Brote de gastroenteritis por agua potable de suministro público

Introducción: La potabilidad del agua induce a descartar el posible origen hídrico de los brotes. El objetivo fue investigar un brote de gastroenteritis por agua potable de suministro público. Métodos: Después de la notificación de un brote de gastroenteritis en el municipio de Baqueira (Valle de Arán) se diseñó un estudio epidemiológico de cohortes retrospectivo. Mediante un muestreo sistemático se eligió a 87 personas hospedadas en los hoteles y a 62 alojadas en diferentes apartamentos. Se recogió información sobre 4 factores (consumo de agua de la red, bocadillos, agua y alimentos en las pistas de esquí) y presencia de síntomas. Se determinó la existencia de cloro, se analizó el agua de la red y se realizó un coprocultivo a 4 enfermos. La implicación de cada factor se determinó con el riesgo relativo (RR) y su intervalo de confianza (IC) del 95%. Resultados: La incidencia de gastroenteritis fue del 51,0% (76/149). Los porcentajes de los síntomas fueron los siguientes: fiebre, 27,0%; diarrea, 87,5%; náuseas, 50,7%; vómitos, 30,3%, y dolor abdominal, 80,0%. El único factor que presentó un riesgo estadísticamente significativo fue el consumo de agua de la red (RR = 11,0; IC del 95%, 1,6-74,7). La calificación sanitaria del agua fue de potabilidad. Se observó un defecto de situación del clorador en el depósito, que fue corregido. Se recomendó incrementar aún más las concentraciones de cloro, lo cual se acompañó de una disminución de los casos. Los coprocultivos de los 4 enfermos fueron negativos para las enterobacterias investigadas. Conclusiones: El estudio demuestra la posibilidad de presentación de brotes hídricos por agua cualificada como potable y sugiere la necesidad de mejorar la investigación microbiológica (determinación de protozoos y virus) en este tipo de brotes

Waterborne outbreak of Shigella sonnei caused by consumption of public supply water

Objetivos: Investigar un brote de gastroenteritis que afectó a la población de València d’Àneu (Lleida). Métodos: Estudio de cohortes sobre el consumo de agua de la red, de agua embotellada y de agua de manantiales. La cohorte se elaboró mediante contacto telefónico con todos los números privados del municipio. Se encuestó al 58,3% de la población censada (105/180) sobre diferentes consumos de agua, número de vasos consumidos diariamente y sintomatología. Se tomaron muestras de agua de la red municipal y de heces de diez enfermos. La implicación de cada agua consumida se estudió con el riesgo relativo (RR) y su intervalo de confianza del 95% (IC95%). Resultados: La tasa de ataque global fue del 64,8% (68/105). La curva epidémica fue concordante con una exposición de 6 días. Resultó implicado el consumo de agua de suministro público (RR = 4,2; IC95%: 1,5-11,9). Además, se constató una relación dosis-respuesta ( 2 = 34,1; p <0,001). Presentaron un riesgo superior de enfermar los consumidores de dos a tres vasos diarios (RR = 4,3; IC95%: 1,9-9,9) y de más de tres vasos (RR = 4,9; IC95%: 2,2-10,9). El clorador del agua de la red se congeló y dejó de funcionar. Seis coprocultivos resultaron positivos para Shigella sonnei. Conclusiones: Brote hídrico causado por S. sonnei por contaminación del agua de la red. Se recomendó investigar el vertido ilegal de aguas residuales. Los municipios deben asegurar el funcionamiento adecuado de los sistemas de desinfección y evitar vertidos cerca de las captaciones

Avoidable Adverse Events Related to Ignoring the Do-Not-Do Recommendations: A Retrospective Cohort Study Conducted in the Spanish Primary Care Setting

