Pathogen-related factors affecting outcome of catheter-related bacteremia due to methicillin-susceptible Staphylococcus aureus in a Spanish multicenter study.

Even with appropriate clinical management, complicated methicillin-susceptible Staphylococcus aureus (MSSA) catheter-related bacteremia (CRB) is frequent. We investigated the influence of molecular characteristics of MSSA strains on the risk of complicated bacteremia (CB) in MSSA-CRB. A multicenter prospective study was conducted in Spain between 2011 and 2014 on MSSA-CRB. Optimized protocol-guided clinical management was required. CB included endocarditis, septic thrombophlebitis, persistent bacteremia and/or end-organ hematogenous spread. Molecular typing, agr functionality and DNA microarray analysis of virulence factors were performed in all MSSA isolates. Out of 83 MSSA-CRB episodes included, 26 (31.3%) developed CB. MSSA isolates belonged to 16 clonal complexes (CCs), with CC30 (32.5%), CC5 (15.7%) and CC45 (13.3) being the most common. Comparison between MSSA isolates in episodes with or without CB revealed no differences regarding agr type and functionality. However, our results showed that CC15 and the presence of genes like cna, chp and cap8 were associated with the development of CB. The multivariate analysis highlighted that the presence of cna (Hazard ratio 2.9; 95% CI 1.14-7.6) was associated with the development of CB. Our results suggest that particular CCs and specific genes may influence the outcome of MSSA-CRB.

Evaluation of scientific output in Dentistry in Spanish Universities.

BACKGROUND: The aim of this study was to assess the scientific output of Spanish universities that offer a bachelor's degree in dentistry through the use of various bibliometric indicators. MATERIAL AND METHODS: A total of 21 universities offered a bachelor's degree in dentistry in academic year 2016-2017. The search for papers published by authors associated with these institutions was carried out using the selection of journals listed in the Journal Citation Reports (JCR) and the Web of Knowledge database for the period 1986-2017. On the basis of these data, we determined the output, the h-, g- and hg-indexes, the most productive authors, international collaborations, and the most relevant journals. RESULTS: Public universities obtained better results than private universities. The University of Valencia was ranked first, followed by the Complutense University of Madrid and the University of Granada. The most productive author was José Vicente Bagán, but the author with the highest h-index was Mariano Sanz and Manuel Toledado. The universities with the greatest output and highest citation rates had more international collaborations. The most developed fields in Spanish universities were Oral surgery, Oral medicine and Dental materials. The universities had different models of production. At universities such as Barcelona or Valencia, the production was focused on very few departments and authors. At the other extreme, the University of Granada had various sources of research and authors, which meant that its output and citation rate could increase more. CONCLUSIONS: University faculties must provide suitable academic and research training, and therefore must be assessed using objective criteria and bibliometric tools. Although the number of university schools and faculties that teach dentistry has increased, and particularly the number of private universities, there is no correlation between their quality and output and the number of places offered on their courses.

An overview of animal science research 1945-2011 through science mapping analysis.

The conceptual structure of the field of Animal Science (AS) research is examined by means of a longitudinal science mapping analysis. The whole of the AS research field is analysed, revealing its conceptual evolution. To this end, an automatic approach to detecting and visualizing hidden themes or topics and their evolution across a consecutive span of years was applied to AS publications of the JCR category 'Agriculture, Dairy & Animal Science' during the period 1945-2011. This automatic approach was based on a coword analysis and combines performance analysis and science mapping. To observe the conceptual evolution of AS, six consecutive periods were defined: 1945-1969, 1970-1979, 1980-1989, 1990-1999, 2000-2005 and 2006-2011. Research in AS was identified as having focused on ten main thematic areas: ANIMAL-FEEDING, SMALL-RUMINANTS, ANIMAL-REPRODUCTION, DAIRY-PRODUCTION, MEAT-QUALITY, SWINE-PRODUCTION, GENETICS-AND-ANIMAL-BREEDING, POULTRY, ANIMAL-WELFARE and GROWTH-FACTORS-AND-FATTY-ACIDS. The results show how genomic studies gain in weight and integrate with other thematic areas. The whole of AS research has become oriented towards an overall framework in which animal welfare, sustainable management and human health play a major role. All this would affect the future structure and management of livestock farming.

