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ABSTRACT: Methane is a potent greenhouse gas produced during the ruminal fermentation and is associated with a loss of feed energy. Therefore, efforts to reduce methane emissions have been ongoing in the last decades. Methane production is highly influenced by factors such as the ruminal microbiome and host genetics. Previous studies have proposed to use the ruminal microbiome to reduce long-term methane emissions, as ruminal microbiome composition is a moderately heritable trait and genetic improvement accumulates over time. Lactation stage is another important factor that might influence methane production, but potential associations with the ruminal microbiome have not been evaluated previously. This study sought to examine the changes in ruminal microbiome over the lactation period of primiparous Holstein cows differing in methane intensity (MI) and estimate the heritability of the abundance of relevant microorganisms. Ruminal content samples from 349 primiparous Holstein cows with 14 to 378 DIM were collected from May 2018 to June 2019. Methane intensity of each cow was calculated as methane concentration/milk yield. Up to 64 taxonomic features (TF) from 20 phyla had a significant differential abundance between cows with low and high MI early in lactation, 16 TF during mid lactation, and none late in lactation. Taxonomical features within the Firmicutes, Proteobacteria, Melainabacteria, Cyanobacteria, Bacteroidetes, and Actinobacteria phyla were associated with low MI, whereas eukaryotic TF and those within the Euryarchaeota, Verrucomicrobia, Kiritimatiellaeota, and Lentisphaerae phyla were associated with high MI. Out of the 60 TF that were found to be differentially abundant between early and late lactation in cows with low MI, 56 TF were also significant when cows with low and high MI were compared in the first third of the lactation. In general, microbes associated with low MI were more abundant early in lactation (e.g., Acidaminococcus, Aeromonas, and Weimeria genera) and showed low to moderate heritabilities (0.03 to 0.33). These results suggest some potential to modulate the rumen microbiome composition through selective breeding for lower MI. Differences in the ruminal microbiome of cows with extreme MI levels likely result from variations in the ruminal physiology of these cows and were more noticeable early in lactation, probably due to important interactions between the host phenotype and environmental factors associated with that period. Our results suggest that the ruminal microbiome evaluated early in lactation may be more precise for MI difference, and hence, this should be considered to optimize sampling periods to establish a reference population in genomic selection scenarios.

Diabetes Mellitus (DM) is emerging as a global concern, affecting people from early ages to adulthood and positioning itself as one of the leading causes of mortality worldwide. The post-COVID-19 era has been characterized by notable progress in the domains of medicine, science, and engineering, creating a favorable atmosphere for the investigation of innovative solutions. The present manuscript aims to investigate the problem of glucose regulation in adults diagnosed with Type 1 Diabetes mellitus (T1D) using a two-degree-of-freedom robust controller technique. A physiological mathematical model involving individuals with T1D serves as the foundation for the proposed closed-loop technique. The control algorithm approach successfully maintains safe glycemic levels in a virtual population of 10 adults using a sophisticated, well-known physiological T1D simulator. We evaluated this with continuous 24-hour simulations. Simulation results support the practicality of the presented approach, and we further validate it using a statistical analysis that incorporates a probability density function and control variability grid analysis (CVGA). Despite being a theoretical and simulation-based methodology, the results of this study demonstrate promise, offering promising opportunities for developments in the field of artificial pancreas technology using Mexican technology.

ABSTRACT: The Resilient Dairy Genome Project (RDGP) is an international large-scale applied research project that aims to generate genomic tools to breed more resilient dairy cows. In this context, improving feed efficiency and reducing greenhouse gases from dairy is a high priority. The inclusion of traits related to feed efficiency (e.g., dry matter intake [DMI]) or greenhouse gases (e.g., methane emissions [CH4]) relies on available genotypes as well as high quality phenotypes. Currently, 7 countries (i.e., Australia, Canada, Denmark, Germany, Spain, Switzerland, and United States) contribute with genotypes and phenotypes including DMI and CH4. However, combining data are challenging due to differences in recording protocols, measurement technology, genotyping, and animal management across sources. In this study, we provide an overview of how the RDGP partners address these issues to advance international collaboration to generate genomic tools for resilient dairy. Specifically, we describe the current state of the RDGP database, data collection protocols in each country, and the strategies used for managing the shared data. As of February 2022, the database contains 1,289,593 DMI records from 12,687 cows and 17,403 CH4 records from 3,093 cows and continues to grow as countries upload new data over the coming years. No strong genomic differentiation between the populations was identified in this study, which may be beneficial for eventual across-country genomic predictions. Moreover, our results reinforce the need to account for the heterogeneity in the DMI and CH4 phenotypes in genomic analysis.

AISI 316L stainless steel lattices were manufactured using two distinct Laser Powder Bed Fusion (LPBF) techniques: a commercial printer equipped with a fiber laser and a novel system equipped with a CO2 laser. Fiber laser systems produce parts exhibiting superior detail, finer cell size, and lower porosity compared to CO2 laser ones because of the stability of the laser beam and the higher absorptivity of the laser light by the material powder. Electrochemical tests indicated that lattices exhibited inferior corrosion resistance compared to solid counterparts for both manufacturing techniques. This disparity is caused by the distinct corrosion mechanisms exhibited by lattices and solid parts, as observed through Electrochemical Impedance Spectroscopy (EIS). The observed differences are attributed not only to the increased different specific surface areas but also to the distinctive morphologies formed in the material beneath the surface. CO2 LPBF lattices demonstrated higher corrosion sensitivity than the fiber LPBF lattices due to their distinct microstructure and the more prevalent presence of defects.

ABSTRACT: Objectives: Information is scarce on clinical experiences with non-neutropenic patients with invasive fungal infection (IFI) receiving isavuconazole. We aimed to report the safety and effectiveness of this drug as a first-line treatment or rescue in real life. Methods: A retrospective, observational multicentric study of non-neutropenic patients who received isavuconazole as an IFI treatment at 12 different university hospitals (January 2018-2022). All patients met criteria for proven, probable or possible IFI according to EORTC-MSG. Results: A total of 238 IFIs were treated with isavuconazole during the study period. Combination therapy was administered in 27.7% of cases. The primary IFI was aspergillosis (217, 91.2%). Other IFIs treated with isavuconazole were candidemia (n = 10), mucormycosis (n = 8), histoplasmosis (n = 2), cryptococcosis (n = 2), and others (n = 4). Median time of isavuconazole treatment was 29 days. Only 5.9% (n = 14) of cases developed toxicity, mainly hepatic-related (10 patients, 4.2%). Nine patients (3.8%) had treatment withdrawn. Successful clinical response at 12 weeks was documented in 50.5% of patients. Conclusion: Isavuconazole is an adequate treatment for non-neutropenic patients with IFIs. Toxicity rates were low and its effectiveness was comparable to other antifungal therapies previously reported.