Objective This study aimed to measure the frequency and severity of avoidable adverse events (AAEs) related to ignoring do-not-do recommendations (DNDs) in primary care. Methods A retrospective cohort study analyzing the frequency and severity of AAEs related to ignoring DNDs (7 from family medicine and 3 from pediatrics) was conducted in Spain. Data were randomly extracted from computerized electronic medical records by a total of 20 general practitioners and 5 pediatricians acting as reviewers; data between February 2018 and September 2019 were analyzed. Results A total of 2557 records of adult and pediatric patients were reviewed. There were 1859 (72.7%) of 2557 (95% confidence interval [CI], 71.0%-74.4%) DNDs actions in 1307 patients (1507 were performed by general practitioners and 352 by pediatricians). Do-not-do recommendations were ignored more often in female patients (P < 0.0001). Sixty-nine AAEs were linked to ignoring DNDs (69/1307 [5.3%]; 95% CI, 4.1%-6.5%). Of those, 54 (5.1%) of 1062 were in adult patients (95% CI, 3.8%-6.4%) and 15 (6.1%) of 245 in pediatric patients (95% CI, 3.1%-9.1%). In adult patients, the majority of AAEs (51/901 [5.7%]; 95% CI, 4.2%-7.2%) occurred in patients 65 years or older. Most AAEs were characterized by temporary minor harm both in adult patients (28/54 [51.9%]; 95% CI, 38.5%-65.2%) and pediatric patients (15/15 [100%]). Conclusions These findings provide a new perspective about the consequences of low-value practices for the patients and the health care systems. Ignoring DNDs could place patients at risk, and their safety might be unnecessarily compromised

Low field photo-CIDNP in the intramolecular electron transfer in naproxen-pyrrolidine dyads

