Correlation between Streptococcus bovis bacteremia and density of cows in Galicia, northwest of Spain.

BACKGROUND: There are few data on the epidemiology of infections caused by Streptococcus bovis (Sb). Some studies suggest that both residence in rural areas and contact with livestock could be potential risk factors. METHODS: We performed a retrospective study for the period 2005-2016 of all cases of bacteremia caused by Sb in Galicia (a region in the northwest of Spain). The association between the incidence rate of Sb bacteremia and the number of cattle by province and district was analyzed. RESULTS: 677 cases were included with a median age of 76 years, 69.3% males. The most frequent infections were endocarditis (234 cases, 34.5%), primary bacteremia (213 cases, 31.5%) and biliary infection (119 cases, 17.5%). In 252 patients, colon neoplasms were detected (37.2%). S. gallolyticus subsp. gallolyticus was the predominant species (52.3%). Mortality was 15.5% (105 cases). The annual incidence rate was 20.2 cases/106 inhabitants and was correlated with the density of cattle (p < 0.001), but not with rurality. When comparing the two provinces with a strong predominance of rural population, but with important differences in the number of cattle, such as Orense and Lugo, with 6% and 47.7% of Galician cattle, respectively, the rates were very different: 15.8 and 43.6 cases/106, respectively, with an RR of 2.7 (95% CI, 2.08-3.71). Some districts of the province of Lugo had rates higher than 100 cases/106 inhabitants. CONCLUSIONS: Our study shows a significant correlation between the rates of Sb bacteremia and cattle density, suggesting a possible transmission of Sb from cows to people.

HLA-E and NKG2A Mediate Resistance to M. bovis BCG Immunotherapy in Non-Muscle-Invasive Bladder Cancer.

Mycobacterium bovis Bacillus Calmette-Guerin (BCG) is the primary treatment for non-muscle-invasive bladder cancer (NMIBC), known to stimulate inflammatory cytokines, notably interferon (IFN)-γ. We observed that prolonged IFN-γ exposure fosters adaptive resistance in recurrent tumors, aiding immune evasion and tumor proliferation. We identify HLA-E and NKG2A, part of a novel NK and T cell checkpoint pathway, as key mediators of resistance in BCG-unresponsive NMIBC. IFN-γ enhances HLA-E and PD-L1 expression in recurrent tumors, with an enrichment of intra-tumoral NKG2A-expressing NK and CD8 T cells. CXCL9+ macrophages and dendritic cells and CXCL12-expressing stromal cells likely recruit CXCR3/CXCR4-expressing NK and T cells and CXCR7+ HLA-EHIGH tumor cells. NK and CD8 T cells remain functional within BCG-unresponsive tumors but are inhibited by HLA-E and PD-L1, providing a framework for combined NKG2A and PD-L1 blockade strategy for bladder-sparing treatment of BCG-unresponsive NMIBC.

Nut Consumption and Depression: Cross-Sectional and Longitudinal Analyses in Two Cohorts of Older Adults.

OBJECTIVES: To assess the cross-sectional and longitudinal associations between nut consumption and depression in two cohorts of older adults. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: The first cohort (Seniors-ENRICA-I or SE-I) included a representative sample of Spanish noninstitutionalized adults aged ≥65 years interviewed in 2010 and 2013. The second cohort (SE-II) included individuals from the Madrid region, Spain, aged ≥65 years interviewed in 2017 and in 2019. Nut consumption was estimated with a validated computer-based diet history. Depression was defined as self-reported physician-diagnosed depression or the use of antidepressants. Logistic regression models were adjusted for the main confounders. The DerSimonian and Laird random-effect method was used to meta-analyze the results from both studies. A participant-level pooled analysis was conducted to examine the robustness of our analyses. RESULTS: The SE-I included 2278 individuals (233 prevalent cases) in the cross-sectional analysis and 1534 (108 incident cases) in the longitudinal analysis; the corresponding figures for SE-II were 2726 (407 prevalent cases) and 1566 (74 incident cases). In the meta-analysis of cross-sectional results from the two studies, compared to consuming <1 serving (30 g) of nuts/week, the odds ratio (95% confidence interval) for depression was 0.90 (0.64, 1.16) for consuming 1 to <3 servings/week and 0.92 (0.70, 1.13) for consuming ≥3 servings/week; the corresponding figures for the longitudinal results were 0.90 (0.41, 1.38) and 0.66 (0.35, 0.97). CONCLUSION: Nut consumption was associated with a lower risk of depression in a pooled longitudinal analysis using data from two cohorts of older adults. Nuts should be recommended as part of a healthy diet in older adults.

Acquired hepatocerebral degeneration: clinical characteristics and MRI findings.

