Estudio descriptivo de la microbiota intestinal en pacientes con infección por Clostridium difficile y en individuos colonizados por Clostridium difficile.

Clostridium difficile es un bacilo Gram positivo, anaerobio estricto y formador de esporas. Constituye la principal causa de diarrea nosocomial en pacientes hospitalizados. Su patogenicidad se asocia al uso de antibióticos y a una respuesta inmune disminuida, así como a la edad avanzada, hospitalización y mayor severidad de la enfermedad de base. La clínica es debida a la producción de las toxinas TcdA y TcdB de acción citotóxica. No obstante, la colonización intestinal de C. difficile puede dar lugar a un abanico de situaciones como la ausencia de síntomas (individuos colonizados) hasta diarrea grave o colitis pseudomembranosa fulminante (individuos infectados). La infección por C. difficile (CDI, Clostridium difficile infection) supone un problema muy importante en cuanto a mortalidad, morbilidad y costes asociados que supone. Además, el riesgo de recurrencia es muy elevado. Asimismo, se ha evidenciado que la epidemiología de la CDI ha cambiado desde los inicios del siglo XXI. Aparte de un aumento en la mortalidad y morbilidad que genera la CDI, ha empezado a describirse la existencia de un gran número de casos provenientes de la comunidad. La disrupción de la microbiota intestinal endógena (disbacteriosis) proporciona el ambiente ideal para que pueda producirse la infección, sin embargo, una microbiota intestinal sana es capaz de prevenirla. A este fenómeno se le denomina resistencia a la colonización. Un mecanismo corrompido de resistencia a la colonización por C. difficile clave es el concerniente al metabolismo de los ácidos biliares. Se ha comprobado que los ácidos biliares primarios presentan una actividad germinante sobre las esporas de C. difficile, mientras que los ácidos biliares secundarios presentan una actividad inhibitoria sobre la germinación. La microbiota intestinal aporta los enzimas encargados de transformar los ácidos biliares primarios en secundarios (principalmente BaiCD). Los miembros de la microbiota intestinal que aporten estos enzimas producirían un efecto inhibitorio sobre la germinación de C. difficile. Estos géneros se están presentes en muy baja cantidad y su pérdida se asocia a CDI. Otras alteraciones características de la microbiota intestinal de los pacientes con CDI son la depleción de familias productoras de butirato como Lachnospiraceae y Ruminococcaceae y el incremento de patógenos oportunistas, principalmente del phylum Firmicutes. Por otra parte, la tasa de portadores o colonizados por C. difficile es variable y dependiente de la edad. Es más elevada en aquellos sujetos con ciertas situaciones concomitantes que favorezcan la colonización. La comparación de la microbiota intestinal de sujetos infectados y colonizados por C. difficile ha sido poco estudiado. Este enfoque podría aportar información relevante sobre grupos susceptibles de desarrollo de CDI o de protectores. El objetivo del estudio es describir y comparar la microbiota intestinal de 15 pacientes con infección por C. difficile sintomática (Grupo CDI), 15 sujetos colonizados por C. difficile (Grupo P) y 15 controles sanos (Grupo CTRL).Medicin

Reducing test request for anti-thyroglobulin and anti-thyroid peroxidase antibodies: trends before and after interventions based on rejection rules and profile management

Introduction: The objective of this study was to identify trends in requests for anti-thyroid peroxidase antibodies (TPOab) and anti-thyroglobulin antibodies (TGab) tests before and after applying set of interventions based on rejection rules and profile management. Materials and methods: Trend analysis was made at semester time intervals (from May-October 2010 to May-October 2017), before and after the intervention semester (May-October 2016). Number of tests (N) TPOab and TGab / 1000 total requests based on total N of both tests and total N of biochemical analysis laboratory requests, was calculated. To find out where the interventions had more impact we distinguished N of requests between Primary Care (PC) and Specialized Care (SC). A joinpoint regression analysis was used to determine time segments and time points in these indicators where the trend changed. Results: Trend analysis of the request of TPOab and TGab showed two clearly differentiated trend lines with a statistically significant Joinpoint (P < 0.001) with an increase in each semester from May 2010 of 7.4% and 7.5% respectively, to the semester of the interventions where there was a decrease of - 45% and - 61% located mainly in PC. Trend analysis in SC setting did not show any Joinpoint and any trend line. Conclusions: Results showed that applied interventions enabled change of trend for TPOab and TGab test requests, especially in PC where the interventions proved to be the most successful

Development of a novel duplex lateral flow test for simultaneous detection of casein and ß-lactoglobulin in food

Milk by-products such as whey and caseinate are widely used as ingredients or processing aids in food industry. However, since they could cause allergic reactions they are included in Allergen Control Plans. ß-Lactoglobulin is the major whey protein and caseins are main proteins in milk. Selection of a unique target to analyze the presence of milk in foods could be insufficient when the source of milk proteins is unknown. A new test based on lateral flow immunocromatography that combines the simultaneous and independent detection of both proteins (ß-lactoglobulin and casein)in one rapid test was developed. The assay was validated according to AOAC guidelines being able to detect ß-lactoglobulin (0.5 ppm), casein (2 ppm), whey and powder milk (1–5 ppm). No cross-reactivity was found with a panel of 38 food commodities. The method is a rapid and suitable tool to identify milk proteins in processed food, ingredients, and rinsing water

