Cross-species infectivity of H3N8 influenza virus in an experimental infection in swine

Avian influenza A viruses have gained increasing attention due to their ability to cross the species barrier and cause severe disease in humans and other mammal species as pigs. H3 and particularly H3N8 viruses, are highly adaptive since they are found in multiple avian and mammal hosts. H3N8 viruses have not been isolated yet from humans; however, a recent report showed that equine influenza A viruses (IAVs) can be isolated from pigs, although an established infection has not been observed thus far in this host. To gain insight into the possibility of H3N8 avian IAVs to cross the species barrier into pigs, in vitro experiments and an experimental infection in pigs with four H3N8 viruses from different origins (equine, canine, avian, and seal) were performed. As a positive control, an H3N2 swine influenza virus A was used. Although equine and canine viruses hardly replicated in the respiratory systems of pigs, avian and seal viruses replicated substantially and caused detectable lesions in inoculated pigs without previous adaptation. Interestingly, antibodies against hemagglutinin could not be detected after infection by hemagglutination inhibition (HAI) test with avian and seal viruses. This phenomenon was observed not only in pigs but also in mice immunized with the same virus strains. Our data indicated that H3N8 IAVs from wild aquatic birds have the potential to cross the species barrier and establish successful infections in pigs that might spread unnoticed using the HAI test as diagnostic tool.We thank Jaime Maldonado and HIPRA (Spain) for the A/Swine/Spain/ 54008/2004 (H3N2) strain, Edward J. Dubovi and Cornell University for the A/Canine/NY/105447/08 (H3N8) IAV strain, T. M. Chambers and the University of Kentucky for the A/Equine/OH/1/03 (H3N8) IAV strain, and Hon Ip and the U.S. Geological Survey National Wildlife Health Center for the A/American black duck/Maine/44411-532/2008 (H3N8) and the A/Harbor Seal/New Hampshire/179629/2011 (H3N8) IAV strains. We thank Sergio López, David Solanes, Francisco X. Abad, Jordi Alberola, Jaume Martorell, and Eduard J. Cunilleras for help in providing different samples and during the experimental infections, as well as the personnel in Cat3 laboratories and the animal house. We thank Adolfo García-Sastre for providing materials and for support as the principal investigator of the NIAID-funded Center for Research in Influenza Pathogenesis (HHSN266200700010C). The research leading to these results received funding from the European Community’s Seventh Framework Programme (FP7, 2007-2013), the Research Infrastructures Action under grant FP7-228393 (a NADIR project), and projects AGL2010-22200-C02-01 and AGL2007-60274 of the Spanish Ministry of Science and Innovation

High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus

We investigated the prognostic role of high MICs for antistaphylococcal agents in patients with methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection (MSSA CRBSI). We prospectively reviewed 83 episodes from 5 centers in Spain during April 2011 June 2014 that had optimized clinical management and analyzed the relationship between E-test MICs for vancomycin, daptomycin, oxacillin, and linezolid and development of complicated bacteremia by using multivariate analysis. Complicated MSSA CRBSI occurred in 26 (31.3%) patients; MICs for vancomycin and daptomycin were higher in these patients (optimal cutoff values for predictive accuracy = 1.5 mu g/mL and 0.5 mu g/mL). High MICs for vancomycin (hazard ratio 2.4, 95% CI 1.2-5.5) and daptomycin (hazard ratio 2.4, 95% CI 1.1-5.9) were independent risk factors for development of complicated MSSA CRBSI. Our data suggest that patients with MSSA CRBSI caused by strains that have high MICs for vancomycin or daptomycin are at increased risk for complications

Uso de las nuevas tecnologías de la información y la comunicación y su incidencia en el proceso de enseñanza-aprendizaje a estudiantes de Segundo Ciclo, en cinco Centros Educativos del Distrito 0703 del municipio de San Rafael Cedros Departamento de Cuscatlán.

