Epidemiology of Non-Tuberculous Mycobacteria isolated from clinical specimens in Madrid, Spain, from 2013 to 2017.

The epidemiology of non-tuberculous mycobacteria (NTM) in Spain is largely unknown because systematic reporting is not compulsory. The aim of our study was to describe the frequency and diversity of NTM species in our region and their distribution according to the source sample, gender, and age of the patients. We performed a multicenter study of all NTM isolated in 24 public hospitals in Madrid from 2013 to 2017. A total of 6.923 mycobacteria were isolated: 4535 (65.5%) NTM, and 2.388 (34.5%) Mycobacterium tuberculosis complex (MTB). Overall, 61 different NTM species were identified. The most frequently isolated species were Mycobacterium avium complex (47.7%), M. lentiflavum (12.2%), M. gordonae (9.2%), M. fortuitum (8.9%), and M. abscessus (3.9%). Whereas MTB cases were stable during the study period, the number of NTM isolates increased considerably from 930 isolates in 2013 to 1012 in 2017; a sharp increase occurred in the last year. The rise in NTM isolates was mostly due to M. lentiflavum, M. kansasii, and M. abscessus mainly isolated from respiratory specimens in patients older than 60. The increase in isolation rate of NTM in our region is consistent with the increasing rates reported worldwide in the last decades. The rise in NTM isolates was mainly attributed to M. lentiflavum but it also should be noted the increasing of species with high pathogenic potential such as M. kansasii and M. abscessus.

[Monophasic Salmonella Typhimurium outbreak due to the consumption of roast pork meat]. / Brote de Salmonella Typhimurium monofásica asociada al consumo de carne asada de cerdo.

This report presents an outbreak of monophasic Salmonella enteric serovar Typhimurium fagotipe 4, 5, 12: i:-, in a motorcycle concentration in Valladolid. Information was collected to one hundred and twelve affected from seven Spanish Autonomous Communities. The epidemiological investigation associated the outbreak with the consumption of roast pork with sauce sandwiches sold at a street market in that event.

Lectin-gated and glycan functionalized mesoporous silica nanocontainers for targeting cancer cells overexpressing Lewis X antigen.

Gated mesoporous silica nanoparticles can deliver payload upon the application of a predefined stimulus, and therefore are promising drug delivery systems. Despite their important role, relatively low emphasis has been placed on the design of gating systems that actively target carbohydrate tumor cell membrane receptors. We describe herein a new Lewis X (Lex) antigen-targeted delivery system comprising mesoporous silica nanoparticles (MSNs) loaded with ATTO 430LS dye, functionalized with a Lex derivative (1) and capped with a fucose-specific carbohydrate-binding protein (Aleuria aurantia lectin (AAL)). This design takes advantage of the affinity of AAL for Lex overexpressed receptors in certain cancer cells. In the proximity of the cells, AAL is detached from MSNs to bind Lex, and selectins in the cells bind Lex in the gated MSNs, thereby inducing cargo delivery. Gated MSNs are nontoxic to colon cancer DLD-1 cells, and ATTO 430LS dye delivered correlated with the amount of Lex antigen overexpressed at the DLD-1 cell surface. This is one of the few examples of MSNs using biologically relevant glycans for both capping (via interaction with AAL) and targeting (via interaction with overexpressed Lex at the cell membrane).

25-Hydroxyvitamin D in Patients With Melanoma and Factors Associated With Inadequate Levels. / Niveles de 25-hidroxivitamina D en pacientes con melanoma y factores asociados con su insuficiencia.

