Can an aerobic exercise programme improve the response of the growth hormone in fibromyalgia patients? a randomised controlled trial

Downgrade alterations in the growth hormone (GH) might be involved in the development of some of the fibromyalgia syndrome (FMS) symptoms. Our aim was to assess the effects of an aerobic exercise programme on the GH levels in patients with FMS. A randomised controlled trial was developed. Sixty-four Spanish women with FMS were randomly assigned to the experimental arm (n = 33) and treated with a 16-week group physical exercise programme based on low impact aerobic dance (three weekly sessions, one-hour each), or to the treatment-as-usual (TAU) control arm (n = 31). The primary outcome was the GH response to acute exercise. Secondary outcomes were GH basal, sensitivity to pain, body composition, aerobic capacity, and quality of life. The ANCOVA results showed a moderate effect of treatment improving the GH response to acute exercise. Other effects were substantial for aerobic capacity, quality of life, and body composition. Pre-intervention GH response to acute exercise was related to improvements in aerobic capacity and quality of life. An aerobic exercise programme may improve the response of the GH, aerobic capacity, body composition, and quality of life in women with FMS. The normalization of neuro-hormonal patterns involving the GH might be key for improving some FMS symptoms

Characterization of plasmid-mediated beta-lactamases in fecal colonizing patients in the hospital and community setting in Spain

Aim: Active surveillance of plasmid-mediated ß-lactamase-producing Enterobacteriaceae (PMBL-E) in fecal carriers in the hospital and in the community setting in a non-outbreak period of time. Methods: Patients were screened for carriage of Enterobacteriaceae resistant to expanded-spectrum cephalosporins and PMBL-E were characterized (extended-spectrum-ß-lactamase [ESBL], plasmid-mediated AmpC ß-lactamase [pAmpC], and carbapenemases) by PCR and sequencing. Results: The prevalence of ESBL and pAmpC carriers was 5.06% and 0.59%, respectively. Overall, CTX-M-like enzymes were the ESBL dominate enzymes (96.15%). The group CTX-M-9 was the most prevalent (81, 54%) [CTX-M-14 (74, 91.35%), CTX-M-9 (5, 6.17%), CTX-M-24 (1, 1.23%), and CTX-M-27 (1, 1.23%)] followed by the group CTX-M-1 (64, 42.67%) [CTX-M-15 (42, 65.63%), CTX-M-1 (13, 20.31%), CTX-M-32 (8, 12.5%), and CTX-M-3 (1, 1.56%)]. One CTX-M-10, one CTX-M-59, and three CTX-M-8 were also found. A very small representation of SHV or TEM ESBL enzymes was found (3.2% and 0.64%, respectively). pAmpC characterization revealed a predominance of CMY-2 (81.25%), followed by DHA-1 (18.75%). We did not detect the presence of carbapenemase producers. Conclusions: The prevalence of ESBL-producers from fecal carriers is stable in our area, but colonization by pAmpC producers has emerged recently as we have confirmed. Periodic active surveillance is useful to identify these human reservoirs and control the evolution of PMBL carriage in a community over time

Respuesta de hipersensibilidad retardada en pacientes candidatos a artroplastia de cadera

