admission to the Intensi-ve Care Unit (ICU) or surgical service, prior antibiotic treatment, Enterobacter, VIM, respiratory and intra-abdominal infections. The HA acquisition was associated with age and comorbidity, nursery home origin, bladder catheterization, greater number of outpatient procedures, previous hospital admission, K. pneu-moniae and E. coli, OXA-48, coproduction of extended spectrum betalactamases, UTI and sepsis. Conclusions. Patients who acquire EPC in nursery homes frequently have an infection. Patients with nosocomial acquisition are colonized by EPC in the ICU, in relation to invasive procedures and transplantation. This population has a higher mortality due to developing respiratory infections by EPC

Non-communicating hydrocephalus from pork tapeworm obstructing the foramina of Monro and its endoscopic management; a case report from Europe

Introduction: Taenia solium is the main causative agent of neurocysticercosis. The tapeworm can manifest inside the ventricles, usually in the form of intracranial hypertension. We present a case of hydrocephalus as a result of a neurocysticercosis lesion obstructing both foramina of Monro. Research question: A comprehensive review of the management is provided, as well as video footage (an invaluable resource to compare, critique and learn with other institutions). Material and methods: A 23-year-old female from Honduras presented with a 7-day complaint of headache. On exam, she was hyperreflexic, but otherwise normal. Magnetic resonance imaging (MRI) revealed a non-specific lesion at the level of the foramina of Monro, with associated hydrocephalus. Additional testing was normal. Results: The patient underwent an endoscopic ventriculoscopy with partial excision of the lesion and subsequent implantation of a ventriculoperitoneal shunt. On postoperative MRI, hydrocephalus resolved and pathological analysis identified the parasite as Taenia solium. Albendazole was administered for 14 days. Discussion and conclusion: Neurocysticercosis should be considered in patients presenting with hydrocephalus, especially those from endemic areas. The long-term prognosis of ventricular neurocysticercosis might be favourable, provided that adequate care is given timely. Endoscopic surgery seems to be effective for the removal of parasitic lesions. However, studies comparing open versus endoscopic surgery are lacking. The majority of cases in the literature correspond to America and Asia. This case shows that neurocysticercosis is also present in Europe, and that a high index of suspicion is necessar

Status of Ornamental Fish Industry in the Philippines: Prospects for Development

The ornamental fish business is a lucrative industry worldwide with huge prospects for livelihood and trade, but the Philippines has not developed this industry to its full potential due to some constraints. This study was conducted to assess the ornamental fish industry in the Philippines using purposive survey interview and focal group discussions in major production areas in the country to determine aspects for development. Information on key stakeholders in the marine and freshwater ornamental fish sector; quantity and value of production by region and by species; and trade were generated from the study. Approximately 8,911,879 pieces of marine ornamental fish were exchanged per year, contributing to PHP 137,165,576 in the country’s annual trade. Production of freshwater ornamental fish was 14,304,739 pieces valued at PHP 145,958,667. The bulk of marine ornamental fish supply came from regions with coral reef areas teeming with marine ornamentals, namely: Regions IV-A (65.56%), III (23.18%), and VII (4.63%). Freshwater ornamental fish were produced mainly by Regions IV-A (34.29%), XI (35.41%), VI (11.96%) and III (10.43%) which have existing local markets. The center of trade for marine ornamental fish is Metro Manila and Cebu City due to the presence of international airports. Meanwhile, freshwater ornamental trade is concentrated in major cities and municipalities given the significant number of local hobbyists. An ornamental fish development program is needed to attain the full potential of the industry with an emphasis on (1) captive breeding of marine ornamental and freshwater indigenous fish, (2) tapping the export market for freshwater ornamental fish, and (3) promoting the sustainability of wild-caught marine ornamental fish

Influencia de la materia en la lectura de textos. Un estudio sobre la interacción profesor-alumnos

En este trabajo hemos evaluado el proceder de un mismo profesor y un mismo grupo de alumnos durante la lectura de textos con contenidos ligados a dos materias diferentes, en concreto Matemáticas y Conocimiento del Medio. Dentro de esas actuaciones docentes, nuestra mirada se ha dirigido hacia tres dimensiones distintas: la primera enfocada a cómo los profesores organizan las tareas de lectura; la segunda dimensión centrada en los procesos cognitivos que se promueven con las lecturas en las dos materias. Y, finalmente, la tercera dimensión hace referencia a la forma en la que los profesores ayudan a sus alumnos en la construcción de conocimiento a partir de los textos leídos y, en relación a ello, la autonomía que muestran los alumnos durante el proceso. Cinco profesores, uno por cada curso de 2º a 6º de Primaria, participaron en el estudio. Todos ellos, con experiencia docente superior a los 5 años (M= 9.6, SD= 3.8), ejercían como docentes/tutores en el mismo colegio de Educación Primaria. Los resultados indican que existen patrones en las interacciones profesor-alumno relacionados con las estructuras de participación, la autonomía concedida por los docentes y los procesos cognitivos que se activan, que caracterizarían la lectura de textos en el aula y que, además, se muestran independientes de la materia analizada. Este trabajo supone una aproximación al análisis de lo que ocurre durante las lecturas colectivas en el aula en dos materias diferentes. Creemos que la descripción detallada de lo que ocurre durante dichas interacciones, es un paso previo –y necesario— que puede facilitar la introducción de cambios en las prácticas docentes

