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Pregnancy and/or the puerperium involve social, physiological and psychological changes that make women more vulnerable to mental disorders such as anxiety and depression, even more so if these develop in stressful contexts such as the pandemic. The aim of this study is to identify factors associated with the risk of postpartum anxiety and depression during the COVID-19 pandemic. A cross-sectional study was conducted among postpartum women (n = 69) who gave birth between March 2020 and March 2021 in Melilla, a Spanish cross-border city with Morocco whose borders were closed, making it a confined city. The scales used were the State-Trait Anxiety Inventory and the Edinburgh Postnatal Depression Scale. Results reported an elevated risk of depression (85.5%) and anxiety (63.8%), with severe anxiety reaching 40.6% of cases. Predictors of postpartum depression comprised a personal history of mood disorders (β = 8.421; CI95% = 4.863/11.978) and having been diagnosed with COVID-19 during pregnancy or postpartum (β = 4.488; CI95% = 1.331/7.646). As regards anxiety, it is predicted on the basis of mood antecedents (β = 14.175; CI95% = 7.870/20.479), the fact of having been diagnosed with COVID-19 during pregnancy or postpartum (β = 8.781; CI95% = 2.970/14.592) and the fact of being a multipara (β = 5.513; CI95% = 0.706/10.321). In conclusion, special attention should be paid to women with a history of mood disorders and a positive diagnosis of COVID-19 during pregnancy or postpartum, even more so in the case of multiparous women, because of its impact on mental health during the postpartum period.

Introducción la pielonefritis en el anciano presenta una incidencia y morbimortalidad elevada. El incremento de las resistencias hace imprescindible un buen manejo empírico. Método estudio observacional retrospectivo en mayores de 65 años ingresados durante los años 2012-2017 en los hospitales de Palencia y Salamanca con diagnóstico de pielonefritis. Se consideró el tratamiento antibiótico empírico inadecuado, aquel que no se ajustaba a las indicaciones de la Guía de la SEIMC (2016). Resultados 292 episodios, edad media de 82 ± 10 años, 48,3% fueron varones. Se aisló Escherichia coli en el 53,8% y Klebsiella spp. en el 8,9%. Ciento ochenta episodios (61,6%) recibieron tratamiento empírico inadecuado. Las 2 causas más frecuentes fueron: el uso de antibióticos no incluidos en la guía 107 (59,5%) y el uso de cefalosporinas de 2ª-3ª generación en los pacientes con factores de riesgo de betalactamasas de espectro extendido 63 (35%). La ausencia de identificación del riesgo de betalactamasas de espectro extendido fue el principal factor de riesgo para el tratamiento antibiótico empírico inadecuado y la presencia de sepsis grave/shock factor de protección (p < 0,05). El tratamiento empírico inadecuado no se asoció a una mayor mortalidad (p > 0,05). Conclusiones la adecuación antibiótica en el anciano que ingresa por pielonefritis complicada es baja. La falta de identificación de factores de riesgo para enterobacterias productoras de betalactamasas de espectro extendido fue el principal factor. El tratamiento empírico inadecuado no se asoció a una mayor mortalidad. Introduction Pyelonephritis in the elderly present high incidence and morbidity-mortality. The increase in resistance makes good empirical handling essential. Methods Retrospective observational study in people over 65 years old admitted during 2012-2017 to Palencia and Salamanca hospitals with a diagnosis of pyelonephritis. Inadequate empirical antibiotic treatment was defined if it conformed to the indications of the SEIMC Guide (2016). Results 292 episodes, mean age 82 ± 10 years, 48.3% male. Escherichia coli 53.8% and Klebsiella spp 8. 9% were the most frequently microbiological isolation found. 180 episodes (61.6%) received inadequate empirical treatment. The two most frequent causes were the use of antibiotics not included in the guidelines 107 (59.5%) and the use of 2nd-3rd generation cephalosporins in patients with risk factors for Extended spectrum betalactamases 63 (35%). Absence of identification of risk factors of extended-spectrum betalactamases was found associated to inadequate empirical antibiotic treatment (p < 0,05). Inadequate treatment did not increase mortality (p > 0.05). Conclusions The adequacy of antibiotic use in the elderly admitted for pyelonephritis according to the SEIMC Guidelines is low. The lack of identification of risk factors for betalactamases-producing Enterobacteriacea was the main factor involved. Inadequate empirical treatment was not associated with increased mortality.

El envejecimiento general de las sociedades y el incremento de la esperanza de vida, ha tenido como consecuencia un aumento del número de personas que se encuentran en situación de dependencia. Esta necesidad es atendida fundamentalmente por cuidadores informales. Debido a la situación socioeconómica actual, cada vez es más necesario compatibilizar la vida laboral y familiar con el cuidado. Objetivos. 1) Conocer las peculiaridades de la vida de los cuidadores informales, su situación familiar, las particularidades del cuidado que llevan a cabo y los apoyos que tiene el cuidador; 2) Identificar el nivel de compatibilidad, el grado de sobrecarga y el nivel de resiliencia; 3) Indagar sobre la relación entre la Interacción trabajo-familia y las características peculiaridades de cada caso. Metodología. Estudio descriptivo, de muestreo intencional con 55 cuidadores informales españoles. Se realizó un análisis descriptivo y bivariante. Resultados. En la dimensión interacción negativa trabajo-familia se obtuvo una media 1.06 (0.667), en la interacción negativa familia-trabajo 0.59 (0.460), en la interacción positiva trabajo-familia 1.57 (0.806) y en la interacción positiva familia-trabajo 2.03 (0.821). En algunos casos, hubo significación estadística entre las características del cuidador, familiar y cuidado, con los niveles de interacción observados. Discusión. Las características de las participantes influyen en la interacción laboral y familiar, esta relación afecta a un mayor o menor logro de compatibilidad entre ambos ámbitos, y con el cuidado informal de una persona dependiente. ABSTRACT The general ageing of societies and the increase in life expectancy has resulted in a trend up of the number of people in a state of dependency situation. This need is being covered by informal caregivers. As a result of the present socio-economic situation, there is an increasing necessity to balance work and family life, with care. Objectives. 1) Identify the circumstances of informal carers, their family situation, the particularities of the care that they carry out and the supports that the caregiver has; 2) Determine the level of Work-life balance, the grade of overburdening and the level of resilience; 3) Investigate the relationship between work-family interaction and the characteristics of each case. Methodology. Cross-sectional, descriptive study of intentional sampling with 55 Spanish caregivers. A descriptive and bivariate analysis was carried out. Results. In the negative work-family interaction dimension a meaning of 1.06 (0.667) was obtained, in the negative family-work interaction 0.59 (0.460), in the positive work-family interaction 1.57 (0.806) and in the positive family-work interaction 2.03 (0.821). In some cases, there was statistical significance between the characteristics of the caregiver, family and care, with the levels of interaction observed. Discussion: The characteristics of each case influence the relationship between work and family interaction, which ends up having a higher or lower level of compatibility between both areas, with the informal care of a disabled person.