Multi-host communities are perfect scenarios for the emergence and spread of pathogens, threatening the recovery of endangered, isolated, or inbred populations, such as the brown bear (Ursus arctos) in northwestern Spain. The population recovery in recent years has forced bears to occupy highly anthropized areas, increasing their interaction with human and domestic animals, with potential consequences for global health. During 2022–2023 a survey of parasites, bacteria and viruses shared between wildlife, domestic animals and humans was performed in this population using non-invasive surveillance, i.e., bear fecal samples (n = 73) and sponge-based sampling of trees (n = 42; 14 rubbed trees and 28 control trees). Pathogen detection rates were defined as the percentage of qPCR or culture-positive samples. Generalized linear models were fitted to assess their relationship with environmental variables including dispersion of the human population, and percentage of agricultural and periurban habitats in a 6 km-buffer around each sample. Canine Adenovirus type 1 (45.2%), Giardia spp. (15.1%), Salmonella spp. (12.3%), and extended-spectrum-beta-lactamases (ESBL) Escherichia coli (1.4%) were identified in fecal samples. In contrast, only five sponges from three rubbed and two control trees resulted positive to E. coli (14.3%). The results suggest that several pathogens are common in the Cantabrian brown bear population and that anthropization of the territory modulates their prevalence and richness.The effective design of management programs for bear conservation will require a one-health approach, in which genetic analysis of non-invasive samples can be key tools for the sanitary surveillance at the wildlife-livestock-human interface.

Small specimen testing technology (SSTT) refers to the examination of tiny samples of materials to evaluate their suitability for use in fusion reactors. This includes assessing their thermal, mechanical, and radiation properties, as well as their ability to withstand extreme conditions. SSTT plays a critical role in the development of nuclear fusion technology, which holds the potential to provide a virtually limitless and clean energy source. SSTT is imperative in cases where not much material is available or must be subjected to special conditions that limit it.One of the main challenges in nuclear fusion is the development of materials that can withstand the harsh environment inside a fusion reactor. These materials must be able to withstand high temperatures, intense radiation, and mechanical stress, and be able to maintain their structural integrity for long periods. Small specimen testing allows characterizing and evaluating these properties in a controlled and efficient manner.Small specimen samples, under conditions similar to those in a fusion reactor, will provide crucial information for the design and development of fusion components when irradiated at IFMIF- DONES. The results of SSTT are used to refine materials, optimize production processes, and develop new materials with improved properties.In this work, numerous tensile tests (SSTT) have been carried out on pure copper, a material of interest for fusion with different thicknesses, analyzing the effect of the variation of this variable in the determination of mechanical properties.

Diabetes mellitus, known as diabetes, is a chronic disease that affects the control of blood glucose concentration levels, it is a disease that mostly affects adults (type 2 diabetes), but it can also occur in children (type 1 or childhood diabetes), as well as in pregnant women (gestational diabetes). Diabetes is one of the diseases with the highest prevalence and high mortality worldwide. Diabetes has no cure, but continuous monitoring to maintain blood glucose levels in normal ranges reduces the possibility of suffering from gastrointestinal problems, vision loss, limb amputations (such as diabetic foot) and damage to vital organs such as the heart and kidneys, among other associated complications. This article compares the results in glucose estimation by using a linear, quadratic and cubic regression considering the electrical characteristics generated in the cardiac conduction (HR, HRV, T-wave peak, and QT interval) recorded on a single-lead electrocardiogram (VII), used as a non-invasive blood glucose estimation model. The best estimate was obtained using a cubic regression. The validation was performed using the Clarke grid having 77.78 % of data in the A zone and 22.22 % in the B zone and a Pearson correlation value of 0.94103 in the cubic regression.

The Mediterranean Sea is one of the most vulnerable ecosystems in the world due to the variety and severity of cumulative impacts faced, including high climate risk. Species distributions are expected to track climate niches in response to warming, with meridionalization (i.e. northern spread of native warm-water species) as a common documented response. However, the Mediterranean environment is also highly heterogeneous and structured at regional scales, constraining generalized species responses. Based on long-term monitoring data of demersal communities in the Western Mediterranean (1994–2019), we calculated seven indicators characterizing the space–time patterns of multiple species distributions and their temporal rates of change. Simultaneously, we computed climate velocity based on the space–time variation of sea surface temperature. Subsequently, we modeled the space–time patterns of species distributions as response to climate velocity, taking into account the species’ temperature and depth preferences. Contrary to the generalized northward expectation as a consequence of communities’ meridionalization, a large number of species have shifted their distributions toward the south and southwest to higher and medium r climate velocity values and averaged warmer conditions. In general, cold-water species with an affinity for low and moderate mean temperature and wide and narrow temperature ranges were better at tracking climate velocity. Furthermore, species distributed over the continental shelf shifted towards shallower and inshore waters in response to high climate velocity, as opposed to shallower waters further away and contrary to a priori expectations of shifts towards deeper waters, following the bathymetric gradient. The ranges of dispersion and the spatial heterogeneity of these species expanded, although not explicitly in response to climate velocity, suggesting additional synergistic drivers. Our results confirm the importance of climate velocity as a useful metric for predicting species responses at sub-regional levels and provide information on expected species responses at the scales required for embracing regional to local management measures.

Background: Pediatric COVID-19 patients have lower rates of hospitalization and fatal outcomes compared to adults with COVID-19; however, children represent a challenge in the detection, diagnosis, and treatment of COVID-19. Our aim was to determine the risk factors for hospital admission, invasive mechanical ventilation, and mortality in pediatric COVID-19 patients in Mexico during the COVID-19 pandemic. Material and methods: A retrospective cohort of pediatric patients with COVID-19 from February 2020 to April 2021 was reported on the National Epidemiological Surveillance System for Viral Respiratory Disease (SISVER) platform. Results: Among the 104,133 patients included in our study, 6214 were hospitalized, and 621 patients underwent invasive mechanical ventilation. A total of 0.65 % died during hospitalization. Children aged

Betablockers (BBs) are prescribed for ischaemia in patients with acute coronary syndrome (ACS). In Spain, bisoprolol and carvedilol are the most prescribed BBs, but patients often had to discontinue them due to adverse effects. Single nucleotide polymorphisms (SNPs) in ADRB1, ADRB2 and CYP2D6 genes have strong evidence of pharmacogenetic association with BBs in heart failure or hypertension, but the evidence in ACS is limited. Therefore, our study focuses on investigating how these genes influence the response to BBs in ACS patients. We analysed the association between SNPs in ADRB1 Gly389Arg (rs1801253) and Ser49Gly (rs1801252), ADRB2 Gly16Arg (rs1042713) and Glu27Gln (rs1042714), and CYP2D* 6 (*2– rs1080985, *4- rs3892097, *10 – rs1065852) and the occurrence of bradycardia/hypotension events during one year of follow-up. We performed an observational study and included 285 ACS-PCI-stent patients. A first analysis including patients treated with bisoprolol and a second analysis including patients treated with other BBs were performed. We found that the presence of the G allele (Glu) of the ADRB2 gene (rs1042714; Glu27Gln) conferred a protective effect against hypotension-induced by BBs; OR (CI 95%) = 0,14 (0,03−0,60), p

