Evaluation and optimization of the Sysmex UF1000i system for the screening of urinary tract infection in primary health care elderly patients

Objective Urinary tract infections (UTIs) are a common problem in the elderly population. Urine culture is still considered the "gold standard" to diagnose infection in this population. However, urine cultures are laborious and costly, and most samples will yield no growth. Methods An evaluation was made of the Sysmex UF-1000i flow cytometer as a screening tool for UTI in an elderly population older than 65 years who lived in the community, using 346 urine samples submitted for culture. Results The Receiver Operating Characteristic (ROC) analysis showed a significant difference (P < 0.01) between 0.98 bacteria area under the curve value and 0.82 of white blood cells (WBC). The combination of both counts for screening did not show any improvement in specificity or sensitivity. According to our data, the use of a single cut-off point of 200 bacteria/μL is suggested, in which the sensitivity and specificity were 99.11% and 91.59%, respectively, with a NPV of 99.49%. Moreover, this cut-off value could avoid 60.24% of the samples to be cultured, with a minimal false negative results rate of 0.87%. Conclusions The stratification of age groups stratification helps in selecting a more adjusted Sysmex UF1000i cut-off limit, leading to an improvement in the screening parameters that would imply a better management of these infections, as well as a high reduction in the workload and cost savings

Los recursos documentales del Servicio de Información sobre Discapacidad : Documentary sources in the Service of Information on Disability

En este artículo mostramos el contenido de una de las secciones que conforman el Servicio de Información sobre Discapacidad (SID), la de Fuentes Documentales, centrándonos en las tesis y artículos de revistas por considerarlas de mayor interés por su profundidad de análisis, investigación y actualidad. Como ayuda en la búsqueda de información se realizan una serie de productos, como son dossieres documentales, que van a agrupar la información temáticamente, vaciados de diferentes revistas, que nos ofrecen el contenido de las revistas científicas españolas.This article discusses the contents of the Document sources of the Information Service on Disability (DIS) which focuses on dissertations and journal articles as these are considered to be of greater interest on account of their depth of analysis and research and their currency. A series of products are elaborated as information search aids: dossiers of documents grouped according to subject from different journals which offer the contents of the most relevant Spanish scientific journals on disabilities; a quarterly contents page bulletin giving the indexes of the most relevant national and international scientific journals. Thematic grouping of dossiers is carried out according to user demand and reports on issues suggested by users are also prepared periodically

P9 23. Seudoaneurisma aórtico con infeción de prótesis en aorta ascendente. ¿Es necesario retirar siempre la prótesis? ¿Cuánto tiempo con tratamiento antibiótico?

IntroducciónEl seudoaneurisma aórtico con infección de prótesis en aorta ascendente (PIPAA) tras cirugía cardíaca es una entidad infrecuente (0,9-2%) pero grave (mortalidad intrahospitalaria > 40%). El tratamiento más extendido es la cirugía con recambio protésico y terapia antibiótica adecuada a antibiograma; pero el recambio protésico en ocasiones es técnicamente inviable e incluso puede aumentar la mortalidad perioperatoria. Existen casos en los que se ha preservado la prótesis infectada con éxito terapéutico, realizándose limpieza/reparación quirúrgica local apoyada con omentoplastia. No existe consenso en la duración de la terapia médica, y el tratamiento «supresor a largo plazo» en ocasiones se complica por efectos adversos de los antibióticos.ObjetivosAportar dos nuevos casos y evaluar el tratamiento realizado tras un seguimiento a largo plazo.MétodoAnálisis descriptivo de aspectos microbiológicos, farmacológicos y resultados de la terapia realizada, en dos casos de PIPAA de pacientes intervenidos por disección de aorta (prótesis de dacrón en posición supracoronariana) y por insuficiencia y anuloectasia aórtica (tubo valvulado). Se realiza tratamiento quirúrgico conservador de la prótesis aórtica (limpieza quirúrgica, reparación del seudoaneurisma y omentoplastia), asociándose terapia antibiótica prolongada ajustada a antibiograma.ConclusiónAmbos casos presentan, tras más de 1 año de seguimiento, según criterios clínicos, microbiológicos y pruebas de imagen, ausencia de signos de recidiva infecciosa, resultando la terapia adecuada. Aun sin poder establecer tiempo óptimo de tratamiento, serían razonables 6 semanas de tratamiento endovenoso seguidas de 24 semanas de terapia supresora, a ser posible oral, y valorar su retirada siempre que no existan signos de recidiva

Endophytic and epiphytic phyllosphere fungal communities are shaped by different environmental factors in a mediterranean ecosystem

