El paper dels sistemes naturals de tractament d'aigües residuals en la protecció dels recursos hídrics

L’aigua és un bé valuós i essencial, indispensable per a totes les formes de vida. Aquest fet, conjuntament amb la seva fragilitat enfront la contaminació, i l’escassetat d’aigua potable en moltes regions del planeta, remarca la necessitat d’una bona gestió de l’aigua, aspecte clau pel desenvolupament humà sostenible. La preservació dels recursos hídrics rau principalment en la prevenció de la seva contaminació. Malgrat tot, la creixent generació d’aigües residuals evidencia la necessitat de sistemes de tractament. El tractament de les aigües residuals és una pràctica àmpliament estesa en la majoria dels països desenvolupats. No obstant, és menys comú en comunitats petites i sobretot en països en vies de desenvolupament on, a més, la potabilització de l’aigua és escassa. Aquest fet es deu bàsicament als elevats costos de construcció i explotació de les plantes de tractament convencionals o intensives. Tècniques de tractament alternatives, com ara els sistemes naturals o extensius, es presenten en aquesta ponència com a sistemes pont per a una gestió sostenible en un futur pròxim. Els avantatges principals d’aquest sistemes són: baix o nul consum energètic, baixa generació de residus, baix impacte sonor, bona integració en el medi, simple operació i fàcil manteniment. Per contra, les principals limitacions són el requeriment de grans superfícies i el cost de construcció (lligat als moviments de terra). Degut a què el control operacional és bastant limitat, les fases de disseny i de construcció són crucials per a assegurar un bon funcionament i una bona qualitat de l’aigua depurada.Peer Reviewe

Efectos de la lazada de la zapatilla del corredor/a sobre las variables espaciotemporales, el confort, la frecuencia cardiaca y la percepción subjetiva del esfuerzo.

El objetivo fue analizar los efectos del tipo de lazada en las variables espaciotemporales, la frecuencia cardiaca, el confort y la percepción subjetiva del esfuerzo, así como también el efecto del tiempo/fatiga. Se analizaron 24 sujetos, empleando dos tipos de lazadas; a) lazada cruzada convencional y b) lazada 'heel lock'. Todos los participantes realizaron 2 pruebas en días separados y distribuidos de manera aleatoria sobre cinta rodante. La prueba de carrera consistió en un calentamiento previo de 5 min a 8 km/h y posteriormente una prueba de 20 min de carrera a 10 km/h con 1% de pendiente. Los valores de frecuencia cardiaca (p =0.029, ES= 0.199) y el esfuerzo percibido (p<0,001, ES= 0.745) en relación con el instante y el sexo eran mayores hacia el final de la prueba y en mujeres. Por otro lado, en referencia al confort, encontramos diferencias significativas en la lazada, donde los valores fueron significativamente mayores con la 'heel lock'. Finalmente, en las variables espaciotemporales se observan diferencias significativas en función del instante, se incrementó la cadencia (p=0.018, ES=0.183) y descendió la longitud de paso (p=0.019, ES=0.166). Y en función de la lazada en el tiempo de vuelo (p=0.019, ES=0.227), de contacto (p=0.013, ES=0.248), altura (p=0.022, ES=0.217) y ángulo de paso (p=0.024, ES=0.212). En conclusión, la variabilidad de resultados de este estudio muestra que el cambio de tipo de lazada puede variar en gran medida la técnica de carrera y su estudio puede ayudar a reducir el riesgo de lesiones en carrera