(1) Background: Numerous educational interventions have been conducted to improve hand hygiene (HH) compliance and effectiveness among nursing students, with mixed results. The aim is to evaluate the effectiveness of posters as a teaching tool and factors associated with HH quality. (2) Methods: A pre-post experimental intervention study was conducted with a total of 293 nursing students randomly assigned to two groups (experimental and control) who, before and after HH, took cell culture samples from their non-dominant hands. Only the experimental group was exposed to the poster. (3) Results: In the experimental group, significant differences were observed among students older than 22 years (p = 0.017, V = 0.188), with a higher percentage of failures (15.7% vs. 3.6%). Poster displaying was associated with passing, other variables being equal, although without statistical significance (ORa = 2.07, 95% CI = 0.81–5.26). Pre-practice hand contamination was weakly associated with lower HH quality (ORa = 0.99, 95% CI = 0.99–0.99). (4) Conclusions: The use of posters as a teaching method shows indications of efficacy. Prior hand contamination slightly affects the quality of HH. Further evaluation of teaching methods is needed to ensure good technical performance of HH to prevent the spread of infectious diseases during the COVID-19 pandemic.

Background/Purpose: Hand hygiene is the most effective method for preventing nosocomial infections. Numerous educational interventions have been implemented to improve adherence to hand hygiene and its effectiveness among nursing students, with mixed results. To assess the effectiveness of posters as a tool for teaching hand hygiene and factors associated with the quality of hand hygiene among nursing students. Methods An experimental pre-post intervention study was carried out with second-, third-, and fourth-year nursing students randomly assigned to two groups (experimental and control). The two groups performed the handrubbing technique using alcohol-based hand rub. The experimental group was simultaneously shown the poster on hand hygiene produced by the WHO. Before and after the hand rubbing, students took cell samples from their non-dominant hands, which were cultured in Petri dishes for 48 hours. The number of bacterial colony-forming units per cm2 determined the degree of cleanliness of their hands (n = 161), significant differences were observed by age, with a higher percentage of fails (15.7% vs. 3.6%) among students aged > 22 years. Viewing the poster was associated with passing, all other variables being equal, albeit without statistical significance (ORa = 2.07). Hand contamination prior to the practices was weakly associated with lower hand hygiene quality (ORa = .99). Conclusions The use of posters as a teaching method for improving hand hygiene shows indications of effectiveness. Prior contamination of the hands slightly affects the quality of hand hygiene after the practice. Evaluation of new hand hygiene teaching methods at College setting ensures that future nurses are educated and sensitised to the spread of infectious diseases during the COVID-19 pandemic.

[EN] Augmented Reality (AR) has become a mainstream technology in the development of solutions for repair and maintenance operations. Although most of the AR solutions are still limited to specific contexts in industry, some consumer electronics companies have started to offer pre-packaged AR solutions as alternative to video-based tutorials (VT) for minor maintenance operations. In this paper, we present a comparative study of the acquired knowledge and user perception achieved with AR and VT solutions in some maintenance tasks of IT equipment. The results indicate that both systems help users to acquire knowledge in various aspects of equipment maintenance. Although no statistically significant differences were found between AR and VT solutions, users scored higher on the AR version in all cases. Moreover, the users explicitly preferred the AR version when evaluating three different usability and satisfaction criteria. For the AR version, a strong and significant correlation was found between the satisfaction and the achieved knowledge. Since the AR solution achieved similar learning results with higher usability scores than the video-based tutorials, these results suggest that AR solutions are the most effective approach to substitute the typical paper-based instructions in consumer electronics., This work has been supported by Spanish MINECO and EU ERDF programs under grant RTI2018-098156-B-C55.

Objective. To evaluate the rejection, the chronic allograft nephropathy (CAN) and the delay in the function of the same (DGF) due to obesity and high BMI. Material and method. In this work, 500 patients of both sexes kidney transplant followed for 5 years were evaluated, post-transplant measurements of biochemical parameters and anthropometric measurements were made. It was also recognized data of chronic nephropathy and delayed graft function.. Results: Five years after the transplant, there was an increase in BMI and an increase in the components of the metabolic profile: triglycerides, total cholesterol and hyperglycemia, as well as blood pressure. As a consequence we have also observed an increase in the incidence of chronic kidney disease and delayed graft function. Conclusion. Obesity significantly increases the incidence of post-transplant complications, which can finally be done through injection. An adequate control of BMI in kidney transplant recipients would directly influence long-term renal graft survival, which reduced the delay in allograft function, the appearance of CAN and prolonged renal allograft survival.

Among enzyme immobilization techniques, the preparation of cross-linked enzyme aggregates has shown promising results in biocatalysis, because they are easy to prepare, versatile, and cheap. The method involves the precipitation of enzymes with ammonium sulfate or an organic solvent and subsequent cross-linking with glutaraldehyde. However, the Schiff base produced with glutaraldehyde is reversible and can be broken with acids or bases, releasing proteins to the reaction medium. To solve this problem, we propose replacing glutaraldehyde with diepoxide compounds to obtain an irreversible secondary amine bond. Such a substitution avoids protein leakage during the biocatalytic process, contamination of the final products, and loss of enzyme. It also improves the synthesis of the biocatalyst, because, while the Schiff base is favored at mildly acidic pH, the epoxide reaction can be made at the optimal enzyme pH, assuring its structural stability and catalytic performance. The proposed method has been successfully used in the production and optimization of aldolase epoxy-cross-linked aggregates, which retain 98% activity. © 2017 American Institute of Chemical Engineers Biotechnol. Prog., 33:1425-1429, 2017.

