Sensitivity of the ISO 6579:2002/Amd 1:2007 standard method for detection of Salmonella spp. on mesenteric lymph nodes from slaughter pigs

The ISO 6579:2002/Amd 1:2007 (ISO) standard has been the bacteriological standard method used in the European Union for the detection of Salmonella spp. in pig mesenteric lymph nodes (MLN), but there are no published estimates of the diagnostic sensitivity (Se) of the method in this matrix. Here, the Se of the ISO (SeISO) was estimated on 675 samples selected from two populations with different Salmonella prevalences (14 farms with a =20% prevalence and 13 farms with a <20% prevalence) and through the use of latent-class models in concert with Bayesian inference, assuming 100% ISO specificity, and an invA-based PCR as the second diagnostic method. The SeISO was estimated to be close to 87%, while the sensitivity of the PCR reached up to 83.6% and its specificity was 97.4%. Interestingly, the bacteriological reanalysis of 33 potential false-negative (PCR-positive) samples allowed isolation of 19 (57.5%) new Salmonella strains, improving the overall diagnostic accuracy of the bacteriology. Considering the usual limitations of bacteriology regarding Se, these results support the adequacy of the ISO for the detection of Salmonella spp. from MLN and also that of the PCR-based method as an alternative or complementary (screening) test for the diagnosis of pig salmonellosis, particularly considering the cost and time benefits of the molecular procedure

Los sistemas defensivos del Valle Medio del Ebro durante la Primera Edad del Hierro

RESUMEN En los momentos iniciales de la Primera Edad del Hierro se atestigua la aparición de un nuevo tipo de asentamientos a lo largo del Valle Medio del Ebro, caracterizado por estar dotado de complejos sistemas defensivos. Este suceso está encuadrado dentro de un proceso de creciente desigualdad social, vinculado al contacto con agentes provenientes de fuera del ámbito peninsular. El objetivo de este trabajo es profundizar en el conocimiento de este tipo de construcciones. Para ello hemos analizado los diferentes elementos que componen estos sistemas de defensa, su posible origen y el trasfondo social de las comunidades que los erigen. Palabras clave: Bronce Final, Primera Edad del Hierro, Valle del Ebro, sistemas defensivos, influencias orientales, complejidad social. ABSTRACT On the first moments of the First Iron Age starts to appear a new kind of settlements along the Middle Ebro Valley, characterised by being provided with complex defensive systems. This event is placed in the context of a rising social inequality, associated with the contact with agents coming from outer the peninsular area. The objective of this essay is to deep into the knowledge of this kind of structures. To this end we have analysed the different items which form these defensive systems, their possible origin and the social background of the communities which build them. Key words: Late Bronze, First Iron Age, Ebro Valley, defensive systems, eastern influences, social complexity

An adaptation of meaning-centered psychotherapy integrating "essential care": A pilot study

Introduction There is a growing interest in the emotional state of cancer patients. The main objective of this pilot study is to assess the feasibility, acceptability, and preliminary efficacy of Meaning-Centered Psychotherapy and Essential Care (MCP-EC) in patients with advanced cancer compared with usual psychological support. We define "Essential Care"as the promotion of patient care and self-care through the recall of good care experiences and discussion of the concepts: responsibility, self-compassion, kindness, and attitude. Method Pilot, single-center, and prospective study of 30 patients with advanced cancer and emotional distress. Our adaptation consisted in three session Meaning-Centered Psychotherapy-Palliative Care, plus a fourth session named "Essential Care". The study was carried out in two phases. First, 20 patients were randomized to one of the two arms: individual MCP-EC (experimental, n = 10) or usual psychological supportive (control, n = 10). In a second phase, 10 patients were assigned consecutively to Group MCP-EC (n = 10). All patients were evaluated at baseline (pre-) and post-intervention with questionnaires for sociodemographic data and clinical scales. Results Nineteen patients completed the 4 sessions of MCP-EC, 9 individual format and 10 group format. Usual supportive intervention was delivered to 10 control patients. Total 28 patients completed pre- and post-treatment evaluations. There were no pre- vs. post-differences in the evaluations of the control group. In the experimental group, significant pre- vs. post-differences were found in EQ-5D-3L, HADS, FACIT, DM, HAI, SCS-SF, and TD questionnaires. These results indicated that MCP-EC reduced anxiety and depression symptoms, hopelessness, demoralization, as well as increased spiritual well-being and sense of meaning. Participants were satisfied and found the MCP-EC intervention positively. Conclusions This pilot study suggests that the MCP-EC has feasibility, acceptability, and preliminary efficacy reducing the emotional distress in advanced cancer patients. Larger studies are warranted to clarify the strengths and limitations of this psychotherapy. © The Author(s), 2021. Published by Cambridge University Press