The online version of this article (https://doi.org/10.1007/s00248-018-1161-9) contains supplementary material, which is available to authorized users.The diversity and factors influencing fimgal assemblages in phyllosphere of Mediterranean tree species have been barely studied, especially when endophytic and epiphytic communities are simultaneously considered. In this work, the endophytic and epiphytic fungal communities from olive tree phyllosphere were studied. This tree species is natural from the Mediterranean region and adapted to grow under adverse climatic conditions. The main objectives were to determine whether there are differences between both fungal communities and to examine whether different abiotic (climate-related) and biotic (plant organs) factors play a pivotal role in structuring these communities. Both communities differed in size and composition, with epiphytic community being richer and more abundant, displaying also a dominance of melanized fungi. Season was the major driver of community composition, especially of epiphytes. Other drivers shaping epiphytes were wind speed and temperature, while plant organ, rainfall, and temperature were the major drivers for endophytic composition. In contrast, canopy orientation caused slight variations in community composition of fungi, but with distinct effects in spring and autumn seasons. In conclusion, epiphytic and endophytic communities are not driven by the same factors. Several sources of variation undergo complex interactions to form and maintain phyllosphere fungal community in Mediterranean climates. Climatic parameters have influence on these fungal communities, suggesting that they are likely to be affected by climate changes in a near future.This work is funded by FEDER funds through COMPETE (Programa Operacional Factores de Competitividade) and by national funds by FCT (Fundacao para a Ciencia e a Tecnologia) within the framework of the project EXCL/AGR-PRO/0591/2012. T. Gomes thanks FCT, POPH-QREN, and FSE for PhD SFRH/BD/98127/2013 grant

Muticenter spanish study for perioperative stroke risk prediction after isolated coronary artery bypass surgery: The PACK2 score

[ES] Objetivos: Desarrollar un modelo predictivo multivariante del accidente cerebrovascular (ACV) intrahospitalario tras cirugía de bypass coronario. Métodos: Veintiséis mil trescientos cuarenta y siete pacientes incluidos en el estudio procedentes de 21 bases de datos de hospitales españoles. El análisis de regresión logística fue utilizado para predecir el riesgo de ACV perioperatorio (ictus o accidente isquémico transitorio). El modelo predictivo fue desarrollado a partir de un subgrupo de datos «de prueba» y validado en otro subgrupo independiente, ambos seleccionados aleatoriamente del total de la muestra. La capacidad predictiva del modelo se relacionó con el área bajo la curva ROC (ABC). Las variables consideradas fueron: preoperatorias (edad, sexo, diabetes mellitus, hipertensión arterial, ACV previo, insuficiencia cardiaca y/o fracción de eyección del ventrículo izquierdo < 40%, prioridad de la intervención no electiva, arteriopatía extracardiaca, insuficiencia renal crónica y/o creatininemia &#8805; 2 mg/dl y fibrilación auricular) e intraoperatorias (cirugía coronaria con/sin circulación extracorpórea). Resultados: Incidencia global de ACV perioperatorio 1,38%. La prioridad no electiva de la cirugía (priority; OR = 2,32), arteriopatía extracardiaca (arteriopathy; OR = 1,37), insuficiencia cardiaca (cardiac; OR = 3.64) e insuficiencia renal crónica (kidney; OR = 6,78) fueron identificados como factores de riesgo independientes de ACV perioperatorio en los modelos uni y multivariante en el subgrupo de prueba; p < 0,0001; ABC = 0,77, IC del 95%, 0,73-0,82. El modelo PACK2 de ACV perioperatorio tras cirugía de bypass coronario se estableció con 1 punto para cada ítem, excepto para la insuficiencia renal crónica que se le otorgaron 2 puntos (rango 0-5 puntos); ABC = 0,76, IC del 95%, 0,72-0,80. En pacientes con puntuación PACK2 &#8805; 2 puntos, la cirugía coronaria sin circulación extracorpórea redujo la incidencia de ACV en un 2,3% cuando se comparó con el grupo con cirugía realizada con circulación extracorpórea. Conclusiones: La escala de riesgo PACK2 muestra una buena capacidad predictiva en los datos analizados y podría ser útil en la toma de decisiones y selección de pacientes de la práctica clínica.[EN] Objectives: To develop a multivariate predictive risk score of perioperative in-hospital stroke after coronary artery bypass grafting (CABG) surgery. Methods: A total of 26,347 patients were enrolled from 21 Spanish hospital databases. Logistic regression analysis was used to predict the risk of perioperative stroke (stroke or transient ischaemic attack). The predictive scale was developed from a training set of data and validated by an independent test set, both selected randomly from the global sample. The assessment of the accuracy of prediction was related to the area under the ROC curve (AUC). The variables considered were: preoperative (age, gender, diabetes mellitus, arterial hypertension, previous stroke, cardiac failure and/or left ventricular ejection fraction < 40%, non-elective priority of surgery, extracardiac arteriopathy, chronic kidney failure and/or serum creatinine ≥2 mg/dl, and atrial fibrillation) and intra-operative (on/off-pump). Results: The overall perioperative stroke incidence was 1.38%. Non-elective priority of surgery (priority; OR = 2.32), vascular disease (arteriopathy; OR = 1.37), heart failure (cardiac; OR = 3.64), and chronic kidney failure (kidney; OR = 6.78) were found to be independent risk factors for perioperative stroke in uni- and multivariate models in the training set of data; P < .0001; AUC = 0.77, 95% CI 0.73–0.82. The PACK2 stroke CABG score was established with 1 point for each item, except for chronic kidney failure with 2 points (range 0–5 points); AUC = 0.76, 95% CI 0.72–0.80. In patients with PACK2 score ≥2 points, off-pump reduced perioperative stoke incidence by 2.3% when compared with on-pump CABG. Conclusions: PACK2 risk scale shows good predictive accuracy in the data analysed and could be useful in clinical practice for decision making and patient selection.Martín, E.; Hornero, F.; Rodríguez, R.; Castellà, M.; Porras, C.; Romero, B.; Maroto, L.... (2014). Estudio multicéntrico español para la predicción del riesgo perioperatorio de accidente cerebrovascular tras cirugía de bypass coronario aislada: el modelo PACK2. Cirugia Cardiovascular. 21(3):175-180. doi:10.1016/j.circv.2014.02.009S17518021