Cistitis no complicada en mujeres: 5 estrategias para mejorar la prescripción

Antibiòtic; Resistències antimicrobianes; Infecció del tracte urinariAntibiótico; Resistencias antimicrobianas; Infección del tracto urinarioAntibiotic; Antimicrobial resistance; Urinary tract infectionLes resistències als antibiòtics afecten la capacitat de controlar les infeccions d’una manera efectiva. S’estima que l’any 2050 morirà més gent per infeccions de bacteris multiresistents que per càncer. En l’atenció primària es duen a terme el 90 % de les prescripcions d’antibiòtics, i es calcula que aproximadament entre el 30 i el 50 % de les prescripcions podrien ser inapropiades. Les infeccions del tracte urinari (ITU) es consideren una de les infeccions més freqüents en aquest àmbit, i amb creences errònies associades al seu maneig, com ara que cal tractar sistemàticament la bacteriúria en absència de símptomes, cosa que contribueix a una sobreprescripció d’antibiòtics. Hi ha evidència que ens indica que la fosfomicina trometamol en una dosi única de 3 grams és el tractament d’elecció, i la nitrofurantoïna és l’alternativa, sempre que el tractament no duri més de set dies. En general, no està indicat l’ús de cefalosporines de tercera generació i fluoroquinolones en el tractament empíric per tal d’evitar el desenvolupament de soques d’E. coli amb beta-lactamasa d’espectre estès (BLEE). En les cistitis recurrents, la profilaxi antibiòtica s’ha mostrat efectiva, però també hi ha altres estratègies, com ara augmentar la ingesta de líquids, utilitzar estrògens vaginals en dones postmenopàusiques o la micció postcoital, que en podrien reduir el risc. El paper dels nabius, els probiòtics, les autovacunes o la D-mannosa en la prevenció de les recurrències és limitat i controvertit.La resistencia a los antibióticos está afectando a nuestra capacidad de controlar las infecciones de forma efectiva. Se estima que en el año 2050 la mortalidad por infecciones de bacterias multiresistentes superará a la mortalidad asociada al cáncer. El 90% de las prescripciones de antibióticos se realizan en el contexto de la atención primaria y se estima que aproximadamente entre el 30 y el 50% de las prescripciones podrían ser inapropiadas. Las infecciones del tracto urinario se consideran una de las infecciones más frecuentes en este ámbito y algunas creencias erróneas, como que es necesario tratar sistemáticamente la bacteriuria en ausencia de síntomas, están contribuyendo a la sobreprescripción de antibióticos. La evidencia disponible indica que Fosfomicina trometamol 3g en dosis única es el tratamiento de elección y la nitrofurantoina su alternativa, siempre que la duración del tratamiento no supere los 7 días. En general no está indicado el uso de cefalosporinas de tercera generación y fluoroquinolonas como tratamiento empírico para evitar el desarrollo de cepas de E. coli BLEE. En las cistitis recurrentes la profilaxis antibiótica ha demostrado ser efectiva. Disponemos también de otras estrategias como aumentar la ingesta de líquidos, utilizar estrógenos vaginales en mujeres postmenopáusicas o la micción post coital que parece podrían reducir el riesgo de recurrencias. El papel de los arándanos, los probióticos, las autovacunas o la D-manosa en la prevención de las recurrencias es limitado y controvertido

Assessment of Efficacy and Safety Using PPAR-γ Agonist-Loaded Nanocarriers for Inflammatory Eye Diseases

Drug-loaded nanocarriers (NCs) are new systems that can greatly improve the delivery and targeting of drugs to specific tissues and organs. In our work, a PPAR-γ agonist loaded into polymeric NCs was prepared, stabilized by spray-drying, and tested in vitro, ex vivo, and in vivo (animal models) to provide a safe formulation for optical anti-inflammatory treatments. The NCs were shown to be well tolerated, and no signs of irritancy or alterations of the eye properties were detected by the in vitro HET-CAM test and in vivo Draize test. Furthermore, no signs of cytotoxicity were found in the NC formulations on retinoblastoma cells (Y-79) analyzed using the alamarBlue assay, and the transmittance experiments evidenced good corneal transparency with the formulations tested. The ocular anti-inflammatory study confirmed the significant prevention efficacy using the NCs, and these systems did not affect the corneal tissue structure. Moreover, the animal corneal structure treated with the NCs was analyzed using X-ray diffraction using synchrotron light. Small-angle X-ray scattering (SAXS) analysis did not show a significant difference in corneal collagen interfibrillar spacing after the treatment with freshly prepared NCs or NCs after the drying process compared to the corresponding negative control when inflammation was induced. Considering these results, the PPAR-γ agonist NCs could be a safe and effective alternative for the treatment of inflammatory ocular processes

Safety of cilostazol in peripheral artery disease: a cohort from a primary healthcare electronic database

Background: Cilostazol has been associated with spontaneous reports of cardiovascular adverse events and serious bleeding. The objective of this study is to determine the relative risk of cardiovascular adverse events or haemorrhages in patients with peripheral artery disease treated with cilostazol in comparison to pentoxifylline users. Methods: Population-based cohort study including all individuals older than 40 who initiated cilostazol or pentoxifylline during 2009–2011 in SIDIAP database. The two treatment groups were matched through propensity score (PS). Results: Nine thousand one hundred twenty-nine patients met inclusion criteria and after PS matching, there were 2905 patients in each group. 76% of patients were men, with similar mean ages in both groups (68.8 for cilostazol and 69.4 for pentoxifylline). There were no differences in bleeding, cerebrovascular and cardiovascular events between both groups. Conclusions: Patients treated with cilostazol were different from those treated with pentoxifylline at baseline, so they were matched through PS. We did not find differences between treatment groups in the incidence of bleeding or cardiovascular and cerebrovascular events. Cilostazol should be used with precaution in elderly polymedicated patients

Increased prevalence of pathogenic bacteria in the gut microbiota of infants at risk of developing celiac disease: The PROFICEL study