Staphylococcus aureus native arthritis over 10 years.

OBJECTIVES: Septic arthritis is associated with significant case fatality and morbidity. Staphylococcus aureus is the most common cause of arthritis. We aimed to analyze the microbiological features of S. aureus causing native arthritis and to investigate their influence on the clinical outcome of the infection. PATIENTS AND METHODS: We conducted a retrospective study including all episodes of S. aureus native arthritis between 2005-2015. Phenotypic (antimicrobial susceptibility, ß-hemolysis, agr functionality, biofilm formation) and genotypic characteristics (pulsed-field gel electrophoresis, DNA microarrays) were investigated. The primary endpoint was microbiological failure of treatment, including infection relapse, persistence, or attributable death. RESULTS: Twenty-nine patients were included (65.5% of men, mean age: 59): seven (24.1%) patients presenting with methicillin-resistant S. aureus (MRSA) native arthritis and 19 with methicillin-susceptible S. aureus (MSSA) native arthritis. Treatment failure occurred in seven (26.9%) patients (4/7 patients [57.1%] among MRSA infections vs. 3/19 [15.8%] among MSSA infections). The persistence rate was similar in MRSA and MSSA infections (1/7 vs. 3/19). However, the case fatality was significantly higher in patients with MRSA infection (3/7 vs. 0/19). The most frequent clonal complex (CC) was CC5 (38.1%). MSSA showed higher genetic variability (nine CCs) versus MRSA (3 CCs). CONCLUSIONS: Beyond methicillin resistance, we did not find phenotypic or genotypic factors associated with the poor outcome of S. aureus native arthritis. CC5 was the major CC, showing the higher genetic variability of MSSA versus MRSA.

Impact of Staphylococcus aureus phenotype and genotype on the clinical characteristics and outcome of infective endocarditis. A multicentre, longitudinal, prospective, observational study.

OBJECTIVE: We aimed to evaluate the impact of Staphylococcus aureus phenotype (vancomycin MIC) and genotype (agr group, clonal complex CC) on the prognosis and clinical characteristics of infective endocarditis (IE). METHODS: We performed a multicentre, longitudinal, prospective, observational study (June 2013 to March 2016) in 15 Spanish hospitals. Two hundred and thirteen consecutive adults (≥18 years) with a definite diagnosis of S. aureus IE were included. Primary outcome was death during hospital stay. Main secondary end points were persistent bacteraemia, sepsis/septic shock, peripheral embolism and osteoarticular involvement. RESULTS: Overall in-hospital mortality was 37% (n = 72). Independent risk factors for death were age-adjusted Charlson co-morbidity index (OR 1.20; 95% CI 1.08-1.34), congestive heart failure (OR 3.60; 95% CI 1.72-7.50), symptomatic central nervous system complication (OR 3.17; 95% CI 1.41-7.11) and severe sepsis/septic shock (OR 4.41; 95% CI 2.18-8.96). In the subgroup of methicillin-susceptible S. aureus IE (n = 173), independent risk factors for death were the age-adjusted Charlson co-morbidity index (OR 1.17; 95% CI 1.03-1.31), congestive heart failure (OR 3.39; 95% CI 1.51-7.64), new conduction abnormality (OR 4.42; 95% CI 1.27-15.34), severe sepsis/septic shock (OR 5.76; 95% CI 2.57-12.89) and agr group III (OR 0.27; 0.10-0.75). Vancomycin MIC ≥1.5 mg/L was not independently associated with death during hospital nor was it related to secondary end points. No other genotype variables were independently associated with in-hospital death. CONCLUSIONS: This is the first prospective study to assess the impact of S. aureus phenotype and genotype. Phenotype and genotype provided no additional predictive value beyond conventional clinical characteristics. No evidence was found to justify therapeutic decisions based on vancomycin MIC for either methicillin-resistant or methicillin-susceptible S. aureus.

