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Resumen Introduccion El objetivo de este estudio es la caracterizacion de cepas de Streptococcus pyogenes con fenotipo mucoide y su comparacion con las cepas no mucoides aisladas entre abril y agosto de 2016. Material y metodos Se llevo a cabo la caracterizacion y el estudio de sensibilidad antimicrobiana de todos los aislados. Se determino el tipo emm y se analizaron los genes de exotoxinas speA, speB, speC, speF, speG, speH, speJ, speZ y ssa. Se recogieron datos clinicos y demograficos. Resultados De 96 aislados analizados, el 47% presentaron un fenotipo mucoide, y de estos ultimos, el 95,5% presentaron los genes speA-speB-speF-speG-ssa y genotipo emm3. La principal manifestacion clinica entre todos los pacientes fue faringoamigdalitis (77,1%) que evoluciono a escarlatina en el 67,5% de los casos. Conclusion Se describe la circulacion de una cepa de aspecto mucoide con perfil de toxinas speA-speB-speF-speG-ssa y genotipo emm3.1 considerado de los mas frecuentes y mas virulentos de SGA.

Resumen Introduccion La esclerosis multiple (EM) es una enfermedad inflamatoria, desmielinizante y neurodegenerativa que afecta al sistema nervioso central. La adherencia al tratamiento resulta imprescindible para modificar el curso de la enfermedad. El trastorno cognitivo afecta hasta el 70% de estos pacientes y supone una limitacion para la administracion y la adherencia al tratamiento. Objetivo El objetivo principal fue valorar el grado de adherencia al tratamiento en los pacientes con esclerosis multiple (EM) y trastorno cognitivo. Como objetivos secundarios, describir los recursos que pueden influir en la adherencia al tratamiento y valorar la efectividad de los dispositivos tecnologicos utilizados para avisar al paciente de que se tiene que autoinyectar. Metodo Estudio piloto descriptivo, retrospectivo y transversal. Se llevo a cabo en la consulta de EM del Hospital Universitario Torrecardenas (Almeria) durante los meses de diciembre de 2018 a septiembre de 2019. La muestra incluyo 20 pacientes diagnosticados de EM tratados actualmente con farmacos inyectables inmunomoduladores que llevan al menos 6 meses. Se utilizo el Symbol Digit Modalities Test (SDMT) para la valoracion del trastorno cognitivo, y para determinar la adherencia los pacientes respondieron al test Morisky Green (MG). Resultados Se incluyeron, durante un periodo de 10 meses, 20 pacientes (8 hombres y 12 mujeres) con EM y trastorno cognitivo (puntuacion en el SDMT menor al percentil 50). Con respecto a la adherencia diferenciada entre sexos, el 75% de los hombres no fueron adherentes al tratamiento; por el contrario, el 66,6% de las mujeres presentaron cumplimiento a la pauta posologica. Los no adherentes tienen un percentil inferior a 50. No existieron diferencias estadisticamente significativas en cuanto a la adherencia diferenciada por los tipos de tratamiento. Los principales metodos para favorecer la adherencia fueron: 10% calendario, 20% un familiar y 30% alarmas como recordatorio. Discusion y conclusion Los resultados de adherencia muestran un predominio de la adherencia en mujeres, aun teniendo trastorno cognitivo. Esto afianza nuestra hipotesis inicial que relaciona la buena adherencia terapeutica con menor progresion del trastorno cognitivo en la EM. Como medida de prevencion destacamos el papel relevante del equipo de enfermeria en la deteccion del trastorno cognitivo y en la valoracion la de la adherencia.

BackgroundImplementation factors are hypothesised to moderate the implementation of innovations. Although individual barriers and facilitators have been identified for the implementation of different evidence-based services in pharmacy, relationships between implementation factors are usually not considered.ObjectivesTo examine how a network of implementation factors and the position of each factor within this network structure influences the implementation of a medication review service in community pharmacy.MethodsA mixed methods approach was used. Medication review with follow-up service was the innovation to be implemented over 12 months in community pharmacies. A network analysis to model relationships between implementation factors was undertaken. Two networks were created.ResultsImplementation factors hindering the service implementation with the highest centrality measures were time, motivation, recruitment, individual identification with the organization and personal characteristics of the pharmacists. Three hundred and sixty-nine different interrelationships between implementation factors were identified. Important causal relationships between implementation factors included: workflow-time; characteristics of the pharmacy-time; personal characteristics of the pharmacists-motivation. Implementation factors facilitating the implementation of the service with highest centrality scores were motivation, individual identification with the organization, beliefs, adaptability, recruitment, external support and leadership. Four hundred and fifty-six different interrelationships were identified. The important causal relationships included: motivation-external support; structure-characteristics of the pharmacy; demographics-location of the pharmacy.ConclusionNetwork analysis has proven to be a useful technique to explore networks of factors moderating the implementation of a pharmacy service. Relationships were complex with most implementation factors being interrelated. Motivation and individual identification with the organisation seemed critical factors in both hindering and facilitating the service implementation. The results can inform the design of implementation programs and tailored strategies to promote faster implementation of innovations in pharmacy.

Background Chagas disease is considered important and presents intense inflammatory and fibrotic processes induced by the perpetuation of the parasite in the affected tissues and organs. Therefore, it is necessary to inquire about the host defense and attack mechanisms to have a more detailed knowledge about Chagas disease. MicroRNAs are found in blood, tissues and extracellular vesicles. These small regulators of gene expression are involved in physiological and pathological processes in both mammals and parasites. Several microRNAs have deregulated expression in chagasic heart disease, although little is known about their extracellular expression. Our main objective was to evaluate the involvement of miR-21, miR-146a and miR-155 in several samples from mice infected with the TcI Ninoa strain from the acute and indeterminate phases. We also explored a potential functional association of the selected microRNAs using STRING software. This software identified 23 pathways associated with Trypanosoma cruzi infection. In addition, eleven genes were identified through bioinformatics analysis, and we found that SMAD family member 5 was downregulated in both phases. This gene serves as a mediator in the TGF-β signaling pathway. Thus, forty female mice of the CD1 strain were distributed into 4 groups and the expression levels of miR-21, miR-146a and miR-155 were measured in samples of heart tissue, total plasma and plasma extracellular vesicles by quantitative real-time polymerase chain reaction. Results Overexpression of miR-21, miR-146a and miR-155 was observed in heart and plasma in both phases. Moreover, in extracellular vesicles miR-21 and miR-146a were also overexpressed in the acute phase, whereas in the indeterminate chronic phase we found only miR-146a up-regulated. Conclusions The expression of inflammatory microRNAs miR-21, miR-146a and miR-155 were up-regulated in each of the samples from acutely and chronically infected mice. The relevant finding was that miR-146a was up-regulated in each sample in both phases; therefore, this miRNA could be a possible candidate biomarker in Chagas disease.

Objectives To evaluate the efficacy of oral colistin-neomycin in preventing multidrug-resistant Enterobacterales (MDR-E) infections in solid organ transplant (SOT) recipients. Methods Multicentre, open-label, parallel-group, controlled trial with balanced (1:1) randomization in five transplant units. SOT recipients were screened for MDR-E intestinal colonization (extended-spectrum β-lactamase or carbapenemase producing) before transplantation and +7 and + 14 days after transplantation and assigned 1:1 to receive treatment with colistin sulfate plus neomycin sulfate for 14 days (decolonization treatment (DT) group) or no treatment (no decolonization treatment (NDT) group). The primary outcome was diagnosis of an MDR-E infection. Safety outcomes were appearance of adverse effects, mainly diarrhoea, rash, nausea and vomiting. Patients were monitored weekly until 30 days after treatment. Intention-to-treat analysis was performed. Results MDR-E rectal colonization was assessed in 768 SOT recipients; 105 colonized patients were included in the clinical trial, 53 receiving DT and 52 NDT. No significant decrease in the risk of infection by MDR-E was observed in the DT group (9.4%, 5/53) compared to the NDT group (13.5%, 7/52) (relative risk 0.70; 95% confidence interval 0.24–2.08; p 0.517). Four patients (5.6%), three (5.6%) in the DT group and one (1.9%) in the NDT group, developed colistin resistance. Twelve patients (22.7%) in the DT group had diarrhoea, eight related to treatment (15.0%); one patient (1.8%) developed skin rash and another (1.8%) nausea and vomiting. Two patients (3.8%) in the NDT group developed diarrhoea. Conclusions DT does not reduce MDR-E infections in SOT. Colistin resistance and adverse effects such as diarrhoea are a potential issue that must be taken seriously.