ABSTRACT: Objectives: Vaccination has been effective in ameliorating the impact of COVID-19. Here, we report vaccine effectiveness (VE) of the nationally available COVID-19 vaccines in Mexico. Methods: Retrospective analysis of a COVID-19 surveillance system to assess the VE of the BNT162b2, messenger RNA (mRNA)-12732, Gam-COVID-Vac, Ad5-nCoV, Ad26.COV2.S, ChAdOx1, and CoronaVac vaccines against SARS-CoV-2 infection, COVID-19 hospitalization, and death in Mexico. The VE was estimated using time-varying Cox proportional hazard models in vaccinated and unvaccinated adults, adjusted for age, sex, and comorbidities. VE was also estimated for adults with diabetes, aged ≥60 years, and comparing the predominance of SARS-CoV-2 variants B.1.1.519 and B.1.617.2. Results: We assessed 793,487 vaccinated and 4,792,338 unvaccinated adults between December 24, 2020 and September 27, 2021. The VE against SARS-CoV-2 infection was the highest for fully vaccinated individuals with mRNA-12732 (91.5%, 95% confidence interval [CI] 90.3-92.4) and Ad26.COV2.S (82.2%, 95% CI 81.4-82.9); for COVID-19 hospitalization, BNT162b2 (84.3%, 95% CI 83.6-84.9) and Gam-COVID-Vac (81.4% 95% CI 79.5-83.1), and for mortality, BNT162b2 (89.8%, 95% CI 89.2-90.2) and mRNA-12732 (93.5%, 95% CI 86.0-97.0). The VE decreased for all vaccines in adults aged ≥60 years, people with diabetes, and periods of Delta variant predominance. Conclusion: All the vaccines implemented in Mexico were effective against SARS-CoV-2 infection, COVID-19 hospitalization, and death. Mass vaccination with multiple vaccines is useful to maximize vaccination coverage.

Preparative liquid chromatography is a technique for separating complex samples or isolating pure compounds from complex extracts. It involves eluting samples through a packed column and selectively collecting or isolating the separated bands in a sequence of fractions. Depending on the column length and the sample complexity, a large number of fractions may be obtained, making fraction collection a laborious and time-consuming process. Manual fraction collection is also tedious, error-prone, less reproducible, and susceptible to contamination. Several commercial and lab-made solutions are available for automated fraction collection, but most systems do not synchronize with the instrument detector and collect fractions at fixed volumes or time intervals. We have assembled a low-cost Arduino-based smart fraction collector that can record the signal from the UV–vis detector of the chromatography instrument and enable the automated selective collection of the targeted bands. The system consists of a robot equipped with position sensors and a 3-way solenoid valve that switches the column effluent between the waste or collection positions. By proper programming, an Arduino board records the detector response and actuates the solenoid valve, the position sensors, and the stepper motors to collect the target chromatographic bands.

Interest on methane emissions from livestock has increased in later years as it is an anthropogenic greenhouse gas with an important warming potential. The rumen microbiota has a large influence on the production of enteric methane. Animals harbour a second genome consisting of microbes, collectively referred to as the “microbiome”. The rumen microbial community plays an important role in feed digestion, feed efficiency, methane emission and health status. This review recaps the current knowledge on the genetic control that the cow exerts on the rumen microbiota composition. Heritability estimates for the rumen microbiota composition range between 0.05 and 0.40 in the literature, depending on the taxonomical group or microbial gene function. Variables depicting microbial diversity or aggregating microbial information are also heritable within the same range. This study includes a genome-wide association analysis on the microbiota composition, considering the relative abundance of some microbial taxa previously associated to enteric methane in dairy cattle (Archaea, Dialister, Entodinium, Eukaryota, Lentisphaerae, Methanobrevibacter, Neocallimastix, Prevotella and Stentor). Host genomic regions associated with the relative abundance of these microbial taxa were identified after Benjamini-Hoschberg correction (Padj

This paper deals with the integration of a Power-to-Power Energy Storage System (P2P-ESS) based on a hydrogen driven micro gas turbine (mGT) for an off-grid application with a continuous demand of 30 kWe for three European cities: Palermo, Frankfurt, and Newcastle. In the first part of the analysis, the results show that the latitude of the location is a very strong driver in determining the size of the system (hence footprint) and the amount of seasonal storage. The rated capacity of the PV plant and electrolyzer are 37%/41% and 58%/64% higher in Frankfurt and Newcastle, respectively, as compared to the original design for Palermo. And not only this, but seasonal storage also increases largely from 3125 kg H2 to 5023 and 5920 kg H2. As a consequence of this, LCOE‾ takes values of 0.86 €/kWh, 1.26 €/kWh, and 1.5 €/kWh for the three cities, respectively, whilst round-trip efficiency is approximately 15.7% for the three designs at the 3 cities. Finally, with the aim to reduce the footprint and rating of the different systems, a final assessment of the system hybridised with battery storage shows a 20% LCOE‾ reduction and a 10% higher round-trip efficiency.

Resumen: La mejora continua de la gestión debería ser una aspiración para todas las organizaciones del sector público. Los elementos de comparación externa o benchmarking identifican buenas prácticas en organizaciones similares. En servicios de salud pública, obtener indicadores de este tipo no es fácil. Los objetivos de este trabajo son describir el proceso seguido para llevar a cabo un ejercicio de benchmarking en una organización de salud pública, y compartir sus frutos. Para ello, se identificaron organizaciones para compararlas, y se buscaron en sus páginas web informes o memorias con indicadores de las actividades o resultados de los servicios de salud pública. Se identificaron limitaciones y condicionantes de los indicadores de las diferentes organizaciones, así como maneras de mejorar su capacidad de comparación. Finalmente, se propone un conjunto de 19 indicadores como núcleo inicial de comparación orientado a la gestión de calidad. Abstract: Continuous management improvement should be an aspiration for all public sector organizations. External comparison or benchmarking identifies good practices in similar organizations. For public health services, it is not easy to obtain such indicators. The objectives of this paper are to describe the process of conducting a benchmarking exercise for a public health agency, and to share its results. For this purpose, agencies that may be compared were identified, and their websites were searched for annual reports or other documents with indicators of the activities or results of public health services. Limitations and contextual aspects of the indicators of the different organizations were identified, as well as ways to improve their comparability. Finally, a set of 19 indicators is proposed, as an initial core for quality management comparisons.