A survey to medical residents on the performance of diagnostic and therapeutic thoracenteses: a training gap? / Una encuesta a médicos residentes sobre la realización de toracocentesis diagnósticas y terapéuticas: ¿una laguna en la formación?

OBJECTIVE: Pleural fluid aspiration is a routine procedure for pulmonologists and internists. Our aim was to evaluate technical and methodological aspects of diagnostic and therapeutic thoracenteses performed by last two-year residents of Pulmonology and Internal Medicine. METHODS: An online 24-item questionnaire was sent to participants, and responses were evaluated according to the medical specialty. RESULTS: The survey was completed by 139 (17.1%) residents (71 internists and 68 pulmonologists). 29.5% and 41% performed one or no diagnostic or therapeutic thoracenteses monthly, respectively. Only 44% used ultrasonography to guide pleural procedures. Less than half of respondents used local anesthesia for diagnostic aspirations. Contrary to current recommendations, 25% of residents employed intramuscular needles for therapeutic aspirations. More than 80% of residents routinely ordered pleural fluid cultures and cytological studies, regardless of the clinical suspicion. About 40% requested imaging studies after a diagnostic thoracentesis. Half or more of the respondents were unaware of pH measurement methodologies, culture type for mycobacteria, and performance of cell blocks. Pulmonologists were more experienced than internists, and also made use of ultrasonography more frequently. CONCLUSION: This survey highlights gaps of knowledge and skills in conducting diagnostic and therapeutic thoracenteses.

[Usefulness of chest sonography in a respiratory medicine unit]. / Utilidad de la ecografía torácica en una unidad de técnicas respiratorias.

Chest ultrasound, a diagnostic technique used mainly by radiologists, is useful for managing pleural effusion. Sonography and computed tomography (CT) are complementary, although the former is more accessible to clinicians because it is safe and easy to use and because results are available quickly. We evaluated the utility of chest sonograms in a respiratory medicine unit managed by pneumologists. During the period under study, requests for CT scans to manage complicated pleural effusions decreased as the use of sonograms increased. We conclude that ultrasound imaging is useful in the hands of pneumologists who use the technique to diagnose pleural effusions.

[Pulmonary metastases of malignant melanoma. A rare endobronchial presentation]. / Metástasis pulmonares de melanoma maligno. Presentación infrecuente endobronquial.

Malignant melanoma has a tendency to metastasize to the lung in the course of tumor growth. Many such cases have been described in the literature, although cases of endobronchial metastasis of this type of tumor revealed during fiberoptic bronchoscopy are difficult to find. We report three cases of extension of the primary tumor to the lung, diagnosed by fiberoptic bronchoscopy during which biopsy specimens were obtained. After tissue inspection, the initial suspicion of metastasis of malignant melanoma was confirmed. We review the prevalence, radiologic presentation, prognosis and treatment options for this type of metastasis.

[Thyroid carcinoma with tracheal invasion: a series of five cases]. / Carcinoma de tiroides con invasión traqueal: serie de cinco casos.

We report five cases of thyroid carcinoma with tracheal invasion. In two patients infiltration was found during thyroid exeresis. Diagnosis was based on respiratory signs such as hemoptysis and stridor in the other three patients. The pathologic diagnosis was papillary carcinoma for four patients and follicular carcinoma for one, the only man in the series. Treatment by thyroidectomy, tracheal resection and end-to-end anastomosis with node removal was followed by long-term survival. A search for tracheal involvement during thyroidectomy and clinical suspicion were the keys to a good prognosis for these patients.

[Fiber bronchoscopy in lung cancer: relationship between radiology, endoscopy, histology and diagnostic value in a series of 1801 cases]. / Fibrobroncoscopia en el cáncer de pulmón: relación entre radiología, endoscopia, histología y rendimiento diagnóstico en una serie de 1.801 casos.