Background In our population, anti-thymocyte globulin (ATG) of 1 mg/Kg/day for 4 days is used; which permits not using valgancyclovir (VGC) prophylaxis in some renal transplant recipients (RTR) with moderate risk (R+), to reduce costs. This study aimed to determine the incidence and risk of developing cytomegalovirus (CMV), with or without prophylaxis, when exposed to low doses of ATG or basiliximab (BSL). Patients and methods A retrospective cohort included 265 RTR with follow-up of 12 months. Prophylaxis was used in R-/D+ and some R+. Tacrolimus (TAC), mycophenolate mofetil, and prednisone were used in all patients. Logistic regression analysis was performed to estimate the risk of CMV in RTR with or without VGC. Results Cytomegalovirus was documented in 46 (17.3%) patients: 20 (43.5%) with CMV infection, and 26 (56.5%) with CMV disease. Anti-thymocyte globulin was used in 39 patients (85%): 32 R+, six D+/R-, and one D-/R-. ATG was used in 90% (27 of 30) of patients with CMV and without prophylaxis. The multivariate analysis showed an association of risk for CMV with the absence of prophylaxis (RR 2.29; 95% CI 1.08–4.86), ATG use (RR 3.7; 95% CI 1.50–9.13), TAC toxicity (RR 3.77; 95% CI 1.41–10.13), and lymphocytes at the sixth post-transplant month (RR 1.77; 95% CI 1.0–3.16). Conclusions Low doses of ATG favored the development of CMV and a lower survival free of CMV compared with BSL. In scenarios where resources for employing VGC are limited, BSL could be an acceptable strategy.

Objective A consistent line of investigation proposes fibromyalgia as a dysautonomia-associated neuropathic pain syndrome. Comorbid anxiety or depression amplifies fibromyalgia symptoms. The recent recognition of small fiber neuropathy in fibromyalgia patients supports the neuropathic nature of the illness. Corneal confocal microscopy accurately identifies small nerve fiber pathology. The newly developed Small-Fiber Symptom Survey captures the spectrum of small fiber neuropathy symptoms. We aimed to correlate corneal nerve density with different fibromyalgia disease severity questionnaires including the Small-Fiber Symptom Survey. We defined the possible confounding role of comorbid anxiety or depression severity in the clinical-pathological association. Methods This is a case series of 28 women with fibromyalgia. A single ophthalmologist quantified corneal subbasal plexus nerve density. Corneal innervation was correlated (Spearman ρ) with the following clinical questionnaires scores: Small-Fiber Symptom Survey, Revised Fibromyalgia Impact Questionnaire, and COMPASS-31 (Composite Autonomic Symptom Survey 31-Item Score). Validated inquiry forms assessed the comorbid anxiety and/or depression severity. Results There were no clinical-pathological correlations in the group as a whole. In the subgroup of fibromyalgia women without severe anxiety or depression (n = 13), there was a strong negative correlation between corneal nerve density with the Small-Fiber Symptom Survey score (ρ = -0.771, p = 0.002) and COMPASS-31 score (ρ = -0.648, p = 0.017). Patients with profound anxiety or depression (n = 15) had more intense symptoms but had not clinical-pathological correlations. Conclusions Small fiber neuropathy and dysautonomia symptoms correlate with corneal denervation in women with fibromyalgia without severe anxiety or depression. This clinical-pathological association reinforces fibromyalgia as a dysautonomia-related neuropathic pain syndrome. Severe anxiety or depression distorts fibromyalgia symptoms. Practical point Corneal confocal microscopy may become a useful procedure to study fibromyalgia patients.

Resumen Los programas de optimizacion del diagnostico microbiologico (PRODIM) promueven actuaciones coordinadas orientadas a optimizar el uso de las tecnicas diagnosticas, propiciando la toma de decisiones terapeuticas, clinicas y preventivas adecuadas y «coste-efectivas». La implementacion de los PRODIM debe sustentarse en la creacion de comites multidisciplinares liderados por microbiologos clinicos para el diseno de algoritmos diagnosticos, la adecuacion del sistema informatico del laboratorio para el control de la pertinencia de las pruebas diagnosticas solicitadas, la puesta en marcha de un sistema de control de calidad, el diseno y realizacion de estudios de analisis de coste-efectividad, la educacion del peticionario y del personal tecnico y de enfermeria y la evaluacion continua del programa. La incorporacion de PRODIM en la rutina asistencial reporta beneficios tangibles para el paciente a la vez que afianza el papel clave del microbiologo clinico en el manejo de las enfermedades infecciosas.

Introduction: Positive dysphotopsia (PD) is a topic of great interest in intraocular lens (IOL) field. Several approaches have been developed from the physics, psychophysics and psychometry fields to measure PD. However, the complexity of characterizing this phenomenon and the lack of standardization have resulted in a considerable bias between studies that avoid its inclusion in systematic reviews and meta-analysis. Areas Covered: The purposes of this review were first to suggest a definition and classification of PD that minimize the bias between studies that use different questions to rate PD prevalence. Second, to describe the limitations found in psychophysical studies. Finally, to identify the associations between photic phenomena (PP) and the design of monofocal and multifocal IOLs. A non-systematic literature review was conducted from the last 30 years. Expert Opinion: PD can be defined as any bothering bright artifact perceived by patients along or around direct bright lights or reflected over objects located in the visual field. If the patient is not bothered by the artifact, the term PP should be used instead. Psychophysical approaches measure PP and not PD. Whereas LED approaches are preferable, these really measure Light Disturbance because the classification of PP cannot be differentiated.

Previous studies have described the clinical, serological and pathological features of patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and antibodies directed against the paranodal proteins neurofascin-155, contactin-1 (CNTN1), contactin-associated protein-1 (Caspr1), or nodal forms of neurofascin. Such antibodies are useful for diagnosis and potentially treatment selection. However, antibodies targeting Caspr1 only or the Caspr1/CNTN1 complex have been reported in few patients with CIDP. Moreover, it is unclear if these patients belong to the same pathophysiological subgroup. Using cell-based assays in routine clinical testing, we identified sera from patients with CIDP showing strong membrane reactivity when both CNTN1 and Caspr1 were co-transfected (but not when CNTN1 was transfected alone). Fifteen patients (10 male; aged between 40 and 75) with antibodies targeting Caspr1/CNTN1 co-transfected cells were enrolled for characterization. The prevalence of anti-Caspr1/CNTN1 antibodies was 1.9% (1/52) in the Sant Pau CIDP cohort, and 4.3% (1/23) in a German cohort of acute-onset CIDP. All patients fulfilled European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) definite diagnostic criteria for CIDP. Seven (47%) were initially diagnosed with Guillain-Barré syndrome due to an acute-subacute onset. Six (40%) patients had cranial nerve involvement, eight (53%) reported neuropathic pain and 12 (80%) ataxia. Axonal involvement and acute denervation were frequent in electrophysiological studies. Complete response to intravenous immunoglobulin was not observed, while most (90%) responded well to rituximab. Enzyme-linked immunosorbent assay (ELISA) and teased nerve fibre immunohistochemistry confirmed reactivity against the paranodal Caspr1/CNTN1 complex. Weaker reactivity against Caspr1 transfected alone was also detected in 10/15 (67%). Sera from 13 of these patients were available for testing by ELISA. All 13 samples reacted against Caspr1 by ELISA and this reactivity was enhanced when CNTN1 was added to the Caspr1 ELISA. IgG subclasses were also investigated by ELISA. IgG4 was the predominant subclass in 10 patients, while IgG3 was predominant in other three patients. In conclusion, patients with antibodies to the Caspr1/CNTN1 complex display similar serological and clinical features and constitute a single subgroup within the CIDP syndrome. These antibodies likely target Caspr1 primarily and are detected with Caspr1-only ELISA, but reactivity is optimal when CNTN1 is added to Caspr1 in cell-based assays and ELISA.