Objective: This work sought to evaluate a physical exercise program of moderate intensity in patients operated of bariatric surgery and its influence on muscle strength. Method: Randomized clinical trial, with an intervention group and a control group. Forty three patients were operated of bariatric surgery. The intervention group was applied a program of moderate physical activity during six months. Grip strength and bioimpedance were measured at their baseline form, at one month, and six months after surgery. A bivariate study was conducted to observe variable changes. Results: Upon conducting Student´s t for independent samples in all the variables (weight, body mass index, grip strength, lean mass, fat mass, and metabolism), the result is that no significant differences exist between the intervention group and the control group with p > 0.05. Conclusion: A program of moderate physical activity lasting six months in patients intervened of bariatric surgery has no significant result in the development of muscle mass evaluated through manual dynamometry and bioimpedance. RESUMEN Objetivo: evaluar un programa de ejercicio físico de intensidad moderada en pacientes operados de cirugía bariátrica y su influencia en la fuerza muscular. Método: ensayo clínico aleatorizado, con un grupo de intervención y un grupo control. Cuarenta y tres pacientes fueron operados de cirugía bariátrica. Al grupo de intervención se le aplicó un programa de actividad física moderada durante seis meses. La fuerza de agarre y la bioimpedancia se midieron en su forma basal, al mes y a los seis meses después de la cirugía. Se realizó un estudio de bivariante para observar los cambios de las variables. Resultados: al realizar la prueba de t de student para muestras independientes en todas las variables (peso, índice de masa corporal, fuerza de agarre, masa magra, masa grasa y metabolismo), el resultado es que no hay diferencias significativas entre el grupo de intervención y el grupo control con p>0,05. Conclusión: un programa de actividad física moderado de seis meses de duración en pacientes intervenidos de cirugía bariátrica no tiene resultados significantes en el desarrollo de la masa muscular evaluada a través de la dinamometría manual y la bioimpedancia. RESUMO Objetivo: avaliar um programa de exercício físico de intensidade moderada em pacientes submetidos à cirurgia bariátrica e sua influência na força muscular. Materiais e método: ensaio clínico randomizado, com um grupo de intervenção e um grupo controle. Quarenta e três pacientes foram operados de cirurgia bariátrica. Ao grupo de intervenção, foi aplicado um programa de atividade física moderada durante seis meses. A força muscular e a bioimpedância foram medidas em sua forma basal em um mês e aos seis meses depois da cirurgia. Foi realizado um estudo de bivariante para observar as mudanças das variáveis. Resultados: ao realizar o teste t de Student para amostras independentes em todas as variáveis (peso, índice de massa corporal, força muscular, massa magra, massa gordurosa e metabolismo), não se verificam diferenças significativas entre o grupo de intervenção e o grupo controle com p > 0,05. Conclusão: um programa de atividade física moderada de seis meses de duração em pacientes submetidos à cirurgia bariátrica não apresenta resultados significantes no desenvolvimento da massa muscular avaliada por meio da dinamometria manual e da bioimpedância.

[EN] Healthy eating habits involve controlling your diet. It is important to know how to interpret the nutritional information of the packaged foods that you consume. These packaged foods are usually processed and contain carbohydrates and fats. Monitoring carbohydrates intake is particularly important for weight-loss diets and for some pathologies such as diabetes. In this paper, we present an augmented reality app for helping interpret the nutritional information about carbohydrates in real packaged foods with the shape of boxes or cans. The app tracks the full object and guides the user in finding the surface or area of the real package where the information about carbohydrates is located using augmented reality and helps the user to interpret this information. The portions of carbohydrates (also called carb choices or carb servings) that correspond to the visualized food are shown. We carried out a study to check the effectiveness of our app regarding learning outcomes, usability, and perceived satisfaction. A total of 40 people participated in the study (20 men and 20 women). The participants were between 14 and 55 years old. The results reported that their initial knowledge about carb choices was very low. This indicates that education about nutritional information in packaged foods is needed. An analysis of the pre-knowledge and post-knowledge questionnaires showed that the users had a statistically significant increase in knowledge about carb choices using our app. Gender and age did not influence the knowledge acquired. The participants were highly satisfied with our app. In conclusion, our app and similar apps could be used to effectively learn how to interpret the nutritional information on the labels of real packaged foods and thus help users acquire healthy life habits.

The Prenatal Distress Questionnaire (PDQ) was developed among English-speaking women in the United States to assess specific worries and concerns during pregnancy. Our aim was to analyze the factor structure of the PDQ, using confirmatory factor analysis, and assess its convergent validity in Spanish women. A sample of 233 pregnant women with ages ranging from 19 to 42 years in the south of Spain (Europe) (January 2015 - March 2016) completed the translated PDQ, the Perceived Stress Scale (PSS) and the Symptom Checklist-90-revised (SCL-90-R). Confirmatory factor analysis revealed a three-factor structure supporting the original PDQ factor structure (χ2 (31) = 55.43, p = 0.004; CFI = 0.96; RMSEA = 0.058; WRMR = 0.702). The Spanish PDQ significantly correlated with the PSS and SCL-90-R (r's 0.18-0.49, p's < 0.05), providing evidence of convergent validity. These results illustrate that the stress dimensions investigated by the PDQ adequately represent pregnant women's distress across a different cultural context and corroborate the psychometric properties of this instrument previously demonstrated in English-speaking women. The Spanish version of the PDQ can be used by clinical practitioners to evaluate specific worries and concerns women experience during pregnancy.

Objective: To analyze the difference in the prevalence of sexually transmitted infections (STIs) between two time periods (2000&ndash, 2007 and 2008&ndash, 2014, with the latter period characterized by the economic crisis), as well as determine differences in sociodemographic factors, clinical care, and risk indicators. Methods: This was a retrospective, observational, and analytical study, reviewing 1437 medical records of subjects attending a specialized center in the province of Granada (Spain) for consultation associated with the presence or suspicion of an STI between 2000&ndash, 2014. Data were collected on variables relating to the research objective. A descriptive and bivariate statistical analysis was performed by multiple logistic regression. Results: In the analysis comparing the presence of STIs between the crisis and non-crisis periods, the percentage of positive diagnoses reached 56.6% compared to 43.4% negative diagnoses during the non-crisis period, while the percentages were 75.2% and 24.8%, respectively, during the crisis period. This difference was statistically significant (p &lt, 0.001) with an odds ratio (OR) of 2.21 after adjusting for age, sex, days since last unprotected sexual intercourse, and partners in the last year. Conclusions: There are significant differences in the prevalence of STIs between the study periods, which is consistent with the reports of some authors regarding the effect of the financial crisis on these conditions, however, it is worth considering other aspects that might explain the differences.