OBJECTIVE: To determine the prevalence of acquired hepatocerebral degeneration (AHD), its clinical and neuroimaging characteristics and response to treatments. BACKGROUND: Acquired hepatocerebral degeneration is a chronic encephalopathy with predominant motor signs in the context of severe liver disease. Its clinical picture is not well defined, and its prevalence and risk factors are not well known. METHODS: Review of a database of 1000 patients with cirrhosis to identify cases of AHD. Clinical and neuroimaging data, follow-up and response to treatments, including liver transplantation, were recorded. RESULTS: Eight patients with AHD were identified. Its prevalence was 0.8% of patients with cirrhosis. The main risk factor for AHD was the presence of portosystemic shunts. Movement disorders, especially a combination of parkinsonism and cerebellar signs were observed in all patients. All AHD cases showed on MRI T1-weighted images hyperintensities in the globus pallidus, and 75% had extrapallidal involvement as well. Antiparkisonian drugs and treatments to prevent acute encephalopathies were ineffective. Three patients who underwent liver transplantation did not experience neurological improvement. Persistence of portosystemic shunts was demonstrated in two cases. CONCLUSIONS: Acquired hepatocerebral degeneration is a chronic encephalopathy which occurs in ∼1% of patients with liver cirrhosis and seems related to portosystemic shunts. Its is characterized by a combination of parkinsonism and cerebellar signs. MRI pallidal and extrapallidal lesions are seen in most patients, probably reflecting intracerebral deposits of manganese. Liver transplant did not improve the neurological signs in our patients, perhaps because of the persistence of portosystemic shunts.

[HIV-1 infection, use of drugs and neuropsychologic efficiency]. / Infección por VIH, consumo de drogas y rendimiento neuropsicológico.

INTRODUCTION: The abuse of substances has been considered as an explanatory factor of the neuropsychologic failure. However, doubts persist on the distinction among direct or indirect effects and even on the interaction between the effect of the HIV and the use of substances. The objective of this investigation consisted on studying the effect of the use of drugs and the seropositivity to the HIV-1 on the neuropsychologic efficiency. METHOD: After obtaining the informed consent 113 patients they were recruited, integrated in four groups (34 seropositives ex-UDPP; 33 seropositives in maintenance programs with methadone; 19 seronegatives; and 27 seronegatives without previous use of drugs. To all they were applied a neuropsychologic battery designed ad hoc, an semistructured interview about sociodemographical, toxicological, neuropsychiatric and clinical-biological aspects and an evaluation of the anxious-depressive symptomatology. RESULTS: The seropositive patients in methadone present bigger rates of prevalence of the damage that the rest of the groups (X2 = 32.22, p < .000) and lower rates of execution in all the studied factors. Also, it is observed that the seropositive patients as group present lower execution levels and higher rates of damage. Also, all the groups had lower levels of execution that the people seronegative non consumers (F = 15.661, p > .000). CONCLUSIONS: The abuse of drugs and the seropositivity are factors that associate to the decrease neuropsychologic efficiency. Also, the situation regarding the abuse explains differences in the execution levels and rates of neuropsychologic damage, being the patients in maintenance programs with methadone those that present the worst execution levels, as well as the highest rates in neuropsychologic affectation.

Meningococcal knee arthritis serogroup W-135. Case report

N. Meningitidis serogroup (A, B, C), are main causers of disease. Serogroup W-135 incidence is lower nowadays and, although it is increasing, is such an uncommon infection in adults. We report a case of a monoarthritis knee due to Neisseria meningitidis (W- 135) in an inmunocompetent 50 year-old male

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[Disseminated Mycobacterium chelonae infection during HIV. ]. / Infection disséminée à Mycobacterium chelonae au cours de l'infection à VIH.

INTRODUCTION: An atypical mycobacterium, Mycobacterium chelonae is a saprophyte germ in the environment, but rarely pathogenic. A few disseminated infections can be noted in immunodepressed patients. OBSERVATION: A 30 year-old man infected by HIV was hospitalised for deterioration in his general status of health with, on clinical examination, pallor, several superficial lymph nodes and hepatosplenomegaly. A biopsy of an axillary node and the liver revealed numerous granulomas with many atypical M. chelonae-like mycobacteria. Adapted treatment led to complete remission. DISCUSSION: Immunodepression facilitates the occurrence of M. chelonae infections, often of severe evolution and leading to dissemination. This mycobacterium is resistant to many antibiotics.

[Antimicrobial susceptibility of the bloodstream infections: a study in a nonteaching hospital]. / Estudio de sensibilidad antibiótica en las bacteriemias de un hospital secundario.