Relationship between Salmonella infection, shedding and serology in fattening pigs in low–moderate prevalence areas

Salmonella is a major foodborne pathogen causing important zoonosis worldwide. Pigs asymptomatically infected in mesenteric lymph nodes (MLN) can be intermittent shedders of the pathogen through faeces, being considered a major source of human infections. European baseline studies of fattening pig salmonellosis are based on Salmonella detection in MLN. This work studies the relationship between Salmonella infection in MLN and intestinal content (IC) shedding at slaughter and the relationship between the presence of the pathogen and the serologic status at farm level. Mean Salmonella prevalence in the selected pigs (vertically integrated production system of Navarra, Spain) was 7.2% in MLN, 8.4% in IC and 9.6% in serum samples. In this low–moderate prevalence context, poor concordance was found between MLN infection and shedding at slaughter and between bacteriology and serology. In fact, most of shedders were found uninfected in MLN (83%) or carrying different Salmonella strains in MLN and in IC (90%). The most prevalent Salmonellae were Typhimurium resistant to ACSSuT ± Nx or ASSuT antibiotic families, more frequently found invading the MLN (70%) than in IC (33.9%). Multivariable analysis revealed that risk factors associated with the presence of Salmonella in MLN or in IC were different, mainly related either to good hygiene practices or to water and feed control, respectively. Overall, in this prevalence context, detection of Salmonella in MLN is an unreliable predictor of faecal shedding at abattoir, indicating that subclinical infections in fattening pigs MLN could have limited relevance in the IC shedding.info:eu-repo/semantics/acceptedVersio

Amino acid profile in malnourished patients with liver cirrhosis and its modification with oral nutritional supplements: Implications on minimal hepatic encephalopathy

Low plasma levels of branched chain amino acids (BCAA) in liver cirrhosis are associated with hepatic encephalopathy (HE). We aimed to identify a metabolic signature of minimal hepatic encephalopathy (MHE) in malnourished cirrhotic patients and evaluate its modification with oral nutritional supplements (ONS) enriched with ß-Hydroxy-ß-methylbutyrate (HMB), a derivative of the BCAA leucine. Post hoc analysis was conducted on a double-blind placebo-controlled trial of 43 individuals with cirrhosis and malnutrition, who were randomized to receive, for 12 weeks, oral supplementation twice a day with either 220 mL of Ensure® Plus Advance (HMB group, n = 22) or with 220 mL of Ensure® Plus High Protein (HP group, n = 21). MHE evaluation was by psychometric hepatic encephalopathy score (PHES). Compared to the HP group, an HMB-specific treatment effect led to a larger increase in Val, Leu, Phe, Trp and BCAA fasting plasma levels. Both treatments increased Fischer’s ratio and urea without an increase in Gln or ammonia fasting plasma levels. MHE was associated with a reduced total plasma amino acid concentration, a reduced BCAA and Fischer´s ratio, and an increased Gln/Glu ratio. HMB-enriched ONS increased Fischer´s ratio without varying Gln or ammonia plasma levels in liver cirrhosis and malnutrition, a protective amino acid profile that can help prevent MHE. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Efectos adversos inmunomediados gastrointestinales y hepáticos inducidos por los inhibidores del punto de control inmunitario: estudio descriptivo observacional