Validation of the human chorionic gonadotropin immunoassay in cerebrospinal fluid for the diagnostic work-up of neurohypophyseal germinomas

Background: The measurement of human chorionic gonadotropin (hCG) in cerebrospinal fluid (CSF) is useful for the differential diagnosis of suprasellar lesions. However, the concentrations that prove diagnostic for neurohypophyseal germinoma have not been well defined. In addition, the immunoassays used for such measurements are the same as those applied in serum, and few studies have been performed regarding the validation of such techniques in CSF. The present study aims to apply the Elecsysw hCG þ b immunoassay from Roche Diagnostics to measure hCG in CSF, as a useful tool in the diagnosis of neurohypophyseal germinomas in children and young adults. Methods: Validation of the immunoassay involved calculation of the functional sensitivity and reference values for hCG in CSF in 35 controls in the absence of pregnancy, trophoblastic disease or tumour pathology. For the clinical application study, three patients diagnosed with neurohypophyseal germinoma have been reviewed. Results: The functional sensitivity obtained was 0.4 IU/L. The reference values for hCG in CSF ranged from undetectable values to 0.7 IU/L. The hCG concentrations in CSF in the three studied patients, with confirmed diagnosis of neurohypophyseal germinoma, were 21.1, 32.6 and 23 IU/L, respectively. Conclusions: The Elecsysw hCG þ b immunoassay from Roche Diagnostics can be used to detect hCG in CSF with high precision. According to our results, CSF-hCG concentrations that exceed the established reference interval (undetectable values to 0.7 IU/L) in the presence of suprasellar lesions and hypophyseal stalk thickening must be considered pathological, establishing the need to exclude the presence of germinoma

Estrategias para la adecuación de la gestión de la demanda en el laboratorio

El 70% de las decisiones clínicas están basadas o sostenidas en datos de pruebas de laboratorio). Con este dato es obvio que el servicio de Laboratorio debiera ser un proceso clave y estratégico dentro de cualquier institución sanitaria. Entre otras medidas, establecer estrategias para la correcta solicitud de pruebas analíticas va a convertir al laboratorio en ese servicio clave, ya que por una parte se va a contener el aumento en el gasto sanitario, y por otra se va a reducir la realización de pruebas innecesarias que generan falsos positivos, visitas innecesarias, pruebas adicionales, interconsultas y aumento de las estancias medias. Se diseñó un estudio cuasiexperimental de tipo ¿Antes-Después¿ implementando medidas previas (modificación de perfiles y guías clínicas consensuadas) y posteriores (rechazo de pruebas) a la realización de la petición en 14 pruebas de la boratorio en el Hospital Universitario del Vinalopó, para observar la reducción en la demanda y comprobar que estas medidas son efectivas en ello. Aplicando medidas estratégicas sobre el control de la demanda en 14 pruebas, en un periodo de tiempo que oscila entre 5 y 12 meses, de un total de 78076 realizadas en el periodo de tiempo control (mismo número de meses anteriores a la instauración de las medidas) hemos pasado a realizar 51435, lo que supone 26641 pruebas menos, que a su vez supone un ahorro de 364071 euros, tomando como referencia el precio que aparece en la Ley de Tasas del 2017. Esto supone una reducción del 34% en las pruebas estudiadas

How Our Microbiome Influences the Pathogenesis of Alopecia Areata

Alopecia areata is a multifactorial autoimmune-based disease with a complex pathogenesis. As in all autoimmune diseases, genetic predisposition is key. The collapse of the immune privilege of the hair follicle leading to scalp loss is a major pathogenic event in alopecia areata. The microbiota considered a bacterial ecosystem located in a specific area of the human body could somehow influence the pathogenesis of alopecia areata, as it occurs in other autoimmune diseases. Moreover, the Next Generation Sequencing of the 16S rRNA bacterial gene and the metagenomic methodology have provided an excellent characterization of the microbiota. The aim of this narrative review is to examine the published literature on the cutaneous and intestinal microbiota in alopecia areata to be able to establish a pathogenic link. In this review, we summarize the influence of the microbiota on the development of alopecia areata. We first introduce the general pathogenic mechanisms that cause alopecia areata to understand the influence that the microbiota may exert and then we summarize the studies that have been carried out on what type of gut and skin microbiota is found in patients with this disease