Antibiotics are added to semen extenders to control the growth of bacteria contaminating semen during collection but may contribute to the development of antibiotic resistance. An alternative would be physical separation of spermatozoa from bacteria. The objective of the present study was to evaluate two low densities of Porcicoll for removal of bacteria, and for their effect on sperm recovery and sperm quality. Semen was collected from boars at a commercial station. Aliquots of 8 extended ejaculates were subjected to colloid centrifugation through 20% Porcicoll (P20) and 30% Porcicoll (P30) in 500 mL tubes and then stored at 17 °C. Microbiological examination and sperm quality evaluation (computer assisted sperm analysis and flow cytometry) were carried out on controls and all colloid-selected samples immediately after preparation and again after storage for 3 and 7 days. The microorganisms found were mainly bacteria from the environment, gut or skin. There was a considerable reduction or complete removal of some bacteria by both colloids. Recovery rates were 86% for P20 and 81% for P30. Sperm quality was not adversely affected by colloid centrifugation on day 0, and thereafter showed a more gradual deterioration in colloid centrifuged samples than in controls, possibly due to lower bacterial contamination. There were no differences in sperm quality between the two colloid treatments. Thus, these results show that contaminating bacteria in semen can be controlled by centrifugation through low density colloids.

Individualized pre-operative assessment of the patterns of the lower extremity anatomy and deformities in patients undergoing total knee arthroplasty seems essential for a successful surgery. In the present study, we investigated the relationship among the coronal alignment and the rotational profile of the lower extremities in the Caucasian population with end-stage knee osteoarthritis. We conducted a prospective study of 385 knees that underwent a pre-operative three-dimensional computed tomography-based model. The lower extremity alignment was determined (mechanical tibiofemoral or hip-knee-ankle angle, supplementary angle of the femoral lateral distal angle, and proximal medial tibial angle). For each case, the femoral distal rotation (condylar twist angle), the femoral proximal version, and the tibial torsion were determined. As the coronal alignment changed from varus to valgus, the femoral external rotation increased (r = 0.217; p

Methotrexate is the gold standard treatment in rheumatoid arthritis. Once absorbed, it is internalized in cells, where glutamate residues are added to produce polyglutamated forms, which are responsible for the effect of methotrexate. The aim of the current study is to determine the relationship between methotrexate triglutamate concentrations and the clinical evolution in rheumatoid arthritis patients, as well as to characterize the variability in both features to propose strategies for low-dose methotrexate optimization. The quantification of methotrexate triglutamate concentration in red blood cells was performed through ultra-performance liquid chromatography coupled with mass spectrometry. Polymorphisms of genes involved in the formation of polyglutamates were determined by real-time polymerase chain reaction. A multivariate regression was performed to determine the covariates involved in the variability of methotrexate triglutamate concentrations and a population pharmacokinetics model was developed through nonlinear mixed-effects modeling. Disease activity score changed according to methotrexate triglutamate concentrations; patients with good response to treatment had higher concentrations than moderate or nonresponding patients. The methotrexate triglutamate concentrations were related to time under treatment, dose, red blood cells, and body mass index. A 1-compartment open model was selected to estimate the pharmacokinetic parameters; the typical total clearance (L/day) was determined as 1.45 * (body mass index/28 kg/m2 ) * (red blood cells/4.6 × 106 cells/μL) and the volume of distribution was 52.4 L, with an absorption rate of 0.0346/day and a fraction metabolized of 1.03%. Through the application of the model, the initial dose of methotrexate is proposed on the basis of stochastic simulations and considering methotrexate triglutamate concentrations found in responders patients.

Introducción: La dieta mediterránea (DM) es un patrón alimentario altamente reconocido como beneficioso para la salud. Objetivo: Evaluar y comparar por sexo la adherencia a la DM de los estudiantes universitarios del norte de México. Material y Método: Participaron 165 estudiantes universitarios, 88 mujeres y 77 hombres, entre 22 y 34 años, fue un estudio comparativo, descriptivo y transversal, se midieron las variables de estatura y masa corporal y se compararon mediante la prueba estadística ANOVA de un factor, se determinó del índice de masa corporal, la adherencia a la DM se evaluó mediante el cuestionario KIDMED y se analizó con tabla de contingencia y U-Mann Whitney. Resultados: Clasificaron con sobrepeso el 30.7% de las mujeres y el 46.8% de los hombres con diferencia estadística (p

Risk-sharing agreements(RSA) allow decision-makers to manage the uncertainty associated with effectiveness and costs of treatments. Our objective was to estimate the economic impact of RSA implementation on treatment of patients diagnosed with rheumatoid arthritis(RA) with certolizumab pegol(CZP) and assess the potential impact of alternative RSA.Under original RSA, treatment with CZP was reimbursed when the response was optimal (DAS28 score3.2) or satisfactory (DAS28 score ≥3.2 and reduction from baseline ≥1.2) at 12 weeks. Alternative RSA would additionally include a 50 % reimbursement for moderate responders(DAS28 score3.2 and ≤5.1, and reduction from baseline between 0.6 and 1.2). We estimated average savings per patient for hospital's pharmacy service(HPS) at 12 weeks, taking into account the pharmacological cost of CZP. Uncertainty associated with effectiveness of CZP was assessed through 1000 Monte Carlo simulations.After 12 weeks of treatment, 57.8 % (n = 52) and 22.2 %(n = 20) of patients had optimal and satisfactory responses, respectively, and average disease activity improved by 1.77 points. Average savings for HPS amounted to 876.9€ and 706.4€ per patient under original and alternative RSA, respectively. Savings in simulated cohort reached 846.2€ and 681.8€ per patient, respectively, leading to estimated net savings for HPS of 846,209€ and 681,790€, respectively.RSA implementation on patients with RA treated with CZP has generated savings and improved efficiency within HPS.

Extraarticular synovial osteochondromatosis is a very rare benign disease whose aetiology may be primary or secondary to pre-existing pathology or after trauma. The diagnosis can be made with plain radiography and CT, and MRI is necessary to evaluate the non-mineralized soft tissue component and assess extension. It must be confirmed with a pathological study by biopsy or resection. There is up to a 5% chance of malignant transformation. The treatment of choice for the extensive extra-articular form is surgery by open resection. The case presented illustrates an atypical form of secondary extraarticular OCS with multiple involvement of the leg, ankle and foot.

Metagenomics and single‐cell genomics have enabled the discovery of relevant uncultured microbes. Recently, single‐virus genomics (SVG), although still in an incipient stage, has opened new avenues in viral ecology by allowing the sequencing of one single virus at a time. The investigation of methodological alternatives and optimization of existing procedures for SVG is paramount to deliver high‐quality genomic data. We report a sequencing dataset of viral single‐amplified genomes (vSAGs) from cultured and uncultured viruses obtained by applying different conditions in each SVG step, from viral preservation and novel whole‐genome amplification (WGA) to sequencing platforms and genome assembly. Sequencing data showed that cryopreservation and mild fixation were compatible with WGA, although fresh samples delivered better genome quality data. The novel TruPrime WGA, based on primase‐polymerase features, and WGA‐X employing a thermostable phi29 polymerase, were proven to be with sufficient sensitivity in SVG. The Oxford Nanopore (ON) sequencing platform did not provide a significant improvement of vSAG assembly compared to Illumina alone. Finally, the SPAdes assembler performed the best. Overall, our results represent a valuable genomic dataset that will help to standardized and advance new tools in viral ecology. This work has been supported by Gordon and Betty Moore Foundation (grant 5334) and Spanish Ministry of Economy and Competitiveness (refs CGL2013‐40564‐R, RTI2018‐094248‐B‐I00 and SAF2013‐49267‐EXP). Work at CRG, BIST and UPF was in part funded by the Spanish Ministry of Economy and Competitiveness, ‘Centro de Excelencia Severo Ochoa 2013‐2017’ and the Spanish Ministry of Economy and Competitiveness, ‘Centro de Excelencia Maria de Maeztu 2016‐2019’.