Resumen: Se presenta una primera propuesta de sistema de vigilancia de salud pública aplicado al cambio climático en el contexto urbano, y el proceso que llevó a su definición. Tras varios años de seguimiento de los diversos aspectos del cambio climático y de su impacto, desde los servicios de salud pública de Barcelona se formuló una propuesta preliminar y se reunió un grupo de trabajo de personas expertas que discutieron y valoraron su contenido. Se partió de cuatro categorías de componentes: datos de clima, impactos en salud del cambio climático y sus determinantes, contribuciones de la ciudad a la mitigación (especialmente con cobeneficios para la salud) y acciones para reducir la vulnerabilidad ante eventos extremos. Se desglosaron en 12 componentes, con indicadores para cada uno. El esquema se refinó con aportaciones posteriores y se ha incorporado al trabajo de los servicios de salud pública de la ciudad implicados en este campo. Abstract: This paper makes a first proposal for a public health surveillance system for climate change in cities, and describes the process that led to its definition. After several years of monitoring different aspects related to climate change and its impact, the public health services of Barcelona made a preliminary proposal and gathered a working group of experts to discuss and review it. Four categories of components were defined: climate data, health impacts of climate change and its determinants, contributions of the city to mitigation (especially those with health co-benefits), and actions to reduce vulnerability to extreme events. They were broken in twelve components, with indicators for each. The proposal was further refined with subsequent reviews, and is being used by the city public health services involved in this field.

Resumen: Objetivo: Realizar una traducción, adaptación y validación de las propiedades psicométricas de la escala MoVac-flu para ser utilizada en español. Método: Estudio observacional analítico de adaptación transcultural y validación al español de la escala MoVac-flu. Se llevó a cabo entre los meses de marzo y julio del año 2022. El tamaño muestral fue de 142 personas que se reclutaron mediante muestreo consecutivo. Los procesos utilizados para la adaptación fueron traducción, validación por comité de expertos, retrotraducción y prueba piloto. Para la validación se comprobaron las propiedades psicométricas de fiabilidad, consistencia interna, validez de apariencia, validez de contenido, utilidad y efecto techo-suelo. Resultados: La consistencia interna de la escala MoVac-flu en su versión traducida al español fue alta, con una ω de McDonald de 0,914. Conclusiones: La escala MoVac-flu en español permite medir el grado de motivación ante la vacunación frente a la gripe de la población adulta. Abstract: Objective: To translate, adapt and validate the psychometric properties of MoVac-flu scale in order to be used in Spanish. Method: The present research was an analytical observational study of cross-cultural adaptation and validation into Spanish of the MoVac-flu scale. It has been carried out between the months of March and July 2022. The sample size was 142 people who were obtained by consecutive sampling. The processes used for the adaptation have been translation, validation by a committee of experts, back-translation and pilot test. For validation, the psychometric properties of reliability, internal consistency, appearance validity, content validity, utility and ceiling-floor effect have been verified. Results: The internal consistency of the MoVac-flu scale in its version translated into Spanish was high, showing a McDonald's ω of 0.914. Conclusions: The MoVac-flu scale in Spanish allows to measure the degree of motivation towards vaccination against influenza in the adult population.

Summary: Background: Human monkeypox, a zoonosis historically endemic to West and South Africa, has led to a worldwide outbreak driven by human-to-human transmission resulting in an international public health emergency. Endemic and outbreak monkeypox cases may differ in their affected populations, clinical features, and outcomes. Thus, profiling cases of the current monkeypox outbreak worldwide is crucial. Methods: We performed a nationwide observational surveillance-based study from May 24 to September 5, 2022. Patients that met the operational clinical definition of monkeypox or symptomatic close contacts of confirmed cases were tested by real-time polymerase chain reaction. Clinical data were collected with a standardized case-report form. We report epidemiologic, sociodemographic, and clinical characteristics of confirmed cases. Findings: Five-hundred and sixty-five human monkeypox confirmed cases were analysed; 97.2% were men, of whom 59.5% identified as men who have sex with men, and 54.5% had human immunodeficiency virus infection. The median age was 34 years. All patients but one had rash (99.8%), 78.9% had fever, and 47.8% reported myalgia. The anogenital area was the most commonly affected one by rash (49.6%), and proctitis occurred in 6.2% of patients. Six patients required hospitalization, of which one died due to causes unrelated to monkeypox. Interpretation: The 2022 monkeypox outbreak in Mexico is mainly driven by middle-aged men who have sex with men, of which a large proportion are persons who live with human immunodeficiency virus infection. Clinical features such as the high proportion of anogenital lesions suggest sexual contact is a pivotal transmission mechanism in this outbreak. Funding: This research was supported by grant A1-S-18342 from Consejo Nacional de Ciencia y Tecnología (CONACyT), Mexico (to S.I.V.-F.).

Resumen: Introducción: Las resistencias antibióticas de Helicobacter pylori (H. pylori) son el principal factor que afecta a la eficacia de los regímenes terapéuticos actuales. El objetivo principal del estudio es describir el patrón de resistencias antibióticas en niños con infección por H. pylori. Pacientes y métodos: Estudio observacional retrospectivo de 2014 a 2019 en el que se incluyen pacientes entre 5-17 años a los que se realizó gastroscopia, con cultivo de biopsia gástrica positivo para H. pylori y estudio de sensibilidad a antibióticos. Los estudios de sensibilidad antibiótica se realizaron mediante E-test. Los puntos de corte para definir las resistencias fueron los propuestos por el EUCAST. El estudio de erradicación se realizó con test del aliento con urea marcada con C 13 o test monoclonal de antígeno de H. pylori en heces a las 6-8 semanas de finalizar el tratamiento. Resultados: Ochenta pacientes (63,8% mujeres). Media de edad 11,9 años (±2,7 DS). Un 38,8% habían recibido tratamiento previo para H. pylori. Un 10% presentaron en la endoscopia lesiones ulcerosas pépticas. El 67,5% presentaba resistencia al menos a un fármaco. Un 16,3% presentaron doble resistencia. Las resistencias primarias fueron: claritromicina 44,9%, metronidazol 16,3%, levofloxacino 7,9% y amoxicilina 2%. Los pacientes que recibieron tratamiento acorde a las nuevas guías ESPGHAN 2017 presentaron tasas de erradicación significativamente superiores en comparación con los que recibieron tratamiento acorde a las guías previas (80% vs. 55,8% p = 0,04). Conclusiones: La alta tasa de resistencias de H. pylori y, en consecuencia, las bajas tasas de erradicación, siguen siendo una preocupación muy importante. El tratamiento de primera línea, cuando esté indicado debe hacerse guiado por estudios de sensibilidad antibiótica y en los casos en el que no se puedan realizar o no estén disponibles, al menos de acuerdo con las tasas regionales de resistencia. La aplicación correcta de las nuevas guías mejora de forma significativa el nivel de erradicación. Abstract: Introduction: The resistance to antibiotics of Helicobacter pylori (H. pylori) is the main factor that affects current therapeutic treatments. The main objective of this study is to describe the pattern of antibiotic resistances in children with an infection due to H. pylori. Patients and methods: An observational, retrospective study was conducted from 2014 to 2019, which included patients between 5 and 17 years old, on whom a gastroscopy, with a gastric biopsy culture positive for H. pylori, and an antibiotic sensitivity study was performed. The antibiotic sensitivity studies were performed using an epsilometer (E-test). The cut-off points to define the resistances were those proposed by the European Committee on Antimicrobial Susceptibility Testing – EUCAST. The eradication study was performed using the 13C-urea breath test or the H. pylori monoclonal test in faeces 6-8 weeks after finalising the treatment. Results: The study included 80 patients (63.8% females), with a mean age of 11.9 years (SD ± 2.7 DS). Over one-third (38.8%) of the patients had received previous treatment for H. pylori. In the endoscopy, peptic ulcer lesions were observed in 10% of patients. More than two-thirds (67.5%) had resistance to at least one drug. 16.3% presented double resistance. The primary resistances were: clarithromycin, 44.9%, metronidazole 16.3%, levofloxacine 7.9%, and amoxicillin 2%. Patients that received treatment according to the new ESPGHAN 2017 guidelines had significantly higher eradication rates compared to those that received treatment according to previous guidelines (80% vs. 55.8%, P = .04). Conclusions: The high rate of H.pylori resistances, and as a result, the low eradication rates, are still a very important cause for concern. The first line treatment, when this is indicated must be given following the antibiotic sensitivity studies, and in the cases where these cannot be done or are not available, at least in accordance with the regional resistance rates. The correct application of the new guidelines significantly improves the eradication rate.