[EN] Photoinduced processes with partial (exciplex) and full charge transfer in donor-acceptor systems are of interest because they are frequently used for modeling drug-protein binding. Low field photo-CIDNP (chemically induced dynamic nuclear polarization) for these processes in dyads, including the drug, (S)-and (R)-naproxen and (S)-N-methyl pyrrolidine in solutions with strong and weak permittivity have been measured. The dramatic influence of solvent permittivity on the field dependence of the N-methyl pyrrolidine H-1 CIDNP effects has been found. The field dependences of both (R, S)-and (S, S)-dyads in a polar medium are the curves with a single extremum in the area of the S-T+ terms intersection. Moreover, the CIDNP field dependences of the same protons measured in a low polar medium present curves with several extrema. The shapes of the experimental CIDNP field dependence with two extrema have been described using the Green function approach for the calculation of the CIDNP effects in the system without electron exchange interactions. The article discusses the possible causes of the differences between the CIDNP field dependence detected in a low-permittivity solvent with the strong Coulomb interactions and in a polar solvent.This study was supported by the grant 14-03-00-192 of the Russian Foundation of Basic Research. The authors are also deeply grateful to Professor Hans-Martin Vieth for the given opportunity to conduct experiments on his unique equipment.Magin, I.; Polyakov, N.; Kruppa, AI.; Purtov, P.; Leshina, TV.; Kiryutin, AS.; Miranda Alonso, MÁ.... (2016). Low field photo-CIDNP in the intramolecular electron transfer in naproxen-pyrrolidine dyads. Physical Chemistry Chemical Physics. 18(2):901-907. https://doi.org/10.1039/C5CP04233JS901907182Reece, S. Y., & Nocera, D. G. (2009). 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B., & Leshina, T. V. (2004). Photo-CIDNP Study of the Interaction of Tyrosine with Nifedipine. An Attempt to Model the Binding Between Calcium Receptor and Calcium Antagonist Nifedipine¶. Photochemistry and Photobiology, 80(3), 565. doi:10.1562/0031-8655(2004)0802.0.co;2Cao, H., Fujiwara, Y., Haino, T., Fukazawa, Y., Tung, C.-H., & Tanimoto, Y. (1996). Magnetic Field Effects on Intramolecular Exciplex Fluorescence of Chain-Linked Phenanthrene andN,N-Dimethylaniline: Influence of Chain Length, Solvent, and Temperature. Bulletin of the Chemical Society of Japan, 69(10), 2801-2813. doi:10.1246/bcsj.69.2801Magin, I. M., Polyakov, N. E., Khramtsova, E. A., Kruppa, A. I., Tsentalovich, Y. P., Leshina, T. V., … Marin, M. L. (2011). Spin effects in intramolecular electron transfer in naproxen-N-methylpyrrolidine dyad. Chemical Physics Letters, 516(1-3), 51-55. doi:10.1016/j.cplett.2011.09.057Khramtsova, E. A., Plyusnin, V. F., Magin, I. M., Kruppa, A. I., Polyakov, N. E., Leshina, T. V., … Miranda, M. A. (2013). Time-Resolved Fluorescence Study of Exciplex Formation in Diastereomeric Naproxen–Pyrrolidine Dyads. The Journal of Physical Chemistry B, 117(50), 16206-16211. doi:10.1021/jp4083147Magin, I. M., Purtov, P. A., Kruppa, A. I., & Leshina, T. V. (2005). Peculiarities of Magnetic and Spin Effects in a Biradical/Stable Radical Complex (Three-Spin System). Theory and Comparison with Experiment. The Journal of Physical Chemistry A, 109(33), 7396-7401. doi:10.1021/jp051115ySubramanian, V., Bellubbi, B. S., & Sobhanadri, J. (1993). Dielectric studies of some binary liquid mixtures using microwave cavity techniques. Pramana, 41(1), 9-20. doi:10.1007/bf02847313Acemioğlu, B., Arık, M., Efeoğlu, H., & Onganer, Y. (2001). Solvent effect on the ground and excited state dipole moments of fluorescein. Journal of Molecular Structure: THEOCHEM, 548(1-3), 165-171. doi:10.1016/s0166-1280(01)00513-9Grosse, S., Gubaydullin, F., Scheelken, H., Vieth, H.-M., & Yurkovskaya, A. V. 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V., Taraban, M. B., Sagdeev, R. Z., & Salikhov, K. M. (1986). Application of the semiclassical description of hyperfine interaction to studies of the dependence of the CIDNP effect on an external magnetic field. Chemical Physics Letters, 129(4), 357-361. doi:10.1016/0009-2614(86)80358-xShiotani, M., Sjoeqvist, L., Lund, A., Lunell, S., Eriksson, L., & Huang, M. B. (1990). An ESR and theoretical ab initio study of the structure and dynamics of the pyrrolidine radical cation and the neutral 1-pyrrolidinyl radical. The Journal of Physical Chemistry, 94(21), 8081-8090. doi:10.1021/j100384a020De Kanter, F. J. J., den Hollander, J. A., Huizer, A. H., & Kaptein, R. (1977). Biradical CIDNP and the dynamics of polymethylene chains. Molecular Physics, 34(3), 857-874. doi:10.1080/00268977700102161De Kanter, F. J. J., Kaptein, R., & Van Santen, R. A. (1977). Magnetic field dependent biradical CIDNP as a tool for the study of conformations of polymethylene chains. 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SOBRINA Spanish study-analysing the frequency, cost and adverse events associated with overuse in primary care: protocol for a retrospective cohort study

Introduction Several institutions and quality national agencies have fostered the creation of recommendations on what not to do to reduce overuse in clinical practice. In primary care, their impact has hardly been studied. The frequency of adverse events (AEs) associated with doing what must not be done has not been analysed, either. The aim of this study is to measure the frequency of overuse and AEs associated with doing what must not be done (commission errors) in primary care and their cost. Methods and analysis A coordinated, multicentric, national project. A retrospective cohort study using computerised databases of primary care medical records from national agencies and regional health services will be conducted to analyse the frequency of the overuse due to ignore the do-not-do recommendations, and immediately afterwards, depending on their frequency, a representative random sample of medical records will be reviewed with algorithms (triggers) that determine the frequency of AEs associated with these recommendations. Cost will determine by summation of the direct costs due to the consultation, pharmacy, laboratory and imaging activities according to the cases. Ethics and dissemination The study protocol has been approved by the Ethics Committee of Primary Care Research of the Valencian Community. We aim to disseminate the findings through international peerreviewed journals and on the website (http://www. nohacer. es/). Outcomes will be used to incorporate algorithms into the electronic history to assist in making clinical decisions

ESPACIO EUROPEO DE EDUCACIÓN SUPERIOR. Situación actual. Marco legislativo.