A retrospective analysis of 1,801 patients with primary pulmonary neoplasm diagnosed by fiber bronchoscopy between 1977 and 1992 was carried out in order to determine the relation between chest X-rays and endoscopic and histological findings, as well as to assess the diagnostic usefulness of the various endoscopic techniques used. Central tumors numbered 1,598 and peripheral ones 203. The largest tissue classification was squamous (39%) and the most common X-ray finding was pulmonary mass (40%). Endoscopy showed neoplastic infiltration in 49% of the cases and endobronchial tumor in 27%. X-rays showing pulmonary mass, hilar involvement and atelectasis were more often associated with infiltration, tumor and necrosis and with a small-cell tissue type. Bronchial biopsy gave the best diagnostic results in these cases. In cases of solitary pulmonary nodule and pleural effusion, on the other hand, normal endoscopic results with non-specific changes or extrapulmonary involvement, predominated, with adenocarcinoma and non-small cell tissue types. Transbronchial biopsy, especially with radioscopic monitoring, was most useful in these cases. We conclude that chest X-rays and endoscopic results can be used to predict the most likely tissue type in lung cancer and that they can serve as guides for the choice of diagnostic technique.

[Selenium: the physiopathological and clinical implications]. / Selenio: implicaciones fisiopatológicas y clínicas.

Selenium is an ultra-trace element widely distributed in the environment, although its consumption varies significantly depending on the region. Its daily requirements range between 50 and 200 micrograms/day (or a minimum of 1 microgram/kg/day), which are supplied by animal and vegetal foods. Its essentiality in human nutrition is derived from its antioxidative action, being a part of the glutation-peroxidase system (GPx). Thus, it is a protective agent against the harmful action of free radicals. Determination of the selenium-dependent GPx activity seems to be the best index for the assessment of nutritional status. A deficit of selenium will result in a decrease of the GPx activity and, therefore, in a increase of cell damage which cannot be counter-balanced by other antioxidative systems. Diet has a relevant role for the maintenance of selenium status. Deficiency conditions may appear in different population groups when the selenium content in the diet is inadequate. Toxicity states are rare, but some diseases are sensitive to this element, which is mainly involved in cancer prevention.

[The value of pulse oximetry during the performance of a forced spirometry maneuver]. / Valor de la pulsioximetría durante la realización de la maniobra de espirometría forzada.

Given that forced spirometry is the main routine exploration in any laboratory of pulmonary functional assessment, we have analyzed the behaviour of O2 arterial saturation (SaO2) during such maneuver in patients with airflow chronic obstruction (AFCO), in order to verify any potential alterations. We have studied three groups of patients: Group A, control, 17 healthy subjects; group B, 18 patients with AFCO and initial saturation higher than 90%; group C, 15 patients with AFCO and saturation equal to or lower than 90%. Total duration of the maneuver was significantly higher in groups B and C compared with the control group (p < 0.001). In groups A and B, we did not observed any significant reductions in SaO2 with respect to the initial value, although we did observed such differences in group C (p < 0.001). None of the patients presented a subjective clinical disorder, although the absence of both complexity and risk suggest the convenience of including the oximetry as an additional parameter when conducting a forced spirometry in patients with AFCO and respiratory failure.

Analyzing the research in Integrative & Complementary Medicine by means of science mapping.

OBJECTIVES: The research in the Complementary and Alternative Medicine (CAM) field is analyzed according to the journals indexed in ISI Web of Science. Science Mapping Analysis (SMA) is used to provide and overview of the conceptual evolution of the CAM field. METHODS: The software SciMAT is used to detect and visualize the hidden themes and their evolution over a consecutive span of years. It combines SMA and performance analysis. Twenty one journals related to CAM were analyzed, in four consecutive periods from 1974 to 2011. RESULTS: Strategic diagrams and the thematic evolution of CAM, together with performance indicators (h-index), were obtained. The results show that CAM research has focused on seven main thematic areas: MEDICINAL-PLANTS, CHIROPRACTIC-AND-LOW-BACK-PAIN, ACUPUNCTURE-AND-PAIN, CELL-PROCESSES-AND-DISEASES, LIPID-PEROXIDATION and DIABETES-AND-INSULIN. CONCLUSION: The research output could be used by the scientific community to identify thematic areas on which interest is focused.