Introduction: The resistance to antibiotics of Helicobacter pylori (H. pylori) is the main factor that affects current therapeutic treatments. The main objective of this study is to describe the pattern of antibiotic resistances in children with an infection due to H. pylori. Patients and methods: An observational, retrospective study was conducted from 2014 to 2019, which included patients between 5 and 17 years old, on whom a gastroscopy, with a gastric biopsy culture positive for H. pylori, and an antibiotic sensitivity study was performed. The antibiotic sensitivity studies were performed using an epsilometer (E-test). The cut-off points to define the resistances were those proposed by the European Committee on Antimicrobial Susceptibility Testing — EUCAST. The eradication study was performed using the 13C-urea breath test or the H. pylori monoclonal test in faeces 6–8 weeks after finalising the treatment. Results: The study included 80 patients (63.8% females), with a mean age of 11.9 years (SD ± 2.7 DS). Over one-third (38.8%) of the patients had received previous treatment for H. pylori. In the endoscopy, peptic ulcer lesions were observed in 10% of patients. More than two-thirds (67.5%) had resistance to at least one drug. 16.3% presented double resistance. The primary resistances were: clarithromycin, 44.9%, metronidazole 16.3%, levofloxacine 7.9%, and amoxicillin 2%. Patients that received treatment according to the new ESPGHAN 2017 guidelines had significantly higher eradication rates compared to those that received treatment according to previous guidelines (80% vs. 55.8%, P = 0.04). Conclusions: The high rate of H. pylori resistances, and as a result, the low eradication rates, are still a very important cause for concern. The first line treatment, when this is indicated must be given following the antibiotic sensitivity studies, and in the cases where these cannot be done or are not available, at least in accordance with the regional resistance rates. The correct application of the new guidelines significantly improves the eradication rate. Resumen: Introducción: Las resistencias antibióticas de Helicobacter pylori (H. pylori) son el principal factor que afecta a la eficacia de los regímenes terapéuticos actuales. El objetivo principal del estudio es describir el patrón de resistencias antibióticas en ni˜nos con infección por H. pylori. Pacientes y métodos: Estudio observacional retrospectivo de 2014 a 2019 en el que se incluyen pacientes entre 5–17 años a los que se realizó gastroscopia, con cultivo de biopsia gástricapositivo para H. pylori y estudio de sensibilidad a antibióticos. Los estudios de sensibilidad antibiótica se realizaron mediante E-test. Los puntos de corte para definir las resistencias fueron los propuestos por el EUCAST. El estudio de erradicación se realizó con test del aliento con urea marcada con C 13 o test monoclonal de antígeno de H. pylori en heces a las 6–8 semanas de finalizar el tratamiento. Resultados: Ochenta pacientes (63,8% mujeres). Media de edad 11,9 años (±2,7 DS). Un 38,8% habían recibido tratamiento previo para H. pylori. Un 10% presentaron en la endoscopia lesiones ulcerosas pépticas. El 67,5% presentaba resistencia al menos a un fármaco. Un 16,3% presentaron doble resistencia. Las resistencias primarias fueron: claritromicina 44,9%, metronidazol 16,3%, levofloxacino 7,9% y amoxicilina 2%. Los pacientes que recibieron tratamiento acorde a las nuevas guías ESPGHAN 2017 presentaron tasas de erradicación significativamente superiores en comparación con los que recibieron tratamiento acorde a las guías previas (80% vs. 55,8% p = 0,04). Conclusiones: La alta tasa de resistencias de H. pylori y, en consecuencia, las bajas tasas de erradicación, siguen siendo una preocupación muy importante. El tratamiento de primera línea, cuando esté indicado debe hacerse guiado por estudios de sensibilidad antibiótica y en los casos en el que no se puedan realizar o no estén disponibles, al menos de acuerdo con las tasas regionales de resistencia. La aplicación correcta de las nuevas guías mejora de forma significativa el nivel de erradicación.

Resumen: Introducción: La Atención Primaria (AP) es el primer contacto entre el paciente y el médico, por lo que es fundamental tener claro los criterios de sospecha de una enfermedad genética y dónde se debe remitir para su estudio. Material y métodos: Cuatro sociedades científicas: la Sociedad Española de Medicina Familiar y Comunitaria (semFYC), la Asociación Española de Genética Humana (AEGH), la Asociación Española de Pediatría (AEP) y la Sociedad Española de Oncología Médica (SEOM), han revisado los criterios de derivación a los servicios de genética clínica de las diferentes guías publicadas, con el objetivo de elaborar unas recomendaciones para AP. Conclusiones: Con este Documento de Consenso el médico de familia y el pediatra de AP conocerán cuándo, cómo y dónde derivar a sus pacientes con patología hereditaria y/o genética a los servicios de genética clínica. Abstract: Introduction: Primary care (PC) is the first contact between the patient and the doctor, so it is essential to be clear about the criteria for suspecting a genetic disease and where it should be referred for study. Material and methods: Four scientific societies: the Spanish Society of Family and Community Medicine (semFYC), the Spanish Association of Human Genetics (AEGH), the Spanish Association of Pediatrics (AEP) and the Spanish Society of Medical Oncology (SEOM), have reviewed the criteria for referral to the clinical genetics services of the different published guidelines with the purpose of define the recommendations for PC. Conclusions: With this consensus document, the PC doctor and pediatrician will know when, how and where to refer their patients with hereditary and/or genetic pathology to clinical genetics services.