Nowadays the number of nursing schools including in their study plans the Practicum subjects are increasing. These subjects are devoted to clinical practice and the majority of practical credits belonging to clinical subjects are concentrated on them. The reasons for it are that these subjects link the learning methodology proposed by the European Space for Higher Education. In the present work, which is a continuation of a previous one published in this journal, we propose a Teaching Project to give the Medical-Surgical Nursing clinical practicum of the study plans for the Registered Nursing degree. Following the same structure of our previous work, we propose a methodology based on the teaching of competences. The program and the system of credits are in line with the ancient Law of University Reform but they are also compatible with convergent method of the European Space for Higher Education. In the same way, we chose this subject on the grounds of its high credit load on the current study plans (being clinical the majority of them). All this make that steps to achieve convergence for this subject could be used for other nursing subject.El objetivo de este artículo es realizar un análisis de la legislación actual y la repercusión del cambio ya iniciado en algunas titulaciones como es el caso de Enfermería en el marco académico de la Educación Superior, reforma importante del Sistema Universitario Español. Para ello se revisa el contenido y análisis de la documentación publicada en el Ministerio de Educación relativa a Educación Superior; la legislación vigente española y la legislación Comunitaria con objeto de aproximar la legislación al marco de los estudios de enfermería

Polysialic acid sustains cancer cell survival and migratory capacity in a hypoxic environment

Polysialic acid (polySia) is a unique carbohydrate polymer expressed on the surface of NCAM (neuronal cell adhesion molecule) in a number of cancers where it modulates cell-cell and cell-matrix adhesion, migration, invasion and metastasis and is strongly associated with poor clinical prognosis. We have carried out the first investigation into the effect of polySia expression on the behaviour of cancer cells in hypoxia, a key source of chemoresistance in tumours. The role of polysialylation and associated tumour cell migration and cell adhesion were studied in hypoxia, along with effects on cell survival and the potential role of HIF-1. Our findings provide the first evidence that polySia expression sustains migratory capacity and is associated with tumour cell survival in hypoxia. Initial mechanistic studies indicate a potential role for HIF-1 in sustaining polySia-mediated migratory capacity, but not cell survival. These data add to the growing body of evidence pointing to a crucial role for the polysialyltransferases (polySTs) in neuroendocrine tumour progression and provide the first evidence to suggest that polySia is associated with an aggressive phenotype in tumour hypoxia. These results have significant potential implications for polyST inhibition as an anti-metastatic therapeutic strategy and for targeting hypoxic cancer cells

EMT transcription factors snail and slug directly contribute to cisplatin resistance in ovarian cancer

<p>Abstract</p> <p>Background</p> <p>The epithelial to mesenchymal transition (EMT) is a molecular process through which an epithelial cell undergoes transdifferentiation into a mesenchymal phenotype. The role of EMT in embryogenesis is well-characterized and increasing evidence suggests that elements of the transition may be important in other processes, including metastasis and drug resistance in various different cancers.</p> <p>Methods</p> <p>Agilent 4 × 44 K whole human genome arrays and selected reaction monitoring mass spectrometry were used to investigate mRNA and protein expression in A2780 cisplatin sensitive and resistant cell lines. Invasion and migration were assessed using Boyden chamber assays. Gene knockdown of <it>snail </it>and <it>slug </it>was done using targeted siRNA. Clinical relevance of the EMT pathway was assessed in a cohort of primary ovarian tumours using data from Affymetrix GeneChip Human Genome U133 plus 2.0 arrays.</p> <p>Results</p> <p>Morphological and phenotypic hallmarks of EMT were identified in the chemoresistant cells. Subsequent gene expression profiling revealed upregulation of EMT-related transcription factors including <it>snail, slug, twist2 </it>and <it>zeb2</it>. Proteomic analysis demonstrated up regulation of Snail and Slug as well as the mesenchymal marker Vimentin, and down regulation of E-cadherin, an epithelial marker. By reducing expression of <it>snail </it>and <it>slug</it>, the mesenchymal phenotype was largely reversed and cells were resensitized to cisplatin. Finally, gene expression data from primary tumours mirrored the finding that an EMT-like pathway is activated in resistant tumours relative to sensitive tumours, suggesting that the involvement of this transition may not be limited to <it>in vitro </it>drug effects.</p> <p>Conclusions</p> <p>This work strongly suggests that genes associated with EMT may play a significant role in cisplatin resistance in ovarian cancer, therefore potentially leading to the development of predictive biomarkers of drug response or novel therapeutic strategies for overcoming drug resistance.</p

