Evolución histórica de las enfermedades causadas por micobacterias no pigmentadas de crecimiento rápido en un Hospital Universitario

Non-pigmented rapidly growing mycobacteria (NPRGM) are a group of organisms of increasing interest due to the growing number of potential patients and the difficulties for a proper treatment in many of them. However, the evolution of these diseases in a long period of time and its evolutionary changes has been described only in a scanty number of reports. Material and methods. We performed a retrospective study between January 1st 2004 and December 31st 2017 in order to evaluate the clinical significance and types of diseases caused by NPRGM. Patients with isolates of NPRGM during this period were selected for the study, and clinical charts were reviewed using a predefined protocol. Results. During this period we identified 59 patients (76 clinical samples) with isolates of NPRGM, with 12 cases of clinical disease and one patient with doubtful significance (including 6 respiratory tract infections, 2 catheter infections, 1 skin and soft tissue infection, 1 disseminated infection, 1 conjunctivitis, 1 prosthetic joint infection and 1 mastitis). Fifty percent of M. chelonae isolates, 37.5% of M. abscessus isolates and 23.33% of M. fortuitum isolates were clinically significant. None of the isolates of other species were significant. Conclusions. Most isolates in respiratory samples were contaminants/colonizations. M. abscessus was the main etiological agent in respiratory syndromes, whereas M. chelonae and M. fortuitum were more frequently associated with other infections, especially clinical devices and skin and soft tissue infections.Las micobacterias no pigmentadas de crecimiento rápido (MNPCR) son un grupo de organismos de interés creciente debido al número cada vez mayor de pacientes potenciales y a las dificultades en el tratamiento. Sin embargo, el número de estudios que analizan la evolución de estos casos a lo largo de un periodo de tiempo largo es escaso. Material and métodos. Se realizó un estudio retrospectivo entre el 1 de enero de 2004 y el 31 de diciembre de 2017 para evaluar el significado clínico y los tipos de enfermedades causados por MNPCR. Se seleccionaron para ello aquellos pacientes con aislamientos de MNPCR, y se revisaron las historias clínicas mediante un protocolo predefinido. Resultados. Se identificaron 59 pacientes (76 muestras) con aislamientos de MNPCR, de los cuales 12 presentaron enfermedad y uno tuvo un significado dudoso (incluyendo 6 infecciones respiratorias, 2 infecciones asociadas a catéter, 1 infección de piel y partes blandas, 1 infección diseminada, 1 conjuntivitis, 1 infección de prótesis osteoarticular y 1 mastitis). El 50 % de los aislamientos de Mycobacterium chelonae, el 37,5 % de Mycobacterium abscessus y el 23,33 % de Mycobacterium fortuitum fueron clínicamente significativos. Ninguno de los aislamientos de otras especies fue significativo La mayoría de los aislamientos de muestras respiratorias resultaron ser contaminantes/ colonizaciones. M. abscessus fue el principal agente etiológico en las infecciones respiratorias, mientras que M. chelonae y M. fortuitum fueron asociados con mayor frecuencia a otras infecciones, especialmente infecciones de piel y partes blandas e infecciones asociadas a dispositivos biomédico

Human–landscape interactions in the Conquezuela–Ambrona Valley (Soria, continental Iberia): From the early Neolithic land use to the origin of the current oak woodland