A new approach based on a variant of differential photoacoustic (PA) cells, and a first-order approximation of RG model, is used to measure directly the thermal effusivity in solids is proposed. The configuration consists of two identical conventional photoacoustic cells, in both, the system is gas-sample-backing. In one of them, the backing works as reference material (RM) and in the other one as study material (SM). The solid sample thickness and the work frequency range are chosen to guarantee the thermally thin regime. The solid sample (SS) is selected to be a strong optical absorber and then it just works as the medium that converts electromagnetic energy into heat. The thermal paste (TP) effect on the photoacoustic signals through the equivalent thermal properties of SS–TP system was considered. The ratio of photoacoustic pressures graph, as a function of frequency, showed an increasing behaviour with concavity downwards when the thermal effusivity of the RM is less than the effusivity of SM, and a decreases behaviour with concavity upwards in the opposite case. The thermal effusivity of two well characterized SM (aluminium and copper) was determined as a concept proof with maximum errors of 0.54 and 2.17%, respectively. And for further experiments this concept proof can be use as the cell calibration PA protocol.

Understanding the threats to wildlife across space and time is essential for developing effective conservation strategies. In Mesoamerica (i.e., the region that extends from Central Mexico to the most southern point in Panama) at least 40% of amphibian species declined between the late 1970s and the early 2000s. Most of these declines have been linked with the destruction of suitable habitats for amphibians as well as the introduction and spread of the fungal pathogen Batrachochytrium dendrobatidis, the causal agent of the disease known as chytridiomycosis. In this study, we quantified geographic and elevational ranges for direct-developing, stream-dwelling frog species (DSFS) in Mesoamerica. Within the range of each DSFS, we estimated the extent of suitable area for the occurrence of Batrachochytrium dendrobatidis and the types of land use to quantify habitat deterioration. To date, 33% of DSFS remain undetected since 2005 or before. At the regional level (i.e., Mesoamerica), as in previous studies, we found that narrow geographic and elevational ranges increased vulnerability to extinction. Nevertheless, the ranges of 83% of DSFS were composed of 50% or more high-quality habitats between the 1980s and 2005, when most species declined. We also found that on average, 80% of the range of each species currently overlaps with predicted suitable areas for the occurrence of Batrachochytrium dendrobatidis. At the local and site level (i.e., focusing on two species ranges where extensive monitoring has been conducted even before decline occurred), we found that the present suitable habitat for Batrachochytrium dendrobatidis corresponded with the reduction in predicted habitat suitability and climatic niche of DSFS. We also found that the location of remnant populations can be predicted by environmental factors, which can help identify regions where remnant populations of these declined species and others with similar ecology may occur. Combined, results from our regional and local analyses support the idea that Batrachochytrium dendrobatidis was the main driver of DSFS declines and of the current lack of recent observations of fifteen DSFS. We used our results to propose specific actions for all DSFS included in this study. This study highlights the importance of considering multiple threats and spatial scales when assessing the status of declined and threatened species.

Resumen: Introducción: Los residentes de Ginecología aprenden a realizar procedimientos quirúrgicos, tales como la conización cervical directamente en pacientes reales. El nivel de habilidad técnica influye en los resultados, aumentando los riesgos obstétricos posteriores de las pacientes si el profesional tiene poca experiencia. Este proyecto tiene como objetivo el diseño y la evaluación de un simulador seguro, útil y reproducible para el entrenamiento en conización cervical con asa diatérmica. Material y métodos: Para la construcción del simulador se ha utilizado material accesible en cualquier hospital docente, empleando productos cárnicos para reproducir el cuello uterino. Para la evaluación del mismo se ha diseñado una encuesta de satisfacción cumplimentada por 16 profesionales que valoraron el simulador, realizando posteriormente un análisis descriptivo de los resultados. Resultados: Durante la primera fase del proyecto se detallaron los pasos para la construcción del simulador de conización cervical. La segunda fase o evaluación del simulador mostró que la mayoría de profesionales valoran los primeros conos realizados por residentes como de mala calidad, dificultando la interpretación de la pieza quirúrgica por parte del patólogo. El 100% de los encuestados afirmó que utilizaría el simulador en su hospital de referencia y lo valoraron como «sencillo, útil, seguro, reproducible y adecuado para docencia». Conclusión: El simulador construido propone un método docente para la enseñanza a residentes de la técnica de conización cervical con asa diatérmica, siendo fácilmente reproducible y posibilitando en un futuro, tras su validación, el diseño de programas de entrenamiento. Abstract: Introduction: Gynaecology residents learn how to perform surgical procedures such as cervical conization directly on real patients. Their skills level determines the outcomes, with an increase in the subsequent obstetric risks of the patients if the physician is not experienced. This project includes the design and evaluation of a safe, useful and reproducible surgical simulator for loop electrosurgical conisation technique training. Materials and methods: Affordable and available material in any teaching hospital was used in the construction of the simulator. The human cervix was simulated using a sausage model. In order to evaluate the project, a satisfaction survey was designed and completed by 16 professionals. A subsequent descriptive analysis of the results was performed. Results: During the first stage of the project, the different steps of the simulator's construction were detailed. The second, or evaluation stage, showed that most professionals rated the first cones of resident doctors as poor in quality, making them difficult to be interpreted by a pathologist. All the respondents stated that they would use the simulator in their hospital, and rated it as “simple, safe, useful, reproducible and suitable for teaching”. Conclusions: The developed simulator proposes a method for teaching residents skills in loop electrosurgical cervical conisation, being easily reproducible and allowing, after future validation, the design of training programs for residents.

Introduction: Although changes in liver function tests can be non-specific in numerous clinical conditions, they can be the first sign of a potentially serious disease in an asymptomatic patient. Material and methods: Retrospective cohort study, performed by reviewing the records of children of a reference hospital central laboratory with alanine aminotransferase enzyme (ALT) elevation during a 6-month aleatory period. Results: 572 blood tests with serum ALT elevation corresponding to 403 patients have been assessed during the period studied. 98 patients were excluded for presenting abnormal liver test before the study period of comorbidity that could produce ALT elevation. The remaining 305 patients, 22.6% were diagnosed with a medical condition during the first blood test that explained the ALT elevation, although only 33.3% of them were followed up until verifying their normalisation. Final study sample consists of 236 patients with abnormal liver test without apparent liver disease. Adequate follow-up was found only in 29% of them. From this group, 9 patients (13%) were diagnosed with liver disease. The rest of the samples were not properly monitored. In patients with higher serum ALT levels, follow-up was early and more appropriate. Conclusions: In our area, most children without apparent liver disease are no properly monitored. Therefore, an opportunity to diagnosis and treat a potential liver disease was lost in a great number of children. All children with unexplained hypertransaminasaemia must be studied. Resumen: Introducción: Las alteraciones del perfil hepático constituyen un hecho inespecífico propio de numerosas condiciones clínicas. Sin embargo, puede implicar la primera manifestación de una patología potencialmente grave en un paciente asintomático. Material y métodos: Estudio observacional retrospectivo que incluye todas las analíticas sanguíneas con elevación de alanino aminotransferasa (ALT) en pacientes pediátricos solicitadas en un sector sanitario en un período de 6 meses. Resultados: Se registraron 572 analíticas correspondientes a 403 pacientes. Se excluyeron 98 pacientes con hipertransaminasemia ya conocida o comorbilidad. De los 305 restantes, el 22,6% se diagnosticaron de patología asociada a hipertransaminasemia, y de estos, se comprobó normalización en el 33,3%. De los 236 pacientes con hipertransaminasemia sin justificar se realizó un seguimiento en el 29%, encontrando patología hepática en 9 pacientes (13% del grupo). En el resto de la muestra no se comprobó analíticamente la evolución de las transaminasas ni la presencia de posible patología hepática. Los pacientes con cifras más elevadas se controlan mejor y antes que los que presentan cifras más bajas. Conclusiones: En nuestra área, la mayoría de los niños sin enfermedad hepática aparente con hallazgo de ALT elevada no son adecuadamente controlados. Esto hace que se pierda una oportunidad única de diagnosticar y tratar precozmente una enfermedad hepática potencial en un gran número de niños. Todo niño con hipertransaminasemia inexplicada debe ser estudiado.