To evaluate the beneficial effects of exogenous NO and an inhibitor of the COX2, and their action levels in a model of SIRS/bacterial translocation (BT) induced by Zymosan A(®).Ninety Wistar rats were submitted to different treatments, and after 12h and 24h they were anaesthetized in order to collect blood, mesenteric lymph nodes, and kidney for subsequent biochemical analyses and microbiological examinations.A nitric oxide donor, Molsidomine(®), was compared with a COX2 inhibitor, Celecoxib(®).Zymosan A(®) was administered to Wistar rats. The animals were divided into 6 groups: one group for survival study, Group (1) No manipulation (BASAL); Group (2) vehicle of Zymosan A(®) given intraperitoneally (SHAM); Group I (control), with Zymosan A(®) (0.6g/kg) intraperitoneally; Group II (Molsidomine), with Molsidomine(®) (4mg/kg) through the penis dorsal vein, 30min prior to administration of the Zy(®) (0.6g/kg); Group III (Celecoxib), with Celecoxib(®) (400mg/kg) orally through a stomach tube, 6h prior to administration of the Zy (0.6g/kg).The parameters survival, bacterial translocation, renal function, neutrophil accumulation, oxygen free radicals (OFR), detoxifying enzymes, and cytokines were measured at different times after Zymosan administration.The model established induced a mortality rate of 100% and generated BT and systemic inflammatory response syndrome (SIRS) in all samples. It also significantly increased all variables, with p.001 for MPO and all pro-inflammatory cytokines, and p.01 for all OFR. Treatment with Molsidomine reduced mortality to 0%, decreased BT, MPO, pro-inflammatory cytokines and OFR (p.001) significantly and increased IL-10 and IL-6 production. Moreover, the Celecoxib(®) showed a lower capacity for SIRS regulation.The exogenous administration of NO prevented BT and controlled SIRS. Therefore these results suggest that Molsidomine could be used as a therapeutic strategy to protect against BT.

Aims The aim of this study was to determine whether there was a direct relation between sexual orientation and sexual practices involving penetration; to analyse whether condom use in the first sexual relation was conditioned by sexual orientation; to verify whether consistent condom use in sexual relations was determined by sexual orientation. Background Recent research suggests that sexual orientation (i.e. heterosexuality, homosexuality or bisexuality) is a determining factor in high-risk sexual behaviour. Design A cross-sectional study with purposive sampling. Methods Data were collected between March 2013–April 2014 from 900 participants (524 males and 376 females). All participants were 15-29 years of age. Their mean age was 20·93 years. The participants were given a socio-demographic survey as well as a psychometric test on high-risk sexual behaviour, which had been used in previous studies. Results There were no statistically significant differences in relation to sexual orientation and sexual practices involving penetration either in the general model for both sexes or in the models for men and women. It was also found that sexual orientation did not significantly affect condom use in the first sexual relation. Furthermore, consistent condom use had a protector effect in the general model for homosexuals and bisexuals. In the model for men, this was also true for homosexuals and in the model for women, this was the case for bisexuals. Conclusion Condom use in the first sexual relation was similar in all sexual orientations. However, the sexual orientation of the subject was found to be a determining factor in consistent condom use.

An improved method based on the p-nitrophenyl long chain esters method is proposed for measuring lipase hydrolytic activity in aqueous media. Using ethylene glycol as co-solvent for hydrophobic p-nitrophenyl substrates in aqueous buffer, lipase activity is measured by following the release of p-nitrophenol. This fast and easy to handle method improves the solubility of both substrate and product, and also the stability of the substrate. It avoids the use of solvents such as ethanol or propanol, permits the comparison of all the p-nitrophenol acyl ester substrates and allows the influence of ions like Ca+2 to be studied, while avoiding turbidity in the reaction medium.

to describe whether there were differences in sociodemographic, obstetric, perinatal and psychological variables between immigrant women and native-born women in Spain during the first 24 h after delivery.The immediate postpartum period is a critical time when physical and psychological disorders are likely to occur. Immigrant women have, in general, poor perinatal and psychological results during this time.One hundred and three women at the Virgen de las Nieves University Hospital (Granada, Spain) were divided into two groups: 50 Spanish and 53 immigrants. The instruments used were the Life Orientation Test, the Stress Vulnerability Inventory, the Perceived Stress Scale and the Symptom Checklist-90-Revised (SCL-90-R). Sociodemographic and obstetric data were obtained from the healthcare providers reports.During the postpartum period, the immigrant women had higher mean scores on the following subscales: interpersonal sensitivity (F(1,102) = 4.06; p 0.05); depression (F(1,102) = 7.24; p 0.01); phobic anxiety (F(1,102) = 4.83; p 0.05), paranoid ideation (F(1,102) = 7.20; p 0.01); and psychoticism (F(1,102) = 4.04; p 0.05). When considering age, education, profession, job situation, immigrant status of the partner and duration of time in Spain as covariates, differences between groups were significant on obsessive-compulsiveness (F(1,102) = 5.37; p 0.05) and depression (F(1,102) = 6.89; p 0.05).Immigrant women are in need of more psychological and emotional support from their families, midwives and the rest of healthcare providers than are native Spaniards immediately after delivery.