Introduction Acinetobacter is a genus that comprises a group of opportunistic pathogens responsible for a variety of nosocomial infections. The Acinetobacter calcoaceticus–Acinetobacter baumannii (Acb) complex includes some species of clinical importance, mainly A. baumannii, A. pittii and A. nosocomialis, which share phenotypic similarities that make it very difficult to distinguish between them using a phenotypic approach. The aim of this study was to evaluate two commercial matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) systems for the identification of different Acinetobacter species, with a special focus among those belonging to the Acb complex. Methods One hundred and fifty-six Acinetobacter spp. clinical strains, identified by amplified ribosomal DNA restriction analysis (ARDRA) and rpoB gene sequencing, were analysed by two different MALDI-TOF systems. Results Considering only the 144 strains of the Acb complex evaluated in this study, the Vitek-MS™ and Microflex LT™ systems correctly identified 129 (89.6%) and 143 (99.3%) strains, respectively. Conclusion After analysing 156 strains belonging to Acinetobacter spp., both Vitek-MS™ and Microflex LT™ proved to be rapid and accurate systems for the identification of Acb complex species showing a good correlation. However, both manufacturers should improve their databases to include new species in them.

Myocardial infarction (MI) is associated with renal alterations resulting in poor outcomes in patients with MI. Renal fibrosis is a potent predictor of progression in patients and is often accompanied by inflammation and oxidative stress; however, the mechanisms involved in these alterations are not well established. Endoplasmic reticulum (ER) plays a central role in protein processing and folding. An accumulation of unfolded proteins leads to ER dysfunction, termed ER stress. Since the kidney is the organ with highest protein synthesis fractional rate, we herein investigated the effects of MI on ER stress at renal level, as well as the possible role of ER stress on renal alterations after MI. Patients and MI male Wistar rats showed an increase in the kidney injury marker neutrophil gelatinase-associated lipocalin (NGAL) at circulating level or renal level respectively. Four weeks post-MI rats presented renal fibrosis, oxidative stress and inflammation accompanied by ER stress activation characterized by enhanced immunoglobin binding protein (BiP), protein disulfide-isomerase A6 (PDIA6) and activating transcription factor 6-alpha (ATF6α) protein levels. In renal fibroblasts, palmitic acid (PA; 50-200 µM) and angiotensin II (Ang II; 10−8 to 10−6M) promoted extracellular matrix, superoxide anion production and inflammatory markers up-regulation. The presence of the ER stress inhibitor, 4-phenylbutyric acid (4-PBA; 4 µM), was able to prevent all of these modifications in renal cells. Therefore, the data show that ER stress mediates the deleterious effects of PA and Ang II in renal cells and support the potential role of ER stress on renal alterations associated with MI.

Objectives Corynebacterium urealyticum is a non-diphtherial urease-producing clinically relevant corynebacterium associated with urinary tract infections. Most clinical C. urealyticum isolates are multidrug-resistant. Whole-genome sequencing (WGS) of C. urealyticum VH4248 isolated from a clinical urine sample at Hospital Universitario Marques de Valdecilla, Santander, Spain, was performed to predict its antimicrobial resistance profile and to compare it with results of culture-based phenotypic antimicrobial susceptibility testing. Methods Classical microbiological methods and VITEK® MS were used for isolation and initial identification of strain VH4248. Draft genome sequencing was performed on an Illumina HiSeq 2500 platform, followed by assembly and annotation using SPAdes and RAST. Resistance genes were identified through PATRIC, the Pathosystems Resource Integration Center. Average nucleotide identity (ANI) analysis was done using the EDGAR and OrthoANI databases. Antimicrobial susceptibility was determined by Etest. Results Isolate VH4248 was initially identified asC. urealyticum. Its genome size is 2 261 231 bp with 64.4% GC content. Genome-based identification tools showed an average 93.7% similarity between VH4248 and C. urealyticum genomes deposited in public databases. Therefore, this isolate must be classified as Corynebacterium sp. The blaA and ermX genes as well as a class 1 integron including the aadB and sul1 genes are present in the VH4248 genome. This isolate is highly resistant to ampicillin, erythromycin and trimethoprim/sulfamethoxazole, and moderately resistant to gentamicin and kanamycin. Conclusions WGS is a powerful tool forCorynebacterium identification to species level and for detection of unusual resistance determinants, such as that encoded by the class 1 integron in isolate VH4248.

Objectives The steady progress in resistance of Pseudomonas aeruginosa (PA) has led to difficulties in treating infections due to multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains. Ceftazidime/avibactam (CAZ/AVI) has in vitro activity against many of these strains, however clinical experience with CAZ/AVI is limited. This study aimed to evaluate the characteristics and outcomes of eight patients with infections due to MDR- or XDR-PA treated with CAZ/AVI, including four strains resistant to ceftolozane/tazobactam. Methods This was a retrospective descriptive study of patients admitted to a teaching hospital between January 2016 and May 2017 who received CAZ/AVI as initial or continuation therapy for infection due to MDR- and XDR-PA. Results The sources of infection were hospital-acquired lower respiratory tract infection in five patients (62.5%) and osteomyelitis, meningitis and catheter-related bacteraemia in one patient each. Clinical cure was achieved in 4 patients (50.0%). The 30-day and 90-day mortality rates were 12.5% and 37.5%, respectively. One patient (12.5%) developed encephalopathy that improved with discontinuation of the drug. Conclusions CAZ/AVI may be a valuable option for serious infections due to resistant PA.

Plants respond to adverse environmental cues by adjusting a wide variety of processes through highly regulated mechanisms to maintain plant homeostasis for survival. As a result of the sessile nature of plants, their response, adjustment and adaptation to the changing environment is intimately coordinated with their developmental programs through the crosstalk of regulatory networks. Germination is a critical process in the plant life cycle, and thus plants have evolved various strategies to control the timing of germination according to their local environment. The mechanisms involved in these adjustment responses are largely unknown, however. Here, we report that mutations in core elements of canonical RNA-directed DNA methylation (RdDM) affect the germination and post-germination growth of Arabidopsis seeds grown under salinity stress. Transcriptomic and whole-genome bisulfite sequencing (WGBS) analyses support the involvement of this pathway in the control of germination timing and post-germination growth under salinity stress by preventing the transcriptional activation of genes implicated in these processes. Subsequent transcriptional effects on genes that function in relation to these developmental events support this conclusion.

The main stabilizing element of the distal radioulnar joint (DRUJ) is the triangular fibrocartilage complex (TFCC). Secondary stabilizers include the distal oblique band (DOB), which is inconsistently found. When TFCC repair has failed or cannot be performed, DOB reconstruction is a therapeutic option. Even though distal radioulnar ligamentoplasty remains the technique of choice, recent papers show similar outcomes from both methods. We present two cases of successful DOB repair with the extensor carpi radialis longus (ECRL) hemitendon.

Resumen Introduccion y objetivos Recientemente, la miocardiopatia arritmogenica del ventriculo izquierdo (MCAVI) ha sido reconocida como parte del espectro de la miocardiopatia arritmogenica. Se caracteriza por el reemplazo fibroadiposo de la pared de dicho ventriculo. Se describen las formas de presentacion clinica mas frecuentes, hallazgos de imagen y eventos en el seguimiento, destacando la importancia de la resonancia magnetica cardiaca (RMC). Metodos Registro prospectivo de pacientes con hallazgos compatibles con MCAVI. Se realizo analisis de imagen de RMC y seguimiento clinico. El objetivo primario fue la aparicion de eventos cardiovasculares adversos mayores (MACE) durante el seguimiento, definidos como muerte subita cardiaca, arritmias ventriculares sostenidas y trasplante cardiaco. Resultados Se incluyeron 74 pacientes consecutivos (edad media 48,6 anos, 50 varones [67,6%]). Las indicaciones mas frecuentes para la RMC fueron dolor toracico con coronariografia normal, arritmias ventriculares y sospecha de miocardiopatias. Los principales hallazgos de RMC fueron: realce tardio meso-subepicardico (91,9%), infiltracion grasa subepicardica (83,8%) y anomalias segmentarias de la contractilidad del ventriculo izquierdo (47,9%). En un seguimiento medio de 3,74 anos, 24 pacientes (32,4%) presentaron un MACE (muerte subita cardiaca 8,1%, arritmias ventriculares sostenidas 21,6% y trasplante cardiaco 4,1%). La presencia en RMC de realce tardio grave, predice independientemente la aparicion de MACE, ademas del hecho de ser varon y practicar deporte. Conclusiones La RMC es una herramienta clave para diagnosticar la MCAVI. La infiltracion grasa subepicardica y el realce tardio meso-subepicardico son hallazgos caracteristicos. El pronostico de esta poblacion es pobre con una alta incidencia de muerte subita cardiaca y arritmias ventriculares.