Effect of the implementation of clinical guidelines on management of candidemia in elderly patients

Introduction: Mortality from candidemia is higher in elderly population than in younger patients, which may be related to suboptimal management. The aim of the present study is to evaluate adherence to the recommendations for the clinical management of candidemia in a population over 75 years before and after implementing specific training. Patients and Methods: We recorded retrospectively data from candidemia episodes in elderly patients during two periods of time: 2010–2015 years (before training) and 2017–2022 years (after training), as well as adherence to the recommendations of the clinical practice guidelines, mortality and consultation to infectious disease specialists. Results: Forty-five episodes of candidemia were recorded in the first period and 29 episodes in the second period. A better compliance to the recommendations of the clinical practice guidelines was observed in the second period: echocardiogram performance (75.9% vs. 48.9% p= .021), fundoscopy (65.5% vs. 44.4% p= .076), follow-up blood cultures (72.4% vs. 42.2% p= .011), removal of central venous catheter (80% vs. 52.9% p= .080) and adequate antifungal treatment (82.6% vs. 52.6% p= .018). A trend towards lower mortality was observed during the second period (27.6% vs. 44.4% p= .144). Conclusion: The improvement of knowledge of clinical guidelines on candidemia and the participation of infectious disease specialists may increase the quality of care in elderly patients with candidemia. It would be necessary to enlarge the sample size to evaluate the real impact of this intervention on mortality

Bacilos gramnegativos multirresistentes. Cuándo tenerlos en cuenta y cómo tratarlos a día de hoy

Infections due to multiresistant gram-negative bacilli are frequent and associated with elevated morbidity and mortality. It is important to recognize those patients at high risk. Its clinical management is complex, having witnessed important developments in recent years. Among these developments, we have new antibiotics, such as ceftolozane/tazobactam or ceftazidime/avibactam. We present a case of a 50 year-old man, with a recent liver transplant, that is admitted with pneumonia caused by multidrug-resistant Klebsiella pneumoniae, including carbapenemic resistance.Las infecciones por bacilos gramnegativos multirresistentes son frecuentes y con elevada morbimortalidad, siendo importante reconocer a aquellos pacientes con riesgo alto. Su manejo es complejo y ha presenciado en los últimos años novedades importantes. Entre ellas, encontramos el uso de nuevos antibióticos, como ceftolozano/tazobactam o ceftazidima/avibactam. Presentamos un caso de varón de 50 años, con trasplante hepático reciente, que ingresó por una neumonía por Klebsiella pneumoniae multirresistente, incluyendo resistencia a carbapenémicos

Value Chain Analysis of Marine Ornamental Fish Industry in the Philippines

The Philippines is a major supplier of marine ornamental fish in the world but the understanding of the overall local industry is limited. This study assessed the marine ornamental fish industry in the Philippines using the value chain analysis approach aimed to describe the market chain and key actors, species collected and traded, cost distribution in each of the stakeholders involved, and value addition across actors. Survey interview using purposive sampling was conducted in major collection areas in the country and data gathered was analyzed through a mixed-methods approach and validated by focus group discussions. The results identified the actors in the chain as diver-gatherer, middleman-trader, and exporter. There were 1,431 stakeholders directly dependent on the industry. The annual trade approximately involved a total of 8,554,729 pieces comprised of 1,200 marine species belonging to 144 families contributing PHP 235,496,302.50 to the country’s economy. The bulk of the supply came from Region 4A (61.06%), Region 3 (26.63%), and Region 7 (5.32%). The value chain of the industry was mapped out, revealing a gross value addition of PHP 88.27 per marine ornamental fish. Cost-return analysis showed the last node actors having the highest monthly net return while the lowest in the first node actors. Appropriate programs, policy, and institutional reforms needed to maximize the benefits of the business across key actors and ensure the sustainability of fish resources in the wild were presented

Use of Monoclonal Antibodies in Immunocompromised Patients Hospitalized with Severe COVID-19: A Retrospective Multicenter Cohort

This work was supported by the Research Institute Puerta de Hierro-Segovia de Aranda (IDIPHSA), funding number 0040200108 (2.400€).Objective: We aim to describe the safety and efficacy of sotrovimab in severe cases of COVID-19 in immunocompromised hosts. Methods: We used a retrospective multicenter cohort including immunocompromised hospitalized patients with severe COVID-19 treated with sotrovimab between October 2021 and December 2021. Results: We included 32 patients. The main immunocompromising conditions were solid organ transplantation (46.9%) and hematological malignancy (37.5%). Seven patients (21.9%) had respiratory progression: 12.5% died and 9.4% required mechanical ventilation. Patients treated within the first 14 days of their symptoms had a lower progression rate: 12.0% vs. 57.1%, p = 0.029. No adverse event was attributed to sotrovimab. Conclusions: Sotrovimab was safe and may be effective in its use for immunocompromised patients with severe COVID-19. More studies are needed to confirm these preliminary data.Depto. de MedicinaFac. de MedicinaTRUEResearch Institute Puerta de Hierro-Segovia de Aranda (IDIPHSA)pu