La investigación se centra en el uso de las Nuevas Tecnologías de la Información y la Comunicación y su incidencia en el proceso de enseñanza – aprendizaje, a estudiantes de segundo ciclo, en cinco centros educativos del distrito 0703 del Municipio de San Rafael Cedros Departamento de Cuscatlán. Se inició con la elaboración del marco teórico en donde se investigó sobre el surgimiento de las NTICS y su evolución con el paso de los años hasta la actualidad. Para dicha investigación se aplicó un enfoque cuantitativo, también se estudió las leyes de nuestro país, así como los diferentes programas y proyectos implementados por el Ministerio de Educación y el seguimiento que se le ha dado hasta hoy. Posteriormente se realizó el vaciado de la información recopilada a través de los diferentes instrumentos estos elaborados por medio de la operacionalización de objetivos y el análisis de los mismos. Se diseñaron las gráficas con las representaciones en porcentajes, permitiendo una lectura analítica sobre las variables en estudio, dando una respuesta a cada pregunta desarrollada, quedando como evidencia la importancia de la tecnología en el ámbito educativo, donde maestros y estudiantes se vieron en la necesidad de adaptarse a un mundo en constante evolución tecnológica. The research Project focuses on the use of the NTICS (New Information and Communication Technologies) and its impact on the teaching-learning process, to 4th, 5th and 6th grade students, in 5 schools of district 0703 of Municipality of San Rafael Cedros Department of Cuscatlán. Beginning with preparation of theoretical framework in which we investigated the emergence of NTICS and their evolution over the years. For this research a mixed approach was applied, we also studied our country ‘laws, as well as the different programs and projects implemented by Ministry of Education and the follow-up given to date. Afterwards, the information collected through various instruments was emptied by means of the operationalization of objectives and the analysis thereof. Graphs were designed with representations in percentages, allowing an analytical reading of the variables under study, giving an answer to each question developed, demonstrating the importance of technology in the educational field, where teachers and students have found themselves in the need to adapt to a world in constant technological evolution

Cumulative exposure to tacrolimus and incidence of cancer after liver transplantation

Cancer is the leading cause of death after liver transplantation (LT). This multicenter case–control nested study aimed to evaluate the effect of maintenance immunosuppression on post-LT malignancy. The eligible cohort included 2495 LT patients who received tacrolimus-based immunosuppression. After 13 922 person/years follow-up, 425 patients (19.7%) developed malignancy (cases) and were matched with 425 controls by propensity score based on age, gender, smoking habit, etiology of liver disease, and hepatocellular carcinoma (HCC) before LT. The independent predictors of post-LT malignancy were older age (HR = 1.06 [95% CI 1.05–1.07]; p < .001), male sex (HR = 1.50 [95% CI 1.14–1.99]), smoking habit (HR = 1.96 [95% CI 1.42–2.66]), and alcoholic liver disease (HR = 1.53 [95% CI 1.19–1.97]). In selected cases and controls (n = 850), the immunosuppression protocol was similar (p = .51). An increased cumulative exposure to tacrolimus (CET), calculated by the area under curve of trough concentrations, was the only immunosuppression-related predictor of post-LT malignancy after controlling for clinical features and baseline HCC (CET at 3 months p = .001 and CET at 12 months p = .004). This effect was consistent for de novo malignancy (after excluding HCC recurrence) and for internal neoplasms (after excluding non-melanoma skin cancer). Therefore, tacrolimus minimization, as monitored by CET, is the key to modulate immunosuppression in order to prevent cancer after LT

Prediction of poor outcome in clostridioides difficile infection: A multicentre external validation of the toxin B amplification cycle