Objective The objective of this study was to determine and compare the distribution of fimA genotypes of Porphyromonas gingivalis (P. gingivalis) in systemic lupus erythematosus (SLE) patients compared with control subjects. Material and methods This observational cross-sectional study included 281 patients divided into two groups. Group 1 (G1) consisted of 162 control subjects (30–54 years old) and, group 2 (G2) included 119 subjects (10–69 years old) diagnosed with SLE. The presence of P. gingivalis was detected by PCR. DNA sequences in acquired plaque samples were identified using P. gingivalis specific sequences and further analyzed to differentiate their fimA genotypes using six sets of fimA genotype-specific primers. Results The presence of periodontitis (PE) was similar in both groups; similar measurements were obtained regarding clinical attachment loss (CAL) (G1 1.76 ± 0.72 vs. G2 1.95 ± 0.76). G2 showed the highest frequency of P. gingivalis (94.95%). FimA genotype II is considered the most virulent and, was the most frequently found in the SLE group (53.09%). Conclusion The genotypes associated with PE are more frequently detected in SLE, which could make them susceptible to develop PE.

OBJECTIVES Multiple sclerosis (MS) is a neurodegenerative chronic inflammatory. Mutations in the vitamin D receptor (VDR) gene can substantially affect serum vitamin D levels or alter its functionality, and can consequently increase susceptibility to developing MS. The objective of this study was to evaluate the association between polymorphisms in the VDR gene and risk of MS in a (Spanish) Caucasian population. PATIENTS AND METHODS We conducted a retrospective case-control study comprising 209 patients with relapsing-remitting multiple sclerosis (RRMS) and 836 controls of Caucasian origin from southern Spain. The ApaI (rs7975232), BsmI (rs1544410), Cdx2 (rs11568820), FokI (rs2228570), and TaqI (rs731236) gene polymorphisms were determined by allelic discrimination real-time PCR using TaqMan probes. RESULTS The recessive logical regression model, adjusted for age and sex, revealed that the TT genotype for VDR FokI (rs2228570) polymorphism was associated with higher risk of MS (P = 0.0150; OR = 1.82; 95% CI = 1.12-2.94; TT vs. CT + CC). No association between the other polymorphisms and development of MS was found in any of the models analyzed. The haplotype analysis, adjusted for age, smoking, and sex, did not find any statistically significant association between the haplotypes analyzed and risk of MS. CONCLUSIONS The VDR FokI (rs2228570) polymorphism was significantly associated with developing MS. We found no influence of the ApaI (rs7975232), BsmI (rs1544410), Cdx2 (rs11568820), FokI (rs2228570), and TaqI (rs731236) gene polymorphisms on the risk of developing MS in our patients.

The current 2019 coronavirus disease (COVID-19) is the world's largest and most pervasive public health emergency in more than one hundred years. Although neonatal units have not been at the epicentre of the current health crisis, they have also been forced to adopt contingency plans with the aim of protecting hospitalised neonates, their families, and professionals. Neonatal units have been forced to alter the neonatal care framework based on promoting neurodevelopment and family-centred care. The peak of the pandemic is falling in most countries, but COVID-19 infection is not eradicated and there is uncertainty about new outbreaks. It is time to reflect about better strategies to preserve the rights and excellence of care for newborns and their families. This column will highlight the changes that have occurred in neonatal units, and their impact on neonatal care and families. It is a time for critical reflection on nursing practice.

Mental health disparities have been documented among sexual minority college students, but there is a dearth of evidence from developing countries. The aim is to estimate the prevalence of 12-month mental and substance use disorders across a range of sexual identities among first-year college students in Mexican universities, and test whether there is an association between sexual identity and disorders and whether the association is moderated by gender. The University Project for Healthy Students, a web-based survey conducted as part of the World Health Organization’s World Mental Health International College Student initiative, recruited 7874 students from nine Mexican universities in 2016 and 2017. Logistic regressions estimated the association of sexual identity with 12-month major depressive episode, generalized anxiety disorder, panic disorder, alcohol abuse/dependence, and drug abuse/dependence, with interaction terms for gender. Compared to heterosexual students reporting no same-sex attraction (SSA), heterosexual students with SSA (AORs range 1.77–3.67) and lesbian/gay and bisexual students (AORs range 2.22–5.32) were at a higher risk for several disorders. Asexual students were at higher risk for drug abuse/dependence (AOR = 3.64). Students unsure of their sexual identity were at a higher risk for major depressive episode, panic disorder, and drug abuse/dependence (AORs range 2.25–3.82). Gender differences varied across sexual identity and disorder. These findings are the first empirical report of sexual minority psychiatric disparities among a college student population from a developing nation and underscore the importance of clinical interventions that address mental health needs among sexual minority college students.

Antecedentes: Trimetoprima-sulfametoxazol (TMP-SMZ) es el antimicrobiano de elección y de uso prolongado en la prevención y tratamiento de infecciones por gérmenes oportunistas en los pacientes con síndrome de inmunodeficiencia adquirida (sida), en quienes la frecuencia de reacciones adversas a medicamentos es de 30 a 50 %.Objetivo: Determinar las reacciones adversas a TMP-SMZ y sus factores de riesgo en pacientes con sida.Métodos: Se incluyeron pacientes mayores de 18 años con diagnóstico confirmado de infección por VIH y que presentaron reacción adversa a fármacos, de enero de 2018 a mayo de 2019. Se revisaron 319 expedientes.Resultados: Se reportó 13.16 % de reacciones adversas; de 42 pacientes con reacciones adversas a medicamentos, 23 fueron a TMP-SMZ (54.76 %). El rash representó 56.5 % de las reacciones adversas, el angioedema 21.73 % y la urticaria 17.39 %. Los factores de riesgo fueron la comorbilidad infecciosa (RM = 2.6) y la cuenta de CD4

Accuracy in the placement of components in revision total knee arthroplasty (R-TKA) surgery is sometimes challenging. The applicability of patient‑specific instruments (PSI) in knee surgery has progressively expanded to types of surgery other than primary arthroplasty. Could this assistive technology be used to facilitate accurate R-TKA surgery? The aim of the current manuscript is to describe this new application of PSI for revision of TKA-to-TKA and to provide a step-by-step technical guideline for use.We will describe the application and a detailed description of PSI technology to TKA revision surgery, step-by-step, from CT images acquisition for preoperative planning and PSI blocks production to the surgery.The system can facilitate the accomplishment of the bony cuts for optimal implant placement and that can be useful in minimally altering the femoral and the tibial joint line. It is obvious that technology alone will not replace surgical skill and that accuracy of the system will also depend on the quality of the CT images and the ability of the software to prevent metal artifacts. Despite that, our initial results are promising and prove that the concept of applying PSI technology to the R-TKA surgery is feasible.

Introduccion: La tecnica de estabilizacion labial (LipStaT®), es un novedoso abordaje quirurgico para el manejo de la sonrisa gingival. Es una tecnica ambulatoria, minimamente invasiva, con baja morbilidad e incidencia de complicaciones. La meta de la tecnica es reducir la excesiva cantidad de encia que se visualiza durante la sonrisa. Objetivo: Describir la tecnica LipStaT ® incluyendo sus indicaciones, evaluacion preoperatoria, abordaje quirurgico y las indicaciones posteriores a la intervencion. Presentacion del caso : Los autores presentan dos pacientes, mujeres, entre 20 y 31 anos, con visualizacion excesiva de la encia de mas de 3mm al sonreir y con experiencias de fracasos con otros procedimientos. La tecnica LipStaT ® permitio lograr un resultado estetico, armonico y funcional. Conclusion: Este es un procedimiento seguro, ambulatorio, que permite obtener resultados predecibles y bien aceptados por los pacientes.