Objectives: The aim of this study was to investigate the feasibility of saliva sampling as a non-invasive and safer tool to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to compare its reproducibility and sensitivity with nasopharyngeal swab samples (NPS). The use of sample pools was also investigated. Methods: A total of 2107 paired samples were collected from asymptomatic healthcare and office workers in Mexico City. Sixty of these samples were also analyzed in two other independent laboratories for concordance analysis. Sample processing and analysis of virus genetic material were performed according to standard protocols described elsewhere. A pooling analysis was performed by analyzing the saliva pool and the individual pool components. Results: The concordance between NPS and saliva results was 95.2% (kappa 0.727, p = 0.0001) and 97.9% without considering inconclusive results (kappa 0.852, p = 0.0001). Saliva had a lower number of inconclusive results than NPS (0.9% vs 1.9%). Furthermore, saliva showed a significantly higher concentration of both total RNA and viral copies than NPS. Comparison of our results with those of the other two laboratories showed 100% and 97% concordance. Saliva samples are stable without the use of any preservative, and a positive SARS-CoV-2 sample can be detected 5, 10, and 15 days after collection when the sample is stored at 4 °C. Conclusions: The study results indicate that saliva is as effective as NPS for the identification of SARS-CoV-2-infected asymptomatic patients. Sample pooling facilitates the analysis of a larger number of samples, with the benefit of cost reduction.

The ciliate Balantioides coli is a human enteric parasite that can cause life-threatening infections. It is a food- and waterborne parasite, with cysts being the infective stage. Despite its importance as a potential pathogen, few reports have investigated its presence in environmental samples, and some issues need attention including i) The accuracy of B. coli identification. In most cases, the protozoa is identified only by its morphological traits, which can be identical to those from other parasitic ciliates of animals. Genetic analysis of cysts recovered from environmental samples is necessary for species confirmation. In addition, genetic methods used with faecal samples need to be adequately validated with environmental matrices. ii) The methodology for searching this parasite in environmental samples. The protocols include an initial phase to isolate the cysts from the matrix followed by a second phase in which concentration procedures are usually applied. The methods may be valid but are not standardised and differences between studies could affect the results obtained. iii) The areas that needs further research. The development of genetic identification methods and standardised analytical protocols in environmental samples are required, as well as the assessment of viability and infectivity of B. coli cysts. The development of axenic culture systems will boost research on this parasite.

Resumen: Introducción: En 2014 se publicó el Documento de Consenso desarrollado por SEIP-SERPE-SEOP para el diagnóstico y el tratamiento de las infecciones osteoarticulares (IOA). En 2015 se constituyó RIOPed como red nacional multidisciplinar para la investigación en IOA. El objetivo del estudio ha sido valorar el grado de adecuación a las recomendaciones establecidas en el consenso durante un año de seguimiento. Material y métodos: Estudio prospectivo multicéntrico nacional realizado entre septiembre de 2015 y septiembre de 2016 en 37 hospitales con inclusión de pacientes menores de 16 años diagnosticados de IOA, confirmada mediante aislamiento microbiológico, o probable: artritis séptica (AS) con > 40.000 leucocitos en líquido sinovial u osteomielitis (OM)/osteoartritis (OA)/espondilodiscitis (ED) con prueba de imagen compatible. Los resultados se compararon con los obtenidos en el estudio retrospectivo realizado entre 2008 y 2012. Resultados: Se incluyeron 255 casos: 131 OM, 79 AS, 30 OA y 15 ED. Respecto a las pruebas complementarias que el consenso consideró de obligada realización, la radiografía se llevó a cabo en el 87,8% de los casos, el hemocultivo en el 91,6% y el cultivo de líquido sinovial en el 99% de AS. Se realizó RM en el 71% de las OM. La elección del tratamiento antibiótico intravenoso empírico se adecuó a las recomendaciones en el 65,1% de los casos, y en el 62,3% para el tratamiento oral. Se llevó a cabo cirugía en el 36,8% de las AS (85,7% artrotomía), con un descenso significativo respecto al estudio retrospectivo (p = 0,014). Solo el 58,5% de casos se ajustaron a las recomendaciones de duración del tratamiento; sin embargo, se comprobó una menor duración del tratamiento intravenoso. Conclusiones: En general, el grado de adecuación a las recomendaciones que marcaron el grupo de expertos es bueno para las pruebas complementarias y aceptable respecto a la elección del tratamiento antibiótico, aun detectándose casi un 40% de inadecuación. Se ha conseguido un descenso de la estancia hospitalaria. Abstract: Introduction: In 2014 the Consensus Document produced by the Spanish Paediatric Societies (SEIP-SERPE-SEOP) was published to help in the diagnosis and treatment of osteoarticular infections (OAI). In 2015 the RIOPed was considered as a multidisciplinary national network for the investigation into OAI. The aim of this study was to assess the level of adaption to the recommendations established in the Consensus during one year of follow-up. Material and methods: A prospective, national multicentre study was carried out in 37 hospitals between September 2015 and September 2016. The study included patients > 16 years-old with a diagnosis of OAI, confirmed by microbiological isolation, or probable: septic arthritis (SA) with > 40,000 white cells in synovial fluid, or osteomyelitis (OM)/spondylodiscitis (SD) with a compatible imaging test. The results were compared with those obtained in a retrospective study conducted between 2008 and 2012. Results: A total of 235 cases were included, of which 131 were OM, 79 SA, 30 OA, and 15 SD. As regards the complementary tests that the Consensus considered mandatory to perform, radiography was carried out on 87.8% of the cases, a blood culture on 91.6%, and culture of the synovial fluid in 99% of SA. A magnetic resonance (MR) was performed on 71% of the OM cases. The choice of intravenous empirical antibiotic treatment was adapted to the recommendations in 65.1% of cases, and in 62.3% for the oral treatment. Surgery was performed in 36.8% of SA cases (85.7% arthrotomy), with a significant decrease compared to the retrospective study (P = .014). Only 58.5% of cases followed the recommendations on the duration of the treatment; however, a lower duration of intravenous treatment was observed. Conclusions: In general, the level of adaptation to the recommendations that were set by the Expert Group, is good for the complementary tests, and acceptable as regards the choice of antibiotic treatment, although inadequate in almost 40% of cases. A decrease in hospital stay was achieved.