the appearance of metabolic syndrome (MS) among renal recipients is one of the greatest post-transplant complications and is associated with an increased risk of graft failure and high rates of obesity and new onset diabetes.the objective of this work is to identify the relationship between the glomerular filtration rate measured by two different methods and the components of the metabolic syndrome and their combinations in kidney transplant patients according to gender.the samples consisted of 500 kidney transplant recipients, of whom 190 had MS, 121 men and 69 women. All subjects underwent clinical evaluation and blood sampling for laboratory measurements. The MS was determined according to the criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP-III). Renal function was estimated using AMDRD equations and CrS determinations.the average age was 55.5 years. The prevalence of MS was significantly higher in men (23.1%vs 9.8%). High blood pressure (HBP) was the most observed component of MS. Significant correlations (Pearson, p0.05) between TFG-AMDRD and TFG CrS and metabolic markers were observed more in men than in women. The body mass index (BMI) was significantly higher in women than in men. CONCLUSIONES: the decrease in renal function associated with the components of MS, HBP and obesity represent a high risk of adverse cardiovascular events and graft rejections.INTRODUCCIÓN: la aparición del síndrome metabólico (SM) entre los receptores renales es una de las mayores complicaciones postrasplante y se asocia con un mayor riesgo de fracaso del injerto y altas tasas de obesidad y diabetes de nueva aparición. OBJETIVO: el objetivo de este trabajo es identificar la relación entre la tasa de filtración glomerular medida por dos métodos distintos y los componentes del síndrome metabólico y sus combinaciones en pacientes trasplantados renales según género. MATERIAL Y MÉTODO: la muestra estuvo formada por 500 pacientes trasplantados renales, de los cuales 190 padecían SM, 121 hombres y 69 mujeres. Todos los sujetos se sometieron a evaluación clínica y toma de muestras de sangre para mediciones de laboratorio. El SM se determinó según los criterios del National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP-III). La función renal se estimó usando ecuaciones AMDRD y determinaciones de creatinina sérica (CrS). RESULTADOS: la media de edad fue de 55,5 años. La prevalencia del SM fue significativamente mayor en hombres (23,1%vs. 9,8%). La hipertensión arterial (HTA) fue el componente del SM más observado. Se observaron correlaciones significativas (Pearson; p0,05) entre TFG-AMDRD y TFG CrS y marcadores metabólicos más en hombres que en mujeres. El índice de masa corporal (IMC) fue significativamente mayor en mujeres que en hombres. CONCLUSIONES: la disminución de la función renal asociada con los componentes del SM, la HTA y la obesidad representan un riesgo elevado de eventos cardiovasculares adversos y rechazos del injerto.

Museum visitors need support tools to facilitate their informal learning. In this paper, we present ARCoins, an augmented reality app to support informal learning about numismatics. Our app helps museum visitors to read the deteriorated text of coins and also shows additional information that offers a clear idea of the general meaning of the coinage of the coins. The app recognizes the real coins. We carried out a study to determine the potential of the app. A total of twenty-eight subjects between 19 and 65 years old participated in the study. The participants observed the real coins using ARCoins and a magnifying glass. From the results, ARCoins allows the participants to read the deteriorated text and even observe the most imperceptible details of the coins. There were statistically significant differences for reading the text when the participants used ARCoins and the magnifying glass in favour of ARCoins. The participants preferred ARCoins for a more enriching museum experience. ARCoins could be a valuable AR app for informal learning about numismatics in museums.

The aim was to present the longitudinal study protocol on the effects of perinatal stress from conception to one year of age. Stress is associated to psychopathological, cardiovascular and inmunological diseases. During pregnancy, the activation of the Hipotalamic-Pituitary-Adrenal results in an increased release of cortisol. Stress during pregnancy is related to maternal, fetal and infant negative outcomes that can last a lifetime. Nevertheless, contradictory findings have been reported. In this longitudinal study maternal stress is assessed from a sample of 807 pregnant women through hair cortisol levels and psychological question- naires during the three trimesters of pregnancy. Besides, associa- tions with the new-borns´ hair cortisol levels, temperament and neurodevelopment at age 6 and 12 months are assessed. Sociode- mographic, obstetrics, delivery, fetal and newborn development variables are included in analysis. Findings will be able to pro- vide a better understanding of perinatal stress and will improve maternal, fetal and infant outcomes.Se presenta el protocolo del estudio longitudinal del estrés perinatal desde la concepción hasta un año de vida. El estrés se relaciona con trastornos psicopatológicos, enfermedades cardio- vasculares e inmunológicas. Durante el embarazo, la activación del eje hipotalámico-hipofisario-adrenal ante un estímulo estre- sante aumenta los niveles de cortisol. El estrés durante el emba- razo tiene efectos sobre la madre, el feto y el bebé que pueden lle- gar a la adultez. Sin embargo, existen resultados contradictorios. En este estudio longitudinal se pretendía estudiar los niveles de estrés materno de 807 mujeres embarazadas durante los 3 trimes- tres de embarazo, mediante evaluación psicológica y mediante la innovadora técnica de niveles de cortisol en pelo. Se estudia la relación con los niveles de cortisol en pelo de recién nacidos, temperamento y neurodesarrollo de los bebés a los 6 y 12 meses de edad. Además, se miden variables sociodemográficas, historia obstétrica, parto y nacimiento, desarrollo fetal e infantil. Los re- sultados obtenidos permitirán promover la adopción de medidas preventivas y de intervención en Salud Pública.

Candida bloodstream infection (CBI) is associated with high mortality. The aim of this study was to compare the utility of the combined use of the Pitt Bacteremia Score (PBS) and Charlson Comorbidity Index (CCI) or Chronic Disease Score (CDS) to predict mortality among patients with CBI. Thereby, all consecutive patients with CBI at our institution between 2010 and 2014 were included. The PBS was used to evaluate CBI severity and the CCI and CDS were used to assess comorbidities of patients with CBI. Logistic regression analysis was used to estimate odds ratios for 30-day mortality in models including the PBS and CCI or CDS. A total of 189 CBI episodes were identified. Logistic regression models including the PBS and either CCI or CDS showed that the combined use of a comorbidity score and a severity score significantly predicted 30-day mortality. The performance of the different models was similar. Aggregated scores of comorbidity (CCI and CDS) and disease severity (PBS) are useful for the prediction of 30-day mortality risk in patients with CBI. Their use may facilitate the analysis of risk factors for poorer outcome and the development of an index for CBI mortality.

N-Acetylneuraminate lyase synthase (NeuB; E.C. 2.5.1.56) is a key enzyme in pathogenic microorganisms for producing N-acetylneuraminic acid through the irreversible condensation of N-acetylmannosamine (ManNAc) and phosphoenolpyruvate (PEP). However, nothing is known about this enzyme in non-pathogenic bacteria. This paper describes, for the first time, one of the two putative N-acetylneuraminate synthases from the halophilic non-pathogenic gamma-proteobacterium Idiomarina loihiensis NeuB1 (IlNeuB1). The obtained 95-kDa dimeric enzyme showed maximal activity at pH 7.0 and 40°C and was more stable at pH 8.0 (8 h half-life) than the previously described NeuB. Its catalytic efficiency towards ManNAc and PEP was 10- and 40-fold higher, respectively, than that determined for Campylobacter jejuni NeuB, but only half that found for Neisseria meningitidis NeuB towards PEP. The phylogenetic and structural analyses of NeuB enzymes revealed the new domain architecture 4 has no cystathionine-β-synthase domain (cystathionine-β-synthetase domain), unlike domain architecture 3. In addition, 10 conserved blocks (I-X) were found, and surprisingly, this study showed that the arginine essential for catalysis that is present in antifreeze-like domain (block X) was not fully conserved in NeuB, but is replaced by a serine in a long sequence (>700 residues) NeuB, such as that existing in domain architectures 3 and 4.