Purpose: To identify the most sensitive visual performance metric for evaluating the pupil-dependency of a multifocal intraocular lens (MIOL) and to determine the pupil measurement method most correlated with such metric. Methods: Twenty-seven right eyes implanted with a MIOL were included in the analysis. Three pupil size measurements were obtained preoperatively and at 1 month after surgery with the Keratograph 5M system: photopic (PP), mesopic (MP), and the average from both (AP). Pupil was also measured with a rule (RP) under the same light conditions of postoperative visual performance measurements that included, corrected visual acuities (VA) at three distances (far, 67 cm and 40 cm), visual acuity (VADC) and contrast sensitivity defocus curves for optotype sizes of 0.3 logMAR (CSDC3) and 0.7 logMAR (CSDC7). Differences in visual performance were also analyzed for eyes with RP > 3 mm (Group A) and RP ⩽ 3 mm (Group B). Results: PP diameter decreased after surgery by 16% ( p = 0.001), whereas MP ( p = 0.013) and AP ( p = 0.008) decreased by 10%. The best agreement with RP was obtained for AP. Group B showed a trend to better performance than Group A for all the included metrics ( p > 0.05). From the three types of defocus curves, CSDC3 obtained generally highest statistical power for testing differences between groups. The strongest statistically significant correlations between pupil size and CSDC3 were obtained for RP and AP. Conclusion: The CSDC3 was the most sensitive metric to detect MIOL pupil-dependency. PR and AP were more correlated with CSDC3 than PP and MP.

Introduction & objectives Liver cirrhosis is a major cause of mortality worldwide. Adequate diagnosis and treatment of decompensating events requires of both medical skills and updated technical resources. The objectives of this study were to search the demographic profile of hospitalized cirrhotic patients in a group of Latin American hospitals and the availability of expertise/facilities for the diagnosis and therapy of decompensation episodes. Methods A cross sectional, multicenter survey of hospitalized cirrhotic patients. Results 377 patients, (62% males; 58 ± 11 years) (BMI > 25, 57%; diabetes 32%) were hospitalized at 65 centers (63 urbans; 57 academically affiliated) in 13 countries on the survey date. Main admission causes were ascites, gastrointestinal bleeding, hepatic encephalopathy and spontaneous bacterial peritonitis/other infections. Most prevalent etiologies were alcohol-related (AR) (40%); non-alcoholic-steatohepatitis (NASH) (23%), hepatitis C virus infection (HCV) (7%) and autoimmune hepatitis (AIH) (6%). The most frequent concurrent etiologies were AR + NASH. Expertise and resources in every analyzed issue were highly available among participating centers, mostly accomplishing valid guidelines. However, availability of these facilities was significantly higher at institutions located in areas with population > 500,000 (n = 45) and in those having a higher complexity level (Gastrointestinal, Liver and Internal Medicine Departments at the same hospital (n = 22). Conclusions The epidemiological etiologic profile in hospitalized, decompensated cirrhotic patients in Latin America is similar to main contemporary emergent agents worldwide. Medical and technical resources are highly available, mostly at great population urban areas and high complexity medical centers. Main diagnostic and therapeutic approaches accomplish current guidelines recommendations.

The effect of partial replacement of wheat flour with turmeric flour (Curcuma longa) on the physicochemical and sensory properties of chorizo made with pork was evaluated. Three levels of turmeric flour substitution were proposed 0.8%, 1.4% and 2.1%, corresponding to a substitution of a 19.04%, 33.33% and 50,00%, respectively, along with a control chorizo without the addition of said flour. The pH, water holding capacity, color, texture and sensory evaluation were measured. The pH tended towards acidity in the treatment with the greatest inclusion of uremic flour. The sensory evaluation was carried out with to untrained panelists who determined the chorizo with the highest acceptability. For the sensory parameters, there were no significant differences, except for color. Therefore, turmeric flour can be used as a partial substitute for wheat flour in the production of common chorizo without affecting physicochemical and sensory properties. Resumen Se evaluó el Efecto del remplazo parcial de la harina de trigo por harina de cúrcuma (Curcuma longa) sobre las propiedades fisicoquímicas y sensoriales de chorizos hechos con carne de cerdo. Se propusieron tres niveles de sustitución de harina de cúrcuma 0,8%, 1,4% y 2,1%, correspondientes a una sustitución de 19,04%, 31,33% y 50,00%. Respectivamente y un chorizo control sin adición de dicha harina. Se midieron el pH, la capacidad de retención de humedad, el color, la textura y la evaluación sensorial. El pH mostró una tendencia a la acidez en el tratamiento con una mayor inclusión de harina de cúrcuma. La evaluación sensorial se trabajó con 70 panelistas no entrenados que determinaron el chorizo con la mayor aceptabilidad. En cuanto, a los parámetros sensoriales, no hubo diferencias significativas, excepto para el color. Por lo tanto, se puede concluir que la harina de cúrcuma se puede usar como un sustituto parcial de la harina de trigo en la producción de chorizo común, sin afectar sus propiedades fisicoquímicas y sensoriales.

We aimed to analyze the impact of two different types of surgical instrumentation (conventional manual instrumentation (CI) and patient-specific instrumentation (PSI)) on length of stay (LOS) and objectify differences in cost. We hypothesized that there are no differences in the LOS and cost due to the instrumentation system used.LOS was registered using inpatient admission data provided by the Institutional Management Control Department. We recorded the costs associated with each procedure that could be influenced by the use of one system or another during the in-hospital stay. We conducted a prospectively single-center cohort study of 305 TKAs. Surgery was performed with conventional CI in 122 cases and with PSI in 183 cases.The mean LOS for the CI group was 4.29 days (SD 1.65) and 4.22 days (SD 1.26), for the PSI group. No significant difference among both instrumentation systems was obtained. When comparing global costs, the mean cost was slightly higher (without a significant difference) for the PSI cases (€3110.24 vs. €2852.7 for the CI cases).LOS and overall cost, in hospitals with a low annual TKA surgery volume, are unrelated to conventional or patient-specific instrumentation.

Resumen Introduccion El HPTP frecuentemente permanece sin diagnosticar en pacientes con hipercalcemia, lo que podria ocasionar un aumento de la morbilidad en estos sujetos. Objetivo Identificar la presencia de hipercalcemia y de criterios de tratamiento quirurgico (CTQ) no identificados desde al menos un ano antes de su remision a endocrinologia en pacientes operados de HPTP. Valorar si este retraso terapeutico se asocia a mayor morbilidad. Metodos Estudio observacional en 116 pacientes consecutivos. Mediante la revision de los registros anteriores a 12 meses previos a su derivacion a endocrinologia se dividieron en 4 grupos: hipercalcemia con CTQ (grupo 1, n = 43), hipercalcemia sin CTQ (grupo 2, n = 23), calcemias normales (grupo 3, n = 18) o ausencia de calcemias en dichos registros (grupo 4, n = 32). Resultados En 84 pacientes (72,4%) habia calcemias previas, 66 (56,9%) con hipercalcemia, de ellos 43 (37%) con CTQ no valorados. La demora media hasta su remision fue de 57 meses. Casi la mitad de las calcemias del grupo 1 procedian de urgencias. Respecto al grupo 4 los pacientes del grupo 1 tenian menor edad, mayor incidencia de nefrolitiasis e insuficiencia renal al remitirseles. Las calcemias en el momento de su derivacion eran similares, superiores a las de los grupos 2 y 3. Discusion Los pacientes con HPTP y CTQ se remiten a endocrinologia con un retraso medio de 5 anos. La inadvertencia de la hipercalcemia y/o el desconocimiento de los CTQ retrasan esta derivacion, determinada por hipercalcemias superiores, y se asocian a una afectacion renal mas severa. Son precisas medidas correctoras para evitar este retraso en el diagnostico y curacion del HPTP.

Introduction Primary hyperparathyroidism (PHPT) remains underdiagnosed among patients with hypercalcemia, potentially causing increased morbidity. Objective To identify in surgically operated patients the presence of overlooked hypercalcemia and patients with criteria for surgery (CFS) for PHPT at least one year prior to referral to Endocrinology, and to determine whether this diagnostic delay leads to increased morbidity. Methods An observational study was carried out in 116 consecutive patients. We evaluated electronic medical records registered at least 12 months prior to referral and divided them in four groups: hypercalcemia with CFS (group 1), hypercalcemia without CFS (group 2), normocalcemia (group 3), and cases without previous biochemical evaluation (group 4). Results A total of 84 patients (72.4%) had a previous measurement of serum calcium at a time interval of ≥12 months. Sixty-six (56.9%) had hypercalcemia and 43 of them (37%) had ≥1 CFS, with an average delay of 57 months in receiving proper evaluation. Almost half of the calcemia measurements in group 1 had been made in the emergency room. Patients from group 1 were younger, and had a greater frequency of nephrolithiasis and renal impairment than patients in group 4. The serum calcium values at referral were similar in both groups and higher than the values found in patients from the other two groups. Discussion In patients with PHPT and CFS, referral to an endocrinologist is made with an average delay of almost 5 years. The identified causes of this delay, which conditions more kidney disease, are unrecognized hypercalcemia and/or unawareness of the surgical criteria, while calcium elevations promote referral. Interventions are needed to avoid this delay in the diagnosis and resolution of PHPT.