8 páginas, 1 figura, 2 tablasCeliac disease (CD) is an immune-mediated enteropathy involving genetic and environmental factors, whose interaction influences disease risk. The intestinal microbiota, including viruses and bacteria, could play a role in the pathological process leading to gluten intolerance. In this study, we investigated the prevalence of pathogens in the intestinal microbiota of infants at familial risk of developing CD. We included 127 full-term newborns with at least one first-degree relative with CD. Infants were classified according to milk-feeding practice (breastfeeding or formula feeding) and HLA-DQ genotype (low, intermediate or high genetic risk). The prevalence of pathogenic bacteria and viruses was assessed in the faeces of the infants at 7 days, 1 month and 4 months of age. The prevalence of Clostridium perfringens was higher in formula-fed infants than in breast-fed over the study period, and that of C. difficile at 4 months. Among breastfed infants, a higher prevalence of enterotoxigenic E. coli (ETEC) was found in infants with the highest genetic risk compared either to those with a low or intermediate risk. Among formula-fed infants, a higher prevalence of ETEC was also found in infants with a high genetic risk compared to those of intermediate risk. Our results show that specific factors, such as formula feeding and the HLA-DQ2 genotype, previously linked to a higher risk of developing CD, influence the presence of pathogenic bacteria differently in the intestinal microbiota in early life. Further studies are warranted to establish whether these associations are related to CD onset later in life.This work was supported by grants AGL2011-25169, AGL2014-52101-P and AGL2007-66126-C03-03/ALI (YS and FP) from the Spanish Ministry of Economy and Competitiveness (MINECO). The scholarship to MO from CSIC (JAEpre) and the contract to ABP from the European Union's Seventh Framework Program under the grant agreement no 613979 (MyNewGut) are also fully acknowledged.Peer reviewe

Influence of Milk-Feeding Type and Genetic Risk of Developing Coeliac Disease on Intestinal Microbiota of Infants: The PROFICEL Study

Interactions between environmental factors and predisposing genes could be involved in the development of coeliac disease (CD). This study has assessed whether milk-feeding type and HLA-genotype influence the intestinal microbiota composition of infants with a family history of CD. The study included 164 healthy newborns, with at least one first-degree relative with CD, classified according to their HLA-DQ genotype by PCR-SSP DQB1 and DQA1 typing. Faecal microbiota was analysed by quantitative PCR at 7 days, and at 1 and 4 months of age. Significant interactions between milk-feeding type and HLA-DQ genotype on bacterial numbers were not detected by applying a linear mixed-model analysis for repeated measures. In the whole population, breast-feeding promoted colonization of C. leptum group, B. longum and B. breve, while formula-feeding promoted that of Bacteroides fragilis group, C. coccoides-E. rectale group, E. coli and B. lactis. Moreover, increased numbers of B. fragilis group and Staphylococcus spp., and reduced numbers of Bifidobacterium spp. and B. longum were detected in infants with increased genetic risk of developing CD. Analyses within subgroups of either breast-fed or formula-fed infants indicated that in both cases increased risk of CD was associated with lower numbers of B. longum and/or Bifidobacterium spp. In addition, in breast-fed infants the increased genetic risk of developing CD was associated with increased C. leptum group numbers, while in formula-fed infants it was associated with increased Staphylococcus and B. fragilis group numbers. Overall, milk-feeding type in conjunction with HLA-DQ genotype play a role in establishing infants' gut microbiota; moreover, breast-feeding reduced the genotype-related differences in microbiota composition, which could partly explain the protective role attributed to breast milk in this disorder

Eligibility criteria for Menopausal Hormone Therapy (MHT): a position statement from a consortium of scientific societies for the use of MHT in women with medical conditions. MHT Eligibility Criteria Group

This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms

A crowdsourcing database for the copy-number variation of the Spanish population

Background: Despite being a very common type of genetic variation, the distribution of copy-number variations (CNVs) in the population is still poorly understood. The knowledge of the genetic variability, especially at the level of the local population, is a critical factor for distinguishing pathogenic from non-pathogenic variation in the discovery of new disease variants. Results: Here, we present the SPAnish Copy Number Alterations Collaborative Server (SPACNACS), which currently contains copy number variation profiles obtained from more than 400 genomes and exomes of unrelated Spanish individuals. By means of a collaborative crowdsourcing effort whole genome and whole exome sequencing data, produced by local genomic projects and for other purposes, is continuously collected. Once checked both, the Spanish ancestry and the lack of kinship with other individuals in the SPACNACS, the CNVs are inferred for these sequences and they are used to populate the database. A web interface allows querying the database with different filters that include ICD10 upper categories. This allows discarding samples from the disease under study and obtaining pseudo-control CNV profiles from the local population. We also show here additional studies on the local impact of CNVs in some phenotypes and on pharmacogenomic variants. SPACNACS can be accessed at: http://csvs.clinbioinfosspa.es/spacnacs/. Conclusion: SPACNACS facilitates disease gene discovery by providing detailed information of the local variability of the population and exemplifies how to reuse genomic data produced for other purposes to build a local reference database

Impact of a Primary Care Antimicrobial Stewardship Program on Bacterial Resistance Control and Ecological Imprint in Urinary Tract Infections

Antimicrobial stewardship programs (ASPs) are a central component in reducing the overprescription of unnecessary antibiotics, with multiple studies showing benefits in the reduction of bacterial resistance. Less commonly, ASPs have been performed in outpatient settings, but there is a lack of available data in these settings. We implemented an ASP in a large regional outpatient setting to assess its feasibility and effectiveness. Over a 5-year post-implementation period, compared to the pre-intervention period, a significant reduction in antibiotic prescription occurred, with a reduction in resistance in E. coli urinary isolates. ASP activities also were found to be cost-effective, with a reduction in medication prescription