Spin chemistry investigation of peculiarities of photoinduced electron transfer in donor-acceptor linked system

Photoinduced intramolecular electron transfer in linked systems, (R,S)- and (S,S)-naproxen-N-methylpyrrolidine dyads, has been studied by means of spin chemistry methods [magnetic field effect and chemically induced dynamic nuclear polarization (CIDNP)]. The relative yield of the triplet state of the dyads in different magnetic field has been measured, and dependences of the high-field CIDNP of the N-methylpyrrolidine fragment on solvent polarity have been investigated. However, both (S,S)- and (R,S)-enantiomers demonstrate almost identical CIDNP effects for the entire range of polarity. It has been demonstrated that the main peculiarities of photoprocesses in this linked system are connected with the participation of singlet exciplex alongside with photoinduced intramolecular electron transfer in chromophore excited state quenching.This work was supported by the grants 08-03-00372 and 11-03-01104 of the Russian Foundation for Basic Research, and the grant of Priority Programs of the Russian Academy of Sciences, nr. 5.1.5.Magin, I.; Polyakov, N.; Khramtsova, E.; Kruppa, A.; Stepanov, A.; Purtov, P.; Leshina, T.... (2011). Spin chemistry investigation of peculiarities of photoinduced electron transfer in donor-acceptor linked system. Applied Magnetic Resonance. 41(2-4):205-220. https://doi.org/10.1007/s00723-011-0288-3S205220412-4J.S. Park, E. Karnas, K. Ohkubo, P. Chen, K.M. Kadish, S. Fukuzumi, C.W. Bielawski, T.W. Hudnall, V.M. Lynch, J.L. Sessler, Science 329, 1324–1327 (2010)S.Y. Reece, D.G. Nocera, Annu. Rev. Biochem. 78, 673–699 (2009)M.S. Afanasyeva, M.B. Taraban, P.A. Purtov, T.V. Leshina, C.B. Grissom, J. Am. Chem. Soc. 128, 8651–8658 (2006)M.A. Fox, M. Chanon, in Photoinduced Electron Transfer. C: Photoinduced Electron Transfer Reactions: Organic Substrates (Elsevier, New York, 1988), p. 754P.J. Hayball, R.L. Nation, F. Bochner, Chirality 4, 484–487 (1992)N. Suesa, M.F. Fernandez, M. Gutierrez, M.J. Rufat, E. Rotllan, L. Calvo, D. Mauleon, G. Carganico, Chirality 5, 589–595 (1993)A.M. Evans, J. Clin. Pharmacol. 36, 7–15 (1996)Y. Inoue, T. Wada, S. Asaoka, H. Sato, J.-P. Pete, Chem Commun. 