Se estudiaron 100 pacientes escogidos de manera aleatoria de entre los candidatos a artroplastia de cadera (47 por fractura subcapital de fémur Garden IV, y 53 por coxartrosis). En el momento del ingresos se determinaron en sangre niveles de albúmina, proteínas totales y hemoglobina; y se midió la respuesta de hipersensibilidad retardada mediante la inoculación de siete antígenos de memoria con un aplicador Multitest® (Mérieux). La lectura de la reacción de induración se realizó a las 48 horas. Los pacientes fueron clasificados en: normoérgicos (+) a dos o más antígenos) y anérgicos (una o ninguna respuesta (+). La población normoérgica representó el 61% de los pacientes, con una edad 12,5 años menor que la población anérgica (p<0,001). Los pacientes normoérgicos presentaron cifras significativamente más altas de hemoglobina (p<0,001), proteínas totales (p<0,05) y albúmina (p<0,001). La situación de anergia fue más frecuente en el grupo de mujeres (29/57) frente al de hombres (10/43; p<0,001), y en el grupo de fracturas subcapitales (31/47) que en el de coxartrosis (8/53) (p<0,001). No se hallaron relaciones estadísticamente significativas entre los distintos parámetros estudiados y la aparición de infección en el postoperatorio. Las diferencias aparecidas reflejan alteraciones en la respuesta inmunológica que, sin embargo, no resultan pronósticas frente a la aparición de infección en nuestra serie.One hundred candidates for hip arthroplasty were chosen at random (47 Garden IV femoral neck fractures, and 53 osteoarthrosis). Before surgery, serum albumin, total proteins and haemoglobin were determined in peripheral blood. All patients were skin tested with seven memory antigens (Multitest®, Mérieux) in order to measure the delayed hypersensitivity response. The diameter of the resulting induration was measured 48 hours after injection. Patients were classified as reactive if they responded to one antigen or showed no response. Reactive patients supposed 61% of total, and anergic patients were 12,5 years older (p<0,001). Levels of haemoglobin (p<0,001), total proteins (p<0,05) and albumin (p<0,001) were higher in reactive patients. Anergy was more frequent in women (29/57) than in men (10/43; p<0,001), and in fractures (31/47) than in osteoarthrosis (8/53) (p<0,001). No association between the variables studied and postoperative infection was found. These differences show immunologic alterations. However, they have no prognostic value for postoperative infection in hip arthroplasty patients

Antimicrobial resistance, virulence factorsand genetic lineages of hospital-onsetmethicillin-resistant Staphylococcus aureus isolates detected in a hospital in Zaragoza

Introduction MRSA population dynamics is undergoing significant changes, and for this reason it is important to know which clones are circulating in our nosocomial environment. Materials and methods A total of 118 MRSA isolates were collected from clinical samples from patients with previous hospital or healthcare contact (named as hospital-onset MRSA (HO-MRSA)) during a one year period. Susceptibility testing was performed by disk diffusion and microdilution. The presence of resistance genes and virulence factors were tested by PCR. All isolates were typed by SCCmec, spa and agr typing. PFGE and MLST were applied to a selection of them. Results Eighty-three HO-MRSA isolates (70.3%) were resistant to any antibiotic included in the macrolide–lincosamide–streptogramin B group. Among these isolates, the M phenotype was the most frequent (73.5%). One hundred and seven of HO-MRSA isolates (90.7%) showed aminoglycoside resistance. The combination aac(6')-Ie-aph(2")-Ia + ant(4')-Ia genes was the most frequent (22.4%). Tetracycline resistance rates in HO-MRSA isolates were low (3.4%), although a high level of mupirocin resistance was observed (25.4%). Most of the HO-MRSA isolates (approximately 90%) showed SCCmec type IVc and agr type II. Fifteen unrelated pulsotypes were identified. CC5 was the most prevalent (88.1%), followed by CC8 (5.9%), CC22 (2.5%), CC398 (2.5%) and CC1 (0.8%). Conclusion CC5/ST125/t067 lineage was the most frequent. This lineage was related to aminoglycoside resistance, and to a lesser extent, with macrolide resistance. The presence of international clones as EMRSA-15 (CC22/ST22), European clones as CC5/ST228, community clones related to CC1 or CC8 and livestock associated clones, as CC398, were observed in a low percentage

Mechanisms of linezolid resistance among enterococci of clinical origin in Spain—detection of optrA-and cfr(D)-carrying E. faecalis

The mechanisms of linezolid resistance among 13 E. faecalis and 6 E. faecium isolates, recovered from six Spanish hospitals during 2017–2018, were investigated. The presence of acquired linezolid resistance genes and mutations in 23S rDNA and in genes encoding for ribosomal proteins was analyzed by PCR and amplicon sequencing. Moreover, the susceptibility to 18 antimicrobial agents was investigated, and the respective molecular background was elucidated by PCR-amplicon sequencing and whole genome sequencing. The transferability of the linezolid resistance genes was evaluated by filter-mating experiments. The optrA gene was detected in all 13 E. faecalis isolates; and one optrA-positive isolate also carried the recently described cfr(D) gene. Moreover, one E. faecalis isolate displayed the nucleotide mutation G2576T in the 23S rDNA. This mutation was also present in all six E. faecium isolates. All linezolid-resistant enterococci showed a multiresistance phenotype and harbored several antimicrobial resistance genes, as well as many virulence determinants. The fexA gene was located upstream of the optrA gene in 12 of the E. faecalis isolates. Moreover, an erm(A)-like gene was located downstream of optrA in two isolates recovered from the same hospital. The optrA gene was transferable in all but one E. faecalis isolates, in all cases along with the fexA gene. The cfr(D) gene was not transferable. The presence of optrA and mutations in the 23S rDNA are the main mechanisms of linezolid resistance among E. faecalis and E. faecium, respectively. We report the first description of the cfr(D) gene in E. faecalis. The presence of the optrA and cfr(D) genes in Spanish hospitals is a public health concern