Resumen Fundamento y objetivo Las bacteriemias causadas por bacterias productoras de betalactamasas de espectro extendido (BLEE) han aumentado de forma exponencial. Nuestro objetivo es conocer los factores asociados a la mortalidad y el reingreso en estos pacientes. Pacientes y metodos Se recogieron datos socioepidemiologicos, clinicos y analiticos (desde 1-01-2008 hasta 31-04-2011). Se clasificaron en nosocomiales, asociadas a cuidados sanitarios o comunitarias. Se realizo un estudio descriptivo analizando las diferencias segun la bacteria responsable y las variables asociadas a mortalidad y reingreso. Se utilizaron: t de Student, ANOVA de un factor, χ2 y prueba exacta de Fisher para comparar variables. Se realizo un analisis de regresion logistica para identificar variables asociadas de forma independiente a mortalidad y reingreso. Se utilizo el programa estadistico SPSS® v18. Resultados Se identificaron 68 pacientes. El 73,5% de las infecciones fueron causadas por Escherichia coli (E. coli) y el 26,5% por Klebsiella pneumoniae (K. pneumoniae). El origen nosocomial, la identificacion en pacientes criticos y el origen abdominal fueron mas frecuentes para K. pneumoniae, siendo el foco urinario mas frecuente para E. coli. La mortalidad intrahospitalaria fue del 20,6% (24% durante el seguimiento). El principal factor asociado a mortalidad intrahospitalaria fue el tratamiento antibiotico previo (OR 8,37; IC 95%: 1.094-64.091), y a la mortalidad durante el seguimiento, la canalizacion de una via venosa central (OR 8.416; IC 95%: 1.367-51.821). El 55,5% de los pacientes precisaron reingreso; las variables asociadas fueron el origen nosocomial (OR 4.801; IC 95%: 1.057-21.802) y el tratamiento antibiotico previo (OR 4.715; IC 95%: 1.125-19.766). El tratamiento antibiotico empirico inadecuado no se relaciono con mayor mortalidad o reingreso. Conclusiones La bacteriemia por E. coli y K. pneumoniae productoras de BLEE conlleva una alta mortalidad y probabilidad de reingreso. El tratamiento antibiotico previo es el principal factor asociado a una mala evolucion.

The anaerobic bacteria resistance to antibiotics is increasing, and even has appeared against the most active of those, like metronidazol and carbapenems. This fact forces to make and periodical sensibility tests -at least in the most aggressive and virulent species, in cases that they are isolated from life locations and in the absence of therapeutic response- to check the local sensibility and to establish suitable empiric therapies, all based on multicentric studies carried out in order to this or well to check the activity of new antibiotics. For the laboratory routine, the easiest sensibility method is the E-test/MIC evaluator. Another alternative is microdilution, that's only normalized for Bacteroides. There are preliminary facts that allow the use of disc diffusion method in some species of Bacteroides and Clostridium. For the temporal and multicentric studies, the procedure is dilution in agar plate, the reference method.

FastPrep cross-linked enzyme aggregates of N-acetylneuraminate aldolase from Staphylococcus carnosus (ScNAL-FpCLEAs) were prepared in order to improve the synthesis of 2-keto-3-deoxy- d -glycero-galactononulosonic acid (KDN), an important building block for therapeutic glycolipids and a possible marker for human prostate cancer. ScNAL-FpCLEAs showed improved thermostability compared with the free enzyme, doubling its half-life at 60 °C. When the effect of substrate ratio (pyruvate: d -mannose) and temperature on the yield of KDN was studied at its optimum pH (pH 7.0), 90% conversion in only 8 h was reached in the presence of 0.6 M d -mannose and 1.2 M pyruvate at 37 °C. This is the highest conversion described to date for enzymatic KDN synthesis. In addition, ScNAL-FpCLEAs exhibited enhanced catalytic activity and stability and could be recycled 10 times with no loss of activity. These results suggest the biotechnological potential of using FastPrepCLEAs to obtain valuable biocatalysts.

The purification of a lipase isoenzyme from an Aspergillus niger lipase A is reported in this manuscript. Purification was carried out in a simple adsorption step, in which the lipase was offered at low ionic strength to the commercially available C8 modified magnetic particles, MaKProt C8. When the isoenzyme was desorbed with a 0.2% solution of Triton X-100, the SDS-PAGE gel showed a single pure band with a molecular weight of 35 KDa. The purified fraction showed 66.75-fold purification compared with the crude extract. The pure fraction was characterized along with the crude extract and the lipase adsorbed on the MaKProt C8. The purified and the adsorbed lipase showed better activity for the tested substrates (p-nitrophenyl acetate, decanoate, myristate and palmitate) than the crude extract, the preferred substrates being myristate (26.7 μmol·min-1·mg-1) and decanoate (17.4 μmol·min-1·mg-1), respectively. The temperature and pH profiles showed no change for the three enzymes, the optimum temperature being 37°C and the best pH 7.0.

Intra-abdominal infections represent a large and wide group of diseases which include intra- and retro-peritoneal infections. Some of them could be defined as uncomplicated, where the infectious process is limited to the organ or tissue of origin (appendicitis, diverticulitis, cholecystitis…). Complications occur when the infection spreads to the peritoneum, triggering localised peritonitis and abdominal abscesses. Most intra-abdominal infections are due to perforation or inflammation of the intestinal wall. The microorganisms that cause these infections come from the gastrointestinal flora, and therefore produce polymicrobial infections mixed with a predominance of anaerobic bacteria. Microbiological diagnosis is essential to determine the aetiology and the susceptibility of antimicrobial agents of the microorganism involved, especially in nosocomial infections or in community infections in predisposed patients due to increasing bacterial resistance to antimicrobial agents, multidrug resistance and fungal involvement. Despite the advances in microbiological diagnosis, in the case of intra-abdominal infections it still remains direct, being based on stains and cultures, the most notable progress is the introduction of mass spectrometry (MALDI-TOF) for the rapid identification of the pathogens involved. This review will provide recommendations on the collection, transport and microbiological processing of clinical specimens. Comments on the pathogenesis, clinical and microbiological diagnosis of peritonitis primary, secondary, tertiary and peritonitis (and other infections) associated with peritoneal dialysis, intra-abdominal abscesses (intraperitoneal, retroperitoneal and visceral), biliary tract infections, appendicitis and diverticulitis are also presented.