Producción CientíficaClassification of patients according to their risk of poor outcomes in Clostridioides difficile infection (CDI) would enable implementation of costly new treatment options in a subset of patients at higher risk of poor outcome. In a previous study, we found that low toxin B amplification cycle thresholds (Ct) were independently associated with poor outcome CDI. Our objective was to perform a multicentre external validation of a PCR-toxin B Ct as a marker of poor outcome CDI. We carried out a multicentre study (14 hospitals) in which the characteristics and outcome of patients with CDI were evaluated. A subanalysis of the results of the amplification curve of real-time PCR gene toxin B (XpertTM C. difficile) was performed. A total of 223 patients were included. The median age was 73.0 years, 50.2% were female, and the median Charlson index was 3.0. The comparison of poor outcome and non–poor outcome CDI episodes revealed, respectively, the following results: median age (years), 77.0 vs 72.0 (p = 0.009); patients from nursing homes, 24.4% vs 10.8% (p = 0.039); median leukocytes (cells/μl), 10,740.0 vs 8795.0 (p = 0.026); and median PCR-toxin B Ct, 23.3 vs 25.4 (p = 0.004). Multivariate analysis showed that a PCR-toxin B Ct cut-off <23.5 was significantly and independently associated with poor outcome CDI (p = 0.002; OR, 3.371; 95%CI, 1.565–7.264). This variable correctly classified 68.5% of patients. The use of this microbiological marker could facilitate early selection of patients who are at higher risk of poor outcome and are more likely to benefit from newer and more costly therapeutic options

A new record of Lycopodiella inundata (L.) J. Holub (Lycopodiaceae) in the Sistema Central of Spain

Se analiza la presencia de Lycopodiella inundata (L.) J. Holub (Lycopodiaceae) en el Sistema Central españo

Eficácia de um programa de formação on-line em uma unidade de enfermagem: extração de hemoculturas

Objective: To assess the effectiveness of an online training platform for procedures among nurses in an internal medicine unit to reduce the number of contaminated blood cultures. Method: This was a quasi-experimental pre-post intervention parallel group study. The sample consisted of internal medicine nurses in a tertiary hospital who participated in an online training program about blood culture extraction technique. Knowledge about the technique was measured pre- and post-intervention. Additionally, the study compared the number of blood cultures taken 6 months before and 3 months after the intervention. Results: Forty-eight nurses participated. Pre-intervention knowledge was homogeneous among both groups, improving significantly after the online training program (p=0.0001). The blood cultures taken prior to the training showed contamination levels above international standards; post-intervention, contamination levels fell by up to 3% in the intervention group. Conclusion: The educational intervention using the digital platform increased knowledge about the procedure and its application in clinical practice.Objetivo: Evaluar la eficacia de una plataforma formativa en línea de procedimientos en una planta de medicina interna para disminuir los hemocultivos contaminados. Método: Estudio cuasi-experimental con grupos paralelos. La muestra la componen enfermeras de medicina interna de un hospital terciario, con las que se lleva a cabo un programa de formación en línea en relación a la técnica extracción de hemocultivos. Se evalúan conocimientos pre y post intervención sobre la técnica. Además, se estudian los resultados de los hemocultivos 6 meses antes y 3 después de la intervención, analizando los contaminados. Resultados: Participan un total de 48 enfermeras. El conocimiento de la técnica antes de la intervención es homogéneo en ambos grupos, mejorando significativamente con la formación en línea (p=0.0001). El análisis de hemocultivos extraídos previos a la formación muestran niveles de contaminación por encima del estándar internacional, disminuyendo en el grupo intervención hasta el 3% después del programa de aprendizaje. Conclusión: La intervención educativa mediante una plataforma digital se muestra válida para la adquisición de conocimientos y su translación a la práctica clínica.Objetivo: Avaliar a eficácia de uma plataforma formativa on-line de procedimentos em uma unidade de medicina interna para diminuir as hemoculturas contaminadas. Método: Estudo quase-experimental com grupos paralelos. A amostra foi composta de enfermeiras de medicina interna de um hospital terciário, com as quais é realizado um programa de formação on-line com relação à técnica de extração de hemoculturas. São avaliados os conhecimentos pré e pós intervenção sobre a técnica. Além disso, são estudados os resultados das hemoculturas sei meses e três depois da intervenção, analisando os contaminados. Resultados: Participou um total de 48 enfermeiras. O conhecimento da técnica antes da intervenção é homogêneo em ambos os grupos, melhorando significativamente com a formação on-line (p=0.0001). A análise de hemoculturas extraídas previamente à formação mostram níveis de contaminação acima do padrão internacional, diminuindo no grupo intervenção até 3% depois do programa de aprendizagem. Conclusão: A intervenção educacional a partir de uma plataforma digital se mostra válida para a aquisição de conhecimentos e sua transição à prática clínica