Placenta‑derived exosomes play an important role in cellular communication both in the mother and the fetus. Their concentration and composition are altered in several pregnancy disorders, such as gestational diabetes mellitus (GDM). The isolation and characterization of placental exosomes from serum, plasma and tissues from patients with GDM have been previously described; however, to the best of our knowledge, to date, there is no study available on placental exosomes isolated from urine of patients with GDM. In the present study, placental exosomes were purified from urine the 1st, 2nd and 3rd trimester of gestation. Placental exosomes were characterized by transmission electron microscopy in cryogenic mode and by western blot analysis, confirming the presence of exosomal vesicles. The expression profile of five microRNAs (miR‑516‑5p, miR‑517‑3p, miR‑518‑5p, miR‑222‑3p and miR‑16‑5p) was determined by RT‑qPCR. In healthy pregnant women, the expression of the miRNAs increased across gestation, apart from miR‑516‑5p, which was not expressed at the 2nd trimester. All the miRNAs examined were downregulated in patients with GDM at the 3rd trimester of gestation. The downregulated miRNAs affected several metabolic pathways closely associated with the pathophysiology of GDM. This provides further evidence of the regulatory role of miRNAs in the GDM. This also suggests that the of urinary exosomes may be an excellent source of biomarkers and therapeutic targets.

Resumen: Objetivo: Analizar la asociación entre funcionalidad familiar, crianza parental y estado nutricional en preescolares. Diseño: Estudio cuantitativo, descriptivo correlacional y transversal. Emplazamiento: Instituciones públicas de educación preescolar en el estado de Nuevo León, México. Atención Primaria. Participantes: Muestra compuesta por 228 diadas (madre o padre y preescolar); se tomó como único criterio de inclusión ser el responsable principal de la crianza del preescolar. Mediciones principales: Se empleó un cuaderno de recogida datos sociodemográficos, el estado nutricional se determinó basándose en recomendaciones de la Organización Mundial de la Salud, se utilizaron la Escala de Evaluación de la Cohesión y la Adaptabilidad Familiar y el cuestionario de Estilos de Crianza Parental. Se obtuvo estadística descriptiva y el coeficiente de correlación de Spearman. Resultados: El promedio de edad de los padres fue de 32,09 años, el 60,5% de las madres se dedican al hogar y el 100% de los padres trabaja; la media de escolaridad en años fue de 12,16; el 68,9% de los participantes son casados; referente a los preescolares, el 29,4% presentó sobrepeso u obesidad. En cuanto a la funcionalidad familiar, se identificó que en la dimensión de cohesión es semirrelacionada el 44,3%. El estilo de crianza parental que predominó en los padres fue el permisivo con el 62,3%. Conclusiones: La mayoría de los padres de familia presentaron desequilibrio en la funcionalidad familiar. No se encontró significación estadística entre funcionalidad familiar y crianza parental con estado nutricional en preescolares (p

This research paper aims to find and show what was written about the 360 degree assessment, applied to students and university professors. It was found, that the application of this method in medical students is dominant since in this profession not only the accumulation of acquired knowledge, but also the human quality, and the skills they can develop, does not matter. However, in the medical sector today there is a great tension to maintain an excellent service and that has quality in the full extent of the word; in most of the reviewed articles one of the best advantages, shown in the 360 degree evaluation, is that given its nature, it can be used to improve the quality of those, evaluated by speaking from bosses, colleagues, subordinates and clients, as long as the evaluation is done in a proper, honest and well-organized way you get benefits the same as the authors of different works describe them as advantages and disadvantages. The research objective was achieved and a table is provided with the main works, dating from 2013 to 2019, with the aim of providing an update of this topic in 2020.

Miembros del Grupo GRAM: Eugenio Garduño, Purificación Hernández Pérez, José Román Muñoz Sanz, Carmen González Velasco, Saray Rodríguez, José M.Navarro Marí, María Dolores Rojo Martín, Marta Álvarez Estévez, Alejandro Peña Monje, Waldo Sánchez Yebra, Carolina Roldán Fontana, Lina Martín Hita, Encarnación Clavijo Frutos, María Gracia Ortega, Begoña Palop Borrás, Pilar Bermúdez Ruiz, José Antonio Lepes, Javier Aznar, M.Carmen Domínguez, Irene Gracia Ahufingeru, Fernando Rodríguez, Ana Domínguez Castaño, Manuel Rodríguez Iglesias, Fátima Galán Sánchez, M.Dolores López Prieto, Juan Manuel Sánchez Calvo, José Luis López Barba, Carmen Martínez Rubio., Introduction: The aim of this study was to determine the antimicrobial resistance rates and their evolution in clinical isolates of Pseudomonas aeruginosa causing invasive infections in the south of Spain between 2012 and 2017. Methods: Retrospective study consisting of the collection of microbiological data from 20 hospitals (14 from Andalucía, 5 from Extremadura and 1 from Ceuta) between 2012 and 2017. The main variables studied were the antimicrobial susceptibility testing system used, interpretation criteria (CLSI or EUCAST) and the rate or percentage of resistant isolates. Results: The most widely used antimicrobial susceptibility testing system was MicroScan (58%). The global resistance rates varied between 25% (ciprofloxacin) and 4% (colistin) using EUCAST, and between 19% (ciprofloxacin and imipenem) and 3% (amikacin) using CLSI. The antimicrobial resistance rates were relatively stable throughout the period 2012-2017. 14% of isolates were MDR and 7% were XDR. Respiratory isolates were more resistant, particularly to ciprofloxacin and colistin, than isolates from urine or blood. Conclusions: The antimicrobial resistance rates in P. aeruginosa are not particularly high in the south of Spain. The highest resistance rates were observed with ciprofloxacin, piperacillin/tazobactam and meropenem, whereas the more active antimicrobials were colistin, tobramycin and amikacin. The highest resistance rates were seen in respiratory isolates. In general, the resistance rates remained stable during the study period for most of the antimicrobials studied.

Mice lacking either colony-stimulating factor-1 (CSF-1) or its receptor, CSF-1R, display osteopetrosis. Accordingly, genetic deletion or pharmacological blockade of CSF-1 prevents the bone loss associated with estrogen deficiency. However, the role of CSF-1R in osteoporosis models of type-1 diabetes (T1D) and ovariectomy (OVX) has not been examined. Thus, we evaluated whether CSF-1R blockade would relieve the bone loss in a model of primary osteoporosis (female mice with OVX) and a model of secondary osteoporosis (female with T1D) using micro-computed tomography. Female ICR mice at 10 weeks underwent OVX or received five daily administrations of streptozotocin (ip, 50 mg/kg) to induce T1D. Four weeks after OVX and 14 weeks after first injection of streptozotocin, mice received an anti-CSF-1R (2G2) antibody (10 mg/kg, ip; once/week for 6 weeks) or vehicle. At the last day of antibody administration, mice were sacrificed and femur and tibia were harvested for micro-computed tomography analysis. Mice with OVX had a significant loss of trabecular bone at the distal femoral and proximal tibial metaphysis. Chronic treatment with anti-CSF-1R significantly reversed the trabecular bone loss at these anatomical sites. Streptozotocin-induced T1D resulted in significant loss of trabecular bone at the femoral neck and cortical bone at the femoral mid-diaphysis. Chronic treatment with anti-CSF-1R antibody significantly reversed the bone loss observed in mice with T1D. Our results demonstrate that blockade of CSF-1R signaling reverses bone loss in two different mouse models of osteoporosis.