The sedimentological, geochemical and palynological analyses performed in the Conquezuela palaeolake (41°11′N; 2°33′W; 1124 m a.s.l.) provide a detailed, multiproxy palaeoenvironmental reconstruction in one of the key areas of inner Iberian Neolithic colonization. Combined with archaeobotanical and archaeological data from well-dated settlements along the Conquezuela–Ambrona Valley we investigate how environmental conditions may affect both socio-economic adaptations and livelihood strategies of prehistoric communities. The first evidences of early Neolithic occupation in the valley ca. 7250–6450 cal yr BP (5300–4500 BC) coincided with the onset of a period (7540–6200 cal yr BP, 5590–4250 BC) with higher water availability and warmer climate as alluvial environments were substituted by carbonate-wetland environments in the basin. The Conquezuela record supports an early Neolithic colonization of the inner regions of Iberia favored by warmer and humid climate features and with preferential settlement patterns associated to lakes. The maximum human occupation of the valley occurred during the mid–late Neolithic and Chalcolithic (6200–3200 cal yr BP, 4250–1250 BC) as evidenced by the high number of archaeological sites. Although a number of hydrological oscillations have been detected during this period, the intense landscape transformation at basin-scale, leading to a deforested landscape, was largely a consequence of widespread farming and pastoral practices. Socio-economic activities during Bronze, Iron and Roman times modified this inherited landscape, but the second largest ecosystem transformation only occurred during Mediaeval times when a new agrarian landscape developed with the expansion of stockbreeding transhumance. The current vegetation cover characterized by patches of holm and marcescent oaks and fields reflects an intense human management combining both extensive herding with agrarian activities in order to transform the previous forested landscape into a dehesa-like system.The funding for the present study derives from DINAMO2 (CGL-BOS 2012-33063) and AGRIWESTMED (ERC Grant Agreement #230561) projects, provided by the Spanish Inter-Ministry Commission of Science and Technology (CICYT) and the European Research Council under the European Union's Seventh Framework Programme (FP7/2007–2013). XRF data were obtained at the XRF Core Scanner Laboratory (CRG Marine Geosciences, University of Barcelona). Josu Aranbarri acknowledges the predoctoral funding provided by the Basque Country Government (ref: FI-2010-5). Graciela Gil-Romera hold a post-doctoral contract funded by “Juan de la Cierva” (ref: JCI2009-04345) program. Eduardo García-Prieto and Maria Leunda are supported by predoctoral FPI grants BES-2010-038593 and BES-2013-063753, respectively. We also thank Elena Royo for her help with the lab procedures and the two anonymous referees for their valuable suggestions.Peer reviewe

Prospective individual patient data meta-analysis of two randomized trials on convalescent plasma for COVID-19 outpatients

Data on convalescent plasma (CP) treatment in COVID-19 outpatients are scarce. We aimed to assess whether CP administered during the first week of symptoms reduced the disease progression or risk of hospitalization of outpatients. Two multicenter, double-blind randomized trials (NCT04621123, NCT04589949) were merged with data pooling starting when = 50 years and symptomatic for <= 7days were included. The intervention consisted of 200-300mL of CP with a predefined minimum level of antibodies. Primary endpoints were a 5-point disease severity scale and a composite of hospitalization or death by 28 days. Amongst the 797 patients included, 390 received CP and 392 placebo; they had a median age of 58 years, 1 comorbidity, 5 days symptoms and 93% had negative IgG antibody-test. Seventy-four patients were hospitalized, 6 required mechanical ventilation and 3 died. The odds ratio (OR) of CP for improved disease severity scale was 0.936 (credible interval (CI) 0.667-1.311); OR for hospitalization or death was 0.919 (CI 0.592-1.416). CP effect on hospital admission or death was largest in patients with <= 5 days of symptoms (OR 0.658, 95%CI 0.394-1.085). CP did not decrease the time to full symptom resolution

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

VIII Encuentro de Docentes e Investigadores en Historia del Diseño, la Arquitectura y la Ciudad

Acta de congresoLa conmemoración de los cien años de la Reforma Universitaria de 1918 se presentó como una ocasión propicia para debatir el rol de la historia, la teoría y la crítica en la formación y en la práctica profesional de diseñadores, arquitectos y urbanistas. En ese marco el VIII Encuentro de Docentes e Investigadores en Historia del Diseño, la Arquitectura y la Ciudad constituyó un espacio de intercambio y reflexión cuya realización ha sido posible gracias a la colaboración entre Facultades de Arquitectura, Urbanismo y Diseño de la Universidad Nacional y la Facultad de Arquitectura de la Universidad Católica de Córdoba, contando además con la activa participación de mayoría de las Facultades, Centros e Institutos de Historia de la Arquitectura del país y la región. Orientado en su convocatoria tanto a docentes como a estudiantes de Arquitectura y Diseño Industrial de todos los niveles de la FAUD-UNC promovió el debate de ideas a partir de experiencias concretas en instancias tales como mesas temáticas de carácter interdisciplinario, que adoptaron la modalidad de presentación de ponencias, entre otras actividades. En el ámbito de VIII Encuentro, desarrollado en la sede Ciudad Universitaria de Córdoba, se desplegaron numerosas posiciones sobre la enseñanza, la investigación y la formación en historia, teoría y crítica del diseño, la arquitectura y la ciudad; sumándose el aporte realizado a través de sus respectivas conferencias de Ana Clarisa Agüero, Bibiana Cicutti, Fernando Aliata y Alberto Petrina. El conjunto de ponencias que se publican en este Repositorio de la UNC son el resultado de dos intensas jornadas de exposiciones, cuyos contenidos han posibilitado actualizar viejos dilemas y promover nuevos debates. El evento recibió el apoyo de las autoridades de la FAUD-UNC, en especial de la Secretaría de Investigación y de la Biblioteca de nuestra casa, como así también de la Facultad de Arquitectura de la UCC; va para todos ellos un especial agradecimiento