Biocontrol Potential of Forest Tree Endophytes

Peer reviewe

The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in Europe. Data from real-world registries are necessary, as clinical trials do not represent the full spectrum of VTE patients seen in clinical practice. We aimed to document the epidemiology, management and outcomes of VTE using data from a large, observational database. PREFER in VTE was an international, non-interventional disease registry conducted between January 2013 and July 2015 in primary and secondary care across seven European countries. Consecutive patients with acute VTE were documented and followed up over 12 months. PREFER in VTE included 3,455 patients with a mean age of 60.8 ± 17.0 years. Overall, 53.0 % were male. The majority of patients were assessed in the hospital setting as inpatients or outpatients (78.5 %). The diagnosis was deep-vein thrombosis (DVT) in 59.5 % and pulmonary embolism (PE) in 40.5 %. The most common comorbidities were the various types of cardiovascular disease (excluding hypertension; 45.5 %), hypertension (42.3 %) and dyslipidaemia (21.1 %). Following the index VTE, a large proportion of patients received initial therapy with heparin (73.2 %), almost half received a vitamin K antagonist (48.7 %) and nearly a quarter received a DOAC (24.5 %). Almost a quarter of all presentations were for recurrent VTE, with &gt;80 % of previous episodes having occurred more than 12 months prior to baseline. In conclusion, PREFER in VTE has provided contemporary insights into VTE patients and their real-world management, including their baseline characteristics, risk factors, disease history, symptoms and signs, initial therapy and outcomes

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

El derecho del trabajo y de la seguridad social en España en 2014

Este documento intenta reflejar algunos de los principales cambios y novedades del ordenamiento laboral español en 2014, levantando acta de cómo la mutabilidad de nuestro Derecho del Trabajo es imparable. Este informe, consciente de ello, ofrece una selección de elementos esenciales, a juicio de sus autores, especialistas en cada una de las materias, encuadrados en la Sección Juvenil de la Asociación Española de Derecho del Trabajo y de la Seguridad Social. En él, conforme a la organización de dicha Sección en grupos de trabajo, se abordan las novedades más relevantes en materia de derechos fundamentales inespecíficos, contratación laboral, vicisitudes del contrato de trabajo, Derecho colectivo, conciliación y corresponsabilidad, protección social y prevención de riesgos laborales. This paper tries to show some of the many changes and novelties in Spanish Labour Law during 2014, drawing up a record of the unstoppable character of our Labour legal system. This report offers a selection of essential elements, according to its authors, all of them specialists in each one of the subjects, being part of the Young Scholars’ Section of the Spanish Association for Labour and Social Security Law. According to the organization of the said Section in working groups, we can find novelties concerning unspecific fundamental rights, work contracts, the life of the work contract and collective Labour Law, work-life balance and co responsibility, social protection and occupational risk prevention