Repeated thoracentesis: an important risk factor for eosinophilic pleural effusion?

BACKGROUND: Eosinophilic pleural effusion (EPE) is a relatively rare clinical condition. Repeated thoracenteses (RTs) are normally considered a frequent cause of EPE. Yet, to our knowledge, there is no firm evidence (apart from anecdotal case reports) supporting such a statement. OBJECTIVE: To investigate potential relationships between the number, type (with or without pleural biopsy) and time elapsed between RTs and the number of eosinophils present in pleural fluid samples. METHODS: We reviewed retrospectively 273 pleural fluid samples belonging to 120 patients (79 males, 41 females), attended in our institution from 1992 to 2000, whose clinical management had required RTs. Apart from the anthropometric and clinical data of each patient, we included the following variables in the analysis: number of thoracenteses performed in each individual, number of pleural biopsies carried out at each thoracentesis and time between consecutive thoracenteses. We also recorded the total (and differential) leukocyte count, red blood cell count, as well as the main biochemical, microbiological and histological data of both the pleural fluid and peripheral blood samples. RESULTS: We did not observe any significant change in the percentage of eosinophils in relation to the number of thoracenteses performed per patient. This lack of relationship was also observed in the subgroup of patients who required one (or more) pleural biopsies (n = 111) (regardless of the number of biopsies). Our results suggest that RTs are not an important risk factor for the development of EPE, regardless of the time elapsed between two thoracenteses. CONCLUSION: We believe, therefore, that multiple punctures should not longer be considered a prevalent cause of pleural eosinophilia.

Pleural cholesterol in differentiating transudates and exudates. A prospective study of 232 cases.

Two hundred and four patients with pleural effusion were studied to investigate the utility of Light's criteria and pleural fluid cholesterol level (pCHOL) in the identification of exudative pleural effusion (EPE) and transudative pleural effusion (TPE). There were 48 TPE, 56 tumor, 47 tuberculous, 30 metapneumonic and 23 miscellaneous patients. A value > or = 54 mg/dl for pCHOL and > or = 0.32 for the pleura/serum cholesterol ratio (p/sCHOL) showed sensitivity (S) and specificity (Sp) of 95.5% and 91.6% for pCHOL, and 97.4% and 91.6% for p/sCHOL, respectively. Combined pCHOL and/or p/sCHOL showed a S of 98.7% and Sp of 89.5%. Light's criteria achieved a S of 100% and Sp of 64.5%. Combined pCHOL and p/sCHOL revealed a similar accuracy to Light's criteria in EPE diagnosis but was found to be more exact in TPE diagnosis.

Diagnostic utility of eosinophils in the pleural fluid.

This study was conducted to assess the prevalence of eosinophilia in 358 consecutive samples of pleural fluid (all cases corresponded to first thoracentesis), to review the cause of eosinophilic pleural effusions, and to determine whether the presence of eosinophils increases the likelihood of nonmalignant underlying disorders. Eosinophilic pleural effusions were identified in 45 patients (12.6%): malignant underlying conditions were diagnosed in 11 patients (24.4% with eosinophilic effusions) and benign aetiologies were found in 27 patients. Benign aetiologies included uncomplicated paraneumonic effusion in 10 patients, tuberculosis in seven, complicated paraneumonic in five, liver cirrhosis in three, hydronephrosis in one and pulmonary thromboembolism in one. Seven pleural effusions were idiopathic. There was no difference in the prevalence between eosinophilic and noneosinophilic effusions according to the different diagnoses. With parameters of sensitivity, specificity, pretest and post-test probability and positive and negative predictive values for any prevalence figure using the Bayes' theorem and for any value of eosinophils (both in percentage or absolute numbers) in the pleural fluid (receiver operating characteristic curve) an adequate predictor of benign disease was not found. It is concluded that pleural eosinophilia at the initial thoracentesis cannot be considered as a predictor of an underlying benign disorder.