Carbapenem-resistant Citrobacter spp. isolated in Spain from 2013 to 2015 produced a variety of carbapenemases including VIM-1, OXA-48, KPC-2, NDM-1 and VIM-2

Objectives: There is little information about carbapenemase-producing (CP) Citrobacter spp.We studied the molecular epidemiology and microbiological features of CP Citrobacter spp. isolates collected in Spain (2013-15). Methods: In total, 119 isolates suspected of being CP by the EUCAST screening cut-off values were analysed. Carbapenemases and ESBLs were characterized using PCR and sequencing. The genetic relationship among Citrobacter freundii isolates was studied by PFGE. Results: Of the 119 isolates, 63 (52.9%) produced carbapenemases, of which 37 (58.7%) produced VIM-1, 20 (31.7%) produced OXA-48, 12 (19%) produced KPC-2, 2 (3.2%) produced NDM-1 and 1 (1.6%) produced VIM- 2; 9 C. freundii isolates co-produced VIM-1 plus OXA-48. Fourteen isolates (22.2%) also carried ESBLs: 8 CTX-M-9 plus SHV-12, 2 CTX-M-9, 2 SHV-12 and 2 CTX-M-15. Fifty-seven isolates (90.5%) were C. freundii, 4 (6.3%) were Citrobacter koseri, 1 (1.6%) was Citrobacter amalonaticus and 1 (1.6%) was Citrobacter braakii. By EUCAST breakpoints, eight (12.7%) of the CP isolates were susceptible to the four carbapenems tested. In the 53 CP C. freundii analysed by PFGE, a total of 44 different band patterns were observed. Four PFGE clusters were identified: cluster 1 included eight isolates co-producing VIM-1 and OXA-48; blaVIM-1 was carried in a class 1 integron (intI-blaVIM-1 - aacA4-dfrB1-aadA1-catB2-qacE¿1/sul1) and blaOXA-48 was carried in a Tn1999.2 transposon. Conclusions: We observed the clonal and polyclonal spread of CP Citrobacter spp. across several Spanish geographical areas. Four species of Citrobacter spp. produced up to five carbapenemase types, including coproduction of VIM-1 plus OXA-48. Some CP Citrobacter spp. isolates were susceptible to the four carbapenems tested, a finding with potential clinical implications

Relationship between GH/IGF-1 Axis, graft recovery, and early survival in patients undergoing liver transplantation

High levels of IGF-1 have been reported in patients with initial poor function of the graft after liver transplantation (LT). Correlation with other clinical variables or early survival has not been extensively investigated

Standard bowel cleansing is highly ineffective in cirrhotic patients undergoing screening colonoscopy

Few data are available on tolerability and quality of standard bowel cleansing for colonoscopy in patients with chronic disease

Relating the ultrasonic and aerosol filtration properties of filters

Abstract Non-contact methods are useful to improve the quality control of particle filtration media. The purpose of this paper is to investigate the correlation between the filtration efficiency of a porous sheet and its ultrasonic properties obtained using a non-contact technique. An air-coupled ultrasonic technique is used to obtain rapid measurements without affecting the integrity of the material. High frequencies (from 0.1 to 2.5 MHz) are used to improve technique sensitivity, and transmitted waves are measured to probe the internal properties of the material. Measurements of transmission coefficient spectra (amplitude and phase) and the corresponding ultrasound velocity and attenuation coefficient at different frequencies are obtained for a set of filtration media with well-characterized properties. Results show that the ultrasonic properties of filtration media vary as a function of basis weight, and therefore filtration efficiency, for a given charge state. However, the effect of electrostatic charge on ultrasonic propagation is almost negligible, as expected. We conclude that ultrasonic transmission may provide a valuable tool for the continuous online monitoring of material quality during fabrication and as a method to tease apart mechanical and electrostatic contributions to particle filtration

Evaluación de un protocolo para el diagnóstico y tratamiento de los trastornos inflamatorios temporomandibulares

Los trastornos inflamatorios de la articulación temporomandibular se caracterizan por un dolor profundo y continuo en el área articular, que se acentúa generalmente a la función y puede llegar a producir efectos de excitación central secundarios. Se realizó un estudio cuasi-experimental en 29 pacientes mayores de 15 años con trastornos inflamatorios temporomandibulares, en la Clínica de Especialidades Estomatológicas de Bayamo, provincia Granma, desde enero a julio de 2014, con el propósito de evaluar los resultados de la aplicación de un protocolo para el diagnóstico y tratamiento de los trastornos inflamatorios temporomandibulares. Se evaluaron algunas variables de interés, tales como: intensidad del dolor, presencia de dolor articular espontáneo, a la palpación, durante los movimientos, así como dolor muscular asociado y restricción al movimiento de apertura. A los datos obtenidos se les realizó análisis estadístico. A los tres meses de evolución hubo un incremento estadísticamente significativo (p<0,05) del número de pacientes sin dolor y una reducción del número de pacientes con restricción al movimiento de apertura bucal. El protocolo de tratamiento resultó efectivo, pues se logró reducir el dolor e incrementar el rango de apertura bucal en más del 70 % de los pacientes tratado

Chest X-ray at admission of a patient with pneumonia by <i>L</i>. <i>anisa</i>.

<p>Radiological signs showed an infiltrate to right lung base (arrow) and a bilateral interstitial pattern.</p