BACKGROUND: To try established antimicrobial susceptibility patterns and frequency of both nosocomial and community-acquired bloodstream infections and and to try identified the prognostic factors that can be modified. MATERIAL AND METHODS: A prospective study of 310 bloodstream infections with clinical significance detected in a non teaching hospital over period from October 2000-2001. A blood culture were identified by Bact-Alert system and the confirmation was performed by MicroScan system; an antimicrobial susceptibility test was performed by reference microdilution methods as described by NCCLS. We studied sentinel antimicrobial/organism combinations with potential clinical importance. Data were computerized using SPSS. Qualitative variables were compared using the X2 test or the Fisher exact test, and quantitative variables with t Student or ANOVA. RESULTS: Gram positive and Candida were frequently recovered in nosocomial bloodstreams. The proportion of oxacillin-resistant S. aureus isolates was 24% and the penicillin resistant pneumococci was 14%. Vancomycin was universal active against gram positive. Gram negatives were often recovered in community bloodstream. The proportion of EBSL E. coli isolates was < 2% and the proportion of multiresistance Pseudomonas aeruginosa was higher among UCI isolates. An independent risk factors for death identified after multivariate analysis was the inappropriate antimicrobial therapy OR 2.6. CONCLUSIONS: Ongoing surveillance of microbial pathogens and their resistance profiles is essential on local scale and permit the selection of appropriate antibiotic therapy which would be reduce the mortality.

[Prognostic factors of bacteremia: prospective study]. / Factores pronósticos de la bacteriemia: estudio prospectivo.

BACKGROUND: To identify the epidemiology and risk factors with influence in the outcome and mortality of a series of bacteriemic patients. MATERIAL AND METHODS: A prospective study of bloodstream infections with clinical significance detected in a secondary hospital of 650 beds over period from May 1998 to May 1999. The true bacteriemia was defined in basis to the criteria both the physician and microbiologist. A total of 16 variables were defined and categorized such as clinical-epidemiologic, intrinsic risk factor, extrinsic risk factor, outcome and survival. We used SPSS statistical package: For cuantitative variables we carried out with the mean with confidence interval of 95%, for cualitative variables: number and %. Univariate analysis of the results was carried out with the X2 test and t Student, the survival was expressed with Kaplan Meyer graphics and the logistic regression model. RESULTS: A total of 320 positive blood cultures were studied but only 272 blood cultures were considered true bacteriemia in 259 patients. The calculated incidence of significant episodes of bacteriemia per 1000 admissions/year was 13. The overall mortality was 22% whereas death attributable to bacteriemia was 16%. The mean age was 66.9 years (IC 95% 65-69), 59% episodes occurred in men. The 78% episodes occurred in patients hospitalized in medical services. 52% episodes were of nosocomial infection and 48% of community acquired infection. According to the severity of the underlying disease, 15% had fatal diseases and 35% episodes occurred in patients without underlying disease. According to the univariant analysis, the variables which where significantly associated with greater risk death were: etiology (fungus), septic shock, the inadequate antibiotic therapy, presence of extrinsic factors (central intravenous catheter, performance of invasive procedures, previous antimicrobial therapy) and the hospital stay of less than 10 days. According to the multivariable analysis showed that the factors remaining independent predictors of mortality were: septic shock (p < 0.0001, OR: 8), inadequate antimicrobial therapy (p < 0.005, OR: 6.7), existence of two or more extrinsic risk factors (p < 0.04). CONCLUSIONS: The presence of septic shock was the most important variable which influenced in the mortality in our serie, together with inappropriate antimicrobian therapy and the association of various extrinsic risk factors. These variables could be modified partly, for this reason the aggressive hemodynamic control and the early and appropriate antibiotic therapy would be the support of the successful bacteriemia management.

[Intracranial complications of otitis: the present-day situation]. / Complicaciones intracraneales de las otitis: situación actual.

The increasing number of intracranial complications of otic origin seen by the AA. in the previous 6 years, prompted them to make a survey of the respective files. In all, 9 patients were included in the group, with ages ranging from 18 to 72 years. Everyone showed marginal tympanic perforations with cholesteatoma. At their first visit to the office neurologic symptoms were present (mean time from beginning was 12 days) as an aftermath of chronic otitis. Meningitis, brain (temporo-parietal, temporal) and cerebellar abscesses of the implicated side were the diagnosis. Decisive for diagnosis was the CAT examination, being much better than the NMR (done once). Cases were managed in cooperation with the neurosurgical team. The mean time of hospitalization was 1 month. Eight cases did well (2 with neurologic sequels); the follow-up of the ninth patient is unknown.

[Tuberculous cervical lymph node inflammation: a diagnosis to be considered in ear, nose and throat practice]. / Adenitis cervical tuberculosa: un diagnóstico a tener en cuenta en ORL.

Involvement of the cervical lymph nodes is one of the commonest forms of extrapulmonary tuberculosis. Given this, we carried out a retrospective study of those cases diagnosed in our health region from 1995-1997, looking at the diagnostic criteria and treatment regimes and comparing our findings with those of other authors.