Effect of antimicrobial therapy against Mycobacterium abscessus and Pseudomonas aeruginosa dual-species biofilms

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 24/02/2021La enfermedad pulmonar crónica es la principal causa de morbilidad y mortalidad en pacientes con fibrosis quística (FQ). Las bacterias se establecen en los pulmones de los pacientes con FQ formando biofilms polimicrobianos, estructuras agregadas de microorganismos con una alta tolerancia frente al tratamiento antimicrobiano. Pseudomonas aeruginosa es la especie más prevalente en estos pacientes. Sin embargo, la microbiota del ecosistema pulmonar también puede estar compuesta por otros microorganismos, entre los que se encuentran las Micobacterias No Tuberculosas (MNT), que se adquieren mayoritariamente a partir de reservorios ambientales. Mycobacterium abscessus es un microorganismo que causa infección pulmonar en FQ cuya incidencia está aumentando globalmente. Algunos estudios sugieren que la terapia con antimicrobianos, a los que estos pacientes se exponen desde la infancia, podría favorecer la colonización pulmonar por M. abscessus dada su resistencia intrínseca a antibióticos. El tratamiento de la enfermedad pulmonar por M. abscessus se basa en la combinación de diferentes antimicrobianos, cuya elección está guiada por el antibiograma del aislado. Sin embargo, la tasa de fallo terapéutico y la recurrencia es alta, sugiriendo una falta de correlación in vitro-in vivo. En este trabajo tratamos de determinar si la incorporación de factores del microambiente del huésped, como células epiteliales de pulmón, y microorganismos con los que M. abscessus comparte nicho, como P. aeruginosa, pueden modificar la sensibilidad a antimicrobianos de M. abscessus. Además, también pretendemos evaluar si el tratamiento antimicrobiano frente a otros patógenos frecuentemente coaislados con M. abscessus, como P. aeruginosa, podría aumentar la supervivencia de M. abscessus en un biofilm dual...Chronic lung infection is the main cause of morbidity and mortality in cystic fibrosis (CF) patients. Bacteria in the CF lung are arranged as polymicrobial biofilms, which are aggregated structures of sessile microorganisms highly tolerant to antimicrobial therapy. Pseudomonas aeruginosa is the most prevalent species causing acute and chronic respiratory infection among CF patients. However, the CF lung microbiota also comprises other microorganisms, such as Non- Tuberculous Mycobacteria (NTM), which are presumed to be acquired from environmental reservoirs. Mycobacterium abscessus is a microorganism that can cause biofilm-related pulmonary infections in patients with preexisting lung disease and is increasingly being isolated from respiratory samples of CF patients. Some studies suggest that antimicrobial therapy, to which CF patients are exposed since childhood, may favor the colonization of the lung environment by M. abscessus, given its intrinsic resistance to antibiotics. The treatment against M. abscessus lung disease is based on a multidrug regimen guided by the in vitro susceptibility testing results of the isolates. However, the rates of therapeutic failure and recurrence are high, suggesting a poor correlation between the in vitro result and the in vivo outcome. This study aims to determine if the incorporation of factors that mimic the host microenvironment, such as lung epithelial cells, and microorganisms that share niche with M. abscessus, such as P. aeruginosa, can influence M. abscessus response to antimicrobial treatment. Furthermore, we aim to evaluate if the treatment directed at other classic pathogens often co-isolated with M. abscessus, like P. aeruginosa, could give an adaptive advantage to M. abscessus...Fac. de MedicinaTRUEunpu

Antimicrobial treatment provides a competitive advantage to Mycobacterium abscessus in a dual-species biofilm with Pseudomonas aeruginosa

The physiological factors that contribute to Mycobacterium abscessus lung infections remain unclear. We determined whether antibiotic treatment targeting a major cystic fibrosis pathogen (i.e., Pseudomonas aeruginosa) could provide the ideal conditions for the establishment of M. abscessus infection. Our data showed that P. aeruginosa inhibited M. abscessus biofilm formation under control conditions and that antimicrobial therapy selectively targeting P. aeruginosa diminished this competitive interaction, thereby increasing M. abscessus survival