AIM The aim of this study was to determine whether a direct relationship existed between absolute telomere length (aTL), obesity and familial functionality in a group of Mexican children. METHODS We recruited 134 children (52% boys) aged 8-10 years during regular primary care check-ups in 2016 and evaluated physical activity (PA), feeding practices, anthropometrics, body fat percentage (BF%) and family dysfunction. Optimised quantitative PCR determined aTL from genomic deoxyribonucleic acid isolated from saliva samples. RESULTS Boys with a healthy BF% showed a higher aTL than their high BF% counterparts (P

Resumen El Comite Espanol del Antibiograma (COESANT) presenta en este documento una sencilla «hoja de ruta» en forma de decalogo de recomendaciones cuya finalidad es facilitar la transicion de la normativa del Clinical and Laboratory Standards Institute (CLSI) a la del European Committee on Antimirobial Susceptibility Testing (EUCAST) en los Servicios y Unidades de Microbiologia Clinica que aun emplean los criterios del CLSI. Su objetivo es adaptar las directrices europeas, mas proximas a la realidad clinico-epidemiologica espanola, y conseguir una implantacion de los criterios del EUCAST en la totalidad de los laboratorios de Microbiologia en Espana.

Background Social capital is employed as an asset when there is a lack of an efficient health-care system. However, this relationship is not homogeneous and can differ according to the characteristics of individuals and their context. In this paper, we aim to analyze the role of social capital in the solution of healthcare problems among individuals with different levels of marginalization and unequal access to health services. Methods This qualitative study examines the role of social capital in the demand for healthcare among Mexican individuals with different levels of marginalization. The research draws data from semi-structured interviews (N = 247) that were collected in four Mexican states with different social welfare benefits: Mexico City, Tamaulipas, the State of Mexico, and Oaxaca. The interviewees were selected using the snowball method and other eligibility criteria such as education, age, and gender. Results Findings suggest that social capital is a relevant factor in solving healthcare problems, depending on the level of marginalization. The role of social capital can be explained by the precariousness of medical service delivery, the poor health infrastructure, and the difficult access to health care in Mexico. Networks are the main resource to deal with health related issues, food, medicine, and out-of-the-pocket medical expenses in contexts of high levels of marginalization. In the middle level of marginalization, networks also help in raising funds for more-specialized medical services and higher quality hospitals. In the least-marginalized levels, social capital is used as companionship for sick individuals, while support networks act as emotional relief. At this level, most individuals have private health insurance, and many of them have major medical healthcare coverage. Conclusions Participants reported low levels of trust in the health care system because of the poor infrastructure and quality of medical service delivery. Although the main criticism is focused on public healthcare institutions, there is a lack of trust in private medical services as well. These facts are related to the access and quality of medical service delivery and turn social capital into a significant asset. Despite that social bonds or links are valuable resources that individuals can use to solve healthcare related issues, the use of social capital is not homogenous. Indeed, it can be influenced by several factors that were represented in this study through the municipal marginalization index.

The Spanish Antibiogram Committee (Comité Español del Antibiograma, COESANT) presents in this document a simple "roadmap" or decalogue of recommendations, with a view to facilitating the transition from the Clinical and Laboratory Standards Institute (CLSI) to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) antimicrobial susceptibility testing regulations to the Clinical Microbiology Spanish laboratories that still use the CLSI guidelines. The objectives are to adapt the closer European regulations to the Spanish clinical and epidemiological reality and to fully implement the EUCAST recommendations in all microbiology laboratories in Spain.

BACKGROUND: An operational definition of serious mental illness (SMI) with well-defined inclusion criteria allows the identification of the most vulnerable individuals and secures resources to meet their needs and develop social programs for their treatment, rehabilitation, and recovery. In addition, the contents of a clinical construct such as SMI have an impact on both the development and the clinical application of the research results. However, currently, different ways of operationalizing the definition of SMI coexist. AIMS: The aim of this review was to explore whether unanimity exists in the operationalization of SMI definitions in quality-of-life interventions research. METHODS: A review of the literature based on searches of the MEDLINE and PsycINFO databases was conducted. Intervention studies were selected in which quality of life was the outcome variable and adults with SMI were the subject population. RESULTS: A wide range of definition of SMI is used in the scientific literature. CONCLUSIONS: There is a lack of unanimity in the variables considered necessary to identify SMI. The scientific literature uses different approaches to operationalize SMI, and these approaches vary considerably among studies. Caution is required when interpreting quality-of-life research that includes individuals labeled with SMI. It is necessary to reach a consensus on the criteria for applying the SMI label to ensure its content validity. Sin financiación 2.385 JCR (2020) Q1, 29/122 Nursing 0.546 SJR (2020) Q2, 13/38 No data IDR 2020 UEV

Background: The LRP1 (CR9) domain and, in particular, the sequence Gly1127-Cys1140 (P3) plays a critical role in the binding and internalization of aggregated LDL (agLDL). We aimed to evaluate whether immunization with P3 reduces high-fat diet (HFD)-induced atherosclerosis. Methods: Female New Zealand White (NZW) rabbits were immunized with a primary injection and four reminder doses (R1-R4) of IrP (irrelevant peptide) or P3 conjugated to the carrier. IrP and P3-immunized rabbits were randomly divided into a normal diet group and a HFD-fed group. Anti-P3 antibody levels were determined by ELISA. Lipoprotein profile, circulating and tissue lipids, and vascular pro-inflammatory mediators were determined using standardized methods while atherosclerosis was determined by confocal microscopy studies and non-invasive imaging (PET/CT and Doppler ultrasonography). Studies treating human macrophages (hMΦ) and coronary vascular smooth muscle cells (hcVSMC) with rabbit serums were performed to ascertain the potential impact of anti-P3 Abs on the functionality of these crucial cells. Results: P3 immunization specifically induced the production of anti-P3 antibodies (Abs) and did not alter the lipoprotein profile. HFD strongly induced cholesteryl ester (CE) accumulation in the aorta of both the control and IrP groups, and their serum dose-dependently raised the intracellular CE of hMΦ and hcVSMC, promoting TNFR1 and phospho-NF-kB (p65) overexpression. These HFD pro-inflammatory effects were dramatically decreased in the aorta of P3-immunized rabbits and in hMΦ and hcVSMC exposed to the P3 rabbit serums. Microscopy studies revealed that P3 immunization reduced the percentage of lipids, macrophages, and SMCs in the arterial intima, as well as the atherosclerotic extent and lesion area in the aorta. PET/CT and Doppler ultrasonography studies showed that the average standardized uptake value (SUVmean) of the aorta and the arterial resistance index (ARI) of the carotids were more upregulated by HFD in the control and IrP groups than the P3 group. Conclusions: P3 immunization counteracts HFD-induced fatty streak formation in rabbits. The specific blockade of the LRP1 (CR9) domain with Anti-P3 Abs dramatically reduces HFD-induced intracellular CE loading and harmful coupling to pro-inflammatory signaling in the vasculature., The main support to develop this project was received from Fundació MARATÓ TV3 Project 201521-10 (to VLl-C) and FIS PI18/01584 (to VLl-C), FIS16/00139 (to JCE-G) from the Instituto de Salud Carlos III (ISCIII) and co-financed with ERDFs. Support was received from Fundació Marató TV3 (Project 201521-10) for post-doctoral funding to OB and from Ministerio de Economía y Competitividad to DdG-C (IJCI-2016-29393). CIBER Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM; CB07/08/0016 to JCE-G) and CIBER Enfermedades Cardiovasculares (CIBERCV; CB16/1100403 to DdGC, VLl-C and CB16/11/00411 to LB and MB-P) are projects run by the Instituto de Salud Carlos III (ISCIII). We also acknowledge support from “Secretaria d’Universitats i Recerca del Departament d’Economia I Coneixement de la Generalitat de Catalunya” [2017SGR946 to VLl-C and 2017SGR1480 to LB]. DdG-C, VL-C and JCE-G are members of the Group of Vascular Biology of the Spanish Society of Atherosclerosis (SEA).

Cardiorenal syndrome is a term that defines the complex bidirectional nature of the interaction between cardiac and renal disease. It is well established that patients with kidney disease have higher incidence of cardiovascular comorbidities and that renal dysfunction is a significant threat to the prognosis of patients with cardiac disease. Fibrosis is a common characteristic of organ injury progression that has been proposed not only as a marker but also as an important driver of the pathophysiology of cardiorenal syndromes. Due to the relevance of fibrosis, its study might give insight into the mechanisms and targets that could potentially be modulated to prevent fibrosis development. The aim of this review was to summarize some of the pathophysiological pathways involved in the fibrotic damage seen in cardiorenal syndromes, such as inflammation, oxidative stress and endoplasmic reticulum stress, which are known to be triggers and mediators of fibrosis.