Este estudio apunta a conocer la percepción que los profesionales de la salud (médicos, enfermeras y auxiliares de enfermería) tienen acerca de su preparación en el cuidado de los enfermos terminales y determinar sus conocimientos sobre la legislación de cuidados paliativos. Se ha realizado un estudio transversal, en un hospital de Granada (España), mediante la aplicación de un cuestionario ad hoc. Los resultados muestran que la mayoría del personal ha trabajado con pacientes en el final de su vida, pero sólo la mitad cree tener la formación adecuada para cuidarlos. Una parte considerable dice no conocer la legislación actual en cuidados paliativos. La mayoría de los profesionales plantearía la retirada de terapias para el mantenimiento de la vida y desconocen el mecanismo para informar sobre la cumplimentación del Testamento Vital, como indica el Plan de Cuidados Paliativos de Andalucía (España). Os objetivos deste estudo são determinar a percepção que os profissionais de saúde (médicos, enfermeiros e auxiliares de enfermagem) têm sobre a sua preparação sobre o cuidado dos doentes terminais e determinar seu conhecimento da legislação sobre cuidados paliativos. Realizou-se um estudo transversal em um hospital em Granada (Espanha), através da aplicação de um questionário ad hoc. Os resultados mostram que a maioria do pessoal trabalha com pacientes no fim de sua vida, mas apenas a metade crê que têm o treinamento adequado para cuidar deles. Uma proporção significativa disse que não conhece a legislação vigente sobre cuidados paliativos. A maioria dos profissionais propenderia a retirada de terapias para a sustentação da vida e não sabem o mecanismo de comunicação sobre a realização do Living Will, como indica o Plano de Assistência Paliativa de Andaluzia (Espanha). The aims of this study were to ascertain the perception that health professionals (doctors, nurses and nursing assistants) have about their preparation for the care of terminally ill patients and to determine their knowledge about palliative care legislation. This cross sectional study was performed at a hospital in Granada (Spain); we administered an ad hoc questionnaire. The results indicated that although most of the staff had worked with terminally ill patients, only half believed that they have been trained to care for them. A significant proportion stated that they did not know about the current palliative care legislation. Most professionals would question the withdrawal of therapies for the maintenance of life; most of them are also unaware of the mechanism for reporting on the completion of a Living Will, as well as a Plan for Palliative Care in Andalusia (Spain).

Within the European Higher Education Area (EHEA) considerable efforts are being made to promote the incorporation of Information and Communication Technology (ICTs) in Higher Education (HE), together with placing emphasis on the cognitive and motivational components underlying learning. The objectives of this research were to analyze: (a) the relationship between different uses of ICTs and the learning outcomes and (b) the relationship between learning strategies and motivation and the use of ICTs. Four factors explain 57.4% of the total variance of the types of use of ICTs. It is possible to discern four patterns of use of ICTs (Social, Technical, Academic and Educational Platforms). Our results show significant associations of the different uses of ICT with expectations of improved performance and satisfaction. In addition, the Educational Platform Use (EPU) is linked to performance. In turn, the EPU is predicted by learning strategies and motivation variables which point to primarily motivational components. The results are discussed in relation to the difficulties inherent in the process of implementing the EHEA.

In Spain there are not many updated population studies about salmonellosis, despite being one of the most common etiologies of acute gastroenteritis (AGEs) caused by bacteria in the world. The aim of the study was to know the most relevant epidemiological features of AGEs produced by Salmonella spp. between 2005 and 2014 in Salamanca (Spain).Descriptive cross-sectional study carried out through review of the clinical microbiologic records at Complejo Asistencial Universitario de Salamanca. Culture, isolation, identification and serotyping were performed according to standard methodology.Salmonella was isolated in 1,477 patients, representing 47.7% of all positive stool cultures and 53.3% of all income bacterial AGE. The average prevalence was 42.1 cases/100,000 people per year. The mean age was 23 ± 28 years and the median 7 years. 40.2% of all isolates occurred in children under 5 years, with an average prevalence of 45.1 cases/ 10,000 people per year. Overall, the most frequently isolated serotype was S. Typhimurium with 57%, followed by S. Enteritidis with 35.8%.The prevalence of Salmonella decreased over time. The group aged 0-4 years had the highest rate throughout the period. However, Salmonella produced the highest percentage of hospitalizations for bacterial AGE. In recent years, S. Typhimurium serotype has replaced S. Enteritidis serotype and predominates in younger patients. It is observed under-reporting of cases of salmonellosis produced in Salamanca despite being mandatory notification of these since 2007.

Resumen Objetivo . La espectrometria de masas (EM) MALDI-TOF se ha convertido en un recurso de referencia para la identificacion de microorganismos en los servicios de microbiologia clinica. No obstante, los datos relativos a algunos grupos de microorganismos son todavia controvertidos. En el presente estudio se ha determinado la fiabilidad de la EM MALDI-TOF para la identificacion de aislamientos clinicos de bacterias anaerobias, en comparacion con tecnicas bioquimicas convencionales, y usando como referencia en caso de discrepancias las secuenciacion de ARNr 16S. Material y metodos Se analizaron 126 aislamientos clinicos de bacterias anaerobias mediante el sistema API 20A (bioMerieux, Marcy l’Etoile, Francia) y mediante EM MALDI-TOF (Autoflex II, Bruker Daltonics, Alemania), utilizando la base de datos BioTyper 2.0 (Bruker Daltonics, Alemania). Cuando se produjeron discrepancias, o la EM MALDI-TOF no fue capaz de identificar microorganismo alguno, se uso como metodo de identificacion de referencia la secuenciacion del ARNr 16S. Resultados El metodo bioquimico y la EM MALDI-TOF coincidieron, a nivel de especie, en el 60,9% de los casos, y solo a nivel de genero en el 20,3%. De las 48 identificaciones discrepantes, la secuenciacion respaldo la identificacion por EM MALDI-TOF a nivel de especie en 32 casos (66,7%), y a nivel de genero en 8 (16,7%). Dicha secuenciacion apoyo la identificacion bioquimica a nivel de especie solamente en 2 casos (4,2%), y a nivel de genero en 26 casos (54,2%). En los 8 casos en que la EM MALDI-TOF no obtuvo identificacion alguna o la obtenida fue refutada a nivel de genero por la secuenciacion de ARNr 16S, la especie a la que correspondia en realidad el microorganismo no se encontraba incorporada a la base de datos BioTyper II. Conclusiones Los datos obtenidos en este estudio demuestran que, en conjunto, la espectrometria de masas ofrece una identificacion de bacterias anaerobias mas fiable que la identificacion bioquimica convencional (un 24% mas de identificaciones correctas a nivel de especie), con un numero de errores mayores (identificacion incorrecta a nivel de genero) 2,5 veces inferior. Puesto que todas las identificaciones fallidas a nivel de genero derivaron de la no incorporacion de varias especies a la base de datos, a medida que esta base de datos se vaya completando, las diferencias probablemente se incrementaran.