Los centros de fitness de la ciudad de Zaragoza

El objetivo de este trabajo es describir de forma detallada las características de los centros de fitness de la ciudad de Zaragoza (España). Un total de 19 centros participaron en el estudio y sus direcciones técnicas o equipos de coordinación, previo contacto telefónico, cumplimentaron un cuestionario creado al efecto, utilizando la herramienta Google Drive. Entre las variables del estudio se encuentran la superficie de los centros, antigüedad, número de trabajadores, cuota mensual, actividades ofertadas, actividades preferidas por los usuarios, tipos de sala de entrenamiento, realización de valoraciones funcionales o adaptación para personas con discapacidad

Penicillin susceptibility among invasive MSSA infections: a multicentre study in 16 Spanish hospitals

Objectives: To determine the prevalence of penicillin susceptibility among MSSA causing bloodstream infections (BSIs) in 16 Spanish hospitals and to characterize the penicillin-susceptible MSSA (MSSA-PENS) isolates. Methods: A total of 1011 Staphylococcus aureus isolates were collected from blood cultures in 16 Spanish hospitals during 2018–19 (6–12 months) and their susceptibility to 18 antimicrobials was determined. The MSSA-PENS isolates were selected and examined by PCR to determine the presence of the blaZ gene, other resistance genes and the genes lukF/lukS-PV, eta, etb and tst. The immune evasion cluster (IEC) type was also analysed. All the MSSA-PENS isolates were submitted to S. aureus protein A (spa) typing and the clonal complexes (CCs) were assigned according to their spa type. Results: The prevalence of MSSA was 74.6% (754/1011) and 14.9% (151/1011) were MSSA-PENS-blaZnegative. MSSA-PENS-blaZnegative isolates (n = 151) were ascribed to 88 spa types and 11 CCs. The most frequent CCs were CC5 (35/151) and CC398 (25/151), with t002-CC5 and t571-CC398 being the most common lineages. Pan-susceptibility was identified in 117 of the 151 MSSA-PENS-blaZnegative isolates (77.5%). In the remaining isolates, erythromycin and clindamycin resistance was the most frequent resistance found, although tobramycin, ciprofloxacin, fusidic acid, mupirocin and/or tetracycline resistance was also detected. Thirty-eight MSSA-PENS-blaZnegative isolates were IEC negative and four isolates were Panton–Valentine leucocidin (‘PVL’) positive. Conclusions: A high penicillin susceptibility rate was detected among MSSA, opening therapeutic opportunities for BSIs. The emergence of new successful MSSA-PENS clones could be responsible for these data. The detection among MSSA-PENS-blaZnegative isolates of the clonal lineage CC398 or the absence of an IEC raises questions about their possible animal origin, requiring further analysis