4, 251–259 (2000)T. Yorozu, K. Hayashi, M. Irie, J. Am. Chem. Soc. 103, 5480–5548 (1981)N.J. Turro, in Modern Molecular Photochemistry (Benjamin/Cummings, San Francisco, 1978)K.M. Salikhov, Y.N. Molin, R.Z. Sagdeev, A.L. Buchachenko, in Spin Polarization and Magnetic Field Effects in Radical Reactions (Akademiai Kiado, Budapest, 1984), p. 419E.A. Weiss, M.A. Ratner, M.R. Wasielewski, J. Phys. Chem. A 107, 3639–3647 (2003)A.S. Lukas, P.J. Bushard, E.A. Weiss, M.R. Wasielewski, J. Am. Chem. Soc. 125, 3921–3930 (2003)R. Nakagaki, K. Mutai, M. Hiramatsu, H. Tukada, S. Nakakura, Can. J. Chem. 66, 1989–1996 (1988)M.C. Jim′enez, U. Pischel, M.A. Miranda, J. Photochem. Photobiol. C Photochem. Rev. 8, 128–142 (2007)S. Abad, U. Pischel, M.A. Miranda, Photochem. Photobiol. Sci. 4, 69–74 (2005)U. Pischel, S. Abad, L.R. Domingo, F. Bosca, M.A. Miranda, Angew. Chem. Int. Ed. 42, 2531–2534 (2003)G.L. Closs, R.J. Miller, J. Am. Chem. Soc. 101, 1639–1641 (1979)G.L. Closs, R.J. Miller, J. Am. Chem. Soc. 103, 3586–3588 (1981)M. Goez, Chem. Phys. Lett. 188, 451–456 (1992)I.F. Molokov, Y.P. Tsentalovich, A.V. Yurkovskaya, R.Z. Sagdeev, J. Photochem. Photobiol. A 110, 159–165 (1997)U. Pischel, S. Abad, M.A. Miranda, Chem. Commun. 9, 1088–1089 (2003)H. Hayashi, S. Nagakura, Bull. Chem. Soc. Jpn. 57, 322–328 (1984)Y. Sakaguchi, H. Hayashi, S. Nagakura, Bull. Chem. Soc. Jpn. 53, 39–42 (1980)H. Yonemura, H. Nakamura, T. Matsuo, Chem. Phys. Lett. 155, 157–161 (1989)N. Hata, M. Hokawa, Chem. Lett. 10, 507–510 (1981)M. Shiotani, L. Sjoeqvist, A. Lund, S. Lunell, L. Eriksson, M.B. Huang, J. Phys. Chem. 94, 8081–8090 (1990)E. Schaffner, H. Fischer, J. Phys. Chem. 100, 1657–1665 (1996)Y. Mori, Y. Sakaguchi, H. Hayashi, Chem. Phys. Lett. 286, 446–451 (1998)I.M. Magin, A.I. Kruppa, P.A. Purtov, Chem. Phys. 365, 80–84 (2009)K.K. Barnes, Electrochemical Reactions in Nonaqueous Systems (M. Dekker, New York, 1970), p. 560J. Bargon, J. Am. Chem. Soc. 99, 8350–8351 (1977)M. Goez, I. Frisch, J. Phys. Chem. A 106, 8079–8084 (2002)A.K. Chibisov, Russ. Chem. Rev. 50, 615–629 (1981)J. Goodman, K. Peters, J. Am. Chem. Soc. 107, 1441–1442 (1985)H. Cao, Y. Fujiwara, T. Haino, Y. Fukazawa, C.-H. Tung, Y. Tanimoto, Bull. Chem. Soc. Jpn. 69, 2801–2813 (1996)P.A. Purtov, A.B. Doktorov, Chem. Phys. 178, 47–65 (1993)A.I. Kruppa, O.I. Mikhailovskaya, T.V. Leshina, Chem. Phys. Lett. 147, 65–71 (1988)M.E. Michel-Beyerle, R. Haberkorn, W. Bube, E. Steffens, H. Schröder, H.J. Neusser, E.W. Schlag, H. Seidlitz, Chem. Phys. 17, 139–145 (1976)K. Schulten, H. Staerk, A. Weller, H.-J. Werner, B. Nickel, Z. Phys. Chem. 101, 371–390 (1976)K. Gnadig, K.B. Eisenthal, Chem. Phys. Lett. 46, 339–342 (1977)T. Nishimura, N. Nakashima, N. Mataga, Chem. Phys. Lett. 46, 334–338 (1977)M.G. Kuzmin, I.V. Soboleva, E.V. Dolotova, D.N. Dogadkin, High Eng. Chem. 39, 86–96 (2005