Introduction: In 2014 the Consensus Document produced by the Spanish Paediatric Societies (SEIP-SERPE-SEOP) was published to help in the diagnosis and treatment of osteoarticular infections (OAI). In 2015 the RIOPed was considered as a multidisciplinary national network for the investigation into OAI. The aim of this study was to assess the level of adaption to the recommendations established in the Consensus during one year of follow-up. Material and methods: A prospective, national multicentre study was carried out in 37 hospitals between September 2015 and September 2016. The study included patients >16 years-old with a diagnosis of OAI, confirmed by microbiological isolation, or probable: septic arthritis (SA) with >40,000 white cells in synovial fluid, or osteomyelitis (OM)/spondylodiscitis (SD) with a compatible imaging test. The results were compared with those obtained in a retrospective study conducted between 2008 and 2012. Results: A total of 235 cases were included, of which 131 were OM, 79 SA, 30 OA, and 15 SD. As regards the complementary tests that the Consensus considered mandatory to perform, radiography was carried out on 87.8% of the cases, a blood culture on 91.6%, and culture of the synovial fluid in 99% of SA. A magnetic resonance (MR) was performed on 71% of the OM cases. The choice of intravenous empirical antibiotic treatment was adapted to the recommendations in 65.1% of cases, and in 62.3% for the oral treatment. Surgery was performed in 36.8% of SA cases (85.7% arthrotomy), with a significant decrease compared to the retrospective study (P = .014). Only 58.5% of cases followed the recommendations on the duration of the treatment; however, a lower duration of intravenous treatment was observed. Conclusions: In general, the level of adaptation to the recommendations that were set by the Expert Group, is good for the complementary tests, and acceptable as regards the choice of antibiotic treatment, although inadequate in almost 40% of cases. A decrease in hospital stay was achieved. Resumen: Introducción: En 2014 se publicó el Documento de Consenso desarrollado por SEIP-SERPE-SEOP para el diagnóstico y el tratamiento de las infecciones osteoarticulares (IOA). En 2015 se constituyó RIOPed como red nacional multidisciplinar para la investigación en IOA. El objetivo del estudio ha sido valorar el grado de adecuación a las recomendaciones establecidas en el consenso durante un año de seguimiento. Material y métodos: Estudio prospectivo multicéntrico nacional realizado entre septiembre de 2015 y septiembre de 2016 en 37 hospitales con inclusión de pacientes menores de 16 años diagnosticados de IOA, confirmada mediante aislamiento microbiológico, o probable: artritis séptica (AS) con >40.000 leucocitos en líquido sinovial u osteomielitis (OM)/osteoartritis (OA)/espondilodiscitis (ED) con prueba de imagen compatible. Los resultados se compararon con los obtenidos en el estudio retrospectivo realizado entre 2008 y 2012. Resultados: Se incluyeron 255 casos: 131 OM, 79 AS, 30 OA y 15 ED. Respecto a las pruebas complementarias que el consenso consideró de obligada realización, la radiografía se llevó a cabo en el 87,8% de los casos, el hemocultivo en el 91,6% y el cultivo de líquido sinovial en el 99% de AS. Se realizó RM en el 71% de las OM. La elección del tratamiento antibiótico intravenoso empírico se adecuó a las recomendaciones en el 65,1% de los casos, y en el 62,3% para el tratamiento oral. Se llevó a cabo cirugía en el 36,8% de las AS (85,7% artrotomía), con un descenso significativo respecto al estudio retrospectivo (P = ,014). Solo el 58,5% de casos se ajustaron a las recomendaciones de duración del tratamiento; sin embargo, se comprobó una menor duración del tratamiento intravenoso. Conclusiones: En general, el grado de adecuación a las recomendaciones que marcaron el grupo de expertos es bueno para las pruebas complementarias y aceptable respecto a la elección del tratamiento antibiótico, aun detectándose casi un 40% de inadecuación. Se ha conseguido un descenso de la estancia hospitalaria.

Introdução: Nos últimos anos a América Latina tem experimentado uma redução importante das coberturas vacinais. Desde 2017, os surtos de febre amarela, sarampo e difteria que tem acontecido em diferentes países da região são consequências desta situação. Métodos: Com o objetivo de determinar as barreiras para a imunização, o impacto da pandemia na percepção da vacinação e a aceitação da vacina contra a COVID-19, realizamos um estudo tranversal online que incluiu 9.487 participantes de 9 países da América Latina (Argentina, Brasil, Colômbia, República Dominicana, Equador, Honduras, México, Panamá e Peru). Todos os participantes responderam um questionario sobre seu histórico de imunização/motivos de não ter tomado as vacinas contra sarampo-caxumba-rubéola (MMR) e tétano-difteria (dT). Pessoas com doenças crônicas também responderam sobre a vacina contra Influenza; profissionais de saúde responderam sobre vacinas contra Hepatite B e Influenza. Pais de crianças menores de 15 anos responderam sobre a situação vacinal de seus filhos para o calendário completo, com destaque para vacinas contra Papilomavírus Humano (HPV), MMR e Influenza. Também foram respondidas perguntas sobre a influência da pandemia na percepção da vacinação e a aceitação da vacina contra a COVID-19. Resultados: A principal barreira para a imunização contra sarampo-caxumba-rubéola e tétano-difteria, assim como contra Influenza para profissionais de saúde, foi o esquecimento da vacinação. Já para vacinas do calendário infantil, como HPV e MMR, e contra Influenza em adultos com doenças crônicas, o principal motivo foi o medo de eventos adversos. A pandemia teve impacto positivo em relação à mudança na percepção da vacinação para 12% dos participantes, o principal motivo dessa mudança foi “alguém próximo teve COVID-19 grave ou morreu devido a esta doença”. Mais de 80% dos participantes estavam dispostos a tomar a vacina contra a COVID-19. Conclusão: Duas barreiras importantes para a imunização na América Latina são o esquecimento de vacinar-se e o medo de eventos adversos. Para reduzir a baixa adesão e melhorar as taxas de imunização é necessário adotar um sistema de lembrete eficaz e educar a população em relação à vacinação. Apesar da queda das coberturas vacinais nos últimos anos a grande maioria dos latino-americanos são a favor da vacinação e estão dispostos a tomar a vacina contra a COVID-19.