INTRODUCTION AND OBJECTIVES: Patients with melanoma appear to take extreme sun-protection measures, which could influence 25-hydroxyvitamin D [25(OH)D] levels. The aim of this study was to measure 25(OH)D levels in patients with cutaneous melanoma and identify factors associated with inadequate levels. MATERIAL AND METHODS: Over a period of 1 year, we prospectively measured serum 25(OH)D in patients with cutaneous melanoma and used logistic regression analysis to identify environmental, phenotypic, and genotypic factors that were associated with insufficient and deficient levels. RESULTS: Of 215 patients analyzed, 8.8% had deficient 25(OH)D levels (<10ng/mL) and just 24.7% had normal levels. Insufficient levels (<30ng/mL) were associated with obesity (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.3-13.3) and blood sampling in autumn/winter (OR, 2.1; 95% CI, 1.1-4). Deficient levels (<10ng/mL) were associated with obesity (OR, 7.1; 95% CI, 1.1-46.9), blood sampling in autumn/winter (OR, 9.0; 95% CI, 1.7-47.0), absence of freckles (OR, 5.4; 95% CI, 1.2-23.4), and, with marginal significance, the presence of fewer than 2 nonsynonymous melanocortin-1 receptor (MC1R) polymorphisms (OR, 5.0; 95% CI, 0.9-28.9). LIMITATIONS: Some factors related to 25(OH)D levels, such as food, were not included in the analyses. CONCLUSIONS: 25(OH)D levels should be monitored in patients with melanoma and the need for oral supplements should be contemplated where appropriate.

[Continuous monitoring of a guideline: Bell's palsy]. / Monitorización continua de un protocolo: parálisis facial a frigore.

INTRODUCTION: The preparation and review of child neurology guidelines can reduce the variability of our medical practice, thus improving health care. We present the continuous monitoring of our Bell's palsy guideline. MATERIAL AND METHODS: Emergency and medical reports of the children seen in Child Neurology surgery from July 2006 to August 2009 (group 2) are reviewed for the purpose of finding out the present level of compliance with guideline quality criteria and compare it with the previously reviewed period (group 1, from March 2003 to June 2006). Scientific evidence on this topic is also updated. RESULTS: Comparing the compliance rate in group 1 with group 2 shows a rise in group 2 from 85.1% to 100% in facial expression description, from 11.1% to 31.6% on whether or not there is evidence of Herpes Zoster vesicles, from 77.7% to 84.2% whether or not there is evidence fundoscopic examination, and from 77.7% to 86.8% as regards cranial nerve function remaining normal. The rate of fact sheet issue, recorded for the first time in group 2, is 21.1%. DISCUSSION: Medical auditing allows us to evaluate our medical practice and set up ways for improvement according to the deficiencies found. We insist on striving to improve the written record of the most relevant data and never overlook the importance of issuing the fact sheets to parents and paediatricians, to ensure continuity of medical care.

Repression of Puma by scratch2 is required for neuronal survival during embryonic development.

Although Snail factors promote cell survival in development and cancer, the tumor-suppressor p53 promotes apoptosis in response to stress. p53 and Snail2 act antagonistically to regulate p53 upregulated modulator of apoptosis (Puma) and cell death in hematopoietic progenitors following DNA damage. Here, we show that this relationship is conserved in the developing nervous system in which Snail genes are excluded from vertebrate neurons and they are substituted by Scratch, a related but independent neural-specific factor. The transcription of scratch2 is induced directly by p53 after DNA damage to repress puma, thereby antagonizing p53-mediated apoptosis. In addition, we show that scratch2 is required for newly differentiated neurons to survive by maintaining Puma levels low during normal embryonic development in the absence of damage. scratch2 knockdown in zebrafish embryos leads to neuronal death through the activation of the intrinsic and extrinsic apoptotic pathways. To compensate for neuronal loss, the proliferation of neuronal precursors increases in scratch2-deficient embryos, reminiscent of the activation of progenitor/stem cell proliferation after damage-induced apoptosis. Our data indicate that the regulatory loop linking p53/Puma with Scratch is active in the vertebrate nervous system, not only controlling cell death in response to damage but also during normal embryonic development.

Detection of decreased susceptibility to fluoroquinolones in Salmonella spp. by five different methods including real-time polymerase chain reaction (PCR).

Detection of Salmonella spp. isolates showing decreased susceptibility to fluoroquinolones has become important owing to the increasing prevalence of these strains and their association with treatment failure. Nalidixic acid agar dilution, nalidixic acid disk diffusion, MicroScan automated system and real-time polymerase chain reaction (PCR) (LightCycler) followed by melting temperature (Tm) analysis are compared with ciprofloxacin agar dilution as suitable methods to detect decreased susceptibility to fluoroquinolones in 100 Salmonella spp. isolates. Three minor discrepancies were found for nalidixic acid disk diffusion, one minor discrepancy was found for nalidixic acid agar dilution and Tm analysis, and one major discrepancy was found for MicroScan. Nalidixic acid disk diffusion was confirmed as a good screening method. Tm analysis is a rapid and accurate method for detecting decreased susceptibility to fluoroquinolones due to gyrA mutations in Salmonella spp.