Introducción Los inhibidores del punto de control inmunitario (immune checkpoint inhibitors [ICI]) son fármacos eficaces en el tratamiento de diversas neoplasias. Sin embargo, se han relacionado con eventos adversos inmunomediados (EAI) gastrointestinales y hepáticos que pueden desencadenar su interrupción temporal o definitiva. Objetivo Evaluar, en condiciones de práctica real, la eficacia y la toxicidad gastrointestinal y hepática de los ICI en tratamientos oncológicos. Material y métodos Estudio retrospectivo con inclusión de pacientes con diagnóstico de neoplasia avanzada que habían recibido al menos una dosis de ICI entre mayo de 2015 y septiembre de 2018. Resultados Se incluyeron 132 pacientes con neoplasia de pulmón no microcítico (65, 15%, n = 86), melanoma (22, 7%, n = 30), carcinoma renal (9, 09%, n = 12) y otros tumores (3%, n = 4). Los fármacos empleados fueron nivolumab (n = 82), pembrolizumab (n = 28), atezolizumab (n = 13), durvalumab (n = 2), ipilimumab (n = 1) y la combinación anti-CTLA-4/PD-1 (n = 6). El 38, 6% (n = 51) desarrollaron EAI, de tipo gastrointestinal en el 12, 9% (n = 17). De ellos, el 47% (n = 8) requirieron esteroides, y un paciente precisó cirugía por perforación intestinal. En el 3, 03% (n = 4) se objetivaron EAI hepáticos grado I: el 50% (n = 2) requirieron corticoterapia y en un paciente fue preciso interrumpir el tratamiento. Entre los pacientes con tratamiento combinado, el 66, 6% (n = 4) presentaron EAI gastrointestinales. La incidencia de EAI no se relacionó con la edad, ni con el sexo, ni con la respuesta al fármaco empleado. Conclusiones Los EAI gastrointestinales figuran entre los más frecuentemente observados en pacientes en tratamiento con ICI. El manejo multidisciplinar y un mayor conocimiento de dichos eventos podrían ayudarnos a reducir su morbilidad, así como las interrupciones del tratamiento. Introduction Immune checkpoint inhibitors (ICIs) are effective agents against several malignancies. However, they are associated with gastrointestinal and liver immune-related adverse events (GI-IrAEs and LI-IrAEs), which can lead to their temporary or permanent discontinuation. Aim The aim of this study was to evaluate the efficacy and gastrointestinal and liver toxicity of ICIs in oncological treatments in actual clinical practice. Material and methods Patients with advanced cancer who received at least 1 ICI dose between May 2015 and September 2018 were retrospectively assessed. Results 132 patients with non-small cell lung cancer (65.15%, n = 86); melanoma (22.7%, n = 30); renal carcinoma (9.09%, n = 12); and other tumours (3%, n = 4) were included. The treatments administered were nivolumab (n = 82), pembrolizumab (n = 28), atezolizumab (n = 13), durvalumab (n = 2), ipilimumab (n = 1) and the antiCTLA-4/PD-1 combination (n = 6). In total, 51 patients (38.6%) developed IrAEs, 17 (12.9%) of which experienced GI-IrAEs. Of these, 8 (47%) needed steroids and 1 patient required surgery due to intestinal perforation. Grade I Li-IrAEs were observed in 4 patients (3.03%): 2 (50%) required corticosteroids and 1 patient had to discontinue treatment. Four patients (66.6%) who received combination therapy experienced GI-IrAEs. IrAE incidence were not associated with age, gender or drug response. Conclusions GI-IrAEs are one of the most common adverse events in patients receiving ICIs. A multidisciplinary approach and a greater understanding of these events could help to reduce morbidity and therapy discontinuation

SARS-CoV-2 infection induces a dual response in liver function tests: Association with mortality during hospitalization

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with abnormal liver function tests. We hypothesized that early altered liver biochemistries at admission might have different clinical relevance than subsequent changes during hospitalization. A single-center retrospective study was conducted on 540 consecutive hospitalized patients, PCR-diagnosed with SARS-CoV-2. Liver test abnormalities were defined as the elevation of either gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), or aspartate aminotransferase (AST), above the upper limit of normality set by our laboratory. Linear mixed models (LMM) evaluated longitudinal associations, incorporating all available follow-up laboratory chemistries. By the end of the follow-up period, 502 patients (94.5%) were discharged (109 (20.5%) died). A total of 319 (64.3%) had at least one abnormal liver test result at admission. More prevalent were elevated AST (40.9%) and GGT (47.3%). Abnormalities were not associated with survival but with respiratory complications at admission. Conversely, LMM models adjusted for age and sex showed that longitudinal increases during hospitalization in ferritin, GGT, and alkaline phosphatase (ALP), as well as a decreased albumin levels, were associated with reduced survival. This dual pattern of liver damage might reconcile previous conflicting reports. GGT and ALP trajectories could be useful to determine who might need more surveillance and intensive care