The possibility of incorporating N-acetylneuraminic acid (Neu5Ac) in infant formulas and other functional foods has opened up the need to synthesize N-acetylneuraminic acid using N-acetylneuraminate lyases (NALs) by reversible aldol condensation of pyruvate and N-acetyl-d-mannosamine. Until now, NALs have been cloned from pathogenic microorganisms; however, this Article describes the expression and characterization of an N-acetylneuraminate lyase from the Staphylococcus carnosus TM300, a GRAS microorganism used in fermented meat. ScNAL showed a high level of expression in E. coli (403 mg L(-1) culture). This, combined with its simple two-step purification procedure, the highest recovery described to date (86%), its kinetic parameters, which are in the same order of magnitude as best reported NALs, and its optimum pH and temperature, make ScNAL a promising and cheap biocatalyst. To confirm its biotechnological potential, the Neu5Ac was synthesized in 3 h in simple industrial working conditions with a high degree of conversion (94%).

La investigación en Enfermería, pese a sus dificultades y limitaciones, tiene ya en España una extensa tradición. Sin embargo, hasta la última década no se ha elaborado en las Universidades españolas un número importante de Tesis Doctorales que desarrollen temas referidos a la Enfermería. De ellas, a su vez, una cifra muy baja está dedicada a la Historia de la Enfermería. La explicación se encuentra en la organización académica española, que además no reconocía la palabra "Enfermería" entre los descriptores de investigación. Finalizamos el trabajo analizando algunas líneas principales de investigación en Historia de la Enfermería en los últimos años.The investigation in Nursing, in spite of its difficulties and limitations, has an extensive tradition in Spain. However, until the last decade it has not been elaborated an important number of Doctoral Theses that develop matters about Nursing, in the Spanish Universities. Among them, as well, a very low number is dedicated to the History of the Nursing. The explanation is in the action line followed by the Spanish academic organization, which in addition did not recognize the word "Nursing" in the investigation descriptors. We finalize the work studing the main lines of investigation in History of the Nursing that have appeared in the last years.

N-Acyl-D-Glucosamine 2-epimerase (AGE) catalyzes the reversible epimerization between N-acetyl-D-mannosamine (ManNAc) and N-acetyl-D-glucosamine (GlcNAc). Bacteroides ovatus ATCC 8483 shows 3 putative genes for AGE activity (BACOVA_00274, BACOVA_01795 and BACOVA_01816). The BACOVA_00274 gene encodes an AGE (BoAGE1) with strong similarity to the AGE previously characterized in Bacteroides fragilis. Interestingly, the BACOVA_01816 gene (BoAGE2) shares 57% identity with Anabaena sp. CH1 AGE, but has an extra 27-amino acid tag sequence in the N-terminal. When cloned and expressed in Escherichia coli Rosetta (DE3)pLys, BACOVA_01816 was able to convert ManNAc into GlcNAc and vice versa. It was stable over a broad range of pHs and its activity was enhanced by ATP (20 μM). The incubation with ATP stabilized its structure, raising its melting temperature by about 8 °C. In addition, the catalytic efficiency for ManNAc synthesis was higher than that for GlcNAc synthesis. These characteristics make BoAGE2 a promising biocatalyst for sialic acid production using cheap GlcNAc as starting material. BoAGE2 could be considered a Renin-binding Protein and its interaction with renin was studied for the first time in a prokaryotic AGE. Surprisingly, renin activated BoAGE2, an effect which is contrary to that described for mammalian AGE and unrelated with the unique N-terminal tag, since a mutant without this tag was also activated by renin. When BoAGE2 sequence was compared with other related (real and putative) AGE described in the databases, it was seen that AGE enzymes can be divided in 3 different groups. The relationship between these groups is also discussed.

Data on fungemia epidemiology and antifungal susceptibility of isolates from children are scarce, leading frequently to pediatric empirical treatment based on available adult data. The present study was designed to update the epidemiological, mycological, and in vitro susceptibility data on fungal isolates from children with fungemia in Spain. All fungemia episodes were identified prospectively by blood culture over 13 months at 30 hospitals. Tests of susceptibility to amphotericin B, flucytosine, fluconazole, itraconazole, posaconazole, voriconazole, anidulafungin, caspofungin, and micafungin were performed at participant institutions by a microdilution colorimetric method. New species-specific clinical breakpoints for fluconazole, voriconazole, and echinocandins were also applied. A total of 203 episodes of fungemia in 200 children were identified. A higher proportion of fungal isolates was from general wards than intensive care units (ICU). Candida parapsilosis (46.8%), Candida albicans (36.5%), Candida tropicalis (5.9%), Candida glabrata (3.9%), and Candida guilliermondii (2.5%) were the leading species. C. parapsilosis was the predominant species except in neonates. C. albicans was the most frequent in neonatal ICU settings (51.9%). Intravascular catheter (79.3%), surgery (35%), prematurity (30%), and neutropenia (11%) were the most frequent predisposing factors. Most Candida isolates (95.1%) were susceptible to all antifungals. When the new species-specific clinical breakpoints were applied, all C. parapsilosis isolates were susceptible to echinocandins except one, which was micafungin resistant. This is the largest published series of fungemia episodes in the pediatric setting. C. parapsilosis is the most prevalent species in Spain, followed by C. albicans and C. tropicalis . Resistance to azole and echinocandin agents is extremely rare among Candida species. The fluconazole resistance rate in Spain has decreased in the last 10 years.