[Liver biopsy in patients with chronic hepatitis C virus infection: experience in a district hospital]. / Biopsia hepática en pacientes con infección crónica por el VHC: experiencia de un hospital comarcal.

INTRODUCTION: Liver biopsy is a highly useful tool in the evaluation of patients with chronic hepatitis C. However, the technique is not free of complications and presents a series of limitations (lack of representativity and interobserver variability in sample interpretation). Due to these limitations and the development of new noninvasive techniques, the role of liver biopsy is currently being reevaluated. MATERIAL AND METHOD: We performed a descriptive retrospective study of liver biopsies performed in patients with chronic hepatitis C virus (HCV) infection from January 2002 to January 2005. Age, gender, genotype, histology of the hepatic cylinder, and the percentage of patients who received treatment after liver biopsy was analyzed. The indications for biopsy in our patients and the reasons for nontreatment after biopsy were identified. We also analyzed whether the decision to start treatment was influenced by the histological grade of the lesion and whether there is any association between histological grade and transaminase levels. RESULTS: A total of 156 patients were included and 72% received treatment after biopsy. Transaminase levels were elevated in 86%. Alanine aminotransferase (ALT) levels were elevated in 92.30% of treated patients and in 66% of untreated patients. The most frequent cause of nontreatment after biopsy was fibrosis stage < 2. The histological results were as follows: G0 in 2%, G1 in 26.8%, G2 in 47.7%, G3 in 22.2% and G4 in 1.3%; stage of fibrosis was F0 in 7.2%, F1 in 30.1%, F2 in 37.9%, F3 in 19.6%, and F4 in 5.2%. Fibrosis was advanced (F >= 2) in 41% of the patients with normal ALT levels and was mild (< F2) in 33% of those with elevated ALT levels. CONCLUSION: Liver biopsy could be useful in patients with indication for treatment but a high risk of treatment-related adverse effects, as well as in those with normal transaminase levels, in whom the degree of fibrosis observed could influence the therapeutic approach.

[Transplant coordination and logistics of intra and extra-hospital cadaver donor tissue. "The Pamplona Model". Sequence of tasks performed from 1992-2006]. / Coordinación y logística del trasplante de tejidos de donantes de cadáver intra y extra-hospitalarios. "Modelo Pamplona". Cadena de actuación 1992-2006.

INTRODUCTION: Tissue and organ donations are the only option for many patients. Cerebral death (CD) facilitates this approach. However, hospitals that do not provide CD donors have to adapt in order to obtain donors, referred to as tissue donors (TD), who have died from cardiac arrest. OBJECTIVE: Is this paper it descripte the model for coordination and donation of intra and extra-hospital TD in the Autonomous Community of Navarra. It creats a program for detection, donation and extractions called the Pamplona Model, from 1992-2006. MATERIAL AND METHODS: In 1990, a transplant team was created by an Intensive Medicine Physician of HVC, INML and SOS-Navarra. In 1996, VCH Transplant Coordination is defined as a reference centre for the Tissue Transplant Programme in the Autonomous Community of Navarra. RESULTS: Consensus protocols for "intra and extra-hospital detection" of persons having died from cardiac arrest are developed: - Alerts from NHS-O hospitals, SOS-Navarra; judges and INML forensic pathologists. - Criteria for selection, search and contacts with relatives. - Alert serology, extraction and transport teams. - Logistics and distribution of tissue. - Agreed incentives: Economic, administrative and relevant regulations. CONCLUSIONS: The Pamplona Model, with the Virgen Del Camino hospital has made important contributions and is unique in the world. Intra and extra-hospital coordination of cadaver donor from a referred hospital, it is a scientific and organizational advance to have in it counts for the creation of extraction and transplant tissues teams.

[Crohn's disease and pregnancy. A descriptive and retrospective study]. / Enfermedad de Crohn y embarazo: un estudio descriptivo y retrospectivo.