Economic Burden Associated with the Treatment with a Cardiovascular Polypill in Secondary Prevention in Spain: Cost-Effectiveness Results of the NEPTUNO Study

Alberto Cordero,1,2 Regina Dalmau González-Gallarza,3 Lluis Masana,4– 6 Valentín Fuster,7,8 Jose Mª Castellano,7,9,10 José Emilio Ruiz Olivar,11 Ilonka Zsolt,11 Antoni Sicras-Mainar,12 Jose Ramón González Juanatey2,13,14 1Cardiology Service, San Juan University Hospital, Alicante, Spain; 2Cardiovascular Diseases Network Research Center (CIBERCV), Madrid, Spain; 3Cardiology Service, La Paz University Hospital, Madrid, Spain; 4Sant Joan University Hospital, Vascular Medicine and Metabolism Unit, Reus, Spain; 5Pere Virgili Institute of Health Research (IISPV), Reus, Spain; 6Center for Biomedical Research Network on Diabetes and Associated Metabolic Diseases (CIBERDEM), Reus, Spain; 7National Center for Cardiovascular Research (CNIC), Carlos III Health Institute, Madrid, Spain; 8Mount Sinai Medical Center, New York, NY, USA; 9Integral Center for Cardiovascular Diseases (CIEC), Montepríncipe University Hospital, HM Hospitales Group, Madrid, Spain; 10School of Medicine, CEU San Pablo University, Madrid, Spain; 11Corporate Medical Affairs, Ferrer, Barcelona, Spain; 12Health Economics and Outcomes Research Department, Atrys Health, Madrid, Spain; 13Cardiology Service, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain; 14Santiago de Compostela Health Research Institute (IDIS), Santiago de Compostela, SpainCorrespondence: Antoni Sicras-Mainar, Atrys Health SA, Calle Príncipe de Vergara, 132, planta 1, Madrid, 28002, Spain, Tel +34 917 819 465, Fax +34 915 776 744, Email [email protected]: The aim of this study was to estimate health-care resources utilization, costs and cost-effectiveness associated with the treatment with CNIC-Polypill as secondary prevention of atherosclerotic cardiovascular disease (ASCVD) compared to other treatments, in clinical practice in Spain.Patients and Methods: An observational, retrospective study was performed using medical records (economic results [healthcare perspective], NEPTUNO-study; BIG-PAC-database) of patients who initiated secondary prevention between 2015 and 2018. Patients were followed up to 2 years (maximum). Four cohorts were balanced with a propensity-score-matching (PSM): 1) CNIC-Polypill (aspirin+atorvastatin+ramipril), 2) Monocomponents (same separate drugs), 3) Equipotent (equipotent drugs) and 4) Other therapies ([OT], other cardiovascular drugs). Incidence of cardiovascular events, health-care resources utilization and healthcare and non-healthcare costs (2020 Euros) were compared. Incremental cost-effectiveness ratios per cardiovascular event avoided were estimated.Results: After PSM, 1614 patients were recruited in each study cohort. The accumulated incidence of cardiovascular events during the 24-month follow-up was lower in the CNIC-Polypill cohort vs the other cohorts (19.8% vs Monocomponents: 23.3%, Equipotent: 25.5% and OT: 26.8%; p< 0.01). During the follow-up period, the CNIC-Polypill cohort also reduced the health-care resources utilization per patient compared to the other cohorts, particularly primary care visits (16.6 vs Monocomponents: 18.7, Equipotent: 18.9 and OT: 21.0; p< 0.001) and hospitalization days (2.3 vs Monocomponents: 3.4, Equipotent: 3.7 and OT: 4.0; p< 0.001). The treatment cost in the CNIC-Polypill cohort was lower than that in the other cohorts (€ 4668 vs Monocomponents: € 5587; Equipotent: € 5682 and OT: € 6016; p< 0.001) (Difference: -€ 919, -€ 1014 and -€ 1348, respectively). Due to the reduction of cardiovascular events and costs, the CNIC-Polypill is a dominant alternative compared to the other treatments.Conclusion: CNIC-Polypill reduces recurrent major cardiovascular events and costs, being a cost-saving strategy as secondary prevention of ASCVD.Keywords: secondary prevention, cardiovascular events, use of healthcare resources, healthcare costs, Spain, CNIC-polypil