Acne, Microbiome, and Probiotics: The Gut–Skin Axis

The objective of this narrative review was to check the influence of the human microbiota in the pathogenesis of acne and how the treatment with probiotics as adjuvant or alternative therapy affects the evolution of acne vulgaris. Acne is a chronic inflammatory skin disease involving the pilosebaceous units. The pathogenesis of acne is complex and multifactorial involving genetic, metabolic, and hormonal factors in which both skin and gut microbiota are implicated. Numerous studies have shown the bidirectionality between the intestinal microbiota and skin homeostasis, a communication mainly established by modifying the immune system. Increased data on the mechanisms of action regarding the relevance of Cutibacterium acnes, as well as the importance of the gut–skin axis, are becoming known. Diverse and varied in vitro studies have shown the potential beneficial effects of probiotics in this context. Clinical trials with both topical and oral probiotics are scarce, although they have shown positive results, especially with oral probiotics through the modulation of the intestinal microbiota, generating an anti-inflammatory response and restoring intestinal integrity, or through metabolic pathways involving insulin-like growth factor I (IGF-1). Given the aggressiveness of some standard acne treatments, probiotics should continue to be investigated as an alternative or adjuvant therapy

Selection of Probiotics in the Prevention of Respiratory Tract Infections and Their Impact on Occupational Health: Scoping Review

The occupational health impact of respiratory infectious diseases is costly to the economy and the health care system. Probiotics are non-pathogenic live microorganisms that, when ingested in adequate amounts, can colonize the intestinal tract, and enhance the immune system. In recent years, numerous studies have described the possible usefulness of certain probiotic strains in the treatment and prevention of respiratory tract infections, with disparate results. In order to assess the possible efficacy and safety of these microorganisms to prevent or ameliorate respiratory tract infections, we systematically searched the bibliographic databases MEDLINE (via Pubmed), EMBASE, The Cochrane library, Scopus, and Web of science, using the descriptors &ldquo;Respiratory Tract Infections&rdquo;, &ldquo;Probiotics&rdquo;, &ldquo;Occupational Health&rdquo;, &ldquo;Humans&rdquo;, and &ldquo;Clinical Trials&rdquo;. After applying our inclusion and exclusion criteria, 18 studies were accepted for review and critical analysis. Our analysis suggests that a combination of different probiotics, most of them in the genus Bifidobacterium sp. and Lactobacillus sp., could be a good mix to strengthen the immune system and reduce the symptoms of URTIs in the healthy working population

Descriptive Study of Gut Microbiota in Infected and Colonized Subjects by Clostridiodes difficile

Clostridiodes difficile can lead to a range of situations from the absence of symptoms (colonization) to severe diarrhea (infection). Disruption of gut microbiota provides an ideal environment for infection to occur. Comparison of gut microbiota of infected and colonized subjects could provide relevant information on susceptible groups or protectors to the development of infection, since the presence of certain genera could be related to the inhibition of transition from a state of colonization to infection. Through high-throughput sequencing of 16S rDNA gene, we performed alpha and beta diversity and composition studies on 15 infected patients (Group CDI), 15 colonized subjects (Group P), and 15 healthy controls (Group CTLR). A loss of alpha diversity and richness and a different structure have been evidenced in the CDI and P groups with respect to the CTRL group, but without significant differences between the first two. In CDI and P groups, there was a strong decrease in phylum Firmicutes and an expansion of potential pathogens. Likewise, there was a loss of inhibitory genus of C. difficile germination in infected patients that were partially conserved in colonized subjects. Therefore, infected and colonized subjects presented a gut microbiota that was completely different from that of healthy controls, although similar to each other. It is in composition where we found that colonized subjects, especially in minority genera, presented differences with respect to those infected

New palaeobotanical records from the Lower Cretaceous of western Cameros Basin (province of Burgos)

Los registros paleobotánicos en la cuenca de Cameros son escasos y se encuentran limitados a unas pocas localidades. Se presentan dos nuevos registros procedentes de depósitos del Barremiense en las cercanías de Salas de los Infantes y de Hortezuelos (Burgos). La nueva flora de Horcajuelos-1, cercano a Salas de los Infantes, se corresponde con los depósitos fluviales de la Formación Pinilla de los Moros. El nivel inferior está dominado por restos de Tempskya, mientras que en el nivel superior aparecen abundantes registros de Onychiopsis cf. psilotoides, Regnellites, Ruffordia y Cladophlebis. Los registros palinológicos de las facies lacustres, equivalentes lateralmente, de la Formación Hortezuelos están dominados por una abundante y diversa asociación de esporas de helechos (principalmente Schizaeaceae) junto con coníferas (Classopollis y Araucariacites) y raros pólenes monosulcados de angiospermasPalaeobotanical records of the Cameros basin are scarce and limited to a few localities. Two new records , mainly corresponding to Barremian deposits near Salas de los Infantes and Hortezuelos (Burgos) are presented. The new flora from Horcajuelos-1 near Salas corresponds to fluvial deposits of the Pinilla de los Moros Fm. A lower bed is dominated by Tempskya, while an upper layer includes abundant Onychiopsis cf. psilotoides, Regnellites, Ruffordia and Cladophlebis. The palynological records of the laterally equivalent lacustrine facies from the Hortezuelos Fm. are dominated by abundant and diverse fern spore assemblages (mainly Schizaeaceae) along with conifers (Classopollis and Araucariacites) and rare monosulcate angiosperm polle