El gen tpi como herramienta en los estudios epidemiolo´gicos de la giardiosis

Giardia duodenalis es un protozoo que causa infección en humanos y animales, que se puede transmitir por vía hídrica, de persona a persona o por contacto con animales, siendo una de las infecciones intestinales más frecuentes en nuestro país, por lo que supone una preocupación de Salud Pública. Su estudio epidemiológico, requiere la caracterización molecular de los parásitos, utilizando genes con gran variabilidad como el que codifica la triosafosfatoisomerasa (tpi) y analizando la homología entre aislamientos. El objetivo del trabajo es establecer el criterio de identidad que permita la comparación epidemiológica de los aislamientos de Giardia. Se recogieron 2-3 muestras de heces en días alternos, de 26 pacientes con giardiosis. Tras la extracción de ADN, se amplificaron por técnicas de PCR, un fragmento del gen tpi y un fragmento del gen de la beta-giardina (bg), que se utilizó como comparación. Los fragmentos obtenidos fueron secuenciados y las secuencias analizadas con los programas BioEdit y DnaSP v.5.0. Las secuencias del gen tpi mostraron una elevada divergencia, con valores de diversidad ¿ entre 0 y 0, 21219. La aparición de picos múltiples en el cromatograma, indicaron la presencia de varios clones en la misma muestra. Las diferencias entre aislamientos del mismo paciente fueron iguales o mayores que las encontradas para el conjunto de todas las muestras. La variabilidad del gen tpi no permite establecer unos criterios de identidad, necesarios para la identificación de aislamientos. Las infecciones mixtas intragenotipo ocurren de una forma muy frecuente, sugiriendo una implicación de la vía ambiental como principal fuente de transmisión o una variación genética muy elevada. Giardia duodenalis is a protozoon that causes infection in humans and animals. It can be transmitted by contaminated water, from person to person or by contact with animals; it being the cause one of the most common intestinal infections in our country, so it is a public health concern. The epidemiological study thereof requires the molecular characterization of parasites, using genes with great variability, such as the one that codes triosephosphate isomerase (tpi), and analizing the homology between isolates. The purpose of this work is to establish the identity criterion for epidemiological comparison of Giardia isolates. 2-3 stool samples were collected in alternate days from 26 patients with giardiasis. After DNA extraction, a fragment of the tpi gene and a fragment of the beta-giardin (bg) gene-used for comparison purposes-were amplified by means of PCR techniques. The obtained fragments were sequenced and the sequences analyzed with the BioEdit and DnaSP v.5.0 software. The tpi gene sequences showed a high divergence, with values of diversity ¿ ranging from 0 to 0.21219. The appearance of multiple peaks in the chromatogram points to the presence of various clones in the same sample. The differences between isolates from the same patient where equal or higher than those found for the collection of all samples. The variability of the tpi gene does not allow identity criteria to be established, which are necessary for isolate identification. Mixed intragenotype infections occur very frequently, which suggests the environmental path is the principal path of transmission and/or there is very high genetic variability

Granzyme A inhibition reduces inflammation and increases survival during abdominal sepsis

Aims: Peritonitis is one of the most common causes of sepsis, a serious syndrome characterized by a dysregulated systemic inflammatory response. Recent evidence suggests that Granzyme A (GzmA), a serine protease mainly expressed by NK and T cells, could act as a proinflammatory mediator and could play an important role in the pathogenesis of sepsis. This work aims to analyze the role and the therapeutic potential of GzmA in the pathogenesis of peritoneal sepsis. Methods: The level of extracellular GzmA as well as GzmA activity were analyzed in serum from healthy volunteers and patients with confirmed peritonitis and were correlated with the Sequential Organ Failure Assessment (SOFA) score. Peritonitis was induced in C57Bl/6 (WT) and GzmA-/- mice by cecal ligation and puncture (CLP). Mice were treated intraperitoneally with antibiotics alone or in combination serpinb6b, a specific GzmA inhibitor, for 5 days. Mouse survival was monitored during 14 days, levels of some proinflammatory cytokines were measured in serum and bacterial load and diversity was analyzed in blood and spleen at different times. Results: Clinically, elevated GzmA was observed in serum from patients with abdominal sepsis suggesting that GzmA plays an important role in this pathology. In the CLP model GzmA deficient mice, or WT mice treated with an extracellular GzmA inhibitor, showed increased survival, which correlated with a reduction in proinflammatory markers in both serum and peritoneal lavage fluid. GzmA deficiency did not influence bacterial load in blood and spleen and GzmA did not affect bacterial replication in macrophages in vitro, indicating that GzmA has no role in bacterial control. Analysis of GzmA in lymphoid cells following CLP showed that it was mainly expressed by NK cells. Mechanistically, we found that extracellular active GzmA acts as a proinflammatory mediator in macrophages by inducing the TLR4-dependent expression of IL-6 and TNFa. Conclusions: Our findings implicate GzmA as a key regulator of the inflammatory response during abdominal sepsis and provide solid evidences about its therapeutic potential for the treatment of this severe pathology