OBJECTIVES: To determine the behavior of Crohn's disease during pregnancy, as well as the influence of this disease on the presence of low birthweight neonates. MATERIAL AND METHODS: A descriptive and retrospective study of all patients with Crohn's disease followed-up in the Hospital Costa del Sol was performed. A total of 124 pregnant women were included, classified in two groups: women who became pregnant before and those who became pregnant after Crohn's disease was diagnosed. In all patients, clinical and epidemiological data, disease activity during pregnancy and in the immediate postpartum period, type of assisted delivery, and neonatal birthweight were recorded. RESULTS: A total of 66.1% of pregnancies occurred before Crohn's disease was diagnosed, 31.5% occurred after diagnosis and 2.4% coincided with disease onset. No significant differences were found between women with and without a diagnosis of Crohn's disease in type of assisted delivery or low birthweight (p = 0.064; p = 0.643). All non-smoking patients remained in the quiescent phase and did not present disease recurrences during pregnancy. Among smokers, the disease remained inactive in 61.1%, while chronic activity or recurrences were observed in 38.9% (p = 0.003). CONCLUSIONS: The course of inflammatory bowel disease does not adversely affect pregnancy or the immediate postpartum period, nor does it increase the presence of low birthweight neonates or the number of cesarean deliveries performed.

[Susceptibility pattern of Acinetobacter baumannii clinical isolates in Madrid vs. Hong Kong]. / Patrón de sensibilidad de aislamientos clínicos de Acinetobacter baumannii en Madrid vs. Hong Kong.

The objective of this study was to compare the susceptibility to seven antimicrobials of Acinetobacter baumannii clinical isolates from H. U. de La Princesa of Madrid vs. A. baumannii clinical isolates from Hospital Queen Mary of Hong Kong from January 2004 to March 2005. A total of 74 strains isolated from our hospital and 30 strains attended to Hospital Queen Mary were studied. The MIC (minimal inhibitory concentration) was determined by agar dilution method. NCCLS recommended breakpoints were used against imipenem, tobramycin, amikacin, ofloxacin and ceftazidime. For sulbactam the break point for ampicillin/sulbactam was used. BSAC breakpoint was considered against colistin. Colistin showed the highest susceptibility percentage in Spanish strains (98.64%), followed by imipenem (94.59%) and tobramycin (78.37%). About 50% of the clinical isolates were susceptible to sulbactam (54.05%) and amikacin (51.35%). The majority of the strains were resistant to ofloxacin (2.7% of susceptible strains) and ceftazidime (1.35% of susceptible strains). In the Hong Kong clinical isolates, high susceptibility percentages were shown for most antimicrobials: 96.66% to colistin, sulbactam, tobramycin and amikacin; lower for imipenem (93.33%) and ofloxacin (90%). Ceftazidime presented the lowest susceptibility percentage (10%). In conclusion, higher resistant percentages in Spanish strains than Chinese strains were obtained for most antimicrobials tested. To ofloxacin, 90% of Hong Kong isolates were susceptible while 93% of Madrid isolates were resistant. Geographically remote populations (such as Madrid and Hong Kong) showed important differences according to the susceptibility patterns.

[Resistance of Mycobacterium tuberculosis in a four-year period in a Madrid hospital]. / Resistencia en Mycobacterium tuberculosis durante un periodo de cuatro años en un hospital de Madrid.

Tuberculosis is considered a serious public health problem. Some factors, such as HIV infection and immigration, have had a major impact on the epidemiology of this illness in Spain. The problem has worsened in recent years due to the dissemination of multiresistant strains. Therefore, a periodic surveillance should be established with respect to the incidence and the resistances observed. In this study we collect M. tuberculosis isolates carried out in the years 2001, 2002, 2003 and 2004, and their susceptibility characteristics in patients from Area 2 in Madrid. To evaluate the isolates' susceptibilities, the MGIT 960 system was used. Of a total of 244 isolates, 15.2% were resistant to at least one antibiotic (different to streptomycin), and 29.9% of the isolates were obtained in samples from immigrant patients. In addition, the immigrant population affected showed a greater percentage of resistances (p <0.01) and a younger mean age (p <0.01) than the indigenous population.